East Meets West

In the 17th century, traditional Vietnamese and Chinese practitioners began identifying their medicine as Dong
Y to distinguish their medicine from the Western colonial medicine. Similarly, people in the West began to use
the term “Oriental medicine” to differentiate Eastern medical practices from Western ones. Today, the terms
Eastern medicine and Asian medicine are more commonly used in this country, and perhaps they are the
better terms. The use of oriental has shifted to refer to home furnishings, carpets especially, and certainly in
the field of cross-cultural communications, the word oriental is never used as a category of culture.

Many Americans quickly associate Chinese herbal remedies and acupuncture with Eastern “alternative”
medicine, but are largely unfamiliar with other common practices from across Asia. The philosophies of health
and illness causation at the root of Eastern medicines are even less understood and just as important.
Traditional Chinese medicine, or TCM, is the best known Asian medicine practiced in the U. S., but it is not the
only traditional medicine worthy of our attention. Traditional Vietnamese medicine (TVM) actually evolved
together with traditional Chinese medicine and arguably the development of the two are so-intertwined that it is
impossible to separate them. However, there are differences. Closely related to both are Japanese and Korean
traditional medicines. Historically speaking, many societies in Eastern and Southeastern Asia have been part
of the Chinese cultural sphere due to trade, migration, and occupation. Thus it is safe to say that the healing
traditions of most Asian cultures are intertwined to some extent, much as their religious philosophies are.

Beliefs and Practices Briefly Described

Traditional Chinese Medicine

TCM is inextricably linked to Chinese Cosmology, as system of beliefs that can be summed up as follows: all of
creation is born from the marriage of two polar principles, Yin and Yang. Examples are earth and heaven,
winter and summer, night and day, cold and hot, wet and dry, inner and outer, body and mind. These pairs of
opposites are connected via a circular harmony. The yin and yang symbol is helpful in representing this
concept. Harmony means health, good weather, and good fortune, while disharmony leads to disease,
disaster, and bad luck. The strategy of Chinese medicine is to restore harmony. Each human is seen as a
world in miniature, and every person has a unique terrain to be mapped, a resilient yet sensitive ecology to be
maintained. Like a gardener uses irrigation and compost to grow robust plants, the doctor uses acupuncture,
herbs and food to recover and sustain health.

Chinese Herbal Medicine

Herbal medicine is an important part of Traditional Chinese Medicine (TCM). Herbs are prescribed holistically
according to the patient’s individual condition (not only on the basis of current symptoms). Herbal medicines
are used to regulate the natural balance of the body and restore health. They come in the form of pills,
powders, tinctures and raw herbs taken internally or as balms for external use. Chinese herbal medicine has
been used for centuries to treat most health conditions and as a preventative dietary supplement. They can
also be used safely in conjunction with many western therapies. Diagnosis is made by talking to the patient,
looking at physical characteristics and employing the ancient arts of tongue and pulse diagnosis.
All cultures 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. Other 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.Cultural issues play a major role in patient compliance. One study showed that a
group of Cambodian adults with minimal formal education made considerable efforts to comply with therapy
but did so in a manner consistent with their underlying understanding of how medicines and the body work.

Asians/Pacific Islanders are a large ethnic group in the United States. There are several important cultural
beliefs among Asians and Pacific Islanders that nurses should be aware of. The extended family has
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.

Some sub-populations of cultures, 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.

Russian immigrants frequently view U.S. medical care with a degree of mistrust. The Russian experience with
medical practitioners has been an authoritarian relationship in which free exchange of information and open
discussion was not usual. As a result, many Russian patients find it difficult to question a physician and to talk
openly about medical concerns. Patients expect a paternalistic approach-the competent health care
professional does not ask patients what they want to do, but tells them what to do. This reliance on physician
expertise undermines a patient’s motivation to learn more about self-care and preventive health behaviors.

