Wednesday, November 21, 2007

Ethnicity and Inequality in the NHS

One of the (now not so) new Secretary of State for Health's stated aims for the NHS was to reduce health service provision inequalities whether regional, age-group, ethnic etc.

A major paper by researchers, sponsored by Cancer Research UK, looking at the perceptions of healthcare professionals into their own interactions with patients and carers of cultures other than their own, has just been published and makes interesting reading.

I need to reread the paper ... but a brief personal comment.

African women carry their babies on their back and Nanda and Kezia were no exception. When Kezia was upset, onto Nanda's back and all worries would disappear.

When we were “interned” at the RMCH, the nurses on the Borchardt Ward noticed this and through their cultural “inexperience” were totally amazed at the calming effect this would have. One day Kezia was upset at a treatment and Nanda, probably in her anxiety at Kezia's distress, completely forgot how Kezia would calm down and sleep on Nanda's back. The white causcasian nurses, with no or little cultural “training” suggested “Try putting her on your back like you've done so may times before ...” And Kezia calmed down and slept.

A conclusion in the abstract of the paper is “A shift away from a cultural expertise model toward a greater focus on each patient as an individual may help.”.

Couldn't agree more!

The nurses had observed what worked and what worked successfully for the individual regardless of her ethnicity.


Lea White said...

Hi there,

Thanks for your comment. On Bianca's treatment plan document it says:

"AALL0331 Standard Risk B - Precursor Acute Lymphoblastic Leukemia", Bianca is classified as "Standard Risk - Average ALL"

We are on the IS arm which is slightly more intense than the usual standard treatment and is part of a clinical study.

Reading your blog entry made me remember when we lived in South Africa 3 years ago and where they have so many different cultures living together.

How does the dexamethasone affect your daughter? In the last phase they wanted to give liquid dex., but did not realise that 2 days notice we required to get it ready and so they gave tablets. This round tablets. This is cool because you can crush it up and mix with something that tastes better... It is standard here to give 3 days co-trimoxazole and then Bianca got Fluconozole after her viral infection a while back and is still on this.

Angus said...

Thanks for the long comment. Patty Feist has a long post on the AALL0331 trial -

Hence I understand some of the differences in treatment (Kezia's ALL is T-cell). Did Bianca have any CNS?

I think we see the side-effects of dex more now they are not so mixed up with the side-effects of everything else. Drowsiness, appetite-gain, moodiness, generally out-of-sorts - she stays off school when she is on dex.

Liquid dex is yummy!

Angus said...

Here's the link again