Cultural Diversity

Cultural Diversity ELDER Project Fairfield University School of Nursing Asian Indian Culture Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Objectives: Upon completion 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 Indian culture 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 Asian Indian American patients. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Introduction: • The 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Introduction: • 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Communication: • The 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Communication: • 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Family and Social Structure: • Several 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Family and Social 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Personal Hygiene: • Modesty is highly valued. • Showers 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture View of Illness: • Health 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture View of Illness: • 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Folk Medicine: • Tend 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 wrist • promising temple god gifts if they recover Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Folk Medicine: • Ayurvedic medicine is the traditional Indian system of medicine. (ī'yər-vā'də, -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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Folk Medicine: • Ayurvedic Medicine • 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Folk Medicine: • Unani (or Yunani) Medicine: • Can be traced back to Hippocrates • Based 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Folk Medicine: • 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 origin. • Uses calcined metals and mineral powders to heal illness. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Note: • Though categorized under Folk Medicine, Ayurveda, Unani and Siddha Medicines are practiced medical systems supported and promoted by the government in India. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Dietary Habits: • Dietary 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 • fertilizing fields • Gelatin based products are avoided because the processed collagen comes from cows or pigs. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Dietary Habits: • 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Dietary Habits: • 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Time Orientation: • Believe 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture 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) • Buddhism • Sikhism (intended to bring the best of Hinduism and Islam together) Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Religious Beliefs: • 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Religious Beliefs: • 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Asian Indian Culture Religious Beliefs: • 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. • Sikh men do not cut their hair and wear a bracelet and a truban. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Reference • About the Systems. Retrieved on March 10th, 2010 from http://indianmedicine.nic.in/index.asp?lang=1. • Asian Indian Culture:Influences and Implications for Health Care. Retrieved March 10th, 2010 fromhttp://www.molinahealthcare.com/medicaid/providers/common/pdf/asian%20indian%20culture%20-%20influences%20and%20implications%20for%20health%20care_material%20and%20test.pdf?E=true. • Health and Healthcare of Asian Indian American. Retrieved December 18, 2010 from http://www.stanford.edu/group/ethnoger/asianindian.html. • The World Factbook: South Asia: India. Retrieved March 25th, 2010 from https://www.cia.gov/library/publications/the-world-factbook/geos/ha.html. • Periyakoil, V.J. and Dara, S. (2010). Health and Healthcare of Asian Indian American Older Adults. Retrieved February 5, 2011 from http://stanford,edu/ethnomed/asian_indian. • Working with People with Disabilities: An Indian Perspective. Retrieved December 12, 2010 from http:// cirrie.buffalo.edu/cultural/monographs/India.php. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Power Point Presentation Created by: Joyce Cunneen, MSN, RN Fairfield University School of Nursing ELDER Project Education Coordinator Monica Starr, BSN, RN Fairfield University School of Nursing ELDER Project Program Coordinator Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Cultural Diversity