Archive for January, 2008

Understanding Singapore Chinese Culture And Its Impact on Health and Illness.

Chinese Culture: The “inherited lens”


As Featured On Ezine Articles

Singapore is a cosmopolitan country and its population comprises the Chinese, Malays, Indians, and others such as the Eurasians. In this heterogeneous, multi-racial, multi-lingual and multi-cultural society, perceptions towards illness, medical treatment and health beliefs are expected to be varied. The fact that such diversity of the population as the various ethnic groups continue to celebrate their own cultures while they intermingle with one another, between people from different backgrounds and different genders. According to Helman (1994), the rules that underpin the organization of a society in the way it symbolized and transmitted, are all part of that society’s culture.Helman (1994) also observed that culture, to a certain extent, can be seen as an “inherited lens” through which the individual perceives and understands the world in which he or she lives and learns to live within. The “inherited lens” has given us different perspectives of how individuals view their health and illness, and affects the way they respond to symptoms. It is also via this “inherited lens” that a patient determines how he seeks out health care.

A Singapore Minister, Mr Yeo, G. (2001) had distinctly highlighted that cultures evolve continuously, and are constantly in competition with each other. Although political correctness required us to view that all cultures are equal, but in reality, to achieve equality in cultures is an absurd proposition. Both cultural understanding and structure of health care, therefore, play an important part in determining health and illness. With the understanding of relevant health belief systems, we will enable the development of culturally sensitive health promotion programmes (Lee et al., 1993).

While culture can be influenced by other social variables like gender, class and age, other personal past experiences may also affect a person’s responses to health beliefs. As a health care professional, we must take care to ensure that patients from certain cultural backgrounds are not stereotyped.

Chinese in Singapore

Chinese settlement has taken place in Singapore from the mid 19th century, with most people coming from southeast China (Singapore Chinese Physicians’ Association, n.d.). Early migrants left China because of wars, floods, famine and poverty, and found work at the Singapore harbours.

Over the past 20 years, Chinese immigrants have arrived from Malaysia, Hong Kong, Taiwan, Vietnam and elsewhere in Indochina. More recently, they have arrived from People’s Republic of China (PRC), and these immigrants speak Mandarin and other Chinese dialects. They bring with them their own culture, and now have to integrate into a new culture. Prior to 1965, most Chinese immigrants were working class (Chang, 1999) and recently, we have seen more professionals immigrating into Singapore.

Reference:

Chang, K. (1999). Chinese Americans. In J.N. Giger & R.E. Davidhizer (Eds.), Transcultural nursing: Assessment & intervention (pp. 385-401). St. Louis: Mosby.

Helman, C. G. (1994). Culture, health and illness: The scope of medical anthropology (3rd ed). Oxford. Butterworth – Heinemann.

Lee, K. L., Schwarz, E. and Mak, K. Y. K. (1993) Improving oral health through understanding the meaning of health and disease in a Chinese culture. International Dental Journal, 43, 2–8.

Yeo, G. (2001, May 17). Interview with BG (NS) George Yeo, Minister for Trade and Industry by Dr Albert Bressand and Catherine Distler of Promethee in Paris. Retrieved January 05, 2007, from https://app.mti.gov.sg/default.asp?id=148&articleID=333&intViewCat=1&intCategory=3&txtKeyword=&txtStart=
&txtEnd=&intOrderBy=1&intYear=&intQuarter=0


Page Tags: chinese culture, health, illness, inherited lens, health beliefs

Leave a comment »

Traditional Chinese health beliefs: Ancient tradition of the Chinese culture and the philosophies

Traditional Chinese health beliefs adopt a holistic view emphasizing the importance of environmental factors in increasing risk of disease. According to Quah (1985), these factors influence the balance of body’s harmony, yin and yang. These are two opposite but complementary forces and, together with qi (vital energy), they control the universe and explain the relationship between people and their surroundings. Imbalance in these two forces, or in the qi, results in illness.

In order to restore the balance, traditional remedial practices may be needed. For example, excess `hot’ energy can be counterbalanced by cooling herbal teas, and vice versa. These beliefs are deeply ingrained among the Chinese, and have been found to be unchanged following migration to Singapore.

Lee, et. al. (2004), found that patients with specific chronic diseases, namely arthritis, musculoskeletal diseases and stroke, were more likely to use Traditional Chinese Medicine (TCM). This was strongly determined by the ‘chronic disease triad’, perceived satisfaction with care and cultural health beliefs.

Hence the use of TCM is not associated with the quality of doctor–patient interaction. Astin (1998) also agreed that it was seen as being more compatible with the patients’ values, spiritual and religious philosophy, or beliefs regarding the nature and meaning of health and illness.

In traditional Chinese culture, taking medication is thought to be aversive, hence medications tend to be taken only until symptoms are relieved and then discontinued; if symptoms are not obvious, medications will probably never be taken.

Apart from parental cultural beliefs, minor side effects of certain antibiotics such as stomach upset may contribute to the poor adherence of medication. The use of “leftover”, “shared” antibiotics and over-the-counter purchase of antibiotics by parents are common situations in the community.

They think that their children suffer from the same illnesses judging by the similar symptoms, so they would give the “leftover” or “shared” antibiotics to their children and only bring them to their doctors if there is no improvement (Chang & Tang, 2006). This may cause their conditions to deteriorate and may necessitate aggressive treatments later which may have unnecessary side effects.

