By: Muhammad Al Assad R.

Worldviews, Beliefs, and Values in Health Communication

CHAPTER 5

Religion and Healthcare

Religion is the main source of cultural beliefs. It strongly influences the way its adherents define life,
death, health and illness, and the way to heal illness. People may define health as spiritual harmony with
god or other deities, and illness as spiritual disharmony with him. So people often seek religious
explanation on their fate, for example by simply thinking that a person is ill because god is no pleased
with him or her and that religion is related to health or illness.

Some religious groups believe that illness is the result of god’s intervention. Based on this view, one may
consider that his illness is caused by his own bad deeds in the past, its purpose being to warm him to
stop the evil deeds or to compensate for his sins or just to remind him to improve his duties to worship
god.

Although they accept the biomedical system, some Christian groups believe that illness is also a warning
from god. Likewise, while viewing that illness his to own reality, some Muslim groups believe that illness
is predestined, or that it is a trial from god to test their belief.

Many Muslims, and some Christians believe that AIDS is a punishment given by god to the people
transgressing His laws (that homosexuality and sex outside marriage are forbidden by Him), and so they
believe that people will never be able to find the perfect medicine to cure AIDS as long as homosexuality
and fornication (adultery) are causing this disease to exist.

The Quran and the sunnah (tradition) of the Prophet Muhammad are full of teaching that define health
and illness and their consequences, and recommend certain ways to cure the illness. In this context, it is
even possible to develop the religious model and more accurately, the Islamic model of healthcare.
Interestingly, some Muslims from Indonesia, Afghanistan, Turkey, Morocco, and other use some text of
the Quran on paper to cure the illness by putting them on parts of the body, sticking them to surface
parts of their house, or to put then in the water they drink. Apparently this style of healing practice is an
influence from the traditional religions that have contaminated Islam as it was never practiced by the
prophet Muhammad itself.

Based on the belief that the chastity of Muslim women must be guarded, especially in the middle-east
insist that only female doctors and female nurses be allowed to examine female patients, including
those who deliver babies. Because women are told by their families to be pure and modest, they may be
reluctant to seek medical help from male medical practitioners, although their sickness is serious.

In countries where authority is in the hands of men, event in non-Muslim countries in Asia, Africa, and
Latin America, it is not always easy for doctor and nurses to treat female patient, as the treatment is
often decided by men, either by their husband or by their fathers, even though their illness may be
critical that need prompt treatment such as surgery. Doctor and nurses may face uncertainty when they
must take a quick action in the absence of the patient’s husband or father.

Different religions also have different views and practice of animal slaughter. The Muslims must
slaughter the animals with sharp tools in order not to hurt the animal too much. The killing of a bull by a
matador in Spain in the fight (corrida) attended by national and international tourists is much
appreciated by Spanish nationals as it symbolizes human bravery and nobility, although it may be
considered as cruelty by Americans.

American may also show similar negative reaction to the slaughter of animals by the Muslims
throughout the world every year in the Islamic month of Zulhija when the Muslims from all over the
world make their pilgrimage on the holy land of Mecca and its surroundings. Meanwhile, in many
countries, there are millions of vegetarians. They do not eat meant at all, and condemn the animal
slaughter for whatever purposes. These people believe that any kind of meat is not health for human
body.

Many Muslims will not consume medicine containing alcohol except in emergency. Some religious
groups also have similar worldviews such as the Buddhist, the Mormons and, to some extent, the
Seventh Day Adventists.

Hindus attribute certain meaning to illness. When a Hindu asked why he is suffering from illness, a
possible answer given by him is that it is a God’s will. The assumption of predestination is also shared by
some Muslim who assume that fate, according to the general Islamic definition, is the result of one’s
worldly efforts and God’s decree.

