Describe The Amish Community
Introduction The Amish Church was established in 1693. They are a group of Anabaptists who migrated to North America in the 1700’s to escape religious persecution. Members strive to live their life according to the Christian Bible and keep themselves separate from non-Amish communities. Their ideology is based upon rejection of pride, arrogance, and social and technological advances. They value strict adherence to God’s tenants, especially humility, self-control and simplicity (Sharpnack, Griffin, Benders, & Fitzpatrick, 2010). “The Amish are a group known for their simple living, deep respect for tradition, and focus on family and community relationships” (Holmes & Block, 2013, p. 371). These beliefs come across in every aspect of their
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culture including health and illness. While caring for Amish patients, it is important to have a clear understanding of their cultural beliefs and practices.
Biological Variations and Cultural Aspects of the Incidence of Disease Hereditary diseases are prevalent among the Amish. Although the group is often referred to as a whole, not all Amish communities are the same (Gillum, Staffileno, Schwartz, Coke, & Fogg, 2010, p. 33). Wenger and Wenger (2013) state the prevalence in genetic disorders is dependent upon whether people in certain communities are closely related (p. 123). Because the Amish typically live in close-knit groups, or communities, with intermarriage occurring, hereditary diseases such as dwarfism, hemophilia B, phenylketonuria, and other genetic disorders are more common than in the general United States population (Strauss, Puffenberger, & Morton, 2012). According to Strauss, Puffenberger and Morton (2012), their health risks are deeply rooted in history including poor access to the health care systems (p. 1302). Although the Amish have a decreased prevalence for certain diseases, including drug and alcohol abuse, cancer, asthma and allergies, other conditions, such as obesity, depression, and anxiety are more prevalent. Due to their European roots, their physical characteristics vary. These physical variations include skin tones ranging from light to olive tone, hair color, and eye color. There are no specific health care precautions relevant to this group (Wenger & Wenger, 2013, p.123).
Communication
Although the Amish are fluent in English, their first language is Dietsch, or Pennsylvania German/Dutch. Dietsch is a primarily spoken while communicating with fellow Amish individuals. According to Kraybill, Johnson-Weiner, and Nolt (2013), informal communication includes first names, but with structure changes with awareness of the person’s position in extended family (Informal section, para. 2). English is used for writing and for communicating with non-Amish people (Wenger & Wenger, 2013, p. 118). Their fluency with English is dependent on the amount of interaction they have with people outside the Amish community. Therefore, they may be more comfortable speaking to healthcare providers in their first language (Katz, Ferketich, Paskett, & Bloomfield, 2013). A third language, Hochdietsch, is used for religious purposes such as reading of scripture verses, and in writings, such as religious booklets, and church regulations (Kraybill, Johnson-Weiner, and Nolt, 2013, Standard German section, para.2). Amish people believe that it is important to know health care providers on a personal level (Nolt, 2011, p. 135). Although Amish will seek health care services, they may be uneasy with health care providers who present messages that seem to lead them away from their community (Nolt, 2011, p. 136). Wenger and Wenger (2013) state that “When choosing health-care providers and options, the Amish usually seek counsel from religious leaders, friends, and extended family, but the final decision resides with the immediate family” (p. 131). Therefore, it has been suggested that health care providers establish common ground with their Amish patients and tailor explanations to their community and its leaders (O’Dell, 2009, p. 47).
Cultural Affiliation Amish communities are primarily based in Pennsylvania, Ohio and Indiana, with communities growing in Wisconsin, New York, Michigan, Missouri and Kentucky. In 2012, the Amish Church was composed of over 65 Affiliations and 463 Settlements (Kraybill, Johnson-Weiner, & Nolt, 2013, Our People section, para. 2). According to Andelson (2011), some groups are traditional and some are more progressive (p. 256). Despite their differences, Amish communities have similarities that make them capable of interacting with each other (Holmes & Block, 2013, p. 375).
