Disease And Culture In Medical Process In Northwest Minority Areas

This dissertation,which chose two hospitals in Xining city as survey locations,is a research on the involvement and the role of culture in the process of disease treatment.Biomedicine,which is the result of the development of science,regards the disease treatment as dealing with physiological lesions.While ethnology and anthropology pay close attention to the relationship between culture and disease treatment.No matter in what place and what kind of local culture,a patient’s experience and feeling of disease usually includes the following basic steps: the patient’s own understanding and explanation of why he or she got the disease,choosing hospital and doctor,getting treatment form doctors,seeking other methods out of hospital especially in folk and traditional ways,taking medication which may be endowed with some kind of cultural characters provided by both doctors and folk healers,the relationship between doctors and patients,and the illness narratives of patients.These matters are all important issues for understanding disease and treatment,but they are less concerned about in the field of biomedicine and the related research.However,studies on culture and disease treatment in ethnology and anthropology can make intensive and meticulous research on these matters,thus promote the overall development of related disciplines.This study,of which the research background is that biomedicine has gotten a leading position in the treatment of diseases,and the relationship between culture and disease treatment is often neglected,is a scientific exploration based on ethnological and anthropological theories and methods.Biomedicine provides the leading ideas and methods for current disease treatment.The relationship between patients’ own initiative,the inheritance of national culture,the religious folklore and disease treatment is easy to be sheltered in the biomedical-dominated and doctor-led environment.Highlighting the patients’ initiative during the treatment of disease,and revealing the value of their cultural traditions in disease treatment and health maintenance,are helpful for people to form an overall and more objective understanding of disease and medical treatment.Cross disciplinary and cross cultural perspective is the basic method of the research.The study,using both field investigation and documents,analyzing through comprehensive perspectives of ethnology,anthropology,sociology,medicine and other disciplines,discuss the involvement and the role of culture in the process of disease treatment in a local environment mainly from the perspective of medical anthropology.The field investigation in the two hospitals in Xining city using open,semi-structured and structured interviews,by face-to-face communication with patients and doctors in the doctor-patient interaction environment,obtains first-hand information as the research foundation.Meanwhile,the researcher records the patients’ and doctor’s treatment practices through clinical observation and participant observation.The questionnaire is used to understand the overall situation of the investigated group.For a number of specific studies,such as the study of thyroid disease cognition,"the patient’s subjective assessment" as a novel method is used.The discourse analysis of doctors and patients is also used in the research.The discourse of the patients is the most vivid reflection of their psychology and local culture.Case analysis of ethnology and anthropology is also made full use of in the study.Before entering the field,the author read the relevant literature to prepare for the hospital investigation.After entering the hospitals,the first step is field observation and get familiar with the investigation environment.Then spend a lot of time and energy conducting interviews.In the early stage of the investigation,the author conducts open interviews with the patients of multi-nationality and the doctors in the two hospitals,finding their concerns from the patients’ and the doctor’s words and learning the patient,the doctor’s culture and treatment behavior.In this way,the issues which are worthy of research in patients’ and doctors’ medical practice gradually emerge up,for example,the cognition of their diseases by patients with thyroid diseases in the outpatient environment,the selection of the Tibetan patients,the contact between the medical practice and the religious culture of the Hui and Sala patients,the selection of hospitals and doctors of Tibetan patients,the relationship between medical practice and religious culture of Hui and Sala patients,and the emphasis on their needs by both doctors and patients in the medical environment and so on.After finding these issues through outpatient-clinical observation and doctors’ or patients’ words,the following study use semi-structured and structured interviews for concentrated research,so as to collect cases more efficiently and accurately.At the same time,the author carries out questionnaire surveys among doctors and patients to understand their needs,and aslo carries out questionnaire surveys of disease treatment and ethnic culture among Tibetan,Hui,Sala patients.After the completion of the above fieldwork,through the classification and comprehensive analysis of the cases,the study finally gets an overall understanding of patients’ disease treatment in the local culture.As a result of the field investigation,the dissertation is a medical ethnography of northwest minority areas.The basic view of the dissertation is that the relationship between culture and disease treatment process,health maintenance is very close.The basic idea of the dissertation is to reveal the importance of the role of culture in disease treatment and health maintenance.The chapters of the dissertation are specific study of the patient’s own understanding and explanation of why he or she got the disease,choosing hospital and doctor,getting treatment form doctors,seeking other methods out of hospital especially in folk and traditional ways,taking medication which may be endowed with some kind of cultural characters provided by both doctors and folk healers,the relationship between doctors and patients,and the illness narratives of patients,promoting the understanding of the relationship between culture and disease treatment from the perceptual level up to the theoretical level,that is,we can use the theoretical framework of the disease treatment process from the perspective of ethnology and anthropology to systematically understand and explain the problem.The findings are a new look at the role and value of culture in the field of medicine and health.At the same time,in the course of the study,the author also published a series of research papers on the needs of the patients,the selection of doctor and hospital of Tibetan patients and the mutual understanding between doctors and patients.As a medical anthropological research,the dissertation makes some academic contributions.In the medical process,there is not only a doctor-dominant side,but also a patient-initiative side.The research emphasizes the patient-emic perspective in medical practice,which can help people get a deep understand of health care,paving the way for a better realization and utilization of culture in health care for the whole society.Study on hypertension,thyroid disease,diabetes and other