Asian Indian Culture and Tradition
NURS236: Transcultural Nursing
March 29, 2016

According to the U.S. census, there are over 1.6 million people of Asian Indian origin in the United States. Asian Indians began immigrating to the U.S. as early as the turn of the 20th century. Most found work in agriculture working on farms. Between 1980 and 1990, the population of Asian Indians in the U.S. increased by 125%. Due to family reunification laws, the number of Asian Indian elders who followed their offspring to this country has also risen (India, 2015).
There are now two major groups of Asian Indians, those who came to U.S. in the late 1960’s and early 70’s, and the group who came much later. According to the 1990 Census data, there were approximately 23,000 Asian Indian elders over the age of 65; 83% are foreign born and 51% do not speak English very well. Only 12%, however are classified as linguistically isolated (without an adult who speaks English in the household) – the smallest of any Asian ethnic group (India, 2015).
Older Asian Indian immigrants are often financially dependent on their children. They face the challenges of a culturally different society, such as a language barrier, culture mismatch, new lifestyle factors, and role reversal. In traditional Indian society, extended family members usually live together as a single-family unit. Often, the husband's parents will join the family after they have retired or when help is needed. The grandparents' role in raising the children is highly respected, and they form the linkage to the Indian culture, religion, and heritage. Older Asian Indian immigrants may not speak English and may need a health care interpreter or translator.
The majority of Asian Indians practice the Hindu religion. Others practice Sikhism, Buddhism, Jainism, Christianity, or Islam. While there are more than three hundred languages and dialects spoken in India, Hindi, the national language is spoken by over 40% of the population (India, 2015). Other languages spoken are Gujarati, Punjabi, Bengali, Urdu, Marathi, Oriya, Kannada, Tamil and Malayalam. However, English is becoming a popular second language. Older Indian immigrants may not speak English and may need a translator for health care transactions.
Health problems prevalent among Asian Indians include: Cardiovascular disease; hypertension; diabetes; cancer; nutritional deficits; tuberculosis; malaria; dental caries and periodontal disease; and sickle cell disease, in selected populations (Giger,2013).
Immigrant Asian Indian men in the U.S. have a high prevalence of coronary heart disease, non-insulin-dependent diabetes, lower high-density-lipoprotein (HDL) cholesterol levels and hypertriglyceridemia. All these have “insulin resistance’’ as a common pathogenic mechanism, which seems to be the most important risk factor (Giger, 2013).
In India only one in 40 women gets breast cancer, but in United States one out of every eight Asian Indian women will get the disease, the highest incidence in the world. According to the American Cancer Society, South Asian women have the second highest incidence of cancer among Asian Pacific Islanders. Asian women, including Asian Indian women, are at a high risk for osteoporosis. According to the National Osteoporosis Foundation, because of the differences in bone mass and density between these groups, Asian and Caucasian women are at higher risk than African Americans and Hispanics. The prevalence of coronary artery disease (CAD) is three times higher in Asian Indian women than in women in the U.S. as a whole (Giger, 2013).
Even though Asian Indian physicians comprise the highest proportion of foreign medical graduates practicing in the U.S, most Asian Indians do not possess adequate knowledge with regard to health issues. The majority of Asian Indians, especially the vegetarians, believe that they are eating a healthy diet, but many Asian Indian dieticians think otherwise. Many Asian Indians are not aware of basic nutritional factors. The typical Asian Indian diet averages 56% of energy intake from carbohydrates, 32% from total fat and 8% from saturated fat. The high fat intake is associated with obesity and low leisure time activity (India, 2015). Exercise is also something many Indians, especially women, do not do on a regular basis. Many Asian Indian women have been conditioned to play passive games rather than be involved in action sports.
Fasting frequently is a common practice among elderly women. It is done because of religious belief that it improves the welfare of the family. Health providers should respect these practices if the patient's medical condition can tolerate it. Nutrition should be taught based on the cultural diet of the patient. Hospital food can present a problem for Asian Indians, particularly those who strictly observe religious dietary restrictions. Hospital meals may also be too bland for most Asian Indians. Many will prefer to know whether the food served to them contains beef as beef is forbidden for Asian Hindus. Foods containing pork are prohibited for Muslims who follow religiously prescribed diet (Indian Culture and Health, 2014).
To care for the individual from Asian Indian backgrounds effectively, it is important for providers to be familiar with their traditional health beliefs and historical experiences that may have influenced their attitudes toward health care. Many believe in the traditional Indian system of medicine called Ayurvedic Medicine as the means of preventing and curing illness. Ayurveda is an intricate system of healing that originated in India, thousands of years ago. Ayurveda is made up of two Sanskrit words, ‘Ayu’ meaning life and ‘veda’ meaning the knowledge of. Ayurveda is not merely a medical system dealing with physical disorders. It is a science that relates to the complete human being (body, mind, senses and soul). It explains how balance can be attained physically, mentally and spiritually. According to it, each individual is made up of three doshas (vata, pitta or kapha). Each Dosha represents certain bodily activity. The ratio of the doshas varies in each individual. When any of the doshas becomes accumulated, Ayurveda will suggest specific lifestyle and nutritional guidelines to assist the individual in reducing the dosha that has become excessive. They may also suggest herbal supplements to hasten the healing process (Indian Culture and Health, 2014).