Cultural Sanctions and Restrictions Amish fundamentalist views support simplicity. This is shown in the simplicity and uniform dress as well as their characteristic quiet demeanor. The men dress in dark solid trousers and a vest or coat. The women dress in dark dresses with a white apron. Women also wear a cover over their hair called a prayer covering. Young men shave but once married they allow their beards to grow long. Conformity to religious and community tenants is extremely important. The community leader, or bishop, makes all major decisions for the community. Their total faith in God’s word and the belief in simplicity make them reluctant to seek healthcare until they are very sick. Birth control is prohibited because children are viewed as gifts from God. If an Amish person does something seriously against their community’s rules or chooses to leave the church after they have been baptized, that person can be shunned, or cast out, from the group (Misiroglu, 2013).
Developmental considerations The Amish are known for their focus on family and community relationships (Holmes & Block, 2013). Therefore, it should be no surprise that giving birth is a community effort. Everyone is involved from the start of delivery to postpartum. Giving birth is usually done at the home and attended by an unlicensed birth attendant, mother, mother-in-law or neighbor (Deline, Varnes-Epstein, Gideonsen, Lynch, & Frey, 2012). Amish mothers are excited about giving birth. To them it is a privilege to carry their husband’s child. During the postpartum phase, they are treated like princesses. Having to cook, do housework or gardening becomes obsolete for a while (Kesslar, 2011). This freedom away from these daily activities, allows mothers to maximize breastfeeding and bonding time. The Amish put the same effort into caring for the elderly as they do welcoming a newborn into the world. The elderly are valued so it is very uncommon to see them in assisted living homes or being cared for by nurses. They are cared for by their families (Mitchel et al., 2012)
Economics
The Amish men take the role as breadwinners, while the women take care of the home. Although many live in areas of low socioeconomic status, they do not rely on electricity, running water, and cars. Many also have jobs outside the Amish communities (Katz, Ferketich, Paskett, & Bloomfield, 2013). Even though participation in government sponsored programs such as Medicare are rare, the Amish developed their own form of insurance called Amish-aid. The community finances the medical cost of its members (Seifter et al, 2013).
Educational background By law, children are only required to attend school through the 8th grade. Amish lifestyle limits attending school until the 8th grade. Literacy tests have indicated that many Amish were reading at the 6th or lower grade level, and had a very low rate for adequate health knowledge when compared to non-Amish participants. These results should be expected since completion of high school, or any post-high school education is not practiced within the Amish community (Katz, Ferketich, Paskett, & Bloomfield, 2013).
Health-related beliefs and Practices The Amish value health and firmly believe it is a gift from God. The practice of “brauche”, a form of faith healing, is evident throughout Amish customs. The Amish are deeply rooted in old traditions and do not follow cultural norms (Gillum et al, 2011). Natural alternatives and spiritual remedies are most prevalent. They are hesitant to take prescriptions medicine, but will freely take natural remedies such as vitamins and herbs. Commonly used alternative healthcare practices were found to be prayer, herbal medicines, relaxation, meditation, self-help techniques, and folk remedies. Herbalists and folk practitioners are common within communities (Mitchell et al., 2012; Sharpnack, Griffin, Benders, & Fitzpatrick, 2010).
Family and Kinship A plethora of perceptions of family exist in the US, but the Amish have a unique perception all their own.
The Amish focus more on the community as a whole, rather than separate families. The family is viewed as the community. What is also unique about an Amish community, or congregation is whenever a community becomes too large, the bishop that oversees the community is in charge of dividing the community. As a result, it is not uncommon for extended family members to belong to different communities. (Misiroglu, 2013). Within an Amish family there are different role patterns for each member of the family. The father takes on as head of the household, and also takes over the family farm. With Amish families averaging seven children, it is the wife’s duty to care for the family, but it is also important to point out that the wife and husband essentially act as partners in the household and the family farm. After grade school, the young people of the family are sent away to work, and experience non-Amish customs and non-Amish behaviors are tolerated. Because of the community focus, part of the earnings from the young people is expected to be sent home to the communities. Another concept observed in an Amish community is the act of the family farm being passed on from ancestors to their children. This is crucial as it is common for the family farm to serve the community (Wenger & Wenger,
2013).
