Module 4: Traditional Theories of Health and Disease PDF

FAMILY AND COMMUNITY MEDICINE TRADITIONAL THEORIES MODULE 4 OF HE...

FAMILY AND COMMUNITY MEDICINE TRADITIONAL THEORIES MODULE 4 OF HEALTH AND DISEASE Abigaille A. Chua, MD, DFM, CSLI 6A, 4D WHY STUDY FILIPINO MEDICINE? OUTLINE To enhance cultural competency of Filipino physicians, I. Why Study Filipino Medicine? nurses, dentists and other health professionals A. The Philippines WHO recommended the integration of traditional medicine in B. Culture and Cultural Awareness medical education and primary health care since 1978 II. Sakit World health assembly resolutions since 1981 called upon A. Disease vs. Illness member states to integrate traditional medicine in their health B. Pain care systems III. Filipino Terminologies for Illness and Health Philippine government policies and laws supportive through IV. Filipino Traditional Medicine’s Definition of Health and the Philippine Institute of Traditional and Alternative Health Wellness Care (PITAHC, Republic Act 8433, 1997) A. Theories and Beliefs Patients already inquiring if not requesting their physicians B. Explanatory Model of Disease and health care professionals for complementary and V. Causes of Illnesses in Filipino alternative medicine A. Naturalistic 1. Pasma THE PHILIPPINES 2. Nabinat, Nabughat Composed of ethnolinguistic groups with their own cultural 3. Namamana identities and health practices 4. Lihi Filipinos are diverse, having different beliefs, religious 5. Dietary Prohibitions practices, traditions, myths, and superstitions B. Personalistic 1. Nabalis, Nabuyagan, Nabati CULTURE AND CULTURAL AWARENESS 2. Binangungot Culture is defined as the totality of socially transmitted 3. Nakulam, Nabarang pattern of thoughts, values, meanings, and beliefs (Purnell 4. Sinapian 2005) 5. Namaligno ○ Is not limited to any specific ethnic group, geographical a) Nuno area, language, religious belief, manner of clothing, b) Duwende sexual orientation and socioeconomic status c) Tikbalang The relationship of culture and health is important to d) Kapre understand its impacts on an individual’s worldview and e) Manananggal decision-making process 6. Nagayuma Cultural awareness is a prerequisite to achieving cultural 7. Sumpa competency 8. Gaba ○ It is the understanding that a cultural divide exists VI. Diagnostic Tools, Therapies, and Prevention in Filipino between the patient and health professional Traditional Medicine (Winkelman 2009) A. Faith Healers 1. Albularyo SAKIT B. Pagtatawas Sakit can either mean disease or illness, or as pain. C. Hilot (Palpation with Massage) D. Magpapaanak DISEASE VS ILLNESS 1. Suob Sometimes used interchangeably, but they're actually a) Steam inhalation/Therapy different from each other E. Tapal F. Unton DISEASE ILLNESS 1. Red Dot G. Anting-anting Refers to abnormalities of Caused by interaction of H. Weapons to Fight Aswang the structure and function of the biological, I. Mag-asawang Gamot body organs and systems psychological, and J. Fate (Eisenberg, 1977) social factors K. Bahala na Refers to the subjective L. Kaloob ng Diyos response of the patient to M. Other Superstitions being unwell VII. Key Points Refers to pathological Refers to subjective REFERENCES: entities that make up the response of the patient to Dr. Abigaille A. Chua — PPT & Lecture medical model of ill health being unwell which can be specifically How he and those around NUMBER OF PAGES: 09 identified and described by him perceive the origin reference to certain and significance of this biological, chemical or other event evidence Module 4 Traditional Theories of Health and Disease 1  THEORIES AND BELIEFS How it affects his behaviour or relationships THEORY OF BODY HUMOURS with other people Init (hot) and lamig (cold) /Yin and Yang in Chinese Medicine Steps he takes to remedy Basa (wet) and tuyo (dry) this situation Balance within the human body and the environment Dominance in one will lead to a disease state (e.g. Disease is objective Illness is subjective pasma/pilay) Disease is something an Illness is something a man BELIEF IN NATURE SPIRITS organ has (Cassell, 1978) has (Cassell, 1978) Filipinos also believe in nature spirits or guardians of nature and spirit ancestors PAIN EXPLANATORY MODEL OF DISEASE Has different qualities or characteristics Can occur anywhere in the body Cultural beliefs and patients’ explanatory models of illness Can be sharp or makirot, burning, squeezing, stinging or may influence their understanding of their condition, how they mahapdi decide regarding medical management and treatment Can be further described in terms of alleviating or options, and how they cope with the condition aggravating factors, severity, timing and its location as it can occur anywhere in the body Example: A patient with the following symptoms may have schizophrenia