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Cultural Relativism in Healthcare

The contemporary world has become one global village, thus creating a multicultural society internationally. In healthcare, professionals are thus expected to interact with patients from various cultures, and without being competent, the delivery of quality, effective, and timely care services could be impaired. For instance, due to the influence of ethnocentrism, a care professional could fail to understand a patient’s beliefs and attitudes towards some aspects of life and perception about health due to underlying cultural differences. Therefore, it is important to apply cultural relativism in deconstructing the misconceptions that result from cultural differences and ethnocentrism. This paper discusses one of my cultural aspects, body ritual among the Nacirema, from an etic perspective and experiences of cancer patients in a referral hospital in Kenya, from an emic perspective. Cultural relativism will be applied to understand how these cultural aspects developed and their purpose as part of a social system.

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The Nacirema is a group of North Americans living in the territory between the “Canadian Cree, the Yaqui and Tarahumara of Mexico, and the Carib and Arawak of the Antilles” (Miner, 1956, p. 503). One of the major characteristics of these people is the ritualized perception and understanding of the human body. Every day, the Nacirema spend a considerable part of their time executing rituals to take care of the body, which is seen as ugly by default with its natural tendency leaning towards disease and debility. According to accounts by Miner (1956), when looked from the outside (etic perspective), the Nacireman cultural beliefs and rituals underlying the actions undertaken to save the body from its natural tendencies could be seen as barbaric and retrogressive with some level of sadism and masochism.

For instance, each family has a shrine whereby various private ceremonies are conducted in secrecy. Different traditional practitioners are involved in the execution of disparate cultural rituals aimed at cleansing and preserving the body. For example, one of the daily body rituals is a mouth-rite, which involves meticulous step-by-step activities to clean the mouth. Miner (1956) argues that this rite “involves a practice, which strikes the uninitiated stranger as revolting…the ritual consists of inserting a small bundle of hog hairs into the mouth, along with certain magical powders, and then moving the bundle in a highly formalized series of gestures” (p. 504). In addition, the Nacirema consult a holy-mouth-man once or twice annually where a set of paraphernalia is used to exorcise evils of the mouth in what an outsider would consider as torture to the involved person. From an etic perspective, these rituals would appear as widespread savagery among the Nacirema.

However, drawing such conclusions by an outsider would be biased probably due to ethnocentrism, hence the need to understand these rituals using cultural relativism. This concept holds that other people’s culture and practices should be understood from their perspective and beliefs, as opposed to being judged based on an outsider’s view. In light of this argument, the mouth rite by the Nacirema makes sense in its cultural context. First, it is important to understand how this ritual developed as part of a social system within this culture. According to Miner (1956), the underlying belief among the Nacirema is that the human body is ugly by nature riddled with numerous weaknesses exposing it to disease, and thus “incarcerated in such a body, man’s only hope is to avert these characteristics through the use of ritual and ceremony” (p. 503). Therefore, the mouth-rite has evolved from this belief seeking to rid the mouth of its resident evils, and this belief runs deep in this culture.

The purpose of this ritual as part of a social system thus becomes clear when seen from the Nacireman point of view. If they do not perform such rituals, these individuals believe that they would probably die. As such, the mouth-rite serves a central purpose in the existence and well-being of the Nacirema. Therefore, while the outsider would term this practice as irrelevant and cruel to humanity, the Nacirema see it as an essential part of life that cannot be disregarded and continue leading a normal life. Such “abnormal” practices take a new meaning when viewed through the lenses of cultural relativism.

The culture being discussed under this section is the views of cancer in-patients in a teaching and referral hospital in Kenya by majoring specifically on how these individuals make sense of their condition and treatment. According to a study conducted by Mulemi (2008), in Kenya, most patients suffering from chronic and terminal health conditions, such as cancer, term it as indigenous diseases or ugonjwa wa kienyeji, in the local Swahili dialect. Therefore, people with these illnesses believe that the conventional healthcare system and physicians cannot treat them, because in most cases, such diseases tend to persist even after biomedical intervention. These beliefs shape the way patients interact with the healthcare system in its entirety.

For instance, one of the cancer patients that Mulemi (2008) interacted with, she became unhappy with her unreasonably prolonged stay in the ward given that even after almost three months of being hospitalized, she had not received an accurate diagnosis of her condition. As such, she started refusing to cooperate with the hospital personnel because it did not make sense why she was being kept in the ward without getting any help (Mulemi, 2008). At this point, the majority of cancer patients resort to looking for alternative therapies following the perceived failure of the conventional biomedical treatment. The perspective that hospitals cannot manage cancer treatment drives many patients to what Mulemi (2008) calls mitishamba, which is a concoction of traditional herbs. Even in the wards, patients use these herbs to supplement therapies, such as chemotherapy and radiation. Therefore, from an outsider’s point of view, a person would wonder why cancer patients would have more faith in traditional medicine, as opposed to modern science and evidence-based health practices.

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Cultural relativism could be applied in this case to explain why this group of individuals has little faith in conventional medicine. The starting point would be to understand how the unwavering belief in traditional medicine developed to become part of a social system in Kenya. According to Mulemi (2008), Kenya is a third world country, which means the healthcare sector is poorly developed to effectively address complex health conditions, such as cancer. Therefore, when patients have to wait for months to be seen by a medical practitioner and spend another prolonged period waiting for proper diagnosis and start of treatment, they are likely to lose faith in such a system. The case mentioned earlier about a patient, who started rejecting any help from the hospital staff, underscore this argument.

Therefore, the tendency to turn to traditional medicine plays a central purpose as part of coping techniques for cancer patients. Within this cultural context, the biomedical field has failed to address such chronic conditions, which explains why patients prefer the said mitishamba as an alternative or supplement to chemotherapy and other related cancer therapies. Therefore, an outsider, who lacks the lived experience of an underdeveloped healthcare system, does not have the lenses to understand the underlying reasons why a cancer patient would resort to untested and unscientific traditional concoctions instead of having faith in the advanced and evidence-based biomedical practices. However, when viewed from the perspective of cultural relativism, someone understands such a seemingly unorthodox thought system of preferring traditional medicine to conventional science.

Globalization has created the concept of multiculturalism in the healthcare sector, and thus professionals should be competent to address their biases and understand their patients’ culture from the perspective of cultural relativism. From the outside, the Nacirema’s practice of ridding their mouths of evils through ritual cleansing might seem backward bordering on sadism and masochism. However, understanding how such practices became part of a social system allows an outsider to acknowledge the important role that they play within such a cultural context. Similarly, the majority of cancer patients in Kenya would prefer using traditional medicine to modern scientific therapies, such as chemotherapy, because the healthcare system is not developed to the point of treating these conditions effectively. Therefore, cultural relativism allows people to interpret and understand practices within a certain culture from an inside perspective based on the underlying contextual factors, instead of being judgmental under the influence of ethnocentrism.

References

Miner, H. (1956). Body ritual among the Nacirema. American Anthropologist, 58(3), 503-507.

Mulemi, B. A. (2008). Patients’ perspectives on hospitalization: Experiences from a cancer ward in Kenya. Anthropology & Medicine, 15(2), 117-131.

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