Running Head: CULTURAL DIVERSITY IN HEALTHCARE
Cultural Diversity: Healthcare Beliefs in South Asian Muslims and Navajo Tribes
Megan Collins
Hutchinson Community College
NR113: Concepts of Professional Nursing
Mrs. Debbie Hackler
November 15, 2021
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Cultural Diversity: Healthcare Beliefs in South Asian Muslims and Navajo Tribe
The term “culturally diverse” is often used interchangeably with the concept of
“multiculturalism.” Rosado (2019) defines multiculturalism as:
A system of beliefs and behaviors that recognizes and respects the presence of all diverse
groups in an organization or society, acknowledges and values their socio-cultural
differences, and encourages and enables their continued contribution within an inclusive
cultural context which empowers all within the organization or society (para. 7).
In a world compromised of different societies and institutions, there exists different types
of culture, ethnic backgrounds and rituals that are characterized by the different beliefs among
these groups. The vast variety of culture is especially challenging in a healthcare setting. Factors
such as language, gender, geography, and education can play a major role in determining the
medical decisions that patients make for their healthcare needs. Of these different cultures, the
Navajo and South Asian Muslims are just two of many that have distinct differences in their
health care beliefs but are commonly seen in America’s hospitals so we must educate ourselves
and open our minds to these diverse cultures so we can best care for our patients up to par with
their cultural beliefs. From the language spoken, to the health practices and rituals performed, the
Navajo and South Asian Muslim cultures differ greatly.
Analysis
Cultural Assessment
The Muslims of Southeast Asia and the Navajo Tribe have a major deficit when it comes
to their population in comparison to each other, but they both make up a majority their cultures,
given both Muslims and Native Americans branch off into several different “cultures”.
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According to the Official Site of the Navajo Nation (2018), the Navajo tribe is amongst the
largest of the Native American group, with over 250,000 Native Americans in their tribe. The
Muslim culture is very large dominating much of Asia and even extending into Africa, but it is
predominantly found in Southeast Asia with the most populated area of Muslims accounting for
over 240 million Islamic people. (Houissa, 2021). The Navajo people have a very distinct
language, it is referred to as Dine Bizzad or Athapaskan. Because the Navajo language does not
always have one single word that is like one English word, to do a nursing assessment and
develop a nursing diagnosis, goals, and interventions, the nurse must remember that what is
being said must be interpreted by approximation. As for Muslims, historically they spoke Arabic,
which is what most people thing of when they hear the term “Muslim”, but in recent decades
Hindi has been the main language known and spoken by Muslims, especially in the Southeast
part of Asia.
While they have very different languages they can compare quit closely when it comes to
who influences medical decisions in both ethnic groups. Both Muslim and Navajo are greatly
influenced by the family, including spouse, children, and even other relatives rather then the
individual patient themselves. There are roles of the family members of the Navajo tribe that are
expected to be carried out, note that most Navajo marriages are arranged, and the woman is not
to excel or succeed more than their husbands. Once the marriage has been finalized, they have
children, and within that family there comes roles. Mothers are responsible for traditional
domestic duties within the home, the father, on the other hand, is responsible for any outside
work necessary to maintain the family and home. Children are sought out as assets rather than
liabilities and are responsible for assisting the mother in the home. Some Navajo Indians have a
perception of health that is not limited to the physical body but encompasses congruency with
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the family, environment, livestock, supernatural forces, and community. The Navajo Tribe feels
they are all responsible for each other, so it is not uncommon to have an abundance of other tribe
members if it comes to a hospital setting for them.
Much like the Navajo Tribe, Muslim men and women in families share the same roles,
women in the home domesticated, and men out in the workforce to maintain the family and
home. They also incorporate their extended families very tightly into their everyday lives, for
them it is believed to provide greater stability, continuity, and support for each other. So, when it
comes to healthcare, it is very common for the whole Muslim family, including close relatives to
help influence a major decision. For Muslims, health is a state of physical, psychological,
spiritual, and social well-being and is considered the greatest blessing God has given humankind
(Odeh Yosef, 2018). The Muslim people attach significant importance to health, so taking care
of one’s health is a religious duty. For some Muslims, spiritual values are a component of their
health belief, and, as such, spiritual needs may take precedence over physical needs. Both Navajo
and Muslim culture maintain their health through their spirituality first and foremost as well as a
very healthy and nutritious diet, both believe this can generally evade any illness.
