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4SOCIOLOGICAL SCIENCES
SITUATION OF BEHAVIOR OF ETHNIC MINORITIES IN MOUNTAINOUS AREAS IN PREVENTION AND TREATMENT OF DISEASES IN NA RÎ DISTRICT, BAC KAN PROVINCE
Le Van Canh
MSc.
University of Science, Thai Nguyen University
Abstract
With the policy of health development in ethnic minority areas in recent years, there have been positive development steps. The health care, prevention, and treatment of ethnic minorities have improved and improved significantly. However, access to preventive and curative medical services for ethnic minorities still has many issues that need to be addressed. The conduct of ethnic minority people in the prevention and treatment of diseases is still limited, such as self-treatment, spiritual healing, and local practices, lack of knowledge, and subjectivity when suffering from illness. From there, they will choose different types of health services. This reflects the awareness, practical ability, and the level of medical culture of the people. Therefore, raising awareness and change the perception of ethnic minorities in disease prevention and treatment are essential issues to improve access to health services in the mountainous areas today.
Keywords: Behavior, ethnic minorities, disease prevention and treatment, sickness.
1. Introduction
In socio-economic conditions, they are still under-develop developed in deep-20s and remote areas of ethnic minority areas. In which, health services and health care for people are facing urgent problems. Na Ri is a mountainous district of Bac Kan province, socioeconomic conditions are still difficult, geographical distancing, medical facilities are poor, and highly qualified medical staff are lacking. The people living here are mainly ethnic minorities, so the treatment of people in the prevention and treatment of diseases is still limited such as self-treatment, spiritual healing, and local customs, lack of knowledge and subjectness when sick. The reactions of patients and families in healthcare when sick, reflecting the way of handling and choosing the type of health services of mountainous households, not only show awareness, practical ability, influence from cultural customs or social institutions in the locality but also show the program awareness of medical culture. Therefore, to raise awareness and actions of mountainous ethnic minorities in prevention and treatment, it is a matter of concern to developing effective health policies.
From that fact, the author conducts a study on the behavior of mountainous ethnic minorities in the prevention and treatment of diseases in Na Ri district, Bac Kan province. At the same time, it overcomes limitations in the perception and behavior of mountainous people in health care.
2. RESEARCH METHODS
Dosing research method: The topic of collecting dosing information using a questionnaire with 300 questionnaires1. With the method of selecting a random system template. Apply the formula for selecting a random pattern k = N/n, where k is the distance between units in the overall. Statistics use SPSS 23.0 statistical
software to process investigative data.
Method of calculation: conducting 10 in-depth interviews in which 04 Tay people, 03 Dao people, and 03 Mong people are living in the study area.
3. RESEARCH RESULTS AND DISCUSSIONS
3.1 Awareness of ethnic minorities in mountainous areas on disease prevention and treatment
The concept of sickness and disease varies and depends on many factors including perception, age, ethnic culture, and geographical area. However, the awareness of sickness, disease, and treatment methods must have specific scientific grounds and grounds. Based on science, according to the Vietnam Medical Dictionary: The disease is the process of abnormal functioning of the organism (people, animals, plants), from the cause of initiation to the final consequences. The causes of the disease are many, which can be synthesized into three main types: The body itself has defects such as congenital genetics or psychological disorders. Due to the harsh living circumstances of the organism such as overheating, too cold, poisoned, insufficient nutrients. Due to parasites by other organisms (especially microorganisms).
In the field of medicine, "disease" is a way of determining health based on scientific grounds of causes, methods, and treatment processes based on a defined system. This view does not take into account the psychological, social, and cultural aspects of the disease but that a person has a "disease" when there are changes in health indicators such as functional indicators, indicators of chemistry, physics, biology ... However, before the development of science, it was found that the connection between the human psychological aspect is related to pathology. That is, psychological factors have an impact on the formation of diseases.
Scientific research project at Thai Nguyen University "Behavior of mountainous people in disease prevention and treatment (Case study in 2 communes Lam Son and Luong Ha of Na Ri district, Bac Kan province" Subject
responsibility: MSc. Le Van Canh, Faculty of Law and Social Management, University of Science, Thai Nguyen University.
