1	Religious and Cultural Determinants of Health Care: A Qualitative Study from India DR. VINOD SHAH Presented at Faith-Based Organizations as Pioneers and Partners in Health Systems Development, May 31, 2005, Omni Shoreham Hotel, Washington DC
2	A QUALITATIVE RESEARCH …based on interviews with Hindu god-men, leaders & devotees.
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8	Role modeling of care-I Did the religious leaders role model caring?
9	VISITING THE SICK… I don’t go visiting and helping the sick because I’m not a doctor. I don’t have time to visit the sick. I help those who come to me and get them to the hospital.
10	CONT. I sit on a seat that is fixed and it does not enable me to move about the whole day. I come here early morning and once I sit on my seat I don’t move. If someone who is sick and comes up to me…I may just help him I don’t have the time to visit the sick.
11	Cont… If I am at prayer…I will not leave my prayer and go to help someone…I don’t think it is important. If I leave my god and my karma and help someone then my god will get angry…my karma will be lost…
12	ROLE MODELLING OF CARE BY GODS AND GODDESS The Christian Gospel is full of Christ role modeling care and compassion Christians too are more interested in healing, caring and compassionate ministries The first hospital in India was mentioned during the time of Ashoka in the 2^nd Century BC - there is no further mention of a hospital in India till the 15^th Century after the advent of the Portuguese.
13	Did God role model healing? There is no such example for god role modeling healing.
14	Cont. SILENCE!
15	"THE ORTHODOX INDIAN CONTEXT" THE ORTHODOX INDIAN CONTEXT Jainism discourages sharing your suffering with others. VISITING THE SICK is not done by the community and is confined to the family and extended family We never see Hindu or Buddhist or Jain Priests coming to pray for supporting the sick. It is not part of their job description.
16	IMPORTANCE OF THE BODY Body- Soul dissociation-II Developed societies To heal the body is also to minister to the soul and indeed to the whole person The body had intrinsic dignity however deformed or diseased. Even in death, the body needed to be respected The body was an integral part of “me”.
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24	Body Soul dissociation The Indian systems have many “holistic” practices However none of them really address the hard core issues of the “body” like- Repair of structures/organs Understanding cellular processes Pathology of infections etc. Body (Dirty) and Soul (Good) were dissociated.
25	SENSE OF COMMUNITY High and low trust societies-III
26	THE ORTHODOX INDIAN CONTEXT
27	JUDEO CHRISTIAN CONTEXT
28	"Institutions that are required for..." Institutions that are required for health such as : Marketing of these herbs Standardization of dosages Ethical committees to set down codes of conduct Medical Training Centres Other disciplines which should cooperate and assist the physician. Farming of ayurvedic herbs All these require community cooperation. But sadly none of these happened in a regular sustainable fashion.
29	INDIVIDUAL WORSHIP I sit here and worship my god alone…this is my temple. I perform all the rites of worship to gods like Ganga, etc…in the morning and evening.
30	Cont. Ones karma is the only true form of worship. Following all rules and regulations is the best form of worship.
31	Cont.
32	Women’s disempowered status IV
33	Woman in Hinduism/Jainism Sentiment towards woman was low Later Vedic period – woman reduced to status of Sudra Women had no place in religious life-no reciting of slokas/ no salvation Degradation through temple prostitution/Tantric practices
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37	Famous tantric Was a close confidante ofone of the PM in India Mr Chandraswamy
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42	STATUS OF WOMEN
43	Family versus truth- V
44	Family values & corruption Scale of familism (World Values survey code book 1994 & World Bank statistics) Correlates well with the CPI.(Regression analysis) Tribalism- Africa and India
45	Family values and corruption Edward Banfield- “ Amoral familism”- The Moral Basis of a backward society Plato- “Children should be institutionalized” –Republic Chapter 5 Lawrence Harrison- Extended family –anti-development (Underdevelopment is a state of mind-page 7) Weber- Family Loyalty and market are antithetical -The religion of China- page 237.
46	Corruption Perceptions Index 2004
47	Corruption Perceptions Index 2004 This table was compiled at the University of Passau on behalf of Transparency International. For information on data and methodology, please consult the frequently asked questions and the framework document.
