The Role of Culture in Medical Treatment

Last GlobeMed meeting, we read a short summary of Anne Fadiman's, The Spirit Catches You and You Fall Down.  In the book, Lia Lee suffers from epilepsy, but her family's traditional Hmong beliefs and culture conflicts with California doctors' treatment protocols, which ultimately led to an episode that caused her to live the later 26 years of her 30-year-lifetime in a vegetative state.  We began to discuss current-day issues we see with cultural differences in medicine.  There are language barriers, age barriers, religious differences, knowledge gaps, etc. that can prevent people from getting medical treatment they need, or influence them to take on unnecessary medical treatments.

Last year, I took a class on Human Rights for Women and Children in Africa, in which we questioned the foundational definitions of human rights.  Part 1 of Article 25 of the UN Declaration of Human Rights states, "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social service, and the right to sexurity in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."  This sounded great when I first read it; I mean who would disagree with that statement?  But then my teacher brough up some things I had never thought about.  First, in chapter 3 of Politics of the Womb: WOmen, Reproduction and the State in Kenya, Lynn M. Thomas discuses "the girls who circumcised themselves" after FGM was banned in Kenya in 1956 to satisfy Western (particularly British) human rights views.  Then we discussed women who prefer to have at-home births with traditional spiritual (and not medically trained) midwives in certain states such as Chad.  Finally, when we were comparing differences between life expectancies in the US and other Western countries with those in many African countries, my teacher posed a question along the lines of, what if people in these cultures would rather die in the way 'fate' had destined them to die than get operations and take medications that might make them live longer, but not necessarily fuller lives?

I have struggled to come up with any sort of solution to this juxtaposition.  I personally believe that under the law of human rights, Lia Lee should have been given her medication, etc.  People with epilepsy can lead semi-normal lives with treatment, and I think that she had the right to be given that opportunity.  I do think doctors should have been more understanding of Lee's family's beliefs, and maybe should have tried to come up with a way to gain the trust of Lia's parents so that they would give Lia the medication, but I'm not sure that would've changed her parents' behavior very much.  I think it should be a human right for people to choose whether they want to take a medication, seek medical treatment, etc., but this does complicate things when cross-cultural medical treatment is involved.  As I said before, I still don't have answers to this question of how to create culturally sensitive treatments that work for certain medical issues.  Do we ifnore culture in order to treat someone that doesn't want treatment, because we think it's the right thing to do?  Do we completely take away culturally embedded practices and beliefs such as at-home-births or FGM because they may violate our western standards of human rights, or do we find ways to alter the practices to make them a bit safer.  I don't know, but I do think that it is an important question to ask.

-Rebecca