Session 10: Indian Culture - POGOe



ELDER ProjectFairfield University School of NursingCultural DiversityAsian Indian CultureObjectives:At the end of this session, the participants will be able to:Discuss the role of religion, traditional health care beliefs, social values, and family structure of Asian Indians and the impact these factors have on health care.Identify specific culturally sensitive practices that can be incorporated into your work with Asian Indian patients and American Asian Indian patients.Food Presentation……………………………………….…….……………….5-10 minutesDepending on one or two presentersIntroduction……………………………………………………………………….....5 minutesThe Asian Indian culture is a complex and diverse ancient culture. Indian Americans, known more commonly as Asian Indians, makeup the largest subgroup of South Asians consisting of people from India, Pakistan, Bangladesh, Nepal, and Sri Lanka. They may refer to themselves as East Indians or Indo-Americans. Their immigrant communities share some common cultural, social and linguistic characteristics and are often grouped together. Some immigrants from the Caribbean, East Africa and Fiji also identify themselves as South Asian. While the majority of this discussion will focus on those people from India, the surrounding nations have a mixture of cultures that include a mixture of religious beliefs. The discussion will center on Hinduism with some reference to Buddhism, where appropriate.Bangladesh: Muslim 89.5%, Hindu 9.6%India: Hindu 80.5%, Muslim 13.4%, Christian 2.3%, Sikh 1.9%Sri Lanka: Buddhist 69.1%, Muslim 7.6%, Hindu 7.1%, Christian 6,2%Nepal: Hindu 80.6%, Buddhist 10.7%, Muslim 4.2%, Kirant 3.6% Pakistan: Muslim 95% and 5% Hindu and ChristianAreas of Focus…………………………………………………………...………..20 minutesCommunicationThe major language is Hindi; however English is commonly used in many areas of life.Most Asian Indians are bilingual or multilingual.Eighteen languages are recognized in India.Use of formal titles is expected (Mr. and Mrs.) until told otherwise.Addressing people older than you by their first name alone is disrespectful.Embracing members of the opposite sex is unacceptable; however it is acceptable with members of the same sex.Public displays of affection are not encouraged.Direct eye contact is limited. Traditional Indian greeting is “namaste” which is uttered while joining palms together as if in prayer under the chin slightly nodding the head and looking down.Family and Social StructureSeveral generations will live in the same household sharing a common budget.Older Asian Indians may be financially dependent on their children.Grandparents play a role in raising children and are highly respected and form a link to Asian Indian culture and heritage.Respect is important and old age signifies wisdom.Strong family bonds exist with a close knit family structure.Asian Indians practice patriarchal extended families.The head of the house is the senior male, who also makes all the decisions.In the US, the American Asian Indian tends to be more a nuclear family.Joint families are temporary; once they are self-sufficient they move out.Personal HygieneShowers are more the norm as tub baths are seen as unsanitary.The focus on bathing is being clean rather than on eliminating body odors.Using deodorants is not a common practice.Odors are not seen as potentially offensive. Modesty is highly valued.View of IllnessHealth is related to connectedness of the body, mind and spirit.Mental illness is concealed and often presented as somatic complaints.The elderly focus spiritually in preparing the soul for life after death.Pain and suffering are viewed as due to bad karma from a past life or past actions. Illness may be seen as something to be accepted and endured rather than fixes or cured. Consequently, Asian Indians may be stoic in their expression of pain.The Asian Indian respects authority of the healthcare provider and feels their own role is passive.They will not ask a lot of questions as this is viewed as impolite.They would rather ignore suggestions if they do not agree, which may result in missed appointments or excuses for not following the plan of care.Offering a variety of treatment choices can make the physician seem incompetent as it is expected that the physician be confident.Family and friends may want to provide personal care when in the hospital.Folk MedicineTend to use home remedies such as massage, ritual bathing and herbal medicine before seeking a physician.Physicians are only sought for serious illnesses.The Asian Indian is less open to homecare or long term care for elders.When caring for the ill, they will utilize behaviors such as:ritual chanting by priests, tying a thread around the sick person’s wrist, writing protective verse and wearing it in a metal cylinder around the neck or wristpromising temple god gifts if they recoverAyurvedic Medicine is the traditional Indian system of medicine. Pronounced (ī'y?r-vā'd?, -vēc')Translated it means the meaning of the knowledge of life. Relates to the complete human being, body, mind, senses and soul. Focuses on attaining balance between the physical, mental and spiritual.Four questions and life span allied issues are elaborately and emphatically discussedWhat is beneficial?What is harmful to life?What is happy life?What is sorrowful life?In Ayurveda, the belief is that every individual is made up of three doshas (fire, wind and water) that represent certain bodily activities. Ayurveda uses specific lifestyle and nutrient guidelines to help decrease the dosha that has become excessive. Mercury and sulfur based medications and herbs