Social structure
The family is a source of stability for Russian Americans.
Elders are expected to help raise their grandchildren if both parents are
working and children are expected to care for their elders in old age. Children
are expected to be respectful of their elders, addressing them as Mr., Mrs.,
Uncle, or Aunt. The strongest personality in a Russian family (mother, father,
eldest son, or eldest daughter) is usually the spokesperson and decision-maker
for the family. Family members have strong kinship bonds, provide support for
each other during a crisis, and are often consulted during health care
planning, especially when consents for release of information are required.
Compared with other major immigrant populations in the U.
S., Russian Americans are generally older (83 percent are age 50 or older),
have fewer children, and are more educated (95 percent have at least a high
school diploma).
In addition to speaking Russian, most Russian immigrants
also speak the language of the republics where they formerly lived (e.g.,
Belorussian, Ukrainian, and Uzbek). Native languages of Yiddish and Ladino are
also spoken at home, although typically only the oldest generation of Russian
Jews can still understand and speak these older languages. Many Russian
Americans hold professional positions as physicians, engineers, and teachers,
although many encounter difficulties pursuing careers in the U.S. due to
certification or licensing requirements. The most recent arrivals tend to be
less educated and are employed in manufacturing, trade, and service industries.
Many small, Russian-owned businesses have been successfully launched in the
United States.
Diet
Russian Americans often maintain a diet high in fat,
carbohydrates, and sodium, contributing to health problems that include
diabetes, hypertension, and coronary and gastrointestinal diseases.
During the early years of communism and food shortages in
Russia, the main concern was eating enough calories to stay alive. Meals were
heavy, fatty, and salty, though otherwise bland. The ideal meal for a working
peasant included boiled buckwheat with lard and a fermented drink made from
dense, sour, black bread—food that would “hold you to the earth” and last a
full working day. Conventional wisdom dictated that the richer and more fatty
the food, the harder one would work. Traditional meals eaten by some Russian
Americans today include pickled and dried meats, fish, bread, potatoes,
dumplings, porridge, cabbage and beet soup, and vegetables.
Religion
In the US, many Russian immigrants practice Judaism or
Eastern Orthodox Christianity, Russia’s traditional and largest religion. The
Eastern Orthodox church is widely respected by both believers and nonbelievers,
who see it as a symbol of Russian heritage and culture. Many Russian immigrants
in the US also belong to Christian Baptist and Pentecostal churches. Smaller
numbers of Russians follow other Christian religions, such as Roman Catholicism,
Armenian Gregorian, and various Protestant denominations. As a product of the
anti-religion policy of the former Soviet Union established in the early 1900s,
many Russian immigrants are atheists.
Medical care
Common diseases seen in immigrants from Eastern Europe
include diabetes, hypertension, coronary disease, gastrointestinal problems,
tuberculosis, mental illness, and alcohol and substance abuse.
Some Russians believe that disability or illness is caused
by something the individual did not do right, such as not eating well or not
dressing warmly enough. Good health is equated with absence of pain. Illnesses
that do not cause pain often go undiagnosed and under-treated, such as
diabetes, hypertension, and high cholesterol. Mental illness is regarded as
disgraceful in many Eastern European countries. Immigrants often do not answer
questions regarding a family history of mental illness or past treatment.
Expression of feelings in Russian culture is different from
that in American culture. Many immigrants are unfamiliar with the cultural
etiquette of American medicine and tend to expect more compassion and emotional
closeness with their physician—seeking a professional yet close relationship
with providers. In Russia, a patient can confess to a doctor as if speaking
with a priest. Problems can arise in the health care setting directly from this
cultural difference. Rather than appreciating the privacy and autonomy of
American medical culture, patients may complain about the quality of medical
treatment they receive and question the physician’s ability to understand their
problems.
Practices associated with physical examinations in Eastern
European culture are different from those in American medical culture. In
Eastern Europe, hospital gowns are not provided during examinations. Most
patients are examined in their undergarments; nudity is not considered
shameful.
Some immigrants from Eastern Europe may be distrustful of
physicians and reject health recommendations, such as refusing to take
medications as prescribed or combining medications and therapies with home
remedies and treatments. Home remedies are often used prior to seeking medical
attention, such as oil rubs, mud or steam baths, and exposure to fresh air and
sunlight. The “bonki” is a cold and flu remedy where glass cups are pressed on
a sick person’s back and shoulders to ease symptoms. The bonki often leaves
behind bruises and welts, which may be misinterpreted as a sign of physical
abuse. When a Russian person is ill, family members and friends are expected to
visit in order to provide support to the individual and immediate family. Bad
health news is not given to a person who is ill or disabled. The family does
not want the person to become anxious. It is commonly believed that the
individual needs to be at peace so physical and emotional conditions do not
worsen. The family prefers to receive the news first, then decides whether or
not to tell the patient of the condition and prognosis. Eastern European
immigrants tend to appreciate the high quality medical care, equipment, and
variety of medications available in America. They especially value the right to
choose their own physician and receive follow-up care from that same physician.
They appreciate having excellent medical services available in cities and
remote areas, with preventive check-ups covered by insurance, home health
aides, transportation services, and programs like meals on wheels.
Death and dying
To ensure a more peaceful death, family may believe that the
patient should not know of imminent death. The moment of death and the
patient’s last words are highly significant. In some cases families may prefer
to care for the patient at home rather than a nursing home. Some family members
may ask a rabbi, priest, or others to pray for the patient. Depending on the
person’s religion, family members may want to wash and dress the body. Jewish
families never leave the body alone until after burial as a sign of respect.
Some Jews believe that the body should remain intact. Because both Christians
and Jews believe the body is sacred, organ donation is uncommon. Most Russians
will refuse autopsy. Jewish law forbids euthanasia and assisted suicide.
Culture in context
Culture is essential in assessing a person’s health and
well-being. Understanding a patient’s practice of cultural norms can allow
providers to quickly build rapport and ensure effective patient-provider
communication. Efforts to reduce health disparities must be holistic,
addressing the physical, emotional, and spiritual health of individuals and
families. Also important is making connections with community members and
recognizing conditions in the community. Get to know your patients on an
individual level. Not all patients from diverse populations conform to commonly
known culture-specific behaviors, beliefs, and actions. Generalizations in this
material may not apply to your patients.
Source: www.stratishealth.org
Source: www.stratishealth.org
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