However, there are small groups of Chinese who also blamed ill-health or misfortunes on supernatural forces, or on divine retribution, or on the malevolence of a ‘witch’ or ‘sorcerer’ (Helman, 1994). Such groups will usually seek cures from their religions.

In Singapore, the Ministry of Health has drawn up the TCM Practitioners’ Ethical Code and Ethical Guidelines to prevent any unscrupulous practitioners from preying on their patients and taking advantage of their beliefs, for example, molesting ignorant patients.

The degree of acculturation has been evidenced in the following case. An old man was brought into our hospital with a week-long history of malaise, nausea and vomiting, and sudden jaundice. He was diagnosed to have an obstructive mass in the liver.

A biopsy revealed hepatocellular carcinoma. The serological test suggested chronic active hepatitis B. When the news broke to his son that his father had cancer, he requested not to disclose that to his father.

When we discussed end of life issues such as hospice care and “do-not-resuscitate” (DNR) orders, the son tried to divert the discussion to other issues such as when his father could go home.

Cultural Issues that may be involved in this case are:

  1. The Chinese tend to protect the elderly from bad news.

  2. Believing in karma – the older folk believe that discussing illnesses or death/dying is bad luck. They think that talking about something bad will cause it to come true.

  3. There is an increased incidence of liver cancer resulting from Hepatitis B due to delayed treatment in the elderly, as it may take a long time for them to accept the initial diagnosis.

Reference:

Astin JA. (1998). Why patients use alternative medicine. J Am Med Assoc 1998; 279: 1548–1553.

Chan, G. C. & Tang, S. F. (2006) Parental knowledge, attitudes and antibiotic use for acute upper respiratory tract infection in children attending a primary healthcare clinic in Malaysia. Singapore Medical Journal, 47(4):266

Helman, C. G. (1990) Culture, Health and Illness. Wright, London.

Quah, S. R. (1985) The Health Belief Model and preventive health behaviour in Singapore. Social Science and Medicine, 21, 351–363.

Lee GBW, Charn TC, Chew ZH and Ng TP. (2004). Complementary and alternative medicine use in patients with chronic diseases in primary care is associated with perceived quality of care and cultural beliefs. Family Practice, 21(6): 654–660.

Page Tags: health beliefs, holistic, imbalance, karma, risk of disease, spiritual and religious, traditional chinese medicine, yin and yang

Leave a comment »

Keppra: Western Drug for seizure.

One of my clients called me to complain that he had two fits in a day and each lasted for half a minute. He went to a hospital and had his blood tested for Phenytoin, which is an antiepileptic drug.

His blood result was normal. The doctor in the Emergency Dept, prescribed another drug for him. Keppra was ordered. Keppra is an expensive drug and my client was wondering if he should take it as he was feeling alright now.

I did a search in the cyberspace and I am glad that he did not start the drug. You will need to depend on this drug for a very long term. If you stop taking it, your episode of fit will increase. It was recommended the this drug should be taken with other antiepileptic drugs.

Unfortunately, my client is taking phenytoin now and by taking it together with keppra, he will feel very very drowsy.

I went to his house and diagnosed that phlegm was building up in his body. He told me that before he had fits, he was eating food with sweet red bean saurce. I told him that the saurce was sweet and that will cause his body to create more phlegm.

Normally, in Chinese Medicine, a herbal formula will be prescribed for clearing the phlegm out of the meridian paths. The stagnation of the paths will reduce the good qi from moving to his head and nourish his brain. The temporary shortage of qi in the brain may cause him to have fits. In his case, a hua tang  jian tang may help to clear the phlegm in his body.

The following is the detailed description of the western drug that the doctor prescibed to him. Nothing much was mentioned to him about the drug, except that he was told that it must be taken for long term.

Generic Name: levetiracetam(lee ve tye RA se tam)
Brand Names: Keppra

It is an anti-epileptic drug and is used to treat partial onset seizures in people with epilepsy. Do not change your doses or medication schedule without advice from your doctor, once you start the medicine.

Swallow Keppra whole, and not to break, crush, or chew before swallowing. The prescription refilled before you run out of medicine completely is important in order to get the most benefit out of this drug.

Blood may need to be tested on a regular basis that also includes the liver function. This is to ensure that the medication is not causing harmful effects. Do not stop taking Keppra suddenly as you may have increased seizures.

You may want to consider the consequence before taking it. Keppra can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid using together with other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxants, and medicine for seizures, depression or anxiety). These drugs can add to sleepiness that was also caused by Keppra.

Get emergency medical help if you have any of these signs of an allergic reaction like:
. hives;
. difficulty breathing;
. swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:
. unusual thoughts or behavior;
. anxiety, hallucinations;
. feeling angry, hostile, or agitated; fever, chills, body aches, flu symptoms;
. weakness, lack of coordination; or
. increasing or worsening seizures.

Other, less serious side effects may be more likely to occur, such as: dizziness; drowsiness; or depressed mood.

Remember that in the case of emergency, do carry an ID card to identify that you are taking Keppra.

Page Tags: keppra, levetiracetam, phenytoin, seizure, side effect

Leave a comment »