Culture clash: a missed opportunity

Erasto is a term infant born by vaginal delivery to a gravida 7 para 7 Somalia woman with full prenatal care in the United States. His mother had gestational diabetes. The delivery was complicated by respiratory distress and an urgent admission to the neonatal intensive care unit for further evaluation for possible pulmonary disease and a congenital heart condition. A female pediatric intern was assigned to update Erasto's mother on the baby's status and to obtain consent for an intravascular line placement. When she entered the room to talk to the mother, multiple family members spanning at 3 generations were with the baby's mother. They were all women with the exception of Erasto's father who was apprised of the baby's clinical status by the male neonatal physician several minutes earlier. Through a telephone translator, the intern explained to Erasto's mother that her baby may have heart and lung problems that may be related to her gestational diabetes. At this point, many family members spoke simultaneously and excitedly. Some accused the intern of keeping the baby in the neonatal intensive care unit "to make more money," and others said they would sue her "if anything happened to Erasto." The mother denied that she had gestational diabetes, and claimed that because she "believed in God...nothing is wrong with my baby." The intern was not prepared for this response and asked herself, "What went wrong?"