Awareness of sickness and disease plays a very important role in guiding the prevention and treatment of diseases. Usually, patients only recognize the phenomena of sickness and disease in the way of explanation by experience, folk knowledge, oral knowledge. On the other hand, there are notions that
sickness or illness is not the result of the reality of life, but it is dominated by spiritual and religious factors. Especially in mountainous rural areas, with difficult economic conditions, low intellectual level, limited propagation of disease prevention and treatment is one of the factors that affect people's perception of diseases.
Table 1
Awareness of importance in disease prevention
The importance of prevention Frequency Percentage %
Especially important 134 44.7
Quite important 105 35
normal 59 19.7
It doesn't matter. 2 0.7
sum 300 100%
Source: Inquiry data from questionnaire
The survey found that the majority of respondents thought prevention was particularly important, accounting for 44.7%, with 35% of respondents saying it was important. 19.7% thought prevention was normal and only 0.7% thought it was not important. With the results of the study, the perception of ethnic minorities is large that prevention is especially important. However, there is no homily between cozy perception and behavior in many cases. That is, they are aware but behavior can go against perception. For example, when asked about the harmful effects of tobacco on health, the majority of responders said that it affects health, but the reality is that smoking behavior still occurs with large weeks. Awareness of the importance of prevention is associated with many factors such as cultural, ethnic, or academic practice. Education reflects people's perceptions of health as well as medical understandings. The results of the correlation test show that
between education and awareness of the importance of prevention, there is a fairly close connection with each other and statistically significant 2
Awareness of the prevention and treatment of diseases on the one hand can be based on modern medicine. On the other hand, the perception of disease and treatment sometimes relies on inherent indigenous experiences and knowledge. As a result of the survey, 38% of respondents said that they only know about diseases and preventive measures, 31% say they only know a little, while only 3% think they know a lot. Up to 20% of them are unaware of preventive measures and treatment of the disease. From the knowledge of indigenous medicine, the life experience of the people will learn the manifestations of sickness and disease, thereby choosing the appropriate form of treatment. There are even many cases where they rely solely on experience then self-treatment with male pills.
Know briefly Know little Know a lot Do not know Do not care
Figure 1: Level of understanding of sickness and disease(Unit: %) Source: Investigation results from questionnaire
The identification and classification of sickness are not only related to personal knowledge and experiences but also relationships, interactions in the family, and social networks. Identifying patients with the disease, differentiating causes, and treatments often go from individual to family members and community members. However, in the current era of information
technology development, people have more information channels to understand and be aware of diseases and prevention methods.
For individuals who are sick, or sick, they always speculate on their causes and discuss with family members or exchange with experienced people, knowledge in the community, or reach out to the healers and priests. For cases where the disease occurs too quickly,
2 **. Correlation is significant at the 0.01 level (2-tailed), r = 0.462, (P <0.05). Correlation between education and awareness about disease prevention
severely, it is impossible to discuss speculation, identify causes and cures with folk experience, the diagnostic process will not follow these levels but immediately transfer to the appropriate medical area.
Thus, family and community relations have an impact on determining the type of sickness through discussions, comments, so that the sick's family seeks appropriate treatment. The identifying of the type of disease and the causes of the disease lies not only in the
sick individual and their family but also in the close relationship and other social networks.
3.2 Manifestations and classification of sickness
There are various manifestations of sickness, disease. The classification between sickness and illness is based on sensory or sensory manifestations. According to the survey of 300 samples, 30.7% of respondents said that they have been sick or sick in the past 1 year, 69.3% have no disease or sickness.
