Caring for the Low German Mennonites: How Religious Beliefs and Practices Influence Health Care by Judith C. Kulig (review)

This book assesses effects of cultural and religious practices on the delivery of health care in a selected minority population. The work is conducted as programmed personal interviews among Low German–speaking Mennonites, primarily in Canada, Mexico, and Belize, with a smaller proportion from the United States and South America. The interview questions and the format of the data collection vary from place to place and are not definitively outlined, making some of the conclusions largely anecdotal and not transformable into a statistical analysis. There are commonly 25 to 50 individuals interviewed in individual communities divided equally between men and women. The individual communities vary widely in their conservative versus more liberal orientations to society and engagement with healthcare professionals. Selection was dependent on the fact that these groups use Low German—Plattdeutsch—as the official language for family communications and religious observances. Great attention is given in research protocols to protect individual confidentiality and to reassure participants that their responses may lead to a better understanding and improved delivery of health care.

The areas of inquiry include impacts of beliefs and practices on perceptions of physical health, mental health, sexual and reproductive activities, and the care of terminally ill patients, including descriptions of funeral services. Interviewed individuals were prepared carefully for the questions that followed and the reader is assured that responses are given voluntarily. Participation often required consent from religious leaders of the groups, which are invariably men. In most instances the individuals surveyed are comfortable dealing with established available healthcare providers from government or other not-for-profit sources. In addition, members of these groups also had access to indigenous providers such as midwives and "bone setters" who are often consulted before licensed practitioners are seen.

The findings are not surprising. Survey observations are similar to previous reports of other Anabaptist communities including Hutterites, Old Order Amish, and Old Order Mennonites, the latter often found in eastern United States settlements, primarily Lancaster, Pennsylvania, and in Ohio and Indiana. Religious beliefs focus on the primacy of a God-fearing life involving family, patriarchal in orientation. Church, prayer, singing, and scriptural guidance are prominent features of the religious experience. In the more conservative branches scriptural teaching is given entirely by men, and individual members are not encouraged or sometimes even permitted to read the scriptural basis of their beliefs. In the best settings, physical, mental, and spiritual strength is derived from closely interactive community relationships.

Some other generalities emerge from these diversely scattered Anabaptist groups. Mental health disorders often carry stigma. Depression, including postpartum "blues," is common. Suicide may require burial outside the cemeteries. Sexual misdemeanors such as premarital sex and adultery may lead to permanent excommunication and require public confession to acknowledge the grave impacts of such events and for forgiveness necessary for return to full religious life. Children are often present when such confessions are made and give opportunity for leaders to claim the justice demanded of an omniscient God.

Curiously, full body burial with feet directed toward the East is a practice in some settings with those unprepared for eternity buried facing west. Cremation is not allowed and body parts such as amputations may be put aside for burial later with the subject. Stillborn infants are buried without public services. Caskets are open for viewing during funeral services.

The data presented in the book provide an in-depth perspective of the importance of healthcare concerns and indicate community openness to improving access and delivery. It is encouraging that these groups by and large are sufficiently aware of and trusting to seek out the best care when available. Science and medicine are appreciated for their values in improving life.