Healthcare systems in societies are influenced by a number of factors. Cultures in themselves are complex sets of shared mores, beliefs and norms among which individuals are born and brought up. The gaining of cultural values is incipient and individuals pick up cultural traits subconsciously. These are also communicated across generations and are acquired from institutions such as schools and universities, from peers and colleagues, and also from the media. Individuals acquire characteristics of culture without conscious learning, and it is the culture which allows individuals to develop methods of dealing with stress and distress. Cultures also empower individuals to cope with stressors, whereas the cultural values dictate what is normal and what is deviance. This also means that the culture and the society decide which condition should be treated and where it should be treated. As a result, cultures dictate what resources are made available, who gets these resources and how these are utilised. In addition, cultures determine what pathways individuals follow for their help-seeking and at what step of the pathways alternative therapies are chosen and utilised.

Healthcare systems

In many cultures more than one healthcare system coexists. Patients and their carers often choose a certain healthcare system because of their previous experience with that particular system, because someone with the same condition recommends it, or becasue other systems have failed to alleviate their distress. The patients bring to their clinicians a series of complaints which are their formulations in their own words and ‘experiences of dissolved changes in states of being and in social function’ (Eisenberg, 1977). These social functions are worth bearing in mind because they include the patients’ ability to deal with social obligations. Help-seeking might reflect a need for social support or might have secondary gain reflected in the release (however temporary) from social obligations and other social processes which may or may not be directly related to the illness or symptom (Mechanic, 1975). Therefore, presentation to the doctor with physical symptoms (which may reflect underlying psychological distress) starts to make sense.

There is no doubt that different cultures see the role of the doctor in different ways. Patients may seek help from structured statutory healthcare if they believe that to be the right source or they may choose to take treatment in the personal or folk sector.