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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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    Back to Module 13: Cultural Issues
    Tools for Diagnosing and Mediating Cultural Misunderstandings

    Touch and Gender
    Medical Subculture
    Suffering
    Traditional Medicine
    Depression
    Body Language
    Bad News
    Fatalism
    Surgery
    Food
    Literacy
    Meaning of Illness Alternative Medicine
    Pain
    Imminent Death

    Meaning of Illness

    How Do People Make Sense of Illness?

    • People always try to make sense out of experience
    • Illness in particular causes people to question the meaning of their own life, life in general, the place of suffering in life
    • You can approach it from a variety of frameworks, as a spiritual challenge, an existential challenge, and a challenge to ego integrity
    • The point is, in all cultures people have ideas about why they get sick, the significance of specific illnesses, the value of suffering, who is responsible for it and who should be involved in the care and cure
    • Senseless suffering is far more of a problem than understandable suffering

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    Common Concerns that May Arise from Meanings Attributed to Illness

    Patients may have many disease specific concerns that they do not express unless you ask them. Here are some common ones:

    • Cancer may be believed to be contagious
      • The patient may isolate herself or may actually be abandoned by friends and neighbors who fear contagion

      • Children may be sent away to protect them

      • Address and refute the misinformation directly and definitively
    • Lingering illnesses may be believed to be a sign of bad luck or ill fate that affect the individual and even entire household
      • Illness could be the result of active malevolence (witchcraft, voodoo) or just “bad vibes”… the evil eye of jealous relatives or neighbors

      • You probably cannot change this belief, but you must clearly convey that you and your team will not abandon them

      • Volunteers and friendly visitors may have to be recruited from outside the cultural community

      • Especially in small communities, support groups may be culturally unacceptable for these reasons
    • In some cases patients are anxious to conceal the illness because they wish to protect the household from being labeled as unlucky and therefore ostracized in the community
      • Many language communities are small, local neighborhoods where gossip gets around fast. Regular nursing visits may not go unobserved. An unfortunate family may have difficulty doing business or finding marriage partners for their children

      • Ask if they fear that their illness may be harmful to the family in anyway besides the cost of care

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    Guilt vs. Shame in the Context of Illness

    Guilt and shame are not the same

    In assessing a patient’s concerns related to the meaning of illness, it is important that you hear the difference between guilt and shame. Cultures tend to emphasize one or the other

       Guilt...

    • Is internal
    • Causes the patient to feel personally to blame for their own misfortune and the burden they feel they are causing their families
    • Often has religious overtones of sin
      • Patients may feel they are being punished for past sins
      • A familiar model is the biblical Job, who could not figure out what sin he had committed to bring such suffering

       Shame...

    • Is external
    • Causes the patient to feel inadequate and that their inadequacies bring more shame on the household
    • Is not exactly embarrassment, but it is more like embarrassment than guilt
    • Is social and interpersonal in nature
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