Culturally driven attitudes and behaviors often create communication challenges between Middle Eastern
patients and Western health care professionals. Middle Easterners approach life differently in significant ways
from Westerners i.e., in terms of time control, power distance, male/female roles, personal space, and privacy.
Similarly, problems in providing health care also develop around family involvement with patient care and ways
of handling “bad news.” This article provides some general guidelines in understanding the cultural
characteristics of Middle Easterners, but as always, it is crucial to see the individual in any health care
encounter. The degree of exposure to Western and/or American culture greatly affects an individual’s attitudes
and behaviors. Religious affiliations are also extremely influential. While it is useful to apply generalizations
when learning about patterns of communication, it is also important to avoid applying hard and fast rules in any
cross-cultural interaction.

Question buttonBefore reading further about the core values, beliefs, and cultural behaviors of people from the
Middle East, it may prove helpful to learn more about what the term Middle Easterners encompasses.

The Importance of Family In Middle Eastern Cultures

Humans develop their sense of identity and self-esteem within a particular cultural context or group, and
assuring in-group survival is arguably the strongest of human drives. Though the need to be affiliated with
other persons is a universal human need, the intensity of the need varies among individuals and cultural
groups. The need for affiliation is very strong among Middle Easterners. They thrive on a large network of
relationships. During illness or crisis, Middle Easterners rely heavily on other persons in their “in-group” instead
of trying to cope more individually as many Americans would typically do. A person seeking medical care may
be accompanied by one or more persons in Middle Eastern culture who expect to be present during the
examination or interview, who listen carefully and often answer for the patient. Usually it is an elderly person
who will feel offended if not invited into the physician’s office. People close to the patient consider themselves
duty bound to be there. The intense connection to family and close friends that is seen in many Middle
Easterners is often accompanied by doubt about the intentions of those outside their intimate circle. Thus,
family members typically see it as their job to make sure that the patient gets the best care possible from
medical professionals. Repetition of demands is often made to show emphasis, as is a loud tone of voice.
Family and friends are expected never to leave a patient alone and to constantly shower care and attention. A
great deal of patience is sometimes needed in dealing with these “demanding” family members.

Health and Illness Behavior

Middle Easterners generally have respect for Western medicine. However, in working with any immigrant
population, health care professionals should be aware of common folk beliefs and practices. Much like Latino
people, Middle Easterners may believe in illness causation such as the Evil Eye. In this belief, anything that
provokes jealousy in another gives the envious person the power to cause illness or misfortune for the lucky
person or family. Often the object of envy is a beautiful baby or child. Much like Latino and Asian people,
Middle Easterners believe in the importance of balancing “hot” and “cold” foods – qualities that do not
necessarily have to do with actual food temperature. They avoid eating incompatible foods at the same meal.
Health professionals have frequently observed among Middle Easterners a fatalistic acceptance of disease or
death – it’s all in Allah’s hands. Preventive care is not practiced as commonly in the Middle East as it is in the
United States. Also, medication is heavily used. Middle Eastern patients may expect to receive a prescription.
Middle Easterners often fear hospital admission because hospitals are considered places of misfortune where
people go to die. Moslems are concerned that a family cannot be sure that the body of one of its members will
be treated correctly according to religious customs, should a patient die in hospital. Family members do not
plan for death and never give up hope until a patient has actually died; grief is not permitted to be shown in the
presence of a dying person. Once death has occurred, mourning may be loud and obvious. A person who is
not overcome with emotion is not admired. It takes more time to consult with a Middle Eastern family, and that
scheduling should be arranged accordingly when possible.

Health Practices
Studies of health practices among Pilipino Americans suggest that people originally from rural areas in the
Philippines are more knowledgeable regarding home remedies, traditional healing techniques, and
supernatural ailments, whereas those from urban areas rely more on Western medical intervention and over-
the-counter drugs. However, in both rural and urban areas, a variety of indigenous folk practices and modern
health care systems are utilized simultaneously (Montepio, 1986/1987; Vance, 1991).

