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Religious and Cultural Determinants of Health Care: A Qualitative Study from India

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Title: Religious and Cultural Determinants of Health Care: A Qualitative Study from India


1
Religious and Cultural Determinants of Health
Care A Qualitative Study from India
  • DR. VINOD SHAH
  • Presented at Faith-Based Organizations as
    Pioneers and Partners in Health
  • Systems Development, May 31, 2005, Omni Shoreham
    Hotel, Washington DC

2
A QUALITATIVE RESEARCH based on interviews with
Hindu god-men, leaders devotees.
3
AACHARYA LAL PRATAP MISHRA
PANDIT HARISH KUMAR TRIVEDI
LORD RAM AND HANUMAN DEVOTEE
SADHU JI
MEMBER OF SANATHAN DHARMA
RAM KRISHNA DEVOTEE
4
PILGRIM SADHU
PILGRIM SADHUS
SANT RAM DAS
SHRI MOHAN LAL MISHRA
SANTOSH HITAU
SHRI MAHARAJ JI
5
SWAMI NANDACHARYA
SWAMI NATWAR DAS
A BLIND HINDU DEVOTEE
DEVOTEE OF BABA KIS
A HINDU DEVOTEE
A DEVOTEE OF VISHNU
6
MANGAL SWAMI
JAGDISH KUMAR VAISH - STUDENT
LAL SHRI
RAJU
WOMEN PILGRIMS
PROFESSOR AJIT DALAL
7
Factors that affected the health caring Culture.
8
Role modeling of care-I
  • Did the religious leaders role model caring?

9
VISITING THE SICK
  • I dont go visiting and helping the sick because
    Im not a doctor.
  • I dont have time to visit the sick.
  • I help those who come to me and get them to the
    hospital.

10
CONT.
  • I sit on a seat that is fixed and it does not
    enable me to move about the whole day.
  • I come here early morning and once I sit on my
    seat I dont move.
  • If someone who is sick and comes up to meI may
    just help him
  • I dont have the time to visit the sick.

11
Cont
  • If I am at prayerI will not leave my prayer and
    go to help someoneI dont think it is important.
  • If I leave my god and my karma and help someone
    then my god will get angrymy karma will be lost

12
ROLE MODELLING OF CARE BY GODS AND GODDESS
  • The Christian Gospel is full of Christ role
    modeling care and compassion
  • Christians too are more interested in healing,
    caring and compassionate ministries
  • The first hospital in India was mentioned during
    the time of Ashoka in the 2nd Century BC - there
    is no further mention of a hospital in India till
    the 15th Century after the advent of the
    Portuguese.

13
Did God role model healing?
  • There is no such example for god role modeling
    healing.

14
Cont.
  • SILENCE!

15
  • THE ORTHODOX INDIAN CONTEXT
  • Jainism discourages sharing your suffering with
    others.
  • VISITING THE SICK is not done by the community
    and is confined to the family and extended family
  • We never see Hindu or Buddhist or Jain Priests
    coming to pray for supporting the sick. It is
    not part of their job description.

16
IMPORTANCE OF THE BODY Body- Soul
dissociation-II
  • Developed societies
  • To heal the body is also to minister to the soul
    and indeed to the whole person
  • The body had intrinsic dignity however deformed
    or diseased. Even in death, the body needed to
    be respected
  • The body was an integral part of me.

17
One of the most difficult austerities a
practitioner can attempt is to hold his arm
upright in the air for twelve years. It is said
that if successfully completed, the practice
results in the attainment of supernatural powers
18
The fingernails of this ascetics hand have
curled around the palm during the four years he
held it upright
19
Offerings are made to a mediator who is buried up
to the neck in sand. He suppresses the sensations
of the flesh while attempting to free his mind
through meditation.
20
Lifting enormous rocks with the penis is one of
the more unusual ways of desensitizing the sexual
organ to overcome lust
21
Perhaps the most well known austerity is lying on
a bed of sharp nails to overcome the limitations
of the physical body.
22
Naga babas perform exercises with their penises,
like lifting stones, stretching and rolling it
around a stick to demonstrate that the nerves
have been severed.
23
Most yogis never cut their hair but grow it long
and matted to discourage vanity. They wear little
or no clothing, rubbing ash from the fires over
their bodies
24
Body Soul dissociation
  • The Indian systems have many holistic practices
  • However none of them really address the hard core
    issues of the body like-
  • Repair of structures/organs
  • Understanding cellular processes
  • Pathology of infections etc.
  • Body (Dirty) and Soul (Good) were dissociated.

