The Shaman Told Me So!

NARRATIVE ESSAYS

The Shaman Told Me So! Salim Hani, MB BCh BAO; Siew Mooi Ching, MMed; Mohd Azizi Sanwani, MSc (Fam Med 2012;44(5):356-7.)

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t was just 11 o’clock in the morning. The nurse wheeled in another patient, Anuk. Instantaneously, a horrible stench seeped through the room. It was so pungent, I could hardly breathe, but Anuk seemed impervious to the smell. He was subdued and tried very hard to avoid any eye contact. I made a quick assessment, just to have an idea what I was dealing with. The distended abdomen underneath his shirt coupled with the bilateral leg swelling suggested congestive heart failure. Politely, I introduced myself, and the gentleman who accompanied the patient told me that he was concerned about the patient’s health conditions. This pleasant gentleman was Anuk’s neighbor, who further informed me that Anuk lived alone, and his income was derived from the sale of the rattan he gathered from a nearby forest. Unfortunately, he hadn’t been able to work for nearly a month due to his medical condition and was dependent on the mercy of his neighbors for his daily needs. Suddenly, Anuk leaped to his feet shakily. I was taken aback. He looked at me straight in the eye and pointed at himself. “Doctor, there’s nothing you can do. I broke the rule when I was in the forest and now the forest guardian is angry. This is what happens when you make the guardian angry!” He sounded defensive and frustrated at the same time. 356

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“How do you know that the guardian is angry at you?” I replied carefully. “The shaman told me so!” he exclaimed breathlessly. Astounded, I tried to hide my expression, I’m afraid, unsuccessfully. Was I really hearing this? “Young doctor like you will never understand,” he said with dismay. I knew I might have gotten off on the wrong foot in this consultation, but I wasn’t ready to give up. There must be a way, I told myself optimistically. I drew a deep breath. “I tell you what. Why don’t you tell me about this forest guardian? I’m new here, and I might bump into it at some point. A young doctor like me doesn’t know about the guardian because your generation gave up on telling us about it,” I explained, trying to sound serious and to avoid another mishap. A few seconds passed in silence. At last he nodded with a weak smile. I listened dutifully as Anuk began to tell me about his clan and how proud he was of its traditions and beliefs system, which has existed for centuries. I understood then that the shaman played a significant role in this community as he was the intermediary between the people and the supernatural power that governs their day-to-day living, including life and death. The shaman was such a respected person in his society that whatever he told them, they believed him implicitly. By this time,

Anuk had become more breathless, arduously gasping for air. Acute pulmonary edema, I thought. I knew I had to do something quickly before he collapsed. “Well, the shaman has his magic, I have mine too. Probably not as good as his but I guess it’s OK,” I said in jest while racking my brain for another way if this fails. Why didn’t anyone teach me how to deal with this kind of situation in medical school? What should I do if he refused to accept my “magic”? “Show me!” he said dubiously. Fortunately, he was so impressed by my “magic,” a simple X ray of his lungs, that he agreed later on to let me “help” him with his problem. I managed Anuk to the best of my abilities and resources and later successfully referred him to the nearest hospital for further treatments. I was able to communicate with the attending physician to update myself on Anuk’s progress and to arrange a follow-up appointment for him to see me once he was discharged. Two weeks later, he walked into my clinic where we sat down and discussed more about his health issues, one thing at a time. I’d realized that by accepting Anuk and showing a respectful attitude toward his beliefs, From the Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor (Drs Hani and Ching); and Centre of Diploma Programmes, Multimedia University, Cyberjaya Selangor, Malaysia (Dr Sanwani).

FAMILY MEDICINE

NARRATIVE ESSAY

it made it easier for him to return back for continuity care. The last time I saw Anuk, he told me that after cycles of rituals by the shaman, the forest guardian already had forgiven his bad deeds and was willing to give him another chance. By this time, he’d already ventured back into the forest in search of rattan. This is my first encounter of a cross-cultural problem, and it is an eye-opening experience for a scientifically trained practitioner like myself. By practicing cross-cultural care, primary care physicians will not only be able to find out the individual patient’s social and cultural factors that can determine his or her health beliefs and behaviors but also manage to negotiate with them for the best health outcome.1 Primary care

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physician should not undervalue the importance of addressing spiritual concern with patients in daily practice.2 Patients’ reflection on spirituality should be discussed further by using the patient’s words and modify them to suit the particular situation during the clinical situation. Further, as a clinical physician, we can develop our own personal style and phrasing to achieve the same wave length of thoughts with our patients for their best interests. Patients often initially remain entranced in their beliefs; therefore, respectful questioning and reassurance will play an important role to overcome this problem. At the end of the day, a patient-centered approach is still the mainstay of focus in cross-cultural care as it definitely

will improve the doctor-patient relationship and subsequently health outcome.3 CORRESPONDING AUTHOR: Address correspondence to Dr Hani, Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia. hani@medic. upm.edu.my.

References 1. Carrillo JE, Green AR, Betancourt JR. Crosscultural primary care: a patient-based approach. Ann Intern Med 1999;130(10):829-34. 2. Puchalski CM. The role of spirituality in health care. Proceedings (Baylor University Medical Center) 2001;14(4):352. 3. Boon H, Brown JB, Gavin A, Kennard A, Stewart M. Breast cancer survivors’ perceptions of complementary/alternative medicine (CAM): making the decision to use or not to use. Qual Health Res 1999;9(5):639-53.

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