THE BLACK CLIENT'S VIEWPOINT OF SICKNESS AND THE HEALTH CARE DELIVERY SYSTEM byB essie W illiam s M orris A Thesis Submitted to the Faculty Of the COLLEGE OF NURSING In Partial Fulfillment of the Requirements For the D egree of MASTER: OF SCIENCE In the Graduate College THE UNIVERSITY OF ARIZONA 19 76 Copyright 1976 B essie W illiams M orris STATEMENT BY AUTHOR This thesis has been submitted in partial fulfillment of requirements for an advanced degree at The University of Arizona and is deposited in the University Library to be made available to borrowers under rules of the Library. Brief quotations from this thesis are allowable without special perm ission, provided that accurate acknowledgment of source is made. Requests for perm ission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the copyright holder. SIGNE APPROVAL BY THESIS DIRECTOR This thesis has been approved on the date shown below: >h(ceml>es' ^ i fliS P C ia te . MARGARITA KAY': P rofessor of Nursing Date ACKNOWLEDGMENTS A number of people afforded various elem ents of support to me as I struggled to write this th esis. I w ill now publicly name those people. Gladys Sorenson, Ph. E d . » Dean of the College of Nursing, University of Arizona, was untiring.in her efforts to encourage my return to school. Dr. Beverly McCord explored various avenues of financial assistan ce, and through her efforts made it possible for m e to pursue my studies on a full-tim e b asis. Dr. Agnes Aamodt and P rofessor A lice Noyes, m em bers of my th esis com m ittee, offered tim ely and much needed advice. Dr. Margarita Kaye pro vided that m ost essential quality in the sharing of her tim e, patience, and phenomenal storage of information. I can truthfully state that without these qualities that she so abundantly shared with m e , not a word of this thesis would have been written. My husband, Robert, and my sons, Robert, Jr. , Ronald, and Richard, made me feel that I was one of the m ost intelligent women alive. TABLE OF CONTENTS Page LIST OF TABLES . ABSTRACT 1. . . . . . . . . . . . . . . . IN TR O D U C T IO N . vi . . . vii . . 1 Need for the S t u d y ........................................ 2. REVIEW OF CURRENT LITERATURE 3. RESEARCH TECHNIQUES . . 4 . . . . . . . . .... .............................. 13 Selection of Informants . . . . . . . . . . . . . Description of the Population .................................. Data Collection . The investigator as a Participant Observer . . . . . . Limitations of the S t u d y ............................ 4. PRESENTATION OF FINDINGS ... . . . . . . . ., . Behavior Toward Whites in General ............................ A ssessm en t . . . . . . . . . . . . . . . R esponses ............................. . . . . . . . . . Resolution . The Cultural Health S y s t e m .................................................... Definitions of the Black Cultural Health S ystem . . . . Rlack Cultural Solution to the Official Health System . . Cultural Rules . . . . . . . . . . . . . . The Reaction* of Whites . . . . . . , .. . . Interpretation of Sickness: Causes and Treatment . . . 5. 6. THE BLACK VIEWPOINT OF THE OFFICIAL HEALTH CARE SYSTEM. IMPLICATIONS FOR NURSES. Summary . . . . . 15 16 17 18 22 . 23 . 23 24 24 26 27 28 30 31 33 36 . . . . . 51 . ............................ iv 6 . . . . . 58 60 TABLE OF CONTENTS—Continued Page APPENDIX A: INFORMANT CONSENT FORM TO PARTICIPATE . . . . . . . . . 63 APPENDIX B: DATA COLLECTION S H E E T .................................64 APPENDIX C: MEDICATIONS AND THEIR USES . . , . . 66 APPENDIX D: GUIDE TO S C R I P T U R E S ...................................... 68 SELECTED BIBLIOGRAPHY . . . . . . . . . . . . 70 LIST OF TABLES Table 1. \ Page A tabulation of preferences of specific components of the black cultural health system according to age of inform ants. . . . . . . . . . An analysis of the types of approaches preferred by black clients who were receiving health care from white professionals when interviewed . . . . . vi . . . . 50 . 61 ABSTRACT Blacks are suspicious and rej active of the present official health care delivery system . These attitudes were prevalent among the low-socioeconom ic black group interviewed in this research. Blacks are refusing those services offered by the present health care system or using those prescriptions in conjunction.with their cultural health care system . Too much is not known by white care professionals about the black client’s perception of his sickness and the treatments he receives from staff in fa cilities set up to m eet his health needs. Therefore, the services that are offered are not geared to the needs of the black client. Blacks have maintained their cultural attitudes and b eliefs in the m idst of a plethora of scientific rationale. Those attitudes and beliefs have fostered and nurtured a health system that may preclude contact with the white dominated health system for long periods of tim e. Diagnoses, treatm ents, and persons who do one of the two or both are w ell defined and adhered to by a large segment of the black populace. CHAPTER 1 INTRODUCTION An elderly female hem iplegic, confined to her wheelchair, is entrusted by the working mothers of 39 infants and pre-schoolers as a sitter and a healer for their children. An elderly man v isits the health Clinic in the neighborhood to ascertain whether his "common sense diagnosis and treatments" are vali dated by the findings of the doctor. A m iddle-aged woman attends the county hospital and its outpatient clin ics on a regular basis. The waiting room of a spiritualist’s office is crowded to overflowing from Tuesday through Saturday with people of all ages seeking help for unexplained or suspicious health m aladies. Despite the various approaches utilized by this group to m eet their health n eed s, they share com monalities that are often foreign to the white providers of health serv ices. F irst, all are blacks living in a poor neighbor hood in a southwestern city. Second, all do not trust whites in general. Third, all feel that the health delivery system s available to them as they now exist are dehumanizing or demeaning. Their attitudes, b eliefs, and opinions about the official health system s are governed by "unwritten rules of behavior." These "rules" are understood in the fullest extent only by m embers of the black culture. 1 2 The degree to which . blacks adhere to the "rules" is the determining factor that guides their acceptance or non-acceptance of the official health system . The description of these "rules" and the interpretation of sickness by a segment of the black community w ill be the subject of this th esis. The idea for the subject of the thesis was conceived from my exposure to the health delivery system as a student# as a professional# and as a black health seeker. It has become evident that the whites in the System have rela tively little, if any# knowledge about black culture. They lack the information that would help in recognizing and understanding the ways in which blacks differ from the low -socioeconom ic white or other ethnic groups of color. There is a tendency to base health care to m eet white m iddle-class expectations. It does not anticipate the requirements of poverty-level blacks. Blacks differ in communication patterns and cultural rules. Blacks have an ethnomedical system that may be the only avenue of cure that they pursue. They may use certain elem ents of that system in conjunction with the prescriptions they receive through the official health system . Blacks have perfected the manner in which they a s se s s and respond to the behavior of Whites. The whites have begun to express their concerns about the dilemma in which they find them selves when caring for blacks. My p e e r s , colleagu es, and fellow workers have prevailed upon me in numerous Situations over the past 20 years to intervene or interpret actions, statem ents, or attitudes of their black clients. Their questions denote their level of awareness about blacks and their culture. The usual theme of the questions is: "Why can’t she speak the English language? We can’t .understand . a word she is saying. How did you understand her ? You don’t talk that way around us. ” 5 "Why doesn’t he realize we are trying to help him ? Be is hostile and physically abusive. "; "Why don’t they keep their appointments? Don’t they care about their health?"; "What is that God-awful concoction on the wound? The doctor gave the wife a prescription but they never had it filled. They used some home remedy, now the wound has to be debrided." Interpretation of the behavior without an understanding Of the cultural rules dictating the behavior does not heighten the awareness and sensitivity that is required to communicate or work effectively with the black client. The questions can be answered when the beliefs and opinions of the group are viewed as an inherent part of their cultural life style. When whites in the health delivery system become receptive to being taught by blacks about blacks, their awareness becomes the tool to utilize in coping with those mani fested beliefs and opinions of the black. There are three areas that are maintained in the black culture that sustain their unique Viewpoint of the health delivery system and sickness. Topically, they may be outlined as follows; I. Behavior Towards Whites in General a. A ssessm en t of the white b. Response to whites c. Resolutions to their feelings toward whites 4 II. Cultural Health System s a. H ealers b. Spiritualists 6. HI. Home rem edies Cultural Solutions to the Official Health Care System Need for the Study Attempts to research the subject of the black’s viewpoint of the health delivery system and his interpretations of sickness revealed scant information. The studies that have been published tend to present those observable medi cinal beliefs and practices of blacks in a quaint and humorous manner. Some studies insinuate in an intriguing manner that there are diverse health .system s within the black culture. None are spelled out. Many of these studies have created the idea that blacks differ only to a slight degree in their m edicinal practices and beliefs about health from the poor white. These studies w ill be d iscussed in the review of the literature. A s a poor black who was raised in clo se proximity to poor w h ites, I can item ize the differences in approaches to rem edy, diagnosis, and practices of health that are different from those in the low-socioeconom ic culture of the white race. The white practitioners in the official health delivery system are unaware of the differences in their names and treatment of a disease and the names and treatments that are used by the black client. When the black client attempts to verbalize his viewpoint about the situation, he speaks in idioms and colloquialism s that are outside the Anglo’s frame of reference. Before more m onies, tim e, and effort are expended by the profes sionals in the official health care system to intervene in the health problems of the black community, much more information needs to be imparted to them regarding how blacks have viewed the past and present official health system s. Other information should be given regarding the names and treatments of ill n esses that are viewed as a normal p rocess in the black culture but an abnormal process in the white culture arid vice versa. The black, interpretation of sick n ess is , "Gettin down or being down to the point I can’t help m yself. ” This interpretation covers a variety of illn esses that may have a different meaning to the white doctor and nurse. CHAPTER 2 REVIEW OF CURRENT LITERATURE There is a vast amount of literature containing attitudes and beliefs of the black community or culture, but m ost of the literature deals with the m ost superficial aspects of the culture* None of the studies dealt in great detail with the cultural rules that are the basis for the observable attitudes and beliefs. The behavior and attitudes of blacks form s a complex chain of behavior pat terns that have only been presented in fragments. I spent an inordinate amount of tim e and effort in an attempt to con sume the vast amount of literature that deals with these fragm ents. I then attempted to connect the fragments in such a way that a correlation could be established between the cultural rules and the manifested attitudes and beliefs that had been researched. I was unable to find any m aterial that dealt solely with the black clien t's viewpoint or opinion of the official health care system . Studies of the black's interpretation of the causes of sickness were not available in large quantities. Blacks view the official health system s that are available to them as dehumanizing and demeaning. Whites in the system view their interventions in the health needs of the black as a necessary phenomena toward bringing the black into the mainstream of society. 