When Alternative Healthcare Equals Noncompliance

04-17-2007 | Categories:

Culture-Ethnicity

Tempted To Noncompliance

Today’s post focuses on the penchant of a significant fraction of the population to choose the offerings of charlatans and shamans over those of scientific healthcare, leading all too often to noncompliance with medical treatment.

This excerpt from Prayer, Faith Is Fine, published in the Swazi Observer characterizes the problem.

Many of those who stop taking ARVs as prescribed are those who have been told to do so by pastors and religious leaders who tell them that they have been healed through prayer and that their faith means they no longer require the lifelong treatment. Others quit adherence after turning to the myriad of concoctions that are freely available on the streets with the dubious promise to heal AIDS and kill HIV.

Commentary

While this story is set in Swaziland, it is not difficult to imagine variations taking place throughout the world, including those countries with far more resources in the areas of healthcare, communication, and education. The thriving enterprises of mysticism, quackery, pseudoscience, and straightforward scams in the U.S. is testimony that national borders are no protection from such dangers.

To read this article is to be reminded that patient noncompliance is caused not only by miscommunication, side-effects of treatment, medication fatigue, and other miscues within the patient-clinician-interface but also by patients who opt out of the system of scientific healthcare altogether, preferentially placing their beliefs in one of the many available alternatives.

While I am aware of the limitations of scientific healthcare and willing to accept the possibility that some other system could prove as beneficial or more beneficial to mankind, I see little compelling evidence indicating that such a theoretical system currently exists. Until such evidence is revealed, I maintain that a fundamental requirement for compliance is the patient’s participation in the best available scientifically supported medical care and, consequently, that those of us involved in providing that medical care have the responsibility not only to practice our techniques carefully and skillfully but also to unapologetically promote the proven effectiveness of those techniques and insist that alternative healthcare methods similarly back up their claims of effectiveness.

The complete article from the Swazi Observer can be found at ~Prayer, Faith Is Fine~

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Religious Practices and Patient Compliance

03-23-2007 | Categories:

Culture-Ethnicity

Impact of Theology on Adherence To Treatment

Source:
Bashir Qureshi, FRCGP, Diabetes in Ramadan J R Soc Med. 2002 October; 95(10): 489–490.

Managing Diabetic Patients Practicing Devotional Fasting and Other Religious Behaviors

This article centers on pragmatic clinical tips on the medical management of diabetic Muslims celebrating Ramadan.

Devoted healthy Muslims commemorate the revelation of the Holy Quran by Allah to the Prophet Mohammed by fasting in the month of Ramadan every year. Ramadan lasts for 29 or 30 days, depending on the sighting of the moon. While continuing their daily occupation without time off, fasting Muslims abstain from food, liquids, tobacco, sexual activity and medication (oral, inhaler or injection) from sunrise to sunset. However, the sick, the pregnant and nursing mothers and children are exempt; moreover, if a fasting person becomes ill, he or she is allowed to end the fast in the day. Ramadan directly influences the control of diabetes because of the month-long changes in meal times, types of foods, use of medication and daily lifestyle.

A brief summary of the relevant customs of Ramadan is followed by “Ten Points Towards Improving Diabetes Care In Muslim Patients.”¹ These examples from that list are representative:

#4 ‘Human insulin’ may be misunderstood by the patient as signifying manufacture from human flesh or pancreas, leading to non-compliance. Some non-westernized Asian and African Muslims do not understand diabetes as western people do. Explain that ‘human’ simply means ‘akin to human’

#5 In Ramadan, a person with type 2 diabetes can take a sulphonylurea at the end of the fast, with the evening meal started within 30 minutes. Advise not to miss the sehri (before sunrise) meal so as to avoid hypoglycaemia later in the day. Repaglinide (NovoNorm) can be particularly useful, since it need only be taken when a meal is eaten, therefore no change in drug therapy will be required in Ramadan. A meal must be eaten within 15 minutes

Other recommendations are less specific to diabetes or Ramadan; Point #8, for example, advises that:

Medical advice is sometimes ignored for religious reasons. Occasionally a devoted Muslim will say, ‘Allah will protect me’. He or she may not fear death or may even want to die so as to meet the Creator. Counsel the patient by saying ‘to see the doctor and comply with treatment is Prophet Mohammad’s sunnat (precedent)’. To refuse would be a sin

Commentary

While this article focuses on a relatively narrow audience, clinicians with limited knowledge of Muslim practices who are providing care for diabetics who are followers of that religion, its readily apparent implications regarding compliance extend far beyond the treatment of a given disease or methods for dealing with those who conform to a single set of theological doctrines. The message to healthcare professionals is clear:

Only by acquainting themselves with the religious and cultural practices of their patients can healthcare providers anticipate and develop insight into potential conflicts between adherence to treatment and adherence to theological obligations and offer those patients the counsel and information necessary to maintain both their faith and their health.

Footnotes

Only nine points are listed under the heading, “Ten Points Towards Improving Diabetes Care In Muslim Patients.” [back]

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Addressing Cultural Threats To Health

01-08-2007 | Categories:

Culture-Ethnicity

Gordidto Doesn’t Mean Healthy

Gordidto Doesn’t Mean Healthy¹ is targeted toward Latino parents, offering information about the dangers of obesity in children and methods for feeding their children nutritiously without forgoing traditional dishes.

As the Publishers Weekly blurb notes,

In Latino culture, one of the nicest things you can say to a mother about her child is, “Oh, que lindo gordito, what a cute, chubby baby, so strong and healthy!” But a gordito child is likely to suffer diseases that will affect him or her for life: type 2 diabetes, high blood pressure and high cholesterol. Nutritionist González and health reporter Alcañiz-mommies both-offer this timely book explaining why it’s imperative that Latino children eat properly, and how the Latino diet (and its flavors and ingredients) can be incorporated into a healthy menu.

The “Latino-Hispanic Food Guide Pyramid” includes traditional foods like jicama, papayas, corn tortillas and avocado; while a section on Latina mothers and breastfeeding debunks myths. Menu suggestions for newborns to 19-year-olds and a section on eating disorders complete this essential guide.

Commentary

Iconoculture, a market research firm, regularly tracks cultural phenomenon that affect economic trends and purchases of good and services. Their take on Gordidto Doesn’t Mean Healthy is that it’s part of a much larger movement within the Latino population of the United States to maintain the essence of their cultural heritage while eliminating certain aspects that are potentially detrimental.

This combination of respect to tradition, sensitivity to an ethnic group, and efforts to improve health being recommended to retailers seems a worthwhile model for healthcare as well.

Footnotes