HELP...Health care considerations for the Amish culture

DuluthMike · Apr 1, 2010

I'll give you a good working framework to begin with. Amish view disease not as pathogenic, but as caused by divine power. Thus, curing can be accomplished only through prayer. Medicine is viewed as healing only through god, as the body is a divine temple. Penicillin doesn't cure, god cures. Preventative medical care is forbiden. This does not mean that they do not take measures to prevent illness.

cluv2nurse · Apr 1, 2010

Thankyou

Baloney Amputation, BSN, LPN, RN · Apr 1, 2010

It's been a few years, but I remember a story from nursing school where a nurse from a university hospital located about 20 minutes away from the largest Amish settlement west of the Mississippi where an Amish woman was in preterm labor and needed medical intervention. However, nothing was to be done until the husband went back to the elders and okayed the financial considerations of this treatment, because apparently the whole community takes the burden of paying for the medical needs like this when necessary.

Again, it's been a few years since I heard it so my recollection of details may be not so great, but it did make an impression on my ears...

SWS RN, ASN, RN · Apr 1, 2010

There is an interesting aspect to this. I am not sure about the Amish and their outlook on disease but I did have first hand experience to a problem.

I was working in a large Childrens hospital PICU and we admitted a very sick 3 mo Amish baby. Respiratory distress, failure to thrive and a multitude of other condition. After much careful testing, it turned out that the baby had SCIDS (congenital immuneodifficiency) basically had no immune system.

Called in a genetic specialist to do a work up on the family.

Found out that the parents were first cousins...and the grandparents were first cousins...wait, it gets better...the greatgrandparents were also first cousins.

These people were not immoral, in fact they were very staid, religious and caring, but this was common in their family's group. They do not marry outside of their religion and usually stay within their community. Not a real big choice of partners.

Really sad for the family, they had a young son that was ok, I guess,who knows what will happen as he grows up. The genetics there were really scary.

s

noyesno, MSN, APRN, NP · Apr 1, 2010

There is an interesting aspect to this. I am not sure about the Amish and their outlook on disease but I did have first hand experience to a problem.
I was working in a large Childrens hospital PICU and we admitted a very sick 3 mo Amish baby. Respiratory distress, failure to thrive and a multitude of other condition. After much careful testing, it turned out that the baby had SCIDS (congenital immuneodifficiency) basically had no immune system.
Called in a genetic specialist to do a work up on the family.
Found out that the parents were first cousins...and the grandparents were first cousins...wait, it gets better...the greatgrandparents were also first cousins.
These people were not immoral, in fact they were very staid, religious and caring, but this was common in their family's group. They do not marry outside of their religion and usually stay within their community. Not a real big choice of partners.
Really sad for the family, they had a young son that was ok, I guess,who knows what will happen as he grows up. The genetics there were really scary.
s

I wanted to be Amish for a long time until I found out about the interbreeding...

I found this website:

http://my.clevelandclinic.org/healthy_living/healthcare/hic_treating_the_amish_and_addressing_their_health_care_concerns.aspx

Its specific to Ohio Amish but it had the following relevant information:

How do the Amish feel about seeking medical attention?

The Amish believe in folk medicine: faith healing, pow-wows, and herbal treatments. They believe that a higher level of medical science is simply not necessary. However, they also believe that good health (mental and physical) is a gift from God, and needs to be taken care of. They believe that medicine helps, but God heals.
The Amish are very careful medical consumers. If an Amish person is seeking medical treatment, it indicates that it is an emergency or a very important concern.
The Amish religion does not forbid its people to seek modern medical care. When necessary, the Amish can have surgical procedures, dental work, anesthesia, or blood transfusions. Organ transplants are permitted, except for the heart. The Amish believe the heart is the soul of the body. (Exception: Pediatric patients who have not been baptized can receive a heart transplant.)
In some Amish districts, all forms of insurance are discouraged, including medical insurance. The Amish believe insurance is a "worldly product," and purchasing it shows a lack of faith in God.
The Amish pay little attention to preventative care. It is hard to impress upon them the importance of immunizations, cancer screenings, PAP smears, and mammograms. This is largely because they believe that God heals them, but also because they might not be able to afford preventative care.
Many Amish will refuse an autopsy.
The Amish do not believe in birth control.
Most Amish need to have church permission to go to a hospital because the church pays for such care.
Amish discourage the use of Life Flight helicopters.

As a health care provider, how should I treat the Amish?