6 No matter how much tim e, money, and energy are devoted to bringing the black into the mainstream of American life , nothing can be accomplished with sufficient depth and intensity until whites have a greater understanding of black culture. It has been stated that, . . in developing programs we have often failed to take into consideration black attitudes toward leadership, energy, time , and money'* (Abrahams 1970, p. 3). Because so little is known about black culture, huge sum s of money, man hours, and energy have been wasted, Education of the black has been so bent toward the white standards of acculturation that it is forgotten that blacks have their w ays, too, and the white needs to be educated about them (Simpson and Yinger 1972). Stereoiyping by social scientists who are consulted in the formulation of approaches to be utilized in reaching certain segments of the black com munity border on the ludicrous details and are often inappropriately applied in white-black relationships. Stereotyped ch aracteristics are often imputed more out of misunderstanding of practices and beliefs than through the practices them selves or the attitudes that lie behind them (Abrahams 1970; Spradley and McCurdy 1972). Blacks have learned to use the stereotype as an aggressive device by which they could fight back. They have developed upon numerous traditional techniques by which they successfully agress in both covert and overt fashion (Grier and Cobb 1968). The idea that poor blacks only differ slightly in their medicinal prac tic es and beliefs about health from the poor white has created only problems when the poor black is approached in the sam e manner as a poor white in m eeting his health needs (Brunson 1962; Rainwater 1960). There are a number of black m edicinal beliefs presented in collec tions of Southern folklore (Botkin 1949; Hughes and Bontemps 1958; Puckett 1969), but these proved to be of lim ited benefit to me. Great emphasis was placed on the practices of the black culture without any attention being given to the cultural rules that maintained the practices. The practices as they are described in the studies become humorous anecdotes. Snow (1971a) offers a more accurate description of the ethnomedicinal system of blacks and their attitudes on various aspects of their beliefs regarding the power of prayer as a healing agent. Reading her study or any other study that has been conducted among a black group by a w hite, I can easily pick up the flaws and om issions in the information that was given. Blacks w ill not tell all. They have learned that too many of their beliefs and opinions are a source of amusement for the white. Students of black fam ily life have generally ignored the interpretations that black people have of their life experiences. Stack (1974, p. 34) s ta te s, M. . . the black community has long recognized the problems and difficulties that all . . . in poverty share. ” Blacks share and communicate their interpretations and feelings through idioms and colloquialism s that are weighty in their covenance and appear exaggerated when compared to white speech patterns. Therefore, much of the content of the communication is lo st on the white who attempts to study the black community. Not only must the white understand the variant of the basic speech pattern of blacks, but he also has to cope with a bastardized form of that pattern. The black who is attempting to give an interpretation of h is sickness or his viewpoint Of the health care system to a white readily encoun ters a communication gap or jeopardizes the relationship with his term inology, gestu res, or body language. A white doctor appears quite puzzled When Mary, an informant, described her fear and physical symptoms as: Lor, hav m ercy on this po soul. Yo know I jist down and can’t help m yself. Sometime I thout my heart was comin rat threw my gizzard. It sem m to jump up, go pitt-pat, flop over, then race aroun my bosum an then jist lay heir and quiver. Her voice is loud, shaky, and intoned, as if delivering a Sunday morning sermon. Her behavior seem ed to em barrass the doctor and his staff. Black behavior that is termed by whites to be emotional, loud, or abusive may be the normal pattern for expressing a specific emotion or feeling (Liebow 1966; Guffy 1971; Kochman 1972). Specific inflections of the v o ice, specific facial expressions, and spe cific body language are additional means of communicating among blacks. The eye movements are varied and significant and are not always the wide, rolling, fear-filled objects that are typified of a black in the throes of fear or anger. A black is angered to the point of becoming violent when a forefinger is shook in his face as a gesture of reprimand or anger. A white nurse is known to use this gesture when reprimanding black clients about their reluctancy to adhere to her instructions. If she had been black, she would have been told: N igger, don’t shake yo fanger in my face. I’m gon warn you this tim e. Now if fin yo do it agin, yo gon pull back a nub where yo han oughta be. 10 The blacks have tolerated her behavior out of fear of retaliation. The nurse has become the butt of unkind jokes among her black clients. Abrahams (1970, p. 54) describes the benefits that this communication pattern affords the group when they stated that single round of a dozen or so exchanges frees more pent-up aggressions than w ill a dose of sodium pentothal. Whites do not understand the release of tension, anger, and frustration that is afforded the black by his communication pattern. Kochman (1972, p. 264) .: ■. ■ . . -’ -I. - ■ - describes the various patterns and the rationale for the pattern. He believes that by blending style and verbal power through "rapping," "sounding," and "running it down," the black establishes his personality. Through "shucking," "gripping," and "copping a p le a ," he shows his respect for power. Through "jiving and signifying," he stirs up. excitement. By utilizing all of the above behavior, a black is supposed to be "able to manipulate and control people and situations. The black who is desperate enough to place him self under the aus p ices of the official health care system does so with great trepidation. His ability to control and manipulate is inhibited. The white health professional is either unaware of or insulted by the manner in which the black controls or manipulates. The black knows that he and his family w ill have a difficult tim e explaining their viewpoint about his sickness and the methods they have used to treat and attempt to cure the sickness. He has learned throughout his lifetim e that whites view blacks as being oddities. 11 How w ill the white doctors and nurses respond to certain anatomical structures that they have heard are different in proportion, texture, and size from the white ? Will they understand that blacks are overly conscious and sensitive about their hair and skin? Will the nurses understand that the black skin turns "ashy" With exposure to soap and w ater, or that he requires a lotion or oil to rem ove the ashen color? That a lubricant applied to his hair before combing le sse n s the pain? To whom can he safely express dissatisfaction with the food or the nurse’s insulting way of caring for him ? How can the doctor or nurses tell if he becom es "blue," or cyanotic ? Many blacks have a normal blue hue to their skin. Their nickname in the black culture is "blue. " Gan the nurse find the vein under the black skin to start the infusion without sticking him a repeated number of tim es ? Only recently have the health professionals undertaken the task to devise tools to a s s e s s and evaluate the level of physical and emotional responses of ethnic groups (Brinton 1972; Darity and Turner 1972; Roach 1972; P iero 1974; Snow 1974; Fabrega 1973; Branch and Paxton 1976). Because the black client fears subjection to a system that imm ediately places him in an inferior role, the em ergency room has become one of his solutions to the problem. He feels that he can get quick service and avoid any lengthy discourse with the whites (Niemark 1976, pp. 17*25). The other solu tion is to maintain his health through the black cultural health system until his health status has deteriorated to the point of his death or a term inal state. It is a documented fact that the health status of the black community is getting w orse while the health status of whites im proves, as given by statistics . 12 in studies that have been done (Killens 1963; Berber F erris 1969; Poindexter 1973; Cerami 1974). of poor health may be self-inflicted. 1965; M eissner 1966; It can be stated that this state The health facilities which blacks could theoretically take advantage of appear to be accessib le, adequately staffed, and, in many c a se s, free of cost. The fact that they are not utilized by the black community is also a matter of record. Blacks will continue to depend m ost heavily upon their own cultural health system as long as they view the official health system as dehumanizing and demeaning and the whites who pre dominate that system as their enem ies (Blackwell 1975, p. 273). If there are types of character traits in the black race that sustain the black cultural health system that are not encountered in the white race, it is because the white is not forced to endure the assaults and hatred that a black grows up and copes with on a daily basis. Grier (1968, p. 24) explains how those daily fears and anger and the complex behavior that occurs in the black culture are generated. He states, "To be ’colored’ has meant far m ore than riding in the back of the bus. . . . there is great m isery in being the la st hired, the first fired and relegated to decaying sections of town, but there is enduring grief in being made to feel inferior. ’’ The black cultural rules have developed out of those inferior feelings. They have become a dictating force in the black community. written, and therefore are not available to whites. The rules are not CHAPTER 3 RESEARCH TECHNIQUES The purpose of the research was threefold. The fir st part consisted of learning the black rules of behavior. The second part consisted of learning how these rules were applied in interpreting sickness within the culture. The third part of the research focused on the manner in which the first two aspects affected the black’s viewpoint of the official health delivery system . Since these rules are not written down* it meant that they had to be learned through communicating with Blacks and observing their behavior. Spradley and McCurdy’s (1972) model for an ethnographic study was used as the guideline for constructing the method of investigation. They sug gest that the investigator listen , observe, and participate in order to learn the ways in which people define their experiences. This was the only way in which I could comfortably carry out the investigation and gain the information that is presented in the study. I shall explain this statement in further detail in the following portion of the study. The area in which the research was to be conducted had to be pre dominantly black in ratio to the population in that area. The area also had to be sm all enough to allow investigation by one person. The Sol Verde neighbor hood (a fictitious name) was found to be such an area to m eet the criteria. 