The Navajo Nation believes that any illness or misfortune to be the cause of the
transgressions of the supernatural or witchcraft. They hold ceremonies when one is ill to cleanse
the spirit of transgressions specific to misbehavior, witchcraft, or misfortunes. Whereas Muslim
patients believe illness, suffering, pain, and dying as a test from God and perceive illness as a
trial by which one’s sins are removed. Both use their spirituality greatly when it comes to
defining illness. Muslims may perform personal prayer (du’a), or prayer form a Prophet, they
believe this to aid in their healing and some also think illness is a repercussion of their sins.
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Healing Practices and Rituals
As mentioned previously, the Navajo tribe perform ceremonies in hopes to cleanse the
soul when it comes to one contracting an illness. Navajo people traditionally received treatment
for illness from native healers or "medicine men." As in a conventional medical care system,
many different types of practitioners exist; these range from diagnosticians such as hand
tremblers, crystal gazers, and "listeners," to individuals who perform healing ceremonies
involving herbs, balms, and purgatives (Sandner, 2016). Native Healers are used most, and most
tribal people use these for common health problems such as arthritis, depression and anxiety,
body aches, mild illnesses, and even diabetes. Although, if severe enough they will see a doctor
along with their Native Healer. The Navajo tribes uses many types of plants and herbs for
healing for just about anything that is not critical in the moment. For example, when women are
in labor, they make a tea called Greasewood, made from the leaves of a greasewood plant to their
belief it makes childbirth quicker and easier. After birth they use a tea made form silkweed to
help ease the pain of labor. Another form of medical care, that is different than a Native Healer,
is called a “medicine man”, but is not a doctor. Medicine men and medicine women have jish, or
medicine bundles, containing symbolic and sacred items, including corn pollen, feathers, stones,
arrowheads, and other instruments used for healing and blessing. These items are gathered in the
sacred mountains that border the Navajo Nation. It is not uncommon for the medicine man or
woman to accompany the patient in a hospital setting and communicate with a physician about
the patients healing.
In contrast, Muslims receive illness with patience, prayer, and meditation. They do use
medications, but there are limitations. Medications that contain gelatin or pork-based are
forbidden. Use gelatin-free alternatives such as antibiotic liquids or halal gelatin tablets.
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Magnesium stearate is forbidden in tablets when derived from an animal source. If it is an
emergency and an alternative is not readily available, the drug may be used, but this should be
explained to the patient. Islam permits the use of any drug in a life-threatening situation (Attum
& Shamoon, 2019). For Muslims, an important time of the year called Ramadan, can arise
challenges when caring for a patient of the Muslim culture. Ramadan is a holy month of
fasting, introspection and prayer for Muslims, the followers of Islam. It is celebrated
as the month during which Muhammad received the initial revelations of the Quran,
the holy book for Muslims. Fasting is one of the five fundamental principles of Islam.
Each day during Ramadan, Muslims do not eat or drink from dawn to sunset
(History.com Editors, 2018). During this time, it is forbidden to receive oral medication, IV
fluids or receive blood transfusions, if this occurs this will result in breaking the fast. As the
same with Navajo Indians, Muslims also use some traditional herbs and other healing techniques.
According to Attum & Shamoon, (2019) some techniques include cupping, some Muslims use
cupping to treat various disorders, including headaches, nausea, vomiting, stomachache, sprains,
muscular pain, sprains, insomnia, and jaundice. Cautery is used in many cultures when
conventional treatment has been unsuccessful. It is used to treat headaches, eye problems,
jaundice, mental illness, and cancer. Patients should avoid ancient methods of cautery and
consult an appropriate healthcare professional. Many Muslim patients with diabetes use honey as
a traditional remedy. Olive oil, Muslims use olive oil to prevent and treat ailments. It is a source
of dietary fat in the Mediterranean diet, which has a low death rate for cardiovascular diseases
compared with other cultures. Some believed that regular olive oil consumption helps reduce
inflammation, endothelial dysfunction, thrombosis, and improves carbohydrate metabolism.
Those are just some great examples of what they use to this day to heal.
