Ethnicity Online

Cultural Awareness in Healthcare

Hindus: Inpatient Care

general

With their ancient and comprehensive tradition of herbal remedies, ayurvedic medicine and prayer, Hindus may be slow to seek medical attention initially. Many also regard western medicine as potentially dehumanising with its insistence on treating the condition not the person, and not treating that condition as part of the whole.

Some see illness as a punishment for bad behaviour in a former existence. However, suffering may be considered to be meaningful, so a patient is unlikely to show self-pity. Hindus are unlikely to give up hope, even if they feel helpless. They may find an explanation for their illness through their belief in the supernatural, in terms of evil spirits that can be warded off by faith healing. However, most Hindus do believe that medical staff act in their best interests and will accept the authority of professionals.

the patient and family

Any decisions regarding treatment may be taken by senior members of the family rather than by the patient themselves. The extended family may expect to visit the patient whenever they choose, and to take on many care tasks such as washing and feeding. Staff should discuss these issues with them and work out acceptable boundaries. Any Hindu in hospital is likely to have a steady stream of visitors, many of whom will bring gifts of food from their own family shrines to aid healing.

mixed wards and staff gender

Most Hindus are likely to feel particularly uncomfortable on a mixed ward, and should be admitted to one only in an emergency. In addition, female patients will probably prefer to be treated by other women. Hindu women may request the presence of a chaperone if they are to be treated by a male healthcare worker and are not accompanied by a senior family member. Men may show great reluctance to be treated by female staff, especially in intimate areas.

medication

As most Hindus are vegetarian, it is important to ensure that they are not prescribed medicines that contain animal products, especially beef derivatives. Hindus have a duty not to be responsible for taking the life of any living creature. It is important to use any acceptable alternative available, and to discuss their treatment with them if no alternative can be found.

Some Hindus take traditional herbal remedies to balance the bodily humours or elements [sky (akasa), wind (vayu), earth (bhumi), fire (agni) and water (apas)], and may wish to continue to do so while in hospital. Remedies include holy water (tirtha) and holy ash, which is derived from medicinal herbs and the dung of cows that have been fed holy herbs.

In addition to taking traditional herbal remedies, many Hindus follow the practices of ayurveda. This is essentially a means of balancing the humours of the body and bringing body and mind into harmony with each other by choosing what food to eat according to its properties. For example, those suffering from a lung infection may avoid milk because it is considered to be a wet and cold food. It may be necessary to discuss diet alongside medication to ensure your patient is getting enough nutrients.

prayer and ritual observance in hospital

Devout Hindus pray three times a day, at sunrise, noon and sunset, only after taking a wash or shower to purify themselves. They should not be disturbed during prayer. They may wish to have religious icons, candles, a bell and food, along with other items at their bedside. Such items should be treated with respect and handled only if necessary.

personal hygiene and care

Hindus need water for washing when they go to the toilet. A bidet is ideal for this purpose but, at the very least, a bowl or jug of water should be made available. Bedridden patients may request assistance with washing from staff of the same gender.

Hindus prefer to wash in free-flowing water and do not like to take baths, which they do not consider to be very clean.

The head is seen as the most important part of the body and therefore Hindus like to wash and oil their hair frequently. Feet are considered to be the dirtiest part of the body, and it is very important not to place items of religious importance near them. Shoes must be kept away from other clothing.

Most Hindus bathe every day, but are likely to object to doing so after a meal.

modesty

Most Hindu women will probably have a strong preference to see female doctors and be placed with female patients. They should be admitted to a mixed ward only in an emergency. They will feel very uncomfortable wearing a short X-ray gown and must be allowed to wear a shawl or gown over the top of it, if this makes them feel more secure. Both genders may choose to expose only the particular part of the body that is to be examined and keep the rest covered.

dress

Traditionally, Hindu women are expected to keep their legs, breasts and upper arms covered. Men must be covered from the waist to knee.

Jewellery and make-up are important to Hindus because of their religious significance as well as decorative value. For example, when a woman marries she is given a brooch or elaborate ring (mangal sutra), often strung on a necklace, which is to be worn while her husband is alive: its removal will cause great distress. Other items of wedding jewellery include bangles, rings, toe rings and nose studs. Married women also wear a red spot on their forehead (bhindi).

