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Module 9: Cultural Beliefs About Service           

Fear of Doctors

Fear and distrust of doctors is a common barrier to health care in the developing world. This fear can be culture-specific, or simply a result of unfamiliarity. For many who do not seek regular medical attention, the health care system is an unknown which can be intimidating, regardless of culture.

“Fear appears to be a major barrier in the region... Most patients expressed fear of the hospital environment, staff and loss of pride and dignity rather than that of cataract surgery… Fear of the unknown appears to have played a major role in deciding on cataract surgery. In a study in Tanzania, it was reported that fear of the city, where to stay, what is going to happen when left alone in the hospital and similar fears far outweighed the perceived advantages of restored sight, among cataract patients.”(1)

Although fear of the unfamiliar or of a poor prognosis can keep patients away in many cultures, there are some culture-specific stigmas associated with doctors and medicine that foreign health care volunteers must be aware of.  

Cultural Beliefs about Medicine

Many Westerners view illness as a chance event or as a result of lifestyle choices, but it is important to realize that this way of thinking is not universal. A view commonly held abroad is that disease results from fate, punishment of sin, sorcery, or other supernatural causes.(2)  It is easy to see how patients who believe the cause of their disease is supernatural will fail to seek medical treatment, which is the attempt to cure the disease by natural means. As a foreign volunteer, it is helpful to understand the cultural beliefs that surround disease and medicine, as this will facilitate communication and understanding with local patients.  Such beliefs about medical care in general extend to beliefs about eye care and the causes of blindness, as the following quotes illustrate:

“The education of the villagers is an entirely different issue altogether. Most of them do not think going to the hospital is necessary; they say that if they go blind, "Inshallah" ("It is God's will").”(3)

“The folktales of India, Europe, Africa, and North America all tell of people being blinded for such transgressions as perjury, theft, rape, incest, adultery, abduction, and murder. In some cases, the sin being punished was committed by a distant relative… This belief is evident even today. For example, a highly educated woman of Italian descent stated her firm belief that her young son's visual impairment was caused by the sins of her robber-baron forebears. Occasionally, newly blind clients report the belief that visual impairment is a test by the powers that be that they must pass.”(4)

Balancing Cultural Sensitivity with Safety and Education

Part of being an effective volunteer requires setting aside ethnocentric ideas of superiority and learning to understand local attitudes toward health care. While Western medicine may be more technologically advanced, it is by no means the universal approach to health care, nor is it the undisputed “best” method. As a foreign volunteer, you may observe unfamiliar medical practices that seem inefficient, ineffective, or backwards to you, but such practices should never be dismissed or ridiculed. Local practitioners often have to take into account various local realities of which you are not aware. More importantly, respecting traditional practices is essential to relating to patients, as certain beliefs are integral to their lives and heritage.(5)

While it is important to be aware of the cultural implications of traditional healers versus local medical providers versus Western medical volunteers, some time-honored traditional practices are not innocuous. In the case of such harmful practices, global health organizations should aim to educate locals about health risks and dangers in a culturally sensitive way.  One example of a harmful traditional treatment for cataracts is the process of couching.

 “A popular practice that is thought to cure cataracts is "couching", a procedure that involves sticking a needle or any other sharpened object straight into the eye to dislodge the lens and therefore allow people who were once blind to now sense light. As one can imagine, couching is extremely harmful to eyes and mostly results in permanent damage that surgeries cannot fix. Traditional healers advocate this practice because they do not know or do not believe that cataract surgeries can restore people's vision; there is still a sense of distrust concerning Western medicine. As a result, Dr. Wanye's office is often frequented by couching cases gone wrong, and most of the time, the damage is irreparable.”(6)

Go To Module 10: Cultural Humility>>

Footnotes

Cultural Competency Online Course

• Table of Contents
• Module 1
• Module 2
• Module 3
• Module 4
• Module 5
• Module 6
• Module 7
• Module 8
• Module 9
• Module 10
• Module 11