13 14 Field work was carried out during a period of one year—May, 1975 through May, 1976. I w ill discuss at this point how the techniques of my research were operationalized. I knew at the onset of defining my method of investigation that I would not be readily accepted in a black low -socioeconom ic community. By virtue of my education, life style, speech, and social affiliations, I am referred to by the black low -socioeconom ic c la ss as an "Oreo" [brown on the outside—white on the inside] nigger the white man bought—an uncle tom, a handkerchief head, or a house nigger. (All are derogatory term s and are meant to identify a black who has disowned the black culture and taken on m annerism s of the white r a c e . ) This type of black is more apt to be verbally or physically abused by other black than a white. The fir st step to be taken in setting up the investigation in the area was to make contact with the directors of the health clinics in the neighborhood. I felt this approach would be in my best interest. I was afraid that any precipi tate actions on my part might result in verbal or physical abuse upon my person. One of the two directors of health clin ics in the area assigned a m ale community worker as my guide around the neighborhood. I was introduced by him to the residents who appeared more receptive to my presence. This method of approaching the black community covered a period of six months. It took this period of tim e for the residents to display an attitude of trust and acceptance of my presence in the neighborhood. There were no insurmountable 15 problems in communicating with the group. My early childhood years had been . spent in a poor black community where the communication patterns were sim i lar to those of the blacks in the research group. It was now a case of status inequality that interfered With my ability to communicate freely with the group. This handicap was overcome by modifying my speech and behavior to a level that m ost conformed to those, of the community. Selection of Informants Random sampling w as not attempted. F irst , I had to gain entrance to the homes in the neighborhood. This was done by contacting the directors of the health clin ics in the area. They would then recommend certain clients in the clin ics and in the community that they felt would be m ost receptive and le s s hostile to my presence and questions. Secondly, I had to consciously _x attempt to establish a rapport or some type of relationship with these people on their own term s. The p rocess was a slow one. As trust was established between me and a few of the contacts, they would tell friends and neighbors what I was doing or had been doing in their homes for one or two hours. As time went on, I would arrive at an informant’s home to find a number of other people from the neighborhood who had heard of what I was doing. The fifty informants mentioned in this th esis were finally chosen on the basis of their w illingness to share information versus the one hundred or so other contacts who were participants in group gatherings or "just set in" to listen to what was being discussed. The names of the informants 16 have been changed to protect their identity. D irect quotations are from notes and tape recordings. Description of the Population The fifty informants who participated in the study had two things in common; they were all black and all were residents of the Sol Verde neighbor hood. None had lived in the area le s s than two years. Ten m em bers of the group had lived in the area for over 39 years. The highest income reported in the group was $6,000 per year on a combined salary basis. The combination consisted of husband/wife, husband/ son or daughter, or w ife / and one or both of son and daughter. A ll of the fifty informants were from states other than the one in which they now resided. Thirty m em bers of the group were "born and raised '1 in Texas, Twenty informants were from various southern or m id-western states. Five of the fifty informants were m ale. The ages of the informants ranged from 20 to 78 years. The neighborhood in which the informants resided is often referred to by whites and m iddle- and upper-class blacks as "nigger town" or "shanty tow n." The first label denotes the predominantly black population in the area. The second label rather adequately describes the state of m ost of the homes in the area that border the main transportation avenues of the neighborhood. 17 Data Collection Those people who were interviewed were the ones who p ossessed extensive knowledge about the cultural health system and had at one tim e been exposed to the official health system . Data were collected by means of interviews and a structured data collection sheet (see Appendix B). P ersons interviewed were seen at least three tim es. Each interview was recorded on tape. Data were gathered during each interview. . Because of the long dialogue or monologue that fol lowed each question on the data collection sheet, rarely was an informant able to answer a ll the questions in a two-hour period. Again, this is an example of the exaggerated speech pattern among Blacks. Every situation and anecdote has to be explained in great detail, accompanied by significant gestures and recollections. Handwritten notations were used to capture the essence of this extra information. The informants Were fascinated with the tape recorder. None had ever heard his voice "coming from a contraption lack d at." There was great fear that the tapes might be made accessib le to persons and agencies that many of the blacks depended upon to m eet their financial needs. After I gave a demonstration of erasing those parts of the tapes that caused the group or the individual informant discom fort and a prom ise to insure confidentiality by changing the name, the informants became very free in expressing their beliefs and opinions about sickness and the health system s. The Investigator as a Participant Observer The cold, brutal fact that I would not be accepted into the neighborhood was soon made clear to m e. On the fir st day that I engaged in a house to house campaign to collect data, the occupants were either reluctant to open the door, or were very impolite and suspicious. I was asked by many of the contacts, in a hostile and threatening manner, "What kinna questions you wanta a sk ?" Or, "I ain’t got no time to answer no questions. I’m cooking" [or washing the floor]. One lady told me that she was cleaning and had no place for me to sit down in the house. I became totally aware of the basis of their refusal to admit me to their homes during my lunch break. Hot, tired, and th irsty, I stopped into a neighborhood cafe, .the only one of three that was open. It became obvious that the black w aitress chose to ignore m e. Other blacks were receiving s e r v ic e , although they entered after I had been seated for ten minutes or so. I felt uncomfortable whenever I encountered a hostile stare. A group of young adults began to d iscuss an incident that had occurred to two of them the previous night at the county hospital. Much profanity and anger was expressed against the nurses and doctors and the extreme length of time that it had taken to be seen by the doctor. The anger was then directed toward me when one of the young ladies in the group called the w aitress by name and said You better wait on M iss rich bitch over there so she can be on her way. I know she jist slumming. Coming round here asking people to talk to her. Hurry up and wait on her so she can git back to her kind. ' 19 When I related the incident to the director of one of the c lin ic s , he tactfully informed me that my attire , speech, and car readily set me apart from the group. He further suggested that I correct those faults as w ell as attempt to establish a close relationship with one of the highly-respected healers or spiritualists in the neighborhood. The benefits of this relationship was stated by him in these term s: "If one of them is for you [approves of me] it ’s more than the world against you. ” On the basis of this advice, I began leaving my car at least some dis tance from the area. My daily attire consisted of le v is , tennis shoes, and a wide-brim straw hat. My speech followed the "down h om e," or hip speech pat tern of the inhabitants of the area. I began visiting the clin ics on a daily basis. My technique in those settings consisted of finding a vacant spot, sitting or standing, and striking up a conversation with the person who filled the adjacent spot. I received much information about that person's interpretation of his sickness and the type of treatments that he was receiving m edicinally from the doctor and any treatm ents that he knew of or had used or presently was using that had not been prescribed by the doctor. It was a foregone conclusion that 1 would share, to a point, any rem e dies that I had heard Of from my family. was a registered nurse. I never shared the information that I Many of the older clients who decided that I was "too young" to know about many of the rem edies they shared with m e , began to invite me to their homes so they could show me Or tell me m ore about rem edies or sick n esses that the doctors in the clin ics did not seem to be fam iliar with. 20 The initial v isits centered around the host or h ostess going out of their way to prepare food or drink and make a conscious effort to tidy the house. My participation in these v isits usually required a w ell-placed reply to the monologue that followed. Those replies were generally, "Well, I’ll say"; "I do declare"; or, "When I was very sm all, I seem to recall something or other like that. " The m iddle-aged and elderly informants derived great satisfaction from teaching me about sickness and rem edies and how to survive. A. stated You know eye lack to teach young folk sews they always know how to carry them selves in this world. The white man owns everything and the onliest way black folk gon git any of it is to know how to carry yo’self. Now those people over at the county ask m e all kinds of questions about how much of the medicine that the doctor give did I take. Or they wants to know if yo making any money outside of what yo gits on them m easly checks. I tell them jist what I want them to know and no mor. White folks learn too much bout yo bizznesS, yo leaving yo’self wide open for trouble. He may pretend to be yo best friend, but if he find out yo during better than he during or yo ain’t during what he tells yo to do , he gon git even. M. substantiated this opinion by telling the group how she "was gotten even with" at one of the clin ics. as they were scheduled. of her better d resses. She had always gone to keep her appointments On this particular day she appeared, dressed in one The white nurse who had always been pleasant in the past, remarked, "What are you doing all dressed up? Are you getting m ore money and not telling us for fear you'll have to pay ? M. replied Ain’t none of yo Cr*D business what I got, cow! Now when I go she . acts like I got sh-t on me and she don’t want to get any on her clean white d ress. I set there from eight in the morning ’til five in the evening before they’ll see m e. 21 While I was gathering data, my constant companion was a man known in the neighborhood as "that wino, wine-head and sw ill barrel'1 but "a good ole boy gone wrong after he and his crazy wife le t them doctors take his lun g." He had intervened in my behalf one morning after one of the men who hung around the liquor store decided to enlighten me as to what, how, and when I could cure his biological illn ess and the price he was willing to pay for the service. E. pointed out to the gang that I was a "lady" and had just been insulted by a "dog. " H e, on the spot, appointed him self as my guardian and guide about the neighborhood until he became too ill to leave his home. As I became more acquainted in the area and trusted by the "leaders," I asked and received the name and address of one of the spiritualists who was w ell known in the city. She has lectured in m edical schools and had been the subject of individual student papers, I visited her a number of tim es during the year. I participated in groups that m et for prayer m eetings in different hom es. The group leaders were known for their healing powers through laying oh of hands. From these m eetings I received a typewritten page of scriptures to read in Specified instants (see Appendix D ). The person who received the blessings became highly emotional and tearful, but appeared comforted later. Although the practices and many of the beliefs of the group were out side my realm of comprehension much of the tim e, I felt warm and comfortable. There is a feeling that invaded my total being when surrounded by a totally black culture that I have felt in no other culture. Their id ea s, opinions, and 22 the manner in which they shared their felt trials and tribulations made one feel proud to be a part of the experience. I felt, in the lingo of the black culture, "lack high hog at the trough" or "happy as a pig wallowing in s lo p ," Limitations of the Study No intent has been made to speak for 22 m illion blacks in the United States, This investigation covers the comments of only 50 or so lowsocioeconomic blacks in a lim ited geographical area. Statements and feelings have been presented at face value. No effort has been made to screen or validate those statements. CHAPTER 4 PRESENTATION OF FINDINGS In this chapter, I w ill discuss what I learned from my informants about: I. H. Behavior Toward Whites in General a. A ssessm en t of .the White b. Responses to Whites c. Resolutions to Their Feelings Toward Whites The Black Cultural Health System s a. H ealers b. Spiritualists c. Home Rem edies , HI. Black Cultural Solutions to the Official Health Care System IV. Black Cultural Rules as They Apply to: a. Interpretation of the Causes of Illness b. Treatment of Illness Behavior Toward Whites in General A s soon as the black child is old enough to identify the differences between his skin color and that of the white ra ce, he is taught the dangers that 23 ■- difference in color means in sustaining his life or his self-esteem . 