Interview with an African American labor and delivery nurse. African American and Caribbean patients are open to sharing and being consoled. The family plays a big part in providing care—in some instances, multiple generations come to provide solace. Spirituality is very important and is reflected in the language of coping and understanding the outcome. The parents may ask for a cleric to perform baptism or for advice before making final deci- sions. They will ask to hold the child, when possible. The death is seen as a part of the cycle of life, and the child is recognized as a member of the family. The parents grieve as if the baby had lived its full life. They appreciate it when we cry with them.
Service delivery issues. Healthcare providers working with bereaved African American families need to bear in mind the historical, cultural, and social factors that help shape these families’ grief responses and needs. Issues to be mindful of include
• historical distrust • culturally linked concept of family structure and the decision-making process • diverse communication styles • the perception of health as physical, with a moral/spiritual balance • a code of ethics that is different, but not wrong or inferior
Death, however early, is a rite of passage with clear meaning for the entire family. In working with a bereaved family, it is important to ask what would be helpful. Facilitate the process for families, but don’t decide for them. It is important to consider the whole person in a nonjudgmental approach.
Other tips for providers: • Go into the community that you would like to learn about.
• Work with culturally/ethnically organized groups—ask about specific issues and prac- tices but understand that they may not share all. Potential resources include religious leaders of different faiths, herbalists, shamans, churches, mosques, temples, patient advocates, and peer counselors in community-based organizations.
• Exchange information and concerns with colleagues, collectively strategize, and work in collaboration, not isolation.
For African Americans in the United States, despite significant gains in many key health indicators, infant mortality and racial disparity in quality healthcare remain critical issues plaguing the population. Several issues remain at the forefront of the national dilemma:
• Disparities in the health of African American women, infants, and children continue to affect community life. This issue needs to be addressed across the entire continuum of healthcare, not just upon the death of an infant or when a mother is in crisis.
• Although the health community is making strides in moving from cultural aware- ness to diversity to competence, with the eventual goal of achieving both proficiency and high levels of patient satisfaction, providers still need to make a greater effort to incorporate culturally competent practices into the spectrum of care.
VOICES FROM THE COMMUNITY: CROSS CULTURAL EXPRESSIONS OF GRIEF AT THE LOSS OF AN INFANT
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