Precisely because we do NOT practice health care as we know we should, is the reason our “person-centered medicine and anthropology will remain superficial“ at best.
Toward An Adventist Theology Of Health (4) - On Therapy 11 February 2016 Hanz Gutierrez said: “Until we seriously consider humanness, with all of its asymmetries, paradoxes, exceptionality, opacity and alternatives, our person-centered medicine and anthropology will remain superficial.”
In response Andreas Bochmann said “… If medicine is just big business for the Adventist world, we are losing our “Ministry of Healing” - in exactly the way Hanz described.”
Many societies believe that illness is the result of supernatural phenomena and promote prayer or other spiritual interventions that counter the presumed disfavor of powerful forces. Spiritual values and religious issues play a major role in patient compliance. Human beings bring their individuality to health care. They have systems of health beliefs to explain what causes illness, how it can be cured or treated, and who should be involved in the process. The extent to which patients perceive patient education as having cultural relevance for them can have a profound effect on their reception to information provided and their willingness to use it. Western industrialized societies such as the United States, which see disease as a result of natural scientific phenomena, advocate medical treatments that combat microorganisms or use sophisticated technology to diagnose and treat disease.
Having ministered in and out of Adventist health care settings most of my adult life as a Chaplain and Chaplain Educator in the United States, Central, and South America, I will cite a few examples of how we have not met the needs of several minorities.
Some patients have extended family that wield significant influence, and the oldest male in the family is often the decision maker and spokesperson. The interests and honor of the family are more important than those of individual family members. Older family members are respected, and their authority is often unquestioned. Among Asian cultures, maintaining harmony is an important value; therefore, there is a strong emphasis on avoiding conflict and direct confrontation. Due to respect for authority, disagreement with the recommendations of health care professionals is avoided. However, lack of disagreement does not indicate that the patient and family agree with or will follow treatment recommendations. Among Chinese patients, because the behavior of the individual reflects on the family, mental illness or any behavior that indicates lack of self-control may produce shame and guilt. As a result, Chinese patients may be reluctant to discuss symptoms of mental illness or depression. Chinese patients seeking care in Adventist facilities in several Adventist facilities, by and large have not been given this consideration.
Some sub-populations, such as those from India and Pakistan, are reluctant to accept a diagnosis of severe emotional illness or mental retardation because it severely reduces the chances of other members of the family getting married. In Vietnamese culture, mystical beliefs explain physical and mental illness. Health is viewed as the result of a harmonious balance between the poles of hot and cold that govern bodily functions. Vietnamese don’t readily accept Western mental health counseling and interventions, particularly when self-disclosure is expected. However, it is possible to accept assistance if trust has been gained. I am not aware of that level of sensitivity being taught to our Adventist medical staff.
Aspects common to Native Americans usually include being oriented in the present and valuing cooperation. Native Americans also place great value on family and spiritual beliefs. They believe that a state of health exists when a person lives in total harmony with nature. Illness is viewed not as an alteration in a person’s physiological state, but as an imbalance between the ill person and natural or supernatural forces. Native Americans may use a medicine man or woman, known as a shaman. This practice is shunned in many clinics and programs that the Adventist sponsor in health care.
Although Hispanics share a strong heritage that includes family and religion, each subgroup of the Hispanic population has distinct beliefs and customs. Older family members and other relatives are respected and are often consulted on important matters involving health and illness. Fatalistic views are shared by many Hispanic patients who view illness as God’s will or divine punishment brought about by previous or current sinful behavior. Hispanic patients may prefer to use home remedies and may consult a folk healer, known as a curandero. This practice and many home remedies are not considered in Adventist facilities when treating Hispanic patients.
Many African-Americans participate in a human experience that centers on the importance of family and church. There are extended kinship bonds with grandparents, aunts, uncles, cousins, or individuals who are not biologically related but who play an important role in the family system. Usually, a key family member is consulted for important health-related decisions. The church should be an important support system for many African-Americans.
As can be seen, each ethnic group brings its own perspectives and values to the health care system, and many health care beliefs and health practices differ from those of the traditional American health care culture. Unfortunately, the expectation of many Adventist health care professionals has been that patients will conform to mainstream values. Such expectations have frequently created barriers to care that have been compounded by differences in language and education between patients and providers from different backgrounds.
Differences in our humanness affect patients’ attitudes about medical care and their ability to understand, manage, and cope with the course of an illness, the meaning of a diagnosis, and the consequences of medical treatment. Provison and priority has to be given in our health care at all levels to encourage better understanding of the needs of all our patients. All patients and their families bring their humanity and individual specific ideas and values related to concepts of health and illness, reporting of symptoms, expectations for how health care will be delivered, and beliefs concerning medication and treatments. In addition, specific values influence patient roles and expectations, how much information about illness and treatment is desired, how death and dying will be managed, bereavement patterns, gender and family roles, and processes for decision making.
Until we start doing what we know we need to do in health care–to make man whole—will remain just—big business.