Health Care Providers' Handbook On Hindu Patients .
Queensland HealthHealth care providers’ handbook onHindu patients
State of Queensland (Queensland Health) 2011.This document is licensed under a Creative CommonsAttribution, Non-Commercial, Share Alike 2.5 Australia licence.To view a copy of this licence, /au/deed.enYou are free to copy, communicate and adapt the work fornon-commercial purposes, as long as you attributeQueensland Health and distribute the resulting work onlyunder the same or similar license.For permissions beyond the scope of this licence contact:Intellectual Property OfficerQueensland HealthGPO Box 48Brisbane Queensland 4001Email: IP Officer@health.qld.gov.auPhone 61 7 3234 1479For further information contact:Queensland Health Multicultural ServicesDivision of the Chief Health OfficerQueensland HealthPO Box 2368Fortitude Valley BC Queensland 4006Email: multicultural@health.qld.gov.auSuggested citation:Queensland Health. Health Care Providers’ Handbookon Hindu Patients. Division of the Chief Health Officer,Queensland Health. Brisbane 2011.Photography: Nadine Shaw of Nadine Shaw PhotographyHealth care providers’ handbook on Hindu patients
Table of contentsPreface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Section one: Guidelines for health services . . . . . . . . . . . . . . . . . . . . . . . 6123456789101112131415Communication issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Interpreter services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Patient rights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Religious observance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Prayer and meditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Bathing and cleanliness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Dietary needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Astrological beliefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Decision making. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Administation of medicines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Traditional medicines and remedies. . . . . . . . . . . . . . . . . . . . . . . . . 10Medicines of animal origin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Clinical examination and procedures. . . . . . . . . . . . . . . . . . . . . . . . . 10Hygiene. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Oral hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Maternity services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Community health services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Home visits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Rehabilitation issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Visiting arrangements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Care of family and older persons. . . . . . . . . . . . . . . . . . . . . . . . . . . . .13End of life issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Deceased patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Autopsy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13Section two: Hindu beliefs affecting health care. . . . . . . . . . . . . . . . . . 141 Food beliefs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Karma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153 Holy days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Fasting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Dress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156 Mental health and/or cognitive dysfunction. . . . . . . . . . . . . . . . . . . . 167 Transplants and organ donation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Sexual and reproductive health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Contraception. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Abortion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Assisted reproductive technologies . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Pain management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1610 Death and dying. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Section three: Additional resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . 171234Hindu organisations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Queensland Health resources and contacts. . . . . . . . . . . . . . . . . . . .Foods suitable for vegetarian Hindus. . . . . . . . . . . . . . . . . . . . . . . . .References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181920223
PrefaceIn 2010, Queensland Health and the Islamic Council of Queensland published the Health Care Providers’ Handbook onMuslim Patients (second edition) as a quick-reference tool for health workers when caring for Muslim patients.This handbook, the Health Care Providers’ Handbook on Hindu Patients, covers a similar range of topics and aims toinform health care providers about of the religious beliefs and practices of Hindu patients that can affect health care.The handbook has three sections: Guidelines for health services Hindu beliefs affecting health care Additional resourcesEach section provides practical advice and information for health care providers which is designed to answer some ofthe more common questions about Hindu patients and the religious practices of Hinduism that affect health care. Thehandbook also provides links to further information and contacts within the Hindu community of Queensland.Health care providers work in an increasingly diverse environment. Those who display cross-cultural capabilities in theirwork use self-reflection, cultural understanding, contextual understanding, communication and collaboration to provideculturally appropriate, responsive and safe health carei. This handbook aims to support health care providers by buildingtheir knowledge of the needs of Hindu patients.The Health Care Providers’ Handbook on Hindu Patients was written under the guidance of an advisory committeecomprising:Jenny Burton (Children’s Health Services)Shyam Das (Global Organisation of People of Indian Origin, Queensland)Kermeen Kansara (Royal Brisbane and Women’s Hospital)Vinita Khushal (Global Organisation of People of Indian Origin, Queensland)Jennifer Mace (Logan and Beaudesert Hospitals)Balaji Motamarri (Princess Alexandra Hospital)Rajni Nair (The Prince Charles Hospital)Pt Sanat Pandey (Shree