Introduction
Culture is a way of life of a people. Therefore the way of life of the people can determined their development over time in all ramifications compared to global growth and society development. It is necessary to concept some keys for such purpose.
According to Edward (1871) quoted by Abasiekoa (2010), that complex which include knowledge, belief, act, morals, laws, custom and any other capabilities and habits acquired by man as a member of the society. Culture in the simplest form could be said to be the way of life of a people. The practices varied from culture to culture, but the common denominator as already pointed out is the absence of the knowledge of the principles and of the causation and treatment. In addition to nature, cause of disease, the concept of evil age (from witches and wizards and from wicked persons), angry deities and ancestors long or recently dead are thought to be the main causes of human misfortunes, for the health and welfare of the people is the traditional medicine man or woman, who has continued to hold esteemed position in rural communities, many people still have infinite faith in his or her healing power and his or her services are much sought after.
The traditional medicine healer, like the modern medicine doctor believes that illness has a specific aetiology (causes). But unlike the modern doctor who attributes illness and diseases to pathogenic micro-organism and other environmental factors, the traditional healer held unto two sources as the main cause of illness; spiritual causes and the evil scheme of witches or evil persons.
Violation of any social customs, tradition or religious practices is sufficient enough to offend a spirit or a deity. This could cause illness, or if sacred enough dead. The other equally important cause of sickness and death result from the evil doing of witches or evil person. A strong belief still exist among Nigerians that there are evil persons mostly women who are endowed with evil spirit that is passed from parent to child. The witch can inflict sickness or death on any individual she selects. Those who excite her jealousy because of the success, riches or good fortune usually motivate her. Her targets are usually people well known to her and invariably within the extended family (Furnham, 1994)
Unexpected and untimely deaths are usually attributed to witchcraft in the Nigerian rural communities. It must be noted that such belief, also permeate the urban population. The onset of sudden and mysterious illness is also attributed to the evil machination of witches. The responsibility of the traditional doctor is to treat the physical illness as well as block the route of the spiritual or psychic attack of the patient.
Conceptual framework
Tradition in societies, culture and determine whom to contact for treatment. An average Nigerian believes that native healers and prophets are more effective in the treatment of psychiatric problems than western trained health practitioners.The implication of this is that before a patient suffering from a chronic illness such as mental illness and chronic cough is taken to the hospital must have tried, several complications, might have set in.
Gbefwi (2006) define culture as established pattern of behaviour and way of life of any group of people or society which has been handed down from generation to generation either verbally and by practices. Most cultural practices are linked with religion, folklore and superstition. These are reflected in form of marriage, dressing and style of living, value belief and attitudes. Lintan (1936), states that the culture of the society is the way of life of its members. They learn share and transmitted from generation to generation.
In other words, culture is the totality of way of life evolved by a people in society to meet the challenges to give order and meaning to the society, political, economic, religious norms and value of the people. It could be expressed in language, dressing, food, act and religion. Edward Tylor (2010), culture is that complex which include knowledge, belief, act, moral, law, customs and any other capabilities and habits acquired by man as a member of the society. Culture in its simplest form could be said to be the way of life of a people.
Cultural factors
Culture refers to all values, practices, materials and beliefs of a group of people which they shared and is passed on from one generation to another. Some of these cultural factors are;
- Customs
- Beliefs
- An act or things
- Practices
Custom: This is a particular way in which a group of people do certain things which had evolved over a long period of time. For example, letting women go back to their parents after childbirth.
Beliefs: This is what people think. It relates to the concept of how things are perceived by the community such as the concept of health and illness as caused by witchcraft or magical beliefs of illness.
An act of things: The society regards as forbidden or abomination
Practices: This is the act of doing things according to cultural practices. For example early breastfeeding is not practised because they believe that the first milk is bad to be given to the baby.
Cultural practices of health and healing
Ankottak CP, (2008) states that all cultures have disease theory system which include attributional concept to explain concept to explain illness causality. The commonly held paradigms of disease across cultures are
- Naturalistic
- Personalistic and
- emotionalistic
Naturalistic
Naturalistic diseases explain disease in objective, scientific terms and have the core concept that illness occurs when the body is out of balance. For instance the western bio-medical model views diseases as originating inside the body due to specific identifiable medical cause or pathogen, virus, bacteria, etc. In the traditional medical model, the pathogens need to be eradicated so that the person is without disease and only then are they considered healthy. The humoral system is another.
