Download Session 10: Indian Culture

ELDER Project
Fairfield University School of Nursing
Cultural Diversity
Asian Indian Culture
Objectives:
At the end of this session, the participants will be able to:
1. Discuss the role of religion, traditional health care beliefs, social values, and
family structure of Asian Indians and the impact these factors have on health
care.
2. Identify specific culturally sensitive practices that can be incorporated into your
work with Asian Indian patients and American Asian Indian patients.
Food Presentation……………………………………….…….……………….5-10 minutes
Depending on one or two presenters
Introduction……………………………………………………………………….....5 minutes
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.
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.
Bangladesh: Muslim 89.5%, Hindu 9.6%
India: Hindu 80.5%, Muslim 13.4%, Christian 2.3%, Sikh 1.9%
Sri Lanka: Buddhist 69.1%, Muslim 7.6%, Hindu 7.1%, Christian 6,2%
Nepal: Hindu 80.6%, Buddhist 10.7%, Muslim 4.2%, Kirant 3.6%
Pakistan: Muslim 95% and 5% Hindu and Christian
Areas of Focus…………………………………………………………...………..20 minutes
1. Communication
 The major language is Hindi; however English is commonly used in many
areas of life.
o Most Asian Indians are bilingual or multilingual.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858
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o Eighteen languages are recognized in India.
Use of formal titles is expected (Mr. and Mrs.) until told otherwise.
o Addressing people older than you by their first name alone is
disrespectful.
Embracing members of the opposite sex is unacceptable; however it is
acceptable with members of the same sex.
o 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.
2. Family and Social Structure
 Several generations will live in the same household sharing a common
budget.
o 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.
 Asian Indians practice patriarchal extended families.
o 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.
o Joint families are temporary; once they are self-sufficient they
move out.
3. Personal Hygiene
 Showers are more the norm as tub baths are seen as unsanitary.
o The focus on bathing is being clean rather than on eliminating
body odors.
o Using deodorants is not a common practice.
o Odors are not seen as potentially offensive.
 Modesty is highly valued.
4. 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.
o Illness may be seen as something to be accepted and endured
rather than fixes or cured.
o Consequently, Asian Indians may be stoic in their expression of
pain.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858
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The Asian Indian respects authority of the healthcare provider and feels
their own role is passive.
o They will not ask a lot of questions as this is viewed as impolite.
o 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.
5. 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:
o ritual chanting by priests,
o tying a thread around the sick person’s wrist,
o writing protective verse and wearing it in a metal cylinder around
the neck or wrist
o promising temple god gifts if they recover
 Ayurvedic Medicine is the traditional Indian system of medicine.
o Pronounced (ī'yər-vā'də, -vēc')
o Translated it means the meaning of the knowledge of life.
o Relates to the complete human being, body, mind, senses and
soul.
o Focuses on attaining balance between the physical, mental and
spiritual.
o Four questions and life span allied issues are elaborately and
emphatically discussed
 What is beneficial?
 What is harmful to life?
 What is happy life?
 What is sorrowful life?
o In Ayurveda, 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
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Unani or Yunani Medicine:
o Can be traced back to Hippocrates
o 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.
o When a person is in perfect balance - a person is healthy.
o Treatment is aimed at restoring natural balance by dietary
modifications.
o The use of ripening, purging, cupping, sweating, diuresis, herbal
bath therapy, massage and exercise is common as well.
Siddha Medicine:
o One of the oldest systems of medicine in India.
o Has close similarity to Ayurveda, with specialization in
Iatrochemistry (seeking chemical solutions to disease and
medical aliments).
o According to this system, the human body is the replica of the
universe and so are the food and drugs irrespective of their origin
o Uses calcined metals and mineral powders to heal illness.
Ayurveda, Unani and Siddha Medicines are practiced medical systems in
India.
6. View on End of Life Care and Death
 Family may not want the doctor to tell the patient their diagnosis.
 Family centered decision making.
 Family is present when the patient is close to death.
o They prefer to die at home.
 Dying patient may want to be moved to the floor to be closer to mother
earth or positioned in specific directions.
 They believe the dying individual should be thinking of God as they go
through the dying process.
o The thoughts that they are thinking at the time of death determine
the destination of the departing soul.
 At the time of death:
o Family will prefer to wash the body.
o Family will chant hymns.
o Hindu priest may perform a prayer and blessing.
o Family will prefer privacy for the family after death for religious
rites.
o Family will openly express grief.
o Prefer cremation.
o Mourn for a 10-40 day period.
 Do not usually agree to post mortem examination or organ donation.
7. Dietary Habits
 Dietary staples include rice, grains and breads.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858
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Many are vegetarians or vegans.
o Have diets rich in carbohydrates, poor in protein and deficiencies
in calcium.
If they do eat meat, it usually is not beef (Asian Hindus).
o The cow is recognized as a life giving role:
 producing dairy products,
 pulling plows, and
 fertilizing fields
Gelatin based products are avoided because the processed collagen
comes from cows or pigs.
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 antiinflammatory.
o Often chewed with tobacco, which can lead to oral cancer.
Use a lot of spices:
o 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.
8. 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.
9. Religious Beliefs
 Religion is central to the way of life.
 80% Hindus:
o Believe everyone goes through a series of births or reincarnations
that eventually lead to spiritual salvation.
o With each new birth, one moves towards enlightenment.
o Believe in a cast system.
 Other religions include:
o Muslim,
o Christianity,
o Jainism (nonviolence towards all living creatures),
o Buddhism
o Sikhism (intended to bring the best of Hinduism and Islam
together)
 Hindu religion has aspects that affect health care decisions:
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858
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o “Karma” involves the actions of past life that affects
circumstances in which one is born and lives in this life.
o Often believe illness is caused by Karma and that every action
leaves an imprint on one’s soul and spirit.
o Believe good actions produce good results and bad actions
produce bad results.
o Karma greatly influences the patient’s world view of health, death
and dying and model of illness.
 Buddhism adheres to non-violence and advocates giving up worldly desire
to attain nirvana (salvation).
o 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.
 Hindu religious paraphernalia include:
o Mangalsutra - a 9 sacred necklace which is worn by a married
woman.
o Women also may wear a bindi or tilak (dot on forehead).
o Other symbols of marriage are bangles and toe rings.
o Men wear a sacred thread around the torso.
o Both sexes may be reluctant to remove these items.
Sikh men do not cut their hair and wear a bracelet and a turban.
Activity……………………………………………………….…………….………..20 minutes
Jeopardy
Conclusion……………………………………………………………………..…....5 minutes
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858
References:
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 from
http://www.molinahealthcare.com/medicaid/providers/common/pdf/asian%20india
n%20culture%20%20influences%20and%20implications%20for%20health%20care_material%20an
d%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