Traditional Medicine as ‘Medical Neglect’: Dilemmas in the Case Management of a Samoan Teenager with Diabetes

Abstract

For migrants, maintenance of traditional cultural practices in a new environment may initially ease the transition but subsequently trigger severe conflict. This seems particularly true in two areas, childrearing and medical care, and particularly when migration is from a relatively rural and less technologically-developed setting to an urban one. This chapter will analyze a case example of one such conflict in an American Samoan family who migrated to Honolulu, Hawaii. Six years later, the father, a traditional healer, was charged with ‘noncompliance’ and ‘medical neglect’ of his diabetic daughter, and was threatened with her removal from family custody by the State of Hawaii’s Child Protective Service. While this case represents an extreme example, it illustrates some crucial issues facing many immigrant populations attempting to maintain their cultural identity in the face of social change. Practices which have represented cultural strengths — and which may in the new environment provide a source of social status and a sense of self-efficacy for members of an otherwise low-status and powerless ethnic group — may place their children at high risk. Indeed, the risk may be not only to children’s health but to the integrity of the family unit and the migrant community.