Chicken stew for granny
A Roma family have rented a VIP ward. Granny, who is a woman in her 40’s, is the patient.
The whole family came to settle in the small ward. The number of visitors allowed is 2. It was impossible to talk about this with them. I kept asking them but they would not accept.
Granny came in for an operation of the gall. She could not eat on the eve of the operation, but we all were doubtful that she would keep to this rule. The family brought all kinds of food for the Granny. “Let her eat it, just a bite?”, for example from the chicken stew with paprika.
On the day of the operation the whole family was making a scene in the nurses’ room: “Granny will be operated on, let them take her right now and she should get her medication”. Before this happened, they were doubting me, suspecting that I gave her laxative instead of the necessary drugs. Granny was the second on the list of the patients to be operated that day.
But they paid for the ward and the doctor too, so that Granny gets the best treatment and she be the first. “Why the long wait”?
After the operation: they kept highlighting how sick their mother is and that I neglected her, because I am with other patients and I do not spend enough time with her. There is a VIP room but there are no VIP nurses and I had as many patients as all the other nurses. Furthermore, the granny is calm, she only wants to rest. The family are disturbing her with their presence and she gets worse because she cannot get any rest. They are “taking” her oxygen from the room, they colonise the bed and the eat their lunch next to the patient who has been recently operated on.
1. Identities of the actors in the situation
Nurse: Young woman resettled from Romania (ethnic identity: Hungarian but also “immigrant”, Romanian nationality). First professional experience.
The Roma family: 10-15 family members of a Roma patient (the grandmother in her 40s): men and women, of all ages, we do not know from which ethnic group. Social status: visibly well-off Roma family.
As a professional, the nurse is in a hierarchically higher position representing the norms of the hospital and also as Hungarian vis a vis the Roma, however, an immigrant she also belongs to a minority and her socio-economic position with respect to the Roma family is lower. Differences are however bigger than similarities and unclear in terms of hierarchical order. This could create a situation where everybody is competing for more control. The only possible common point is in the context: both the family members and the nurse want to make sure the granny is all right.
2. Context of the situation
The situation happens in the hospital, which has its own institutional rules. Within the rules, there is a possibility to pay for extra services (an individual room), but these extra services do not give the right to exceptional professional treatment. In the wider context, there is the mutual suspicion and hostility amongst the Roma and non Roma. This is because they both consider each other as an emblematic figure of the Other.
3. Emotional reaction
She panics as she is responsible for the patient getting adequate treatment and she feels that the family’s behavior puts the patient in danger.
She is obscured because the behavior of the family contravenes the rules.
She is also frustrated, feeling that her professional competences are put into question.
She feels helpless, angry, worried and exasperated because she had no means to influence the family.
She also feels humiliated and threatened (they complained to her superior)
She feels undermined.
4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.
The rules of the hospital are rational: they take into account the interests of the patients. As a professional she knows what is good and what is bad for patients.
She also knows that family members often break the rules. “This is just one more case like this”. (irritation)
What the family is doing is against the rules, it is also bad for the granny.
Definition of the situation: This is a conflict situation. The reason: the family want special treatment because they feel they have paid for it – but there is no special treatment, beyond the room. “There is a VIP room but no VIP nurse “(irritation).
The big Roma family correspond to expectations: they are numerous, loud, unruly and threatening. They also correspond to a “new rich” image: they think they have the right to everything for their money.
If there is conflict, it is certainly an all or nothing situation. Only one party can win – and she has to, as she represents the hospital and is responsible for the health of the granny.
Health-sickness: sickness is in the body of the patient. It is due to a disorder that has to be reestablished with medical help. For this calm and a certain sterility (not only physical but also social) is essential. “they are breathing out the air from the room”
The family challenge professional evidence.
The operation of the gall: a routine and non-serious procedure if there are no complications. The type of behavior of the family is more likely to cause complications.
5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?
Rather negative although she recognizes that the family cares for the granny.
6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.
Any sickness that takes you to bed is potentially lethal. The patient’s life could be in danger, given the hostile environment (the hospital). The family “arm” themselves in advance, against the discrimination and contempt which they expect. They pay an extra price so that they can get the treatment that they have the nominal right to. However, as there is always the suspicion of discrimination, they think they are treated badly, they do not recognise that they want extra attention. For them the amount of attention they demand is just normal.
Sickness for them is disruption of an order. Social as much as physical. The whole family take part in it and the whole family participates in the reestablishment of the order: they know what is good for their granny.
Eating is about health, chicken stew is probably her favorite dish, it proves their love to her and it is good for health.
Definition of the situation: conflict: granny is in a life threatening situation and she is not getting the care she is entitled to and she needs. She is treated reluctantly by hostile personnel. It is an all or nothing situation: they have to substitute for the care the hospital refuses to granny.
7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?
There is a perceived conflict, a competition situation between the family and the personnel, despite their aims being the same, in that they want the patient to get better soon. Often in such situations there is a debate about the rules instead of looking for a common denominator. In this case, such a common denominator is easy to find.
The tricky thing is, how to communicate it with the family? The family is not a body that a health professional can effectively communicate with. From the beginning, part of the problem is that the nurse sees the family as a mass (that is why in the place of the “other” there is a group instead of one specific person). In hospital, the family represents a context rich, collectivist culture in a context poor, individualist context. This distance can be bridged by changing communication style (taking the hand of the granny for example and assuring the family that she is in good hands) and by identifying the person in the group who is entitled to speak for the whole community.