Question

 

Amira is a 27-year-old Syrian refugee who has been residing in a local homeless shelter since her arrival here in the United States 4 weeks ago. She was brought into the emergency room this morning via squad after being found by a shelter employee sitting in a pool of blood on the bathroom floor crying and holding her abdomen. Due to her limited English speaking abilities, she is unable to provide specific details as to her complaints but the shelter employee states that she has recently stopped eating and has not looked well for the past couple of days.

Based on the limited information provided, please answer the following questions.

How will you prioritize your care of Amira, what assessments will you complete, and in what order? Please provide rationale for choosing this order.

Are there any cultural beliefs/practices that must be taken into consideration when planning her care?

Considering her symptoms of abdominal pain and bleeding, is it possible that her status as a homeless refugee is a causative or contributing factor to her illness? Please provide rationale for your response.

Answer 1

How will you prioritize your care of Amira, what assessments will you complete, and in what order? Please provide rationale for choosing this order.

Due to lack of communication from the patient’s end and having history of she crying catching her abdomen, tests related to her abdomen could be ordered. It would include ultrasound first. Trying speaking to her in sign language or use of flash cards would help, like pointing out to flash cards of body parts asking level of discomfort, showing flash cards related pain / discomfort and finding the level of pain.

If she cooperates, other test can be started such as CT. If the patient is ruled out of pregnancy diagnosis, she can be taken for X-rays as well. If the patient is an assault (physical or sexual) survivor, she would need assessment for the same. Major emotional support and someone who could help her explain the turmoil she has just gone through would do a great help.

Are there any cultural beliefs/practices that must be taken into consideration when planning her care?

Yes. As per Syrian culture the family information, especially medical is kept within the family. Families stay in very close contacts. If any other family member of close acquaintance is available, they could be called for divulging further information. For dealing with female patient, a female doctor should be preferred as they are very conservative in nature.

Considering her symptoms of abdominal pain and bleeding, is it possible that her status as a homeless refugee is a causative or contributing factor to her illness? Please provide rationale for your response.

It may be a contributing factor. The reason is since being in refugee camps, she may be very hesitant to reach out to aids. There are lot of news where numerous refugees think that to avail aid they would be harassed physically / sexually, etc. Due to this, even if they have identified themselves as sick, they are not able to reach out for medical attention / aid. Other factors contributing are depression, which has made her emotionally weak to such an extent that she could not reach out for help.