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Chinese Health Beliefs and the Health Service
From: London School of Economics and Political Science
| By:
Marie-Claude Gervais |
EDITOR'S INTRODUCTION |
 Trying to explain to a doctor trained in Western biomedical traditions that good health is actually about the harmonious balance between yin and yang can be taxing. Yet this is just the simplest of challenges faced by the Chinese community in Britain when translating their health beliefs into the language of the National Health Service (NHS). In this interview, Marie-Claude Gervais, lecturer in social psychology at the London School of Economics and Political Science, discusses some of the problems faced by a Chinese community where not only language but culture puts up barriers to effective health care. |
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| Marie-Claude Gervias discusses Chinese usage of the health service. | |
Fathom: What kind of impact have the health beliefs of the Chinese community had on use of NHS? |
Marie-Claude Gervais: Let me first state two very important facts which often go unrecognised. First, health services are social and cultural practices; they are not neutral organisations which simply dispense health care. Health services and health professionals do not only put forward certain understandings of health and illness and recommend certain treatments. They also propose and legitimise particular forms of social reality (such as a distinct communication style and role structure), which relates to wider cultural beliefs and assumptions. Second, people tend to like what they are familiar with. This has important implications when we discuss the relationships between health beliefs and use of health services. If people have had experience of biomedical institutions and hospitals in China, Hong Kong (whether it is cosmopolitan or rural Hong Kong), Malaysia or Vietnam, then it is very likely that they will turn to biomedical care in hospitals here as well. However, if people have been mainly exposed to classical doctors, folk healers, acupuncturists and herbalists, they will seek to turn to these same resources when they experience health difficulties in England. Previous experience and what people are already familiar with, at a cultural level, will have an impact on which health resources they use in the UK. |
Service utilisation is also dependent on how happy people have been with their medical encounters. In hospitals in Chinese countries, you do not usually have to make an appointment. When you turn up, you are seen immediately or at least within an hour or two. Here in England, as we know, it doesn't quite work like that. You have to make an appointment. Most of the time, or at least in relation to minor ailments, Chinese people are really put off by this system of appointments. They reason, "Well, in four days' time I will be fine again! I will have changed my diet, I will have rested, I will have been taken care of and my health will be restored. I do not need an appointment in four days' time." |
Moreover, Chinese people expect doctors to do things to them, and very often that is just not how medical encounters unfold in England. Because consultation with doctors in China (and in most Eastern countries with a sizable Chinese population) is done for a fee, the doctor does various things to you, such as conducting blood pressure checks, taking urine samples, palpating the body area which causes pain, taking X-rays, etc. In addition, you are given medication. There is always something concrete that takes place, and the doctor spends a lot of time with you. This is very reassuring and it instils confidence. So of course Chinese people expect pretty much the same of their encounters with the NHS. But the contrast is quite sharp. In the UK, there is much more focus on prevention. Doctors often talk to their patients about the health risks associated with, for instance, certain dietary practices, sexual-health behaviours, lack of exercise, or smoking behaviour. This health education is appreciated, but it should be not delivered on its own. Many GPs also try to avoid prescribing medication unless it is really necessary. More than before, GPs and doctors attempt to discuss with their patients and to explain their condition, in an attempt to move away from paternalistic forms of medicine. Generally, Western doctors tend to prescribe medication much less than in classically trained Chinese doctors. None of this goes down very well with Chinese patients. |
Needless to say, Chinese patients often end up very disappointed with their medical encounters, and they come to distrust the health care dispensed through the NHS. Their expectations are not fulfilled and therefore their trust in the institution itself, or at least in their particular GP, is undermined. Often, Chinese people fear going to the doctor because they fear being misunderstood. Doctors won't understand when a patient walks in and says, "I have too much heat in my body." They will take the temperature and say, "No, actually. You have no fever. Don't worry." And of course Chinese people resent not being understood. The problem is compounded if they don't master the English language. So what happens very often is that what is normally a dyadic relationship between doctor and patient becomes a social event where the children of the patient might have to come in and act as interpreters, which of course impedes a number of disclosures and prevents the kind of intimacy that one might expect to have with one's doctor. |