Among the more traditional forms of self medication are certain Chinese oils or ointments, which serve as cure
alls in relaxing, heating, and comforting the muscles or providing relief for dizziness, colds, headaches, sore
throats, and so forth. Other self medication may include the use of folk healing techniques consistent with the
Chinese hot/cold classification system of diseases and the concept of wind illnesses (see Chapter 8). For
example, a technique called ventosa is used for treating joint pains believed to be caused by the presence of
bad air. This technique consists of wrapping a coin with cotton, wetting the tip with alcohol, lighting it, and
placing the coin on the aching joint area, then immediately covering it with a small glass or cup. The fire is
extinguished as soon as it is covered, creating a vacuum that will suck the bad air out of the joint (Montepio,
1986/1987).

Beyond such home remedies, more serious illnesses typically warrant seeking the help of a local healer who
may utilize a variety of treatments including the use of herbs and roots (McKenzie and Chrisman,
1977)although healers are presumed to possess a God given gift, their relative popularity and prestige in the
community depends a great deal on their interpersonal relationships with their patients. People in rural areas
are accustomed to friendly and accommodating folk healers and expect the same treatment from physicians. If
these expectations are not met, they avoid Western health centers or switch doctors. Moreover, when healers
are viewed with trust and respect, they often are expected to perform instantaneous healing. If there is no
immediate improvement in an illness or related symptoms, individuals may change doctors (Montepio,
1986/1987).

The various types of healers common throughout the Philippines include midwives, masseurs, and specialists
for supernaturally caused ailments. Although these types of healers each have native labels, there is no
traditional word for faith healers, the newest and increasingly popular genre of Philippine folk healers. In fact,
there are as many as 15,000 faith healers found in the Philippines, and most are devout Christians (Harper and
Fullerton, 1994). Faith healers do not attempt to identify or diagnose a disease, which is in contrast to the
traditional concern for identifying the cause of illness (which could presumably be supernatural). Their
orientation is holistic and uniform and incorporates the belief in concurrent physical, emotional, and spiritual
healing. Regardless of the individual's specific affliction, the same techniques are employed (Montepio,
1986/1987).

In a regular session, the faith healer's techniques include blessing the body with holy water, laying on of the
hands, and anointing with oil. The technique of laying on of the hands is a very important aspect of faith
healing and is practiced by several other groups such as the Pentecostal Charismatics and the Cuban-
American santeros. In laying on hands, it appears as though the healer is attempting to transfer the healing
energy from his or her hands to the individual's body through the forehead. The healer also anoints the
individual by wetting his or her fingers with consecrated oil and making the sign of the cross on the forehead,
on each eye, and on the chin of the person. If certain body parts need healing, they will be directly anointed.
The person, in turn, typically attests to the sense of warmth or flow of energy that seems to enter his or her
body and provides instant well-being (Montepio, 1986/1987).

These healing techniques are enhanced by ritualized prayer, chanting, and the creation of an atmosphere that
reinforces the individual's faith. During healing sessions, the faith healer, for example, typically wears a white
dress of soft, flowing material, creating an ,ephemeral quality; white (worn by the Virgin Mary) is the symbol of
purity and is associated with environmental ghosts and spirits (Montepio, 1986/1987).

One of the most dramatic forms of faith healing that has attracted significant international attention is psychic
surgery. It involves the painless insertion of the healer's fingers into the individual's body, removal of tissues,
tumors, growths, or foreign matter, and closing the incision without a scar (Harper and Fullerton, 1994, p. 62).
Numerous Western scientists have investigated tales of miracle cures produced by psychic surgeons and
found evidence of fakery; however, they also have reportedly witnessed incredible feats of healing (Harper and
Fullerton, 1994).

Whether in the Philippines (considered the world's faith healing center) or the United States, faith healing and
more traditional folk healing practices typically are utilized simultaneously with modern medicine. In fact, The
healer never advises against going to doctors or hospitals. In several cases, spiritual healing is used only after
these doctors have diagnosed a disease as incurable. Even after a patient feels that he has been healed by
[traditional healers], he still goes back to his doctor to establish that he is actually cured. Western medicine is
thus used to validate the efficacy of spiritual healing. (Montepio, 1986/1987,pp.159-160).

Folk healers may serve as indigenous allies whose work can complement modern health practitioners and who
can provide the psychological, emotional, and spiritual well being necessary to the healing process.