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Case Study Healthcare

Ayesha is a 22 year old female. She has recently moved to Australia with her husband where she has been accepted into an Architecture degree. She is enjoying her studies and has an aspiration to complete her studies in the next 3 years, and accept an offer she has received to work in a Sydney architecture firm once she has graduated. Once she has enough experience it is her long-term dream to establish her own architecture firm. This is an exciting dream which was never possible in her home country. 

Ayesha’s husband, Suman, is 43 years old. Their marriage was arranged. Despite this, Ayesha is mostly content in her relationship. Their culture is primarily patriarchal wherein it is the male who makes decisions for his wife and family’s healthcare decisions (among other decisions). Ayesha is brought into hospital one day with dehydration secondary to severe nausea and vomiting for the past 2 weeks.  Suman is concerned about Ayesha and demonstrates genuine love and concern for her. He remains by her bedside at all times. 
Ayesha calls the nurse and requests assistance to go to the toilet. While in the toilet Ayesha tells the nurse that she thinks she is pregnant. She has not had her period for 6 weeks, the nausea commenced about 3 weeks ago and the vomiting 2 weeks ago.  She is not using any current contraception as her husband would like to have a baby. If Ayesha has a baby she will need to defer her studies, and there is a cultural expectation that she would be the primary care giver of the baby, so it is possible that her studies would not be able to resume for many years at which point she may not receive credit for the subjects she has done and will need to start from scratch. This will revoke the offer of working with the architecture firm and then damage her ambition of starting up her own architecture firm. 

She tells the nurse that she would like some tests done to confirm the pregnancy, and then she would like to have an abortion. She says she does not her husband to know so does not want anyone to tell him what the investigations are for and what the results are. 
The medical team organises some blood tests and abdominal ultrasound to be conducted. Suman asks what the tests are for and the doctor replies that they are trying to determine the cause of Ayesha’s illness and the results of these tests may help us to understand the full clinical picture. Suman appears satisfied with this answer. 

Tests confirm that Ayesha is about 4 weeks pregnant. The medical officer determines that she is eligible legally for an abortion as having the child could cause emotional, psychological and financial harm to Ayesha (as per the legislation). She is admitted to a general surgical ward for IV hydration, anti-emetics and the obs-gyn team are consulted to arrange for a termination of her pregnancy. You are the ward nurse and Suman asks you “do we know the results of the tests, do the doctors have any idea what is causing Ayesha to be sick?” You tell Suman that you are not sure what is wrong with Ayesha, even though you do know that she is pregnant. You suggest that Suman speaks more closely with the medical team. 

Overnight Ayesha is consented for a D&C in theatre and the next day Suman arrives and is told that Ayesha is having an operation and is already in theatre. Suman becomes upset as he was unaware that Ayesha needed surgery, he was not informed and had no say in his wife’s treatment. He demands to know what is wrong with Ayesha and why she is having an operation.  The team leader overhears this conversation and comes over to provide assistance. She tells Suman that she thinks Ayesha is having her appendix removed due to appendicitis as this explains all of her clinical symptoms. 
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