Siloam Scenario (Part 3 of 3)

Morgan Wills writes…

In our previous two posts, we presented the case of a Vietnamese woman with arm pain who was noted to exhibit signs of a folk healing practice known as “cupping.”  So what is the relevance of this finding?  Is it just a curiosity of caring for patients from exotic homelands? 

Jina Hawk Lotze, Family Nurse Practitioner, educates a patient about carpal tunnel syndrome.

Well, such “X-factors” do make everyday problems at Siloam a bit more fun and complicated!  But there are important learning points as well.

First, an awareness of such practices by health care personnel can prevent some major problems.  Although not every folk remedy is benign, cupping is neither particularly harmful nor mean-spirited.  Unfortunately, some Southeast Asian immigrant parents who apply this practice to their children in the setting of minor illness have been unjustly accused of child abuse by well meaning but uninformed American health care personnel.

Second, we need a posture of humility and teachability in practicing cross-cultural medicine.  It is important to be continually learning about our patient’s social and cultural context.  The pursuit of such knowledge constantly re-frames the possible list of diagnoses and treatments.  As much as we want and can benefit from protocols in medicine, the bottom line is that each patient is ultimately an individual.  A truly whole person care plan will respect that unique, God-given particularity in each of us and keep the wonder in the medical encounter.

Third, this case is a reminder that all medicine is to some degree or another “cross cultural”—whether at an academic Medical Center or your neighborhood “doc-in-a-box.”  In the end, Cultures are the outward and systemic manifestations of a people’s basic faith commitments or worldview (a set of lenses for viewing reality, religious or otherwise).

We all bring our own understandings of “health”, “illness”, and “good treatment” to bear in the setting of illness.  We may see this reality more clearly in treating someone from a significantly foreign culture, but culturally-bound belief structures play into the care of less exotic patients as well.  Consider the degree of confidence (faith?) modern American patients put in antibiotics, stimulants, or mega-dosed vitamins.  Or the similar trust that the biomedical system implicitly places in expensive laboratory tests and imaging studies!

Whether and how to assess what we should trust in the wild world of health care is beyond the scope of this blog entry.  But the point is that our perceptions of health are affected by the influence of both faith and culture—and often in ways we don’t expect.  If the Siloam Institute of Faith, Health, and Culture does nothing else, it seeks to foster in its trainees increased self-awareness about their own worldview and how it influences the care of patients.  

We hope this leads to humble respect for both the benefits and the limitations of the biomedical model.  To the extent that this leads to a genuine openness to considering what the ends of health care really are, then the process of forming whole person caregivers has truly begun!

2 thoughts on “Siloam Scenario (Part 3 of 3)

  1. Thanks for this excellent blog. In my practice I was struck by the number of patients of German origin who had deeply rooted beliefs in folk medicine. One such family stuffed garlic cloves in the ears of their children for earache. In one child a nasty otitis externa resulted. Surprising dietary remedies for this and that and mustard plasters for coughs surely complicate modern care.

    It takes skill and patience to relate respectfully to people who hold to unproven folk remedies. They may not know from whence these notions originate, but still hold to them tenaciously. The modern caregiver must choose how to respond; often his/her choice is based on “folk methods” of one’s own! You have suggested the more taxing, but deeply considered “whole person” approach, which I support.

    Dr. Morley Phillips

    • Morley,
      Thanks for the long-distance post from Beautiful British Columbia! Yes, there are a lot of interesting practices out there. In the absence of obvious physical signs, the key is to create an environment where patients will feel comfortable enough to tell you about them. Obviously you have done that well over the years!


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