Topic 8 - Applications:
Cultural Communication & Health
Various Cultural Perspectives on Health have emerged around the globe over the past millennia each with their own conception of health, disease and cure. The relationship between mind and body differs for each worldview and so does the the approach to preventative health promotion vs. restorative disease cures.
Gurung (2006) identifies a number of "cultural worldviews" on health that are indigenous to various places in the world. These included TCM, Ayurveda, Curanderismo, Aboriginal, and biomedical approaches.
Historically these approach stem from studies that are 100s to 1000s of years . <table 2.1>
Issues at play
in Cultural Systems of Health
Cultural worldviews play an important role in understanding of disease and our communication about healthcare. While each culture will have an array of beliefs about health and disease, they fall within a larger worldview that includes notions of reality, spirituality, and the supernatual.
Dualism and holism
Samovar & Porter (2004) identify several types of
worldview: including dualism, holism, mechanistic and spiritual.
Dualism is the view that the mind and the body are distinct and separate components to the human being. As such what happens to the body may not be directly related to the mind.
Holism views the mind and body as connected, perhaps separate but interdependent. This may also be a form of monism, where the mind and the body are seen as one entity, identical and inseparable. In treating the mind or the body one must treat the other.
Mechanistic and non-mechanistic world views
Western medicine and natural science is based upon a mechanistic view that assumes there is a physical cause behind disease. The text suggest that this involves reason, objectivity, and science vs. eastern views that involve: intuition, subjectivity and religion.
"Western" medicine is seen as having faith in technology and science to cure disease
"Eastern" perspectives are often characterized as being more intuitive and spiritual, magical.
This has been seen as as an ethnocentric perspective taken from "western" countries that denigrate other systems of health and wellness.
Wade Davis and his explorations in indigenous spiritual and healing methods. Scholar in ethno-botany, anthropology of language and geo-cultural practices, and ethno pharmacology he has had a career as Resident explorer at the National Geographic Society He is best known for his early work with Voodoo in Haiti - revealing the Zombie Potion.
In 2009 He delivered the Massey Lectures on Wayfinders: Wht ancient wisdom matters in a modern world. He has also published on Light at the Edge of the World: A Journey through the Realm of Vanishing Cultures . and has done two ted talks on endangered cultures and worldwide web of belief and ritual.
II. Health Belief Systems and Causes of illness
..... as indicated above numerous worldviews exist, each including at least one implicit system of health beliefs
Biomedical - is the dominant model in NA that suggests disease is due to
agent that damages the physical body.
Diagnosis is done through
'objective' methods and places
emphasis on the removal or prevention
of disease. This is the basis of the germ theory that dominates "western" medicine.
Biomedical causes - bacteria, viruses, genetic disease, chemical exposure, etc.
Personalistic - disease is seen as the product of a supernatural agent
(deity), spirit (ghost)
or human (witch) that causes the disease. Treatment may involve the casting of spells or
removal of curses (Haiti-AIDS).
Personalistic causes - Hmong -spirit of nature causing illness, cao gio cold drafts causing colds,
punishment for one's sins? Karma?
Naturalistic - disease is explained in terms of natural factors such as
winds, or other elements that have upset the balance of the body. (i.e., 'hot' foods or medicines).
Naturalistic causes - Asian views that stress harmony of forces - Taoist, Chinese medicine
& Health Care
& Health Care
a number of important roles in communication in health care.
Part of its effects are due to the nature of culture and relationships, others have to do with specific aspects of communication, i.e., verbal & non-verbal. Samovar & Porter (2004) outline a number of areas where inter-cultural communication play a role in Health Care.
a number of important roles in communication in health care.
Family roles play an important role in the manner in which health care is sought and received
1. Male dominance - may lead to the situation where only the male (head of the household) is to be spoken to. Alternatively the mother may not answer questions to a male doctor or in the presence of her husband. It might be best to ask both the wife and the husband in order not to offend either of them.
2. Modesty and female purity - For many cultures women should be treated by female doctors and nurses and males by male doctors and nurses. Illness may affect the honour or purity of women and their prospects for marriage. Thus secrecy about illness is often found in some cultures where disclosure to medical staff and to friends and community members is found.
