Ms. Q was a 43-year-old Vietnamese woman

Ms. Q was a 43-year-old Vietnamese woman who came to the US in 1990 and was diagnosed with HIV and Hepatitis C at that time. She came to the United States with her husband, who was also HIV-positive; her daughter was not infected. Her husband was abusive and their marriage eventually ended. Since her diagnosis, however, Ms. Q has struggled with adherence to antiretroviral therapy. She has been in and out of homelessness since the end of her marriage, often working as a nail technician. At one point, she moved to another state and came back with a CD4 count under 100 and a viral load of 700,000. According to Mary Tornabene, Family Nurse Practitioner at Heartland Health Outreach in Chicago, Illinois, care providers were able to get Ms. Q’s CD4 count up to 400, but around that time, Ms. Q complained of constipation. She received medication for the constipation, but it did not help, and care providers learned that the full scope of her symptomology had not been clear due to the language barrier. (Ms. Q persistently refused interpretive services, leading to miscommunications.) Three large tumors were discovered in Ms. Q’s colon, and she was diagnosed with Stage 3 colon cancer. The first round of chemotherapy did not help, and the cancer progressed to Stage 4.Since her cancer diagnosis, Ms. Q has had increasing difficulty securing housing due to her difficulties paying rent and keeping resources, even with financial help from her church and her 25-year-old daughter who lives out of state. Though she qualifies for some rental assistance programs due to her HIV-positive status, she does not want to reveal her status to potential landlords; this is also complicated by the fact that she holds a green card but is not a citizen of the United States. As a result, Ms. Q lived in a shelter and couch-surfed while undergoing chemotherapy. At this stage, she has been placed in a hospice program in a nursing home and is being provided with palliative care. Please answer the filling questions : 1. How can care plans, particularly palliative care plans, be adequately explained to clients with language barriers? 2. What role does cultural background play in the choices a client may make about their health care? 3. What can be done if a client refuses housing assistance or chooses not to connect with resources that are disease-specific out of a preference not to disclose their health status? 4. Consider what reasons immigrants who are undocumented or green card holders might be hesitant to access health care or housing resources that are available to them

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