Question

Elmer and Mary Miller, both 35 years old, live with their five children in the main
house on the family farmstead in one of the largest Amish settlements in Indiana.
Aaron and Annie Schlabach, aged 68 and 70, live in the attached grandparents’
cottage. Mary is the youngest of their eight children, and when she married, she and
Elmer moved into the grandparents’ cottage with the intention that Elmer would take
over the farm when Aaron wanted to retire.
Eight years ago, they traded living space. Now, Aaron continues to help with
the farm work, despite increasing pain in his hip, which the doctor advises should be
replaced. Most of Mary’s and Elmer’s siblings live in the area, though not in the same
church district or settlement. Two of Elmer’s brothers and their families recently
moved to Tennessee, where farms are less expensive and where they are helping to
start a new church district.
Mary and Elmer’s fifth child, Melvin, was born 6 weeks prematurely and is 1
month old. Sarah, aged 13, Martin, aged 12, and Wayne, aged 8, attend the Amish
elementary school located 1 mile from their home. Lucille, aged 4, is staying with
Mary’s sister and her family for a week because baby Melvin has been having
respiratory problems and their physician told the family he will need to be hospitalized
if he does not get better within 2 days.
At the doctor’s office, Mary suggested to one nurse, who often talks with Mary
about “Amish ways,” that Menno Martin, an Amish man who “gives treatments,” may
be able to help. He uses “warm hands” to treat people and is especially good with
babies because he can feel what is wrong. The nurse noticed that Mary carefully placed
the baby on a pillow as she prepared to leave.
Elmer and Mary do not carry any health insurance and are concerned about
paying the doctor and hospital bills associated with this complicated pregnancy. In
addition, they have an appointment for Wayne to be seen at Riley Children’s Hospital,
3 hours away at the University Medical Center in Indianapolis, for a recurring cyst
located behind his left ear. Plans are being made for a driver to take Mary, Elmer,
Wayne, Aaron, Annie, and two of Mary’s sisters to Indianapolis for the appointment.
Because it is on the way, they plan to stop in Fort Wayne to see an Amish healer who
gives nutritional advice and does “treatments.” Aaron, Annie, and Elmer have been
there before, and the other women are considering having treatments, too. Many
Amish and non-Amish go there and tell others how much better they feel after the
treatments.
They know their medical expenses seem minor in comparison to the family
who last week lost their barn in a fire and to the young couple whose 10-year-old child
had brain surgery after a fall from the hayloft. Elmer gave money to help with the
expenses of the child and will go to the barn raising to help rebuild the barn. Mary’s
sisters will help to cook for the barn raising, but Mary will not help this time because
of the need to care for her newborn.
The state health department is concerned about the low immunization rates in
the Amish communities. One community-health nurse, who works in the area where
Elmer and Mary live, has volunteered to talk with Elmer, who is on the Amish school
board. The nurse wants to learn how the health department can work more closely with
the Amish and also learn more about what the people know about immunizations. The
county health commissioner thinks this is a waste of time and that what they need to do
is let the Amish know that they are creating a health hazard by neglecting or refusing
to have their children immunized.

4. If you were the nurse to whom Mrs. Miller confided her interest in taking the baby
to the folk healer, what would you do to learn more about their simultaneous use of
folk and professional health services?
5. List three items to discuss with the Millers to prepare them for their consultation at
the medical center.
6. If you were preparing the reference for consultation, what would you mention about
the Millers that would help to promote culturally congruent care at the medical
center?
7. Imagine yourself participating in a meeting with state and local health department
officials and several local physicians and nurses to develop a plan to increase the
immunization rates in the counties with large Amish populations. What would you
suggest as ways to accomplish this goal?

Answer 1

4.Some of the things which has to be known in the simultaneous use of folx medicine and professional health service are

• Make sure that there will even no interaction between two treatments which can cause adverse reactions
• Assess for the use of traditional herbal medication and its effects
• Have a knowledge regarding the religocultural aspects of them in regards to health care services

5.The three items to be discussed are

• The necessity and importance of immunization for children which can prevent certain diseases and can reduce the risk of their being infected
• Health educating on the need to do genetic screening on their child to assess for any type of disorders because certain genetic diseases happens generation after generation continuously
• Annual health checkup or periodic health check up for elders especially and for them annually ,for childrens as per the provider advice and necessity
• Informing them about the level,type of care which will be provided to the child

6.The best way to mention is they belong to Amish community .This prior information can help them to be prepared to handle and meet their specific needs in a cultural competent way.

7.Some of the things which can be suggested are

• Health educating the childrens right from their schooling, so that atleast the future generation will know its importance and get vaccinated to prevent illness and stay healthy
• Regular screening for genetic disease in the community and creating awareness
• Use 9f technology to show them the rate disorders in visual form which can change their mind and think towards the need of immunization.