as a differential. (+) Hallucinations FILIPINO TERMINOLOGIES FOR ILLNESS AND HEALTH (+) Delusions Health in Tagalog is kalusugan (+) Disorganized thinking ○ Root word is lusog = full development; progressiveness (+) Abnormal motor behavior Worldview/Understanding: Health-seeking behavior: mental illness health professional (psychiatrist) possessed by a demon priest/albularyo CAUSES OF ILLNESSES IN FILIPINO Disease etiology: divided into naturalistic and personalistic NATURALISTIC PERSONALISTIC Pasma Nabati Binat Sumpa Namamana Gaba Mataba Malusog Payat Lihi Namaligno (Fat or Obese) (Healthy) (Thin) Dietary Prohibitions Kaloob ng Diyos A healthy person is described as malusog in contrast to payat NATURALISTIC (thin) who has not attained a full potential of physical PASMA development Similar to the Spanish word “espasmo”, which translates to ○ A payat person is not malusog, but is also not ill spasm Other terminologies to describe a person who is sick is It refers to the imbalances of the hot and cold and how mahina (weak) or matamlay (lethargic) water facilitates the entry of negative or cold energy to the ○ If one is “may sakit” (ill), it means that person is unable to body perform physical tasks and therefore should rest at home ○ This is why Filipinos do not take a shower immediately after a workout or after a strenuous physical activity FILIPINO TRADITIONAL MEDICINE’S DEFINITION OF Often the reason cited behind hand tremors, sweaty palms, HEALTH AND WELLNESS numbness, and pain Health and wellness is the state of harmony, balance and It does not exist in modern medicine, NO pasma in textbooks synergy ○ Between humankind and the universe Baths are generally avoided after childbirth, for as long as 14 to ○ Between humankind and nature 21 days. Until now, this is being practiced. However, not taking a ○ Between and among humankind bath can lead to infection. ○ Within the human body, mind, and soul If broken and not mended, then disease, death, and destruction will occur Module 4 Traditional Theories of Health and Disease 2  NABINAT, NABUGHAT PERSONALISTIC A state of disease or severe discomfort that results when NABALIS, NABUYAGAN, NABATI a person who has undergone a stressful or change of life Transfer of energy from one person to another situation, a body mind, fatigue, or prolonged illness upon the “Balis” is believed to be caused by an admiring or first few hours of feeling well returns to his normal daily complimentary greeting routine Believed that the comment carries “bad wind”, entering the weak and defenseless bodies of infants and young children The sick person, before they have fully recovered, will get sick Immediate antidote is to say: “pwera bati” or “pwera usog” again. Some people do not post their babies, or if they do, they cover NAMAMANA their faces. They believe that jealousy/envy can cause harm and A belief that when a relative has the condition, it is possible misfortune to the baby. To counter this dark energy, a charm in that he or she will pass on the trait to the younger generation the form of the evil eye is used. Inheritance ○ Acquiring a behavior or disease trait from a parent BINANGUNGOT ○ Passing on a trait to a younger generation. Sudden nocturnal death syndrome Example: a father with achondroplasia may pass on his trait ○ Sudden and unexplained death in sleep (SUDS) to his son Mythological creature called Batibat or Bangungot Creature sits on the victim’s face or chest to immobilize and LIHI suffocate them A concept used to explain why some children are noted to ○ The victim is experiencing sleep paralysis have certain specific characteristics “Do not sleep when your stomach is full” ○ “Pregnancy cravings” ○ Belief that sleeping while full leads to sudden nocturnal During the “lihi” period (first trimester of pregnancy), the death syndrome pregnant woman experiences a number of physical Medical explanation: Sudden arrhythmic death syndrome or discomforts including feelings of dizziness, nausea, irritability Acute hemorrhagic pancreatitis and general weakening of the body ○ She develops an intense craving for certain foods and Other Asian countries have names for this peculiar phenomenon: intense liking for certain objects “Lai Tai” in Thailand It is believed that an offspring will take the features of the “Hukuri” in Japan food that the mother has craved for a while she is in the “lihi” period NAKULAM, NABARANG Examples: ”Mangkukulam” is the term used for the people who practice ○ Children with crab-like arms and legs were brought about sorcery for revenge or to do evil things to people by their mother's craving for crab ○ Also called as sorcerers ○ Those with skin resembling fish-like scales were brought ○ Usually found in rural areas or provinces in the about by a craving for fish Philippines ○ “Albularyo” or herbal doctors are known