Nutrition
culture including health and illness. While caring for Amish patients, it is important to have a clear understanding of their cultural beliefs and practices.
Biological Variations and Cultural Aspects of the Incidence of Disease Hereditary diseases are prevalent among the Amish. Although the group is often referred to as a whole, not all Amish communities are the same (Gillum, Staffileno, Schwartz, Coke, & Fogg, 2010, p. 33). Wenger and Wenger (2013) state the prevalence in genetic disorders is dependent upon whether people in certain communities are closely related (p. 123). Because the Amish typically live in close-knit groups, or communities, with intermarriage occurring, hereditary diseases such as dwarfism, hemophilia B, phenylketonuria, and other genetic disorders are more common than in the general United States population (Strauss, Puffenberger, & Morton, 2012). According to Strauss, Puffenberger and Morton (2012), their health risks are deeply rooted in history including poor access to the health care systems (p. 1302). Although the Amish have a decreased prevalence for certain diseases, including drug and alcohol abuse, cancer, asthma and allergies, other conditions, such as obesity, depression, and anxiety are more prevalent. Due to their European roots, their physical characteristics vary. These physical variations include skin tones ranging from light to olive tone, hair color, and eye color. There are no specific health care precautions relevant to this group (Wenger & Wenger, 2013, p.123).
Communication
Although the Amish are fluent in English, their first language is Dietsch, or Pennsylvania German/Dutch. Dietsch is a primarily spoken while communicating with fellow Amish individuals. According to Kraybill, Johnson-Weiner, and Nolt (2013), informal communication includes first names, but with structure changes with awareness of the person’s position in extended family (Informal section, para. 2). English is used for writing and for communicating with non-Amish people (Wenger & Wenger, 2013, p. 118). Their fluency with English is dependent on the amount of interaction they have with people outside the Amish community. Therefore, they may be more comfortable speaking to healthcare providers in their first language (Katz, Ferketich, Paskett, & Bloomfield, 2013). A third language, Hochdietsch, is used for religious purposes such as reading of scripture verses, and in writings, such as religious booklets, and church regulations (Kraybill, Johnson-Weiner, and Nolt, 2013, Standard German section, para.2). Amish people believe that it is important to know health care providers on a personal level (Nolt, 2011, p. 135). Although Amish will seek health care services, they may be uneasy with health care providers who present messages that seem to lead them away from their community (Nolt, 2011, p. 136). Wenger and Wenger (2013) state that “When choosing health-care providers and options, the Amish usually seek counsel from religious leaders, friends, and extended family, but the final decision resides with the immediate family” (p. 131). Therefore, it has been suggested that health care providers establish common ground with their Amish patients and tailor explanations to their community and its leaders (O’Dell, 2009, p. 47).
Cultural Affiliation Amish communities are primarily based in Pennsylvania, Ohio and Indiana, with communities growing in Wisconsin, New York, Michigan, Missouri and Kentucky. In 2012, the Amish Church was composed of over 65 Affiliations and 463 Settlements (Kraybill, Johnson-Weiner, & Nolt, 2013, Our People section, para. 2). According to Andelson (2011), some groups are traditional and some are more progressive (p. 256). Despite their differences, Amish communities have similarities that make them capable of interacting with each other (Holmes & Block, 2013, p. 375).
