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Educational Insight Part II: A Health-Care Provider's Handbook on Hindu Patients
Category : January/February/March 2013

E D U C A T I O N A L   I N S I G H T   P A R T   I I

A Health-Care Providers’ Handbook on Hindu Patients

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Excerpts from a new booklet by Queensland Health, Australia

image SKILLED MEDICAL GROUP IN AUSTRALIA has produced an impressively accurate and comprehensive 24-page booklet that is packed with vital, insightful information for health care providers. Put together in 2011 by the Queensland Health Multicultural Services (multicultural@health.qld.gov.au), it is entitled Health Care Providers’ Handbook on Hindu Patients. The first half of the booklet, guidelines for health services, covers a wide gamut of subjects: including communication issues, religious observances, dietary needs, astrological beliefs, decision making, traditional medicines and remedies, medicines of animal origin, maternity services, home visits, rehabilitation and end of life issues. The second half is devoted to Hindu beliefs that relate to health care. It includes cogent sections on food, karma, holy days, fasting, abortion and more. The text as written is in a terse summary form meant for easy access by care givers and we share it unedited, believing that its sensitive wisdom will guide health-care providers all over the world looking after the needs of Hindu patients. On the advisory committee, ensuring depth and authenticity, was a host of persons of Indian origin: Shyam Das, Kermeen Kansara, Vinita Khushal, Balaji Motamarri, Rajni Nair, Pt. Sanat Pandey, Surendra Prasad, Sarva-Daman Singh and Krimesh Shukla.

Introduction

Queensland is a culturally and religiously diverse state—in 2006 nearly one in five Queenslanders (17.9 per cent) was born overseas, 7.8 per cent of the population spoke a language other than English at home, and more than 129,000 people followed a religion other than Christianity. Between 2001 and 2006, one of the fastest growing religions in Queensland was Hinduism. Figures from the 2006 census show there are more than 14,000 Hindus living in Queensland [total population 4.5 million]. This figure is now likely to be higher, as between 2007–08 and 2009–10, permanent migration to Australia from Southern Asia (which includes India, Sri Lanka, Bangladesh and Nepal) was second only to permanent migration from Europe. The increasing cultural, linguistic and religious diversity in the Queensland population means that to be safe, health services need to be culturally appropriate and responsive. Research indicates a strong link between low cultural competence and poor quality health outcomes, and significant risks.

Personal level of adherence

Hinduism is the world’s oldest living faith and third largest religion. It is practiced in many countries around the world, including by large populations in Southern and Southeast Asia, Europe, Africa, North America and Australia.

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Setting a high standard: Queensland Health. Health Care Providers’ Handbook on Hindu Patients. Division of the Chief Health Officer, Queensland Health. Brisbane 2011. Photography: Nadine Shaw of Nadine Shaw Photography
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There is much diversity in the beliefs and practices of Hindus, with hundreds of diverse sects and no central doctrinal authority. As Hinduism grants individuals complete freedom to practice his or her religion as they choose, there are personal and cultural variations that make it difficult to provide definitive rules and regulations that apply to all Hindu patients. Because of these personal variations, it is important that health care providers consult the patient about their personal level of religious observance and practice.

However, Hindu patients should not be regarded as a “special” group that require additional attention from health care providers. Due to the common Hindu beliefs of karma (the belief that every action has a consequence which is experienced in this or future lives) and reincarnation, Hindu patients may display acceptance of difficult circumstances and be inclined to comply with the instructions of health care providers.

Section I: Religious Observance

Hinduism grants individuals complete freedom to practice his or her religion as they choose. As a result, it is important that health care providers discuss religious observance needs with each patient. Some topics that health care providers may wish to discuss with their patients include prayer and meditation, bathing and cleanliness, dietary needs and astrological beliefs.

Prayer and Meditation

Bathing and Cleanliness

Dietary Needs

Astrological beliefs

Decision-making

Hinduism views the needs of the individual in the greater context of family, culture and environment. As a result, family members, especially elders, can have a strong influence on decision-making related to health matters, including informed consent. Hindus may wish for family members to be responsible for making treatment decisions.

Administration of medicines

Traditional Medicines and Remedies

imageHindus may use a variety of ayurvedic medicines, home remedies and spiritual remedies, often in conjunction with Australian medicine. It is important for health care providers to be aware of their patient’s preferences. Ayurveda is a holistic system of medicine practiced by many Hindus around the world. It is a highly valued and respected health science in India. Ayurveda is practiced by many Hindus in Australia, and ayurvedic medicines are regulated by the Therapeutic Goods Administration (TGA). As a discipline, ayurveda sits alongside Traditional Chinese Medicine in the TGA classification of complementary medicines.

Based on ayurvedic principles, Hindus believe that all illnesses, whether physical or mental, have a biological, psychological and spiritual element. Ayurveda seeks to maintain a balance between the body’s three elemental energies (humors). Good and bad health is related to the level of balance of these three energies. Many Hindus also use traditional home remedies which are based on ayurvedic medicine and are easily available from Indian grocery stores.

One of the most common Hindu spiritual remedies is vibhuti, or holy ash. Vibhuti is commonly used in Hindu religious worship and is believed to contain protective, purifying and healing properties when applied on the skin (particularly on the forehead), consumed in small quantities, or carried on the person in a small packet.

