African-American case study #2

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African-American case study #2

Appalachian case study #1

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Mr. and Mrs. Evans are an African American couple who retired from the school

system last year. Both are 65 years of age a

nd reside on 20 acres of

land in a large rural

community approximately 5 miles from a Superfund site and 20 miles from two

chemical plants. Their household consists of

their two daughters, Anna, aged 40 years,

and Dorothy, aged 42 years; their grandc

hildren, aged 25, 20, 19, and 18; and their 2-

year-old great-grandson. Anna and Doro

thy and their children all attended the


Mr. Evans’s mother and three of his

nieces and nephews live next door. Mr.

Evans’s mother has brothers, sisters, ot

her sons and daughters, grandchildren, and

great-grandchildren who live ac

ross the road on 10 acres of land. Other immediate and

extended family live on the 80 acres adjacent

to Mr. Evans’s mother. All members of

the Evans family own the land on which they live.

Mrs. Evans has siblings and extended fa

mily living on 70 acres of land adjacent

to Mr. Evans’s family, who live across the road. Mr. and Mrs. Evans also have family

living in Chicago, Detroit, New York, Sa

n Francisco, and Houston. Once a year, the

families come together for a reunion. Every other month, local family members come

together for a social hour. The family believes in

strict discipline with

lots of love. It is

common to see adult members of the family

discipline the younger children, regardless

of who the parents are.

Mr. Evans has hypertension and diabetes

. Mrs. Evans has hypertension. Both

are on medication. Their daughter Dorothy is

bipolar and is on me

dication. Within the

last 5 years, Mr. Evans has had several re

latives diagnosed with lung cancer and colon

cancer. One of his maternal uncles died last

year from lung cancer. Mrs. Evans has

indicated on her driver’s licen

se that she is an organ donor.

Sources of income for Mr. and Mrs. Ev

ans are their pensions from the school

system and Social Security. Dorothy receives SSI because she is unable to work any

longer. Mr. Evans and his br

others must assume responsibility for their mother’s

medical bills and medication. Although she ha

s Medicare parts A and B, many of her

expenses are not covered.

Mr. and Mrs. Evans, all members of th

eir household, and al

l other extended

family in the community attend a large Bap

tist church in the city. Several family

members, including Mr. and Mrs. Evans, sing

in the choir, are members of the usher

board, teach Bible classes,

and do community ministry.

Study Questions


Describe the organizational st

ructure of this family and identify strengths and

limitations of this 

family structure



Describe and give examples of what you be

lieve to be the family’s values about


    3.  Discuss this family’s

views about child rearing.

    4. Discuss the role that spirituality plays in this family. 


Identify two religious or spiritual practices in which members of the Evans

family may engage for treating hypert

ension, diabetes, and mental illness.


Identify and discuss cultural

views that Dorothy and her parents may have about

mental illness and medication. 


To what extent are members of the Evans fa

mily at risk for illnesses associated

with environmental hazards? 


Susan has decided to become an organ donor. Describe how you think the Evans

family will respond to her decision. 

    9. Discuss views that African Ameri

cans have about advanced directives.

    10. Name two dietary health risks for African Americans. 


Identify five characteristics to consider

when assessing the skin of African


    12. Describe two taboo views that Afri

can Americans may have about pregnancy.


Elmer and Mary Miller, both 35 years old, liv

e with their five children in the main

house on the family farmstead in one of th

e largest Amish settlements in Indiana.

Aaron and Annie Schlabach, aged 68 and 70, live in the attached grandparents’

cottage. Mary is the youngest of their ei

ght children, and when she married, she and

Elmer moved into the grandparents’ cottage

with the intention that Elmer would take

over the farm when Aaron wanted to retire.

Eight years ago, they traded living space.

Now, Aaron continues to help with

the farm work, despite increasing pain in hi

s hip, which the doctor advises should be

replaced. Most of Mary’s and Elmer’s sibli

ngs live in the area, though not in the same

church district or settlement. Two of Elmer’s brothers and their families recently

moved to Tennessee, where farms are less expensive and where they are helping to

start a new church district.

Mary and Elmer’s fifth child, Melvin,

was born 6 weeks prematurely and is 1

month old. Sarah, aged 13, Martin, aged

12, and Wayne, aged 8, attend the Amish

elementary school located 1 mile from thei

r home. Lucille, aged 4, is staying with

Mary’s sister and her family for a w

eek because baby Melvin has been having

respiratory problems and their physician told

the family he will need to be hospitalized

if he does not get better within 2 days.

At the doctor’s office, Mary suggested

to one nurse, who often talks with Mary

about “Amish ways,” that Menno Martin, an

Amish man who “gives treatments,” may

be able to help. He uses “warm hands” to

treat people and is

especially good with

babies because he can feel what is wrong. Th

e nurse noticed that Mary carefully placed

the baby on a pillow as she prepared to leave.

Elmer and Mary do not carry any hea

lth insurance and are concerned about

paying the doctor and hospital bills associat

ed with this complicated pregnancy. In

addition, they have an appointment for Wayne

to be seen at Rile

y Children’s Hospital,

3 hours away at the University Medical Cent

er in Indianapolis, for a recurring cyst

located behind his left ear. Plans are being

made for a driver to take Mary, Elmer,

Wayne, Aaron, Annie, and two of Mary’s sist

ers to Indianapolis

for the appointment.