Sanatan Dharam Hindu Association of Queensland)Surendra Prasad (Federation of Indian Communities of Queensland)Jennifer Ryan (Mater Health Services)Sarva-Daman Singh (Indian Consulate in Brisbane)Krimesh Shukla (Princess Alexandra Hospital)Other resourcesThe Health Care Providers’ Handbook on Hindu Patients forms part of the Queensland Health Multicultural ClinicalSupport Resource which provides ready-reference information on issues that affect health care provision to people fromculturally and linguistically diverse backgrounds.The Multicultural Clinical Support Resource also contains the Health Care Providers’ Handbook on Sikh Patients and theHealth Care Providers’ Handbook on Muslim Patients.All resources are available on the Queensland Health website at www.health.qld.gov.au/multiculturali The Queensland Health Cross-Cultural Capabilities are: self-reflection, cultural understanding, context, communication and collaboration.Refer to www.health.qld.gov.au/multicultural4Health care providers’ handbook on Hindu patients
IntroductionQueensland is a culturally and religiously diverse state– in 2006 nearly one in five Queenslanders (17.9 percent) was born overseas, 7.8 per cent of the populationspoke a language other than English at home, andmore than 129,000 people followed a religion otherthan Christianity. Between 2001 and 2006, one of thefastest growing religions in Queensland was Hinduism.Figures from the 2006 census show there are more than114,000 Hindus living in Queensland . This figure is nowlikely to be higher as, between 2007–08 and 2009–10,permanent migration to Australia from Southern Asia,which includes India, Sri Lanka, Bangladesh and Nepal,was second only to permanent migration from Europe2.The increasing cultural, linguistic and religious diversityin the Queensland population means that to be safe,health services need to be culturally appropriate andresponsive. Research indicates a strong link between lowcultural competence, and poor quality health outcomesand significant risks3.There is much diversity in the beliefs and practices ofHindus, with hundreds of diverse sects and no centraldoctrinal authority. As Hinduism grants individualscomplete freedom to practice his or her religion asthey choose, there are personal and cultural variationsthat make it difficult to provide definitive rules andregulations that apply to all Hindu patients. Because ofthese personal variations, it is important that health careproviders consult the patient about their personal level ofreligious observance and practice.However, Hindu patients should not be regarded as a‘special’ group that require additional attention fromhealth care providers. Due to the common Hindu beliefsof karma (the belief that every action has a consequencewhich is experienced in this or future lives) andreincarnation, Hindu patients may display acceptance ofdifficult circumstances and be inclined to comply with theinstructions of health care providers.Personal level of adherenceHinduism is the world’s oldest living faith and thirdlargest religion. It is practiced in many countries aroundthe world, including by large populations in Southernand South East Asia, Europe, Africa, North America andAustralia.5
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1. Communication issues2. Interpreter servicesThe 2006 census showed that more than 80 per centof Queensland’s Hindu population was born overseas,with the majority of people coming from a non-Englishspeaking country. Health care providers should beaware that many Hindu patients may not be proficient inEnglish.All Queensland Health patients have a right to aninterpreter at no charge. Queensland Health policy isto always use a professional interpreter and to only usefriends or family in an emergency. People under18 years of age are not to be used as interpretersunder any circumstances.The other languages most widely spoken by Hindus inQueensland include:Queensland Health staff can request interpreters onlinethrough the Interpreter Services Information System(ISIS). Queensland Health staff should contact theirHealth Service District Interpreter Coordinator for l/interpreters/QHIS contact.aspBengaliMarathiFijian ashmiriTamilMalayalamTeluguIf a patient is assessed to have inadequate English,health care providers should engage a professionalinterpreter. Queensland Health provides a statewideinterpreter service that can provide onsite, telephone andvideo remote interpreters in more than 100 languages.Other Queensland Health resources which can assist witheffective communication include: Language Identification Card – a card/poster whichcan assist health care providers to identify more than60 languages Guidelines on working with interpreters – acomprehensive guide for health care providers on howto work with interpreters Ward Communication Tool – a booklet which features30 words commonly used in health care, translated in30 languages, with an accompanying graphic.Further information about communicating with patientsfrom a culturally and linguistically diverse background iscontained in the Queensland Health Multicultural ClinicalSupport rt tools/mcsr.asp3. Patient rightsQueensland Health supports and implements theAustralian Charter of Healthcare Rights.The charter specifies the key rights of patients andconsumers when seeking or receiving cr exp improve/australiancharter.aspUnder the charter, all patients have seven healthcare rights: Access – a right to access healthcare services toaddress healthcare needs. Safety – a right to receive safe, high-quality healthservices provided with professional care, skill andcompetence. Respect – a right to be provided with care thatshows respect to culture, beliefs, values and personalcharacteristics. Communication – the right to receive open, timelyand appropriate communication about health care ina way that can be understood. Participation – the right to participate in makingdecisions and choices about care and about healthservice planning. Privacy – a right to the privacy and confidentiality ofpersonal information. Comment – the right to comment on, or complainabout care and have concerns dealt with promptly andproperly.7
