Dealing with diseases in different cultures

Every culture has a different attitude towards life. Everywhere on earth there are various rituals, also when it comes to cases of illness or death. Religion, tradition and geography often determine how different people feel about hygiene and diseases. Below is a brief summary of some common view.

Within several African cultures it is believed that illness or premature death are caused by negligence, crossing the edge, envy and/or sorcery. Most Africans have no problem being treated by a doctor – there’s no harm in trying - but will still visit a witchdoctor afterwards to find out the "real" cause.

According to Indian culture your destiny fully depends on your deeds. Life is sacred and your karma is determined by your actions. It is best described with the European view that all good things come to those who make them happen. Further more, interference like euthanasia is not allowed in the Indian culture. God is the only one who can decide when a person comes to life and death.

European culture, molded by Christianity, seems fairly uniform to outsiders. Yet there are still discover many differences between the countries, especially with regard to healthcare and handling diseases. In the Netherlands for erxaple it is still extremely popular to give birth at home. This is due to a system years between midwife and pregnant woman (if healthy of course). This in contrast with most

Other European countries, where woman give birth in hospital and prefere to do so.


Different beliefs

Islam teaches its followers that a Muslim should be clean and pure. A Muslim cleanses himself several times a day, which makes the transfer of bacteria noticeably less. Muslims mostly rely on the advice of a physician, but only if the treatment is ‘Halal’. A male doctor can only treat or investigate a woman if this is really necessary, in some cases a woman must be around. Islam forbids euthanasia; God determines when a person comes to life and death.

In Judaism it is very important to visit patients. This is seen as a commandment. Besides that Jews pray in the Synagogue for supporting a patient. Jews believe that healing helps to restore health and spirit, so that a person can resume a full life. The acceptance of treatment and medication is seen as a gift from God. Judaism says that life should be as long as possible therefore euthanasia is not permitted.

In Christianity you’re supposed to look after each other. Helping out the weak and sick are commandments for every Christian. Some Christians believe that illness; pain or death are signs from God; He wants to make something clear. Within Christianity a doctor is seen as something positive, as God-given. Christians also believe in inner healing of "exorcism" where evil is removed from the body through a ritual. Christianity says that we should not intervene in Gods work, euthanasia is therefore not permitted.

Hindus look for the cause of everything that happens to you in your own karma. Disease is therefore the result of your own behaviour and is considered as a kind of cleaning. Hinduism respects medicines, but there are many traditional solutions to heal witch are used more often. An example is performing yoga exercises. Euthanasia in Hinduism is not explicitly rejected, but there are guidelines to the more natural life.

Meditation plays a very important role in the healing of a Buddhist. They are open for a doctor, but they prefer various traditional solutions for a person to heal. Wrongdoings in a previous life can affect the karma of a Buddhist. The actions in the present life of a Buddhist may affect his next life, so during the dying process is euthanasia not forbidden, but not a popular option.


Healthcare in Holland

Something specific for the Netherlands is home birth. Women can choose whether they give birth at home or in the hospital. As many as 70% of the parents prefer a home birth, but due to medical complications this is not always possible. Eventually, about 35% of all women give birth at home.

In the Netherlands, all children aged from  0 to 4 are closely monitored by a children healthcenter. This center monitors children's development and provides various vaccinations. This typical Dutch regulation from the early 20th century originated from the idea to protect mother and child against diseases.

The use of antibiotics in the Netherlands is the lowest in Europe. An average of 1% of the population uses an antibiotic. Research shows that use among women is higher, because it is used as a remedy for cystitis. Doctors are reluctant to prescribe antibiotic because resistance occurs quickly. In severe cases the antibiotic becomes useless. Furthermore, it appears that for viruses like flu antibiotics has no effect.

In the Netherlands you cannot go to the hospital without referral from the GP. The GP acts as a gatekeeper and assesses the severity of the complaints. Only serious cases are sent to the hospital. This way specialists deal with specific cases and work can be done efficiently.


Healthcare in Germany


You won’t find strong medicine, such as painkillers, in a drugstore or supermarket. Most medicine you can only get in a pharmacy.