Cultural Sanctions and Restrictions Amish fundamentalist views support simplicity. This is shown in the simplicity and uniform dress as well as their characteristic quiet demeanor. The men dress in dark solid trousers and a vest or coat. The women dress in dark dresses with a white apron. Women also wear a cover over their hair called a prayer covering. Young men shave but once married they allow their beards to grow long. Conformity to religious and community tenants is extremely important. The community leader, or bishop, makes all major decisions for the community. Their total faith in God’s word and the belief in simplicity make them reluctant to seek healthcare until they are very sick. Birth control is prohibited because children are viewed as gifts from God. If an Amish person does something seriously against their community’s rules or chooses to leave the church after they have been baptized, that person can be shunned, or cast out, from the group (Misiroglu, 2013).
Developmental considerations The Amish are known for their focus on family and community relationships (Holmes & Block, 2013). Therefore, it should be no surprise that giving birth is a community effort. Everyone is involved from the start of delivery to postpartum. Giving birth is usually done at the home and attended by an unlicensed birth attendant, mother, mother-in-law or neighbor (Deline, Varnes-Epstein, Gideonsen, Lynch, & Frey, 2012). Amish mothers are excited about giving birth. To them it is a privilege to carry their husband’s child. During the postpartum phase, they are treated like princesses. Having to cook, do housework or gardening becomes obsolete for a while (Kesslar, 2011). This freedom away from these daily activities, allows mothers to maximize breastfeeding and bonding time. The Amish put the same effort into caring for the elderly as they do welcoming a newborn into the world. The elderly are valued so it is very uncommon to see them in assisted living homes or being cared for by nurses. They are cared for by their families (Mitchel et al., 2012)
Economics
The Amish men take the role as breadwinners, while the women take care of the home. Although many live in areas of low socioeconomic status, they do not rely on electricity, running water, and cars. Many also have jobs outside the Amish communities (Katz, Ferketich, Paskett, & Bloomfield, 2013). Even though participation in government sponsored programs such as Medicare are rare, the Amish developed their own form of insurance called Amish-aid. The community finances the medical cost of its members (Seifter et al, 2013).
Educational background By law, children are only required to attend school through the 8th grade. Amish lifestyle limits attending school until the 8th grade. Literacy tests have indicated that many Amish were reading at the 6th or lower grade level, and had a very low rate for adequate health knowledge when compared to non-Amish participants. These results should be expected since completion of high school, or any post-high school education is not practiced within the Amish community (Katz, Ferketich, Paskett, & Bloomfield, 2013).
Health-related beliefs and Practices The Amish value health and firmly believe it is a gift from God. The practice of “brauche”, a form of faith healing, is evident throughout Amish customs. The Amish are deeply rooted in old traditions and do not follow cultural norms (Gillum et al, 2011). Natural alternatives and spiritual remedies are most prevalent. They are hesitant to take prescriptions medicine, but will freely take natural remedies such as vitamins and herbs. Commonly used alternative healthcare practices were found to be prayer, herbal medicines, relaxation, meditation, self-help techniques, and folk remedies. Herbalists and folk practitioners are common within communities (Mitchell et al., 2012; Sharpnack, Griffin, Benders, & Fitzpatrick, 2010).
Family and Kinship A plethora of perceptions of family exist in the US, but the Amish have a unique perception all their own.
The Amish focus more on the community as a whole, rather than separate families. The family is viewed as the community. What is also unique about an Amish community, or congregation is whenever a community becomes too large, the bishop that oversees the community is in charge of dividing the community. As a result, it is not uncommon for extended family members to belong to different communities. (Misiroglu, 2013). Within an Amish family there are different role patterns for each member of the family. The father takes on as head of the household, and also takes over the family farm. With Amish families averaging seven children, it is the wife’s duty to care for the family, but it is also important to point out that the wife and husband essentially act as partners in the household and the family farm. After grade school, the young people of the family are sent away to work, and experience non-Amish customs and non-Amish behaviors are tolerated. Because of the community focus, part of the earnings from the young people is expected to be sent home to the communities. Another concept observed in an Amish community is the act of the family farm being passed on from ancestors to their children. This is crucial as it is common for the family farm to serve the community (Wenger & Wenger,
2013).
Nutrition