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International / Culture
The purpose of this section is to address some of the cultural issues involved in providing health care to international students. It is impossible in this brief review to address the cultural differences of the hundreds of countries represented by international students in the United States. Perhaps it will help students to recognize and identify those areas of the U.S. medical model that are different form their own cultural medical model. These small steps are to be taken by both you and your health care provider.
This section includes some general elements to reflect on regarding cultural issues involved in health care. We recognize the danger of generalizations since they can set the basis for stereotypes. We have made our best effort to avoid stereotypes or generalizations. If you feel that any of these statements stereotype a particular culture or group of people, please let us know by sending your comments or suggestions to:
Dr. World
Student Health Center
University of North Texas
P.O. Box 305160
Denton, TX 76203-5160
Introduction
Art, music, religion, language, economic systems, customs, rituals, myths and assumptions about the world define one's cultural heritage. This heritage, in turn, forms a culture's definition of sickness, health, and treatment methods. Health and medical care are perceived in widely varying ways due to cultural differences.
How one interprets the common cold is an example of how culture views illness. Sometimes individuals may think that exposure to a cold draft may be responsible disease. Others may feel that it's just bad luck. Others may say that it is God's will. Others fight the side effects with antibiotics, while others use remedies learned from mothers and grandmothers.
There are a number of approaches or terms associated with how sickness and health are viewed. Some cultures use a holistic approach and do not separate the mind from the body. Treatment might include an herbal remedy for the body, although something for the mind would be considered too.
Cultures that view health within a naturalistic approach look for balance of the forces that are within the body, the ying and the yang. The Chinese refer to a life energy force as "chi", or "qi". Japanese speak of this force in terms of "ki" and the Indians in terms of "prana".
The most common approach in the U.S. is the scientific one, which relies upon medical data to determine a diagnosis and treatment. This is the foundation of the U.S. medical model. It is a complex blend of medical and nursing schools, hospitals, research institutions, insurance companies, and allied medical fields. It is the foundation of university student health centers as well.
U.S. Assumptions
To understand the U.S. approach and how it defines the causes and cures for illness, it is important to identify some basic assumptions of the U.S. health care system, which is based on a scientific model. In discussing some of the cultural differences one might find on U.S. university campuses, an international educator, Gary Althen, discussed some of the assumptions regarding the U.S. health care system:
- Except for problems caused by genetic factors, accidents, or aging, people can be free of sickness. Sicknesses can usually be cured.
- Nearly all sicknesses have physical and material causes that can be detected through proper testing and measurements.
- The human body is a collection of physical parts and systems which can be repaired through proper medication or physical rearranging with surgery, exercise, or limitations on mobility.
- Diagnosing a medical problem is largely a matter of getting measurements of body temperature, blood pressure, composition of the blood and urine, and the duration or severity of the symptoms. Patients are expected to provide doctors with detailed information about their medical problems, such as location and nature of symptoms, patterns of the symptoms ("Does it hurt more at night or during the day?"), and remedies that have been attempted. Patients are expected to participate in some decisions about their treatment. ("This medicine would probably help, but it can cause dizziness and shortness of breath. Do you want to try it?")
- Male and female doctors may care for either male or female patients.
- Nurses can take notes of routine information; carry out basic diagnostic procedures such as measuring body temperature, collecting blood and urine samples, and give routine vaccinations. Only doctors and some nurse practitioners can give advice on diagnosis and treatment.
- Should students be hospitalized, they will find themselves in the care of doctors, nurses, and various aides. Their families and friends will be allowed to visit during certain hours.
Forms of health care outside the scientific model are not generally viewed as treatment options. In many instances these treatment models may be viewed as superstition or quackery. Students whose basic medical assumptions fall outside the scientific model may find themselves at odds with the widely used drug prescription treatment method.
Treatment and Time Factors
How quickly you receive medical attention is determined by the severity of the illness or the symptoms you describe to the doctor's office staff. Primary care practitioners (e.g. M.D.s, D.O.s, physician assistants, nurse practitioners) may be able to schedule immediate appointments. A primary care physician may refer you to a specialist, but an appointment may not be available for several weeks.
Often the pre-approval of insurance companies and health management organizations (HMOs) is another factor influencing the delivery of health services in the U.S.
A request for a male or female physician may further delay an appointment.
U.S. patients believe they have some control over disease through preventative measures such as exercise, diet, and annual physical exams. This assumption is based on the belief that actions taken in the present will prevent future problems. This belief that one can influence the future is not one that is shared universally by all cultures.
