Health can be defined as one of the cultural concepts since culture helps individuals in framing as well as shaping the way we visualize the world. Apart from the other health determinants and diseases, culture helps individuals in analyzing how the patients and the health practitioners define health as well as illness. Under the Vietnamese culture, mystical beliefs explain the physical and the mental illness of the patients. Under this specific Vietnamese culture, health is defined as a result of the good balance between hot and cold poles which monitors the body functions (Clark, 2010). Vietnamese practice Western medicine and they are all defined as life-saving antibiotics. In this essay, a case study on end of life will be discussed where after the admission of a 25 years old Vietnamese woman in the hospital, the hospital doctors declared it as brain death. To proceed in detail with the case study, certain aspects will be discussed here like case study overview, biomedical context, historical and sociocultural context along with implications for the professional practice (Dhoot, 2017).
One 25-year-old Vietnamese woman names Binh Pham had been admitted to the hospital since she was faced with a workplace accident. Here paramedics are one medical term that means a person who wanted to resuscitate (save the patient from unconsciousness or sudden death) the lady. However, after the admission to the hospital, the doctors declared that the woman had gone to brain death. The woman was placed under life support. After arriving at the hospital, Mr. Pham asked for the cessation (end) of her life support the following day that is Thursday which he thought will be the favorable day for her spouse’s death. However, the authors like Clark (2010,p.210), have critically argued the fact in this context that the doctors at the hospital in this situation need to be more cautious in handling the patient’s family members. They should be more responsible in tacking the situations and also need to analyze what Mr. Pham is trying to say through cessation of life support. This point has been argued by Tran (2019,p.40), where he stated that it might be the fact that Mr. Pham had lost all hope from Binh Pham regarding her survival and that was the reason he had commented that. In this stage, the doctors should be more concerned and careful and should try to make the patient party understand that though brain death can be termed as a new death indicator, however, there are ways for the patient to survive since many latest medical technologies have arrived (Velalearn, 2020). Here comes the fact that the doctors need to have clear perceptions and knowledge regarding the brain death which they could present to the patient party who are coming from different cultural and religious backgrounds having different ideologies.
End of life (dying) is considered as every individual’s unique experience. In this stage, the clinicians always felt privileged in meeting the people at their crisis time and helping them by providing them their expert guidance. Any individual’s outlook towards death is shaped largely by their cultural heritages and their upbringings, family units, and their religious practices (Medicine, 2016). The birth region, income level, and the mentality always influences individuals in taking decisions and also influences him in taking the things differently. In this situation, a caregiver or a doctor should develop cultural competences. It is defined as an ability in understanding, communicating, and also interacting with the people coming from different cultures to make them understand the real fact that is the condition of the patient. As per the statistical data, it has been found that daily 24 percent of the brain death cases can be observed in Vietnam. In the biomedical context, there are certain signs of brain death like the patient’s pupils don’t respond to the lights along with no movement of the head. In addition to this, the person also does not breathe when the ventilator gets switched off. In this situation, an electroencephalogram test indicates that no brain activity could be found (Velalearn, 2020).
The side effect of brain death is progressive organ dysfunction. The brain death also causes liver dysfunction which ultimately leads to hemodynamic instability. Brain death is problematic and acute for patients who are suffering from ischemia and reperfusion. There are certain types of medical causes behind brain death. Hence in this situation, the doctors in the context of the case study could be more aware and responsible at the time of announcing the brain death of the patient (Georgia, 2014). In this situation, the caregiver or the doctor should develop cultural competences to provide more accurate treatment and care to the patients to avoid miscommunications and the errors in the treatment. In 2013, the management of the US Office of Minority Health has developed certain standards that involve cultural competency practices to give proper guidance to the patients and also reducing unequal treatment among the people coming from different cultures (Shultz & Peterson, 2019).