Attitude towards medicine

People in Germany are very careful with strong medication, such as painkillers, antibiotics or psychotropic drugs. Often they prefer to try alternative therapies.

Attitude towards physicians

People in Germany try to get as much information as they can about their illness and possibilities of treatment, in order to form an own opinion and to be critical towards different methods and treatments.

There is a specialist in Germany for children, “Kinderarzt”. You won’t go to the GP with your child until it is around 12 years old.

Breast feeding is very popular in Germany, sometimes for quite a long time, may be a year or more. Breast feeding at public places is seen as normal and accepted.


Healthcare in Spain

Family Doctor

The figure of, family doctor' refers to the professional who dispenses primary care. Formerly called, General Practitioner ', still some people uses this term.

For any any illness or disease, the patient should go to the family doctor who will attend the patient  and forward him/her to a specialist if necessary.


The Government approved last April 2013 the Plan for Childhood and Adolescence 2013-2016 proposed by the Ministry of Health, Social Services and Equality, which includes among its measures to extend pediatric care until 18 years of age. Thus, states that patients may remain under pediatric units up to 18 years of age.


Prescriptions issued by doctors are presented by the patients in the pharmacies for the collection of medicines.

Pharmacies are the only places that can dispense medicines, and should be run by a licensed pharmacist. There are also the so-called ‚parafarmacias’ where you can buy medicinal products other than medicines.

With the current economic crisis, the government has introduced in the Spanish health system new formulas as the drug copayment, payment of 1 euro per prescription (in some regions), and recently co-payment by chronic patients of 10% of medications dispensed in hospital pharmacies (42 medicines).

Traditional Medicine

In general terms, in Spain the public health service (Social Security) does not include traditional medicine. Only in very exceptional cases were acupuncture, naturopathy and homeopathy treatments were provided in public hospitals. Alternative therapies or practicioners titles are not officially recognized.

However, there is some interest to achieve legal recognition of acupuncture, naturopathy and homeopathy. Some medical official schools discus on the subject, and the Ministry of Health has created a technical committee negotiating with the more representative associations of the sector.


Healthcare in Portugal

National Strategy to Reduce Consumption of Salt in Food in Portugal

The General Directorate of Health released the report "National Strategy to Reduce Consumption of Salt in Food in Portugal" and Informative Document "Using Herbs & Similar in Food", which reinforces the importance of using herbs as a substitute for salt.

The World Health Organization recommends a level of salt intake of the population of less than 5 grams per person per day for the prevention of cardiovascular disease. However, salt intake in most countries of the WHO European Region is far above the suggested amount.

In Portugal, the amount of salt in the diet is roughly twice that which is recommended, making it therefore urgently start to reduce, gradually, the amount of salt in food.

The General Directorate of Health through the National Program for the Promotion of Healthy Eating has been providing various formats to promote literacy and empowerment of citizens, particularly the Book "Smart Food", free distribution and animation series and other materials intended for a young audience, and now the "National Strategy to Reduce Consumption of Salt in Food in Portugal" and Informative Document "Using Herbs & Similar in Food."

Aware of the importance of reducing salt intake and of the added value of herbs due to their nutritional composition, DGS recommends from now, the use of these plants in replacement of salt, since many citizens don’t have enough information about their benefits for health.

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Health Care in Lithuania

Lithuanian Health Care System is based on compulsory health insurance. The scheme is financed from actual employers’ and self-employed persons’ social contributions. The following persons are insured with public funds:

  • persons entitled to any kind of pension,

  • the disabled,

  • the unemployed,

  • pregnant women,

  • mothers (fathers in single parent family) until their children become 8 years of age,

  • mothers (fathers in single-parent family) with two or more children until the latter become of 18 age,

  • persons under the age of 18,

  • schoolchildren and students,

  • persons entitled to social assistance benefits,

  • persons ill with dangerous diseases,

  • persons who contributed to the elimination of consequences of nuclear accident at the Chernobyl nuclear power plant and other suffered persons.

