Chinese medicine teaches that health is a state
of spiritual and physical harmony with nature. A healthy body is in a
state of balance. When it gets out of balance illness results. They
view their bodies as a gift given to them by their parents and fore
bearers. A person's body is not his personal property. It must be
cared for and well maintained.
In Asia the balance is between yin and yang. All
things in the universe are primarily either yin or yang, including
diseases, which may result from excess yin or yang, deficient yin, or
deficient yang. Yin and yang are generally translated as hot (yang)
and cold (yin), these refers to qualities, not temperatures. 2
The Asian patient rarely complains about what
bothers him. Often the only indication that there may be a problem is
an untouched food tray and the silent withdrawal of a patient.
A middle-aged Chinese patient refused pain medication following
cataract surgery. When asked, he replied his discomfort was bearable
and he could survive without any medication. Later the nurse found
him restless and uncomfortable. Again the nurse offered pain
medication. Again he refused, explaining that her responsibilities at
the hospital were far more important than his comfort and he did not
want to impose. Only after she firmly insisted that the patients
comfort was one of her most important responsibilities did the
patient finally agree to take the medication.
Chinese are taught self-restraint. The needs of
the group are more important than those of the individual. Another
factor that may be involved in Asian's refusal of pain medication is
courtesy. They generally consider it impolite to accept something the
first time it is offered. The safest approach for the nurse is to
anticipate the needs of an Asian patient for pain medication without
waiting for requests. Nurses should be aware of Asian rules of
etiquette when offering pain medication, food or other services. But
if the patients continue to refuse medication, their wishes should be respected.
A Vietnamese woman was rushed to the hospital by her adult children.
The emergency room personnel discovered dark red welts running up her
arms, shoulders and chest, yet the only presenting complaint was
dizziness. When questioned, her son explained that he had rubbed her
body with a quarter.
A nurse becomes concerned when she finds an
elderly Chinese patient rubbing him self with a quarter( she thought
he was trying to hurt himself). When she took the coin away from the
patient, he became very upset, grabbed it back from her and continued
to rub his arms and legs, leaving dark red scratches.
A Vietnamese girl in her first year at an
American elementary school, was not feeling well one morning, so her
mother rubbed the back of her neck with a coin. When the school staff
discovered the welts on the girls neck, they immediately assumed they
were seeing a case of child abuse and reported the family to the authorities.
In each case the patient was practicing a
traditional form of healing known as coin rubbing. There are several
variations, including heating the coin, but they all involve
vigorously rubbing the body with a coin. This produces red welts,
which can distract medical staff from the real problem or be mistaken
for child abuse. It is important to recognize and become familiar
with this practice, and not to be distracted from the real problem or
mistakenly make accusations of child abuse.
Asians rubbing their children with coins is not
any more abuse than Americans having thin pieces of metal wrapped
around their children's teeth and tightened until their teeth move
out of place. Braces are usually applied for merely aesthetic
reasons. Coin rubbing, at least, is an attempt to heal. Apparently,
it often works, only the failures show up in the medical system.
A 24 year old Korean man, visiting family in the United States,
became ill and was hospitalized. With a diagnosis of renal and
respiratory failure, was put on strict bed rest because exertion
would be dangerous. Conflict arose when the family would get him out
of bed to squat over the bedpan on the floor. The nurse tried to
explain that the bedpan was to be used in bed, but they spoke little
English and became very upset.
In most Asian countries, traditional toilets are
holes in the ground. To eliminate from the bowels, one squats over
the hole. There is no other way to do it. Elimination is considered
unclean and certainly should not be done in bed. The patient was
trying to maintain standards of cleanliness and decency. He was using
the bedpan in the only way he knew how. After a co-worker explained
the patients behavior, the nurse called the doctor and had him
rewrite the orders from strict bed rest to bathroom privileges as
needed with assistance. The patient and family were much happier and
more cooperative as a result.
