Providing culturally sensitive care poses many challenges, including communication difficulties, unfamiliar customs, family dynamics, and dietary variations. Understanding and accepting the culture of the patient is as important as understanding her health concerns. “Grace” provided us with a beautiful example of that lesson. Grace immigrated to the United States from Liberia in 2004. She suffered the loss of most of her family during the war and her only daughter accompanied her to their new home. She brought with her many challenges and strengths.
Grace came to the clinic at 16-week gestation and extensive testing revealed the fetus had multiple life-threatening anomalies. Numerous clinicians attempted to inform and advise her regarding the viability of her pregnancy, but Grace believed God would not give her an infant with a problem, and if the infant was sick she would feel sick too. She refused to return to the Maternal Fetal Medicine clinic and declined to participate in any planning for the birth and care of the neonate. The team knew a lethal fetal anomaly was present, and we all grew more anxious and frustrated in finding the best way to care for Grace for the remainder of her pregnancy. An ethics consult was obtained and Schwartz Rounds was utilized to assist staff with all the emotions surrounding this case.
A plan of care was formulated by the interdisciplinary team that incorporated pastoral care services to meet Grace's spiritual needs. A collaborative model incorporates a partnership between disciplines and includes knowledge sharing and problem solving, while placing the patient at the center. Three physicians volunteered to be on call and attend a vaginal breech birth. With a known lethal anomaly, it was decided that resuscitative measures would be futile and cause more harm than good, so we prepared for palliative care. Pastoral care and a labor and delivery nurse trained in bereavement volunteered to be present at the birth. Despite the difficult situation, Grace later expressed to us that she felt very well cared for throughout her experience. Grace's journey taught us all lessons in patience, acceptance, and understanding of the human condition.