are used to treat ailments and emetic herbs to maintain body homeostasis or balance. Surgical techniques are also used and are aimed at preserving life and promoting well-being. Unani or Yunani Medicine:Can be traced back to HippocratesBased on the ancient Greek theory of four basic elements (air, earth, fire and water) and four bodily humors which determine one’s temperament and health - blood, phlegm, yellow bile and black bile. When a person is in perfect balance - a person is healthy.Treatment is aimed at restoring natural balance by dietary modifications. The use of ripening, purging, cupping, sweating, diuresis, herbal bath therapy, massage and exercise is common as well.Siddha Medicine:One of the oldest systems of medicine in India.Has close similarity to Ayurveda, with specialization in Iatrochemistry (seeking chemical solutions to disease and medical aliments).According to this system, the human body is the replica of the universe and so are the food and drugs irrespective of their originUses calcined metals and mineral powders to heal illness. Ayurveda, Unani and Siddha Medicines are practiced medical systems in India.View on End of Life Care and DeathFamily may not want the doctor to tell the patient their diagnosis.Family centered decision making.Family is present when the patient is close to death.They prefer to die at home.Dying patient may want to be moved to the floor to be closer to mother earth or positioned in specific directions.They believe the dying individual should be thinking of God as they go through the dying process. The thoughts that they are thinking at the time of death determine the destination of the departing soul.At the time of death:Family will prefer to wash the body.Family will chant hymns.Hindu priest may perform a prayer and blessing.Family will prefer privacy for the family after death for religious rites.Family will openly express grief.Prefer cremation. Mourn for a 10-40 day period.Do not usually agree to post mortem examination or organ donation.Dietary HabitsDietary staples include rice, grains and breads.Many are vegetarians or vegans. Have diets rich in carbohydrates, poor in protein and deficiencies in calcium.If they do eat meat, it usually is not beef (Asian Hindus). The cow is recognized as a life giving role:producing dairy products, pulling plows, and fertilizing fields Gelatin based products are avoided because the processed collagen comes from cows or pigs.Asian Muslims do not eat pork and consume halal foods which are religiously accepted.Lactose intolerance is very common in the older person.Fasting is common; believe it improves the welfare of the family.Chew betel leaves because they act as anti-flatulent and anti-inflammatory.Often chewed with tobacco, which can lead to oral cancer.Use a lot of spices:Curcumin is an active ingredient in turmeric, a key ingredient in Indian curry that has anti-inflammatory and antioxidative properties. Thought to be a protective factor in the aging brain and dementia. Eating and drinking from another person’s plate or glass or using dishes that have been used by someone else is not acceptable.Time OrientationBelieve things will happen when they have to happen. Bulk of Indian population live in villages or in the country and time is measured by seasons instead of dates and watches.Religious Beliefs Religion is central to the way of life.80% Hindus: Believe everyone goes through a series of births or reincarnations that eventually lead to spiritual salvation. With each new birth, one moves towards enlightenment. Believe in a cast system.Other religions include: Muslim, Christianity, Jainism (nonviolence towards all living creatures), BuddhismSikhism (intended to bring the best of Hinduism and Islam together)Hindu religion has aspects that affect health care decisions:“Karma” involves the actions of past life that affects circumstances in which one is born and lives in this life.Often believe illness is caused by Karma and that every action leaves an imprint on one’s soul and spirit.Believe good actions produce good results and bad actions produce bad results. Karma greatly influences the patient’s world view of health, death and dying and model of illness.Buddhism adheres to non-violence and advocates giving up worldly desire to attain nirvana (salvation). Believe in four truths: Life leads to suffering Suffering is caused by desire, Suffering ends when you give up desire and attain enlightenment,Reaching this state is achieved by the eight fold path.Hindu religious paraphernalia include: Mangalsutra - a 9 sacred necklace which is worn by a married woman. Women also may wear a bindi or tilak (dot on forehead). Other symbols of marriage are bangles and toe rings. Men wear a sacred thread around the torso. Both sexes may be reluctant to remove these items.Sikh men do not cut their hair and wear a bracelet and a turban.Activity……………………………………………………….…………….………..20 minutesJeopardyConclusion……………………………………………………………………..…....5 minutesReferences:About the Systems. Retrieved on March 10th, 2010 from Indian Culture:Influences and Implications for Health Care. Retrieved March 10th, 2010 from and Healthcare of Asian Indian American. Retrieved December 18, 2010 from World Factbook: South Asia: India. Retrieved March 25th, 2010 from , V.J. and Dara, S. (2010). Health and Healthcare of Asian Indian American Older Adults. Retrieved February 5, 2011 from with People with Disabilities: An Indian Perspective. Retrieved December 12, 2010 from http:// cirrie.buffalo.edu/cultural/monographs/India.php. ................
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