25
SENSE OF COMMUNITY High and low trust
societies-III
IMPACT ON HEALTH/ ECONOMICS
ACCORDING TO FRANCIS FUKUYOMA.
Author of book on Trust
26
THE ORTHODOX INDIAN CONTEXT
LOW TRUST SOCIETIES
LESS WEALTH CREATION
SOLITARY WORSHIP
LESS SPONTANEOUS SOCIALIBILITY
FAMILY BUSINESS ONLY
LESS SOCIAL CAPITAL
27
JUDEO CHRISTIAN CONTEXT
HIGH TRUST SOCIETIES
MORE SPONTANEOUS SOCIALIBILITY
MORE WEALTH CREATION
COMMUNITY WORSHIP
MULTINATIONAL CORPORATE BUSINESS
MORE SOCIAL CAPITAL
28
  • Institutions that are required for health such
    as
  • Marketing of these herbs
  • Standardization of dosages
  • Ethical committees to set down codes of conduct
  • Medical Training Centres
  • Other disciplines which should cooperate and
    assist
  • the physician.
  • Farming of ayurvedic herbs
  • All these require community cooperation. But
    sadly none of these happened in a regular
    sustainable fashion.
  •  

29
INDIVIDUAL WORSHIP
  • I sit here and worship my god alonethis is my
    temple.
  • I perform all the rites of worship to gods like
    Ganga, etcin the morning and evening.

30
Cont.
  • Ones karma is the only true form of worship.
  • Following all rules and regulations is the best
    form of worship.

31
Cont.
32
Womens disempowered status
  • IV

33
Woman in Hinduism/Jainism
  • Sentiment towards woman was low
  • Later Vedic period woman reduced to status of
    Sudra
  • Women had no place in religious life-no reciting
    of slokas/ no salvation
  • Degradation through temple prostitution/Tantric
    practices

34
The eldest son of the family pays his last
respects to his deceased father before completing
the customary rituals and putting torch to the
funeral pyre.
35
Erotic sculptures abound temple prostitution
was one of the results
36
TANTRA- Motionless sex and meditation at the same
time.
Sex sans lust
37
Famous tantric
  • Was a close confidante ofone of the PM in India
  • Mr Chandraswamy

38
A Memorial The women who committed Sati suicide
were immortalized in India. Their praises were
sung and temples were built for them. Offerings
are made to many memorials even after several
decades later.
39
Memorials Erected for Women Who Committed
Sati. These stones are called Maha-Sati stones
and can be found in several parts of India
40
Decorated Sati from a Hero-stone (Mahasati Stone)
41
Bridal Makeup of a Woman Committing Suicide
42
STATUS OF WOMEN
A womans religion is only to serve her
husband. We Hindus believe this. We dont believe
we have any status without a husband.
43
Family versus truth- V
A father and a husband is like a God
44
Family values corruption
  • Scale of familism (World Values survey code book
    1994 World Bank statistics)
  • Correlates well with the CPI.(Regression
    analysis)
  • Tribalism- Africa and India

45
Family values and corruption
  • Edward Banfield- Amoral familism- The Moral
    Basis of a backward society
  • Plato- Children should be institutionalized
    Republic Chapter 5
  • Lawrence Harrison- Extended family
    anti-development (Underdevelopment is a state of
    mind-page 7)
  • Weber- Family Loyalty and market are antithetical
    -The religion of China- page 237.