A Vietnamese woman, after giving birth to a son, refuses to cuddle
him but she willingly provided minimal care such as feeding and
changing his diaper. The nurse feeling sorry for the baby, picked him
up, cuddled him and stroked the top of his head. Both the mother and
the husband became visibly upset.
This apparent neglectful behavior does not
reflect poor bonding, but instead indicates a cultural belief and
tradition. Many people in rural areas of Vietnam believe in spirits.
They believe these spirits are attracted to infants and are likely to
steal them (by inducing death). The parents do everything possible
not to attract attention to their new born, for this reasons infants
are not cuddled or fussed over. This apparent lack of interest
reflects an intense love and concern for the child, not neglect.
Not only did the nurse attract attention to the
infant but she touched him in a taboo area. Southeast Asians view the
head as private and personal, it is seen as the seat of the soul and
is not to be touched.
Another Vietnamese tradition that is seen as a
sign of poor bonding is the delay in naming the infant. The name is
often decided on by the family in a naming ceremony that takes place
at the parent's house with all relatives present. This custom
emphasizes the infant's importance as a member of the family.
A 27 year old Vietnamese woman in the delivery room with very strong
and closely spaced contractions. The baby was positioned a little
high and there was some discussion of a possible c- section. Despite
her difficulties, she cooperates with the doctor's instructions and
labors in silence. The only signs of pain or discomfort were her look
of concentration and her white knuckles.
Vietnamese women, as most Asians, believe that a
woman must experience pain and discomfort as part of childbirth. To
express these feelings, however, brings shame upon her. It might be
very disconcerting for an Asian woman accustomed to controlling her
emotions to labor next to a highly expressive Middle Eastern or
A Chinese woman in her mid-twenties, had just given birth. The
nurses became concerned when she would not eat the hospital food and
did not bathe. She would only eat foods her family brought to her.
The patient later explained her custom prevented her from bathing for
seven days after childbirth and permitted her only to eat certain foods.
This patient was practicing the traditional
lying-in period observed in much of Asia and Latin America. It is
believed that for a period of time after childbirth, the women's body
is weak and susceptible to outside forces. New mothers are encouraged
to avoid exercise and bathing (bathing could introduce organisms into
the body and cause illness.)
Pregnancy is thought to be a hot condition.
Giving birth causes a loss of yang, or heat, which must be restored.
This is accomplished by eating yang foods such as chicken and
avoiding cold liquids. The woman is to rest, stay very warm, and
avoid bathing and exercise. The price for not observing these customs
is aches, pains, arthritis and other ailments in later life.
Compromises can be made. The use of boiled water
(removes impurities) may make a sponge bath more acceptable. Do not
assume the patient will follow orders that would violate the
traditions and wisdom's of her own culture.
In China there is a strong cultural aversion to donating blood. By
tradition, giving ones blood is considered disrespectful to parents
and ancestors. Blood is thought to contain qi, or life energy.
The Chinese believe the more blood in the body,
the better. Health care workers there acknowledge the wasteful
distribution of what is known as sympathy blood in hospitals. This
practice occurs sometimes when a patient is about to die, a nurse
will give him blood, just to make him feel better. While some wealthy
Chinese request blood transfusions in hopes to improve the qi.
This year, Beijing's state owned Giyou Department
Store held a lottery to determine which of its employees would
"voluntarily" give blood. Those selected were handed $120
bonus-twice the average monthly salary- and 15 days of vacation. But
they were still unhappy. "Thank God I wasn't chosen," said
Mao Mao, a 28-year-old telephone operator at the store. "I would
never give my blood if I could help it." (U.S. News & World
Report, 1998. (p.44))
Galanti G.A.: Caring for Patients from Different
Cultures. University of Pennsylvania Press, Philadelphia, 1991
Spector R.E.: Cultural Diversity
in Health and Illness. Appleton-Century-Crofts, New York, 1979
U.S. News & World Report, Why
it's really hard to draw blood in China Bay Fang November 9, 1998. (p.44)