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Traditional Navajos had a somewhat unique relationship with death. On the one hand,
they accepted death as a natural part of being a living being. However, the Navajos had many
fears about the dead themselves. They also had fears about death-related omens or signs. For
example, hearing an owl hoot was something a Navajo might be afraid of, as it was thought to be
a sign that a death was imminent. Navajo beliefs about death and the afterlife involve the belief
in a “chindi.” In Navajo culture, a chindi is a spirit that remains after a person has died (Oliveto,
2021). The Navajo take their after life and death traditions very seriously. It is the part of Navajo
people to require three members of the family to enfold the dead body in a coverlet after
cleansing. Then, they must load the body on a newly acquired horse. The three members of the
family need to trek as far North as possible. They also need to pick a funeral ground and conceal
the body. Afterwards, the horse needs to be slayed and buried. They believe that the dead person
would take the new horse on the journey to the life after death. If a member of the tribe dies in
their home, most Navajo will burn all their belongings in fear of them returning to haunt them,
some are also so extreme as to have the family members of the deceased to stand in the smoke
and fire of the burning belongings to purify their soul.
The Muslim culture is not quite as extreme but have some very different beliefs when it
comes to death and dying. Muslims believe in an afterlife and that once an individual’s soul is
freed from the physical body, they await a reckoning where they can account for their actions
in this life. As part of this belief, Muslim funerals and burials are usually held as soon as
possible after death to free the soul from the body. In most cases, family and friends will
accompany the funeral procession to the grave; condolences and assistance are usually offered
at that time. Excessive or demonstrative mourning is forbidden, and condolences are brief.
Guests generally leave after speaking briefly to the family (Muslim Death, Funeral, and Burial
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Customs and Traditions, 2016). There are also other things unique to the Muslim culture during
funerals, things such as, flowers being unacceptable, men and women sit separately with women
covering their arms and heads. Muslim women also do not attend the burial. Bodies are usually
buried with a shroud, without a casket and with their heads facing toward the Mecca (Muslim
direction of prayer). If a wife loses her husband, she must wear black for a year, other than that
they do not acknowledge anniversary of the death. Postmortem examination is forbidden, and for
most, so is organ transplantation. The Muslim culture is very diverse in itself, so there are many
variances of beliefs and traditions based on location of the Muslims.
To conclude these two cultures, one needs to understand the vast differences and apply it
to their care as a nurse. We will encounter many different cultures in our career as nurses and I
believe it is important to have a general knowledge of other cultures and come at it with an open
mind. At the very least you can always ask the patient them self or a family member to help
educate you about their beliefs for the time being and apply it to the next patient of that culture.
We will encounter diversity in any setting of nursing care, and it is critical to apply your
knowledge to the care of each individual patient. If I am to care for a Muslim patient, it would be
important to make sure for a female patient that she maintains female health care professionals
throughout her stay, to respect their prayer and accommodate the influx of family members that
may be there. When caring for a member of the Navajo Tribe, it would be very important to
understand that they do not make eye contact, and it is also valued by them to have the same sex
caretaker as the patient. I believe this is going to be a forever learning experience, especially
depending on the location of where we work, there are diverse cultures all over America today
and at some point, we will encounter very different cultures. This will no doubt allow me to have
an open mind and listening ear to every patient I encounter.
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References
Attum, B., & Shamoon, Z. (2019, January 19). Cultural Competence in the Care of Muslim
Patients and Their Families. Nih.gov; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK499933/
History.com Editors. (2018, September 12). Ramadan. HISTORY.
History. (2018). Navajo-Nsn.gov. https://www.navajo-nsn.gov/history.htm
Houissa, A. (2021). LibGuides: Islam in Southeast Asia: Home. Guides.library.cornell.edu.
Retrieved November 22, 2021, from
https://guides.library.cornell.edu/IslamSoutheastAsia
Muslim Death, Funeral, and Burial Customs and Traditions. (2016, April 8). HealGrief.
https://healgrief.org/muslim-death-funeral-burial-customs-traditions/
Oliveto, J. (2021, September 20). Navajo Beliefs about Death, Burials & Funerals Explained.
https://www.joincake.com/blog/navajo-beliefs-about-death/
Rosado, C. (2019). What Makes a School Multicultural? Edchange.org.
http://www.edchange.org/multicultural/papers/caleb/multicultural.html
Sandner, D. (2016). Navaho symbols of healing. Harcourt Brace Jovanovich.
https://www.history.com/topics/holidays/ramadan
Yosef A. R. (2018). Health beliefs, practice, and priorities for health care of Arab Muslims in the
United States. Journal of Transcultural Nursing: Official Journal of the Transcultural
Nursing Society, 19(3), 284–291.
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