Exercise 2: FAMILY MEDICINE

Aristotle is an 8-year old boy from San Jose, Antique, and he is the youngest in a
brood of three. His father is a 42-year old fisherman while his mother is a 40-
year old housewife who sometimes sells native delicacies (e.g. “pinasugbo” and
“bandi”) to augment their family income. Aristotle lives in a small hut, along with
his siblings, parents, and paternal grandmother. They are Jehovah’s witnesses.

Aristotle’s medical problems started several months earlier when he first

experienced intermittent febrile episodes with associated pain in the pelvic and
lower extremity regions. He was also described to be very pale with note of
palpable, matted lymph nodes in the cervical, axillary, and inguinal areas. This
prompted consult and subsequent admission at the Antique Provincial Hospital
where initial laboratory work-up was done, including a bone marrow examination
and a complete blood count, which revealed the presence of blasts. Aristotle
was then diagnosed to have acute lymphocytic leukemia, and was advised
chemotherapy. To correct his anemia, blood transfusion was also
recommended. However, due to financial constraints and religious beliefs,
Aristotle’s parents did not heed the doctors’ advice and opted to bring home
Aristotle against medical advice.

There is strong family history of cancer in both sides of the family. Aristotle’s
paternal grandfather died of lung cancer, while his maternal grandmother
succumbed to cervical cancer. His mother had an older sister who died of acute
lymphocytic leukemia at the age of 7 years.

Aristotle’s grandmother did not believe in the explanation of the doctors, and
theorized that Aristotle’s present condition was because of “evil” spirits. She
strongly insisted on bringing Aristotle to a traditional faith healer or
“mambabarang” for second opinion.

However, Aristotle’s parents have not yet decided on what to do now with their
son. His parents are also hoping that their local politicians will help Aristotle with
his medical needs, especially with the chemotherapy cycles.

At present, Aristotle had to stop schooling due to his poor and weak physical
condition. Aristotle’s 17-year old brother also had to stop schooling and had to
find regular work as a fast food chain crew member to help the family earn more
to cover for Aristotle’s medicines. His 13-year old sister also started selling
native delicacies in her school.
1. From the given data above, draw the FAMILY GENOGRAM of Aristotle (use
the back of this page). What is their FAMILY STRUCTURE and at what
stage of the FAMILY LIFE CYCLE does the family belong to?

42 40
2

17 13 8

LEGEND: NOTE:

acute lymphocytic leukemia The symbols used in

referring to each medical
cervical cancer condition in the genogram
may vary.
pulmonary cancer

Aristotle’s family is unilaterally EXTENDED. In the Family Life Cycle, they

are currently in the FAMILY WITH ADOLESCENTS.

2. Using the FAMILY ILLNESS TRAJECTORY, explain how the illness (acute
lymphocytic leukemia) impacts on the patient and his family. At this stage of
the family illness trajectory, what biopsychosocial issues must be addressed?

Stage in the Family Illness Trajectory: MAJOR THERAPEUTIC EFFORTS

A. BIOLOGICAL ISSUES:

The pressing problem of Aristotle is ALL --- acute lymphocytic leukemia (the
terms “lymphocytic” and “lymphoblastic” are interchangeable). ALL is a
form of leukemia, or cancer of the white blood cells characterized by excess
 lymphoblasts. Malignant, immature white blood cells continuously multiply
and are overproduced in the bone marrow. ALL causes damage and death
by crowding out normal cells in the bone marrow, and by spreading
(infiltrating) to other organs.

ALL is most common in childhood with a peak incidence at 2-5 years

of age, and another peak in old age (> 50 years). ALL accounts for
approximately 70% of all childhood leukemia cases (age 0-19 years),
making it the most common type of childhood cancer. ALL is slightly more
common in males than females.

Cure is a realistic goal, assuming appropriate medical intervention is given

immediately. As much as ≥94% of children have continuous disease-free
survival for five years and appear cured, while 30-40% of adults have
continuous disease-free survival for five years.

B. PSYCHOLOGICAL ISSUES:

In time, coping mechanisms will develop not only in Aristotle, but in other
family members as well. Coping mechanisms are necessary when dealing
with chronic, life-long illnesses, such as cancer.

Screening for depression is also crucial, especially for the parents of

Aristotle.

C. SOCIAL ISSUES:

In times of medical crises, all family members must cope with the stress
associated with the disease, such as ALL. Family support, family dynamics
and functionality (as measured by the Family A.P.G.A.R. and/or
F.A.C.E.S.), as well as the ability of family members to assume particular
roles and responsibilities in the holistic management of a patient with ALL
(Family S.C.R.E.E.M.) will have to be assessed thoroughly.

It is very possible that other siblings may be neglected, when parents tend
to focus most of their attention on the “sick” child. Similarly, the family’s
financial resources may eventually be depleted just to meet the economics
of chemotherapy. Thus, family counseling may be necessary to
understand how other family members perceive the medical condition, ALL,
and how the illness impacts on their own lives (using the Family Illness
Trajectory).

3. From the given information, identify the different factors present in Aristotle’s
family that may prove to be advantageous (a resource) or disadvantageous
(a pathology) in managing his illness. Accomplish the FAMILY SCREEM
below.
PARAMETER Is this
RESOURCE or
PATHOLOGY?
Social It appears that the family is quite supportive RESOURCE
of the needs of Aristotle. The siblings are
willing to help the family earn more by
contributing to the monthly income of the
family. The parents see the need for
external help by tapping local politicians to
provide financial assistance to Aristotle.
Cultural Typical of Filipinos who have cultural / May be a
indigenous health beliefs, the grandmother RESOURCE (if
of Aristotle seem to have animist (e.g. belief indigenous health
in “evil” spirits) and magical beliefs (e.g. beliefs are
belief in “mambabarang”. practiced together
with Western
Medicine).
Otherwise, if ALL
is attributed solely
to “evil” spirits,
then this may be a
PATHOLOGY.
Religious Chronic anemia is common in ALL patients. PATHOLOGY
As Jehovah’s witnesses, the family will
never agree to blood transfusion due to
religious dogmas.
Economic The family of Aristotle belongs to the lower PATHOLOGY
socioeconomic status. Prognosis will
definitely be affected by the financial
capacity / capabilities of the family to pay
for the needed chemotherapy sessions.
Educational Education is apparently not a priority of the PATHOLOGY
Aristotle’s family as of the time being. Both
Aristotle and his older brother had to stop
schooling for different reasons. In the long
run, good education can lead to better job
placement due to better academic
qualifications.
Medical There is a very strong family history of PATHOLOGY
malignancy on both sides of the family of
Aristotle. Family medical history is a non-
modifiable risk factor. If finances will not be
an issue, screening of other family
members for different types of malignancy
is recommended.