Naturalistic disease theory originated from Greek and Roman philosophers and popularised by Hippocrates. According to Hippocrates, the body contains four elements (humors)
- Blood
- Phlegm
- Yellow bile and
- Black bile
Health comes from an equal balance of the four humors. In this theory, healing occurs by restoring the proper balance of humors through removal (Bleeding, starvation or replacing, special diets, medicine) of the deficiency.
Personalistic
This disease theory attributes illness to intervention by an agent such as another human, witch, sorcerer, non human or supernatural force.
Emotionalistic
This disease theory explains illness caused by strong emotional states (for example, intense anger, jealousy, shame, grief or fight). The personalistic or emotionalistic disease theories are easily applied to patients of non western cultural backgrounds who are familiar with and have faith in the medical beliefs and practices from their own cultures.
These health attributions and beliefs however are significantly different from those of western medicine. Some Asian cultures believe in the yin and yang principles in which there is a balance between opposite forces (for example positive and negative, light and darkness, hot and cold) that inflect the difference between health and illness. Others believe that illnesses are caused by spirit or ghost.
In order to effectively treat, natural personalistic and emotionalistic aspect of illness there has been an increasing interest and training in asteopathic medicine and complementary alternative medicine.
Cultural bond syndrome
Cultures are influenced directly by cultural belief systems and other cultural factors. In the (Diagnostic and Statistical Manual of the Psychiatric Association) added culture bound syndrome troubling patterns of behaviour-experience that may not fall into one of the traditional Western Diagnostic and Statistical Manual categories. Culture bound syndrome are considered within the and the majority have local names for example is a disorder affecting Indians male that involves an intense fear that losing semen will result in the depletion of vital energy is thought to occur through intoxicants eating energy, heated foods, having a fiery constitution and sexual excesses which can cause fatigue, weakness, body aches, depressants for the point of suicidal feeling, anxiety and loss of appetite (Suchol, 1997).
Migration can have a significant effect on cultural health beliefs and practices. Immigrants may have certain infection diseases which are endemic to the patient country of origin. Immigration itself can cause illness and diseases due to disrupted family and social networks, financial hardship and discrimination that prevent the maintenance of a healthy lifestyle, Immigrants leave their countries for a variety of reasons including violent, economic hardship or natural disaster all of which cause extreme stress and even physical injury.
Model of cultural health beliefs
Different cultural group have diverse belief systems with regards to health and healing in comparison to the western biomedical model of medicine. These belief systems may include different disease model, wellness and illness paradigms various culturally specific disease and disorder, feeling about health care providers and seeking western healthcare and the use of traditional and indigenous health care practices and approaches. Helman suggests that people attribute causes of illness to:
- Factor within individual themselves (for example bad habits, negative emotional state).
- Factor within the natural environment (for example pollution and germs).
- Factors associated with other on the social world (for example interpersonal stress, medical facilities and actions of others).
- Supernatural factors including God, destiny and indigenous belief such as witchcraft or voodoo
Western tends to attribute the cause of illness to the individuals on the natural world whereas individuals from non industrialized nation are more likely to explain illness as a result of social and supernatural causes. In a study comparing African American Latinos and Pacific Islanders with white American on causal attribution of illness, the ethnic minority groups rated supernatural beliefs as significantly more important that white American. There was no difference between the groups about illness causation due to interpersonal stress, lifestyle, environment and chance.
Stanton Rogers (1991) describes eight “theories” that people use as a basis of thinking about health and illness. Body as machine, body under siege, inequality of access, cultural technique, health promotion, robust individualism, God’s and willpower. Supernatural health related beliefs, older people and those health left wing politicians belief were more likely to emphasis external causes and cures for illness and people who believed in alternative medicine were more likely to endorse controllable or internal causes of health, illness and recovery and less likely to believe in fatualistic or external causes, behaviour determine health and illness. Furnham also examine health belief across the three cultural, Botswana, Uganda and South Africa and found that African are more likely to attribute illnesses to “evil power” but all of the group rated interpersonal stress as a potential source of illness.
