Haiti is one of the poorest countries in the Western Hemisphere. More than two-thirds of its population has a living wage of less than US$2 a day (Caporiccio et al., 2019). One of the results is that many women cannot afford maternity services, with fatal consequences for both mothers and children. Haitians have different attitudes to unplanned pregnancies, but for the most part, Haitians prefer not to have an abortion, even if the child is not planned (Meffen, 2018). This may be due to religion and also due to different pro-life cultural beliefs. However, due to the country’s economic poverty, families often cannot fully raise their children and provide them with all the basic necessities, so some opt for abortion. Concerning viruses, Haitians generally do not associate viruses with the risks for pregnant mothers and children and see a doctor as soon as they are infected without taking any preventive measures.
In terms of attitudes towards blood transfusion, there are different opinions among Haitians and various reasons for these opinions. For the most part, only particular religious communities refuse blood transfusions, while a more significant number of residents have a neutral attitude. However, the situation regarding blood donation is much more ambiguous. One factor in why many Haitians are mainly reluctant to donate blood is the racial prejudice associated with immigration (Penteado, 2020). The social and economic integration of Haitians in the first wave of immigration went smoothly, which was a factor in favor of blood donation. However, then came the events of the contaminated blood case – the population was massively misinformed that African-American blood was contaminated with disease. On the other hand, when it comes to emergency blood transfusion, the need for transfusion among close acquaintances is undoubtedly as much a priority for Haitians as it is for residents of any other country.
Patients’ objections to blood transfusion may arise for personal, medical, or religious reasons. For example, in this particular case, the patient’s parents refuse a transfusion because they are Jehovah’s Witnesses. The anesthetist in such a situation should follow her procedures to minimize the harm caused by refusing a blood transfusion. The anesthetist should discuss with the patient what blood products they are willing to take (Crowe & DeSimone, 2019; Scharman et al., 2017). In addition, an assessment for anemia should be undertaken. In obstetric cases, such as our case study, the increased risk of hysterectomy and the use of ultrasound to locate the placenta should be discussed (Mason et al., 2015; Open Anestesia, 2021). During the operation itself, the use of local anesthesia is recommended, as the patient can then remain conscious and refuse the prohibition of blood transfusions if she feels the need to do so.
The fact that the girl whose parents refuse a blood transfusion is a minor also plays a role in this particular case. The child’s right to life is paramount and should be considered before her parents’ religious beliefs. In a life-threatening emergency, a child who cannot give competent consent must be given any life-threatening treatment, regardless of the patient’s wishes. To make such a decision, one must be convinced that there is no other way to save the life and health of the patient. In this situation, each step should be considered carefully and consciously, taking into account the patient’s age, illness, and condition.
Caporiccio, J., Louis, K. R., Lewis-O’Connor, A., Son, K. Q., Raymond, N., Garcia-Rodriguez, I. A., Dollar, E., & Gonzalez, L. (2019). Continuing education for haitian nurses: Evidence from qualitative and quantitative inquiry. Annals of Global Health, 85(1), 93. Web.
Crowe, E. P., & DeSimone, R. A. (2019). Transfusion support and alternatives for Jehovah’s Witness patients. Current Opinion in Hematology, 26(6), 473-479.
Mason, C., LaToya, M., Tran, D., & Connie K. (2015). Caring for the Jehovah’s Witness Parturient. Anesthesia & Analgesia, 121(6), 564-1569.
Meffen, K., Burkhardt, G., & Bartels, S. (2018). Abortion care in Haiti: A secondary analysis of demographic and health data. Plos One, 13(11), 23-35. Web.
Open Anestesia. (2021). Refusal of blood transfusion. Open Anestesia. Web.
Penteado, S., Rocha, A., Cunha, T., Guiotoku, S., & Moysés, T. (2020). Access of Haitian migrants to public healthcare: a bioethical question. Revista Bioetica, 28(2), 384-389.
Scharman, C. D., Shatzel, J. J., Kim, E., DeLoughery, T. G. (2017). Treatment of individuals who cannot receive blood products for religious or other reasons. Am J Hematol, 92(12), 1370– 1381. Web.