24 In later life , this indoctrination colors his perception of all his dealings with whites. A ssessm en t He has been taught to a s se s s the receptiveness of a white to his black presence in the classroom , on the street, in a. job situation, and endless other encounters. A set of rules has been devised and taught to govern the black’s response in practically every situation that requires contact with Whites. The rule of thumb to test the white’s level of acceptance or prejudice states Look at they face. If they gits that old sharp nose, pinched look to they face, a nigger is in trouble! They tries to look plumb threw you ! Jist lack you ain’t there. R esponses The black’s reaction to the white may be verbal or non-verbal, depending upon the degree of acceptance he receives from the white. Any white who deliberately insults a black lo se s any consideration of respect. The non-verbal response to the insult may be an aversion of the eyes or masking the facial expressions. This masking is referred to as "looking dumb" or "staring lack a stam ated calf in a thunderstorm ." The verbal response to the insult is an unintelligible mumble as a reply. The m ost subtle and le s s self-threatening approach is to converse with the white if it is unavoidable. If the white is persistent in his efforts to engage in an interaction with the black, the black w ill never extend the courtesy of 25 acknowledging the fact that the white has a name. Avoid calling the name at all c o s t! Blacks always acknowledge each other by name—a nickname or a title of some meaning, even if no more than "nigger, " Incidentally, it was found that the term "nigger" has uncountable connotations. It is used as a friendly greeting, an expression of lo v e, hate, anger, or hostility and is used frequently by blacks of all ages. The context of the usage is interpreted by the tone of v o ic e , facial, and physical gestures. An insult is not quickly forgotten or forgiven. The type of insult and the name of the person who insulted the black is told to other blacks with a great deal of emotion. The full expression of the emotions is revealed through a communica tion pattern that may be term ed exaggerated expression. This exaggeration is som etim es so great that whites become confused or unable to appreciate the communication for its content value. An example of this communication pat tern is conveyed in the following situation. In relating an insulting incident to another black, the initiator may remark Wliitey [honkey, ofay, cracker, the blue-eyed devil, Mr. Charlie or M iss Ann] come on with that off-the-w all stuff [talking down or using taboo names such as boy, girl, or girley to an adult black]. I had to go to page 39 in the rule book. A s has been previously stated, there Is no written rule book. That inherent response that has been taught to the black regarding such an incident alerts the listener to the seriousness of the m atter. When the speaker refers to "page 39," he is indicating that the behavior of the white was of a profoundly upsetting nature. An example of the reply to the insulting term may be 26 You talking to me ? I thought I heard yo say boy, and my name " i s —— — ‘ Or, You talking to m e , Honkey ? Or, I don’t see any sm all peoples in here that could be called a boy. Who yo calling a boy ? A more militant black would use more profanity during the dialogue. Serious threats may be intimated by the tone of the voice and various eye move ments. The words denote hostility. Physical movements increase as the speaker outlines what further verbal or physical abuse he intended to use if the white had not modified his behavior. The final resolution may have precipitated a trip to the penetentiary for "wiping out” (killing] or "tearing down" [seriously maiming] a white. Resolution A black is usually able to avoid the latter resolution by beclouding h is anger, fear, or hostility with humor. Under the guise of humor, negative statem ents, words of double meaning, subtle, insulting m annerism s or innu endos , his anger can be safely expressed against the white. Humor is used as a survival mechanism. Blacks recognize the disparity between their resolution of their hatred for the white and the white's resolution of their hatred for the black. Any resolution that the black fee ls is appropriate must be viewed by the white as 27 an innocuous one. If the white interprets the resolution as a threat, blacks anticipate a lo ss of those p rivileges that can only be extended to them through the good w ill of whites. Those p rivileges are many , but of greater importance than others is the privilege to expect and receive adequate and humanistic health care. The Cultural Health System It is known that there are such things as cultural health system s. The system s that have been studied vary greatly from the contemporary, official health system . A ll groups that have been studied have a health system that is unique in some aspects and sim ilar to others in some aspects. Preferences within any group determines, which aspect of their health system is utilized m ost often. The three m ost often utilized components of the black cultural health system in the study group were; 1. H ealers 2. Spiritualists 3. Home rem edies Medical system s include ideas of what constitutes illn ess and who ■ ' ' treats it and with what. Authors (Coe 1972; Bauwens 1974; Spradley 1975; . Branch and Paxton 1976; Brink 1976) have been able to delineate a method of choice or decision-making within health seeking groups. It is further noted that the choice or decision is made based upon cultural p ra ctices, availability, or accessib ility of avenues of cure. 28 Blacks are sim ilar to other poor ethnic groups in the respect of health dec is ion-making when the health problem exceeds the medicinal prow ess of the cultural health system . A ll three components—h ea lers, spiritualists, and home rem edies—of the black cultural health system may be operationalized for a particular illn ess. When all have failed to bring about a cure, the health seeker might initiate contact with the official health system . Definitions of the Black Cultural Health System There are vast numbers of healers within the black community. They are usually elder m em bers of the family or withm the kinship clan. Their p ractices, in addition to known home rem ed ies, include close-guarded personal rem edies and laying on of hands. Specific passages from the Bible are also included in their practice. Healers are rarely paid in coin for their serv ices. The remuneration is in the form of returning a favor. F resh vegetables, m ea ts, clothes, or personal serv ices are generally used as a token of appreciation. Spiritualists are those members of the group who p rofess to; endow-* ments of curing that are God-given gifts. This form of health care is usually sought for health problems that are felt to be created by an enem y, a lover, or ah envious neighbor. There is a segment of the population within the study group that denies any knowledge of those p ra ctices, namely hoodoo, voodoo, and witchcraft, that make one feel that a spiritualist m ust be consulted. Spiritualists are aware of the licensing laws and do not charge a fee for their serv ices but accept "donations." 29 The dealers believe that if they express a belief in the existence of the evil powers of witchcraft, voodoo, or hoodoo, they w ill become vulnerable to the effects of the practice. The thought that one may be suffering the effects of any of the three provokes excessive fear and anxiety, som etim es to the point of death. A spiritualist is the only avenue of cure for the person who has been "fixed." Emma, an informant, describes the effects in this graphic manner: Some of them folks that m ess around with fixing peoples can go back home to Looseyanna and git dem roots and hi-john-deconqa [a root commonly used in the practice of hoodoo] and have anybody they want to walking on they dam eyebrows. A doctor ain’t gon do yo no good either cause he can’t find out what's causing yo problem. My Papa had a ol’ girlfrien that got jea lous cause Papa kept coming back to Mama. She had Mama fixed. Mama took sick to death. The doctor couldn’t do nothin! When Mama died, we laid her out on a cooling board til the man bought the coffin. Little frogs started comin outer her skin and [from] between her leg s. I don't fool with that stuff or nobody that do [fOol around with it] so don’t ask me no questions. If yo ever thank you been fixed, git to a two-headed person [another name for a spiritualist] as quick as you can. The three terms-^-hoodoo, voodoo, and witchcraft—are defined as follows: Hoodoo: A practice that bases its effects upon the use of ro o ts, herbs, and specific disposition of the clothing, hair, fingernail clippings, and internal and external secretions of the victim . Voodoo [Obei]: Accomplished through the use of specific animal parts. Chicken feath ers, entrails , and blood are used in the ceremony. Animal blood and the blood of the victim are used to paint symbols on designated surfaces during certain phases of the 30 moon. The voodoo dolls are also used and adorned with pins, powders, and scraps of clothing of the victim . W itchcraft; D evil worship. A person with satanic powers is able to affect the victim . The desired effects can be accomplished without contact with the victim . Brews of roots, herbs, animal p arts, and.insects are combined with incantations and rituals. It is considered to be the m ost deadly.of the three practices. Home .remedies are those products that can be obtained without legal prescription. The specific remedy is determined by the interpretation of the sickness. These rem edies are well known and widely used in the black community. Black Cultural Solution to the Official Health System . Blacks have reached a solution to the official health system . The solution that has been reached is based on their interpretation of sickness and cultural rules. The solution conflicts with the philosophy of the staff that pro vides health care in the official system . The philosophy of the official health system has been perpetuated based on scientific data. The white staff of the health care system attempts to reach the black client and change his health habits through this scientific approach. Scientific rationale has no frame of reference in the low -socioeconom ic black culture. The cultural rule dictating the behavior of the black is applied before a decision is made about the sickness and how it w ill be treated. 31 Cultural Rules I shall explain how those rules are applied in the following two situa tions, In situation one, the doctor insisted that the black fem ale sign a surgical perm it for a panhysterectomy. He explained the procedure, the out com e, and the various advantages of the procedure to her in great detail, but in highly technical term s. The resident and I felt that he explained thoroughly, to our satisfaction on a graduate le v e l, why the surgery was necessary. After fifteen m inutes, the doctor sm iled, patted her hand, and instructed her to sign the perm it. The client refused. The doctor asked me to accompany him into the hallway. His frustration was manifested by shouting at m e, "What in hell else could I have told her? Can’t she see that she can’t continue to come to the clinic and the em ergency room every month for the same problem ? If she would sign that perm it, I could solve her problem once and for all. She can get over a thousand dollars worth of care here and it won’t co st her a penny. ” I was reluctant, but I felt that I should attempt to explain the cultural rule regarding surgery. The rule is: Never let the doctors cut anything outer you or offer you. God put you in this world as a whole person. Be sure that you leave here and go back to him the same way. Black women are obsessed with the fear that a hysterectom y will leave the woman as "jist a empty shell down th e r e ." She w ill be unable to satisfy her husband’s sexual needs and therefore invite the possibility of losing him to another woman. 