Rivka Cohen Case

This case focuses on a Hasidic patient with cystic fibrosis and her family. As you read through this story, pay special attention to the various cultural and religious factors that influence this child’s medical management.

The city that surrounds Rivka Cohen sprawls and towers around her, but the Hasidic Jewish community that she moves in is so tightly knit that it feels like a village. Much of her life revolves around the neighborhood synagogue, her extended family, and their Hasidic Jewish community.

Rivka is six years old. She lives with her parents and four siblings in a house packed closely against her grandparent’s house next door. The Cohen house is awash in the smells of Mrs. Cohen’s cooking, the sounds of Yiddish prayer and conversation, and the laughter of children. The Cohens speak English fluently, but only when they must.

Rivka’s mother stays home full time to care for Rivka and her four siblings, ages 3, 7, 9, and 10. Rivka’s father, Mr. Cohen, works for a family business, and when not working he is usually at the synagogue—praying, socializing, and consulting with the rabbi. The family receives Medicaid insurance.

Rivka was diagnosed with cystic fibrosis (CF) when she was twelve months old. At the time, the CF team recommended that her siblings have sweat tests, but her parents declined. The Cohens felt that their children’s health was in God’s hands. Rivka’s condition was stable then, and she and her mother attended regularly scheduled appointments with the CF team. Rivka’s father, while concerned, did not usually come to Rivka’s appointments.

When Rivka was 18 months old, she came to the clinic with an increased cough and weight loss. The team recommended that she be hospitalized. Rivka’s parents initially declined but agreed a week later after her cough had worsened.

At age 4, Rivka again went into the hospital for pneumonia. Mr. and Mrs. Cohen agreed to the admission. Once Rivka appeared to be responding to the IV antibiotics, her parents pressured the team to complete her course of antibiotics at home. Once home, the family continued to give her the antibiotics, but refused visiting nurse services because they did not want the neighbors to know about Rivka’s illness.

When Mrs. Cohen became pregnant with her fifth child, the team strongly suggested that she go for genetic counseling. After discussing the issue with their rabbi, Mr. and Mrs. Cohen decided not to have genetic testing. Again, they felt that, “whatever will be, will be.”

Today, Rivka has come to the clinic for a routine follow-up appointment. This is her first visit since beginning school. Her respiratory status is good, but she’s having more frequent stools. After being questioned, Mr. and Mrs. Cohen admit that they don’t want the school to give Rivka the required enzymes. They haven’t told anyone at school that Rivka has cystic fibrosis. Today Rivka is being seen by the entire CF team, including the doctor, nurse practitioner, social worker, and nutritionist.

There are several issues to consider about this case. You will explore these issues more fully in the learning activities.

What are the various ways in which religious beliefs can affect the understanding of illness?
What are some of the main tenets of Hasidic Judaism?
In what ways might Hasidic beliefs impact the care of a CF patient?

Now that you have read the case, go to the lecture section to gain a better conceptual understanding of the relationship between religious beliefs and healthcare.