to have knowledge to help cure the person who has been under the spell Sorcery, use of black magic Revenge to enemies Voodoo doll, needle, or any belongings of the victim and a recitation of a spell in Latin Sicknesses that are visually disfiguring are also commonly If a woman steps over her sleeping husband assumed to be caused by kulam. (lalaktawan/lalakdawan), the pregnancy symptoms will be passed to him. The husband will experience nausea, intense Examples: food cravings, etc. Psoriasis where patches of thick red skin and raised patches are seen on skin. DIETARY PROHIBITIONS Women are told not to breastfeed when tired, or else they will Ascites is a chronic illness and a condition in which fluid builds pass the tiredness to the baby up in the abdomen. This is often caused by liver problems but Ilocos region: Eating malunggay is prohibited during the some people believe that a mangkukulam placed a foreign wake because of the way it is prepared – by stripping the object into the sufferer’s body. leaves one by one Psychosis or Paranoia is a medical condition that involves ○ This is believed to mean that the family members will also irrational suspicions or uneasiness with others. Patients with die one after the other paranoia often believe that they are being threatened despite Batangas: When a family member dies, the household is not having little to no evidence. allowed to eat vegetables that crawl, like squash or eggplant ○ It is believed that there will be succeeding deaths in the According to Dr. Michael Tan (2024), kulam reveals that family. Filipinos lack of health literacy and how widespread and Wasting food is believed to cause busong (bad luck) dangerous that can be. Eating twin bananas can lead to birthing twins Bringing home food from a wake is prohibited because it leads to bad luck Module 4 Traditional Theories of Health and Disease 3  SINAPIAN Spirit possession by the devil Not unique to the Philippines Recorded in the Bible ○ The story of man possessed by demons, and the demons begged Jesus to send them to the pigs instead KAPRE Are basically tree giants NAMALIGNO They stand about 7 to 8 feet tall with a muscular build ”Namaligno” is an umbrella term They only exhibit violent tendencies when the tree they are Describes being exposed to evil spirits of malicious entities resided is under the threat of being cut down or when you cut thought to cause various ailments down their tree A Filipino belief that a disease is caused by an intervention of a supernatural or a mystical being Used as an explanation in conditions which remain to be mysteries because of the absence of an apparent cause NUNO Nuno sa Punso or Nuno is a dwarf-like nature spirit in Philippine mythology Believed to live in or inhabit places such as: ○ An anthill or termite mound “Nuno sa Punso” means ancestor, old man, or grandparent living in the anthill ○ Underneath large rocks ○ Trees ○ Riverbanks ○ Caves MANANANGGAL Also known as “tiktik” o “wakwak” ○ Backyard Mythical creature in the Philippines that is able to separate its Described as a small old man with a long beard upper torso from the lower part of its body When walking in a grassy area, a farm, or a forest, people Their fangs and wings give them a vampire-like appearance say "tabi-tabi po" (please move aside) To feed: ○ To tell the Nuno to stand aside because they’re passing ○ Manananggal chooses an isolated place where she will through his territory leave her lower torso while she hunts at night A goblin that is easily angered and will do harm to those who ○ When she separates from her lower torso, she then gains damage or disturb his mound her ability to fly ○ Example: He will seek retribution by causing the foot of ○ She then goes off in search of houses where pregnant someone who kicked his mound to become swollen women reside ○ Upon choosing a suitable victim, the manananggal alights DUWENDE on the house and inserts her tongue through the roof A playful goblin who shows himself to children The tongue is long, hollow, and extremely flexible She uses it to puncture the womb of the sleeping TIKBALANG woman and to suck out the fetus They are relevant in the Filipino traditional medicine because A giant creature with a face of a horse, body of a man, and miscarriages and stillbirths were blamed on the fetus-eating feet of a horse manananggal They can transform into human form or turn invisible to Whereas, there are a lot of medical conditions that can humans explain miscarriages and stillbirths, such as: In the Philippines, they are known to scare travellers by ○ Chromosomal abnormalities playing tricks on them which will keep them from returning to ○ Diabetes the correct path ○ Infection from cytomegalovirus, mycoplasma, chlamydia, Since they have shape-shifting abilities, they pretend to be a diphtheria, toxoplasma, etc. familiar