46
Corruption Perceptions Index 2004
47
Corruption Perceptions Index 2004 This table was
compiled at the University of Passau on behalf of
Transparency International. For information on
data and methodology, please consult the
frequently asked questions and the framework
document.
48
Country Rank Country 2004 CPI
Score Confidence Range Surveys
Used
1 Finland 9,7 9.5 - 9.8 9 2 New
Zealand 9,6 9.4 - 9.6 9 3 Denmark 9,5 9.3 -
9.7 10 Iceland 9,5 9.4 -
9.7 8 5 Singapore 9,3 9.2 -
9.4 13 6 Sweden 9,2 9.1 -
9.3 11 7 Switzerland 9,1 8.9 -
9.2 10 8 Norway 8,9 8.6 -
9.1 9 9 Australia 8,8 8.4 -
9.1 15 10 Netherlands 8,7 8.5 -
8.9 10 11 United Kingdom 8,6 8.4 -
8.8 12 12 Canada 8,5 8.1 -
8.9 12 13 Austria 8,4 8.1 -
8.8 10 Luxembourg 8,4 8.0 -
8.9 7 15 Germany 8,2 8.0 -
8.5 11 16 Hong Kong 8,0 7.1 - 8.5 13
49
Country Rank Country 2004 CPI
Score Confidence Range Surveys
Used
17 Belgium 7,5 7.1 - 8.0 10 Ireland 7,5
7.2 - 7.9 10 USA 7,5 6.9 -
8.0 14 20 Chile 7,4 7.0 -
7.8 11 21 Barbados 7,3 6.6 - 7.
6 3 22 France 7,1 6.6 - 7.6 12 Spain 7
,1 6.7 - 7.4 11 24 Japan 6,9 6.2 -
7.4 15 25 Malta 6,8 5.3 -
8.2 4 26 Israel 6,4 5.6 -
7.1 10 27 Portugal 6,3 5.8 -
6.8 9 28 Uruguay 6,2 5.9 -
6.7 6 29 Oman 6,1 5.1 - 6.8 5 United
Arab Emirates 6,1 5.1 - 7.1 5 31 Botswan
a 6,0 5.3 - 6.8 7
50
Country Rank Country
2004 CPI Score Confidence Range
Surveys Used
  • 31 Estonia 6,0 5.6 - 6.7 12
  • Slovenia 6,0 5.6 -
    6.6 12
  • 34 Bahrain 5,8 5.5 - 6.2 5
  • 35 Taiwan 5,6 5.2 - 6.1 15
  • 36 Cyprus 5,4 5.0 - 5.8 4
  • 37 Jordan 5,3 4.6 - 5.9 9
  • 38 Qatar 5,2 4.6 - 5.6 4
  • 39 Malaysia 5,0 4.5 - 5.6 15
  • Tunisia 5,0 4.5 - 5.6 7
  • 41 Costa Rica 4,9 4.2 - 5.8 8
  • 42 Hungary 4,8 4.6 - 5.0 12
  • Italy 4,8 4.4 - 5.1 10
  • 44 Kuwait 4,6 3.8 - 5.3 5
  • Lithuania 4,6 4.0 - 5.4 9
  • South Africa 4,6 4.2 - 5.0 11
  • 47 South Korea 4,5 4.0 - 4.9 14
  • 48 Seychelles 4,4 3.7 - 5.0 3
  • 49 Greece 4,3 4.0 - 4.8 9

51
Country Rank Country 2004
CPI Score Confidence Range Surveys
Used
  • 49 Suriname 4,3 2.1 - 5.8 3
  • 51 Czech Republic 4,2 3.7 - 4.9 11
  • El Salvador 4,2 3.3 - 5.1 7
  • Trinidad and 4,2 3.6 - 5.2 6
  • Tobago
  • 54 Bulgaria 4,1 3.7 - 4.6 10
  • Mauritius 4,1 3.2 - 4.8 5
  • Namibia 4,1 3.5 - 4.6 7
  • 57 Latvia 4,0 3.8 - 4.3 8
  • Slovakia 4,0 3.6 - 4.5 11
  • 59 Brazil 3,9 3.7 - 4.1 11
  • 60 Belize 3,8 3.4 - 4.1 3
  • Colombia 3,8 3.4 - 4.1 10
  • 62 Cuba 3,7 2.2 - 4.7 4
  • Panama 3,7 3.4 - 4.2 7
  • 64 Ghana 3,6 3.1 - 4.1 7
  • Mexico 3,6 3.3 - 3.8 11
  • Thailand 3,6 3.3 - 3.9 14

52
Country Rank Country 2004 CPI
Score Confidence Range Surveys Used
  • 67 Croatia 3,5 3.3 - 3.8 9
  • Peru 3,5 3.3 - 3.7 8
  • Poland 3,5 3.1 - 3.9 13
  • Sri Lanka 3,5 3.1 - 3.9 8
  • 71 China 3,4 3.0 - 3.8 16
  • Saudi Arabia 3,4 2.7 - 4.0 5
  • Syria 3,4 2.8 - 4.1 5
  • 74 Belarus 3,3 1.9 - 4.8 5
  • Gabon 3,3 2.1 - 3.7 3
  • Jamaica 3,3 2.8 - 3.7 6
  • 77 Benin 3,2 2.0 - 4.3 3
  • Egypt 3,2 2.7 - 3.8 8
  • Mali 3,2 2.2 - 4.2 5
  • Morocco 3,2 2.9 - 3.5 7
  • Turkey 3,2 2.8 - 3.7 13
  • 82 Armenia 3,1 2.4 - 3.7 5
  • Bosnia and 3,1 2.7 - 3.5 7
  • Herzegovina

