Diversity in Medicine
It is difficult to find more heterogeneous and multicultural country that the United States of America. People have been coming to it for centuries and creating a unique American culture that consists of multiple ethnical identities. Even though the 21st century is the age of globalization, the traditions are still very important in the US. Ethnical minorities guard them as something that makes them original and different from the crowd.
Cultural and religious diversity of the United States can be definitely called a continuous challenge for Emergency Medical Services (EMS). There are many issues that influence the work of the EMS and the most serious and, perhaps, harmful, are nontraditional methods of treatment that are loved by people, their cultural and religious background. These three factors can be called “the rule of stereotypical thinking”, because each of them is not bad on its own account, but when they lead to rejection of traditional medicine, the results are often horrible. People who usually overuse these stereotypical thinking do not allow the EMS personnel to deliver patients quickly to the hospital.
According to the information of National Health Interview Survey (NHIS), many Americans use alternative and complementary medicine methods, and even pray for health. Some of the religious and cultural issues can create problems in the work of emergency services. That is why it is essential to go into details of non-traditional medicine, so that it would be easier to provide patient with care.
Western medicine is often opposed to alternative methods of treatment that are usually based on cultural and religious features. Nontraditional medicine uses a great variety of methods like diet changing, connection of spirit, body and mind, yoga practice, treatment with herbs and acupuncture. Popular alternative healing practices include aromatherapy, exercising based on particular system like Tai Chi, and massage. According to the classification proposed by the National Center for Complementary and Alternative Medicine (NCCAM), alternative and complementary therapies are classified into five distinct categories:
“Alternative whole medical systems (homeopathic and naturopathic, Chinese, and Ayurvedic medicine);
Mind–body interventions (meditation, prayer, mental healing, art, music, and dance therapy);
Biologically based therapies (herbs, foods, vitamins and other dietary supplements, including natural products such as shark cartilage);
Manipulative and body-based methods (chiropractic and osteopathic manipulation, massage);
Energy therapies (qi gong, Reiki, therapeutic touch, and electromagnetic field exposure)” (National Center for Complementary and Alternative Medicine) (Ventola, 2010).
All these things are not harmful and are often used by doctors of traditional western medicine in combination with the main prescription. However, the main drawback of nontraditional methods of treatment is that people prefer them to traditional ones. They do not go to see the doctor, taking herbs instead of medicines and it often leads to serious problems with health. In addition, insurance companies not cover alternative ways of healing and these methods are not regulated be the government at all. That is why there is a risk to be fooled by a charlatan, and that will be not only the problem of lost money, but also the problem with lost health.
Herbal supplements and vitamins are very popular among Americans nowadays. Reuters writes that nontraditional medicine became a successful and actively growing business in the United States. The reporter gives the information:
“Complementary or alternative therapies make up 1.5 percent of the $2.2 trillion in total health care expenditures.
Popular products included fish oil, glucosamine to treat arthritis and Echinacea to prevent or treat colds.
Common treatments included acupuncture, chiropractic and osteopathic manipulation and traditional healing.
On average, an adult spent $121.92 on visits to providers and paid $29.37 out of pocket per visit.
People spent $14.8 billion out of pocket to buy nonvitamin, nonmineral, natural products – a third of what is spent on pharmaceuticals” (Briand, 2009).
The Food and Drug Administration writes that there are approximately 54.000 varieties of food supplements that can be easily brought in the Internet or in the stores without any prescription. USA Today described one of the big number of accidents that happened because of the overuse of nontraditional food supplements and because the patient neglected traditional doctors. The accident happened in Philadelphia. A 12-year-old girl was taken to the hospital by an emergency, where she was diagnosed with pancreatitis. Her mother gave her more than 80 food supplements and that caused hard intoxication of the girl’s organism. The girl was treated from a so-called “chronic Lyme disease”, which is not recognized by traditional medicine at all. Her mother gave those numerous supplements for four last years. This disease does not require excessive long-term treatment with antibiotics, like alternative practitioners propose. The girl was discharged from the hospital in several weeks after she underwent traditional healing. This situation seems to be strange, but many doctors note that is it a usual thing in their practice (Szabo, 2013).
Another situation connected with nontraditional methods of treatment had a fatal outcome. This story took place in the Rocky Mountains where a group of geologists was working. There was one woman in that group and she had intimate relationships with a man from their team, and soon she understood that was pregnant. She did not want to give birth for a child and decided not to go to the nearby city for abortion. An Indian woman told her an old method of nontraditional abortion. It was necessary to take a poisoned tooth of a viper, crush it, wrap into a piece of cloth and “insert” into vagina. The snake’s poison was supposed to dissolve the fetus. The woman did everything according to the ancient Indian instruction and returned to work. It is crucial to not that she changed the height and went from the mountain to the plain. Soon after she returned to the campus, menstruation began and in a day she was dead. The postmortem diagnosis stated that she had a menstrual retardation because of the change of climate and atmospheric pressure. As a result, the viper’s poison absolutely burnt the woman’s uterus.