Table 2
Correlation between age group and disease of respondents
Age group Number of sick people Percentage %
From 1 to 20 15 16.1
From 21 to 40 20 21.5
From 41 to 60 25 26.9
Over 61 years old 33 35.5
sum 93 100%
Source: Inquiry data from questionnaire
The data table above shows that the age group and the extent of the responder's illness are related. The higher the age group, the greater the likelihood of getting the disease, which is proportional to each other. In the group of people aged over 61 years with a higher
90 -83,9
80 -
70 60
50 -
40 -
30
20 -
10 0
incidence, 35.5% were mainly cardiovascular and oste-oarthritis-related diseases. The link between the age group and the number of people with the disease suggests a correlation with each other and statistically sig-nificant3.
72
64
Headache
Sore throat
Osteoarthritis pain
Cough
Fever
Flu
■ Weather factor
Figure 2: The link between the manifestation of the disease and the weather factor (Units %) Source: Inquiry data from questionnaire
The survey results show that some common diseases are thought by the majority of people to be caused by weather conditions as the most basic cause of the current disease. On the other hand, some diseases such as blood pressure, cardiovascular, and osteoarthritis are thought to be largely caused by eating, food is the main cause of the disease. Genetics is also considered one of the causes of diseases such as asthma, tuberculosis, goiter, deformity...
3.3 Behaviour of family members in sickness
Most when patients feel that their body has abnormal symptoms, they often conjecture only about the disease or not caring about the symptoms of the disease. The subjectness of people's perceptions may in part be due to habits and thoughts that are just common diseases, not serious. The survey found that in the past year, 30.7% of respondents said that their family has sick and sick people. The average age of the person with the disease is 40.23 with a standard deviation4 of 22.24.
3 Correlation coefficient r = 0.6 with statistical significance
p < 0.05
4 The average age of the patient Means 40.23, Std. Deviation: 22.24
Table 3
Behavior when sick
Act when sick or sick Frequency Percentage %
Do nothing. 23 6.8
Rested 33 9.7
Work less 67 19.8
Go see the healer 22 6.5
Buy medicine and drink by myself 102 30.1
Self-treatment with natural drugs 35 10.3
To medical facilities 63 18.6
sum 345 100
Source: Inquiry data from questionnaire
To clarify the behavior of ethnic minorities in the treatment of illness, 9.7% of them took a little break and only 6.8% did nothing. Most common diseases or sicknesses, people only rest a little and still work normally but the intensity of work decreases. And they only decided not to do anything when the disease was already severe, while they worked only 19.8% less. Thus, the pressure on the family economy and the diligence of the farmer has had a significant impact on their behavior when sick. The majority of sick people's first act is to buy their medicines for treatment, accounting for the highest proportion of 30.1% of the questioned. Thus, when there are signs of sickness, the patient's family only comes to the Western pharmacy to present the symptoms encountered and consulted by the drug seller, and then they will buy the drug home for self-
45,0% -
40,0% — 35,0% 30,0% 25,0% — 20,0% — 15,0% 10,0% 5,0% 0,0%
treatment. If repeated treatment does not cure them with the decision to go to medical facilities for examination accounts for a fairly high rate of 18.6%. However, according to the results of an in-depth interview, people who sell western medicines to treat someone have a degree in medicine and pharmacy, but many also sell drugs sedates in grocery stores. Especially in mountainous areas when travel conditions are difficult, access to health services is limited, so people self-treatment or treatment with male medicine is also a method chosen by many people to account for 10.3%. However, currently, the mentality wants to cure quickly and only diseases that only cure western medicines with cure, so it is understandable that they choose western medicines for treatment.
41,2%
15,4%
_9,4%
22,4%
_11,6%
Self-purchase and Use it out of habit use according to the knowledge of the drug
Pharmacist's advice
Indications of the treating physician
Advice from relatives
Figure 3: Acts of using Western drugs Source: Inquiry data from questionnaire
The chart above shows that the majority of households using the drug are consulted by drug sellers. When they have symptoms of illness, they will seek the advice of drug sellers and buy medicines that account for the highest rate of 41.2%. In which, buying drugs prescribed by the treating doctor accounted for 22.4% when they had examined and treated in medical facilities. While people taking the drug remained a habit, they self-guessed the disease from the manifestations or by feeling and bought the drug themselves for treatment without the advice of someone who accounted for 15.4%. Some manifestations such as headache, flu, cough, runny nose are diseases that people take medicines as a previously treated habit. On the other hand, the counseling of relatives in drug use also accounted for 11.6% of the number of questioned people. When asked about the benefits of taking western medicines,
37.7% thought it was easy to treat the disease, 32.8% said that many diseases only take western medicine with cure and 24.1% think it is easy to use and convenient. As such, the behavior of using the drug reflects their perception and behavior in the treatment of the disease.
