EBSALUTA’s MAR [15-08]: “Binat” as an Obstacle in Delivering Healthcare

Medical Anecdotal Report
Indexing Title: EBSALUTA’s MAR [15-08]
MAR Title: “Binat” as an Obstacle in Delivering Healthcare
Date of Medical Observation: September 10, 2015
Tag: The influence of traditional beliefs on healthcare
Category: Professional/ Ethical (Reinforcement)

Narration:

One time while I was doing my evening rounds, I noted that a patient s/p Appendectomy for Acute Suppurative Appendicitis was having a fever (38.2ºC). I promptly tried to look for the source of her fever and asked her if she is currently experiencing any coughs, colds, abdominal pain, and difficulty in urination. I also auscultated her lungs and palpated her abdomen to see if there are any problems. On inspection of her hand, I noted a slight swelling and erythema from where her previous intravenous line was inserted. I told her and her mother to put a warm compress on her hand to remove the swelling. I also told her mother to accompany the patient to the restroom to help her take a bath. The patient’s mother was not looking me in the eye and was not giving any cues if she agrees to follow my instruction. I then repeated my instructions and asked her if she understood what I told her. The patient’ mother’s face then turned to a frown and told me that she would have to ask her husband first about the matter since before when she took a bath after giving birth she had gotten “binat” and her husband scolded her afterwards. I do not know then if I would laugh at her words or be angry that she does not believe me, a medical personnel, or pity her for having such backward beliefs. After a while I gotten hold of my composure and told her that in the end it will be her choice but my stand as a doctor is still for her to give her daughter a bath in order to lower down her fever. When I left the room I could hear her conversing with the guardian of another patient vehemently defending her decision.

Insight:
Category: Physical, Professional/ Ethical, Psychosocial) (Discovery, Stimulus, Reinforcement)

I remember when I was a small child, my mother would scold me to not play outside after having a fever. She would tell me that I might catch “binat” and that would be the end of the conversation. Even as I reach adulthood I still hear the word “binat” being thrown around, whenever someone is still feeling under the weather. It just falls under one of those things that you take as truth without questioning its source. But now as a physician, I consider it only as a source of misunderstanding.

So what is “Binat”? There is no equivalent English word for it. It may mean having a relapse of illness, after having an episode of illness. Or for postpartum women, performing forbidden activities that would result in illness not only in the immediate post-delivery period but also years after. With a cursory search in the internet, you could see pages of websites discussing how to combat “binat”. These are tech savvy women, who belong to the Generation Me, but still dispenses old wives’ tales to cure a vague medical phenomenon.

Miscommunication is one of the problems that we health professionals often encounter. And in my case a miscommunication happened when a traditional belief did not translate well into our medical field. It might be tempting to get high and belittle the patient’s mother’s beliefs. But her belief is a deeply-rooted one. It was what was taught to her by her mother, her other relatives, and her friends. And follows well with the Filipino saying, “wala namang mawawala kung susundin.” In her mind the validity of the belief is proven by the absence of any illness, because she performed the rules surrounding “binat” to a point.

In the end, as health professionals it is tasked upon us to explain our instructions well and distinguish which among the traditional beliefs are helpful for our patients. We must remember that we should treat our patients as partners in dealing with their medical condition. And antagonizing them would lead to a toxic relationship or worse the patient would drop our consult and pursue his/her harmful beliefs.

ROJoson’s Notes (17jan20):

The best approach in dealing with the mindset of patients and their beliefs is to respectfully control them with a clear and convincing explanation.  If faced against the wall, agree to disagree.

 

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