Worldviews may have some tenets related to cleanliness, factors that may contribute to healthcare.
Shintoism, for example emphasizes love of nature, its adherents are taught to take care of every
mountain, hill, lake, river, tree, etc. The way Japanese maintain harmony with nature is reflected in the
tranquility of Japanese flower arrangement called ikebana. According the traditional Javanese world
view, every tangible object, such as a tree, rock, or the keris (Javanese dagger) contains a supernatural
being. Therefore, Javanese traditional often hold various rituals to ask the spirits occupying those
objects not to disturb them physically and emotionally

Cultural Beliefs and Healthcare

A belief is a subjective assumption that an object or an event has certain characteristic or values with or
without evidence, Some of our beliefs related to health, illness and healthcare. Marks et al. (2000 : 53) is
right in saying that “The way people react to illness is rooted in their broader health systems which are
culturally immersed.”
There are indeed many specific cultural beliefs about healthcare, some which might be strange to us.
For instance in the past many Indonesians, especially Muslim did not follow the family planning program
simply because they believed that “banyak anak banyak rezeki” (the more children we have, the more
wealth we will have).

As Werner (1993 : 10) Illustrates, people who live in the mountains of Mexico believe that if someone is
bewitched he will get well if his relatives harm of kill the witch. People in rural Mexico also believe that
there are certain home remedies to cure goiter such as to tie a crab on the goiter, all of which not true
in a scientific sense.

Meanwhile, the Japanese do not believe in organ transplants to save a patient’s life. In a case where the
patient has a terminal illness, this illness is kept a secret by the doctor based on the argument that the
disclosure of the illness will make the patient depressed and motivated to commit suicide. In fact the
Japanese court imposed a rule that a medical doctor cannot be forced to fully inform the patient about
what disease the patient is suffering (Samovar & Porter, 1991:259).

In Chinese culture, expect that a patient’s body organ should not be amputated even in emergency
situation based on the belief that they will be alive again in the next life in the state in which the body
was buried (Rasinski, 1993 : 170).

In India, common colds, headaches, stomach aches, gonorrhea and syphilis are considered as natural
diseases, while persistent headaches, repeated stomach aches, menstrual problem and continued
miscarriages are associated with supernatural intervention (Samovar & Porter, 1991 : 257).

Some of the beliefs of local people are not conductive to promote health practices. For example, the
Japanese consider that four (shi) is an unlucky number.

More superstition can be found among the mien people who they not believe in surgery, instead, they
rely on animal sacrifice and rituals by a tribal shaman (Lustig & Koester, 1999:305). To reiterate based on
their biomedical perspective, most Americans and North Europeans assume that illness is caused by a
virus, bacteria, or the dysfunction of body organs, so they rely on empirical explanations and assume
that illness can be explained scientifically.

Yet literature has mentioned some non-western attitudes toward the biomedical model of healthcare
practiced in the west. In fact a lot of research support these non-westerns’ attitudes regarding health
and illness. A study of medical treatment comparing European and Canadian students and Asian
undergraduate students found some interesting result. The study indicated that Asian students were
more likely to believe in non-biomedical causes of illness, especially “imbalance” of cold and hot food,
lack of harmony with nature and these Asians students were less satisfied with the western healthcare
services. (Armstrong & Swartzman; Evans & Kazarian, 2001:406).

Murdock in 1980 differentiated natural beliefs from supernatural beliefs, this supernatural causation is
composed of three causation;
 - mystical causation (predestined misfortune or caused by some act or experience of the
individual),
- animistic causation (caused by a personalized supernatural being such as god or spirit), and
- magical causation (caused by sorcery or witchcraft done by somebody else based on his
envy or hate toward the victim).

And the four most common causes across 189 cultures were (in descending order) spirit aggression,
sorcery, mythical retribution, and witchcraft.

Values and Healthcare

A value is an evaluate component of our beliefs incorporating: utility, goodness, esthetics, and
satisfaction. It refers to the relatively long belief about an object, behavior, or an event based on certain
criteria. According to Rokeach, a person who has a value means that he prefers a certain mean of action
and a certain goal of existence to other means and other goals, personally, and socially. These means of
action include duty, courage, sacrifice, loyalty, responsibility, honesty, and friendship, while the goals of
existence include justice, welfare, prosperity, freedom, and safety (Kim, 1992:53). People value
generally stem from greater philosophical issues. That is why values are usually stable and are difficult to
change.

For example, in individualist cultures such as the US, Germany, and the Netherlands, it is common to
treat suffering people according to the seriousness of the illness. In the collectivist cultures, however,
the priority is often given to the elders. Without considering such a cultural value, a medical team from
an individualist country intending to help patients in a collectivist country may encounter an obstacle.