Emergency treatment|
Essential medical aid is provided free of charge to all persons. In case of emergency call an ambulance by dialing 112.

Inpatient health care
Essential medical care services in inpatient care institutions (national and territorial hospitals, nursing and palliative hospitals and medical rehabilitation institutions including sanatoriums) for insured persons are provided free of charge. In case patients choose more expensive services, substances and procedural services, the difference between the actual and basic costs are covered by the patients. The patients also pay additional services.

Free of charge medical care services are provided to all persons ill with tuberculosis, sexually transmitted diseases, AIDS, mental diseases, oncological diseases and addictive diseases.

Outpatient health care- provided by polyclinics, general practitioners, centres of family medicine
Free of charge for persons insured by the compulsory health insurance. The patient is granted the right to choose treatment institution and doctor - any working with one of the territorial patient funds. If the patients choose more expensive services, substances and procedural services, then the difference between the actual and basic cost is covered by the patients.

Polyclinics, centres of family medicine and doctors’ offices do not work in the evenings and on weekends.

If you need treatment of a specialist, your family doctor will write a referral and the consultation will be free of charge. You can choose a specialist; ask your family doctor for advice. If you are not insured by a compulsory health insurance you will have to pay a specified price for the consultation.

However, for some tests and services you will have to pay while you are covered by a compulsory health insurance. These may include some blood tests or treatments.

Dental Care
Dental care will be free of charge for persons insured by the compulsory health insurance when consulting a dentist who works with one of the territorial patient fund.  Patients (excluding children under 18) pay for dentures, some medicine and materials used for dental care. Pensioners, disabled persons and recipients of social assistance some dentures are reimbursed by the Health insurance scheme. Dental care is only partly covered by the Health insurance scheme, and the treatment is largely provided by private dentists.

Medicines are sold in pharmacies. Some of them require doctor‘s prescription.
The Lithuanian Ministry of Health has approved a price list of prescription medicines, where basic prices and co-payments are given. Basic prices are reimbursed by the State Patient Fund and co-payments are covered by the patients.

Parental leave
In Lithuania all residents are entitled to parental leave and allowance for 1 year (100% of average earnings) or 2 years: 52 weeks 70% and 52 weeks 40% (either mother or father can take it or take the leave in shifts).


Healthcare in Romania

The most effective and most common way for foreign citizens to receive medical treatment in Romania is via private health insurance valid for the duration of the person’s stay in Romania (if short, e.g. for tourism). In most cases, foreigners prefer private practices and clinics, unless they are dealing with a medical emergency. 

Recently however, the EUROPEAN HEALTH INSURANCE CARD was introduced to the Romanian health care system and widely publicized. EU citizens holders of this card are now reported to seek and receive medical assistance in state-funded hospitals, just like regular Romanian patients.

Some cultural specifics and issues from the patients’ perspective:

-        Generally speaking, Romanian patients expect as much free health care as possible, including free medication, free hospitalization and time off work (with costs covered by the state). This is now slowly beginning to change, as forms of co-payment are being introduced on a wider scale. Depending on the case, patients should expect to have to pay for some elements of certain treatments.

-        It is also very common in Romania that patients prefer to call the ambulance or to go straight to the hospital rather than first see their family doctor / GP or an ambulatory clinic, even when the condition or ailment is not serious or life threatening. This is why emergency rooms are often very crowded and patients have to wait for hours until they can be fully treated, discharged or redirected.

-        There is a popular belief that one must pay/bribe the medical staff in order to be treated with proper care and attention. Unfortunately, this belief is fed through mouth-to-mouth and media reports of real instances of bribery, especially related to surgery. Fortunately, more and more medical teams and entire clinics are affirming and reinforcing their ethical approach to providing fair treatment to all patients.

  • The Romanian Code of Medical Ethics does allow doctors and nurses to receive gifts from patients who want to express their gratitude, but ONLY AFTER the patients have been treated and WITHOUT CONDITIONING the care of the patient!

From the doctors’ perspective:

-        State hospitals are chronically understaffed while being overflooded with patients, which is often why doctors and nurses are stressed and busy. This may result in minimal conversations and less availability for individualized treatment, which should not be seen as unwillingness or rudeness. The situation is not at all helped by the fact that these difficult, high risk, high stress professions are still very poorly paid.

