Cultural practices and its health implications

Introduction

Oxford Advance Learner Dictionary (7^th Edition) defines culture as the customs and belief, art, way of life and social organization of a particular country or group of people. It is also a belief and attitude about something that people in a particular group or organization share.

Gbefwi (2004) defines culture as established patterns 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 or by practice. Most cultural practices are linked with religion folklore and superstition. These are reflected in forms of marriage, dressing and style of living, values, beliefs and attitudes.

Linton (1936), stated that the culture of a society is the way of life of its members; the collection of ideas and habits which they learn. Share and transmit from generation to generation.

In other words culture is the totality of the ways of life evolved by a people in their attempts to meet the challenges of living in their environment. In this regard culture gives orders and meaning to the social political, economic, aesthetic, religious norms and values of people and this distinguishes them from other people. It could be expressed in language, dressing, food, arts and religion etc. which may be regarded as the main element of culture.

Health care delivery is the various macro and micro structural facilities by which health services are dispensed or provided. There is a wide variety of health care system around the world with as many historical and organizational structures. In some countries health care system planning is distributed among market participants. There is also concerted effort among governments, trade unions, charities, religions and other co-ordinated bodies to deliver planned health care services targeted to the population they serve.

However, health care planning and delivery has been described as often evolutionary rather than revolutionary. Health care can form a significant part of a country’s economy. According to WHO (2008) the health care industry consumes an average of 9% of the Gross Domestic Product (GDP across the most developed countries in the United States (16%), France (11.2%) and Switzerland (10.7%) were the spenders. Health care is conventionally regarded as an important determinant in promoting the general health and well being around the world.

An example of this is the worldwide eradication of smallpox in 1980, declared by the WHO as the first disease in human history to be completely eliminated by deliberate health care interventions. One of the major factors affecting health care delivery is culture. It has been in existence before the health of the people positively or negatively.

The health states of individual and families in the community are always in a state of decline due to culture belief and practice people consider cultural theories as a source of their medicine or prevention against diseases or illness. The traditional medicine sometimes referred to as alternative to orthodox medicine in indigenous healing system based on the cultural tradition of the people with their belief about the causes of ill health (natural or supernatural) it is first medical care known to Nigerians and which has existed since pre-colonial period. It is the main source of health care in rural areas where 70-80% of the population reside; without them some of rural inhabitants would otherwise have been without health care. In urban areas where most of the existing health facilities are located, traditional medicine provide useful health services for various group (both low and high income earners, the uneducated and the educated).

The traditional health system complements and sometime supplements the orthodox health care delivery system because it enjoys large patronage, as well as being accessible to its users. The acceptance of the system is not only due to its proven efficacy in the treatment of certain health problems such as psychiatric (mental health), orthopaedics (bones) and maternal and child health problems mystical explanation to health problem.

Conceptual framework

The International Student Advance Learners Dictionary (7th edition) defines culture as the customs and belief, art, ways of life and social organization of a particular country or group. Ralph (1936) stated that the culture of a society is the way of life its members, the collection of ideas and habit which they learn, share and transfer from generation to generation.

Wikipedia the free encyclopaedia defined health care system as the organization of people, institutions and resources to deliver health care services to meet the health needs of target population. There is a wide variety of health care systems around the world with as many histories and organizational structure as they are in nation. In some countries health care system planning is distributed among communities. In other word, there is a concerted efforts among government, trade unions, charity organizations, religious bodies and other co-ordinated bodies to deliver planned health care services targeted at the population they serve. However, health care planning has been described as often evolutionary rather than revolutionary.

Wikipedia the free encyclopaedia as mentioned above defined health care as the treatment and prevention of diseases, illness, injury and other physical and mental impairment in human. Health care by practitioner in medicine, chiropractic, dentist, nursing, pharmacy, allied health and other care providers. It is refers to the work done in providing primary care secondary care as well as in public health. Access to health care varies across countries, groups and individuals, largely influenced by social and economic conditions as well as the health policies in place. Countries and jurisdiction have different policies and plans in relations to the personal and population based on health care goals within their societies. Their exact configuration varies from country to country. In some countries and jurisdictions, health care planning is distributed among communities. Whereas in others, planning is made more centrally among governments or other coordinated bodies. In all cases according to World Health Organization (WHO, 1968) a well functioning health care system requires a robust financing mechanism, a well trained and adequately paid workforce, reliable information on which to base decision and policies as well maintained facilities and logistic to deliver quality medicines and technology.

Simon (2009) stated that health care come from a significant part of the country’s economy. John (2008) noted that the health care industry consumed an average of 9% of the Gross Domestic Product (GDP across the most developed countries the United States (16%), France (11.2%) and Switzerland (10.7%) were the to three spenders. He further said that Health care is conventionally regarded as an important determinant in promoting the general health and well being of people around the world. An example of this is the worldwide eradication of small pox in 1980 declared by the world health organization as the first disease in human history to be completely eliminated by deliberate health care interventions.

