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Cultural Issues in Medicine

By Rod Moser, PA, PhDJanuary 15, 2009
From the WebMD Archives

America is truly a melting pot of cultures, and this is even more apparent in a medical setting. Not only can language be an issue, but cultural beliefs are equally as important – even if they tend to clash with Western philosophy.

If I throw one of my pharmaceutical ink pens out of my office door, I take the chance of hitting a medical assistant from Ethiopia, Mexico, China, Vietnam, or Russia. Of course, I wouldn’t do that (unless they ignored me). It is nice to have some in-house interpreters from time to time, but I often encounter language barriers beyond the rich resources of our immediate office.  Last week, I noticed that our group is installing a special speaker phone for interpreter services that will cover dozens and dozens of other languages. Being about to communicate effectively in the language of a patient is only half the battle. A medical provider needs to understand culture.

Cultures can be very complex. There are ethnic issues, religious issues, and even family belief systems that come into play when dealing with a medical issue – even one as simple as a sore throat or headache; or one as complex as the birth of a baby.

The daughter-in-law of our very good friends is due to have her second baby – the first one born in the U.S. She is from a rural island community in the Philippines where birthing is done in the homes, usually by an experienced, but informally-trained midwife. One of most important rituals of the delivery is the disposition of the placenta. In her culture, the placenta must be buried near the house so the spirit will always be able to find its way home. Her four-year old, a delightful little boy named Conner, has his placenta buried at the family home in Palawan.  She has been very worried about what will happen when her new baby is born here – in a hospital.

She was told that the placenta will be kept by the hospital and subsequently destroyed after the delivery. When we informed her that she has a right to take her placenta, to be buried near her home in the U.S., she was delighted. She was also frightened since this is not the common practice here. Fortunately, her father-in-law is a university professor of cultural anthropology, and her mother-in-law is both assertive and opinionated. I have no doubt she will be bringing the placenta home; for a proper burial. Someday, the spirit of baby #2 will not have to wander aimlessly looking for home.

Not all cultures believe in germs as the cause of illness. They strongly believe that illnesses are caused by spirits (bad spirits, of course). Bad spirits are always hanging around, especially in hospitals and doctor’s offices. I think I have seen or felt those bad spirits myself, especially on Mondays.  Hmong patients are unbelievably stoic and quiet during medical encounters. Why? They do not want to draw the unwanted attention from these bad spirits. If the child cries from an injection, they are quickly quieted, lest the spirits spot them.  When dealing with Hmong patients, I talk very quietly and try not to ask very many questions. If there are spirits in that room, I don’t want them gettin’ me either.

California has a huge Mexican population, perhaps since California was once Mexico until we took it. With our state budget crisis, it would be good to give it back now. Mexico doesn’t want it now.  Mexican patients tend to have strong cultural and religious beliefs associated with illness and medical care. In many area of Mexico, there are not doctors, just Curanderos – spiritual healers. Curanderos are often a part of modern medicine, too. Why not have a shot of penicillin AND a bit of spiritual healing, too? It certainly can’t hurt.

Several years ago, I was with one of my medical students near Lake Tahoe.  She was seeing a Mexican woman who was in a catatonic state; staring blankly and not speaking. The hospital felt she was in a coma of sorts and ordered a CT scan (normal). We were doing the follow up in the office. She was surrounded by dozens of concerned and worried family members, some of which flew in that day and others who drove all night to be with their critically-ill mother.

“When did this all start?” asked the concerned medical student. The answer was one that I didn’t expect.

“It started when she heard the news that her son was getting married in Mexico and she would not be able to attend the wedding.” Prior to that, she was perfectly fine. Interesting.

As the student asked more medical questions, I just watched her eyes. They would quickly, but purposely, glance at the student – not an action you would expect from a person in a coma. They were the eyes of a person following the conversation. I caught her looking at me, too. She was faking it! So, after a few minutes, I decided to try something a bit unorthodox.

I asked all of the family members to hold hands and close their eyes. I put my hand on her forehead and told her that God wants her to wake up now. I asked everyone to pray that she will come out of her coma.  Within a few seconds, Mrs. Garcia (not her real name) started to react.

“Where am I?” she said. It was just like the movies. It was a fine performance; one that would have earned her an Academy Award. Family members screamed and cried as she sat up. After a few minutes, the startled student watched her coma patient, get down from the gurney, and simply, walk out.

Mrs. Garcia needed an “out”. She had played her little game a bit too long, so I just gave her permission to stop.  No, I am not a faith healer, but faith did heal this woman.  For that brief moment, I was a Curandero, sort of.  Incidentally, the wedding of her son, postponed because of her sudden illnesses, was rescheduled and Mrs. Garcia was able to attend.

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