-        State hospitals are also undersupplied, which is why patients are often asked to buy their medication, bandages etc. themselves in order for the prescribed treatment or intervention to be carried out.

-        Doctors with good local reputation are often very knowledgeable about and/or involved in international collaboration programmes and local NGOs providing various forms of support (including financial), especially in cases of emergency or severe medical conditions.


Healthcare in Bulgaria

School doctors

The school doctors and support medical personnel have been a typical element of the healthcare services in Bulgaria for many years. The activities of the school doctors are focused on providing emergency medical help to children and pupils prior to arrival of a specialized emergency medical unit; promotion, preventive care and rehabilitation of the health of children and pupils; organising and implementing activities for prevention and containment of the spreading of contagious and parasitic diseases; participation in the preparation, implementation and control of various forms of leisure activities, tourism and sports for children and pupils; organising and implementing programmes for health education, healthy nutrition, prevention of use of narcotics, alcohol, smoking as well as for forming an adequate sexual culture.

The practice of the school doctors was not included in the state budget in 2008 and their activities practically ceased, but they are planned to be renewed as of fall 2013. The immunizations and preventive check-ups, however, will continue to be performed by the general practicians (GPs).       

Traditional medicine

In the last few years the traditional medicine and various forms of herb treatment have gained a wide popularity in Bulgaria. With the advancement of the modern medicine and pharmacy people are more and more willing to turn back to the traditional medicine in an effort to avoid or reduce the daily consumption of chemistry-based substances. Of course, no one is denying the benefits of the modern medicine, but there are certain conditions, types of pain or diseases which could be overcome or improved with the help of the traditions medicine. For example a mild cold, high blood pressure or trouble sleeping could be fought with the help of herbs. In Bulgaria there is a wide variety of herbs which could have a medical application. However, the preparation of potions, infusions and ointments should be made only by professionals with sufficient information. It is advised that before you start using the methods of the traditional medicine, you make a consultation with a specialist.


Healthcare in Cyprus

In Cyprus social insurance is related to retirement and does not cover the provision of public and free medical care. However specific population groups, such as civil servants, pensioners, people with low incomes, etc., were entitled to free medical care until recently. After the outbreak of the financial crisis in March 2013, the government decided to apply fees for providing health care even in public hospitals. Currently the public health care is being reshaped as a consequence of the economic crisis in the country.

The male population in Cyprus presents high rates of cardiovascular diseases due to unhealthy lifestyles. In general Cypriots consume large amounts of red meat and do not play sports as much as they could in order to be kept in good physical condition. Also very often they consume large amounts of medicines, especially antibiotics, even in cases where this could be avoided.

One of the traditions concerning the birth of a child is the eve of the infant and mother for 40 days in their home. It is a custom that even nowadays many women observe. Apart from etiquette exist and health reasons, as the baby and the new mother in this way avoid exposure to infectious agents and minimize the risk for diseases during this sensitive postpartum period and until the infant to obtain antibodies and strengthen the immune system. Breastfeeding is one of the ways in which this is achieved and the Cypriot mothers routinely breastfeed their infants.

One of the documents needed for the religious wedding in Cyprus is the certificate examination for thalassemia. To perform this test the couple makes an appointment at the Center of thalassemia. Thalassemia is found mainly in people who live in humid climates, such as Cyprus, which often appears as malaria. Thalassemia is a mechanism of protection of the inhabitants of such areas of malaria due to the sedimentation of erythrocytes. Apart from Cyprus, is very common in other Mediterranean countries, and this is why this test is mandatory in Mediterranean countries before committing marriage. Mandatory screening for thalassemia before marriage had enabled each of us to know if we are a carrier or not. So if in a couple both of them are carriers, they can proceed to have children, but making prenatal testing. By checking this, they know the status of the embryo and if suffering from Thalassemia they could interrupt pregnancy. In this way, thalassemia has almost disappeared from the new birth diseases.