32 The doctor's response to my explanation w as, "Rot! Surely In this enlightened age your people don’t believe that. Those are old w ife’s tales. ’’ So they may be, but the fear invoked by those tales are very real. There are black women who believe that removal of the "womb" before "change of life" w ill cause menstruation to occur from the nasal passages each month with sim ilar regularity. In situation two, a white nurse told me she was quite puzzled about her black clien t’s behavior. It seem ed that he refused to le t her or the student nurses give him a bed bath. He was too ill to bathe him self . After conversing with her and the students, I approached the patient and offered my assistance. He readily accepted my help and attempted to pay me a dollar for a "good bath." He stated, gratefully I don’t know what I would have done. M iss, if you hadn’t come along this morning. I was gitting in bad shape. I ain’t had a bath since I com e in here two weeks ago. It was not the fault of the staff that he had not been bathed. They had offered to bathe him every morning and he had politely refused by saying, "No, thank you m a’a m ," to each offer. The rule governing his behavior is adhered to stringently by the elderly black m ale. He fears the moment when a white woman, nurse, or doctor, regardless of her age, may ask him to expose his "privates," even in the p rocess of giving him a bed bath. He fears that he may inadvertently make a movement or a gesture that she could interpret as seductive, suggestive, or disrespectful. Black men have .been severely punished and/or put to death in the past for m erely looking directly in the face of a white woman. The Reaction of Whites Let us now turn to ways in which the whites have attempted to deal with the recognized behavior of the black client. Many whites have expressed their belief that "poor, uneducated blacks need to be taken care of. They are like, children and don't know what is best for their own good. " Whites predict, when setting up a health program or c lin ic , that blacks w ill readily accept the staff and their ministrations as long as the service is free and they are teaching the blacks in the community a "better way" to m eet their health needs. It has now become obvious to the staff of health care facilities in pre dominantly black areas of the city that an educated guess originated in an isolated, academic setting is not applicable in a culture that differs drastically from Anglo norms. The staff has begun to ask questions such as: When m on ies, fa c ilitie s, doctors, and tramed personnel are available in adequate numbers to m eet the health needs of a community, why does the populace of the community ignore the availability of the facility and m ost of the prescriptions of the doctors Two clinics have been set up in the Sol Verde neighborhood (a fictitious name). Either clinic is within six blocks distance from the furthest boundary of the area. The attendance record of the blacks is poor. A census of the clients waiting to be seen by the doctors revealed no acute c a ses or even serious illn e sses. One informant stated 34 I only come cause my case worker tole me to. If I don't, she treat me like I'm a dog. They always act like they [whites] know mor bout what’s good for you than you do. Another informant states I'm old and sick all the time now. If I don't come over hyar, I might lo ss my checks and stamps. I have to come here to prove that I can’t work full-tim e no m or. This informant spends her tim e at the clinic harassing staff and other clien ts, even m e, to buy som e of the sundry item s she carries in a suitcase (pencils, napkins, sp ic e s , and p rayers). Emma, who lives across the street from the clin ic, has been diag nosed as hypertensive and suffered a debilitating stroke two years ago. She was taken to the county hospital at that tim e on the intervention of well-m eaning neighbors. She rem ains bitter to this day about the treatment she received at the hospital. She explained her reasons for not attending the clinic. She says I don't m ess with them doctors and I don't want them m essin ’ with me. I ain’t gonna go over there and wait to see no white man—I don't care what he suppose to know about my case. I know mor bout it than he do anyway. I was born in Januaarrie. Folks born then can see [predict, diagnose] what a ils them and cure it them self. If I can’t core it then it’s God’s w ill that I can’t be cored. Young mothers refuse to take their infants to the well-baby clinic. One young mother exp resses her preference to her grandmother’s style of keeping her infant w ell. She says There ain’t nothing bout babies that grandma don’t know. She know mor bout babies than all them jiv e -a ss nurses and doctors at the clinic or the horsepital. Why does the group feel that they are unable to communicate with the white personnel ? Why are certain m embers of the group hostile toward doctors and nurses who have never come in contact with them as patients or clients ? Would more black health professionals in the facilities help in eradicating the problem ? The latter question was answered in emphatic term s by the group. A summary of those answers is They [the whites] thank putting a black director or a black nurse over there or in they horsepitals w ill make the niggers see they is trying to help us. W ell, them niggers put on they little white uni form s and try to act jist like the white n u rses. They past right by yo or talk to yo w orse than the whites. If I’m gon have a black nurse or doctor, I want one that acts, talks, and knows they still black. They accuse the black doctors that are in private practice of being more money hungry than the white doctors and le s s caring in the bargain. This suspicious and rejective attitude toward the official health system has prevented blacks from accepting health care even when it is free. This attitude has sustained the black cultural health system . And that system precludes any contact with the white dominated health system until a realization is reached that the black system has failed to bring about a cure. White health professionals remain puzzled as to the m ost effective approach to use in m eeting the black client’s health needs. The puzzle will remain unsolved until whites become more adept in recognizing the differences between their approach to health and the black’s approach to health. Whites w ill have to recognize and understand the manner in which blacks communicate. 36 They w ill have to learn the black’s interpretation of sick ness and how it is treated* Generations of traditions cannot be changed by scientific truths. Interpretation of Sickness; Causes and Treatment The informants define optimum health as a state in which the body responds immediately and consistently and on demand. Snow determined that this state of health and functioning in her black group of study was ’’attained by proper maintenance of the body and its constituent p arts, requiring manipula tion of various bodily sy stem s, e .g . , the blood. Such manipulation employs constant attention to what goes into the body and what com es out (Snow 1971a, p. 54). Informants did not always know the name of the particular illn ess that created the " m iseries” [specific or generalized pain, or a feeling of being "down"], but they spoke as if knowledgeable about the cause of the illn ess. They emphasized the manner in which the sick one lived his past life. Inade quate covering of the body when one is young leads to multiple health problems when one begins to age. Cold air is considered to be one of the causative agents of many illn e sse s. Therefore, the greater the area of the body that is exposed, the greater the amount of air that enters the blood stream . The blood also picks up and throws off im purities. Edna, an informant, was always noted to be attired in an extreme amount of clothing after the birth of a baby. Her grandmother had cautioned that she was to prevent cold air from entering her body. 37 Louise, another informant, always wore a short decorative housecoat over her d r e s se s , silk Stockings , and a veil over her hats which covered her ears and cheeks. She was prone to give a lecture to me or rem ark on the attire of the young adults or teenagers in the area. Her pet subject was short d resses or m ini-skirts. You young girls don't know the m isery you bring on yourselves when you young. Y o'll running round half dressed trying to look cute. Yo better put some covering on yo chest, yo feet, and yo behin. A ll that air going up there bloats yo organs and yo bound to have female trouble for the r est of yo life. In addition to cold air as a cause of fem ale trouble , filth or im purities are picked up from parents, the environment, lo v e r s, and acquaintances and circulated by the blood stream to weak sites of the body. Emma, a healer for children as w ell as adults, explains that Babies are born with all that filth in they little system s from they mother and father. See how they breaks out in rashes ? W ell, all that filth has to be worked out of they system or you gon have a sick baby on yo hand. The treatment of choice was catnip tea three tim es a day and warm baths every morning. The "bowels" of the infant are kept open through the judicious use of glycerine suppositories or an enema. Fletcher's Castoria and a "drop or two" of castor oil was used if constipation was noted. No matter What the mother of the baby had been taught by the hospital staff regarding the care of the baby, the instructions given by grandmother, paternal or m aternal, or an elder in the kinship chain, superceded those instructions. The baby was wrapped warmly regardless of the clim atic conditions to encourage "sweating out" of the 38im purities. Young mothers who refused to follow the cultural beliefs in the care of her baby aroused anger and fear for the baby’s safety in the older group. I heard a group of eight elderly fem ales give their prescriptions for ; ' ' ", - ■ ” the care of babies and p re-sch oolers. A partial lis t of those prescriptions follows: 1. Care of the ’’m ole’’ [fontanel]: Bub the spot with castor oil every morning to keep it from falling. Use m ineral oil to eradicate cradle cap. 2. For the ”winds" [colic]: Caused from exposing the baby to ’’fresh” air or breath from an adult's mouth. The rule is , ’’Never blow your breath in a baby’s face or k iss the baby in the mouth. " Treatment: a pinch of baking soda in a teaspoon of water. A "few drops of pare goric” is available. Prevent the baby from breast feeding if the mother has ingested onions. If the mother has been emotionally upset, her milk w ill "curcle on the baby’s stomach” and cause colic. 3. The ’’grunts” [the baby makes grunting sounds]: Caused by a woman who is on her menstrual cycle cuddling or holding the baby. Prevent any woman in this shape from holding the baby. The baby should be placed on his abdomen across the knees of the mother or other respon sib le party or in his bed or crib until the condition is corrected. 4. ’’Misshaped head” [molding of the head as it p asses through the birth canal]: An adult lubricates her hands w ell with m ineral oil and applies gentle pressure to the affected area each morning for ten or fifteen minutes. Turn baby frequently to prevent deformity from becoming permanent. "Birth marks” [markings]: The cause of mongolian spots [greenishblue spots on buttocks, hands, or feet] is w ell understood. The b elief is that if a white baby is bom with the spots, there is "black blood" somewhere on the family tree. Emma snickers and s a y s , "That's when the white man has a nigger in the woodpile." Otherwise, markings are symbols of the physical and emotional state or states that the mother entered while carrying the baby. Charles has three distinct marks on his w rist shaped like sm all fish. Caused by his mother's craving for fish. Ardella has clubbed fingertips. Caused by her mother putting her hands to her face when frightened by a snake. Ruth has an area on the back of her head that hair will not grow to the length Of the rest of the hair on her head. Caused by her mother "making fun of another lady in the neighborhood who is 'baldheaded. ’ " Paul is so ugly because Ms mother read those horror funny books and saw horror m ovies. Ann has a lazy husband who will not work and spends m ost of his tim e in bed even when awake. Caused by his mother who "didn’t do nothing but wallow in the bed all day long while she was carrying h im ." W illie has a "high behind" [protruding buttocks] because his mother often got angry "and told people to k iss her behaind." Henry sucks his thumb. He has sucked it from 40 infancy. He is now 33 years of age. Caused by Ms mother engaging in cunnilingus with his father when her abdomen became too huge to allow for conventional intercourse. There is an explanation for every abnormality in physical or emotional functioning, whether it is interpreted to be of natural causes or a punishment from God. Normal eMldhood ailments are treated at home or by one of the "sitters. " Emma is a trusted sitter who is often consulted by parents