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Last year, when a quiet but very pleasant Amish boy in Central Pennsylvania contracted leukemia, his father took him to Mexico for some of his chemotherapy treatments. The Amish community, plus non-Amish friends and supporters, put together a bake sale in the nearest town and organized a blood drive to help with expenses. The family was willing to accept charitable contributions from non-Amish friends. A year later, the young man’s cancer seems to be in remission.

None of the facts of the story are particularly unique, however, as a group of articles in the fall 2006 issue of the Journal of Multicultural Nursing and Health makes clear. For instance, while the Amish will generally seek professional medical care if necessary, they do not hold health insurance. An article by Linda L. Graham and James A. Cates provides a good overview of Amish beliefs regarding medical care and health practices. The piece, a literature review, indicates that Amish families often leave the U.S. to seek cheaper healthcare services in Mexico, just as the Pennsylvania family did. The article, like the others in the issue, is written for busy American healthcare providers who need to be informed about the culture, worldview, and practices of their Amish patients.

Jane M. Armer and M. Elise Radina report, in another article, the results of a research project to study the beliefs and behaviors of Old Order Amish people at an unspecified location in the American Midwest. The authors interviewed 86 Amish adults, 52 percent of whom were females. They asked them questions that sought their definitions of health care, illness, and the conditions under which they would seek medical care. Their face-to-face interviews, lasting from one to two hours, included open-ended and semi-structured questions to determine the Amish perceptions of medical care issues.

The researchers found that one of the most consistent themes expressed by the Amish is the importance of hard work. Older respondents continue to want to maintain their usual roles as contributing members of the community, and younger adults accept that they are expected to work. Hard work is a normal, defining characteristic of good health.

The Amish also equate good health with freedom—being “able to do whatever you want,” as one of them replied during an interview. One woman indicated that being healthy allowed her to travel and visit her family. Another, doubtless reflecting her own personal interests, equated health with themediability to “enjoy the beauty of nature.” These adults also thought of good health in terms of their ability to provide for their families and their own spiritual well-being.

In another interesting article in the issue, Betty Spencer Lemon describes how benefit auctions, bake sales, and private donations may be raised to assist Amish families in coping with unexpected medical crises. But the thrust of her article is a case study of health care workers who provide neonatal care for Amish women.

She points out that since the Amish view babies as gifts from God, most do not practice birth control. They also don’t allow invasive diagnostic techniques to be performed on expectant mothers. But the women will go to Lamaze classes, if they are held conveniently in a nearby church, and many will accept prenatal care, though not as often as other women. Because they are typically well nourished, the pregnant Amish women usually have fewer problems such as hypertension and diabetes than other women. The Amish women often prefer to use lay midwives or nurse midwives for their prenatal care.

The article points out that some of the women, while they will accept modern medical practices when necessary, will also use herbal preparations, particularly during the final weeks of their pregnancies. The author describes five different herbals they may use: red raspberry leaves, butcher’s broom root, black cohosh root, dong quai root, and squaw vine root.

Lemon describes a visit to an Amish birthing center located in Topeka, Indiana, called the New Eden Care Center. Built in 1997, the center is designed to provide good care for Amish women when they give birth, in a setting where they will be comfortable and relaxed. All women are screened by doctors or nurse midwives before they are accepted as patients at the center. The center provides nursing care, meals, and housekeeping, while families often bring in food to eat with the new mother in a large, kitchen-like facility that looks like home.

Since these women do not have insurance, one of the goals is to keep costs as low as possible. The absence of separate nurseries for the babies, and of course the lack of televisions, help keep down expenses and make the Amish comfortable. The center charges fees for 72 hours of care in the facility, plus extra supplies that might be required. Doctors and nurse midwives affiliated with the center bill the patients separately.

Many of the women prefer to visit midwives in their own offices for prenatal classes, where they get some privacy and quiet time. And many prefer home births, where their husbands can be involved with the delivery of their babies. One midwife rhapsodized about her own experience one time: “It was well worth the difficult drive [to the Amish home] when, following the delivery, a great peace seemed to take over in the still of the night as I listened to the singing of the dad to the newborn, the creaking of the dad’s rocking chair, and the hum from the kerosene lantern. Where else could one hear such beautiful, peaceful sounds” (p.58).

Armer, Jane M. and M. Elise Radina. 2006. “Definition of Health and Health Promotion Behaviors among Midwestern Old Order Amish Families.” Journal of Multicultural Nursing & Health 12(3): 44-53

Graham, Linda L and James A. Cates. 2006. “Health Care and Sequestered Cultures: A Perspective from the Old Order Amish.” Journal of Multicultural Nursing & Health 12(3): 60-66

Lemon, Betty Spencer. 2006. “Amish Health Care Beliefs and Practices in an Obstetrical Setting.” Journal of Multicultural Nursing & Health 12(3): 54-59