Introduction Patients usually go through a lot and in most instances; other people influence their decisions in all aspects. They are forced to follow certain aspects even though they themselves are against them. This is because they are sick and as thus depend on the help of others in order to regain their healthy. The scenario Ella has been sick and as thus has been requiring medical help. She wishes to stick to the alternative and complementary medical practices but is coerced to follow the mainstream medical advice. Her husband, who insists to make decision on her behalf, as he is the head of the family, opts for traditional practices. There are alternatives for her care as she may be discharged home to receive treatment and care from there.However; the family members at home also have individual problems. The son is an alcoholic while the daughter has diabetis.The grandson has drugs problems while the grand daughter is bipolar and also has drug problems. The daughter in law is also stressed because of the medical issues in the family which include nephew with leukemia, brother who has HIV and her father’s view that they are all crazy. Ella is expected by the doctor to go home and receive care from there. The family members are thus expected to provide her with all the care needed in order to enhance her recovery. The question is, keeping in mind the current situation with family members; will she be able to recover adequately? Cultural Aspects and alternative treatments Ella’s husband wants the family traditions to be followed in her medications. Assessment of therapy process and its outcome usually vary across cultures. A cure in a system may be regarded as a failure in another system. This makes assessment of success or failure a daunting task. The biomedical perspective of traditional systems is that they usually lack models necessary for chronic disorders. In a scenario, a medicine man may say that their therapy works as their patients never come back. A physician may say that their therapy works as their patients do come back. Physicians view this as success to an ongoing process while the medicine mans` cure does not appear to need any further therapy. These thoughts reflect the different expectations of people on illnesses and therapy. These methods are based on various expectations of patients and their families. (Jennifer Christine Mills Niemeyer, 2010) The current scenario is complicated further as the husband opts for traditional mechanisms. He wants a therapy that will adequately provide a permanent cure and relief. The husband challenging the use of biomedical to traditional poses a great task to physicians and healers of any tradition. This makes the patients to struggle and reject with the chronic illness. The physician should thus recognize the psychosocial problems and try to analyze the complexities of the cross-cultural settings of caring for the patient. This is to ensure positive progress of the patient’s .

1. Introduction
Patients usually go through a lot and in most instances; other
people influence their decisions in all aspects. They are forced
to follow certain aspects even though they themselves are
against them. This is because they are sick and as thus depend
on the help of others in order to regain their healthy.
The scenario
Ella has been sick and as thus has been requiring medical help.
She wishes to stick to the alternative and complementary
medical practices but is coerced to follow the mainstream
medical advice. Her husband, who insists to make decision on
her behalf, as he is the head of the family, opts for traditional
practices.
There are alternatives for her care as she may be discharged
home to receive treatment and care from there.However; the
family members at home also have individual problems. The son
is an alcoholic while the daughter has diabetis.The grandson has
drugs problems while the grand daughter is bipolar and also has
drug problems. The daughter in law is also stressed because of
the medical issues in the family which include nephew with
leukemia, brother who has HIV and her father’s view that they
are all crazy.
Ella is expected by the doctor to go home and receive care from
there. The family members are thus expected to provide her
with all the care needed in order to enhance her recovery. The
question is, keeping in mind the current situation with family
members; will she be able to recover adequately?
Cultural

2. Aspects and alternative treatments
Ella’s husband wants the family traditions to be followed in her
medications. Assessment of therapy process and its outcome
usually vary across cultures. A cure in a system may be
regarded as a failure in another system. This makes assessment
of success or failure a daunting task.
The biomedical perspective of traditional systems is that they
usually lack models necessary for chronic disorders. In a
scenario, a medicine man may say that their therapy works as
their patients never come back. A physician may say that their
therapy works as their patients do come back. Physicians view
this as success to an ongoing process while the medicine mans`
cure does not appear to need any further therapy. These
thoughts reflect the different expectations of people on illnesses
and therapy. These methods are based on various expectations
of patients and their families.
(Jennifer Christine Mills Niemeyer, 2010)
The current scenario is complicated further as the husband opts
for traditional mechanisms. He wants a therapy that will
adequately provide a permanent cure and relief. The husband
challenging the use of biomedical to traditional poses a great
task to physicians and healers of any tradition. This makes the
patients to struggle and reject with the chronic illness. The
physician should thus recognize the psychosocial problems and
try to analyze the complexities of the cross-cultural settings of
caring for the patient. This is to ensure positive progress of the
patient’s health.

3. In dealing with this Ella’s husband, the physician may apply the
following guidelines:-
Negotiate with the patient, Ella’s husband and the family at
large on all issues that are related to the biomedical illness
processes and Ella’s experience and views on the illness.
Create awareness to the family of their importance in involving
themselves to therapy. This should be emphasized at all levels
of care and physicians should empower and support the patient
and the family in the whole care process.
Physicians should also encourage actions in the family that will
enhance the peoples needs in participating to help and
neutralize the fears that are linked between the traditional
beliefs and the biomedical aspects.
Physician should also compare the various explanations given
by the patient and the patient’s husband. From this, they should
mould a therapeutic plan that will accommodate the special
perceptions and beliefs held by the patient’s husband.
The physician should analyze the discrepancies between the
patient-family goals and the biomedical goals. All the
difficulties that may relate to miscommunication or
communication style should be addressed that cut across
cultural boundaries.
Complementary
medicine
and
beliefs
Ella wishes for the use of a complementary system in her
treatment. These treatments are used in addition to the