chronic diseases,can make doctors pay more attention to the role of social life,psychological factors in the inducement of diseases,which provides treatment reference for both patients and doctors.Exploring the tension between doctor-patient through supply-demand barriers is a new perspective.Correlation analysis can deepen our understanding of the relationship between doctors and patients.The analysis of the influence of Tibetan,Hui and Sala ethnic cultures on the relationship between doctors and patients is the expansion of the research field of doctor-patient relationship.,which can help us understand the particularity of doctor-patient relationship in ethnic areas.Cultural adjustment is one of the important ways to improve the relationship between doctors and patients.In the part of illness narratives,the research not only records the patients’ feeling and expression to their disease,but pays more attention to the care and morals inherent in medical anthropology,so as to provide cultural nourishment for the human mind.The study emphasizes the patient perspective.The patients’ treatment experience and disease perception are vivid reflections of the local ethnic and religious cultures from the medical point of view.Therefore,it is valuable for the research of the ethnic minorities and the local medical cultures.The research promotes the study of doctor-patient relationship from the perspective of medical anthropology and thus has reference value to people’s livelihood and policy adjustment.The first chapter is about the survey locations of the fieldwork,including the definition of the hospital community,the ecology and operation of the two hospitals,the cognitive and psychological characteristics of the doctors and patients in the hospital community.The second chapter,as the beginning step of a disease process,which is based on a brief review of disease cognition in western medicine,traditional Chinese medicine and national medicine through a cultural point of view,puts forward the importance of the patients’ view of his own diseases and analyses the emic cognition related to social psychological factors of patients with thyroid disease.The third chapter is about choosing hospital and doctor in a disease process.A prominent phenomenon is that Tibetan patients’ choosing hospital and doctor is deeply influenced by their national culture.Furthermore,the differences of patients’ performance after they enter hospital are also discussed in this chapter.The fourth chapter and the fifth chapter are the investigation of the influence of national culture on the treatment of disease.The research on how the Tibetan culture influence disease treatment,which is carried out in Y Tibetan Hospital and full of Tibetan medicine culture atmosphere,includes two parts,that is,the practices of doctors and the practices of patients.Meanwhile,the patient’s practice can be divided into two aspects: getting doctors’ treatment in the hospital and seeking treatment in their local religious culture.The blessing process of Tibetan medication highlights the cultural attributes of Medication.The influence of national culture on the relationship between doctors and patients is also very obvious.The fifth chapter is a discussion on patients’ treatment practices of Hui and Sala nationality from the perspective of national and religious culture.Patients of Hui and Sala nationality generally hold the view that disease and health are closely related with religious culture.The patients treat their diseases in diverse ways,which includes both treatments in hospitals by doctors,and methods in national culture,such as Zuo Duwa,Chui Duwa and Ju Nietie.However,No matter which treatment is used,this is just a kind of Sai Baibu,because patients of Hui and Sala nationality believe that whether a disease can be cured or not depends on Allah,not the doctors.The sixth chapter is a study of the relationship between doctors and patients,which is also a step of disease process in ethnological and anthropological view.The analysis,inspired by Malinowski’s concern for human "needs",shows us the diversity and hierarchy of the needs of patients and doctors and then puts forward that the relationship between doctors and patients is a kind of relationship based on demand and supply.In this two-way relationship,there are docking obstacles between supply and demand at the technical level,psychological level,economic level,communication level,role level,moral level,management and service level,which are factors that affect harmonious doctor-patient relationship.Chapter seven is the last part of the disease process.In the narratives of Han,Hui,Tibetan patients in a context of a multi-national environment,it is not difficult to find some common topics.One is that disease is a part of patients’ life experiences and it usually means a kind of pain and suffer,which is the nature of disease;The second topic is that mind and body is a whole.A good mental state is very important for disease and health.Negative mental state and thoughts,together with strong desires are all important factors that restrict disease recovery.The third one is that moral is also medication for treatment and prevention of diseases and for maintaining physical and mental health.In medical environment,patients and their family members,because of being in a state of pain,generally have a common consensus on moral issues.The final part of the dissertation is the conclusion and thinking consisting of three aspects: the close relationship between culture and disease,the cultural adjustment of the relationship between doctors and patients,and the value of traditional medicine.Through the research,the author puts forward: first of all,the medical pluralism is a social reality which can not be ignored.For the understanding of medical pluralism,we formerly review it from the perspective of the coexistence of various medical methods.However,from the perspective of a patient’s disease treatment experience,we can also find and study medical pluralism.Secondly,the influence of national religious culture on patients’ psychology and action is extremely profound.For example,there is a huge difference in the understanding of disease,the choice of doctor and hospital,and the treatment of disease between Tibetan patients and patients with and Hui nationality and Sala nationality.Thirdly,Maslow’s theory of needs can not be mechanically applied to doctors and patients.On this the dissertation makes a more specific study.The barrier in the supply and demand between doctors and patients is a new perspective to analyze and understand the relationship between doctors and patients.Culture plays an important role in adjusting the barriers.In a word,the research of this dissertation shows that culture is actively involved in the process of disease treatment.Body and mind of a person is a whole.The role of culture in the treatment of disease and physical-mental health should be given due attention.Medicine can not be separated from culture,and can not be separated from humanistic care.Disease treatment is not only a physiological process,but also a process of cultural participation.From the patients’ practices,the study reveals completely different medical features with biomedicine,which can promote the transformation of medical and health services from the biological medicine to the biopsycho-social medicine in current China.