Ateneo de Davao University

Graduate School

Name: Dennis N. Muñoz, LPT, RM, RN Course: Nsg 697 - Theoretical Foundation
Student Number: 22017001253391 in Nursing Practice

Degree: Master’s in Nursing Professor: Dr. Patria V. Manalaysay

REFLECTION ON MADELEINE LEININGER’S CULTURAL CARE THEORY

Bangsamoro Autonomous Region for Muslim Mindanao (BARMM) remains at the

bottom from all other regions of the country in terms of the health conditions and socio-
economic status of its constituents. Maguindanao is recognized as needing
sophisticated health facilities, workers, and financial support that cater to the supposed
to more than four (6) million population in the region. The incidence of child morbidity
due to infectious diseases presents a concern for promoting quality health education
among school children. The cases of dengue, diarrhea, tuberculosis, substance abuse,
smoking, and others are among the health issues among the young populations. In the
study of Daguino in 2015, the dental health conditions of school children showed that
almost 70% of the children in schools have dental problems.

Further, the problems have been aggravated and troubled by the prevailing arm conflict
between the rebels and the government. In July 2008, more than 500 residents of the
Municipality of Buluan in the province of Maguindanao had been displaced due to arms
conflict between the Philippine Army and the insurgency forces of the Moro Islāmic
Liberation Front. Another factor that had aggravated and brought a spark in the area
was an internal political conflict between two heavy-handed tyrants and powerful lords
of the region. This resulted in weeklong fighting against each other’s camp to gain
power and control of the area. The political dynasties are prevalent on the western part
of Mindanao, their predominance is to amass so much wealth and power while turning a
blind eye to their excesses because they need community support. The result is a
culture of impunity that emboldens even more atrocities. These are those clans who are
not willing to give up the position in the name of power, domination, corruption, and
recognition. Political influence is coupled with a tyrannical ruling that had led to troubling
health conditions, marginalization of the poor, displacement of the community members
to a temporary settlement area, and worst economic deprivation lack of financial
resources and commercial activities.

In November of 2009, the historic multiple murders of a total of 58 people, including 32

journalists, have gone unpunished for the last ten years until its conclusion on Dec 19,
2019. This armed conflict has further sparked controversies when a small group of
Special Action Forces (SAF) of the Philippine National Police who fought fearlessly,
even though outnumbered in terms weaponry, backup troops and resources, those men
tried in all of their powers combine to suppress the terrorist rebels which had led to the
demise of the 44 soldiers.
Let me first describe the picture of the Filipino-Muslim-Lumad inhabitants in the
municipality of Buluan, Province of BARMM. I have a strong connection to this
community since my early beginnings as an Advance beginner nurse started my journey
in 2009. I will illustrate how the health and cultural practices intertwined in this
community as part of the day to day life activities among Maguindanaon and low-land
lumad tribes, their implication to the theoretical concepts of Madeline Leininger’s
Transcultural theory.

Different inhabitants in Mindanao result in big differences in cultural practices and

beliefs. A flagrant Discrimination is everywhere, even denigration, and treating each
other as a third-class priority are common examples of public humiliation among fellow
citizen who does not have cultural knowledge, and appreciation of a particular culture.

Despite all these situations, Lumads, Catholic, and Non-Catholics Christians, and
Muslims are free to express their beliefs and socio-cultural activities without inhibitions.

For Lumad tribes or indigenous non-Muslim tribes of Mindanao or better yet known as
“native to the place,” are described by some people as “innocent and naïve,” have not
succumbed to the modern ways of social living practices and had preferred to live in the
mountainsides enduring the traditional ways. They keep much of their way of life
inextricably linked to their ownership and control over their land and resources. Lumads
in the Philippines, particularly in Mindanao have 18 ethnolinguistics tribes that are
widely dispersed both in the high lands, lowlands and even in the coastal communities.
These people are the Bagobo, Banwaon, Bla’an, Bukidnon, Dibabawon, Higaonon,
Mamanwa, Mandaya, Mangguwangan, Manobo, Mansaka, Matigsalug, Subanen,
Tagakaolo, Talaandig, Tboli, Teduray, and Ubo.

Of the 18 tribes in the Philippines, which greatly concentrates in the area of south-
central Mindanao Bla’an, Manobo, Tboli, and Teduray were the most common. Lumad
culture is rich and diverse, with a wide range of languages, chants, rituals, dances, and
other traditions.

For example, in my hometown in Datu Odin Sinsuat Municipality, formerly Dinaig is

dominated by the Teduray group. Their cultural artifacts remain as a unique identity for
recognition and distinction against other tribes. The mother tongue dialect gives
superior distinctions since artifact could be shared, but their communication abilities
have commonalities and similarities in syllabication to other tribes but different in
pronunciation. Other Tiduray tribes have been Christianized, others were baptized to
Muslim rites, and while seldom have remained purely traditional or had never been
indoctrinated by other religious sects. Ceremonial activities in terms of religious rituals,
burial practices, and marriage vows have remained a distinctive feature that can be
delineated from one another tribe.

