There have been different definitions of culture by different scholars and in different models but according to the Purnell model culture is defined as the totality of socially transmitted lifeways, customs, values, beliefs, art, behavioral patterns, and all the other human work products and thought characteristics of people that are the guide to decision making and worldview (Purnell, 2002). The patterns may be implicit or explicit, are emergent phenomena that change depending on the global phenomena, are shared by most members of a culture, and are primarily learned and transmitted within the family. The Purnell model is a circle containing the outer circle which is a representation of the global society. The global society is composed of world politics and communication, warfare and conflicts among others. The second ring of the model is the community defined as a group of people with the same identity or interest and habiting a known locality. The third ring of the model represents the family. The model has a fourth ring which represents a person. In accordance with the model, a person is defined as a constantly adapting biopsychosociocultural human being. From the ring containing the person are 12 cultural concepts and domains represented by wedges. One of the 12 wedges is composed of healthcare practices (Purnell, & Paulanka, 2003). Apart from the healthcare practice wedge, there are other wedges that are vital in gaining an insight into the health practices of a patient.
The healthcare practice is focused on health care. It entails information on the type of treatment that culture seeks, beliefs in healthcare, traditional practices, the health responsibility at the personal level, self-medication practices, how the culture perceives some health practices such as rehabilitation, mental illness, or organ donation. The healthcare practice also contains information on the role of the sick, barriers to health practices, and how pain is expressed.
I conducted an interview with a patient had been a Chinese resident but currently resided in the U.S. The patient was in the U.S. to further his education in economics and statistics. The interviewee availed information that was informative in understanding some of the health practices in China. According to my interviewee, according to their culture health is maintained through a balance between hot (Yang) and cold (Yin). The lack of “Chi” (energy) results in illness. They perceive the body as a gift that must be given a prioritized value through care.
The Chinese focus more on preventive treatment compared to acute treatment; most medicines taken are medicines of prevention. The interviewee described their medicine as an “acupuncturist”. The process of taking the medicines is comprehensive and extremely thorough. The interviewee gave an example of a headache stating that when one complains of a headache the treatment is not focused solely on the headache but rather the entire body in all its aspects. The interviewee defended her statement stating that a headache is only a symptom and the treatment should be focused on the main cause. The body is perceived as a whole and any alteration call for a treatment focused on the entire body. In the event, there are multiple symptoms the treatment is dependent on the symptom severity. If a patient has acute symptoms and that result in distress the initial treatment focuses on the symptom elimination following which is the root cause treatment.
According to the interviewee, their traditional healing is divisible into two parts; secular and sacred folk healing. The value of folk healers is slowly diminishing and they are only consulted in some medical conditions by a very limited number. Most of the folk healers are found in Taiwan and Hong Kong, the interviewee comes from Taiwan. The sacred folk healing encompasses a wide assortment of religious experts including temple base spiritual ritual specialists, interpreter of fortunes, various spirit mediums, magicians and Taoist priests and Shamans (wu). The folk healers are only present in some remote areas and do not practice their healing within the cities. Though these healers exist, the current medicine has taken a hold of the means of handling illnesses in China, the folk healers receive little consultations from the residents. The interviewee stated that the secular folk medicine has taken a different approach in the modern China. The secular folk medical practices included martial art conducted for health purposes, itinerant herbalists who are mostly illiterate and practice empiric herbal tradition that is currently overcome by the modern medicine. Some of the secular folk healers have been retrained to be the modern health care providers while most seem to have withered away. Though the Folk healers are limited in number, there exists people who consul them. one of the key treatment that the folk healers are well renown for is a practice referred to as scrapping. Scrapping entails the use of pieces of smooth stones, horns, animal tusk, bone or smooth jade to scrap along the skin in an effort to release toxins and obstructions that are trapped on the skin surface.
There were numerous traditional healthcare practices that the interviewee describes. One of the practices was a type of massage that entailed the placing of several plastic or glass “cups” on the body. This practice is referred to as capping (a type of massage). The other traditional health practice was the use of herbs which can come from different seeds, leaves, flower, stem, or roots. One of the traditional herbs that is currently widely used is the ginseng. The Chinese also use the practice of needle insertion into the muscles, subcutaneous tissues and superficial skin at particular acupuncture points and manipulate them (acupuncture). There is a belief that acupuncture helps in keeping a balance between “yin” and “yang” thus allowing the flow of “Qi” which is essential in the restoration of health to the body and the mind (Mervak, Kalinowski, & Gupta, 2011). Other applicable traditional health practices include moxibustion and the Tui Na Massage.
In China, the human body is perceived as a sacred being and a gift, therefore, some medical procedures such as surgeries or organ donation can be refuted. For them, it is best to die with body intact. They also believe in reincarnation.
There are various communication patterns in China that affect healthcare provision. A case in point is starring too much into a persons’ eye which is perceived as a sign of disrespect. Too much physical contact is not acceptable. The elderly in the Chinese culture is highly respected and their opinions in an access to care may impact the care approach an individual takes. Some of the other health barriers for people include communication barriers. According to the interviewee the dominant language in china is Standard Mandarin which makes it difficult for non-English Chinese to access care from regions where English is the only language used in care provision. The other challenge to care provision was the negative perception by some of the China residents on the western treatment. The western medicines are not entirely welcomes in china and in addition to this the traditional medicines are highly valued in China. In china emotions are often hidden, a smile may be an indicator of lack of comprehension rather than agreement. This may affect the manner in which a healthcare provider attends to a patient (Snowden, & Yamada, 2005). The Chinese diet has a positive contribution to an individuals’ health. Most of their diet is composed of vegetables, meat, seafood and rice. The Chinese prefer home cooking and meals may be availed to a sick patient particularly soup which is believed to clean the system.
There are health conditions that are highly stigmatized and those suffering from them highly discriminated upon. Among the most challenging health aspects in China are the mental health. The issue of mental health is rarely openly talked about and seeking medical assistance from such an illness becomes a problem. Those with mental problems are avoided or rejected and sadly in some cases by those close to them. The interviewee stated that the stigmatization associated with mental illness is a universal phenomenon and she believed that it is in the same margin as the case in China only that the mental illness perception is different in China. In China, any cognitive impairment is associated with psychoses and there is a belief by most China residents that psychological problems like anxiety and depression can be healed without treatment. There are few people that visit mental health centers with the heightened belief that it is not a health condition. Additionally, the interviewee stated that some health conditions such as mental health are influenced by family emphasis as well as Confucian philosophy. She stated that their culture focuses more on social goals and personal duties rather than personal and individual rights; the failure of fulfilling an individual’ duties at societal or family level can result in a feeling of shame or guilt or to some extent mental health problems.
References
Mervak, B., Kalinowski, A., & Gupta, M. (2011). Acupuncture in China. Southern Medical Journal, 98(3), 310-337.
Purnell, L. (2002). The Purnell model for cultural competence. Journal of transcultural nursing, 13(3), 193-196.
Purnell, L. D., & Paulanka, B. J. (2003). The Purnell model for cultural competence. Transcultural health care: A culturally competent approach, 2, 8-39.
Snowden, L. R., & Yamada, A. M. (2005). Cultural differences in access to care. Annu. Rev. Clin. Psychol., 1, 143-166.
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