As a member of a dominantly ethnocentric American culture, it is easy to never ponder on the validity of non-scientific based or “factual” healthcare diagnoses and practices. However, American or western medicinal techniques are equally as inflected with cultural biases as systems more seemingly exotic or spiritually based. If this were not the case, hospital and medical care professional’s web sites would not contain links to policies on cultural, spiritual and religious sensitivity or information pages on American ethnocentrism in healthcare. A basic anthropological understanding of cross-cultural differences is evidently the frame for the provision of healthcare to patients who belong to non-dominant cultures. Religion and spiritual beliefs play a vastly important role in beliefs concerning truths and non-truths in healthcare across the world. In this paper I will be looking at several different case studies looking at Hmong, Brazilian, Japanese, American and Native American cultural beliefs in healthcare.
In North East Brazil in a village called Alto do Cruzeiro, babies die of a phenomena that is virtually unthinkable in wealthy western nations. The babies are dying of selective maternal neglect. However, this is not as straight forward as infanticide. It is far more complex and supported by cultural back-ups that have been created out of desperate necessity. Nancy Sheper-Hughes, an anthropology professor at the University of California at Berkeley did revealed heart-wrenching truths about infant mortality in the disease ridden and poverty-stricken region of N. E.
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Brazil. Her case study was focused on Alto do Cruzeiro where she looked at the overwhelming rate of infant mortality and investigated the consequent affect of these deaths on the culture. Due to the difficulty Sheper-Hughes had in finding out the number of infant deaths that occurred in the past year, many questions arose. When asking a producer of pauper coffins how many infant coffins he made the previous year, he frankly responded that he did not keep track because nobody cares. This kind of casual attitude, an attitude that exudes normalcy to the huge death tolls, is a cultural condition, an escape hatch created as a coping mechanism for something so terrible.
This information helps to explain the truths that the mothers of Alto stand by; a child “ill-fated for life [is] better off dead” (Sheper-Hughes).
How does such a truth come to exist? If the chances of a baby dying are greater than its surviving, maternal love cannot begin with the deliverance of the newborn. The birth of a newborn is hardly a time of rejoicing (Sheper-Hughes).
To western mothers, an initial reaction of indifference or the selective neglect that occurs may be completely incomprehensible, as to them, there is always something that can be done because of their belief that mothers have a “savagely protective maternal instinct” (Sheper-Hughes).
If a mother from Alto fought savagely and invested so much emotion into a diseased newborn she does not have the money to provide treatment for, she would soon psychologically breakdown. It is a humanly impossible thing to ask for, which is why the Alto culture provides the socially accepted indifference as an escape hatch, a survival mechanism.
Sheper-Hughes goes on to explain that oftentimes the babies remain untreated even if the parents are aware of available treatments for their infants who often have easily curable diseases such as dehydration (Sheper-Hughes).
This occurs because of the society’s belief in “child sicknesses” that if born with, are indications of a weak spirit, a spirit that lacks the desire to live, which is why it would be pointless, in the parents eyes, to aid a baby that does not want to live (Sheper-Hughes).
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The second area of focus involves a book written by Anne Fadiman titled The Spirit Catches You and You Fall Down. This true story focuses on a family of Hmong refugees from Laos and their trials in taking care of their daughter, Lia Lee, who American doctors diagnose with epilepsy. There is intense conflict between parents and doctors as the parents’ disagree with practices of western medicine. The parents call Lia’s illness “the spirit catches you and you fall down”, and believe her seizures are caused by her soul taking flight from her body (Fadiman).
These types of beliefs are categorized as “personalistic causes” (Porter, Samovar 244).
The western scientific belief for the reason of illness is categorized as “biomedical causes ” Both the doctors and the parents have Lia’s best interest in mind, but frustrate their efforts with their conflicting beliefs, resulting in tragedy for all parties involved. The parents frequently disregard feeding their daughter the correct medication in the proper doses, much to the doctor’s frustration. The doctors fail to understand the parent’s Hmong beliefs and cannot understand why the medications minor side effects should be cause to worry. Hmong spiritual beliefs and healing techniques differ completely from western medicinal techniques.
Animal sacrifices, rituals, special herbs and practices are techniques practiced for healing a person stricken with “the spirit catches you and you fall down” (Fadiman).
In this story, there is unfortunately a degree of stubbornness by both the doctors and the parents’, and is a clear indication of the dangers of obstinate lack of understanding in cross-cultural healthcare. The doctors exhibit an inability to think outside the scientific box when concerning disease and healthcare (Fadiman).
In western culture, though a person may be enthusiastically religious, when concerning treatment, contradicting beliefs in science and spirituality tend to be put aside in the best interest of curing the illness. According to Fadiman’s book, Hmong people are “legendarily fierce” and in this story, is part of the cause of their inability to compromise their spiritual beliefs (Fadiman).
Shamanism is a common practice with Indians throughout the United States and Mexico.
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Their practices for curing diseases are focused on tapping into the spirit world through trance to consult spirits about the matters at hand. Mundurucu Indians of North America smoke excessive amounts of tobacco when diagnosing and curing illnesses (Murphy 204).
Tobacco, though not considered a very powerful drug by most standards, in fact is, when smoked or eaten in large quantities (204).
Mundurucu Indians consume large amounts of tobacco to aid them to go into a trance-state.
Once in a trance-state, the Shaman will search for signs of a malignant object, sent through the ill will of a sorcerer or an evil shaman (205).
