In her article “Regla de Ocha in the Hospital,” anthropologist Eugenia Rainey presents a long-standing problem in the relationship between the Lukumí religious community and U.S. medical care that requires attention not only from the medical profession, but also from the Lukumí.
The dichotomy between modern medicine and Lukumí religious practice presents a challenge to health care systems. The medical doctor (onishegun in Lukumí) is viewed as a complement to the Lukumí adahunshe, who specializes in natural and spiritual approaches. These complementary diagnostic systems mean that the medical doctor and the adahunshe should work together. But the Lukumí patient has the greater burden in American hospitals. For example, if Lukumí beliefs are a hidden factor, a patient’s anxiety may lead the physician to misdiagnose. I believe a long-term education process can produce a reconciliation that balances the interest of both sides.
Health is a very important concern to all Lukumí. Hospitals are secular institutions that follow their own complex cultural and professional protocols. Yet in the United States, they must adhere to Title IV of the Civil Rights Act of 1964, known as ADA (Americans with Disabilities Act), as well as the Standards for Culturally and Linguistically Appropriate Services (CLAS), which address culturally-specific care. In general, they follow what anthropologist Madelein Leninger has termed “transcultural nursing,” leading to inclusive practices.
Although many Lukumí people work in hospitals, thus contributing to their understanding of diversity with regard to patient care, my decades-long work training hospital staff in Miami have provided me with first-hand knowledge of the current situation. Even though culturally-specific care is generally addressed in hospital policies and taught at nursing schools, there are still barriers that need to be overcome by Lukumí patients as well as providers.
The first barrier is the lack of sensitivity training among some hospital staff.
A lack of intercultural training in terms of Eurocentric biases in some instances triggers Lukumí psychological defensiveness and a poor communication among providers and patients. In my lectures at nursing schools, I often encounter cultural biases, which lead to a reluctance to accommodate cultural and religious demands. In some cases, nurse practitioners have articulated a rigid belief that a patient must abide by staff commands at all times. They believe that they have full authority over the patient. The manner in which nurses project themselves leads patients to believe that they do not have any room for negotiation. At the same time, many Lukumí patients lack knowledge of their civil rights and therefore fail to demand reasonable accommodations for medical protocols.
A recurrent theme in my lectures is explaining to nurses that Lukumí, unlike mainstream religions, has a holistic health method of diagnosis and treatment. In most instances, western medicine is viewed as the alternative. The patient primarily relies on spiritual divination diagnosis and seeks affirmation of medical treatment. Rituals are performed to ensure a positive outcome. Nurses with a one-sided rigid western view seem to struggle with the notion that religion may override or affirm a medical procedure or treatment. Some nurses take the position that the patient is relying on superstitious beliefs.
Language usage seems to be a frequent point of tension encountered by health providers. Many lay people refer to Lukumí religion as “la Regla de Ocha,” a term popularized by well-known writers-scholars like Lydia Cabrera. Ifa-Ocha is a competing term, increasingly used. At the same time, the pejorative Santería, of colonialist overtones, continues to be widely used as an identifier. Do hospital staff nationwide need to learn multiple names for the same religion in order to provide culturally-specific care? In areas where the Lukumí population is significant, hospitals can take practical approaches to training, in order to familiarize staff with multiple identifiers, while also providing culturally-specific accommodations. A greater challenge would be faced by hospitals in areas where the Lukumí population is insignificant.
Hospital intake forms need to allow for Lukumí religious identification, rather than expecting patients to fill the “other” box, or their nominal religious affiliation, be Catholic or Protestant. The expectation should not be that Lukumí, as a minority religion, falls in the category of otherness. In my research, I have found instances where hospital staff has inappropriately inquired about religious affiliation. However, the Lukumí patient should not expect medical staff to possess religious expertise. For instance, it is the responsibility of the Lukumí patient to state that her or his wrist bracelet and necklaces are not jewelry. Typically, personal items containing metal are temporarily removed because it may interfere with electrical instruments used by the first respondent or hospitals. Emergency room personnel need to be informed that the items have religious significance and should not be treated as jewelry because they fall under the religious exception.
A feeling of embarrassment or religious discrimination can be easily provoked by the health provider or patients. Lukumí patients should be prepared to identify as a contact person a Lukumí priest or priestess. When a patient declares his or her Catholic faith, or other denomination, pastoral services at the hospital know to send a minister to visit the patient in the room, should the patient request it or need it. Lukumí patients need to fill out intake forms correctly, so that they are afforded the same visiting rights. As patients, they have the right to request religious services at any time, and they should exert those rights without fear of embarrassment or discrimination.
Hospitals can do more to accommodate patients. The lessons can be found in Caribbean hospitals where staff has a good understanding of the culture. Executives in American hospitals and nursing schools could place more emphasis on culture-specific training and integrate Lukumí and other similar Afro-Caribbean religions into the curriculum. It is my experience that when both sides enter a professional dialogue with an open mind, the healthcare delivery and patient outcome significantly improves.
Cover Image by Lynn Friedman: “Milwaukee Doctor’s Office.”