face to the victim before revealing their true form in ○ Uterine abnormalities an attempt to get people to follow and trust them ○ Incompetent cervix Victims have been lost for days at a time and returned after ○ Substance abuse the tikbalang they encountered gets bored of messing with They are often confused with aswang them, while others have been lost forever, never to be seen again Module 4 Traditional Theories of Health and Disease 4  Discovered (by collecting blood samples and studying the DNA samples of this family) over 50 family members who had the same rare condition in glaucoma patients: Juvenile-Onset Open-Angle Glaucoma (JOAG) ○ JOAG involves a novel myocilin (MYOC) gene mutation, leading to the elongation of the myocilin protein, and the death of the trabecular meshwork cells in the eye occurs as the mechanism brought by elongation, thereby causing ASWANG glaucoma in the affected family members, as explained Shape-shifter by Dr. Collantes Human by day but transforms at night Feeds on fetuses and internal organs (e.g. liver) Goes after the sick, dying, and the dead “Aswang Central” is Capiz Sex-Linked Dystonia Parkinsonism (XDP) ○ To someone who is unfamiliar with it as a disease, they see someone who could be “about to transform into something” ○ Males are affected An image showing JOAG. Read more: Selvan, H., Gupta, S., Wiggs, J. L., & Gupta, V. Juvenile-onset open-angle glaucoma – A clinical and genetic update. Survey of Ophthalmology. Read More: Yang, A. Y. Award-winning Pinoy eye doctor shares his incredible story. GMA News Online. NAGAYUMA Also known as “black magic” Another concept in Filipino medicine is “gayuma” ○ Gayuma increases sexual attraction/energy The use of black magic to persuade or control victim for his/her personal gain or intentions “Love potion” Dr. Chua’s example is Little Mix’s song “Black Magic” and in the lyrics, Doc implies that it is evident that it is not only known in the Philippines, but also in other parts of the world Progeria GABA “Gaba” is the Cebuano word for “karma” Curse inflicted by a divine being and it is usually God The impact of “sumpa” and “gaba” is shared by the whole family and extends to the next generation Inflicted to a person because he/she committed a social sin Predominantly a belief of Filipinos in the central islands of Visayas A love potion as an example of gayuma SUMPA Curse inflicted by human being Example: For Progeria, a female child with baldness and senile appearance may be thought to be cursed and be blamed for the family’s struggles Another example by Dr. Chua is a family who believes that they are under a curse or “sumpa” ○ Gratefully, Dr. Ryan Collantes discovered the genetic In the history of Philippine cinema, the theme of our horror condition of this family, starting with the 16-year-old movies are based on these Filipino mythical creatures patient who consulted them, who suffered from ○ One of the best movies that has a lot of these elements is early-onset glaucoma. Dr. Collantes finds it rare, “Takot ka ba sa dilim” specifically for that age group. In this movie, there are nuno, manananggal, ○ Patient history mentioned about his siblings blind in one albularyo, diwata, etc. eye each, including the father, becoming then a familial ○ Other local TV series/movies shown as example: disease Magandang Gabi, Bayan ○ Driven by curiosity and desire to help, Dr. Collantes went Patayin sa Sindak si Barbara to the provincial hometown to learn more about the Aswang patient’s family history and genetics Module 4 Traditional Theories of Health and Disease 5  DIAGNOSTIC TOOLS, THERAPIES, AND PREVENTION IN FILIPINO TRADITIONAL MEDICINE Some diagnostic tools in Filipino traditional medicine ○ Pulse diagnosis (“pamulso”) Not only utilized in the Philippines, but also in traditional practices in China ○ Use of external diagnostic tools: “tawas”, eggs, bottles, (“dahon ng saging”) banana leaves ○ Use of “hilot” (palpation with massage) ○ Laying of the hands HILOT (PALPATION WITH MASSAGE) ○ Reading of aura In rural areas, hilot refers to two different roles: Part of these are faith healers in the Philippines ○ Midwife (Magpapaanak) ○ Chiropractic practitioner (Manghihilot, masahe) FAITH HEALERS In alternative context ALBULARYO ○ Hilot is a practitioner of the craft chiropractic manipulation They are knowledgeable in most of folkloric modalities and and massage are well-versed in the use of medicinal herbs ○ Focuses on the diagnosis and treatment of They usually have a history of a healer in the family line, and musculoligamentous and musculoskeletal ailments their healing is a continuum of a calling, the power or ability bestowed by a supernatural being, often attributed to the Holy Spirit Skills are based and honed on hand-me-down practices Modalities: the prayers (bulong and orasyon) and the use of