Cultural denial of reality
Majority of the rural dwellers in Nigeria are at variance with reality when it comes to treatment of chronic diseases such of diabetes mellitus, bronchial asthma, hypertension, arthritis and epilepsy. Obot (2012) on repeated follow-up treatment and check-ups. The people concluded wrongly that orthodox medicine does not have effective remedy for such diseases; therefore they opt for traditional African medicine whenever the people envisage that treatment outcome may be unsuccessful. For example during critical during critical illness like terminal cancer, coma, tetanus and babies with congenital abnormalities, they decide to go home from hospital to seek traditional medicine attention with the hope that herbalist can restore life.
Health implication of cultural practices
According to Tipping and Segail (1995) any action undertaken by individuals who perceive themselves to have a health problem. For the purpose of funding an appropriate remedy, community ideal and attributed towards health and illness affect the way people utilize health services. In Nigeria and in many developing countries, the factors that commonly affect the way rural dwellers sort for health and multi-varied and hence, provide different diseases and infections.
From the diagram above, it can be deduced that the people cultural practices affect their health either negatively or positively, depending on the prevailing practices. Also people’s health considerably affects the scientific and economic development and vice versa. It is the combination of these three levels which interrelated and intertwine that determines the people life expectancy, growth and development at any point in time. This chain tends however is not static because culture and behaviour of human change from time to time. On the other hand, the amount of scientific and technological development people command determine to a large extend, the prevailing culture practices among them. This is because as popularly said, when the desirable is not available the available becomes the desirable.
Nigeria as earlier mentioned is a pluralistic as well as a multiethnic and multi-cultural nation made up of over 250 ethnic groups even in the same ethnic groups where different cultural practices exists, most of these practices are based on trial and error and have endures centuries. Some of the practices in Nigeria that promote health and those that affect health adversely are examined below. It is interesting to know that these practices cut across families, marriages, religious beliefs, etc and create a difference amongst people which are also passed from one generation to another.
Possible ways of reducing disease causation associated with cultural practices
Religious beliefs
Everywhere the quest for health easily shades into issues of morality and religion which play a significant aspect of social life. The basic explanation is that in serious illness there is an underpinning of the supernatural, the most frequently evoked agency is ancestral spirit.
Ojua and Omono (2012) stated that ancestral spirit contributes part of the ordered structure of the African religion. People believed that upsetting the ancestors produces a disturbance of this order and illness occur. In African though to all living things including man are liked in harmonious relationship with the gods and spirits. Such relationship is ascribed to vital forces which each entity generates. A state of health exists when there is perfect harmony between man and his environment.
Abia (2012) asserted that this belief is inherent in those who practice African traditional religion as well as in many Christian and Muslim religion practices at one point in time or the other, ill health and other misfortunes, which oftentimes defile scientific and orthodox treatment are explained as spiritual forces directed by witches, wizards, sorcerers, evil spirits or angered ancestors. Illness is believed to have its origin on a primary supernatural cause. The people see the causes of illness from viruses, bacteria and parasites.
Traditional medicine
This has been very popular with the rural dwellers for generations and also for the fact that orthodox medicine is often in short supply, expensive and oftentimes fakes, the people’s approach in terms of ill- health is first turned towards patronizing the easily accessible traditional medicine.
Fundamentally, most people specifically belief in the efficacy of traditional medicine and as enunciated earlier. This belief and practices have long been with them and have affected or influences to a greater extent their attitudes and behaviours to themselves and others around. An average rural dweller before now in Nigeria for instance belief, utilizes and concentrates on traditional medicine like for the cure and treatment of fracture, explainable ailment, malaria, poison and even infertility to mention but a few. Although development, civilization and education among other factors have helped to introduce change tremendously towards these beliefs and behaviour to orthodox medicine patronage.
People though show that considerable positive results have been attained by these practices, also issues of complications, standardization, efficacy, etc. have hindered the progressively positive results that are being envisaged, hence due to fake claims of its all purpose efficacy in illness treatment more deaths have been recorded in and amongst rural dwellers who are noted as higher percentage of those who patronize them. It is when this fails that they resort to chemist shops or medicine vendors and then the hospital as the last resort.
Katung (2001), in traditional medicine, divination (consulting the oracles, enchantments), confession, ritual sacrifices, incantations and potion made from plants and animal parts are essential components of illness management. These are aimed at restoring the patient to a harmonious relationship with his environment and to counter the effect of evil forces. Our clear and very enticing reason for patronage is that almost every illness condition is interpreted as a spiritual (evil) attack that needs traditional healing powers.
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