There are several different aspects of a culture. These aspects are influenced by the person’s background, beliefs and practices.  

Culture is defined by the Geographic Organization as being: The accumulated habits, attitudes, and beliefs of a group of people that define for them their general behavior and way of life; the total set of learned activities of a people. People living in different areas develop cultures unique to their group. 

The world as we know is “growing smaller”. It now only takes a few hours for news to make it from one side of the world to the other. The ‘shrinking’ of the planet has encouraged international travel. Many more people move to the United States than ever before, becoming either temporary or permanent residents.

This brings a variety of cultures to our area. There are a variety of interesting and diverse ethnicities living in the area. 

We have developed our individual culture from the time we were born and inherited a portion of our cultural beliefs from our families that may go back several hundred years. For example, some people open their Christmas gifts on Christmas Eve, while others open theirs on Christmas Day. Other families don’t celebrate Christmas at all. They may celebrate Hanukkah, Ramadan or Kwanzaa. 

Take a look around at some of our cultural “norms”. This could include a “typical” family having several cars, television sets and computers. Our children would rather be inside playing a video game than go outside to play. To other cultures, this would seem very odd, but we accept it as normal. 

Marietta Memorial Hospital is committed to helping people who present themselves for care, regardless of their ethnicity or cultural background. As healthcare providers we need to understand everyone is affected by culture. We all have beliefs, ideas, practices and habits we have learned through the years.  

We need to be aware of cultural practices which may affect communication and care for patients. At MMH, every patient is asked at the time of admission if there are any cultural or religious beliefs that might affect their care. Patients are also asked about alternative medicines they may be taking. Religious beliefs may prohibit a person from accepting blood products. Religious or personal beliefs may affect the patient’s dietary preferences and needs. 

As healthcare providers, we also need to know the patient’s educational level and their ability to read. Despite this being a difficult question to ask, it is important to know. If we give the patient reading material concerning their condition or medication, but they cannot read it, we haven’t helped the patient at all.

Aspects of Culture 

 The overview domain: This aspect of a person concerns where the patient is from and what effect their surrounding geography has on them and their healthcare. 

The communication domain: This is a very rich, complex aspect of a person. It includes not only the written word, but also non-verbal gestures. It also consists of voice inflections, accents and tone of voice. 

Family roles and organization: This part of a person deals with the family structure and interaction. This can vary a great deal from culture to culture. This aspect of culture deals with who is the head of the household and who is in charge of healthcare. 

Workforce issues: This facet of culture deals with how the culture fits into the scheme of the person being a productive member of society. In some cultures, the person takes their identity from the work they do or the position they hold. In other cultures, a job is just a way to provide for the family. 

Biocultural ecology: This deals with the ethnic background and the physical, biological and physiologic issues that may arise from their ethnicity. Some races are more prone to certain diseases than others. For example, African Americans are more prone to high blood pressure than other races. 

Nutrition is an important part of some cultures. Some cultures do not eat meat while other cultures enjoy rich, spicy or flavorful food. In some cultures, it is normal to drink wine with a meal or to sit down to dinner at what we would consider a very late time of the evening. 

Pregnancy and childbearing practices can vary from culture to culture. In the United States, pre-natal care is expected while in other countries obtaining medical care during a pregnancy would be very unusual. 

Death rituals are cultural practices and beliefs that surround death and burial rituals. Some cultures require certain rituals and rites to be conducted before or after death.

Spirituality deals with the religious beliefs and practices within a culture. Also, a culture may be a part of a recognized religious organization, but may have developed certain, localized customs within the confines of the recognized religion.

Healthcare practices may involve not just formal ‘western medicine’ but may also include home remedies alternative therapies or other practices that have not been scientifically proven. 

Healthcare practitioners may be a traditional physician or midwife but some cultures have Medicine Men/Women or Shamans to attend to their healthcare needs.

The Appalachian Culture

Southeast Ohio is part of the Appalachian culture. There are several sub cultures living in the same area, such as Hispanic and Philipino cultures. When one of your coworkers is from a different country or culture, ask them about their traditions and healthcare beliefs. Their beliefs are certainly not “bad” or “wrong”—just different. 

Most Appalachians can trace their heritage back to Europe. The original immigrants to our area were highly educated. Due to the rugged geographic nature of Appalachia and the rural, isolated placement of many families, educational opportunities have been limited for the subsequent generations. In addition, many of the local jobs did not require any formal education and thus education was not seen as something necessary in order to earn a living. This belief was passed from one generation to the next. 

Communication in the region has similar characteristics. Many native Appalachians drop the “g” on the end of a word ending in “ing” so that “reading” becomes “reading”. In addition, there are different pronunciations for some words. For example, “creek” becomes “crick” and “dish” is pronounced “deesh”. Other more familiar terms are “poke”, which is the term for a bag or sack. Words may also be altered and changed when they are spoken in the past tense. For instance, “climbed” will become “clum”.  

To people from other cultures, these Appalachian words, expressions and beliefs are very different to their way of understanding. The point is—the beliefs of the various cultures are not bad—not wrong—just different. 

The family plays an important role in the Appalachian culture. The father is generally recognized as the head of the home, but the mother makes most of the healthcare decisions and is generally responsible for child rearing, etc. Although most Appalachians pride themselves on being independent, they remain family oriented and distrust outsiders.

Because the family is valued, sometimes work or other commitments may not be a priority when a family member is ill. Patients may not be compliant with their treatment or follow up appointments because they feel they need to defer to another family member with a greater need. 

Healthcare risks include pulmonary problems, cardiovascular disease, diabetes and stroke due to living and work environments as well as lifestyle factors. Smoking, deep-frying and sedentary lifestyles are all factors in Appalachian health status. Dr. Schwartz once said “In Appalachia how do you show someone you love them? You feed them. How do you show you love them more? You feed them more.”

People in our culture may be reluctant to seek healthcare for a variety of reason. The patient may only come to the hospital after they have exhausted all the home remedies they can think of. In addition, they may have tried to “doctor” themselves by taking someone else’s medicine. This behavior poses challenges for healthcare workers. 

The death of someone may bring family members from far away. If the dying loved one is a patient in the hospital, the family may try to arrive before the patient dies in order to pay their respects. This can lead to numerous visitors in the waiting area. As members of the healthcare team, we need to provide care that meets the needs of both the patients and family. Also, the pastor and fellow members of the church to which the patient/family members belong are important. Church members may visit frequently and are a source of comfort and encouragement to the patient and their family. 

Many Appalachians believe sickness, disease and accidents are God’s will. This belief may make them appear reluctant to do things to help themselves and improve their state of health. 

Keep in mind—regardless of the patient’s culture and upbringing, they may have practices we won’t know about until we ask and learn

Notable Cultural Bloopers

Pepsodent tried to sell its toothpaste in Southeast Asia by  emphasizing how it ‘whitened teeth’. However,   officials at the Pepsodent Company found the local natives chew betel nuts in order to blacken their teeth—something the  local native find attractive!