53
Country Rank Country 2004 CPI
Score Confidence Range Surveys Used
  • 82 Madagascar 3,1 1.8 - 4.4 4
  • 85 Mongolia 3,0 2.6 - 3.2 3
  • Senegal 3,0 2.5 - 3.5 6
  • 87 Dominican 2,9 2.4 - 3.3 6
  • Republic
  • Iran 2,9 2.2 - 3.4 5
  • Romania 2,9 2.5 - 3.4 12
  • 90 Gambia 2,8 2.2 - 3.4 5
  • India 2,8 2.6 - 3.0 15
  • Malawi 2,8 2.2 - 3.7 5
  • Mozambique 2,8 2.4 - 3.1 7
  • Nepal 2,8 1.6 - 3.4 3
  • Russia 2,8 2.5 - 3.1 15
  • Tanzania 2,8 2.4 - 3.2 7
  • 97 Algeria 2,7 2.3 - 3.0 6
  • Lebanon 2,7 2.1 - 3.2 5
  • Macedonia 2,7 2.3 - 3.2 7

54
Country Rank Country 2004 CPI
Score Confidence Range Surveys Used
  • 97 Nicaragua 2,7 2.5 - 3.0 7
  • Serbia and 2,7 2.3 - 3.0 7
  • Montenegro
  • 102 Eritrea 2,6 1.6 - 3.4 3
  • Papua New 2,6 1.9 - 3.4 4
  • Guinea
  • Philippines 2,6 2.4 - 2.9 14
  • Uganda 2,6 2.1 - 3.1 7
  • Vietnam 2,6 2.3 - 2.9 11
  • Zambia 2,6 2.3 - 2.9 6
  • 108 Albania 2,5 2.0 - 3.0 4
  • Argentina 2,5 2.2 - 2.8 11
  • Libya 2,5 1.9 - 3.0 4
  • Palestinian 2,5 2.0 - 2.7 3
  • Authority
  • 112 Ecuador 2,4 2.3 - 2.5 7
  • Yemen 2,4 1.9 - 2.9 5

55
Country Rank Country 2004 CPI
Score Confidence Range Surveys Used
  • 114 Congo, 2,3 2.0 - 2.7 4
  • Republic of
  • Ethiopia 2,3 1.9 - 2.9 6
  • Honduras 2,3 2.0 - 2.6 7
  • Moldova 2,3 2.0 - 2.8 5
  • Sierra Leone 2,3 2.0 - 2.7 3
  • Uzbekistan 2,3 2.1 - 2.4 6
  • Venezuela 2,3 2.2 - 2.5 11
  • Zimbabwe 2,3 1.9 - 2.7 7
  • 122 Bolivia 2,2 2.1 - 2.3 6
  • Guatemala 2,2 2.0 - 2.4 7
  • Kazakhstan 2,2 1.8 - 2.7 7
  • Kyrgyzstan 2,2 2.0 - 2.5 5
  • Niger 2,2 2.0 - 2.5 3
  • Sudan 2,2 2.0 - 2.3 5
  • Ukraine 2,2 2.0 - 2.4 10

56
Country Rank Country 2004 CPI
Score Confidence Range Surveys Used
  • 129 Cameroon 2,1 1.9 - 2.3 5
  • Iraq 2,1 1.3 - 2.8 4
  • Kenya 2,1 1.9 - 2.4 7
  • Pakistan 2,1 1.6 - 2.6 7
  • 133 Angola 2,0 1.7 - 2.1 5
  • Congo, 2,0 1.5 - 2.2 3
  • Democratic
  • Republic
  • Cote dIvoire 2,0 1.7 - 2.2 5
  • Georgia 2,0 1.6 - 2.3 7
  • Indonesia 2,0 1.7 - 2.2 14
  • Tajikistan 2,0 1.7 - 2.4 4
  • Turkmenistan 2,0 1.6 - 2.3 3
  • 140 Azerbaijan 1,9 1.8 - 2.0 7
  • Paraguay 1,9 1.7 - 2.2 7
  • 142 Chad 1,7 1.1 - 2.3 4
  • Myanmar 1,7 1.5 - 2.0 4
  • 144 Nigeria 1,6 1.4 - 1.8 9
  • 145 Bangladesh 1,5 1.1 - 1.9 8

57
Time orientation-VI
  • Clocks/Watches Clock makers
  • Protestants vs Catholic areas (Culture makes
    almost all the difference-David Landes)
  • Time orientation among the rural/urban
  • No watches among the sadhus

