Culture shapes attitudes and beliefs about disease, health, and how health care is perceived. As health professionals, we must not only be aware of our patients’ diversity but also our own cultural influence when handling health issues.
by Barbara Lutz, AAS, RDH, BS
Medical and dental practices in America are highly influenced by Western culture. Patients’ health-care planning, health perceptions, expectations of care, treatment choices, and other areas of care are influenced by class, culture, and religion. Health providers need to be sensitive to the ethnicity and culture of their patients in clinical care. Cultures shape attitudes and beliefs about disease, health, and how health care is perceived. In Western culture, the physician has become the gatekeeper for a person’s medical condition. This makes the physician a driving force or possible wedge between science and one’s beliefs. The medical and dental communities must become more educated on diversity and its impact on one’s overall well-being.
Chinese Culture
Traditional Chinese people honor the spoken word, and consequently tend not to write down directives prescribed by physicians. Many Chinese believe that speaking about death can bring bad omens, and so they may reject such conversations. The Chinese culture forbids declining treatment or assisting in suicide. Children are rewarded in the present or the next life for taking all life-saving measures to extend their parents’ lives. Families may request all measures to preserve the cultural ideal of longevity, although they may refuse some invasive procedures. Confucius thought that the physical body was not one’s property and must be whole on death. Chinese culture places an emphasis on achieving harmony that leads to good health, good weather, and good fortune, while disharmony leads to disaster, disease, and bad luck. Chinese medicine aims to restore harmony.
Native American Culture
Native American medicine is based on the understanding that man is a part of nature and health - a matter of balance. Traditional Native Americans believe that some illnesses are caused by evil spirits, witches, or by the power of mistreated animals. They also believe that the natural world thrives when its complex system of interrelationships is honored, nurtured, and kept in harmony. Native American medicine addresses imbalances on every level of life. Disease is not defined by a germ or pathology, but is viewed from an expanded form that includes body, mind, spirit, emotions, social group, and lifestyle. Ceremonial and ritual medicine is the largest surviving component of Native American medicine. Their medicine historically included interventions in body work, bone setting, midwifery, naturopathy, hydrotherapy, botanical, and nutritional medicine - methods that have been lost through the years.
African American Culture
History has not been kind to the African American culture. A history of slavery, racial discrimination, the Tuskegee experiment, sickle cell screening, and minority-focused sterilization initiatives has produced a mistrust of the medical profession. As a minority, these people have a poorer quality of health and receive fewer health care and treatment options. African Americans are more likely to see hospitals and doctors as profit-makers than caregivers. African Americans are six times more likely to distrust doctors, so they are slower to seek use of the health-care system. An adult will generally stay with a hospitalized child at all times. African Americans may also use herbal remedies from their African culture. Health-care workers must be aware of such usage when prescribing medications.
Islamic Culture
The Islamic people have their own special needs as patients. Their deep religious commitments require prayer five times daily - before sunrise, at noon, during the afternoon, at sunset, and in the evening. A sick person is allowed to combine noon and afternoon and sunset and evening prayer times. Privacy is very important during prayer, especially for Islamic women. Bedridden patients are allowed tayammum only. Those who are gravely ill take comfort in their remembrance of God by reading the Qu’ran. During prayers, unclean hands must not touch the rug or Qu’ran. Some Muslims wear amulets (black strings, or gold or silver chains on which sections of the Qu’ran are attached), which should not be removed and must remain dry. Muslim women are very modest, wearing clothes that cover the entire body and generally preferring female doctors.
Hispanic Culture
The Hispanic population has a deeply religious culture generally based on Catholicism. The Hispanic people pray to many saints and keep statues in their homes and wear medals on their bodies. They are a people who believe that health is a gift from God and should be appreciated as such. The elder male member of the family is the head of the house, and family members will consult him with personal issues. Hispanics show genuine concern for ill family members and may indulge the sick person. A curanderismo is a holistic healer associated with homeopathic, scientific, and spiritual medicine. This healer follows Christian practices of prayer, candles, touch, and penance to help restore one’s health. Health issues are private matters and should only be handled within the family unit.
Conclusion
Geri-Ann Galanti, who has developed numerous programs for working with cultural diversity in health-care settings, makes important points regarding disease etiology. The treatment, for example, must be appropriate to the cause: if the germs cause disease, kill the germs to restore balance; if the soul is gone, retrieve it; if a spirit has taken over the body, exorcise it; if a rule has been broken, do penance; and if an object has entered the body, remove it. All cultures believe in this philosophy in one form or another. How medical personnel approach these points is the main ingredient in the success or failure of patient compliance.
Health professionals are inadequately trained to handle the growing number of nationalities within the United States. The diversity of the direct descendents of the Mayflower points to our country’s future. The relatives of the pilgrims now have ethnic backgrounds as diverse as Chinese, Russian, Jewish, Zionist, African, and/or Choctaw Indians. As health professionals, we must be aware of not only our patients’ diversity but also our own cultural influence when handling health issues. We must learn to make informed decisions for better patient care.About the Author
Barbara Lutz, RDH, AAS, BS, is an administrator for Dental Arts of South Jersey and Dr. Jack Piermatti in Voorhees, N.J. She is also an adjunct faculty member of Camden County College in Blackwood, N.J.
References
- Avery C. Native American medicine: traditional healing. JAMA 1991; 265(17):2271-2273.
- Beinfield H, Korngold E. Chinese medicine: how it works. Healthworld online. http://www.healthy.net.
- Berger JT. Cultural and ethnicity in clinical care. Arch Intern Med Commentary Oct. 26, 1998; 158:2085-2090. http://www.ama~assn.org/ethic/vm/journal/icm80166htm.
- Fernandez V, Fernandez K. The Hispanic American community. 1997-2005. Retrieved from http://culturediversity.org./April 2007.
- Galanti G. Cultural diversity in health care. http://www.ggalanti.com/cultural_profile/african_american.html.
- Galanti GA. Caring for patients from different cultures. University of Pennsylvania Press, Philadelphia, 1991.
- Medline Plus. News by health topic. More blacks than whites don’t trust docs. Reuters Health. Nov. 25, 2002. Source: Archives of Internal Medicine. 2002:162:2458-2463. http://nlm.nih.gov/medlineplus/news/.
- Mehl-Madrona LE. Native American medicine and the treatment of chronic illness: developing an integrated program and evaluating its effectiveness. Alternative Therapy 1999; 5(1):36-44.
- Roberts C, Steve. Pilgrims in progress. USA Weekend. Nov. 22-24, 2002; 8-10. Gannet Company Inc.
- Rutz D. Native Americans combine old and new medicine. Sept. 13,1999. http://www.cnn.com/health.
- Sachedina D. Issues in Islamic medical ethics. http://www.people.virginia.edu/~aas/ismedeth.html.
- Spector RE. Cultural diversity in health and illness. Fifth edition. Prentis-Hall, Inc., 2000.
- Underwood A. Learning from China. Newsweek. Dec. 2, 2002; 54-58.
Glossary of Terms
Sickle Cell Anemia - sickling of red blood cells genetically inherited by Africans to fight malaria. These cells do not flow properly through the blood vessels.
Tayammum - symbolic ablution.
Tuskegee Experiment - In Alabama, from 1932 to 1972, 623 African American men were used for the research; 399 had syphilis. Researchers allowed men to suffer despite the availability of effective treatment. Many went blind or insane.
Curanderismo - defined as a medical system.
