How Do Culture and Belief Affect Our Capacity to Heal?

Yesterday I was researching chronic pain and stumbled across a great article on how cultural differences affect the success of treatment outcomes. 


The writers identified two main ways in which their physiotherapy training (that's physical therapy for us Americans) failed them when they went to work in a rural Zulu community in South Africa, serving women with low back pain.

For starters, the way the women used their body (farming, carrying children on their backs, carrying water and other heavy loads on their heads) was so different from how Westerners use their bodies (sitting at desks, driving) that the biomechanical and ergonomic instruction the physiotherapists had learned in school did not apply. 

Second, this population's beliefs about the origin of pain were different than those of the physiotherapists. In the Zulu community pain is "understood primarily as a whole-person illness rather than as a sign of isolated injury."  Frequently this whole person-illness is blamed on being bewitched, and traditional healers treat it by using various methods to counter the bewitchment. The suggestions made by the physiotherapists therefore did not make sense for the patients.

Another obstacle from the clash of two different belief systems is that in Zulu culture healing is received from another, and the sick person is a passive recipient; their continued health is not seen as being dependent on self-care. This led to low rates of follow-through on the self-care techniques the physiotherapists taught their patients, a crucial component of this particular model of healing.

While there were many other obstacles to successful outcomes (insufficient privacy in the clinics, not enough translators, burdensome distance for the women to travel, etc.) the two listed above were the only ones related to the training of the physiotherapists.

I found this fascinating.

Low back pain is a huge problem in the West and though poorly understood, frequently blamed on how we use our bodies. Yet these women were suffering the same pain although they used their bodies in a completely different way (one that had more respect for spinal alignment, it should be noted.)

This implies that the pain is coming from different sources, and therefore our "modern" understanding is limited. Or, the pain is coming from the same source, which has yet to be discovered.

Isn't it interesting that the difference in beliefs surrounding the source of pain made it difficult for people from one culture to effectively treat those from another?

The paper did not include any data on how effective traditional healers were vs the physiotherapists, unfortunately, which I think would be a great avenue for further research.

(Lest you think that traditional healers must have been ineffective or else these women would not have had an incentive to use physiotherapy, the writers did note that a main barrier to traditional healing was that it was considerably more expensive than the physiotherapy clinics, which I believe were state-funded.)

Regardless of which one was more effective, the existence of two different systems implies that there is more than one way to get well, which I was quite pleased with because it is in alignment with my own beliefs and experience.

This paper also demonstrates the shortcomings of allopathic (Western) medicine, which here in the multi-cultural United States is dominant. What are we missing out on by not fully incorporating so-called alternative and complementary medicine into our health care system? What are we missing out on by not developing a model of care that embraces different solutions for different people, not only based on physiology but mentality?

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If you want to read the full article, you can find it here. A summary is here. Should those links ever be broken, the paper is entitled "'Our Training Left Us Unprepared' - Two Physiotherapists' Reflections After Working with Women with Low Back Pain in a Rural Zulu Community in South Africa," and can be found in the Journal of Community and Health Sciences, October 2013, Volume 8, Issue 2.