On Saturday morning our renal team surrounded the bedside of a patient who spoke Haitian Creole, using an interpreter phone to communicate. The patient had no past medical history, hadn’t seen a doctor in years, and presented to the ED with acute renal failure of unknown etiology. He was initially admitted to the MICU for emergent dialysis then transferred to our team with a tunneled line catheter after completing two sessions of dialysis. We knew this limited medical background, that his entire family lived in Haiti, and nothing else about him.
We didn’t get far with the interpreter phone before he started yelling. He had no medical complaints and it was unclear why he yelled. We asked his nurse, who is also Haitian, if she could help us interpret. She started by asking him basic questions about how he felt, then started shaking her head: “he’s just talking about that spirit thing…he’s into Vodou and the spirits. I can’t keep talking about the spirits with him.” We were making little progress. My (very well-intentioned) attending asked if it was normal to practice Vodou, and whether we should get a psych consult? I knew enough to defer the psych consult and reassure the attending that Vodou is relatively mainstream in Haiti, but not much beyond that.
Through some quick reading later that weekend, I learned that Haitian Vodou originated during the French colonial empire in the 18th century. The religion developed amongst some West African people who were enslaved when traditional African religious practices were suppressed and many enslaved Africans were forced to convert to Christianity. Vodouists believe in a distant Supreme Creator that directs worship through spirits that are subservient to him. There are spirits responsible for every aspect of life. (5 minute National Graphic video on Haitian Voodoo https://www.youtube.com/watch?v=kpeLdXeIbwA). Contextualized, our patients’ reaction made a lot more sense.
The medical student on our team called for an in-person Haitian Creole interpreter, who arrived bedside later that morning. We found out that our patient believed the nurse had woken him up too early each morning, his spirit was disrupted, and that’s why he was still sick and in the hospital. He did not know what a kidney was, and he thought we had done enough tests and we should probably have an answer for him about what was going on at this point.
I left the renal service that day, but I’ve been thinking about him. I don’t know for sure, but I imagine he works in the U.S. to provide income for his family back in Haiti. He has no family in the U.S. and was unable to give us an emergency contact person. I can only imagine the potential financial consequences for him and his family if he can’t work three times per week due to dialysis. I’m also curious how the team will describe dialysis to someone who doesn’t know what kidneys are and believes the spirits’ anger is making him sick. Beyond a language interpreter, the renal team will need a cultural interpreter. I haven’t found a way to dial one of those yet for assistance, but my experience with this patient reminded me that we work at a special institution that requires us to be cultural interpreters, in addition to medical ones. My brief internet search on Vodouism was much more helpful in understanding our patient than an UpToDate search on the etiologies of acute renal failure.