Case Study: Traditional Healers

You are the clinician.

You are seeing Erik Gbodossou, a 38-year-old West African man, who is HIV infected and has just been released from the hospital after successful treatment with pneumonia. He has improved clinically since being treated; however, he is having trouble eating because of a persistent candida infection and also has struggled with early to moderate periodontal disease, especially in the mandibular arch that has not responded to non-surgical therapy even though he has been compliant with dental visits and home care procedures. He was willing to take the antibiotics prescribed for his pneumonia, but is balking at taking antiretroviral therapy which you know may help improve his life expectancy and his oral condition. You are frustrated that this patient is not interested in treatment that can help him. You’ve checked and his insurance will pay for most of the cost of his medications.

You are the patient.

You are a 38-year-old man named Erik Gbodossou. You are originally from West Africa. You have just been released from the hospital after being treated for pneumonia. You feel much better than when you first came to the hospital. You found out 2 years ago that you are infected with the AIDS virus. You have been seeing a traditional healer who is well respected in your community. He has successfully treated you with diarrhea, gum, and skin problems in the last 6 months by mixing special herbs and medicines for you. Using divining bones, the healer has helped you understand that your illness has happened in part because you have been distant from your family and community since leaving Senegal. Now, this doctor is telling you that you must take western medicines to keep you HIV infection from getting much worse. You are not convinced that this is the right thing to do. You want to talk this over with the healer.

Discussion Questions

1.What differences do you see between the patient and the clinician?

2.What are these differences based on culture, communication style, etc.?

3.How well is the clinician dealing with these differences?

4.Is he or she being sensitive to the patient’s concerns, beliefs, etc.?

5.Do you have any suggestions for the clinician to help him/her work more effectivelywith this patient?

Reference: Educational Strategies for Developing a Cultural Competent Workforce, JoanI.Gluch, RDH, Ph.D., May 12, 2006

Case Study: Global Perspective

The Impact of AIDS Worsens Famine

Southern Africa, 2002 to Present

The HIV/acquired immune deficiency syndrome (AIDS) epidemic is fueling a widening and increasingly deadly famine in southern Africa. The African famine is an example of how the impact of HIV reaches beyond the loss of life and health care costs traditionally associated with disease.

Sub-Saharan Africa has the highest number of HIV-positive individuals. In the predominantly agricultural societies in South Africa, the populations are battling serious AIDS epidemics, with more than 5 million adults currently living with AIDS out of a total adult population of 26 million. A total of 600,000 children under 15 living with HIV infection.

AIDS is combining with other factors, including droughts, floods, and in some cases shortsighted national and international policies, to cause a steady fall in agricultural production and to cut deeply into household income. Seven million agricultural workers in 25 African countries have died of AIDS since 1985.

Question

1.In order to minimize the number of deaths in the six agricultural countries significantlyaffected by AIDS-related deaths, what would be your first priority among the activities listed below? Assume you have the financial resources to complete only one objective. Explainthe rationale for yourchoice.

a.Provide antiretroviral therapy to those showing signs of AIDS.

b.Educate the public on the importance of consistent and correct condom use.

c.Set up a research center designed to develop an HIV vaccine.

d.Provide food to those who are currently starving.

e.Educate the surviving populace about how to develop a sustainable agricultural system.

Reference: Anderson, Rodney P. (2006). Outbreak Cases in Real-World Microbiology. ASM Press: Washington, D.C.

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