There are three guiding principles which describe howthe charter is applied in the Australian health system:1. Everyone has the right to be able to access healthcare and this right is essential for the charter to bemeaningful.2. The Australian Government commits to internationalagreements about human rights which recogniseeveryone’s right to have the highest possible standardof physical and mental health.3. Australia is a society made up of people withdifferent cultures and ways of life, and the charteracknowledges and respects these differences.These rights apply to patients from all cultures and faithsin the health care setting.4. Religious observanceHinduism grants individuals complete freedom topractice his or her religion as they choose. As a result, itis important that health care providers discuss religiousobservance needs with each patient.Some topics that health care providers may wishto discuss with their patients include prayer andmeditation, bathing and cleanliness, dietary needs andastrological beliefs.8Prayer and meditation Prayer and meditation are important to many Hindus. There are no set times for prayers. However, mostHindus prefer to pray in the morning. Prayer can take place in any location, including in bedor in hospital prayer rooms. Hindu patients may wish to have religious statues oricons close by when in hospital.Bathing and cleanliness The concept of purity is important to Hindu life andsome Hindus may be quite meticulous about bathingand cleanliness. Most Hindus have a ritual of cleanliness and prayereach morning which includes brushing the teethimmediately upon waking, followed by bathing, prayerand then eating. A delay in eating to follow this ritual should not beinterpreted as a refusal to eat. Washing of hands prior to eating is important as manyHindus eat with their hands. Washing with running water is important to Hindusand most will prefer a shower rather than a bath. Women may be considered impure or unclean whenmenstruating or following childbirth4,5.Health care providers’ handbook on Hindu patients
Dietary needs Many Hindus are strict vegetarians, abstainingfrom all meat, fish and eggs. Vegetarian Hindus doconsume dairy products. Hindus who choose to follow a vegetarian diet do sobecause of a belief in non-violence which extendsto animals, and a belief that non-vegetarian foodimpedes spiritual development6. Some Hindus choose to eat meat and do not follow avegetarian diet. Most non-vegetarian Hindus do not eat beef orpork7 as cows are considered sacred and pigs areconsidered unclean4. Many non-vegetarian Hindus may choose to abstainfrom eating meat on particular days of the week. Forexample, a strict vegetarian diet may be observed onMondays. Some strict vegetarian Hindus will not eat from platesor use utensils that have previously been used toserve meat. Most Hindus will eat only with the right hand. Somemay not eat food which has been passed to them withthe left hand. Fasting is common for Hindus and can vary fromcomplete abstinence to only avoiding certain typesof foods7. Fasting on a particular day of the week is also acommon practice.Refer to section three for a table of foods suitable forvegetarian Hindus.Astrological beliefs Many Hindus hold strong astrological beliefs and maybelieve the movement of the planets has a stronginfluence on health and wellbeing5. Patients may wish to schedule appointments orsurgeries according to these beliefs.5. Decision-makingHinduism views the needs of the individual in the greatercontext of family, culture and environment8.As a result, family members, especially elders, can havea strong influence on decision-making related to healthmatters, including informed consent.Hindus may wish for family members to be responsiblefor making treatment decisions.9
6. Administration of medicinesHindus may use a variety of Ayurvedic medicines, homeremedies and spiritual remedies, often in conjunctionwith Australian medicine. It is important for health careproviders to be aware of their patient’s preferences.The manufacturer’s product information gives detailsabout the composition of the medicine (i.e. listingthe active and inactive constituents/ingredients) andprovides a description of how the medicine was produced(e.g. whether manufacture of the product includedexposure to animal derived s/documents/general policies/prods anim origin.pdfAyurveda is a holistic system of medicine practiced bymany Hindus around the world. It is a highly valued andrespected health science in India.7. Clinical examination andproceduresAyurveda is practised by many Hindus in Australia andAyurvedic medicines are regulated by the TherapeuticGoods Administration (TGA). As a discipline, Ayurvedasits alongside Traditional Chinese Medicine in the TGAclassification of complementary medicines9.Modesty is an important consideration for Hindu menand women, and patients may prefer to be examined by ahealth care provider of their own gender. Hindu patientsmay also wish to have a family member present during aclinical examination or procedure.Based on Ayurvedic principles, Hindus believe that allillnesses, whether physical or mental, have a biological,psychological and spiritual element10. Ayurveda seeks tomaintain a balance between the body’s three elementalenergies (humors). Good and bad health is related to thelevel of balance of these three energies.The need for invasive examinations may need to becarefully explained, particularly if a same-sex cliniciancannot be accommodated.Traditional medicines and remediesMany Hindus also use traditional home remedies whichare based on Ayurvedic medicine and are easily availablefrom Indian grocery stores.One of the most common Hindu spiritual remedies isvibuthi, or holy ash. Vibuthi is commonly used in Hi
4 Healt ar ovider atients Preface In 2010, Queensland Health and the Islamic Council of Queensland published the Health Care Providers’ Handbook on Muslim Patients (second edition) as a quick-reference tool for health workers when caring for Muslim patients. This handbook, the Health Care Providers’ Handbook on Hindu Patients, covers a similar range of topics and aims to
4 Health care providers’ handbook on Muslim patients Preface In 1996, Queensland Health and the Islamic Council of Queensland published the Health Care Providers’ Handbook on Muslim Patients as a quick-reference tool for health workers when caring for Muslim patients. The handbook aimed to
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