Heath Care Cultural Influences on

Context

If you are not in tune with the universe, there is sickness in the heart and mind.

Navaho saying

We will focus on:• Beliefs about health care and treatment and

prevention of illness

We will also look at• Cross-cultural medical competence

• Language complications

Theories of health and disease causation

• Generally theories of health and disease/illness causation are based on prevailing worldview held by a group.

• These worldviews include a groups health-related attitudes, beliefs and practices.

• Are frequently referred to as health belief systems.

Theories of health and disease causation

• Generally theories of health and disease/illness causation are based on prevailing worldview held by a group.

• These worldviews include a groups health-related attitudes, beliefs and practices.

• Are frequently referred to as health belief systems.

Health Care Belief Systems

• Supernatural/magico/religious

• Holistic

• Scientitic/biomedical

Supernatural/Magico/Religious Tradition

• Comes from a belief system in which the world is perceived as an arena where supernatural forces predominate.

• Hold strong beliefs in sorcery, magic, and evil spirits.

Hmong of SE Asia

• Often attribute disease to spiritual forces such as malevolent spirits or ghosts.

• Believe an individual’s spirit is the guardian of the person’s well being

• If the spirit is happy, then the person is happy and well.

Phillipinos

• Some Phillipinos may believe that disease may be caused by a sorcerer who causes a poison to be introduced into the body.

Latinos and Phillipinos

• Among some Latinos and Phillipino’s health and disease is deemed to be consequences of God’s approval. Good health is by the grace of God.

The Evil Eye – Jealousy and Envy

• One of the oldest superstitions is the evil eye, the belief that someone can project harm by gazing or staring at another.

• The Nazar is thought to ward off the evil eye.

Treatments -- Shamanism

• Treatments are carried out by healer-practitioners known as shamans.

• In some cultures, known as medicine men, Kahunas, santeros, or spirit healers.

Shamanism

• Shamanism is neither a religion or a science but an activity that takes place in a world that is ordinary, yet spiritual – sacred.

• A healing or helping technology.

Shamanism

• Powers of a shaman may include hands-on power to heal by removing harmful spirit stuff from the body and restoring energy.

• Also, a visionary power to see into the body of a sick person and power to retrieve the lost soul or spirit of the sick.

Treatments: Korea

• “Hanyak,” which has its roots in ancient Chinese medicine.

• Diagnoses impalances in the body that are believed to cause illness and then prescribing herbal remedies.

• Balance of opposites – yin/yang.

Treatments: Korea

• Light complements dark; males complements female.

• Various organs are associated with the five elements of the world, fire water, wood, metal, and earth.

Treatments: Cuba, Haiti, Puerto Rico, Brazil

• “Santorini.” Santero is contracted who consultas a orisha deity to assist in the cure.

• AKA voodoo.

Holistic Tradition – Underlying Premises

• Holistic health is based on the principle that a whole is made up of interdependent, interacting parts.

• Holistic health is about more than just not being sick. It is an approach to life that focuses on connections of mind, body and spirit.

Holistic Tradition – Causes

• For people to be healthy, they must remain in harmony with nature’s laws and willingly adapt to changes in the environment.

• Do not believe they have the right to control nature. Many Asians possess a perspective where people must adjust to the physical world rather than controlling.

First Nations Peoples

• Although many First Nations tribes have different worldviews most consider the earth to be a living organism – the body of a higher individual with a desire to be well.

First Nations Peoples

• Believe that is the earth is harmed, humankind itself is harmed.

• Conversely, when humans harm themselves, they harm the earth.

• Cause and effect relationship with the earth creates an eternal chain.

Scientific/Biomedical Tradition -- Premises

• Evidence-based approach the relies on laboratory test.

• This system usually disavows the metaphysical and holistic.

Scientific/Biomedical Tradition

• Is geared to conquer disease by battling microorganisms and diseased cells.

• This Western biomedical ethnocentrism can often be a serious barrier to effecgtive health care communication and result in derisive response to alternative supernatural or holistic approaches.

Scientific/Biomedical Treatment

• Attempt to return the body to a normal state through surgery, medications, chemotherapy, radiation, antibiotics.

Intercultural Competence

• Cultural awareness

• Cultural knowledge

• Cultural understanding

• Cultural sensitivity

• Cultural skill

Intercultural Competence -- attributes

• Culturally diverse staff

• Interpreters who speak patients’ languages

• Training for providers about culture/language

• Multilingual signage and instructions

• Culturally specific health care settings.

Communication strategies, include

• Allow patients to be open and honest

• Do not discount effects of belief in supernatural

• Employ empathy

• Be restrained in relating bad news

• Follow patient’s lead in communication style