So, for a number of structural and symbolic reasons, many Chinese people are disappointed with NHS services and turn to other services or resources when these are available, which is not always the case. Not everybody has a Chinatown next door; not everybody has the money to pay for the healer or the Chinese doctor. There is a great deal of distrust for folk healers, because their practice is not regulated, whereas there are standardised formal procedures in order to become an NHS doctor which everybody can recognise. There is certainly that level of trust in the NHS. Before a patient turns to a classically trained Chinese doctor or folk healer, they would need to consult within the community to avoid quacks or charlatans. Word of mouth is very important in choosing a specific person, but that means that you need to be inserted into a whole social network, which is not always going to be the case. Clearly it is a complicated issue. The usage of health services depends on a whole range of variables, some cultural, some distinctly social psychological, some structural, some based on the specific conditions one suffers from. |
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| Marie-Claude Gervais on the consequences of communication breakdown between doctor and patient. | |
Fathom: What were the consequences of breakdown in communications between Western doctor and Chinese patient, especially among the older generations who would be far less integrated into mainstream society? |
Gervais: We assumed, rightly or wrongly, that the elderly settlers would carry with them pretty much unchanged the kinds of health beliefs they would have been exposed to "back home," and so we didn't focus on them. We were more interested in the whole hybridisation of knowledge that happens when people speak more or less the same language. |
For instance, a woman who is now probably 55, relatively old, was given the coil as a mode of contraception when she first arrived in this country. Yet she proceeded to have a baby. This seems like an obvious contradiction. The problem was caused by a lack of communication. She never managed to explain to the doctor what kind of contraception she was using and the doctor never enquired into the kind of contraception she was using. We have heard stories of people dying of cancer because they were misunderstood by doctors and deemed to be attention seekers. Even if they spoke relatively competent English, this is not just a linguistic issue; it is also a cultural issue about how you are communicating your knowledge. So there are so many instances of communication breakdown, sometimes with very tragic consequences. |
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| Marie-Claude Gervais on mixing and matching Chinese and Western health beliefs and practices. | |
Fathom: What about with these hybridised communities that you were interested in--were they mixing and matching a lot of knowledge. Was there a potpourri of diagnosis and cure? |
Gervais: The potpourri is a good metaphor for what is happening, but it does not quite capture the structured ways in which people combined health knowledges and practices. People go and see a Western doctor and then they toddle off to the herbalist. Very often they trust Western technology as a way of giving them a "snapshot" of the state of their body, a way of giving a technology-based diagnosis, health checks, urine samples and blood pressure checks. These procedures are thought to be very useful in terms of identifying what the problem might be, but the descriptive diagnosis they yield is then understood and dealt with according to the traditional Chinese way of thinking. The suggested cure will have its roots in Chinese medicine and folk observations. This being said, there isn't a pattern whereby people systematically use Chinese medicine as a first recourse and then turn to NHS resources, or, conversely, first and always use NHS resources and then, if that is not successful, turn to Chinese medicine. It seems to depend very much on each condition. If there is a known aetiology in Chinese medicine for the condition, you can turn to Chinese medicine first, and if that doesn't work then you turn to the NHS. |
Some of the services available here have no direct equivalent in Chinese cultures. For example, social workers and psychologists are still either shrouded in mystery or stigmatised. The elderly population often still have a very traditional, superstitious and highly problematic aetiology of schizophrenia, which is often interpreted as being caused by supernatural forces such as ancestors seeking revenge or punishment. With this kind of aetiology comes a great deal of fatalism, so the normal recourse becomes exorcism instead of psychiatry. Mental illness goes untreated, or mistreated, and this causes enormous suffering, both to those who suffer from mental health difficulties and to their families. |
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