Different values professed by different cultural groups seem to effect the utilization of healthcare
service. Anderson (1986) found that Chinese parents use the healthcare service less frequently due to
their emphasis on keeping their chronically ill children as happy and content as possible. Different
cultures may designate different meaning and values to certain foods and behaviors during meals as to
what food is health or what food is not. Different cultures also attribute different meanings and values
to eating utensils

Ethnocentrism, Stereotypes, and Healthcare

According to Summer, ethnocentrism is the view of things in which one’s own group is the center of
everything, and all others are scaled and rated with reference to it (Gudykunts, 1998:106). Thinking that
our ways of doing this as superior and rate others people’s as inferior will lead to difficulties in
interacting with other people. The problem of communicating with others will be very serious if other
people are also ethnocentric as we are.
A stereotype refers to “Judgments made on the basis of a group membership” (Jandt, 2013:86).
According to Guirdham (2005:150). “A stereotype is a stable set of beliefs or preconceived ideas that the
members of a group share about the characteristic of a group of people”. But most of stereotypes are
misleading. If we think rigidly that a group of people have the same characteristic, this creating barriers
in our communication with others in that stereotypes we hold are inaccurate predictors of other
people’s behaviors.

Some people stereotype medical doctors that they are ethnocentric due to their pride of being
intelligent, well-educated and members of the middle or even the high-class society. Interestingly
research has indicated that healthcare providers, including medical doctors, also stereotype their client,
based on the client’s race, ethnicity, religion, gender, age, level of education, level of income, level of
attractiveness, type of illness, etc. with such stereotype in mind, the medical professionals treat their
patients differently, depending on the patient’s physical and socio-cultural characteristics (Kreps &
Thornton, 1992:9)

In health communication the stereotype held by the medical doctor or by the nurse as mentioned above
will be mirrored in the way he or she acts verbally and nonverbally toward the patient, often in subtle
ways.

It is assumed that stereotypes can even trigger a fulfilling prophecy involving extreme physiological and
chemical reaction within the body of the person being stereotyped. When cast research has indicated
that less educated people are more likely to stereotype other. Assuming that in general patient are less
educated than physicians, patients are more likely to stereotype physicians-than vice versa-by relating
their physical and social characteristic and appearance with certain traits.

All medical practitioners cannot escape completely from stereotyping others, including their clients.
Stereotyping is a matter of degree. Yet, it to be successful medical professional, and to have fruitful, rich
and satisfying experiences in interaction with others, they have to keep their stereotypes toward others
to the minimum.

Stereotypes are often reflected in the language we use. People create, transmit, modify, and maintain
stereotypes through language, although the processes are very subtle (GudyKunts, 1998:125). People
who exhibit certain characteristic of language are often associated with certain stereotypes.

The Complexity of Language in Therapeutic Communication

CHAPTER 6

In many case, simple words may be interpreted differently. The meaning of words conveyed on our
message are often ambiguous, this is because the meanings or words are culture-bound. Situational
factor such as the context of place and time and the mood of communicators also influence how
communicators interpret messages.
In doctor-patient communication more understandings are likely to emerge between a doctor and a
patient if the doctor is fond of using jargon when interacting with his patients. Many healthcare
providers are not aware that the overuse of medical jargon often make patients upset.

The most common complaint coming from patients was that doctors did not listen; they over controlled
consultation which hampered the collection of accurate and complete information, whereas, according
to research, even terminally ill patients want to receive all relevant information about their ailment
(Berry, 2004:64-70). It is based on that reason that medical providers must learn how to listen to their
patients, as it is an important skill that can contribute a lot to accurate diagnosis. According to kwong et
al. (2009:10). Apart from listening medical doctors’ ‘sins’ of communication include:

- Asking question too soon in the consultation.

- Rushing the patient.
- Looking bored and showing disinterest.
- Being patronizing, dictatorial or rude.
- Making assumption that is incorrect and unsupported by the information gained.
- Ignoring cultural sensivities.