There are aspects of the Hindu religion that commonly affect health care decisions. Hinduism is a social system as well as a religion; therefore, customs and practices are closely interwoven. "Karma" is a law of behavior and consequences in which actions of past life affects the circumstances in which one is born and lives in this life. Despite complete understanding of biological causes of illness, it is often believed that the illness is caused by "Karma". Health is usually related to the connectedness of the body, mind and spirit. Most elderly focus spiritually in preparing the soul for life after death. Some believe that mental illness is due to possession of the evil eye (Giger, 2013).
Modesty is highly valued among Asian Indians, and patients usually feel more comfortable with same sex-care providers. Direct eye contact from women to men may be limited (Giger, 2013). Sensitivity and care should be taken in situations that may cause the patient embarrassment, such as wearing an examination gown, which the patient may consider too short. Some patients hesitate to wear clothing that others have worn before them, even though it has been washed and sterilized. When a patient is in the hospital the sacred thread across the chest in men and around the neck in women should not be removed or cut without the permission of the patient or family. Sikh men do not cut their hair and wear a bracelet and kirpan. If the hair must be cut, it is important to explain the need to the patient and family.
The patient may expect the doctors to have all the answers and make all the decisions. As a result, the patient takes a passive role, answering but not asking questions, and waiting for physicians to impart their diagnosis and recommendations. Most of the time medical advice is accepted without question. An active and commanding doctor who takes charge and gives prescriptions for medications may be preferred. Physicians may be perceived as incompetent if they say something such as, “I do not know what is wrong, we need to do more tests,” or “It is just a cold. There is no need for medicine.”
Mental illness is considered as a stigma, so it is frequently concealed and presented to the physician as somatic complaints, such as headaches or stomach pain, instead of anxiety or depression. Elderly patients may be stoic in expression of pain. It is important to observe non- verbal behavior. Many elderly Asian Indians do not prefer counseling as an option for problem resolution (Indian Culture and Health, 2014).
Because of the close-knit family structure, healthcare decisions are frequently discussed within the immediate family before seeking outside help. Women are more passive in the Indian Culture and men play a major role in health care decisions. These roles are slowly changing among immigrants now.
Some prefer to have the surgery only on some auspicious days. If procedures such as an enema or bladder catheterization must be done, elders would prefer that someone of the same sex do it. Family and friends will likely want to stay with a hospitalized person and be included in performing personal care (India, 2015). The patient will be more likely to feel happy rather than tired after a visit by their family members and friends, and may be disappointed if certain people do not appear. It is not only enough to drop in briefly, but instead the visitors are expected to sit and spend time with the patient. For many Indians, hospital visits are a very important way to provide support for the sick person and the family.
The cultural and religious background of Asian Indian elders often influence end of life care decisions. Older patients are more likely to subscribe to family centered decision making rather than being autonomous. Sometimes family members may ask the physician not to tell patients their diagnosis or other important information. Open-ended questions as to why the family does not want the patient to know may be helpful.
Many patients prefer to die at home, and there are specific rituals and practices in each religious community. Many believe suffering is due to karma, which is inevitable. When close to death, family members are likely to be present in large numbers. A dying person may wish to be moved to the floor, with an idea of being close to the mother earth. Family members will prefer to wash the body after death. The preference is also for cremation. The mourning Hindu family may prefer to have a Hindu priest perform a prayer and blessing. It is very important to provide privacy to the family after the death of a family member to allow for the religious rites to be performed. It is an accepted practice for family members and others to have an open expression of grief. After cremation there is a mourning period of from 10 to 40 days. Most Indians do not readily agree to a post mortem examination or organ donation (Indian Culture and Health, 2014).
Older Asian Indian women often recommend home treatment. Home remedies, such as massage, bathing and herbal medicines may be used first, while a physician is sought out only for serious illness. Some behaviors that many elders prefer include: ritual chanting by a priest; tying a thread around the sick person’s wrist; and writing a protective verse to be worn in a metal cylinder on a chain around the neck or wrist. Sick persons may also promise gifts to the temple god if they recover (India, 2015).
For many Asian Indian elders, the activities of social workers and home care nurses are unfamiliar and often not welcomed. Home visits by these providers are not always acceptable. They seek help from family and friends and are unlikely to place an elder in a nursing home except as a last resort.
A truly self-aware nurse would be most respectful of the wishes of an Asian Indian patient. They would seek out an interpreter and also have any English-speaking family members assist with translation to the patient and their family. They would ask if there are any cultural practices the hospital staff could help them adhere to. The nurse or any other member of the medical staff should not be hesitant to ask any questions of the culture in the most professional way.
I find the topic of Ayurvedic Medicine very interesting. I have practiced some with health issues like using turmeric and black pepper for inflammation or in practicing meditation. I like the vegetarian ways of the Hindu religion and a lot of this dishes are quite delicious. I believe there is a happy medium to be found in using complimentary medicine along with the medicine of the Western world.

References
Giger, J. N. (2013). Transcultural nursing: Assessment & interventions. St. Louis, MO: Elsevier/Mosby.
India. (2015). Retrieved March 16, 2016, from http://www.everyculture.com/Ge-It/India.html
Indian Culture and Health Care Go Hand In Hand. (2014). Retrieved March 20, 2016, from http://allnurses.com/general-nursing-discussion/indian-culture-and-276257.html