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Cultural Influences within a Healthcare Delivery System

Yasmine Rodriguez

Aurora University

Cultural Differences within a Healthcare Delivery System

Armenia, who gained its independence from the Soviet Union in 1991, is today a country in the South Caucasus in Southwestern Asia which shares frontier lines with Azerbaijan, Nagorno-Karabakh Republic, Turkey, Nakhchivan Autonomous Republic, Georgia, and Iran. Owning a territory totaling 11,484.square miles, with an estimated population of 2.93 million as of 2017. Multiple factors play into the healthcare system of Armenia: Culture of that Country and its impact on the system, beliefs, viewpoints and stances, healthcare delivery, and Values.

Armenian healthcare system

Armenia practices care in hospitals as well as ambulatory care services, in a more provincial level. Working side by side with private health care services. Armenia in 2010 began making gradual changes in its healthcare system. According to the World Health Organization (WHO), had 2.3 magnetic resonance imaging for every 1 million residents. Armenia is amongst the lowest in the world when it comes to the government expenditures on health care. Although multiple measures were undertook towards structural and financial reforms of the health system, they only ended in partial improvements. However, public financing of the Armenian health system has increased in recent years going from $17.8 million to about $173.6 million. (CITE)

Culture of Armenia

 Christianity is a very known religion across the world, although it is known across the world Armenia was the first country to adopt Christianity as its state religion circa 301 A.D. With religion comes holidays and Armenian holidays include both Christian cultural holidays as well as Pagan cultural holidays such as Armenian Christmas (January 6) and Trndez (Pagan worship of sun/fire). Pagan culture is influential today due to the empires that ruled the land before Christianity took over. Likewise as celebrating holidays plays an important role in Armenian culture food also plays a role as well. A traditional meal one may see is Harissa, which consists of wheat grain and cooked lamb. But daily food consists of staple food (bread and salt). In fact, Armenia even has a national fruit which is the pomegranate, because it symbolizes fertility. If a holiday takes place then traditional clothing called Taraz is worn and circle dancing is seen. Despite the environment, touching isn't involved unless the people are personally associated. When communicating the Indo-European originated language is prefered although there are two dialects available, eastern and the western Armenian. The Republic of Armenia Ministry of Culture takes care of policies regarding the culture sector in the government.

Beliefs related to health, healthcare delivery

A standard belief of Armenian residents is that everyone residing in the country is ultimately covered by the system of medical benefits, even including maternity and sickness benefits for the self employed and employed. The systems are funded by the people of Armenia through wage taxes and contributions of employers. However if one is to die there are certain beliefs regarding death and the afterlife. Armenians pay respects to their loved ones through services with food and brandy, as well as anniversaries. A common thought about cemeteries is that they are used as a way to communicate between the dead and the living. Armenians believe that health is important to a certain extent depending on the type of care they may afford. Health care is typically delivered through regional polyclinics or rural health stations. There is a scarcity in the ratio of physician to patient, being 1:2,000. Even with the scarsities in place hospital care continues to be the national health system, even though heavy reductions of capacity in hospitals outside the capital, as well as closings of small rural hospitals took place. Reductions were done for financial savings because Armenia lacked resources as before. There is a higher access to care for city and urban residents compared to the lower accessible care for rural residents. The physical conditions in healthcare setting are poor causing staff to not treat patients with the best possible care. The medical reform in Armenia gives patients the right to choose who their primary physician is; however, patients cannot access direct specialists if the primary physician does not refer the patient.Thus, even though the public costs are greatly reduced, actual out-of-pocket costs increase for patients who see a specialist.

Healthcare Practices

 Following recommendations from the World Health Organization, there were more practices implemented to improve education about topics such as, sexual health and hygiene. In January 2004, there was a four day course on management of sexually transmitted infections for gynaecologists and specialists. One may think that having these programs shows an excellent health care funding but that is incorrect. Armenia is known for under-funding their healthcare system. Therefore, diminishing the percentage of rational prescribing practices. Though against the law, antibiotics and injectable medicines that need a prescription may be sold over the counter without a prescription. Causing an illegal practice of drug marketing. In spite of these positive and negative practices, the practice of medicine is highly respected and takes a minimum of six to seven years with additional required practice.  

Viewpoints/stances related to health, disease, treatment vs prevention, healthcare delivery

During the Soviet period, people linked the concept of “disease” to feelings of physical distress. Going about treatments with that mentality included prophylactic examinations to restore patients' health in resorts and special guest houses. In other terms, diseases were not seen as degrading but something that should be prevented and treated in positive settings. Starting from 1989 the public's attitude regarding health began to shift. “Health became a matter of livelihood (ability to survive), and the concept of “illness” was linked to individual's extremely agonizing physical conditions and being bedridden” (Yerevan, 2005, p.35). There are negative viewpoints such as people worrying that once in the system it is highly difficult to be freed and patients having to buy and access drugs for treatment themselves. Many prefer “the ostrich method: Better not to know about our disease, rather than knowing about it and not being able to treat it because of lack of access to drugs” (Yerevan, 2005, p.29). Whereas, The Armenian Public Health Union has avid supporters because it advocates for disease prevention, health promotion and protection. Other programs such as The National Programme for the Early Detection, Treatment and Prevention of Cervical Cancer in Armenia can be seen as positive preventative measures. In the end Armenia emphasizes preventative measures more than treatment measures because the more prevention there is the less of treatments will be needed.

Values and its relation to health, disease, health maintenance, healthcare delivery

Values such as family, spirituality, and education to an extent play a role in health, disease, health maintenance, and healthcare delivery. An Armenian family today includes a married couple with children. In comparison to a family during the soviet rule, families consisted of multi generational members from the paternal side. According to Lamar Soutter Library (2017), women are considered the “bearers and transmitters of culture, customs, and tradition and are seen as responsible for child rearing”(para 6). The oldest member is the head of the family and is very respected as well as consulted in everything done. However, the common 21st century Armenian family does not include older members. Depending on the family structure the type of healthcare delivery is altered. In any family maintaining a healthy environment is key because sicknesses are easily transmitted. Nevertheless, if a member is sick the head of the family will decide what type of care is delivered. On the other hand, Armenian spirituality although it is closely similar to Armenian Christianity, varies in its relation to health, disease, health maintenance, and healthcare delivery. Armenia as a Christian country decides individually how to manage the previously mentioned subjects, taking into consideration the environment and resources or lack thereof. Before, rural areas with less access to education were less likely to have any health messages given. As a result the Ministry of Education decided to include health education programs in the curriculums. Gaining knowledge regarding health, diseases, how to maintain good health, as well as knowing what type of healthcare is delivered positively impacts Armenians from a young age by knowing how to prevent and treat certain diseases.

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