Manobo Bla’an Teduray English

Meapon Flabi Temegen afternoon
Yaya Ya Memala, mala ashamed
 Telaki Sawag lagi; bachelor
Tebaw Sut Fen genga be born
Measeb Lgad Embager energetic
Amay Ma Boh father
Temek Yeel bunge; Feket; bor juice
Siis Salek Bewer lip
Metasan; Tua lukes mature
Sipaon Lakaf Ngor mucus
Anak Asal tinga nephew, niece
Tiyok Tbak Tèyuk puncture, inject
Neantay To Uyagen revive
Metibolo Lbatu Lifutut round
Adek Ungaf Têrehung smell
Meyonok Lumal Mèlèmak soft
Ame Flo Linu swallow
Aneng-aneng Fdam Fegitung think
Pingin Fingin Sefing twins
Wayeg Yeel Wayeg water
Adi Twali Toow younger
tuwarey

Another distinctive feature among Lumads were the cultural artifacts. The art is in
harmony with nature can be depicted on the woven clothes with intricate designs and
tapestries. Other bangle ornaments and necklaces are uniquely sewed with a fine
thread containing myriads of shells, colorful seeds, and even teeth bones of certain wild
animals they captured during hunting. Lumads as well as a strong superstitious belief
and that they believe in multiple deities, spirits, and gods. There were two known as far
as I can remember. They believe that the supreme creator of the world is a woman.
Contrary to other tribes where man is the dominant creator of the world like Bathala
among Manobos who is dominated by man. For the Tedurays, the goddess who creates
the world was Minaden, while Tulus, her brother was the chief of all good spirits who
bestow gifts and favors upon human beings. There is a god for land, another for water,
another for harvest, to name a few. For them, the mountain is sacred. Death and illness
or bad faith are believed to be the god’s way of showing anger. The offering of live
animals like pigs and chicken are common during tribal ceremonies for a good harvest,
health and protection, and thanksgiving.

Mindanao is one large community of diverse people. Understanding one another

regardless of his or her religion or belief is best because we are all children of God,
each created unique. Respect, understanding, and appreciation of differences are
important. As far as I understood, I do not see the conflicting status in terms of cultural
backgrounds, but I see the domination of the people in the area in terms of wealth and
political power.
The Muslims in the locale were truly religious, just like many Christian, believing in the
Islamic faith is a form of monotheistic religion. The place of worship and meditation is in
the mosque. Congregational prayer is traditionally done every Friday. They follow the
five pillars of Islam, which requires them to pray five times a day. Another global
practice of Islam is the Ramadan, where Muslims abstain from food, drink, and sex.
However, this practice is not binding to all Muslims; on occasions, pregnant women and
old folks Muslims are exempted from doing such religiosity due to some health-related
reasons and as part of being adherent to the sacred words and writings in the Holy
Quran. Although some Muslim patients are excused for health reasons, many want to
fast during Ramadan, including those with diabetes. The importance of monitoring blood
sugars regularly should be enforced, especially if fasting patients take insulin. Pre-dawn
and post-evening meals should be tailored, for example including carbohydrates that
release energy slowly in the pre-dawn meal. Idle Fetre is a major Muslim prayer
practiced signifying the end of Ramadhan. Idle Adha is prayer and celebration practiced
by Muslims Hadji (referring to a male) and Hadja (referring to a woman) who went to
Holy Land in Mecca.

As a nurse, it is our moral and humane act to understand cultural diversity as to the way
Muslims wore clothes, especially among women. Indeed, it has major implications to
their practices that women have to wear “long” or “abaya”, a prescribed kind of Muslim
clothing and the wearing of “hijab”- a fine veil or headdress to cover the hair, cheek, and
neck of a woman is a must. Therefore, male or female nurses must be very cautious not
to reprimand them for removing such clothes unless otherwise, it interferes with the
initiation of care during emergencies and or for support sterility and safety.

The old Muslim folks were considered the leader, and the source of wisdom, they are
the most respected group since their influence on the tradition is so strong and
inviolable. They congregate during occasions that require the celebration and
conventions of the elders, relatives, and clans. Some Muslim traditions have health
implications and ceremonial practices that have been rooted since immemorial remain a
practice even up to modern days.