48	Country Rank Country 2004 CPI Score* Confidence Range Surveys Used*
49	Country Rank Country 2004 CPI Score* Confidence Range Surveys Used*
50	Country Rank Country 2004 CPI Score* Confidence Range Surveys Used* 31 Estonia 6,0 5.6 - 6.7 12 Slovenia 6,0 5.6 - 6.6 12 34 Bahrain 5,8 5.5 - 6.2 5 35 Taiwan 5,6 5.2 - 6.1 15 36 Cyprus 5,4 5.0 - 5.8 4 37 Jordan 5,3 4.6 - 5.9 9 38 Qatar 5,2 4.6 - 5.6 4 39 Malaysia 5,0 4.5 - 5.6 15 Tunisia 5,0 4.5 - 5.6 7 41 Costa Rica 4,9 4.2 - 5.8 8 42 Hungary 4,8 4.6 - 5.0 12 Italy 4,8 4.4 - 5.1 10 44 Kuwait 4,6 3.8 - 5.3 5 Lithuania 4,6 4.0 - 5.4 9 South Africa 4,6 4.2 - 5.0 11 47 South Korea 4,5 4.0 - 4.9 14 48 Seychelles 4,4 3.7 - 5.0 3 49 Greece 4,3 4.0 - 4.8 9
51	Country Rank Country 2004 CPI Score* Confidence Range Surveys Used* 49 Suriname 4,3 2.1 - 5.8 3 51 Czech Republic 4,2 3.7 - 4.9 11 El Salvador 4,2 3.3 - 5.1 7 Trinidad and 4,2 3.6 - 5.2 6 Tobago 54 Bulgaria 4,1 3.7 - 4.6 10 Mauritius 4,1 3.2 - 4.8 5 Namibia 4,1 3.5 - 4.6 7 57 Latvia 4,0 3.8 - 4.3 8 Slovakia 4,0 3.6 - 4.5 11 59 Brazil 3,9 3.7 - 4.1 11 60 Belize 3,8 3.4 - 4.1 3 Colombia 3,8 3.4 - 4.1 10 62 Cuba 3,7 2.2 - 4.7 4 Panama 3,7 3.4 - 4.2 7 64 Ghana 3,6 3.1 - 4.1 7 Mexico 3,6 3.3 - 3.8 11 Thailand 3,6 3.3 - 3.9 14
52	Country Rank Country 2004 CPI Score* Confidence Range Surveys Used* 67 Croatia 3,5 3.3 - 3.8 9 Peru 3,5 3.3 - 3.7 8 Poland 3,5 3.1 - 3.9 13 Sri Lanka 3,5 3.1 - 3.9 8 71 China 3,4 3.0 - 3.8 16 Saudi Arabia 3,4 2.7 - 4.0 5 Syria 3,4 2.8 - 4.1 5 74 Belarus 3,3 1.9 - 4.8 5 Gabon 3,3 2.1 - 3.7 3 Jamaica 3,3 2.8 - 3.7 6 77 Benin 3,2 2.0 - 4.3 3 Egypt 3,2 2.7 - 3.8 8 Mali 3,2 2.2 - 4.2 5 Morocco 3,2 2.9 - 3.5 7 Turkey 3,2 2.8 - 3.7 13 82 Armenia 3,1 2.4 - 3.7 5 Bosnia and 3,1 2.7 - 3.5 7 Herzegovina
53	Country Rank Country 2004 CPI Score* Confidence Range Surveys Used* 82 Madagascar 3,1 1.8 - 4.4 4 85 Mongolia 3,0 2.6 - 3.2 3 Senegal 3,0 2.5 - 3.5 6 87 Dominican 2,9 2.4 - 3.3 6 Republic Iran 2,9 2.2 - 3.4 5 Romania 2,9 2.5 - 3.4 12 90 Gambia 2,8 2.2 - 3.4 5 India 2,8 2.6 - 3.0 15 Malawi 2,8 2.2 - 3.7 5 Mozambique 2,8 2.4 - 3.1 7 Nepal 2,8 1.6 - 3.4 3 Russia 2,8 2.5 - 3.1 15 Tanzania 2,8 2.4 - 3.2 7 97 Algeria 2,7 2.3 - 3.0 6 Lebanon 2,7 2.1 - 3.2 5 Macedonia 2,7 2.3 - 3.2 7
54	Country Rank Country 2004 CPI Score* Confidence Range Surveys Used* 97 Nicaragua 2,7 2.5 - 3.0 7 Serbia and 2,7 2.3 - 3.0 7 Montenegro 102 Eritrea 2,6 1.6 - 3.4 3 Papua New 2,6 1.9 - 3.4 4 Guinea Philippines 2,6 2.4 - 2.9 14 Uganda 2,6 2.1 - 3.1 7 Vietnam 2,6 2.3 - 2.9 11 Zambia 2,6 2.3 - 2.9 6 108 Albania 2,5 2.0 - 3.0 4 Argentina 2,5 2.2 - 2.8 11 Libya 2,5 1.9 - 3.0 4 Palestinian 2,5 2.0 - 2.7 3 Authority 112 Ecuador 2,4 2.3 - 2.5 7 Yemen 2,4 1.9 - 2.9 5
55	Country Rank Country 2004 CPI Score* Confidence Range Surveys Used* 114 Congo, 2,3 2.0 - 2.7 4 Republic of Ethiopia 2,3 1.9 - 2.9 6 Honduras 2,3 2.0 - 2.6 7 Moldova 2,3 2.0 - 2.8 5 Sierra Leone 2,3 2.0 - 2.7 3 Uzbekistan 2,3 2.1 - 2.4 6 Venezuela 2,3 2.2 - 2.5 11 Zimbabwe 2,3 1.9 - 2.7 7 122 Bolivia 2,2 2.1 - 2.3 6 Guatemala 2,2 2.0 - 2.4 7 Kazakhstan 2,2 1.8 - 2.7 7 Kyrgyzstan 2,2 2.0 - 2.5 5 Niger 2,2 2.0 - 2.5 3 Sudan 2,2 2.0 - 2.3 5 Ukraine 2,2 2.0 - 2.4 10