when their child's illn ess does not respond to all of the rem edies that they have tried. - She explains her ability to diagnose and treat as coming from God. She was born in January and believes that anyone born in that month has the power to do what she does. Her favorite ingredients of cure are non-prescriptive. "Collbil" [coal oil] is given (ten drops on a teaspoon of sugar) for w orm s, cold in the stomach (diagnosed from the presence of stomach cramps) and severe cold symptoms. Rock candy, steeped in alcohol, is used to "break up" congestion of a cold or chest problem s. Turpentine is also used as an oral agent or as an ingredient in salves or ointments. The ointments are made from meat tallow, mustard, baking soda, or specified meat drippings, e.g . , goose grease. Vicks salve is used in abundance. If the child appears to be acutely ill and all rem edies have failed, the parent is encouraged to take the child to the hospital. Unknown to the nurses 41 and doctor, the healer many tim es accompanies the parents and p asses judg ment on the doctor’s approach to the problem, his decision to the problem, and the prescriptions that he renders. If he is unable to suggest something other than what the healer has already been doing anout the ca se, the parents may elect not to return for further treatments for the child. A case in point is the young patient who was seen by a doctor because of his vomiting and high fever. The doctor recommended "lots of fluids and baby aspirin" at specified intervals. The child was admitted to the pediatric ward two days later with his body area blistered, as if burned. The grandmother had attempted to lower his tempera ture by wrapping his body, covered with petroleum jelly, baking soda, and turpentine, in a tightly bound sheet. Emma believes that rubbing "colloil" from the forehead to the navel and then across the chest from armpit to armpit in the sign of the cross w ill cure a cold that "stops up the nose and settles in the c h e s t." Julie believes that When these young mothers start during right when they carrying these babies , there wouldn’t be so much sickness when they and these children gits older. They [the mothers] are up out of the bed too soon. They should lie in for six weeks after they birth a baby before they even sticks they head out the door. They cain’t have anything to do with they husbands [intercourse] for three months. They go up and down stairs. Go to dances and act lack they ain’t go no sense. She has a mental lis t of dos and don’ts for pregnant women. The lis t includes such things as what to eat and when to eat it. A ctivities that the expectant mother can engage in do not include reaching above her head, even to hang 42 laundry. This activity w ill cause the cord to tangle and choke the fetus. When the mother has given birth, she should immediately bound her abdomen with a girdle or any m aterial that w ill give the sam e results to prevent air from invading the cavity because "she ain't nothin but a empty hole up th e r ." She should not touch foodstuffs that others in the house may be forced to eat. Milk w ill curdle in the carton if she touches it. She is seen as unclean and rem ains in this state for three months, at least, after the delivery of the baby. Interpretation of illn esses in the adult population is grounded in the past history of his childhood. Charles described his illn ess in detail. He has been diagnosed at the clinic as an arthritic (mild) and an asthmatic. He states I jist let these doctors say anythin they wants to about my trouble, but I know what caused it. When I was a kid, I loved to eat black walnuts. My Mama had a hard time keeping me away from them trees. W ell, them nuts is got a whole lot of grease in 'em. That grease got in my lungs and started giving me dispepsey [a spitting up of watery mucus]. After while , I couldn't spit it all up and it got in my lungs and give me the tizzie. Now I don had this all my life, and the doctor tries to tell m e that it's caused by somus else. When questioned about the treatment, he admitted that he only took the "pill that the doctor give me when I can't seem to get no r e lie f ." Before he takes the pill he wears copper bracelets and rubs his chest with Vicks or an ointment that he makes from tallow drippings, turpentine, or coal oil. Clothes are then spread over the chest. Hot flannel The only thing that "keeps the tizzie from gittin the best of me is c hawin terbacco. It keeps me spitting up all that stuff. " He accuses the doctors of being disinterested when he attempts to impart to them what makes him feel better. He becomes indignant and states 43 I come from the part of the country where we didn’t know what a doctor was. I’m an uneducated man, but I’m still living and I’m an old man. How do them doctors figure I got thru [lived]. They sure wasn’t round to help m e. So now I don’t try to tell them any thin. I jist keep on during what I been during for nigh on to 70 years. I jist come over here [to the clinic] to talk to the people over here. The doctors can’t do nothin for me. They don Showed me that. A knowledge of virus or m icroorganism is m issin g in the group. Causation of an illn ess has its roots in the manner in which a person was born, has lived or is still living. Etha is in the terminal stage of cervical cancer. There is no sympathy expressed by the group for her. Of the 30 or so people in the informant group that knew h er, 20 agreed that the cancer was due to the immoral sexual life style Etha had enjoyed during her young adulthood and m iddle-aged years. The consensus was verbalized by Edna: She [Etha] done laid around with ever Tom, Dick, and Harry. Cancer ain’t caused from nothin but not being clean with your self. A woman’s got to douche. You can’t jist git up and shake yo d ress tail. This group became offended and angry when I asked if one of them would take me to Etha’s home and introduce m e. Their anger was expressed in no uncertain term s: You’se a decent upstanding woman. Yo ain’t got no business going over there. There ain't nothing she [Etha] can tell yo that yo ought to know. Anyways, that ole nigger she got'll be trying to hit on yo [talk sweet to or proposition]. She can't make no money fur 'em now. He jist looking fur a young fool to replace her. N eedless to say, I avoided that house for the duration of my stay in the area. It was upsetting to m e to hear Etha referred to as "that old nasty dirty thing. .44 Can’t do nothin but lay up there and stin k ." Since it was not m y intention to reveal my status as a health professional, I did not correct their erroneous belief about the cause of cancer. Leroy agreed to talk to me after he became convinced through his interrogations that I had some knowledge and awareness of the "teachings of sweet Jesus Christ” about his enlarged and painful prostate gland. He told me that his condition was punishment from God that he had brought upon him self. He had been a young, headstrong "ruegaeing [pronounced rue-gay-ing] fool" [a person who likes and pursues an immoral life style]. He had . . . no respect for anybody but my Mama. I used women lack yo use a mop. Now yo know that ever time a man goes to bed with a woman, he lo se one drop of blood when the feeling gits on ’em [at the point of ejaculation]. I guess I done strained m yself over the years and this pain is jist God’s way of letting me know he ain’t forgiven me for my sin s. Lea is 26 years old, the mother of six sm all children. Most of her teeth are m issing. She talks with her hand covering her mouth. The lo ss of her teeth occurred . . . with ever baby I had I got toothaches. I always had a mouth full of holes [cavities]. The doctors over at the county wanted to put me in the horsepital and put m e to sleep and pull ’em all. But I didn’t have nobody to watch my kids. My Mama lo st all her teeth or had Papa pull ’em fore she was 30. I guess I’ll be jist lack her. When I ain’t got no m or, I'll jist grind my food up before I eat i t . " In the case of Leroy and Lea, their existing condition that would lend itse lf to correction has been accepted as status quo. Other conditions such as seasonal physiological impurities are treated in the same manner. These 45 conditions center around the purging or cleansing routines that are adhered to in the community. These procedures are historically based (Postel 1951, p. 59). They are explained thoroughly by an earlier investigation in a black community (Snow 1971a, pp. 64-65). As the seasons of the year change, so do the humoral factors in the blood and the physiological system s change. laxatives are required to return the system s to normal functioning. If the seasonal rituals are not adhered to, one can suffer dire consequences. is one of the ones who neglected to carry out the seasonal ritual. Strong Mabel She has been detained on psychiatric units and hospitals over the past five years. Her sis te r , Mae, believes that Mabel let her system git all clogged up and it m esses with her head. When she starts go in off, can't nobody control her. She wanders round like a lo st soul. The m edicines that the doctors give her in the horsepital only keep her system plugged up. I give her a big dose of black draught last tim e she come home. Yo can see she is pretty quiet. She jist goes across the street a lot. But she don't carry that dam doll talking bout it being her baby, This siste r is 48 years old. Cleo is known in the neighborhood as "a little tetched in the head." She believes that her problems—forgetfulness, talking to h erself, and insomnia—are caused by the treatm ents, mental and physical, that she received from white doctors. They keep telling me that my pain in my arm from the car accident is a ll in my head. My g—d head ain't got nothing to do with it. They lied on the form that asked if m y pain prevented me from working. They wrote no. They jist didn't want to give m e anything cause I was Black. I been going to Mother B. and she has done 46 more for me than any of those doctors. But I still can’t get no help to eat and pay my bills cause the doctors won’t declare me disabled. She is ingesting certain powders mixed with her food on the instruction of the spiritualist. Certain powders rubbed on her body affords her a period of calm each day. The elderly informants talked about "change of life" [menopause] as if it was a dreaded disease that all fem ales would be afflicted with and afraid of. The fear com es from the possibility of "gitting caught" [getting: pregnant]. They believe that the condition "m esses up yo mind. ’’ They recited endless ca ses in which acquaintances or family m embers had "gone stark raving mad. " All this happens because the woman has "thrown babies" [intentional abortions] when she was younger, or w orries because she interprets change of life as rendering her role in the household as "null land void. ” The emotional problems can be pre vented by keeping the system flushed out [drinking plenty of water and taking blood-building tonics. Lydia Pinkham is the tonic of choice]. They also recom mend plenty of exercise or engaging in hobbies such as sewing and quilting. One informant suggested that acquiring a young lover would settle all the problems a woman in the change would experience. The manner in which this group interprets their illn esses will deter mine whether they accept or reject the official health system . Emma, a hernia p leg ic, confined to a wheelchair from the results of stroke states that the doctors who diagnosed her condition as a stroke were wrong. ' . : 47 I was standing looking out my window one morning and that's the la st thing I remember til I woke up in the horsepital. I bit and kicked the nurses when they got sm art with me. Cause I knew I didn't have any business being in no horsepital. She points to her disabled side and says What you see here is the leavings [results] of the beating my Mama and Papa give me when I was a girl of 19. They beat me with a lid poker from the ole stove in the kitchen. It jis t didn't catch up [affect] with me til I got ole. The doctors recommended a diet for her which she refuses to acknowledge. I was forced to carry a bottle of maalox in my car when I visited her because I felt to refuse her food offerings would have been taken as an insult. Everything was highly spiced or contained liberal portions of fats and o ils. Another ethnic health provider was Mother B, a spiritualist. Members of the group were known to be followers of her teachings. I decided to seek an audience with her to gain an understanding of this component of the black health System. The day I called for an appointment with Mother B. , the party who answered insisted that I explain to her what I wanted to see Mother B. about and who had recommended me. I was accompanied to Mother B. *s home by Aretha J. , who had been a regular visitor to Mother B. 