Illnesses are experienced and perceived differently around the world. The perception of illness is invariably influenced by the prevailing cultural norms, beliefs, behaviors, attitudes, and practices which inform the patient’s perspective. It is, therefore, important to understand illness in the social context of a patient’s life. In this reflection paper, I consider the differences in how illness is perceived and treated among Kenyan communities and compare it with those in the United States. I interrogate the cultural differences in accessing care and providing care, delineating the strategies that may be implemented to bridge the cultural and socioeconomic differences. The core strategies a health provider may employ to overcome the cultural and socioeconomic barriers include providing community education to change perceptions and attitudes, strengthening the family support systems, and guaranteeing patient privacy.
Differences in Accessing and Providing Care
The Kenyan community can best be described as a community caught between the past and present. While a substantial part of the population has increasingly become westernized as the country makes economic and sociological progress, there is still a large part of it that is holding on to the native cultural beliefs and practices. These cultural aspects impact on how illness is perceived and treated among some communities in Kenya, especially those in the rural areas. Among the communities predominantly residing in the rural areas, illness is often perceived as an adverse interference from a supernatural being or a powerful human being with extraterrestrial powers. These communities employ a personalistic system of belief in the conceptualization of a disease and explaining its causation. They believe that illness results from a retaliation of an evil force for, among other reasons, moral and spiritual failings. A sick person, hence, is marginalized as one who, publicly or privately, has violated a social norm or has breached a social taboo. Among such communities, patients assume that all illnesses are fatal and death is expected. The sick persons in these communities often probe their minds or a medium to establish where they could have gone wrong or what has necessitated that retaliation. For instance, in a study by Gona et al. investigating the perceptions of the origin of Autism Spectrum Disorders (ASD) among the people living in Kenya’s coastal region, preternatural causes were the most cited, as opposed to biomedical causes. A significant number of them reckoned that ASD is caused by evil spirits, witchcraft, and curses.
While divine punishment is the dominant narrative among the rural Kenyan communities, there is also an influence of the luck factor. Those who do not view illnesses as punishments from divine forces perceive themselves as incredibly unlucky or having bad karma. Employing the personalistic system of belief, most of these natives prefer to address the illnesses through ritual and symbolism interventions, often involving the invoking of healing spirits and sometimes combining with traditional medicine.
The perceptions of illness among the Kenyan communities could not have been any more different from those in the U.S. Here, personalistic causes of illnesses are barely acknowledged in the mainstream care system. Instead, the majority subscribe to the biomedicine point of view. Instead of an illness being perceived as an adverse intervention by a powerful being, it is perceived as a malfunction of the human body. The treatment, therefore, centers on understanding the human body as a machine or system. As such, the diagnosis and treatment here are based on scientific data; the importance of research studies in promoting the standards of healthcare cannot be overstated. Considering the previous example of ASD, for instance, the causes would have been identified as infections, drug abuse, malnutrition, and genetic-related problems among others.
Bridging the Differences
In my considered opinion, cultural beliefs and religion are the most significant influencers in accessing and providing care between these two communities. The primary barriers to overcome are negotiating a useful understanding of illness to change the perception and understanding of illness in the social context. The ability to bridge the cultural and socioeconomic differences between the health care provider and the receivers is key in promoting health outcomes in a community.
The core strategy I would employ as the health care provider working with patients with different perceptions and cultural beliefs is to provide community education to change the limiting perceptions. For instance, I would prepare fliers and posters explaining the causes of an illness and distribute them among the community members. Through the varied means of communication, I would negotiate an understanding of what causes the various illnesses to prompt the community members to seek medical health care. For instance, up to the turn of the new millennium, many people in Asia, South America, and Africa contracted HIV/AIDS because they refused to acknowledge that it is a disease whose spread could be prevented. However, when they acknowledged it as a disease and not some form of a curse and started using the biomedical interventions, HIV/AIDS infection rate and mortality in these areas reduced significantly. Changing these beliefs, therefore, would not only be critical in utilizing health care facilities by individuals, but also in adherence to treatment plans.
An additional strategy would be to guarantee privacy. Some sick people dread seeking biomedical interventions because of stigmatization in their communities. For instance, in some parts of the world where the people living with HIV/AIDS are still subjected to stigmatization, some would rather die at home than be seen going to the hospital for the antiretroviral drugs. Since addressing stigmatization requires varied and extensive interventions which I cannot manage on my own, guaranteeing patient privacy is the next best available recourse.
A further strategy when working with patients with different cultural and socioeconomic standing would be to strengthen the family support systems. Functional social support is critical in prompting a sick individual to seek medical care. The social support gives them the confidence to perceive the illness they are experiencing in the most positive light possible. It further encourages them to stick to the prescribed treatment schedule and plan and, further, to experience benefit-finding in the most adverse of situations. Even if the cultural and socioeconomic differences between the care provider and the patient subsist, the social support network ensures that both parties work towards the recovery of the patient.
In conclusion, it is evident that the prevailing cultural norms, beliefs, attitudes, and practices in a community influence the perception of illness in that community. Understanding illness as a social context is, therefore, critical in designing strategies and interventions that promote access to health care services for all. The Kenyan community on the one hand predominantly subscribes to the personalistic cause of illness narrative where illness is perceived to have been caused by a supernatural being or a human being with extraterrestrial powers. The U.S. community on the other hand predominantly subscribes to the biomedical cause narrative where illness is perceived as a malfunction of the body system. Some of the strategies I would employ to bridge these differences in perceptions and beliefs include undertaking community education to change the illness narratives, guaranteeing patient privacy, and strengthening the family support systems to encourage utilization of health care resources and adherence to the prescribed treatment plans.