BELIEF SYSTEMS AND CULTURAL INFLUENCES

ON HEALTH AND DISEASE

 INTRODUCTION:
The pattern of disease has shifted - from more acute curable diseases to chronic
diseases.
From “quick fix “ to long term involvement in chronic disease.
Importance of building a meaningful and lasting relationship between the patient
as a person
Caring for a person within the person’s social context
Important to explore culture and spirituality or belief systems and their
implications in health and disease and the rendering of health care.
The human being consists of a body, mind and soul.
the holistic approach
Confronted with spiritual and cultural issues in your patients.
 TRADITIONAL AFRICAN VIEWS
OF HEALTH AND ILLNESS:
- reflects
a belief in an integrated, interdependent totality.
- does not separate present and past.
-Biological, spiritual, social and interpersonal functioning are inter linked.
-Any disturbance will manifest at every level of function.
-There is a greater emphasis on emotionality and spirituality

The West : predominantly cognitive, empirical view

- attempts to isolate observable, etiological factors to understand illness

As societies mix and mingle - you are forced to work over cultural barriers
 WHAT IS CULTURE ?
many variations and different definitions:
- not an individual thing - in a social context
- defines what is acceptable
- distinguishes humans from animals and is linked to symbols and language
- shapes behavior and is closely linked to traditions, customs and beliefs
- We are not born with, but rather “learn” culture.
- Culture is a process – it continuously changes
- viewed as normal by people practicing it; bizarre by others from different culture
- influence all aspects of life - will also influence whether one consults a traditional
healer or a Western doctor
ELEMENTS OF CULTURE:
Values
Norms
Sanctions
Symbols
Material culture
Rituals
 VALUES:
what is wrong or right,
good or bad
and desirable or undesirable.
Like the values of honesty and integrity reflect society’s disapproval of crime.

Norms:
-the expectations of how people are supposed to act, think and feel in specific
situations.
- Norms are either formal or informal. Formal documented norms are laws.
- Informal unwritten norms are the behaviour which are understood and accepted
by society.
 SANCTIONS:
Formal or informal.
Formal sanctions are applied by people and groups in
authority.
E.g. students that cheat in examinations will be expelled from
class.

Informal sanctions are applied by friends and peers.

A person that repeatedly intimidates persons of the opposite
sex will by reprimanded by peers.
Symbols:
Culture depends on people’s ability to create and use
symbols
These symbols would be:

- Language: written and spoken

- Dance
- Music
- Art
These symbols are used to express one self
Material culture

Physical objects like tools, books, clothing,

machines
Material culture which has a religious meaning to
one group may only have an ornamental meaning
to another.
 RITUALS
Rituals act as a “bridge” linking the stages of human life. These phases include
birth, puberty, marriage and death.
In Western culture these rituals have largely disappeared. In non Western culture
we still find many of these rituals.
Christening, circumcision, baptism, graduating from school, graduating from
university, going through puberty getting married and many more.
The ritual death and mourning is important. In some cases social death actually
precedes biological death. Like a person being admitted into a mental institution
or being jailed.
Death is a biological event but can be seen as a social birth to the ancestors.
Rituals concerning death and mourning help people to come to terms with events.
In western society anti depressants and medication often substitutes the role.
 GOING TO THE BUSH
Marks the end of being a child – a ritual
Helps the boy to see himself as a man
Helps the community to see him as a man
He is supposed to be taught how to be a worthy adult
A circumcision will be done (safe?)
This will give him status in his culture
It will improve hygiene
It will help prevent HIV
It may improve his sex life
Go up the mountain a child – come down a man
Equivalent in other cultures - Jews
 BELIEFS DURING PREGNANCY
- Africanwoman conceal her pregnancy to prevent witchcraft harming
the unborn baby.
- Some wear wrist and ankle bracelets to prevent evil spirits from
entering the body.
- They don’t plait their hair to prevent the umbilical cord from knotting.
- They don’t eat eggs, beer and meat and milk as this could result in
abortion or delayed obstructive labour.
- Eating and standing while pregnant is prohibited lest the baby is born
feet first.
- Hot food is avoided - not to burn the unborn baby.
- Intercourse during pregnancy is encouraged- but not allowed during the
lactation period
 BELIEFS DURING BIRTH/THERE
AFTER
- Pain relief during labour is restricted - woman should no show any sign of pain.
- Colostrum is discarded on day one and the baby fed porridge and water.
- Men do not attend deliveries as the blood of labour will weaken the man.
- Previously the umbilical cord was covered with soil. (caused tetanus.)
- The placenta was buried near the place of delivery.
- Death of a previous infant - poison the mother’s milk - making next kid ill
- Intercourse during lactation - leads to illness in the infant.
CULTURE OF TRADITIONAL
HEALERS:
Future doctors should learn about their methods.
- Doctors should identify possible dangers - like re-use of blades
- By advising of the dangers of the spread of disease like HIV and
Hepatitis B we could ensure better health for the community who will
visit these healers
- We could use their influence in communities to address issues like
tuberculosis.
- These are only possible where different healers can coexist
constructively.
 ETHNICITY
Sociologists attach different meanings to the term:
•All people from a specific geographic region, like the Irish, Italian Jewish
•A group speaking the same language and practicing the same religion
• any group that is distinguished from other groups,
• recognizable differences :those from the ethnic group and those
outside..
•Race and ethnicity are two different concepts although they often
overlap.
•One such example is the white South African community
• Racial groups like the black South Africans consists of many ethnic
groups
e.g. Zulu Xhosa, Sotho…
 ETHNOCENTRISM:
- It is the tendency to see your own culture as superior to others
and judge other cultures by the standards of your own
- As physician it is important that you should refrain from this
practice, but still have pride in your own culture.
- To assure that you treat your client properly you should be able to
understand his/her culture and know out of which frame of reference
as far as culture and society is concerned, he/she comes.
- Spirituality consist of all the beliefs and activities by which individuals
S P I R I T U A L IT Y