To mention the few, here are some of those traditions I encountered during the period of
my exposure and immersion in a Muslim community of Buluan Maguindanao. An
example would be Kalilang- the form of Muslim wedding, Kanduli - a Muslim ceremony
that may be associated with the commemoration of death or burial of their love ones;
Sagayan or Bagipat - another traditional religious ceremonials and celebrations are
conducted to drive spirits and act of healing for those who are sick, ill and spiritual
possession where the officiated by a “Taligamut or the quack doctor”; Mauludin Nabhi –
this is a time Prophet Mohammad announced to his followers of faith in Islam where all
young Muslims have to baptized, this is called “Antiyak or Tabungawan, as mentioned
in their local dialect,” accompanied by circumcision among young men. Therefore,
circumcision has its religious significance as part of the tradition and for health and
sanitation.
The traditional health practitioners stay another challenge on my part as a community
health nurse and as DR Nurse, this would sometimes cause argumentation in terms of
opposite ways of practice. Let me compare Modern day western Medicine man from a
traditional practitioner and their corresponding designations as a traditionalist
practitioner:

“Taligamut” - A male quack doctor

“Walian” – a female midwife or a nurse
“Pakayan or Duka” – a Witch who makes a love potion, magic spells, and witchcraft
“Pagalamatan” – clairvoyant, mystic or fortune-teller
Implications of knowing the patient's culture as cited from the above examples must be
considered in rendering care. Transcultural nursing helps heighten our awareness in
terms of ways in which Muslim- Maguindanaon clients integrate faith and health system
to take effect the desired action for which they are intended to practice. There are ways
in which the nurse may perceive as exactly dangerous or may endanger the life of the
client if we are to refer the acts from the western medicine concept. One might say it is
truly stepping beyond the point of the health care system, but it is, therefore, the
initiative and effort of the nurse to find the strength and limitation of such act provided,
so as it doesn’t interfere or endanger the life of the client. Nurses need some familiarity
with Muslims’ rites of passage from birth to death, overly simplified summaries of Islam
and health practices risk reinforcing stereotypes and prejudices. Many Muslim patients
understand that illness, suffering and dying are part of life and a test from God, and
perceive illness as a trial from God by which one’s sins are removed; it is, therefore, An
opportunity for a spiritual reward; A reminder to improve one’s health; A sign of personal
failure to follow Islam’s tenets. Death is part of the journey to meet God. In many
Muslims, they slam has rules about the types of food that are permissible (halal) or
prohibited (haram). The main prohibited foods are Pork and its by-products; Alcohol;
Meat that has not been slaughtered according to Islamic rites.

I learned to foster understanding, respect, and appreciation of such unique individuality

and diversity of patient’s beliefs, values, and culture. It also defines how Muslims view
what illness into their perspective, its meaning, cause, treatment, and outcome. To
know how they integrate the developmental patterns of every individual young Muslim is
on the religious reference see the example of circumcision. For example, Circumcision
is patterned with religious celebration Mauludin Nabhi however the challenges and best
health practices create a pressing issue in terms of sterility, control of infection, and
methods of taking care of the wound. As a nurse, it is a moral responsibility to provide
health education that is patient sensitive, directive, and complaint to infection prevention
and control.

Another challenging issue is how gender sensitivity during labor and delivery and
manners in which traditional birth attendants handle the delivery of a baby. These
examples post challenging issues in the practice of midwifery and nursing. The “Walian”
or the traditional birth attendant, for example, is the main reason for most of the
disagreements in the practice of delivery in the Rural health unit. This is an extra mile
challenge on the part of the nurse especially for those women who opted to give birth in
the far countryside where prenatal care is scarce and other health care services are ill-
served. What modern medicine can offer to these traditional birth attendants are to
teach them the proper and safe process of handling a baby during labor and delivery.
Rural health must provide health teachings and community campaign the importance of
hospital delivery for multigravida patients since they are the most vulnerable group and
prone to hemorrhages. But nowadays, traditional birth attendants are encouraged to
help the women and assist during delivery at the RHU providing comfort and support
during postpartum.

As a whole there are five things that I have best learn about the experience:

1. Having a basic understanding of the Muslim worldview will inform the delivery of
care that is culturally sensitive
2. Muslims believe they should meet illness and death with patience, meditation,
and prayer
3. When caring for Muslim inpatients, their spiritual needs, privacy, and modesty
are Paramount
4. It is important to discuss patients’ dietary requirements, including the need to
avoid pork or medication that contains alcohol
5. In a life-threatening emergency, there are no restrictions on the treatment that
can be provided to a Muslim patient

To sum up, identifying religious and cultural differences helps strengthens my

commitment to relationship-centered nursing science that emphasizes care of the
suffering person and not attention simply more to the pathophysiology of the disease. It
important that every service of care rendered by the nurse must embody the ethical
principles of autonomy and informed consent, beneficence, nonmaleficence,
truthfulness and confidentiality, AND Justice. If these ethical virtues are maintained,
meeting the patient's needs in the context of their own culture and beliefs is the virtue of
the act of caring.