's home. There were no item s in her consulting room that could be termed out of the ordinary or other equipment that is usually depicted by the unaware as part of the consulting routine. After the fir st v isit, I returned a number of tim es by m yself. During and after each v isit, I felt as if all ca res, s tr e s se s , and w orries had evaporated from my consciousness. I became enthralled with 48 her teachings, which were religiously oriented, but realistic. motto focused on the black’s survival in a stressfu l society. She taught a There was no elem ent of the occult or secretiveness to her actions. Her motto was, "The blacks are not supposed to su ffe r., The Bible has all the information that a black needs to overcome poverty, hate, and sickness. " I had tried to cope with a nagging pain in the right sid e of my head, neck, and arm. I never mentioned this pain to Mother B. One morning as we were talking, she rose from her seat on the bed, crossed the room where I was seated and began to m assage my scalp with a tremendous amount of p res sure. She then struck my arm a sharp blow above the elbow and followed with a m assage of the arm. I have had no further pain. I might mention that I had experienced this condition on a recurring basis since 1967. I had spent one year in very extensive therapy under a highly recognized orthopedic sp ecialist, but the pain had always reoccurred. Mother B. not only cures through m assages, but she also uses h erb s, sp ices, and powders. Her use of them is based on her interpretation of the sickness. It is evident by the findings presented here that the black cultural health system is as complex and specific as the official health system . of all ages are participants in it. Blacks The informants feel that it does not matter whether you are young or old when the black health system is operationalized. There is a stated preference within the group for certain aspects of the system . ■ 49 Table 1 num erically denotes by age the preference for the three components of the black cultural health system . So we see that the black client’s interpretation of sick ness is based on the causative agents or elem ents in his environment: air, contaminants, or filth. The types of sick n esses are the outcome of the exposure to a particular element. The exposure occurs externally, but affects the blood stream and is carried to the weakest area of the body, e .g . , a sore throat is the result of the body being exposed to cold or damp weather, but only the throat was affected because it was the weakest area of that person's body. Since the blood is seen as the system that has to be manipulated to insure optimum health, it must be thinned in the summer with laxatives and thickened in the winter with laxatives. conjunction with the laxatives. Certain types of foods are also used in Chittlins, pork, and fatback are taboo foods in the summer. Vegetables, especially greens, lamb, fish , and beef are summer foods. One suffers "m iseries" [generalized feelings of poor health] due to old age, poor health habits in the earlier y e a r s , or neglect of the health rituals that are seasonal. The decision as to how the "m iseries" will be interpreted and treated depends upon the cultural rule that applies to the cause of the sickness. 50 Table 1. A. tabulation of preferences of specific components of the black cultural health system according to age of informants. Age Bracket Number Interviewed Home Remedies Healers Spiritualists 20 - 30 7 5 2 0 30 - 40 16 10 4 2 40 - 50 5 2 2 1 50 - 60* 9 9 9 9 13 13 13 13 N = 50 N = 39 N = 30 N = 25 60 - above - *The older the informant, the higher the preference for all components of the black cultural health system . The older informants had discovered various elem ents of each of the components in the black health system that were spe cific for certain illn e sse s. They did not hesitate to use any one or all of the components of the system when necessary. CHAPTER 5 THE BLACK VIEWPOINT OF THE O f FICIAL HEALTH CARE SYSTEM to this chapter I w ill discuss black viewpoints of the official health care system . On the assumption that one has to be a participating party in an incident before one can give a perceptive evaluation of it, only those informants . who had received some form of treatment in the official health system were interviewed. However, I decided to include the Views of other blacks who were onlookers and m erely gravitated to a home as a form al interview was in p rogress. Many of them had surprisingly hostile views toward a system and its staff that they had never been exposed to. Their decisions as to whether i they ever intended to seek care in that system or not were based on reports that the informants and others had given them regarding their experiences— positive or negative. It was not surprising that m ost of the reports dealt with the negative incidents that clients remembered. The white nurse or doctor who "sat down and talked" to a black client like they were "human beings" received compli ments and a desire on the part of the client "to do everything he or she asked me to do. " The highest compliment was, "he [or she] is alright for a white person. They don’t seem to care whether yo black, blue, or purple. type of compliment was rarely heard. 51 This 52 Blacks are oriented to two types of approaches from w h ites, namely acceptance or rejection. Blacks readily sense whether the white is comfortable or uncomfortable with his black presence. The course of action taken by the white in the first instance is a friendly greeting, the sam e as if greeting another white. M the course of the conversation, if one follows the greeting, the white te lls no ethnic jokes. His everyday a ctiv ities, feelin gs, fe a r s , or opinions are shared on an equal basis with the black. The white does not appear uncomfortable when found in the company of a black by another white. He w ill readily and spontaneously greet the black wherever the m eeting takes place. If the white talks to the black in the classroom and ignores him in the cafe teria 20 minutes la ter, I and other blacks w ill draw the conclusion that "whitey ain’t sh™t” [he is insincere or ashamed of his relationship with a black in the presence of other w hites. ] if the white is uncomfortable with the presence of the black but has seen other whites talking to the black, he w ill invariably open his mouth and ’’put his foot in it" or "sh-t and fall in it" as we blacks say. His opening state ment usually sounds Something like, "I had a black frien d ," or "There were some blacks who used to live in my neighborhood. ” How many blacks open a conversation with a white by saying, "I had a white friend" ? If the black seem s to be m iddle-class in d ress, speech, or m aterial objects, the white will ask, "What does your husband/wife do?" or "Where does your husband/wife work?" If the answer denotes a high-salaried position, the black is forgiven by the white with the statement, "Well, you certainly deserve the best. You have 53 worked hard enough. " Whites interpret the information they receive from blacks from a white cultural frame of reference. The manner in which the white then utilizes that information can be harmful to the black. So blacks do not reveal information to whites that may jeopardize his welfare or self-esteem . Blacks fear being open and straightforward with a white who has power over the black's survival, be it financial or health. Many feelings and fears or anger can only be satisfactorily expressed through curse words, idiom s, and even humor by the black. It is w ell known by blacks that whites do not com municate in the same manner. Our way w ill be misunderstood and create hard feelings in the white. An example is the term M—F'er. The term as it is used by blacks can be used in any situation to denote an opinion about what is going on. Examples of its use are: "Ain't that a m—f ?” ["Ain't that som ething," or, "Have you ever seen anything like it?"]; "Why that m—f" [same as son -of-a-]; "Say, m--f" [a greeting. May be hostile or friendly, depending upon the circumstance]; "This m—f is . . . " [may be a person or an inanimate object]. A black client informed the doctor, "If I don't git this m—f off [referring to a cast that enclosed his le g ), I'm gon be flipping lack yesterday!" [If the cast isn't removed imm ediately, I'll lose my mind . . . now!]. It is a highly prized compliment for a black woman to be referred to by a black male as a "fine bitch. " Could he express his admiration of a white woman in the same term s ? The word is worn as jewelry around the neck or as emblems on tee-sh irts by the younger black woman. If a white attempts to use these words to im press the black without first having passed the test 54 [observations and opinions that blacks use to ascertain that the white "is alright" or that the black knows where the white’s "head is"], he has erred in j his judgment. . The black client’s viewpoint of the system and the staff derives from these errors in judgment that are so often made by the white professionals— individually and collectively. Martha, an informant, feels that the white doctor in the clinic she attends at the county should not attempt to joke with her as if he were another black. He obviously does not understand that over^familiarity of a white man with a black woman is unacceptable behavior. He always joking about the fact that I been pregnant twice in one year. He says things lack, "That young buck of a husband yo married to only has to hang his pants on the foot of the bed and yo knocked up agin. Why don’t yo let us tie that thing up ? How yo gon to take care of all these kids. Yo on the county now. The taxpayers are gettin awful mad at folks lack yo. " Martha says that she and her husband had decided to have two more children (a total of four) while they are young, and she is to have a tubal ligation after the birth of the la st child. She is so bitter about the treatment she is receiving now that she states I was going to let the doctors do it at county, but now I’ll borrow money from a finance company and go to a paying hospital to git it done. White people sure treat yo bad when yo on charity. They want yo to beg for ever little thing they do for yo. Rita, a young mother of two children, refuses to consult a doctor about her recurring "stomach pains. " She becomes angry and tearful when relating the repetitiveness of her treatment at the clinics and the hospital. 55 ■ The doctors don’t even bother to give m e a good examination. They just read my records and give me the same bottle of p ills. She has five such bottles in a d resser drawer. The only touching they do on m e is when the nurse takes my blood pressure. They git paid for giving Black people the shaft. Joe, who is 32 and the son of a m inister, feels that the only way to be treated like a "human being" around doctors and nurses is to be militant and make violent threats. He says this approach serves to make 'em scared about what I might do to one of them if they don't hurry up and get me out of there. A ll of the informants who seek care at the available clin ics and the hospital expressed anger about the length of tim e they have to wait for examina tions or prescriptions. Many feel that they cannot take a full day from work and their fa m ilies, especially if the children are sm all, to wait in the waiting areas without drink or nourishment. Most of the clients do not know where the machines are located on the p rem ises that offer a respite from hunger and thirst, and many cannot afford the price that it takes to operate the machines. Aretha sums up the viewpoints with her poignant monologue on places that are set up to "help the peoples" that cannot help them selves. She States, in part They come in here and start what is supposed to be something new that's gonna help a ll us poor folks to get the help we need when we sick. Pretty soon we find out ain't nothing changed. They [clinics, hospitals] are still run by whites who thank they know what's good for us. Why don't they ask us fir st, eh? They don't even know how to treat us lack we human beins. B elieve me yo there is something to the ole sayin' if you white „ yo right. If you brown, stick aroun. - ' 56 If yo black, git back and stay back. The only way to git thru this life is to be light and dam near white , if yo a nigger [meaning pass for white]. Arthur feels that whites m anifest their beliefs that blacks are inferior. He says From the minute you enter the door, their [whites] attitude changes. They can be talking to a white person