56	Country Rank Country 2004 CPI Score* Confidence Range Surveys Used* 129 Cameroon 2,1 1.9 - 2.3 5 Iraq 2,1 1.3 - 2.8 4 Kenya 2,1 1.9 - 2.4 7 Pakistan 2,1 1.6 - 2.6 7 133 Angola 2,0 1.7 - 2.1 5 Congo, 2,0 1.5 - 2.2 3 Democratic Republic Cote d´Ivoire 2,0 1.7 - 2.2 5 Georgia 2,0 1.6 - 2.3 7 Indonesia 2,0 1.7 - 2.2 14 Tajikistan 2,0 1.7 - 2.4 4 Turkmenistan 2,0 1.6 - 2.3 3 140 Azerbaijan 1,9 1.8 - 2.0 7 Paraguay 1,9 1.7 - 2.2 7 142 Chad 1,7 1.1 - 2.3 4 Myanmar 1,7 1.5 - 2.0 4 144 Nigeria 1,6 1.4 - 1.8 9 145 Bangladesh 1,5 1.1 - 1.9 8 Haiti 1,5 1.2 - 1.9 5
57	Time orientation-VI Clocks/Watches & Clock makers Protestants vs Catholic areas (Culture makes almost all the difference-David Landes) Time orientation among the rural/urban No watches among the sadhus
58	TIME ORIENTATION Circular vs the Climactic
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60	Subjective cultures versus Objective cultures- Factor VII
61	Subjective cultures versus Objective cultures
62	Subjective cultures do not support scientific development because Interpret reality subjectively Access knowledge subjectively Subjective attitudes in justice and gender
63	WHY DO WE FALL SICK?
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65	Cont. We believe that each organ of the body is influenced by some deity. When we deviate from the path of religion …the gods leave our side. This is why we fall sick.
66	Mantra that can shatter the moon
67	Indian religions… In their fundamentals were subjective till Global influences reached them. WASAV (Widely Accepted Shared Absolute Values) characterize an objective culture and needed for development. Polytheistic idolatry does not produce a WASAV culture.
68	AYURVEDA
69	Origin of Ayurveda is attributed to Brahma 4 headed Brahma (first person of the Trinity ) who created the universe revealed Ayurveda. Since it was revealed research was not thought of as necessary.
70	"7 causes of diseases-" 7 causes of diseases-
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73	Buddhist influence & Ayurveda Susruta 7 th century BC Charaka
74	EIGHT PARTS OF AYURVEDA Shalya – surgery Shlakya – treatment of diseases of parts situated above the clavicles, such as disease of the eyes, nose, etc Kaya-chikitsa – general diseases affecting the whole body Bhoot-vidya – demonical diseases
75	Eight parts of Ayurveda Kumara-bhritya – management of children Agada – antibodies for poisons Rasayana – treats of medicines preserving vigor, restoring youth, etc. Vajikarana – describes the means of increasing the virile power by giving tone to the weakened organs of generation.
76	Waning of Buddhist influence Ayurveda declined..became subjective Surgery was banned
77	Arabic influence-7^th AD to 13AD Arabic scholars from the east helped document the remedies (Tuhafatul-masiha) Bimaristans were established.
78	Colonial rule.. Ayurveda developed Colleges were established Herbs were grown
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80	Ideas Can we create an instrument to measure subjectivity levels in a culture? Will subjective cultures be more resistant to development than objective ones? Will Polytheistic Idolatrous cultures be more subjective than monotheistic ones?