herbal medicinal plants Albularyo’s diagnostic rituals (e.g. tawas) and treatment modalities (tapal, lunas, bulong, orasyon) are affected by the belief in these creatures and to the maladies they cause: na-nuno, na-dwende, na-lamang-lupa MAGPAPAANAK Albularyo is different from mangtatawas Involves prenatal visits and delivering babies There are some issues in terms of payment, as some In impoverished communities, deliveries are performed by albularyo are requiring high PF (professional fees), some are friends, neighbors, or relatives, who have gained experience, having modern methods or ways for convenience, like online confidence, and the basic expertise in umbilical cord care consultations, and these topics (as a documentary, not a Although uncertified, they have basic knowledge on promotion) are discussed and/or can be watched from some postpartum care and massage, and the use of medicinal trusted sources, GMA Public Affairs, as per Dr. Chua. herbs for the ritual of “suob” Dr. Chua also stated that some albularyos do not require any payment, and are accepting donations (instead of payment or PF), or any amount, or even none at all, since requiring payment can or may affect their power. SUOB PAGTATAWAS Ritual of postpartum care performed two to three weeks after A popular diagnostic ritual performed by most alternative childbirth healers that serves in providing clues as to the nature and Prior to the “suob”, cold body massages are performed by the cause of the illness midwife or “hilot”, for 18 to 21 days after a first born, and 14 Originally derived its name from its chemical nature, “alum”, days for subsequent births which is an astringent crystalline double sulfate of aluminum ○ The massages last 20 to 30 minutes, twice daily for 4 and potassium days, every afternoon for 4 days, every morning for ○ Earlier, it was used exclusively in diagnostic ritual another 4 days, then alternate mornings and afternoons Today, tawas refers to a diagnostic ritual or procedure for a total of 18 to 21 days utilizing a variety of materials — candles, eggs, mirror, paper, ○ The massages are believed to hasten the mother’s return cigarette rolling paper, and alum to health and healing of her obstetrical wounds ○ Most common: candle (melted candle wax method) ○ During these 2 to 3 weeks, bathing other than sponge The candle is melted and dropped into a basin filled baths is prohibited. with water On the 18th day, preparations are started for the situal “suob” As it cools down, the candle wax forms into an image ○ Nine to ten indigenous herbal ingredients are collected which reveals the evil spirit that might caused the and placed in a big wok-like ware, at the center of which disease is placed an indigenous rock (batong-buhay) of sufficient Done by a mangtatawas size for the mother to sit on ○ Diagnose only, but not treat Suob has also been used to drive away evil spirits and ○ They refer the patient to the albularyo “negative” physical influences Module 4 Traditional Theories of Health and Disease 6  RED DOT A Kapampangan practice of putting a red dot or red lipstick on a child's forehead to ward off "balis" or "usog" STEAM INHALATION/THERAPY Steam inhalation is a widely used home remedy to soothe and open the nasal passages and get relief from the symptoms of a cold or sinus infection ANTING-ANTING Also called steam therapy Filipino counterpart for “amulet” or “charm.” It involves the inhalation of water vapour Filipinos wear anting-anting or agimat to protect them from The warm, moist air is thought to work by loosening the evil spirits and remove hexes mucus in the nasal passages, throat, and lungs ○ Mainly for protection and to ward off evil spirits This may relieve symptoms of inflamed and swollen blood Preventive vessels in the nasal passages Sinukuang Kahoy TAPAL ○ Para sa mga may galit o sama ng loob sa iyo, pangontra Prayer is essential and integral to rural life and its approach din ito sa mga mababangis na hayop to health and illness ○ Ginagamit din ako pang sangkap sa gayuma, sinasabing In some areas, there are prayerist who are asked to invoke kapag meron ka nito ay kaya mong mapasuko ang isang on behalf of their healing needs taong matigas ang puso at mapaamo ang mababangis na The prayers, usually in Latin, are often used for countering hayop evil spirits, preventing physical harm, or as an added ritual to many mundane events ○ Examples: headache, hiccups, burns, sprains, back pain Used usually in provinces where babies have a paper in their forehead, known as tapal, with written prayer on it ○ Scribbled onto the patch is a prayer in piglatin. The user has found it to be the most effective in her armametarium of prayers, orasyon or bulong WEAPONS TO FIGHT ASWANG To ward off “aswangs,” the weapons that we use include: Young child with an orasyon patch on the forehead placed ○ Garlic because of protracted hiccups ○ Buntot pagi ○ Palm leaves (palaspas) UNTON Waived by Catholics after the Palm Sunday mass to Used primarily for the prevention of "balis" commemorate Jesus’ triumphant entry to Jerusalem It's a malady in infants and young children, manifesting with before his passion and death headaches, abdominal cramps, flatulence, nausea or vomiting It is believed to be brought about by a bad wind or negative energy that accompanies innocent complimentary greetings or comments The bad winds unintentionally delivered with the greetings enter the weak and defenseless bodies of infants and young children Buntot pagi, palm leaves (palaspas), and garlic Module 4 Traditional Theories of Health and Disease 7  MAG-ASAWANG GAMOT “Husband and wife medicine” ○ Usually in rural areas ○ Also called “kambal na gamot” Amoxicillin + Mefenamic Acid (or Paracetamol) Dispensed by the “botica” (drug store), even by some sari-sari stores, upon request without a prescription It is usually taken as a single dose for a variety of illnesses Painting of seven horses for good luck and complaints ○ Examples: flu-like symptoms, colds, gastrointestinal disorders Self-medicating placebo and pharmacy based combination therapy commonly used by the rural folk in the Quezon area Implications: antibiotic resistance ○ Because of single dose of amoxicillin FATE Oro, Plata, Mata for the steps of the stairs Based on astrological influences and the belief in individual predestination BAHALA NA Filipinos sometimes attribute their experiences to fate, which “Bahala na” is both an expression and attitude is commonly associated with: It is the openness to uncertainty, the exercise of free will to ○ Palad - the palm of the hand is believed to reveal one’s take a risk in the face of known and unknown factors that fate come into play ○ Swerte - luck, believed to be attracted by performing In Sikolohiyang Pilipino, Bahala na is described as specific practices determination in the face of uncertainty Examples: ○ It is a way of taking risks under uncertainties ○ Preparing a prosperity bowl on New Year's Eve It is the most common notion of fatalism or passive ○ Picture or painting of seven horses (inside Filipino acceptance in the Philippines: attributes human events to the homes) “will of God” Correct placement must be facing inside the room and ○ Bathala = God not facing the door ○ Bahala = to care, to take charge ○ Steps of the stairs are believed to not be divisible by 3; Can be translated as “What will be, will be.” they must always end with Oro or Plata in the chant “Oro, Plata, Mata” KALOOB NG DIYOS Translates to Gold, Silver, Death respectively “God’s will” Many Filipinos will go through great lengths just to When a Filipino individual experiences an unexpected event avoid the stairs from ending in Mata, which brings bad in their life, whether negative or positive, it is typically luck attributed to the grace of God This concept helps families cope and accept their life experiences Common among Filipinos, especially those devout to their religion, to surrender their problems to a higher being, usually God This highlights the Filipino value of religiosity and faith to a higher being as someone who is all-knowing and almighty For both kaloob ng Diyos and bahala na, what actually happens is that people do whatever they can and then resign themselves to whatever will happen (Dr. Michael Tan, 2008) Guide on Palm Reading OTHER SUPERSTITIONS AS TOLD BY DR. CHUA Eating pansit/spaghetti during duty = longer/toxic duty (a lot of admissions); Groupmates can hate you Ice cream is known nationwide to ward off toxicity, “pampa-benign” ○ Eating ice cream before duty, [it is believed] you will have minimal patients only The night before your next duty, you are not supposed to do “dirty living” ○ Do not drink alcohol, party, or have sex ○ Otherwise, you will have a toxic duty the following day Prosperity bowl on New Year’s Eve ○ Whenever one’s duty is toxic, they do the joke and ask “Nag-dirty living ka ‘no?” Module 4 Traditional Theories of Health and Disease 8  KEY POINTS When a genetic or medical condition appears to have no apparent cause, the patient or family may resort to use these beliefs as a form of rationalization to explain why they are affected Cultural health practices may help patients comprehend and make sense of a disease condition that is otherwise overwhelming and to have a perceived sense of control to the eventual outcomes of the condition What does the Bible say? ○ Dr. Chua presented three Biblical Verses (one of these is Deuteronomy 18:9-14), implying that these practices are detestable to the Lord as stated in the Bible: Fortune telling Astrology Horoscope Lucky charms Compassion without competence is just kindness. - Dr. Chua Module 4 Traditional Theories of Health and Disease 9