Amish and conservative Mennonite communities might get identified as “Plain,” but health-care providers have found offering services to them can be anything but simple.
A patient might pay with cash rather than use insurance. There might be language challenges or different perspectives about medical options. Cultural differences are pronounced but manageable if a health-care provider makes an effort to build relationships.
The Young Center for Pietist and Anabaptist Studies at Elizabethtown (Pa.) College will address such complexities June 6-8 when it hosts a conference on “Health and Well-Being in Amish Society.”
Plenary speaker and medical anthropologist Martha King said the first job of any health-care provider who wishes to understand an Amish community’s local context is to build and maintain positive relationships.
“Sometimes that means building health-care teams of doctors, nurses and medical anthropologists,” said King, who works in the department of anthropology at the University of North Carolina at Chapel Hill. “But it also requires medical professionals to put in the real slow work to build relationships with Amish in their local community.”
This is partly to build trust and partly to learn each context, because Amish practices can vary from one church district to another.
“The tendency to lump them into one homogeneous group — but to also see them as part of a nostalgic past or that their lives are ruled by top-down religious edicts, or being cultish or leading all-natural organic lives — feeds into mischaracterizations,” she said.
King has studied medical decision-making in Amish circles in Pennsylvania. She said traditional Western medicine “doesn’t enjoy a pre-eminence or cultural authority in most Amish communities.”
“For most of us, the first thing that comes to mind is doctors and nurses, and everything else is an alternative,” she said. “. . . If the wait is too long or the cost is too high or the procedure is questionable or the quality of care is absent, many of us will stick around anyway to get that medicine.
“Many Amish won’t stick around. They’ll go somewhere else and make other kinds of health-care decisions. They’ll go with the chiropractor or the herbalist.”
In addition to several other presenters, the keynote address will be given by former Harvard Medical School dean Joseph B. Martin, a graduate of Eastern Mennonite University, who will review recent developments in medical genetics.
In addition to genetics, seminars and papers cover topics such as mental health, patient agency and choice, Asian perspectives on Amish community and minimizing barriers to care.
Melissa Thomas, an assistant professor at the Ohio University Heritage College of Osteopathic Medicine, said the changes some hospitals have made reflect a willingness to better serve people at their doorsteps.
She is the founding director of the nonprofit Center for Appalachia Research in Cancer Education, which has hosted a national health-care conference since 2015. In 2017, the CEO of Pomerene Hospital in Millersburg, Ohio, shared about his experience serving one of the world’s biggest Amish populations.
“He looked at population data and noticed half of Holmes County was Amish but was not served by his hospital, going elsewhere for care, and I think health-care systems are starting to ask why,” she said.
Pomerene was the first hospital in the nation to hire an Amish community liaison. These kinds of workers can be the key to bridging cultural differences.
Thomas said health-care systems value efficiency and speed as a patient moves through diagnosis and treatment, but that value is not shared equally in many Amish circles.
Respecting faith choices
Her work focuses especially on breast cancer. She has found that a woman may undertake a community process after a positive screening. She may need a few weeks to talk with her family, or her church, or to pray.
She recalled an incident in which a health-care facility wanted to do additional testing with a female patient whose travel methods were limited. But a community liaison health worker couldn’t be present that day, and the patient felt pressured.
“I remember saying at the time among our team, ‘It would be better for the woman to die from a disease than for her to live knowing she had questioned her faith,’ ” Thomas recalled. “I often say faith is such an elementary and critical decision piece, and we need to be respectful of that.”
Other changes health-care providers make to better serve Plain groups include better upfront pricing for cash payments, since many conservative groups avoid insurance programs.
Though cultural competency trainings can help providers offer better care, Thomas noted there is a danger of such initiatives perpetuating stereotypes.
“In health care it’s more important to see the common bonds we have,” she said. “The experiences I have with an Amish family are not at all different from people in other communities. . . . There’s a foundation for treating every patient the same way, that they want to feel respected and that they are getting the best health care.”