3.4 People's conduct in the treatment of diseases
Self-treatment: When sick or sick, the choice of medical services also reflects the behavior of mountainous people in the treatment of diseases. If you are sick or sick, the majority of people buy their medicines to treat the disease or use male medicines. The treatment with male drugs most people find the healer are experienced and knowledgeable about the effects of each drug. However, most people still know simple male remedies with oral indigenous knowledge. The results
of the investigation also showed that up to 65.3% of people between the ages of 45 and 60 know and use some male medicinal plants to cure some common diseases. Self-treatment is understood to include the act of
treating with male drugs and buying Western medicines. When there are serious manifestations or self-treatment without healing, the majority of people decide to go to medical facilities. This clearly shows their healing responses.
Due to the serious illness
57,!
Advice from relatives
11,0%
Self-treated but not cured
31,2%
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
Figure 4: Cases where people decide to medical treatment at medical establishments Source: Inquiry data from questionnaire
Whether or not a patient decides to go to a medical facility depends on a variety of factors such as patient subjecting, access to medical services, and geographical distance. The results of the study show that the majority of patients decide to go to medical facilities when the disease is already too severe, accounting for 57.8% and accounting for the highest proportion. Meanwhile, 31.2% said they had self-me treated but did not cure themselves and went to medical facilities to know the disease well and have effective treatments. This indicates that there is a match between self-treatment and due to too severe illness they go to medical facilities. On the other hand, the selection of treatment facilities also shows significant differences. In which district hospitals are selected the most accounted for 63.3%, treatment at commune health stations accounts for 33.3%, provincial hospitals are 42.7% and private medical facilities are 35.4%. Thus, the selection of district
hospitals in the treatment and treatment of diseases is used more than most. This shows that the place of initial registration for medical examination and treatment in the commune is not of much interest to the people. According to the results of the in-depth interview, the majority of people said that they only go to the commune health station because the health care is not too serious and because the route is easier, and at the same time to get medicines under insurance and examination of common diseases and the main purpose is to apply for a referral to transfer to the district hospital. Especially when the route in examination and treatment in the district has increased the level of treatment in district hospitals today. According to the statistics, there are many reasons that patients do not go to medical facilities for examination and treatment.
Table 4
Reasons for not going to the doctor and treating the disease
Reasons for not going to the doctor and treating the disease Frequency Percentage %
Because it can be cured on its own 89 29.7
Due to the high cost 95 31.7
Due to incorrect awareness of the disease 147 49
Due to habits 87 29
Due to medical facilities away from their residences 56 18.7
Due to his service attitude, doctors 33 11
Due to cumbersome administrative procedures 64 21.3
Due to non-serious illness 143 47.7
Other factors 29 9.7
Source: Inquiry data from questionnaire
The table above shows why patients do not visit medical facilities with many concerns. In particular, because people's awareness of the disease does not understand correctly, it accounts for the highest rate of 49%, which has a contradiction between perception and behavior in the behavior of mountainous people in the treatment of diseases. If they did not understand the disease, they should have been consulted, examined, and treated by the medical facility to understand information about the disease. But when they do not understand the disease correctly, they do not need to go to medical facilities and this is a problem that rural people in general and mountainous people, in particular, are
facing. The cause was that the disease was not serious, accounting for 47.7%. Among the above causes, the cost factor for treatment is also one of the basic causes accounting for 31.7%. Economic hardship and the cost of health services are some of the barriers that make it difficult for people to access health facilities, especially those who do not participate in health insurance. The results of the examination of the correlation between those who are in health insurance and those who do not participate in health insurance with the examination and treatment of the disease show that. More people
with health insurance than those without health insur-ance1.