58
TIME ORIENTATION Circular vs the Climactic
Circular Climactic
Rebirth philosophy Death and then Judgement
Time not crucial Deadline to be met
There is always another bus syndrome Improves time utilization
59
11.13 AM
630 P.M.
60
Subjective cultures versus Objective
cultures- Factor VII
61
Subjective cultures versus Objective cultures
Subjective Objective
Changing standards Absolutes
Non-shared standards Widely shared standards
Kings/Leaders above Standards Standards above Kings/Leaders
Oral tradition scriptures not rooted in history Documentary tradition rooted in history
62
Subjective cultures do not support scientific
development because
  • Interpret reality subjectively
  • Access knowledge subjectively
  • Subjective attitudes in justice and gender

63
WHY DO WE FALL SICK?
Earlier our religion was pure so we did not fall
sick People are bodily sick now because they get
up to bed tea which is slow poison. We must get
up instead to one jug of Ganga water. Water
cleanses the body
64
PLANETARY INFLUENCES
  • We fall sick due to the influence of the
    planets.
  • The position of the planets have either negative
  • or a positive influence on peopleoften
    sickness
  • is caused due to negative planetary positions.
  • Negative planetary positions can be avoided by
  • performing certain rites and rituals.

65
Cont.
  • We believe that each organ of the body is
    influenced by some deity.
  • When we deviate from the path of religion the
    gods leave our side.
  • This is why we fall sick.

66
Mantra that can shatter the moon
There are a few mantras that are more powerful
than any medicine Among all othersthe maha
mithunjay mantra is very important. This mantra
saved the moon from breaking into pieces
67
Indian religions
  • In their fundamentals were subjective till Global
    influences reached them.
  • WASAV (Widely Accepted Shared Absolute Values)
    characterize an objective culture and needed for
    development.
  • Polytheistic idolatry does not produce a WASAV
    culture.

68
AYURVEDA
2 of the 4 books of vedas have Ayurveda-RIG
Atharvaveda
Claim Practiced for 4000 years
Revealed science- The first
person of Trinity-Brahma
Had more magic than logic till the Buddhist period
69
Origin of Ayurveda is attributed to Brahma
  • 4 headed Brahma (first person of the Trinity )
    who created the universe revealed Ayurveda.
  • Since it was revealed research was not thought of
    as necessary.

Sons of the Sun Ashwini Kumars
Dakhsprajapati
70
  • 7 causes of diseases-

Derangement of Humors in the body
Pregnant women Eating Forbidden food
Super human agencies
Variations in climate
Mother nature
Corrupt Semen
Accidents
71

Karmic causes of diseases
Drunkards get skin diseases
Killing a Brahmin causes anemia
Back biters get Breathing difficulty
Sleeping with your masters wife causes
sexual diseases
Prying into other Peoples secrets
Causes blindness
72
3 humoral categories of
Ayurveda
Governs mental functions
Governs form substance
Governs digestion
73
Buddhist influence Ayurveda
  • Susruta 7 th century BC
  • Charaka

74
EIGHT PARTS OF AYURVEDA
  • Shalya surgery
  • Shlakya treatment of diseases of parts situated
    above the clavicles, such as disease of the eyes,
    nose, etc
  • Kaya-chikitsa general diseases affecting the
    whole body
  • Bhoot-vidya demonical diseases
  •      

75
Eight parts of Ayurveda
  • Kumara-bhritya management of children
  • Agada antibodies for poisons
  • Rasayana treats of medicines preserving vigor,
    restoring youth, etc.
  • Vajikarana describes the means of increasing
    the virile power by giving tone to the weakened
    organs of generation.

76
Waning of Buddhist influence
  • Ayurveda declined..became subjective
  • Surgery was banned

77
Arabic influence-7th AD to 13AD
  • Arabic scholars from the east helped document the
    remedies (Tuhafatul-masiha)
  • Bimaristans were established.

78
Colonial rule..
  • Ayurveda developed
  • Colleges were established
  • Herbs were grown

79
Rise in objectivity
Rise in objectivity
EV 300BC 200AD LV 700 AD
1100 AD
Influence on Ayurveda as an objectivity
indicator
Colonial
Buddhist
Arabic
80
Ideas
  • Can we create an instrument to measure
    subjectivity levels in a culture?
  • Will subjective cultures be more resistant to
    development than objective ones?
  • Will Polytheistic Idolatrous cultures be more
    subjective than monotheistic ones?
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