Because it is on the way, they plan to stop in

Fort Wayne to see an Amish healer who

gives nutritional advice and does “treatment

s.” Aaron, Annie, and Elmer have been

there before, and the other women are considering having treatments, too. Many

Amish and non-Amish go there and tell others

how much better they feel after the


They know their medical expenses seem minor in comparison to the family

who last week lost their barn in a fire

and to the young couple whose 10-year-old child

had brain surgery after a fall from the hayl

oft. Elmer gave mone

y to help with the

expenses of the child and will go to the barn raising to help rebuild the barn. Mary’s

sisters will help to cook for the barn raisi

ng, but Mary will not help this time because

of the need to care for her newborn.

The state health department is concer

ned about the low immunization rates in

the Amish communities. One community-health nurse, who works in the area where

Elmer and Mary live, has volunteered to talk

with Elmer, who is on the Amish school

board. The nurse wants to learn how the health

department can work more closely with

the Amish and also learn more about what

the people know about immunizations. The

county health commissioner thinks this is a wast

e of time and that what they need to do

is let the Amish know that they are creating

a health hazard by ne

glecting or refusing

to have their children immunized.

Study Questions


Develop three open-ended questions or

statements to guide you in your

understanding of Mary and Elmer and what

health and caring mean

to them and to

the Amish culture.

  1. List four or five areas of perinatal

care that you would want to discuss with Mary.

  1. Why do you think Mary placed the baby

on a pillow as she was leaving the doctor’s


  1. If you were the nurse to whom Mrs. Mill

er confided her interest in taking the baby

to the folk healer, what would you do to le

arn more about their simultaneous use of

folk and professiona

l health services?

  1. List three items to discuss with the M

illers to prepare them fo

r their consultation at

the medical center.

  1. If you were preparing the reference fo

r consultation, what would you mention about

the Millers that would help to promote cu

lturally congruent ca

re at the medical


  1. Imagine yourself participa

ting in a meeting with state

and local health department

officials and several local physicians and nur

ses to develop a plan to increase the

immunization rates in the

counties with large Amish

populations. What would you

suggest as ways to accomplish this goal?

  1. Discuss two reasons why many Old Orde

r Amish choose not to carry health


  1. Name three health problems with genetic

links that are prevalent in some Amish



How might health-care providers use the

Amish values of the three-generational

family and their visiting patterns in pr

omoting health in the Amish community?

  1. List three Amish values to consid

er in prenatal education classes.


Develop a nutritional guide for Amish wome

n who are interested in losing weight.

Consider Amish values, daily lifestyl

e, and food production and preparation


  1. List three ways in which Amish express caring.


William Kapp, aged 55 years, and his wife, Gloria, aged 37, have recently moved from an

isolated rural area of northern Appalachia

to Denver, Colorado, because of Gloria’s

failing health. Mrs. Kapp has had pulmonary t

uberculosis for several years. They decided

to move to New Mexico because they heard that the climate was better for Mrs. Kapp’s

pulmonary condition. For an unknown reason, they stayed in Denver, where William

obtained employment making machine parts.

The Kapp’s oldest daughter, Ruth, ag

ed 20, Ruth’s husband, Roy, aged 24, and

their daughter, Rebecca, aged 17 months, moved with them so Ruth could help care for

her ailing mother. After 2 months, Roy return

ed to northern Appalachia because he was

unable to find work in Denver. Ruth is 3 months’ pregnant.

Because Mrs. Kapp has been feeling “mor

e poorly” in the last few days, she has

come to the clinic and is accompanied by her husband, William, her daughter Ruth, and

her granddaughter, Rebecca. On admission, Glor

ia is expectorating greenish sputum,

which her husband estimates to be about a teac

upful each day. Gloria is 5 ft 5 in. tall and

weighs 92 pounds. Her temperature is 101.4°F,

her pulse is regular at 96 beats per

minute, and her respirations are 30 per minute

and labored. Her skin is dry and scaly with

poor turgor.

While the physician is examining Mrs. Kapp, the nurse is taking additional

historical and demographic da

ta from Mr. Kapp and Ruth. Th

e nurse finds that Ruth has

had no prenatal care and that her first chil

d, Rebecca, was delivered at home with the

assistance of a neighbor. Rebecca is pale and

suffers from frequent bouts of diarrhea and

colicky symptoms. Mr. Kapp declines to offer in

formation regarding his health status and

states that he takes care of himself.

This is the first time Mrs. Kapp has s

een a health-care provider since their

relocation. Mr. Kapp has been treating his wife

with a blood tonic he makes from soaking

nails in water; a poultice he ma

kes from turpentine and lard,

which he applies to her chest

each morning; and a cough medicine he makes from rock candy, whiskey, and honey,

which he has her take a tablespoon of four

times a day. He feels this has been more

beneficial than the prescription medicati

on given to them before they relocated.

The child, Rebecca, has been taking a

cup of ginseng tea for her colicky

symptoms each night and a cup of red ba

rk tea each morning for her diarrhea.

Ruth’s only complaint is the “sick headach

e” she gets three to four times a week.

She takes ginseng tea and Epsom salts for the headache.

Mrs. Kapp is discharged with prescr

iptions for isoniazid, rifampin, and an

antibiotic and with instructions to return in

1 week for follow-up based on the results of

blood tests, chest radiograph, and sputum cultures.

She is also told to return to the clinic

or emergency department if her symptoms

worsen before then. The nurse gives Ruth

directions for making appointments with the pr

enatal clinic for herself and the pediatric

well-child clinic for Rebecca.

Study Questions

  1. Describe the migration patterns of

Appalachians over the last 50 years.

  1. Discuss issues related to autonomy

in the workforce for Appalachians.

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