The Amish do not like to be seen by a health care provider who is in the "learning" process. The Amish believe if they are going to pay out-of-pocket for their health care, they want to be seen by an experienced practicing physician. Use interns as observers.
Amish patients prefer to be on a first-name basis. They also prefer doctors who will sit with them and discuss their health care questions one-on-one.
Speak to them at an eighth-grade level. The Amish learn well with demonstrations, picture stories and role modeling. Take time to educate them.
Speak to both the husband and wife if a response or health care decision is needed. If the church is paying for the care, you will also need to speak with the church's clerical representative.
When seeing an Amish patient, do not discuss money first . Educate the patient and family on the condition, the healing process, and the signs and symptoms of an emergency.
Allow more than the regulated number of visitors in the hospital. Because the Amish have to pay for someone to bring them to the hospital, it is not uncommon to have the whole family present.
Because the patient and family can only make limited Clinic visits, try to incorporate as much as possible into one appointment (such as assessments, test, educational sessions, etc.).
The elderly believe in rationing care near the end of life because they do not want to waste the family's, church's, and community's money.
Discuss all possible treatments and interventions. However, realize the Amish might refuse treatment due to lack of electricity, money, or understanding of their condition or treatment options.
If the Amish patient refuses treatment but you feel treatment is needed, speak to the patient about his or her potential disability. The Amish fear disability more than the threat of death. Also speak to the patient's clerical representative.
Let the Amish patient know in advance when he or she is being discharged so transportation arrangements can be made. Drivers are not easy to hire on short notice.
The Amish prefer to die at home rather than in a hospital.
Encourage home health care whenever possible. Home health care can be less expensive than a hospital stay and care delivered in their environment could lead to a better understanding of their illness and how to care for it.
When prescribing medicines, keep in mind that they might not have a means of keeping them consistently cold.
Because the Amish pay in cash, they expect discounts on the bill. Many times they will refuse treatment if they feel it will cost too much. Ask the patient and his or her family if they will have difficulty paying their hospital bills, then offer whatever assistance is possible (for instance, recommend the BCMH Fund [bureau for Children with Medical Handicaps] or the Crippled Children Fund. The Ohio Crippled Children Fund, run by the state of Ohio, provides free medical care for children up to the age of 17 who have long-term illnesses. Free medical care is also available at the Shriners Hospitals.) Some liberal Amish do have limited health insurance, with a $500 to $1,000 deductible before the church or work insurance coverage begins. Contact social services to assist with billing questions and problems. The Amish take their financial obligations seriously. Paying bills is more than just a family affair, it's the whole community's and sometimes the church's obligation.

Elvish, BSN, DNP, RN, NP · Apr 1, 2010

You may not be talking specifically about OB concerns, but 'A Midwife's Story' by Penny Armstrong is a great book. She was/is a nurse midwife who delivered babies for Amish families in Pennsylvania and even if you aren't interested OB practices/beliefs specifically, it is still a very interesting book. Great insight on the customs and beliefs of the Amish. :up:

mamamerlee, LPN · Apr 1, 2010

Funny little story - - An Amish gentleman was going to have some surgery, and needed to take a shower w/an antiseptic soap. I explained about the shower, and gave him towels and a clean gown and robe. It didn't occur to me that he didn't know to keep turning the knob until that water got warm.

Poor guy took an ice cold shower.....I was so apologetic, but he was stoic.

rph3664 · Apr 1, 2010

I live in an area with a large Amish and Mennonite population, and they are often patients here. Most do not have prenatal care, because they believe that pregnancy is not a disease (and usually it isn't) and most babies are born at home, delivered by lay Amish midwives who often carry solar-powered cell phones and know when to call an ambulance if they are in over their heads.

Most are also unvaccinated, which has led to some extremely tragic and preventable illnesses.

Otherwise, they pretty much have the same health problems as the non-Amish, except we're much less likely to be injured in buggy accidents. There was a fatal one in this region a couple years ago. :scrying:

taz628, BSN, RN · Apr 1, 2010

Oooo... the Amish. My grandmother was Amish - but then shunned for marrying a heathen. I've taken care of SEVERAL Amish patients. One of my FAVORITE patients ever was an Amish man in his 70's who had suffered a stroke. lovely man, until he ripped out his A-Line. :) Not his fault - we under estimated his overall lack of understanding. Overall, they can be a wonderful group to work with if you have patience. The information above pretty much sums everything up. The ones I've come across have become fairly knowledgeable in their own way when it comes to medications - especially if it's for their children. Other beliefs tend to be a bit antiquated as well. Had one young child brought in for rattle snake bite, father tied a very tight tourniquet on the child's leg and cut open the wound to suck out the poison. The docs were worried the child may lose that leg... but from lack of circulation d/t the tourniquet mostly - it was in place for over an hour as they carried the pt from deep into the woods to the nearest place to phone for help.

Baloney Amputation, BSN, LPN, RN · Apr 1, 2010

The Amish children around here are barefoot a lot, even in grocery stores...it could be a health care consideration, I guess.

rph3664 · Apr 1, 2010

The Amish here in Illinois and Missouri seem to be a little more accommodating to modern ideas than the Ohio Amish. Many have kerosene- or propane-powered appliances, and if someone has a medical condition that requires the use of electricity, may have a solar panel on their house.