Men often wear a white, cotton thread called the jenoi over the right shoulder and around the body, which should not be touched unnecessarily. The jenoi is significant because it is placed around a boy's shoulders during the ceremony (the upanayana) that marks his transition from boyhood to adulthood, and his entry to the brotherhood of the twice-born. It must not be removed and care must be taken to keep it clean because it is a sign of ritual purity. Hindu men may also wear a ring, medallion or amulet blessed by a priest, the removal of which is also likely to cause distress.

family and visitors

The family of a Hindu patient may perform religious ceremonies with them. These may include reciting hymns, blessing their sick relative with holy water or tying a symbolic string of jewels around their neck, arm or body. Family elders or a woman's husband may make any decisions required regarding the patient's treatment.

food and drink

Devout Hindus revere all life (ahinsa, the principle of non-injury) and are therefore reluctant to eat meat or animal products. They wash and pray before eating. They use only the right hand for eating; the left is used for toilet and hygiene purposes.

Most Hindus do not eat beef because cows are considered to be sacred as they are a representation of the bounty of the gods. Also, pork may not be eaten by Hindus because pigs are considered to be unclean animals. Some Hindus do not eat eggs, but will eat dairy products that do not contain animal fat (e.g. cottage cheese is fine because it is not made using rennet). A strict vegetarian may refuse food that they cannot be sure has been prepared according to the standards of purity their code of religion requires, or which has touched the same plate or utensils as meat. Vegetarianism is regarded as an indication of spirituality and it is felt that the consumption of animal products leads to spiritual pollution.

It is best to offer a vegetarian menu to Hindu patients, and important to ensure that no cross-contamination has occurred during the preparation and serving of the food. Many Hindus will find hospital food quite bland and they may not eat enough. If hospital policy and medical dietary regime allow, it may be better to allow the patient's visitors to bring in food for them.

Hindus may choose not to drink tea or coffee because they are stimulants and may unbalance the humours in their body. Water or fruit juice should always be readily available.

Some medicines contain animal products and should be avoided when treating vegetarian patients.

Very few Hindus will fast during a hospital stay. They are likely at least to take hot milk, fruit, tea, salad (no salt) and yogurt. Some may fast in thanks for a successful recovery. At the end of a period of fasting, a Hindu patient's visitors may bring them some sweets or other foods (prashad) that have been blessed. Other holy foods include ghee, milk, honey, sugar and yogurt.

names

Naming conventions vary greatly; however, westernised Hindus tend to have three names: a personal first name, an auspicious middle name and a family last name. Their last name should be used as a surname. However, this practice is not universal, and so it is always better to ask a patient what they would prefer to be called and make a note of this in their patient records.

Children are not given their full name until a naming ceremony (namakarma) a few weeks after birth. If the family have left hospital by then, it is important that the child's records are updated at their next appointment.

language and interpreters

Although it may seem natural to allow a family member to interpret for a patient who does not have adequate English language skills, this can bring about issues of censorship, lack of medical understanding and patient confidentiality. The ideal interpreter is an older Hindu woman who has been trained in medical terminology and is not a member of the patient's family.

preparation for surgery

Many Hindu women have long hair, which they will be reluctant to cut without their husband's permission. Similarly, they may seek the permission of their husband or father before signing a consent form. They may also be concerned that any jewellery that they normally wear can either be left on or, if it must be removed, that it will be stored safely in a clean environment, and returned promptly.

When preparing a male Hindu patient for surgery, similar considerations regarding personal items apply. In particular, most men who wear a jenoi (sacred thread) will probably refuse to remove it and may be concerned that it will become soiled by contact with body fluids during their operation.

body language

Hindus are taught that every movement of the body has a meaning. They try to greet others with a pleasant expression and kind words. They consider it offensive to point with the forefinger of the right hand because the right hand is believed to possess a powerful force, which the finger concentrates through to the nervous system of the recipient. An acceptable way to point is with the whole hand, palm upwards. Pointing one's legs towards a Hindu when sitting down also causes offence, and crossing one leg over the other knee should also be avoided.

Because the left hand is used for toileting, it is considered unclean and should not be used to pass something to a Hindu or other Asian person.

Transactions and conversations through doorways are considered inauspicious and should be avoided.

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