The Complexity of Language

Language is a system of symbols. Words are essentially arbitrary symbols based on the agreement of a
cultural group. Word often do not have specific meanings; rather, the meanings of words are in people’s
heads. Different in using words referring to environmental qualities, events, various types of behavior,
ideas, beliefs, values, and other more abstract condition. People may attribute meanings to the same
word, depending in their socio-cultural background.

Language enables us to communicate with others. The more accurate the language we use, the more
effective our communication will be. Yet language has also some weakness:

- The number of words in a language is relatively limited; they cannot represent all possible
objects, event, behaviors and feelings that can be observed and experienced by human
being.
- Word are ambiguous, their meaning are contextual, since word represent the perception
and interpretation of people from different socio-cultural backgrounds. There are no words
or statements that can exactly represent the real world.

Naming Illnesses and Their Symptoms

According to barker (1984:22-23), language has three functions: naming or labeling, interaction, and
transmission of information. The most basic function of language is to name or to label people, objects
or events.
Like words in general, names are basically arbitrary. So essentially we may create words or names or
change them to mean certain things as we like that ultimately apply among us.

In therapeutic communication words are no less complex. For example, while patients describe
symptoms of their sickness in a vague way, medical and psychiatric jargons used by doctors, psychiatrist,
and nurses may confuse patients.

Cultures also have name for certain sicknesses. Not only are the names foreign but the categories of the
illness are sometimes difficult to translate to other languages.

Also cultures have certain names for jobs or professions, places, events and practices related to the
medical field. Although the term “doctor” is very popular, its translated version in other countries is not
always associated with medical doctor. For example; adding “Dr.” at the first name of doctor
professions, Rumah sakit, Kaki gajah (Filariasis).

The Complexity of Language Translation

Language represents culture. Certain words used in one language cannot literally be translated into
another language. So word cannot be translated into another language without losing some of its
nuances.

For examples; Sabar, iklhas, Setia words from Indonesia and Malay do not have parallels in English, for
instance Setia is a word combining attributes loyal, faithful, and true. Literature also illustrates how
language is complicated, tricky, misleading and sometimes amusing when it is translated into other
language. For example; Bud Lite Beer “Delicious less filling”, in Spanish; “Finger Lickin’good” into “Eat
your finger off”.

The language is not only descriptive, as a means to describe phenomena or environment, but also
influences us to see our environment in a certain way (Infante et al., 1990:199). Language also reflects
the social hierarchy in a culture and how people see various context of time inherent in the activity and
the event being said.

Words used in everyday life may have somewhat different meanings after being translated into or
adopted by other languages. Language can be considered as an extension of culture. Interaction
between medical practitioners and patients is complicated if they speak different languages (mother
tougues). Often is difficult for patients to describe symptoms of their illness, pain sensations, and their
illness experience in foreign languages.

Verbal Communication Styles

Verbal styles refer to recognized patterns of verbal characteristic such as forms of greetings, from of
courtesy, topic of conversations, and distinct speech patterns based on one’s culture.

We often do not always know what the proper way is to greet people from different cultures, even
when we speak the same language.

There was once an incident in which a medical doctor in a public hospital in Bandung, West Java, was
angry because a relative of his patient called him as “Mas” when the doctor was examining the patient
lying on a bed. “I am a doctor, not Mas,” said the doctor.

In low-context cultures, in general people seldom discuss religions and political orientations in private
conversation. Private question are often avoided, especially in first encounters. But it is not uncommon
for an Easterner, say in Indonesian, to ask his Western Communication Partner visiting his country,
question such as, “Are you married? How many children do you have? How much money do you get a
month?” Western should be warned no to take question in first encounters literally.

People from low-context cultures are more likely to use talk to control others, while people from high-
context cultures are more likely to use silence to do the same thing. While in the west silence is
regarded as pause to be filled in the Ease silence is very meaningful.

According to Lebra there are four meanings of silence in Japan: Truthfulness, social discretion,
embarrassment, and defiance. He suggests that social discretion refers to silence deemed to be
necessary or desirable in order to get social acceptance or to avoid social penalty.

We conclude that language is a complex phenomenon that should be given serious consideration. To be
effective medical professionals, we should use the best language we can; and it should be clear and with
the minimum amount of jargon.