4. conventional medicine. She wants to integrate both the
scientific proven therapy with the traditional herbal formulas.
Complementary medicines unite the best practices of both
worlds. (Helen E Sheehan; Barrett P Brento, 2002)
Some of the reasons patients opt for complementary medicine
and therapy include: some patients emphasize on the value of
treating the whole person; some believe that the complementary
medicine will be effective on the specific problem than
mainstream therapy; the believe that the complementary therapy
will enable them to take an active role in maintaining their
health; while others believe that the mainstream treatment was
not adequately effective on the specific problem.
As Ella has been chronically sick for a long time, the above
factors are the basis for her choice of opting for a
complementary therapy.
Mainstream medicine
Mainstream medicine is the system applied by medical doctors
in diagnosing and treating diseases. (Helen E Sheehan; Barrett P
Brento, 2002)
This is the doctor’s choice for Ella’s therapy. The doctor will
provide guidelines and procedures to be followed in the whole
therapy process. As both the Ella and her husband are against
this system, the doctor may be unable to effectively provide the
medical care during therapy.
In conclusion, the different aspects of traditional,
complementary and mainstream systems of treatments are
incompatible and will only make the patient’s situation even
harder to manage. The three parties should agree on which
system is most effective in order to enhance medical care of the
patient.

5. Family conflicts and differences likely to be encountered in the
family
Everyone in the family have their own individual problems.
They range from drug addiction, illnesses such as diabetes,
leukemia and HIV to stress. These are the family members that
are supposed to take care of Ella. In case of therapy, the family
members are assigned responsibilities as too how each is
supposed to play a role in the therapy.
In view of this, everyone in the family feels that even them they
require special care. This is because everyone is undergoing
difficult situations in their lives that affect them physically,
socially and emotionally.
From the scenario, one can truly say that each member of the
family does whatever they think is best for them without
considering the repercussions or other family members. It seems
like all the family members are irresponsible and there is no one
to guide them into doing what is right. With Ella coming home
and requiring special care from all family members, this will
indeed be a hard task. The other family members will too feel
that they also need the special care as they too are undergoing
difficult situations in their lives.
All the above factors will cause conflicts and differences among
the family members and make everyone’s situation even worse.
All these aspects will derail Ella’s progress in her therapy. They
will indeed have an impact on their social and psychological
perspective on their basis of life.

6. Reaction and role of the community in meeting the diverse
family circumstances
The extended family plays an important role in the whole
therapy process of Ella. They are the immediate people to offer
therapy care to her and in view of this, their action on the
situation will indeed have an impact on the situation. The
neighborhood is also like part of her family as they live in the
same surroundings.
High chances are that the extended family and the neighbors
may not feel it as right to have Ella be taken care of at home.
This is because of the circumstances surrounding her family
members who are supposed to take care of her. Their view
would be that the family members might have a negative impact
on the treatments of Ella and thus derail her recovery.
As all the family members are in need of therapy because of
their various situations, the communities has resources and
programs to deal with the circumstances. This include -
The alcohol anonymous program that is run in the community
helps alcoholics who are in need of changing their situations.
They usually meet, share their experiences on how alcohol has
ruined their lives and they are given therapy on how to change.
Also those that have successfully finished their therapy
encourage others of the impact of such therapy on their lives.
This program will indeed help her son Sam, grandson Josh and
granddaughter Lucy.
There is also a social agency in the community that offers
counseling services to people. The various counselors at the

7. station are trained with vast experience to help in mitigating
some problems people encounter in their lives. This counseling
service will best suit all the family members including Ella’s
husband. After successful completion of the counseling process,
the family will now be joined together in helping Ella.
The above community services will adequately help in meeting
the needs of the diverse family circumstances.
Hospital care and home care
A home based care is usually affordable and cost effective than
a hospital based care especially for chronic conditions.
However, the cost of caregivers remains at a higher rate as
compared to their incomes.
Palliative care is the best option for Ella as its most suitable for
people experiencing stress, pain or other conditions caused by a
serious illness. This care is appropriate at any of the stages of
serious illness and patients usually are given together with the
treatment prescribed to cure the patient. (John Arras, 1995)
Importance of Palliative care
The palliative care team helps in identifying the sources of
discomfort and pain and thus provides the necessary treatments
that offer relief.
The team comprises of good communicators and as thus, they
apply their communication and coordination skills in ensuring
that the family needs are met. This will indeed be most essential
to Ella’s family as there lacks communication and coordination.
The palliative team offers emotional support focusing on the
person as a whole rather than just the illness. The team
addresses the psychological, social or emotional needs of the
family.

8. This team also offers support to the family members as they
also go through a lot of stress. They help to ease their stress and
tension and also help in decision-making.
In view of the above, a home care enables one to have a more
control of their lives and care and provides a supportive and
comfortable atmosphere that helps to reduce stress and anxiety.
The home care also with palliative team enables one to go on
with their daily lives while at the same time improving their
ability to continue their therapy. It helps one to better
understand their conditions and the treatment choices available.
Impact of the situation and each person perspectives on their
lifespan development
The situation has indeed changed the whole family’s perspective
of life. There are many problems to be solved and with a patient
at home requiring care, this will make things even worse. Each
member of the family minds about their affairs without being
responsible for others in relation to the actions they show. This
will indeed hinder a positive development of their lives’. As
everyone in the family requires the same care, their position on
the situation may shift. They may understand what Ella is going
through but may not be able to help her appropriately.
However, with the necessary social agencies around the
community, the situation may change and have a positive
impact.
References

9. Helen E Sheehan; Barrett P Brento (2002)
Global perspectives on complementary and alternative medicine
John Arras (1995)
Bringing the hospital home : ethical and social implications of
high-tech home care
Jennifer Christine Mills Niemeyer (2010)
The impact of a coordinated care program on chronically ill
patients