Family Medicine

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World Book of Family Medicine – European Edition 2015 1996; 312(7023): 71-2. 8. Goodyear-Smith F. Practising alchemy: the transmutation of evidence into best health care. Fam Pract 2011; 28(2): 123-7. 248
World Book of Family Medicine – European Edition 2015 Tkachenko Victoria, MD, PhD witk@ukr.net 81 – Developing Culturally Sensitive Services in Primary Care Tkachenko Victoria, MD, PhD Associate Professor P.L. Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine The capacity for migration has increased in the 21st century due to the expansion of international relations, opening of borders, and the development of democratization processes in modern society. The reasons for migration differ with every case and may include; international expansion or work abroad, family reunion, return to the native land, looking for better quality of life, education, economic reasons or simply, a more peaceful life. The process of migration results in a population that has a variety of religious and cultural characteristics that must be considered during the provision of medical care. The importance of cultural sensitivity was initially emphasized in providing services to members of ethnic minority groups, especially given the language and cultural barriers faced by non-English-speaking immigrants and the ethnic and economic barriers (8). Patients may not understand a prescription or general health recommendations correctly which may lead to low adherence to treatment (3). Patients may be prevented from discussing their problems as a result of language barriers or religious prohibitions. The family doctor should start with the principles of individual liberty, human ethics and deontology, respect for beliefs, feelings and rights of patients, be aware of the cultural religious characteristics of its population, know manners, rituals and norms of behaviour, and consider them when providing medical care (1-3, 7). For example, the various cultures and religions have different attitudes to abortion, vaccination, euthanasia, blood transfusion, organ transplantation, resuscitation, autopsy, artificial insemination, sterilization, etc. Euthanasia and abortion are rejected by most religions, including Catholicism, Judaism, Buddhism, Christianity and Islam. Abortion is prohibited in most religions, but Muslims believe that the soul of the foetus appears in the first week of the fourth month of pregnancy, so abortion is allowed within that time frame. Artificial insemination is not recognized in Buddhism, but allowed by the Orthodox. In Buddhism and Islam, organ transplants and blood transfusions are only allowed from a living donor of the same religion and with his consent. The Jewish faith is against autopsy and organ transplantation, unless permission was given by the patient and his family before death. Buddhism and Judaism also deny artificial continuation of life, when medical equipment and intensive therapy prevent natural death, however, the physician should make every effort to preserve and save human life according to the Hippocratic Oath. In daily life, there are also many occasions when it is necessary to be aware of religious and cultural diversity in the provision of health services, such as religious restriction diet, fasting, hygiene, possibility of examination etc (7-8). For example, religious restriction of food (fasting, restriction of meat) may lead to deficiency disease and decreased immunity. Also, religious diet restriction can influence prescribing therapy. Thus, Islam forbids the use of any products derived from pork. In India the cow is sacred, so medications based on bovine serum (some vaccines, regenerating drugs etc.) cannot be used. In Judaism, only kosher products are allowed to be ingested, and accordingly, 249
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Family Medicine

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