What is the biggest barrier you face in providing care to Bana at this point?
The biggest barrier to Bana’s care is her lack of understanding what exactly is going to be done to provide her adequate care in America. The linguistic barriers don’t allow Bana to appropriately be questioned privately or ensure her understanding of interventions and follow up. If she were experiencing intimate partner violence (IPV) her husband could interpret for her which would leave her at increased risk without the knowledge of the provider. Per JAMA (2018) she is at increased risk for IPV because of her age and her recent assault which could have been perpetrated by her husband, we are unsure because she does not understand what we are asking her. What is the priority action for you to take at this time?
My priority would be to get a medical interpreter and then proceed with the visit. I would question her further about her assault in Syria and if it included rape. The timing of her pregnancy is close to the time she was assaulted, and it should be explored. It could create another stressor for her and her husband that just adds to their financial issues and adjusting to life in a new country.What action is most important for you to take to ensure the health and safety of the fetus?
Per the CDC (2012a) refugees should have a complete H&P with comprehensive labs that include a CBC, UA, and glucose. Diseases that are easily transmittable such as TB, malaria, lead, parasites, and HIV/AIDS should be tested for as well, but HIV/AIDS is no longer tested for everyone, but I should be done as part of Bana’s pregnancy care. She is at increased risk of transmission if she was raped during her assault (CDC, 2012a). Testing for STIs should be done as part of her pregnancy care as well. Given Bana’s financial situation, you are concerned about her and her family having adequate nutrition. Which intervention would best address this concern?
Testing for anemias and deficiencies should be done. Getting a comprehensive H & P related to nutrition can help to identify long term issues from new issues with obtaining adequate nutrition. Directing Bana to local places where she can get help with food such as WIC and state aid or places where she can obtain food like local food pantries should be done (CDC, 2012b).References
Centers for Disease Control and Prevention. (2012)a. Summary checklist for the domestic medical examination for newly arriving refugees. Retrieved from https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/checklist.html Centers for Disease Control and Prevention. (2012)b. Guidelines for evaluation of the nutritional status and growth in refugee children during the domestic medical screening examination. Retrieved from https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/nutrition-growth.html JAMA. (2018). Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults. US Preventive Services Task Force Final Recommendation Statement. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/2708121