U.S. practitioners expect patients to play an active part in the medical process. Physicians may offer choices of treatment models or medications. They will answer questions about the options, the pros and cons, and treatment costs. Think about how your illness would be treated in your home country. Ask the physician if one of the options could include any of the treatment measures offered in your home country.
In addition, as an international student, you need to be prepared to pay for any health care received and the health care of your dependents. If finances are a problem, some practitioners are willing to make payment arrangements; but this needs to be discussed at or before the time of treatment.
Some physicians may ask a lot of questions, while some seem to spend little time with their patients. Even U.S. residents complain about the time factor: "It takes too long to get an appointment." "It takes too long to wait in the doctor's office." "They are never on time. "It takes too long to get the test results." HEALTH CARE TAKES TIME. In spite of perceived time problems, efficiency and thoroughness are characteristics central to the U.S. medical system. These are responsible for the quality of medical services offered. However, if your cultural model requires that you spend a lot of time to establish a doctor/patient relationship, disappointment and negative feelings about the care received may be experienced.
It is important to arrive on time, or even early, for a scheduled appointment and to check-in with the receptionist. At this time you will be asked to complete an information sheet and to present your insurance information. Let the staff or physician know if you need a translator or if you plan to bring along a friend. Be a participant! Ask the personnel to write down or repeat instructions and medical terms to be sure you understand what you need to do. Read the printout from the pharmacist if a prescription is ordered and ask for clarification if you need to. Pharmacists are there to assist you and will tell you what foods to avoid and what allergic reactions you may encounter. Share information about your cultural views with either the physician or the pharmacist. If you need assistance with terminology, ask the Student Health Center if they have a list of terms translated in your native language.
Social Aspects of Health
International students in their first year may be at a higher health risk for physical, International students in their first year may be at a psychological and social problems. Leaving home, spouses, and support groups to begin an educational program in another country may create negative feelings and/or medical problems associated with relocation and transition. This may have a major impact on health in ways that you sometimes dismiss.
Student health centers see this impact when students seek treatment for continuous headaches, gastrointestinal problems, stomachaches, and general fatigue. Often these are the physical symptoms of underlying emotional problems, sometimes unrecognized by students.
The term "psychosomatic illness" may be used in these instances. Sometimes female students may experience changes in their menstrual cycle as a result of stress. Students need to recognize that prolonged feeling of loneliness and anxiety, difficulty in concentrating on their studies and any problems associated with sleeping or eating, are a warning sign that stress may be a factor. Maintaining good nutrition is vital to maintaining good health.
Fatigue is often caused by anxiety and tension. Trying to understand a language that is not familiar, or being able to express yourself in a language you are not comfortable with, may compound the fatigue. One international student describes it in this way in an article on intercultural communication.
"During those several months after my arrival in the U.S.A., every day I came back from school exhausted so that I had to take a rest for a while, stretching myself on the bed. For, all the time, I strained every nerve in order to understand what the people were saying and make myself understood in my broken English. When I don't understand what American people are talking about and why they are laughing, I sometimes have to pretend to understand by smiling, even though I feel alienated, uneasy, and tense" (Barna 351).
It is important to know that, just as it is true for our U.S. counterparts, a number of your health problems may be stress- induced. Pay attention to your body and to the symptoms that may have either a biomedical or psychological base.
In the U.S. system an individual is not "crazy", or "loony" for seeking help for emotional problems. It is preventative care. It is taking care of the future.
Some student health centers offer the services of a staff psychiatrist, a doctor who is licensed to prescribe medications for psychological problems. In other instances, this is handled through the counseling center and staff psychologists.
Either type of service may require you to participate in what is commonly referred to as "talk therapy." Ask what is available on your campus or check with the international office. As professionals they will assist you in finding help. All of these professionals recognize that during the time of cultural transition, the well-being of students is related to the whole student: the mind, the body, and the spirit.
Feel free to use this educational sojourn to assist the University Student Health Center to address the needs of international students. You can be the guide to assist with recognizing the needs of international students.
Ask if you can "just be there" when someone needs a friend. Ask about opportunities to talk with medical personnel or the health educator. Ask if there is a health center peer advisor program. Ask your friends to read this web site and share how different cultures view sickness, health and treatment.
Let us know how certain medical situations may be treated in your home country. In this way, you, too, can play an important role in the understanding of medical health issues for international students.
Resources
Althen, Gary. (1994.) "Cultural Differences on Campus." Learning Across Cultures. Revised Ed. Ed.Gary Althen. Washington, D.C.: NAFSA.
Barna, Larry M. (1991.) "Stumbling Blocks in Intercultural Communication." Intercultural Communication: A Reader. Sixth ed. Larry A. Samovar and Richard E. Porter. Belmont, CA: Wadsworth
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