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Twenty-nine percent of the U.S. population and one out of every three children is a member of an ethnic or racial minority group. By 2025, almost 40 percent of Americans and about half of all U.S. children with be minorities. Thus, emergency room (ER) clinicians will often encounter children needing emergency care who come from families with cultural differences or who don't speak English at all or only haltingly.
Failure to appreciate the importance of culture and language in pediatric emergencies can be catastrophic. It can lead to problems in obtaining informed consent, inadequate understanding of diagnoses and treatment by families, unnecessary medical and social service evaluations, inadequate analgesia, and dissatisfaction with care, warn the authors of a study supported in part by the Agency for Healthcare Research and Quality (HS11305).
Glenn Flores, M.D., of Boston Medical Center, and his colleagues reviewed studies on culture and language in the emergency care of children that were published in English or Spanish from 1966 to 1999. A final database of 117 articles yielded numerous insights. For instance, parents and children with limited English proficiency often don't get the interpreters they need and have a poor understanding of their diagnosis and treatment. Also, certain ethnic-specific beliefs such as the Navajo hozhooji (the belief that negative thoughts and words can cause harm) can impede informed consent (for example, to surgery that a doctor acknowledges to have some risks).
Numerous folk illnesses, such as empacho among Latinos (term for chronic indigestion in children with diarrhea), can affect care because symptoms often overlap with potentially serious biomedical conditions such as intestinal blockage or appendicitis. The first clinical contact may be with folk healers, and certain folk remedies are harmful or even fatal (for example, use of lead powders for empacho). Use of cultural code cards could help ER clinicians quickly identify and treat pediatric problems in ways acceptable to parents. Such cards would depict folk illnesses and symptoms of specific ethnic groups, folk remedies used to treat them, and related biomedical conditions, conclude the researchers.
See "The importance of cultural and linguistic issues in the emergency care of children," by Dr. Flores, Jennifer Rabke-Verani, B.A., Whitney Pine, B.A., and Ashu Sabharwal, B.A., in the August 2002 Pediatric Emergency Care 18(4), pp. 271-284.
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