It is crucial for Emergency Medical Services to recognize and deal effectively with such cases of harmful nontraditional treatment. EMS specialists need to know the common use of food supplements and other drugs that are not usually prescribed by doctors. They also need to know the most characteristic symptoms of such supplements. It is necessary to understand the potential reaction those drugs can on traditional medicines. The EMS specialists also have to monitor the signs of intoxication and other adverse events. In addition, it is important to give patients information about the danger of nontraditional treatment without medical supervision.
Religious and cultural gender bias can also create many difficulties for EMS personnel. The first problem is that there are many religions in the United States and it is difficult for doctors to know all the details about it. This lack of knowledge might lead to strange effects like insults and negative reaction to the treatment. The second problem is that women in certain religions and cultures do not dare to go to the hospital if they have a problem. This also refers to cultural gender bias that exists in our society.
This example is about the cultural stereotypes about gender and age. The story took place in a small town where everyone knew what is going on in their neighbor’s house. A 14-years-old girl from a descent family got pregnant from her classmate and could not dare say that news to her parents. She also could not find enough money for abortion in the hospital without letting her parents know about her circumstances. The girl was afraid of public reprimand and once she learned that a man in a neighboring village could help her free. That man was an animal technician and knew how to treat cows. The problem was that he was a virgin and never saw a naked woman. Therefore, when the time of surgery came, he scraped out something that was supposed to be a fetus not from the uterus, but from the girl’s anus. The animal technician mixed those two things. The girl died from the loss of blood on her way home.
Another example of religious bias refers to Muslim women. It is not a new thing that women from this religion are not allowed to show their body to men, even if they are doctors. Muslim women explain such behavior citing the Hilali-Khan translation of the Koran:
“And tell the believing women to lower their gaze (from looking at forbidden things), and protect their private parts (from illegal sexual acts, etc.) and not to show off their adornment except only that which is apparent (like palms of hands or one eye or both eyes for necessity to see the way, or outer dress like veil, gloves, head-cover, apron, etc.), and to draw their veils all over Juyubihinna (i.e. their bodies, faces, necks and bosoms, etc.) and not to reveal their adornment except to their husbands, their fathers, their husband’s fathers, their sons, their husband’s sons, their brothers or their brother’s sons, or their sister’s sons, or their (Muslim) women (i.e. their sisters in Islam), or the (female) slaves whom their right hands possess, or old male servants who lack vigour, or small children who have no sense of the shame of sex” (The Koran).
This leads to numerous inconveniences the EMS specialists face in their work, because not every team has a female doctor and there is usually no time to call for help, because the cases are urgent. The EMS personnel do not only need to transport the patient to the hospital. They also have to examine the patient and react quickly to the situation. The presence of the husband, the father and the brother of the woman patient might make the EMS specialists nervous and disturb them from doing their work. Even though the situation is difficult, the doctor needs to keep calm and be polite with the family.
The example that is very characteristic for gender bias caused by religious stereotypes is about abortion at home. The family had six children and the woman did not want to have the seventh one, but she also refused to go to the hospital, because they were living in a small town and she was known to be a religious woman. Therefore, the friend of the family, who was just a physician, agreed to “help” the woman at home. In the end, he pierced her womb and opened the bowel. He clearly understood that it was necessary to call the EMS, but he was afraid of prison. It was possible to save the woman with immediate abdominal operation. However, the friend of the family put the bowel back with the forceps, gave the woman tetracycline and went home. She died from peritonitis in five days.
The EMS personnel face numerous problems connected with ignorance, stereotypes, prejudices and overall inadequacy in their work. Many people are scared of doctors. Those who are very religious think that a good prayer might cure all the diseases, but in reality, it does not help paralytics stand up. A great number of people die without professional medical help because they fear the reaction of the society. The examples of delicate problems like unwanted pregnancies illustrate the gender nuances fully. The EMS specialists need to be good psychologists, because they deal with patients of different cultural and religious background and have to keep in mind many details about each tradition.
It is difficult to overestimate the importance of work of the Emergency Medical Services. The first help, the psychological support of the family and the patient, the quick and safe transportation to the hospital depends on them. The EMS personnel need to be skillful in the questions of medical help and flexible in the psychological issues to avoid problems with patients. However, there is one thing that might make the work of EMS easier – it is the war with medical ignorance of people, who sometimes prefer to drink herbal tea instead of calling the EMS or seeing the doctor.
Briand, X. (2009, July). Alternative medicine a big business in U.S.: report. Reuters. Retrieved from http://www.reuters.com/article/2009/07/30/us-usa-health-alternative-idUSTRE56T6MN20090730
Szabo, L. (2013, July). Book raises alarms about alternative medicine. USA Today. Retrieved from http://www.usatoday.com/story/news/nation/2013/06/18/book-raises-alarms-about-alternative-medicine/2429385/
The Koran. Retrieved from http://quran.com/
Ventola, L. C. (2010, August). Current Issues Regarding Complementary and Alternative Medicine (CAM) in the United States. US National Library of Medicine. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935644/