Multicultural End-of-Life Care : Case Studies : Cross-Cultural Complexity Case Study

Lolita is a transgender (male to female) Latino with lung KS and anemia. Her prognosis is less than three months. She speaks English fluently but when she feels very sick she reverts to Spanish. Her spiritual practice is Santeria. Her home is adorned with altars with offerings to the saints. She practices many Santero rituals to restore her health and to bring her peace. She inconsistently adheres to her medication regimen because she believes that her Saints are going to restore her health. Lolita does not believe that she is dying but when she has a medical crisis she promises her health care providers that she is going to take her medications.

After living in a hotel in the Tenderloin for a year, she decided to move into her ex-lover?s studio apartment. They don't have a relationship now and she states that he does not know she has AIDS. He is not involved at all in her care. She has a history of using speed and although she quit, her ex-lover is still using. Lolita does not have any relatives in San Francisco. Her mother lives in New York but they don't have a good relationship. Her support system is very limited, just her ex-lover and a friend in Oakland.

Her doctor, who speaks Spanish, sees her at a community clinic and wants to send her to SF General Hospital for hydration. Lolita refuses to go to General Hospital because she is afraid she will be hospitalized and would not be able to do her rituals. Every other week she kills a live chicken, collects the blood and offers it to the Saints. This offering gives her physical strength. This patient thinks that most people do not understand her religion and think that she's "bizarre". That is why she refuses to be placed in residential care. The only place she feels safe to do the rituals is at home. She has struggled with establishing advanced directives because she thinks that her Saints will lift her from a coma.

[ Go Up ]


This content is provided by Access to End-of-Life Care, an organization devoted to bringing multiculturalism to end-of-life care. Visit our main web site at www.access2eolcare.org.