Charlie (2007) found out that the definition of the various types of health care services vary depending on the different culture, political, organizational and disciplinary perspective, they appear to be some consensus that primary health care constitutes the first element of continuing health care process that may also include the provision of secondary and tertiary level of health care. An important major public health concern is diabetes. In 2006 according to World Health Organization, at least 171 million persons worldwide suffers from diabetes. Its prevalence is increasing rapidly and it is estimated that by 2030 this number will double.

Sources of health care delivery

Mumbor (2007) outline two types of health care comprises of

1. Orthodox type of health care delivery
2. Traditional source of health care delivery

The orthodox sources of health care delivery are mainly government and non-government founded. Examples are hospitals, health centres, health, posts, mobile clinic, maternity home, chemists or pharmacist store, drug shops that dispense tablets and injections. While the traditional sources of health care delivery are the local or traditional doctors. They have been in existence even before the orthodox medicines. They played major roles in various communities and they are still contributing to the maintenance of health of Nigerians despites their short comings.

They go by different names such as babalawo, dibia, herbalist, native doctors, bone setters, mallam among other names. Their shortcomings are unexplainable because they involve in mixture of herbs and incantations.

Level of health care delivery

According to Mumbor (2007), Nigeria has a mixed economics, this health services are provided by government, privates, individuals and non-governmental organization and management is on the concurrent legislative list of the constitution.

The level of health care in Nigeria could be described in a triangular illustration; the tiers of health care and their responsibilities.

He further summarized the tier of health care as follows:

1. Tertiary level of health care: He emphasized on rehabilitees health care and it is operated at federal levels.

Health facilities at tertiary level

• Teaching hospital
• Specialist hospital e.g. orthopaedics, psychiatric, etc.

Functions of the tertiary level

1. Medical training
2. Acceptance of referral cases
3. Rehabilitative services
4. Medical research

Personnel at tertiary level

1. Statisticians
2. Radiologist
3. Nurses and Midwives
4. Pharmacists
5. Doctors (with different specialists)

Secondary level of health care: They lay emphases on curative services and it’s operated at state government level.

Health facilities at secondary level

1. General or central hospitals

Functions of secondary levels

1. Ante-natal and post-natal clinic
2. Referral of complicated medical cases to tertiary level
3. Treatment of medical and surgical condition
4. Confirmation of diagnosis

Personnel at secondary level

1. Radiologist
2. Doctors
3. Pharmacists
4. Nurses and Midwives
5. Laboratory technicians

Primary level of health care: This is a level that emphasizes on preventive care which is operated at local government level.

Health facilities at primary level

1. Primary health care
2. Health post
3. Family health clinics

Functions of primary levels

1. Early diagnosis
2. Immunization against locally endemic and epidemic diseases
3. Health education and community mobilization
4. Referring complex cases to higher level
5. Treatment of minor ailment
6. Identification of health condition
7. Implementation of primary health care programmes
8. Integration of primary health care services to the communities.

Health personnel in primary level

1. Medical officers of health
2. Community health officers
3. Health educators
4. Public health officers
5. Community health extension workers
6. Medical laboratory assistants/technicians
7. Traditional birth attendants
8. Trained volunteer and village health workers

Factors affecting health care delivery

Bono (1994) in his book titled “Sociology of health care” stated that socio-economic factors affect health in general. They are

1. Bad roads
2. Poverty
3. Ignorance
4. High unemployment rate Illiteracy
5. High cost of health care
6. Large families with low income
7. Seasonal bad weather, flood and famine

Mumbor (2007), highlight and explained four basic factors that affect care in Nigeria

1. Cultural factors: Cultural factors that affects health care includes
2. Customs: This is a particular way in which people or group of people do certain things in their community e.g. marriage
3. Belief: This is what people hold in their mind to be the cause or solution to a particular thing in their society e.g. religion.
4. Practice: This is the way people behave, act and respond to a particular situation in their daily life activities.
5. Taboo: This is a certain thing which people regard to be an abomination in their society examples includes health
6. A woman that is seeing her menses is not allowed to cook for her family
7. The eating of new yam is forbidden until certain rituals are performed in the community.

Environmental factors: These are factors affecting the immediate surroundings of the member of the community. They are

• Pollution
• Inadequate water supply
• Poor housing
• Poor refuse disposal
• Presence of industrial waste
• Poor road network
• Inadequate and unsafe water supply
• Location of health facilities in hilly or swamping road
• High incidence of diseases vectors and pest

Personal factors: Individual factors sometimes affect the psychological well being of one’s health. Such factors include

• Experience
• Family problem
• Educational status
• Awareness of health matters
• Attitudes of health system
• Poor personal hygiene

Geographical factors:

(a) Vegetation

(b) Weather (hot or cold)

(c) Topography of the soil, rivers and mountains

(d) Deserts

Cultural practices that affects health

These are practices that affect the health of individuals in the community. Negligence of community members in modem medicine, involving themselves only in traditional practices for examples the use of unsterilized sharp objects during circumcision may bring about increase rate of blood transmitted infections like HIV / AIDS.