3. Pregnancy and childbirth - surrounded by cultural values and practices. Expectations for women to bear children are present and when that should occur. Contraception is often seen taboo in cultures. Who is present at the birth varies from culture to culture as does the expression of pain, sometime eliciting gifts (Iran).
Self-disclosure - Cultural norms vary about the type and amount of information to be disclosed. Clearly in a health setting this can be serious and form a significant barrier to suitable healthcare. Example in the text indicate that in translation it might appear that adequate consent is being achieved, but the barriers for sons and mothers or fathers and daughters to talk about certain issues my not offer accurate information.
Language barriers - Challenges of translation occur where literal translation may not be possible. Where medical treatments require accurate information the consequences of false info can be detrimental and serious. The patient may hard time telling what is ailing them due to a dearth of language. Accents may also cause some trouble where clear communication is difficult.
1. Eye contact - as in other areas of communication different standards in eye contact may lead to interpretations of disrespect or hostility for one of the individuals. This may damage the relationship between health care provider and patient.
2. Facial expressions - may lead to miss communication such as smiling that might indicate politeness or happiness. The medical professional might misinterpret it thinking all is well (e.g., counselling).
3. Touch - also have varied standards for how and where medical professionals can touch patients. This may lead to serious situations for certain issues, especially when gender is involved. Elsewhere touch can be seen as a method for cure, or causing disease-laying on of hands or touching the head.
4. Time - is important for when one is to show up for an appointment, how long to wait and the impact on mood of mental state as a result of conflicts in time expectations.
a. Informal time (tardiness and pace) - expectations for when to arrive and what it means to be late: NA 5 minutes vs. Indian 1 hour or 2 hours for Italian and maybe not at all for Javanese.
Pace is how fast things happen and how fast to expect service or action.
b. Past, present and future orientations
- Past-oriented cultures have a strong sense of tradition and custom.
-Present oriented cultures tend to enjoying and living in the moment
-Future oriented cultures tend to emphasize planning ahead- low tolerance for postponements but more interest in change.
c. Monochronic (M-time) and polychronic (p-time) classifications
M-time is characteristic of "western" cultures that view time as a fixed linear process to be scheduled and rationed.
P-time is characteristic of "collectivist" cultures that have amore holistic view of time where they can interact with many people at once and carryon various activities with interruptions. Characterizations of M & P time by Hall & Hall
5. Silence (cross-cultural and co-cultural differences)
This can be difficult to managed in an intercultural setting where expectations of having to fill the silence may be at odds with expectations of having the silence.
Formality of language use and addressing others as well as greeting
Notions of politeness, Chinese three refusals, agree to follow prescribed action but not understand what it is or even wish to follow it.
III. Survey of Healthcare Approaches
In thinking of other cultural settings for healthcare, each with it's own 'culture.' In Canada there are multiple systems of healthcare, one can survey a number of those traditions that are a currently found here.
Traditional Chinese Medicine has been around for 5000 years and is built upon a naturalistic perspective.
Ayurvedic Medicine has a long history in India and has influenced the development of naturopathogy and homeopathy as natural forms of medicine. AC-UK What is Ayuerveda
Naturopathy - Very similar to traditional western medicine, generally setting is a little less formal than mainstream medicine, but makes us of natural treatments for disease and illness. It was first identified by name in around 1895, but it's practices have been around for many centuries. See BCNA CAND for some information.
Homeopathy - Again similar in style to mainstream medicine, but also resting on a worldview that is largely rejected in traditional western medicine. BHA CSoH
Europe and the Americas have a historical tradition of herbalists and witches who have
explored the healing powers of plants and minerals, potions and powders.
Native American traditions - Tend to be closer to the place of living. Elders advise on herbal and ritualistic treatments for health problems. Nancy Turner UVic ethnobotanist.
E.g, the use of:
trillium root (which grows throughout the coast) in childbirth to stop bleeding.
Wild Choke Cherry Bark to help with respiratory issues: asthma, allergies, and colds.
Santeria , Voodoo and other spiritualistic perspectives ....
Mayan Medicine as a spiritualistic and naturalistic perspective