Transcultural Health


Elmer and Mary Miller, both 35 years old, live with their five children in the main
house on the family farmstead in one of the largest Amish settlements in Indiana.
Aaron and Annie Schlabach, aged 68 and 70, live in the attached grandparents’
cottage. Mary is the youngest of their eight children, and when she married, she and
Elmer moved into the grandparents’ cottage with the intention that Elmer would take
over the farm when Aaron wanted to retire.
 Eight years ago, they traded living space. Now, Aaron continues to help with
the farm work, despite increasing pain in his hip, which the doctor advises should be
replaced. Most of Mary’s and Elmer’s siblings live in the area, though not in the same
church district or settlement. Two of Elmer’s brothers and their families recently
moved to Tennessee, where farms are less expensive and where they are helping to
start a new church district.
 Mary and Elmer’s fifth child, Melvin, was born 6 weeks prematurely and is 1
month old. Sarah, aged 13, Martin, aged 12, and Wayne, aged 8, attend the Amish
elementary school located 1 mile from their home. Lucille, aged 4, is staying with
Mary’s sister and her family for a week because baby Melvin has been having
respiratory problems and their physician told the family he will need to be hospitalized
if he does not get better within 2 days.
 At the doctor’s office, Mary suggested to one nurse, who often talks with Mary
about “Amish ways,” that Menno Martin, an Amish man who “gives treatments,” may
be able to help. He uses “warm hands” to treat people and is especially good with
babies because he can feel what is wrong. The nurse noticed that Mary carefully placed
the baby on a pillow as she prepared to leave.
 Elmer and Mary do not carry any health insurance and are concerned about
paying the doctor and hospital bills associated with this complicated pregnancy. In
addition, they have an appointment for Wayne to be seen at Riley Children’s Hospital,
3 hours away at the University Medical Center in Indianapolis, for a recurring cyst
located behind his left ear. Plans are being made for a driver to take Mary, Elmer,
Wayne, Aaron, Annie, and two of Mary’s sisters to Indianapolis for the appointment.
Because it is on the way, they plan to stop in Fort Wayne to see an Amish healer who
gives nutritional advice and does “treatments.” Aaron, Annie, and Elmer have been
there before, and the other women are considering having treatments, too. Many
Amish and non-Amish go there and tell others how much better they feel after the
 They know their medical expenses seem minor in comparison to the family
who last week lost their barn in a fire and to the young couple whose 10-year-old child
had brain surgery after a fall from the hayloft. Elmer gave money to help with the
expenses of the child and will go to the barn raising to help rebuild the barn. Mary’s
sisters will help to cook for the barn raising, but Mary will not help this time because
of the need to care for her newborn.
 The state health department is concerned about the low immunization rates in
the Amish communities. One community-health nurse, who works in the area where
Elmer and Mary live, has volunteered to talk with Elmer, who is on the Amish school
board. The nurse wants to learn how the health department can work more closely with
the Amish and also learn more about what the people know about immunizations. The
county health commissioner thinks this is a waste of time and that what they need to do
is let the Amish know that they are creating a health hazard by neglecting or refusing
to have their children immunized.
Study Questions
 1.  Develop three open-ended questions or statements to guide you in your
understanding of Mary and Elmer and what health and caring mean to them and to
the Amish culture.
 2.  List four or five areas of perinatal care that you would want to discuss with Mary.
 3.  Why do you think Mary placed the baby on a pillow as she was leaving the doctor’s
 4.   If you were the nurse to whom Mrs. Miller confided her interest in taking the baby
to the folk healer, what would you do to learn more about their simultaneous use of
folk and professional health services?
 5.   List three items to discuss with the Millers to prepare them for their consultation at
the medical center.
 6.  If you were preparing the reference for consultation, what would you mention about
the Millers that would help to promote culturally congruent care at the medical
 7.  Imagine yourself participating in a meeting with state and local health department
officials and several local physicians and nurses to develop a plan to increase the
immunization rates in the counties with large Amish populations. What would you
suggest as ways to accomplish this goal?
 8.   Discuss two reasons why many Old Order Amish choose not to carry health
 9.   Name three health problems with genetic links that are prevalent in some Amish
10. How might health-care providers use the Amish values of the three-generational
family and their visiting patterns in promoting health in the Amish community?
11. List three Amish values to consider in prenatal education classes.
12. Develop a nutritional guide for Amish women who are interested in losing weight.
Consider Amish values, daily lifestyle, and food production and preparation
13. List three ways in which Amish express caring.
Selecting a “typical” Jewish client is difficult. An ultra-Orthodox Jew has a particular set
of special needs. Yet, it is more common to see a Jew who is a middle-of-the-road
Sonia is an 80-year-old woman who was born near Kiev, Russia. Most of her
family was killed in the pogroms, and she escaped to the United States at the age of 10.
She married and raised a family in a Conservative traditional home. As she aged, she
became less committed to keeping kosher outside her home, although her home is kosher.
At age 62, she was diagnosed with type 1 diabetes. She initially expressed some
concern about her use of pork-based insulin. Currently, she is admitted for amputation of
her right leg owing to the complications of diabetes. Her hospital room is always filled
with visitors.
Study Questions
1. What questions will you specifically ask Sonia about her dietary preferences?
2. How would you have responded to her initial concern about using insulin made
from pork?
3. What questions do you need to ask in the initial patient interview to assess her
degree of religious practice? How will you determine her spirituality needs?
4. What must you anticipate discussing with her about her surgery as it relates to the
disposition of her leg?
5. What is your understanding of the reason she has so many visitors in her room?
6. How might your care be altered if the client in this case study were a Hasidic
man? (Your answers will vary depending on whether you are a male or a female
health-care provider.)
7. Describe three genetic or hereditary diseases common among Ashkenazi Jews.
8. Describe the Jewish ritual of circumcision.
9. Discuss the laws of Kashrut in regard to food practices for observant Jewish
10. What should the health-care provider keep in mind when entering a Jewish home
to provide care?
11. Distinguish between the terms Sephardic and Ashkenazi.
12. How might a non-Jewish and a Jewish coworker share holidays in the workforce?
13. What is the official language the Jewish people use for prayer?
14. Identify fertility practices for Jewish Americans from all three denominations.