The historical study of those who had sustained the traumatic brain injuries at the time of the military conflicts had facilitated the research in different fields like neurosurgery, psychiatry, neuroimaging, etc. The Vietnam Head Injury Study is defined as one of the prospective, long term studies with penetrating brain injuries that have been stretched over more than 40 years (Shultz & Peterson, 2019). The history of Combat-Related TBI Research states that traumatic brain injury is one of the major causes behind the occurrence of death and disability for those who are under 35. Every year, TBI research highlights around 55,000 deaths as well as 50,000 cases in the context of associate physical, social, behavioral as well as cognitive deficits. In Vietnam, The Vietnam Head Injury Study has been set up by William F Caveness, who had served at the time of the Korean war. He had also designed the VHIS registry who has gathered the information on 1,221 Vietnam veterans who had sustained TBI between 1967 and 1970. Out of 58000 US combat fatalities during the Vietnam war, 40 percent of them had been suffered from both head and neck wounds (Tran, 2019). Previously, there were different medications and traditional practices present for individuals to maintain a stable and healthy life. The first one was coining that is bringing balance in the body by curbing out the excess wind from the body. This is one of the techniques used to treat cold, coughs, flues, and certain ailments. Pinching was often used to treat headaches and sore throats and then comes steaming where the treatment was done through the use of medicinal herbs through either inhalation process or bathing (Georgia, 2014). Acupuncture or head massage was also one of the known treatments to give relaxation to the patient. Along with this, certain Western medicines especially antibiotics also being preferred for the patients to treat severe illness. These were certain treatments that might be followed by the doctors in the case study or the caregivers.
Withdrawing life support from the patient always turns out to be difficult. When both the patients as well as the healthcare professionals come from different ethnical backgrounds, their way of looking at the end of life that is the brain death is different. Here actually lies the social experiences among different individuals who shape the particular cultural organization as well as the value systems (Tran, 2019). The social thinking of individuals varies and also differs from the cultures and beliefs of the caregivers. This is the reason, it became difficult for Mr. Pham to accept the death of his spouse quickly. Hence at the time of complicated end-of-life conversations, it turns out to be important by the care providers to relate the things and the occurrences properly to their patients also to the patient parties. In the Vietnam culture, the family is highly valued and at the same time, the elders also got respected well. At the time of communicating with the patient parties, it is the responsibility of the care providers to bow their heads and address the problem of the patient parties and also telling them the exact meaning of brain death at the time of consoling them. The other social-cultural factor which is equally important at the time of communication with the patient parties is the gentle bows, smiles by avoiding eye contact (Clark, 2010).
Before removing the life support, the extensive family discussion was required by the doctors. It is also to be recommended for the doctors to be equipped well with the languages which might create future barriers in communicating the patient issues to her family. The clear and specific language needs to be used every time by the caregivers to help both the patient and the family to understand the prognosis (Georgia, 2014). Like doctors, the patient party is not at all comfortable and open in accepting the deaths of their near and loved ones. In this situation, at the time of consoling the patient parties, the doctors should have prior knowledge regarding the religion and the cultural lifestyles, the patient parties are having Like that way, the doctors need to communicate with them at the time of releasing the patient body from the hospital (Tran, 2019)
Clark, K. (2010). End of life care: The importance of culture and ethnicity. Australian family physician, 39(4), 210.
Dhoot, S. (2017). Cultural Implications of Brain Death – A Literature Review. Retrieved August 09, 2020, from https://ethnomed.org/resource/cultural-implications-of-brain-death-a-literature-review/
Georgia, M. A. (2014). History of brain death as death: 1968 to the present. National Library of Medicine, 29(4), 673-678. doi:10.1016/j.jcrc.2014.04.015
Medicine, S. S. (2016). End-Of-Life Care: The Vietnamese Culture. Retrieved from https://geriatrics.stanford.edu/ethnomed/vietnamese/delivery_of_care/end_of_life.html
Shultz, C. J., & Peterson, M. (2019). A Macromarketing view of sustainable development in Vietnam. Environmental management, 63(4), 507-519. doi:10.1007/s00267-017
Tran, B. (2019). Depressive Symptoms among industrial workers in vietnam and correlated factors: A multi-site survey. International journal of environmental research and public health, 16(9), 16-42. doi: 10.3390/ijerph16091642
Velalearn. (2020). What is Cultural Competence? Retrieved from https://www.velalearn.com/node/1177251
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