• It will discourage the acceptance of modem medicine due to high rate of hospital bills. In traditional medicine it is chapter (affordability) and reachable to the community at large.
• Community may fail to acknowledge certain causes of illness in the sense that they believe that their gods in their community are responsible for their illness due to their gods in their community are responsible for their illness due to their unbelief that sickness can be caused by different micro organisms present in their environment.
• There will be increase in infant and maternal mortality due to belief and cultural practices in the sense that some cultures discourage maternal care in their community. They believe that any woman that is pregnant with a child is capable of taking care of herself and her unborn child. They fail to believe that before and after delivery the woman is supposed to be cared for by the nurses and midwives.

Negative culture health practice

Retting (2005) and Mumbor (2007) discovered some harmful health practices as follows:

1. Tribal marks: This is done by cutting the body, face, belly etc (scarification) with unsterilized instruments can lead to infection, easy identification of tribal marks will also deprive them from attending ante-natal clinic because they will be easily identified by the members in the health centre and they also believe that this tribal mark can protect them from evil and prevent them from contacting diseases.
2. Widow’s inheritance: In some culture, when a woman loses her husband to death, it is expected that any member of the deceased can inherit the widow and her children. Some women are not happy to marry any member of her late husband’s family.
3. Language difficulties: Inability of an individual to comprehend the language used is otherwise known as language barriers. This is communication barriers among people of different tribes. There is no way a person from Hausa can communicate with a person from Ibo who speaks only Ibo language, thereby causing communication barriers. During health education in rural areas, if an interpreter is not interpreting the health information to the community members, the health message will not be comprehended by the participant thereby it is not improving the health status of the community members.
4. Female genital mutilation: This is done culturally by cutting off the clitoris which is the most sensitive part located at the opening of the vagina (genitalia). This is bad because in this process, the female might end up having complications like excessive bleeding which might led to death, the female may never be satisfied of having sex and also may not have the urge for sex because the most sensitive part in her is being cut off which is the clitoris.
5. Early marriage: This is a bad aspect of our culture that affects health. When our young girls are being given out for marriage as a result of cultural belief. This will lead to early child birth and also during the process of delivery if the uterus is very narrow due to immature organs it can lead to a disease known as vesicle vagina fistula (VVF). It can also lead to broken homes and termination of education. The young mother also finds it difficult to take care of herself and her baby’s health medically.

Ways to combat and improve cultural theories in the community

According to Mumbor (2007), in his book “Primary Health Care for Colleges and School of Health Technology contributed in improvement of health status and possible ways to combat cultural practices in a given community. These includes

1. Immunization: This involves the inoculation of antigens into the body to produce antibody that helps to fight against diseases or infections. Through these vaccines the health of the people is secured.
2. Health education: These are activities carried out by health educators to encourage people to engage in health activities that will improve, promote their health and discourage them from practices that are harmful to their health.
3. Boosting of agricultural production: To increase agricultural products so that there will be enough food for all.
4. Adequate ante-natal and post-natal care: This includes taking care of pregnant women before delivery (ante-natal) and also taking care of the mothers and their babies after delivery (post-natal).
5. Adequate water supply: This is the provision of pipe born water and other safe sources of water. By this diseases like cholera, dysentery, diarrhoea which are water born disease are reduced.
6. Proper environmental sanitation: This is the maintenance of a clear and healthy site for living. It refers to good and adequate water supply, ventilation, good housing, safe drainage, clean air, proper refuse and sewage disposal for healthy living.

He further proffered possible way to combat cultural theories in a given community as:

1. Operation of drug revolving fund system
2. Advocacy service
3. Health education and community mobilization
4. Formation of community ownership control of primary health care services.
5. Utilization of locally available resources in primary health care
6. Involvement of traditional rules in primary health care services.

References

Bono, J. (1994): Sociology and Health Care Delivery; Churchill Livingstone, St. Joseph’s Books.

Charlie, B. (2007): Health Profession: Washington. Caroll and May Publishers.

Gbefwi, N. B. (2004): Health Education and Communication Strategies: A practical approach for Community-based health practitioners and rural health workers. West African Book Publishers Ltd. Ilupeju

John, H. (2008) Patient Care Tertiary Care Definition Emory University, John Willey and Seph.

Linton, R (1936). Handbook of Sociological Theory. Springer Science Business Media. New York.

Mumbor, M. I. (2007): Primary Health Care for Colleges and School of Health Technology, Ofuoma — Ughelli, Mudis Press.

Retting, V. (2005): Harmful Effect of Health Practices; Meldourne, New House Publication

Simeon, J. (2009) Primary Care Needs New Innovations: Copeuhanger, Health Lender Media.

World Health Organisation (2008): International Classification of Primary Care.  Geneva.