The St. Fleur family is well respected in the Haitian community because they are religious, faithfully practice Jehovah's Witness, and have great moral values. Rhonda, the youngest daughter of this family, is 17 years-old and lives at home with her mother and father. Recently, she began having fevers and subsequently developed severe abdominal pain. She was admitted to the hospital, where laboratory tests were hCG and COVID-19 positive. Rhonda was in shock when the doctor informed her that she was pregnant and COVID-19 positive. She confessed to the doctor that she has been sneaking out during the Pandemic to see her boyfriend, but swears that she uses sexual prevention techniques. However, as her symptoms have de-compensated, she is rushed to the OR with a diagnosis of Ectopic Pregnancy. The family is at the bedside and reminds the surgical team that Rhonda's faith prevents her from receiving any blood products due to her religion and cultural beliefs.
What are Haitian's views on unplanned pregnancy and viral infections?
What are Haitian's views on blood transfusions?
What are your procedures/responsibilities as a Nurse Anesthetist if the family refuses blood products for Rhonda's emergency surgery?
| Mistrust and Spiritual Causes: There can be significant mistrust of the healthcare system (especially in a foreign setting). Illness, particularly a new or severe viral infection like COVID-19, may be interpreted not just as a medical condition but also as having spiritual or supernatural causes (e.g., a punishment, a curse, or lwa intervention). This can lead to delays in seeking Western medical care in favor of traditional remedies. |
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Haitian's Views on Blood Transfusions
The St. Fleur family's refusal of blood products is primarily a matter of religious faith, not cultural heritage. While Haitian culture itself does not forbid blood transfusions, the family's adherence to the Jehovah's Witness faith dictates their refusal.
| Belief | Rationale |
| Jehovah's Witness Faith | The refusal is based on their interpretation of biblical texts, such as Acts 15:28, 29, which instructs Christians to "abstain from blood." They believe this command applies to transfusions, viewing it as taking blood into the body, which violates a divine law. |
| Medical Position | Members of this faith are often prepared for medical emergencies and will accept non-blood volume expanders, plasma expanders, or bloodless surgical techniques. Hospitals often coordinate with a Hospital Liaison Committee (HLC) for Jehovah's Witnesses to ensure communication and non-blood alternatives are used. |
Export to SheetsIn this specific case, the Jehovah's Witness religious refusal is the operative factor, overriding any general Haitian cultural view on the matter.
Responsibilities as a Nurse Anesthetist (CRNA)
Rhonda is a minor (17 years old) in an emergency life-threatening situation (ruptured ectopic pregnancy). This scenario involves a conflict between the parents' religious/cultural authority and the minor's right to life-saving treatment.
1. Immediate Patient Advocacy and Consent
Assess Patient Autonomy (Rhonda): Although Rhonda is a minor, she is nearing the age of majority and has enough information about her condition. As a CRNA, you must inquire directly whether Rhonda consents to the necessary blood transfusion, even against her parents' wishes. In some states, a mature minor doctrine may apply, allowing her consent to override her parents' refusal.
Acknowledge Parental Refusal: Clearly document the parents' refusal, the specific religious basis, and that they have been informed of the immediate risk of death without a transfusion.
Sample Answer
That's a complex scenario involving a medical emergency, cultural beliefs, and religious tenets. As a healthcare provider, the priority remains the patient's immediate safety while respecting her legal and ethical rights.
Haitian Views on Unplanned Pregnancy and Viral Infections
Haitian cultural views on health are heavily influenced by a mix of Western biomedicine, spiritual beliefs, and traditional healing (Vodou and folk practices). These are generalizations, and individual family views (like the St. Fleur's Jehovah's Witness faith) take precedence.
| Topic | General Haitian Cultural View |
| Unplanned Pregnancy | Strong Family and Community Values: Pregnancy is typically viewed as a sacred, life-affirming event. However, an unplanned teenage pregnancy in a religious family, especially one that values high moral standards, would likely bring significant shame (or honte) upon the individual and the family. Decisions and care may be heavily influenced by the immediate and extended family. |