attempt to relate their lives to God or to a divine being

- Spirituality is not synonymous with religion.
- Physicians should look beyond the physical alone.
- Irrespective of the physician’s own religion, respectful attention must be
paid to the impact religion and belief systems on the patient’s decision
making about health care especially at the end of his life.
- Physicians experience tension if a patient’s decision about medical care is
religiously unacceptable to themselves.
- Lack of awareness of this conflict can lead to ethical dilemmas in some
cases.
- It is possible to maintain balance between science and spirituality without
 INFLUENCE OF SPIRITUAL
AND CULTURAL GROUPS

- Different customs and beliefs has direct impact on modern medicine

- Cultural factors can cause, contribute and prevent disease

- Illness is frequently attributed to ancestors who are displeased.

- Spiritual influences extend to all aspects of life: natural disasters, any calamity which can affect health.
- Ancestors do not only cause illness, but also prevents it.

- Resorting to prayer or to divine intervention often occurs in medical settings.

- In Africa both Western medicine and spiritualty is regarded as useful in prevention and treatment of
illness.
 AFRICA’S (TRADITIONAL)CONCEPT
OF MULTI CAUSALITY
A few examples:

- The wrath of ancestors still plays a role in disease.

- Congenital abnormalities are believed to be visitations of the ancestors.

- Abnormalities appear in the off springs of those that have disrespect to the handicapped.

- Ill health may be caused by destructive spiteful wanton spirits who are not familial ancestral
spirits but are the spirits of persons who died bearing a grudge

- unfaithfulness of a wife may result in an ill baby or prolonged labour.

 EXAMPLES OF ETHNIC AND SPIRITUAL GROUPS:
ISLAM (MUSLIM):
Has specific beliefs as far as organ donation, abortion; autopsy, genetic counselling and declaring
patient’s brain dead are concerned.
Islam reveres the human being both during life and after death: thus Islamic teachings declare that
“breaking the bones of a dead person is like breaking it alive.”
BUT “necessity permits the previously forbidden” allowing autopsy in unexplained or criminal deaths.
Islam encourages early burial and strongly prohibits mutilation or destruction of the body. This rule
can be broken if it conflicts with a more important and urgent interest like saving a human life.
Muslim people will thus accept organ donation.
Muslim scholars understand death as cessation of all bodily activities including breathing, movement,
hearing and the heart beat. Many concede that a brain dead person is dying but will not accept that he
is dead. This has an impact on the termination of life support in a brain dead person
Because many Muslim Imams (leaders) are strongly against abortion and many Muslims follow the
doctrine of their leaders you will find that many Muslim people are opposed to abortion
 RAMADAN:
Ramadan lasts a whole month
It is in the 9 th month of the Islam calendar. ( according to the moon)
The Muslim person practice daytime fasting for this month.
He/she gives up all nourishment including liquid from sunrise to sunset.
For the healthy it has no implication
Amongst sick people it could cause dehydration, electrolyte imbalance and hypoglycaemia.
Although sick people are exempt from fasting by the holy Quran they may still follow their
religious beliefs and do it
This has implications for the doctor treating these people.
Epileptics or other patients on chronic medication where pills should be taken more than
once a day – you must try and find a long acting drug that can be administered once a day
 JEHOVAH’S WITNESS
Jehovah’s Witness refuse blood transfusion, even at the risk of organ injury
or death.
The doctor is placed in the position where the request or refusal of the
patient has ethical and often life threatening implications.
A patient must give informed consent to the administration of blood.
JHWs are strongly discouraged from discussing critical religious issues with
outsiders
At present there are confusion and reforms amongst the faith which should
be taken into account. Vaccination and organ transplant which were
previously not allowed are now accepted practices.
Thus the blood transfusion doctrine might also change in the future.
 (6)
:
This includes:

CULTURAL AND SPIRITUAL FACTORS THAT HAVE AN

INFLUENCE ON HEALTH AND DISEASE
(1) ECONOMIC STATUS
(2) FAMILY STRUCTIRE
(3) GENDER ROLES
(4) MARRIAGE PATTERNS
(5) SEXUAL BEHAVIOR
(6) CONTRACEPTIVE PATTERNS
7) POPULATION POLICY.
(8) PREGNANCY AND CHILDBIRTH PRACTICES
(9) CHILD REARING PRACTICES
(10) BODY IMAGE ALTERATIONS
……MORE
(11) DIET
(12) DRESS
(13) PERSONAL HYGIENE
(14) HOUSING ARRANGEMENTS
(15) SANITATION ARRANGEMENTS
(16) OCCUPATIONS
(17) RELIGION
(19) CULTUROGENIC STRESS
(20) MIGRANT STATUS:
DIET ACCORDING TO
CULTURE
……..AND MORE
(21) USE OF CHEMICAL COMFORTERS
(22) LEISURE PURSUITS
(23) DOMESTIC ANIMALS AND BIRDS
(24) LIFE-CYCLES
(25) AUTHORITY PATTERNS WITHIN THE HOUSEHOLD
(26) PAIN AND CULTURE
(27) COMMUNICATION AND CULTURE
(28) THE MEANING OF COLOUR IN MEDICINE
CULTURE ASSIGNMENT

Due to time restrictions and other logistical problems arising from the Corona
pandemic, the assignment will not be done like previous years.
The mark given for the assignment done on the clinic visits and questionnaires will be
the one used to generate the module mark.
We will have a few slides demonstrating what students would have gained from the
assignment.
TOPIC OF ASSIGNMENT:

According to studies on the Burden of Disease in South Africa,

the 7 leading causes of death are HIV/AIDS, TB, Lung
infections, Diarrheal diseases, strokes, heart attacks and
Diabetes.
The Zulu people of South Africa has a unique culture. Shortly
describe the cultural practices of the Zulu people that (a) make
them prone to these described causes of death and (b) the
cultural practices that make them less vulnerable to the same
causes of death ( protect them)
6 OF THE PRACTICES THAT
THE MDOC CLASS OF 2019
FOUND:
1. Many Zulu's eat a healthy vegetable rich diet
2. they are very hygienic while preparing and eating food
3. they do a lot of dancing during ceremonies and functions
4. they make a alcoholic drink called Umqombothi (and drink it!)
5. boys are circumcised in a coming of age ritual
6. polygamy is accepted
 Are these practices good/bad
and do they prevent or cause any of the 7
mentioned causes of death?
1. a healthy diet is obviously GOOD. It can prevent Diabetes. It can prevent Hypertension so there will be less heart attacks
and strokes. Well fed people will have a good immunity – thus protecting them from infections like diarrhea, lung infections
and TB

2. Good hygiene regarding food – GOOD. Less diarrhea.

3. Dancing a lot – a lot of exercise – GOOD for preventing obesity, diabetes, hypertension, strokes, heart attacks

4. drinking Umqombothi – nutritious ( GOOD) in moderation but if brewed too strong (BAD) – alcohol content goes too high
and blood pressure goes up( hypertension) resulting in heart failure and strokes. Drunk people engage in unsafe sex – risk of
HIV infections that in turn lower the immunity and lead to infections like diarrhea, respiratory infections and TB

5. Male circumcisions – Can help prevent HIV.(GOOD) BUT if done with dirty instruments, it can transfer HIV from one boy to
the next (BAD) It can also give a false sense of immunity against HIV- leading to unsafe sexual practices (BAD)

6. Polygamy - more than one sexual partner means that all the partners can get HIV if any party in this marriage contracts
HIV (BAD)