Treatment with folk medicine: The healing by folk medicine has existed for a long time with ethnic minorities in the mountains. The area of folk medicine has the presence of langs, priests, and people who know how to make "summers" for healing. Also according to the results of the investigation from the questionnaire showed that the level of use of male drugs in the treatment of the disease, very often is 4.3%, regularly is 13.7%, sometimes accounting for the highest rate of 52.7% and 20.3% is rare. Thus, the use of male drugs in the treatment of diseases of mountainous people remains one of the important cues. When studying the benefits of using male drugs shows the reviews of the population. The most basic benefit is thought to be because available raw materials accounted for 35.3%, due to the 21.4% cheap economic cost, no 20.4% side effects and 11.5% thought male drug treatment was effective.
Healing by faith: Through surveys and field studies, it shows that today there are still a part of ethnic minorities who believe in spiritual healing methods, fortune telling is still valued by many people, and consider this a psychological relief for the patient himself. The results of the study showed that 36.1% said that they believe that worship contributes to the cure of diseases, while 37.5% think that they do not believe in this method of healing. And there are 26.4% of respondents that they do not know and difficult to answer. When conducting in-depth interviews, many people believe that when they are sick, they are haunted by ghosts, so they have to perform worshiping rituals to quickly recover from their illness. Thus, the worship to cure diseases comes from invisible reasons but is done with purposeful actions. Although there is no scientific basis for this problem, it gives them faith in healing. On the other hand, healing by worshiping and fortune-telling can be explained from the psychological perspective of the patient and the shaman. Worshiping, fortune-telling, exorcism, or ancestor worship has brought faith to the patient as a psychological relief and considered it a therapeutic result from spirituality. The magicians and Then said that they often treat psychological diseases and in this treatment, psychological factors and beliefs play an important role in the treatment method for the patient.
3. Conclusion
Research results show that the awareness and behavior of ethnic minorities in disease prevention and treatment are social issues. The patient only perceives
the phenomena of illness and disease in a way that is explained by life experiences. At the same time, a part of ethnic minorities also believes that illness and disease are also influenced by spiritual and religious factors. The identification and classification of illness are not only related to personal knowledge and experiences but also relationships, interactions in the family, and social networks. For individuals, when they are sick, or sick, they always guess what the cause of the illness is, and initially, they will treat themselves with personal knowledge. The subjectivity in people's perception may be partly due to habit and thinking that it is just a common disease, not serious. If they are sick or sick, most people buy medicine to treat the disease or use herbal medicine. However, if self-treatment or spiritual healing does not go away, they decide to go to medical facilities for examination and treatment. This depends on many factors such as the subjectivity of the patient, the ability to access medical services, and the geographical separation. But most notably, the level of medical culture, in general, is still low, from which there is no proper attitude in how to behave when treating diseases. Therefore, this is a matter of concern for current health policies and health care communication in mountainous areas.
The author would like to thank the University of Science, Thai Nguyen University for sponsoring the research project with the subject code BH2016-TN06-07.
References
1. Le Van Canh, " The behavior of mountainous people in the prevention and treatment of diseases (Case study in Lam Son and Luong Ha communes of Na Ri district, Bac Kan province" Scientific research project at Thai Nguyen University, 2017
2. Tong Van Chung, SYDT of Rural Socio-Economic Institutionsin Viet Nam, Social Work Publishing House, 2011
3. Le Si Dao (eds), Hoang Luong, Lam Ba Nam, Le Ngoc Thang, General Ethnic Education, Education Publishing House, 1998
4. Le Dai Nghia, Duong Van Quan, Ethnicity and ethnic Policy in Vietnam, People's Army, 2010
5. Doan Kim Thang, Ethnic Minority Health and Health Care in Viet Nam, Journal of Ethnic Minorities No. 4, 2007
6. Report on results of implementation of socioeconomic development, security and defense tasks in 2018; directions and tasks in 2019 of Luong Ha commune.
1 Correlation coefficientsr = 0.73, p<0.05