Medicines of Animal Origin

Some medicines may not be suitable for Hindu patients because they are derived from cows, pigs or other animals. The Queensland Health Guideline on Medicines/Pharmaceutical Products of Animal Origin states that health care providers should inform patients about the origins of their proposed medication if it is derived from animals and no suitable synthetic alternative exists. Patients should be encouraged to make informed decisions regarding their treatment.

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Serving with sensitivity: A nurse’s daily rounds; doctors everywhere are working to improve cultural knowledge of their patients
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Oral Hygiene

Maternity Services

Community health services

Home Visits

Rehabilitation Issues

Visiting Arrangements

Care of Family and Older Persons

End of life issues

Deceased Patients

Autopsy

Section II: Hindu Beliefs Affecting Health Care

Food beliefs

Hindu dietary practices can vary depending on the individual’s beliefs and customs. Most Hindus do not eat beef or pork and many follow a vegetarian diet. Fasting is common among Hindus, but there are no set rules, and the decision to fast is up to the individual. Many Hindus follow ayurvedic dietary practices. Under this system, certain foods are classified as hot or cold and can adversely or positively affect health conditions and emotions. The classification of foods as hot or cold is unrelated to temperature. Hot foods are generally those foods which are salty, sour or high in animal protein, while cold foods are generally sweet or bitter. Some strict Hindus do not consume garlic or onion, as the properties of these foods disturb spiritual practices such as meditation.

Karma

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Health throughout life: A couple take joy in their new child, born in a modern hospital; administering intravenous medication
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Holy days

Hindus do not observe a specific day of worship, although some days of the week may be associated with particular Deities. Hindus do observe a number of holy days and festivals which can have an impact on health care due to associated fasts. Most Hindu holy days are based on the lunar calendar, and the dates can vary from year to year. Some festivals can occur over an extended period, with celebrations lasting for days or weeks.

Fasting

Fasting is an integral part of Hinduism and is seen as a means of purifying the body and the soul, encouraging self-discipline and gaining emotional balance. Fasting may be practiced on specific days of the week, during festivals or on holy days, or in conjunction with special prayers. It is not considered obligatory for a Hindu patient to fast during hospitalization. However, some patients may wish to fast while in hospital. There is no specified way to fast, but individuals may choose to abstain completely from all food and drink or only abstain from certain foods.

Dress

While there is no religious requirement for modest dress, many Hindus choose to dress modestly and may be reluctant to be examined by health care providers of the opposite sex. Hindu women may wear a sacred thread or gold chain around their necks, and Hindu men and boys may wear a sacred thread across the chest. These items should not be removed during examination. If it is necessary to remove an item, permission should be sought prior to removal .

Hare Krishna followers, and some other Hindus, may wear sacred tulsi beads around the neck. If it is necessary to remove these beads, they should be retied around the wrist (preferably right). In addition, some jewelry worn by Hindus may have a sacred meaning, and patients should be consulted before removal.

Mental health and/or cognitive Dysfunction

Hindus believe that all illnesses, whether physical or mental, have a biological, psychological and spiritual element. Treatments which do not address all three causes may not be considered effective by a Hindu patient.

Many Hindus attach a stigma to mental illness and cognitive dysfunction. Many have a strong belief in the concept of the evil eye and may believe this to be a cause of mental illness. In addition, all illness, including mental illness, may be seen as the result of karma from this life or a previous life.

Transplants and Organ Donation

Hinduism supports the donation and transplantation of organs. The decision to donate or receive organs is left to the individual.

Contraception

There is no official Hindu position on contraception.

Abortion

Beliefs about abortion may vary depending on cultural or religious interpretations. Many Hindus believe that the moment of conception marks the rebirth of an individual, which may make abortion unacceptable, except in emergencies.

Assisted Reproductive Technologies

There is no official Hindu position on assisted reproductive technologies.

Pain Management

Hinduism encourages the acceptance of pain and suffering as part of the consequences of karma. It is not seen as a punishment, but as a natural consequence of past negative behavior and is often seen as an opportunity to progress spiritually. This may affect triaging or the monitoring of pain levels as Hindu patients may not be forthcoming about pain and may prefer to accept it as a means of progressing spiritually. However, this behavior may be less prevalent in Australia, especially among young people.

Death and Dying

Hindus believe that the time of death is determined by one’s destiny and accept death and illness as part of life. As a result, treatment is not required to be provided to a Hindu patient if it merely prolongs the final stages of a terminal illness. Under these circumstances, it is permitted to disconnect life supporting systems. However, suicide and euthanasia are forbidden in Hinduism.

Web Resources

The booklet, in its fullness (including a list of appropriate Hindu vegetarian foods at the back), can be seen here:

www.health.qld.gov.au/multicul ... h_workers/hbook-hindu.asp

A religious calendar that includes Hindu holy days may be found at:

www.health.qld.gov.au/multicultural/support_tools/mcsr.asp

Health Care Providers’ Handbook on Hindu Patients is licensed under a Creative Commons Attribution, Non-Commercial, Share Alike 2.5 Australia licence. To view a copy of this license, visit:

www.creativecommons.org/licenses/by-nc-sa/2.5/au/deed.en