In their beliefs, illness is caused by the activity of other people. Though they believe in the malignant object travelling through the air and entering the body, much like western medicine believes germs do, Mundurucu beliefs allow for a satisfying placement of blame (205).
Mundurucu healing techniques differ greatly from western medicine as well. Though it is believed that medicines must be administered, the rest of the techniques lie strictly in their spiritual beliefs.
For example, it is believed that a good shaman must remove the cause of the injury. A shaman will smoke deeply to gain a magical “vision” to see the malignant object’s location (Murphy 205).
He will then blow the smoke over the patient’s body to loosen its hold. Next, he will manipulate the ailing part to bring the malignant object towards the surface of the body, where he will then apply his mouth, and suck out the source of illness (205).
Though nothing more than a ritual to western eyes, in Mundurucu, their healthcare beliefs do more than treat illnesses, it is a cultural support, much like the selective neglect in Alto, Brazil is. When a Shaman reveals who is to blame for an outbreak of disease or the death of a person, it is a way to eradicate malicious or troublesome people in their settlements (Murphy 165).
When an overbearing and distressing chief gets out of hand, oftentimes a Shaman will blame him for ill will, thus eliminating their society’s problem (204).
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However, just because Mundurucu techniques appear to be nothing more than superstitious beliefs according to western standards or a cultural support according to many anthropologists, this does not mean it is purely “hocus pocus” and has no validity. Though defiant of some people’s logic, Shamanistic cures often work, just as people can become ill due to supernatural afflictions (Murphy 205).
On top of this, western medicine can sometimes be insufficient in curing or aiding someone who is ill because of supernatural or Shamanistic reasons. In the 1970’s, there was a case of an aborigine fell ill upon learning that he had been bewitched (205).
This man’s vital functions rapidly declined, inexplicably through the eyes of western medicine (205).
The patient soon died, as it was an ailment that was impossible to cure through any type of pharmaceutical prescription. This was a case of psychosomatic illness that could perhaps, only be cured with a counter psychosomatic cure. A psychosomatic cure such as a Shamanistic ritual, immunizing the patient and dispelling the evil spell. Highly technological cultures such as the United States, other western nations and countries such as Japan share highly similar healthcare practices.
Despite the similarity in techniques, the cultural differences make for very diverse experiences. The United States emphasize self-service and independence (Galanti).
For example, when a patient is recovering from surgery, the nurses try to provide less and less service. Waiting for the patient to make himself use his limited amounts of strength to teach himself to feed himself, go to the bathroom and more (Galanti).
However, in Japanese culture, the nurses would not be so “demanding” and would allow the wife or another family member to meet the needs of the male patient (Galanti).
This is owing to their male-dominated society that also emphasizes family interdependence to a higher degree than American culture (Galanti).
In the United States, asking questions to the doctor is greatly encouraged and is a means to comfort the patient and patient’s family as well as to make sure the diagnosis and treatment will be correct. In Japan, questioning the doctor is a severe sign of disrespect that is frowned upon as rude behavior. It has been written that Japanese doctors intimidating nature make most patients afraid of asking questions, and it leaves some doctors room to seemingly arrogantly not even bother to explain either the diagnosis or the treatment fully (Hall).
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In a survey conducted by the Ministry of Health and Welfare in 2000 showed some highly informative results concerning patient satisfaction in Japan. The statistics showed that the around 30% of the patients have to wait for an hour or more, and once given the opportunity to consult with the doctor, 66% of the patients are given 9 minutes or less of the doctor’s time (Hall).
Doctors are also not required by law to show the patient the contents of their medical chart (Hall).
Therefore if a misdiagnosis occurs, which seems relatively likely if patients are not allowed to question and are given such a small amount of time with the doctor, the mistake need never be explained to the patient. Personal experience in Japanese hospitals has been very frustrating as well. As someone holding on to American cultural baggage, talking to a male doctor who was so obviously offended and angered that a young girl questioned his diagnosis, was quite unnerving. I was misdiagnosed and given medicine that contradicted with a different illness I had before catching the second one I went to the hospital for.
All in all it was disturbing and frustrating for someone who is used to being listened to, reassured and receiving friendly gestures and attitudes. This paper sheds light only slightly on how diverse people’s understanding of healthcare and illness is around the world. It is an important field of study as some of the situations presented before show the dire consequences of not being able to successfully cross-culturally communicate. It is an aspect of healthcare that is taken for granted by many patients, or perhaps more commonly, it is a subject that many patients are unaware of. It is very difficult to be knowledgeable of such information, there are so many different medical systems and beliefs to keep track of.
This is the reason for fields such as medical anthropology and the reason why most hospitals in the United States seem to have links to pages explaining cultural differences by medical anthropologists. In a world continuously becoming globally and cross-culturally tied together, understanding is of the utmost importance. If medically advanced cultures such as the United States are to be able to share their knowledge and help people across national borders, then cross-cultural differences in healthcare will need to be understood. Bibliography Fadiman, Ann. The Spirit Catches You and You Fall Down. Farrar, Straus and Giroux.
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New York: 1997. Galanti, Geri-Ann. “The Challenge of Serving and Working with Diverse Populations in American Hospitals.” web > Hall, William. “Patient Patients.” @ Japan Inc, February 2001. web > Kreisler, Harry. “Habits of a Militant Anthropologist.” December 14, 1999.
web > Murphy, Robert F. Cultural and Social Anthropology, An Overture. Prentice- Hall, inc. New Jersey: 1989.
Sheper-Hughes, Nancy. “Mother Love.” New Internationalist, issue 254. April 1994. web.
