Understanding Cultural Factors

 Holistic treatment becomes holistic in reality only when doctors understand the significance of cultural factors, study them and appropriately utilize them in diagnosis and treatment of patients.

Man has always lived with his fellow human beings as a part of a small or big society. He has identified himself as a part of the society, consciously or unconsciously, accepted the habits and belief systems of the society and conditioned himself accordingly. This dependence of man on society is aptly described by Aristotle when he said, "The man who can live without society is either a beast or god." Brownlee (1978) from her experience advised all health care personnel to study all aspects of ones own culture and that of the community where one serves if one indeed desired to meet the requirements of the community.

This is important (White 1982) because one's thinking processes, emotions, experiences and behavior are colored by the cultural norms.

What Benedict R. wrote in 1934 about the need of understanding culture of patients is even more meaningful today. "The life history of the individual is first and foremost an accommodation to the patterns and standards traditionally handed down in his community. From the moment of his birth the customs into which he is born shape his experience and behavior. By the time he can talk he is the little creature of his culture and by the time he grows up and is able to take part in his activities, it's habits are his habits, it's beliefs are his beliefs, it's impossibilities are his impossibilities. Every child that is born into his group will share them with him and no child that is born into one on the opposite side of the globe can ever achieve the thousandth part. There is no social problem. It is more incumbent upon us to understand that this is the role of custom. Until we are intelligent as to it's laws and varieties, the main complicating facts of human life must remain unintelligible.

How the understanding of cultural practice can influence the health status of person can be illustrated from the study conducted at the city of Detroit. It was noticed that when the various steps for preventing infant mortality were in full swing a specific section of the society was not showing positive signs. The study revealed that these particular Mid. European nationals did not breast feed the infants for sufficient period. The adult food was started very soon. In this section of society infant death due to digestive disturbances and intestinal infections were alarming. Hence, do put efforts to study cultural peculiarities of your patient and accordingly give specific suggestions with proper explanation

and motivation.

It is all the more difficult to change the cultural habits and conditions. Patients tend to resist any change even if it is going to improve their health status. First of all, they may tend to rationalize their habits, Secondly, they become suspicious when you bring an outsider and suggest any new idea. In a rural area of western Saudi Arabia health workers wanted to motivate local people to get some blood tests done for correct diagnosis. People became suspicious. They thought that these health workers wanted to sell the blood. They even doubted that the health workers were using the powder of their blood in tea. Thirdly, they also feel that the change would lead to more problems and difficulties. Fourthly, even after proper conviction it may be difficult for them to adopt the better and healthy environment. In Bombay some builder constructed multi -storied buildings on the land where huts existed He He gave the owners of the huts proportionate space in the building. But they could not adjust to this better housing conditions and hence after sometime some of them sold the houses and once again started living in slum areas, I had similar experiences while dealing with patients who have suffered heart attacks and were found to have high cholesterol and serum triglyceride. When they were advised to stop or reduce non-vegetarian food which definitely increases this risk factor, although they were convinced, initially they found it difficult to change their habit and adjust to the vegetarian diet.

I have pointed out these four difficulties in changing the cultural habits so that doctors put more effort and try various strategies for their patients. Such an approach can certainly bring a long term change. Your job can become very easy if you can convince them to change their habits without changing the belief system. It is more difficult to change the belief system. Our objectives to change their behavior. There is a need to clarify all doubts, suspicions, fears, anxieties, etc. which would result in health promoting habit. To the patients who agree to accept a vegetarian diet I always emphatically explain that vegetarian food contains all necessary ingredients in the required quantity. I give them some examples of people who are vegetarian since birth, yet maintain very good physical health. It is also clarified that initially they may have some problem about the palatability of vegetarian food but after sometime would definitely also develop a taste for vegetarian dishes .All points need clarification otherwise people may adopt one healthy habit but land up with another more unhealthy habit. Brushing of teeth was initiated to a tribal community. As a result of this behavioral change people started brushing teeth in the canal from which they also used to obtained drinking water; thus contaminating it with bacteria which proved more hazardous to health.

Credit: Brahma Kumaris

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