ahead of you in a nice, pleasant voice, but when you walk up, their voice and attitude change. He described these changes as They act lack they don’t want you there or you ain’t got no busi ness being there. They don’t care that we might be awfully sick. You jist wait til they get to you. It m ust be rem embered that the comments quoted here are from indi viduals. One would wonder then how these sam e feelings are m anifested by so many blacks in the community. This is so because blacks have developed a rapid and effective method of communication. A "grapevine” so to speak. The information is passed on to alert other blacks to the inequities that ex ist in the official health system . This supports the belief that if other blacks know what to "expect" [anticipate], then they will know what cultural rule w ill have to be applied in the situation. Situations that have occurred in the black-white relationships in the official health system s are viewed as negative ones. The outcome has been that blacks are suspicious of the official health system . to utilize the system , even when the serv ices are free. Many blacks refuse 57 Blacks communicate the idea that the official health system was estab lished to m eet the needs of black and white m iddle-class and "a poor nigger ain't got a chance." The poor black does not feel that his health needs are satisfactorily met. The approaches that have been attempted by whites have been critiqued by application of black cultural rules. The black viewpoint of the official health system has been maintained through generations of unwritten rules of behavior. CHAPTER 6 IMPLICATIONS FOR NURSES The information received from the informants indicates that different approaches to dispensing health care to blacks needs to be considered. That consideration should be based on a working knowledge of the black culture. The knowledge can be obtained through studies conducted by nurses. It is im possible to do justice to the com plexities of the various components of the black cultural health system in one study. The cultural rules dictating the behavior of black women in the pregnancy or post-partum periods should be known by nurses. N urses who teach the black mother regarding her own care and that of her baby are fighting an uphill battle. The instructions and care given by the black grandmother or surrogate supercedes the nurse’s instructions. Low socioeconomic blacks are unable to grasp or embrace concepts of virus and m icroorganism s as causative factors of illn ess. Nurses must then modify their scientific approach to the illn ess to incorporate the black's ideas of causative factors of his illn ess. I would suggest that the activated patient approach be considered. the nurse m anifests her willingness to learn, she can. Her statement of "What can I do as a nurse that will help you?" may be her ticket to an enlightening and rewarding experience into the black culture. ' If 59 Blacks further believe that no illn ess is a serious one until it has incapacitated h is functioning. This state is referred to as "being down to the point I can’t help m yself. " An investigation is needed to define the types of sick n esses that render one to this state. Confinement to a bed whether in the home or in a hospital is feared by the black client. This state signifies that he is "sick unto death." As long as he can remain "on his f e e t ," he has a good chance of overcoming the sickness. Nurses and doctors could lower the threshold of fear and anxiety of the bedridden black client. F ir st, they should understand the cultural rule regarding bedrest. Secondly, they should teach or explain to the patient and his family the reasons for placing him in that state. There are numerous health practices within the black community that have a direct bearing on the manner in which blacks respond to prescriptive treatment. A nurse concerned with finding a solution to the problem that impedes her nursing care of a black has no established guidelines to follow. Studies should be conducted on black cultural rules regarding all aspects of health care offered in the official system . The material from those studies could be implemented in planning health care to m eet the needs of the black community. Fifty blacks were interviewed. A ll expressed a d esire to have suffi cient funds to receive private care. They saw no immediate change in their status that would satisfy their desire to have enough money to pay for health serv ices. Their alternative to private care was to state preferences for 60 certain approaches they felt white professionals should employ when caring for the black client. An analysis of those preferences appear in Table 2. When asked what type of treatment they preferred when they are sick , the informants interpreted treatment as meaning the type of approach or the personality of the nurse of doctor caring for them. Forty of the informants spoke of a kind approach and asked for under standing. Only 20 of the informants hoped for friendliness. A ll of the 50 persons interviewed were more Concerned that the right diagnosis and treat ment be given and that the person making those decisions be knowledgeable in those areas. The informants stated that they would be glad to participate in pro grams that would help the white health professionals learn about blacks in the hopes that the teachings "will teach them that we are human be in s." They expressed a need to be part of any planning that is done to m eet their health needs. Nurses could assum e the responsibility of including blacks .in the construction of those plans. Summary It has been noted that the black client approaches the official health care system with preconceived attitudes and beliefs. He has either heard via the grapevine or has experienced in the past that health care offered to blacks does not m eet his needs. He generalizes that all whites are untrustworthy. His method of communication w ill be misunderstood or ignored. The manner 61 Table 2. An analysis of the types of approaches preferred by black clients who were receiving health care from white professionals when interviewed. Preferred Approach Loving, caring Number of Responses 4 Humane 50 Kind 40 Knowledgeable (re: sickness) 50 Friendly . 20 Understanding 40 Teaching (re: procedures) 35 thorough examination 15 Right treatment (re: procedures and medications) 50 N = 50 62 in which he interprets his sickness and the n ecessary treatments he has employed cannot be shared with the white personnel. Whites are either amused or appalled by the medicinal practices of blacks. Because of this lack of understanding by w hites, the behavior of the black client has created problems for white professionals in the health system . Whites do not understand how the black cultural rules are applied in sickness and interpretation of sick n ess. They have little or no knowledge of how blacks communicate those interpretations. Blacks have perfected their approaches to whites in any given situation. Their interpretations of the official health system is governed by unwritten rules of behavior that are the outcome of these approaches. The black has been taught a specific response to use in any encounter with a white. These responses conflict with the philosophy of the staff in the health delivery system . This phenomena w ill prevail as long as whites refuse to become knowledgeable about the rules of black behavior. Blacks are suspicious of the official health delivery system . They w ill continue to be so as long as they view the whites in the system as their enem ies. . APPENDIX A INFORMANT CONSENT FORM TO PARTICIPATE The purpose of this study is to learn if people use the health delivery system s that are available to them. This study deals specifically with ideas and. opinions that Black people have regarding sickness and the type of treatment's) they receive and the methods in which treatments are dispensed. If you participate in this study , it w ill require several hours of your time while I am talking with you. I w ill not record your name so no one can tell whose ideas or opinions are written down. Your relationship with any public agency will not be affected if you decide to participate in this study. If you should decide not to participate, or if you decide to withdraw from the study at any tim e in the future, that w ill be perfectly all right. This study has been explained to me, and I would like to participate in it. I understand that my participation does not affect my relationship with any public agency. Furtherm ore, I understand that I may withdraw from the study at any tim e. Name Date 63 APPENDIX B DATA COLLECTION SHEET 64 65 Age M arried Male . Female_ Single Race_______________ _____ . Divorced Where were you born? Separated_____ .. ... . ........ How long have you lived in the neighborhood ? . .. ................. ,..................................... - How many tim es have you been sick in the past y e a r ? .................... What was wrong with you ? .... Widow ............ • . ............................... ................ Where were you treated for your sickness ? Doctor's office Clinic Hospital Other ........ - . , If the above answer is "Other," describe the treatment(s) or medicine that you took or that was given to you What was the name of your sickness ? What kind of sickness did you or do you have that you feel a doctor cannot cure ? Do you believe that your sickness could be due to voodoo or Witchcraft ? What type of treatment do you prefer when you are s ic k ? .................. .. Why do you prefer the type of treatment listed above ? A P P END IX C MEDICATIONS AND THEIR USES Medication Use Asafoetida and rainwater or whiskey Shortness of breath and colic Camphor (to sm ell) T izzie (asthma) Coal oil Colds, toothache, nail punctures Corn m eal poultice Chest congestion Epsom salts Flush various organs Lamb chop grease Impetigo Olive oil, honey Flu or pneumonia Hoe hound Candy, whiskey Flu or pneumonia Tallow grease Cold Lemon or grapefruit tea with honey Flu Whiskey with rock candy and Vicks 44 Chest congestion Quinine F ever, abortion Hog hoof tea Pneumonia Liquid of po’k salad applied with hot towels High Temperature Sheep shed balls M easles \ 66 67 Medication U s e ................ Snuff Insect bites Sassafras tea Blood purifier Catnip tea Hives (baby) Greasewood twig (chew) Upset stomach Garlic juice with lemon and hot water Stomach gas Hot ginger tea Menstrual cramps Turpentine (around navel) Worms Mouthwash of salt and warm water . Retention of teeth Pepper and coal o il Toothache Blue stone, salt peter, mixed tallow Brown pigment (liver spots, petogosy) Baking soda applied to the tonsils Sore throat Bluing applied to the tonsils Sore throat Urine (rubbed on the face) Acne Urine (one-half glass full after each voiding) Chicken pox or m easles Castor oil Blood purifier (winter) Black draught Blood purifier Rummer) Castor oil, epsoin s a lts , black draught To increase contractions of the pregnant mother Ginger tea, By sol douches, turpentine or sugar To speed the p rocess of threatened abortion Sponge with liquid from boiled peach tree leaves Fever - . APPENDIX D GUIDE TO SCRIPTURES When things look blue Isaiah, Chapter 40 When tempted to do wrong Psalm 139 When facing a c r isis Psalm 46 When discouraged Psalm 23 When bored Psalm 103-104 or Job 38-40 When business is poor P salm 37 When lonely or fearful Psalm 27 When anxious for loved ones Psalm 107 When planning budget St. Luke, Chapter 19 To live successfully with your fellow man Romans 19 When sick and in pain Psalm 91 When leaving home for labor or travel Psalm 121 When very weary St. Matthews 2:2-9, Romans 8:31-39 When everything seem s to be going wrong Timothy 3 The best investment St. Matthew 6 God in your national life Dueteronomy 8 68 69 When friends seem to go back on you, hold fast to I Corinthians 13 For inward peace consider St. John 14 When placed in a position of authority or great responsibility Joshua I If you have been bereaved I Corinthians 15 , Revelation 21 For a stirring record of what God can do (in trust) Hebrews n If you are satisfied with being "well-to-do" St. Luke 15-16 If you have experienced severe lo sse s . . . the last paragraph Romans 8 If putting up a stiff fight, find equip ment at the end of Ephesians When you have sinned John 3:1-21, Isiah 53, Psalm 51 The way of prayer Kings 1:8, P salm 42 and 51, St. Luke 17, Ephesians 3 If you have a fear of death St. John 2:17-20, II Corinthians 4 and 5, Romans 8, Revelations 7: 21-22 Pray for your enem ies P salm 109:1-15, P salm 110:1 Seek the security of God’s protection P salm 3:1-6 SELECTED BIBLIOGRAPHY Abrahams, Roger D. 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