Health and Well-Being in Amish Society
Friday, June 7, 2019 • 3:15–4:45 pm
A. Papers: Bridging the Gap between Providers and Patients (B)
Perceptions about Childhood Vaccinations in the Old Order Amish of Lancaster County, Pennsylvania
Pamela Cooper, DHSc, MPA, P-C
Although the Amish religion does not prohibit childhood vaccinations, only about half of Amish children have been vaccinated. Amish opposition to vaccines is often based on limited understanding of the benefits and safety of the vaccines. Some Amish parents report that vaccinations are simply not a priority given the other demands of daily life. To stop these diseases from becoming more prevalent, it is important to increase vaccination rates in the Amish populations.
The purpose of my quantitative descriptive study was to better understand Amish parents’ attitudes regarding childhood vaccinations. The study was done at Parochial Medical Center from April through July 2017. Of the 157 participants, 97 (62%) reported that they were likely to vaccinate their children. A total of 117 (75%) stated they had never discussed vaccines with a health care provider.
One of the important findings of this study is that many Amish parents are willing to vaccinate their children, but are poorly educated regarding vaccine safety, childhood illnesses, and complications from contracting childhood diseases. Providers are missing opportunities to discuss vaccines with Amish parents.
Pamela Cooper is a physician assistant at the Parochial Medical Center in New Holland, Pennsylvania, which serves Amish and Mennonite communities. Cooper earned her doctorate degree through A.T. Still University and is an adjunct faculty member in the Lock Haven University physician assistant program.
Health Care Provider Understanding of Health Care Beliefs and Preferences in Anabaptist Communities
*Dawn Garrett-Wright, PhD, PMHNP-BC, CNE
M. Eve Main, DNP, APRN-BC
M. Susan Jones, PhD, CNE, ANEF
Deborah B. Reed, PhD, MSPH, RN, FAAOHN
Limited knowledge of the differences between members of Anabaptist communities and mainstream US culture in terms of health care beliefs and preferences are reported in health professional literature, and few health care providers (HCPs) have experience providing care for Anabaptist communities. The aim of this qualitative descriptive study was to explore the attitudes and lessons learned by HCPs who have experience providing services for members of Anabaptist communities. Eighteen HCPs from three states participated in the study, which used a Community Based Participatory Research model. The HCPs were videotaped as they responded to a structured set of questions regarding their experience, attitudes, and lessons learned while delivering care in Anabaptist communities. The interviews were transcribed, and a thematic analysis of responses was conducted.
The analysis revealed seven commonly expressed themes: 1) Anabaptist communities place value on negotiating their prescribed plan of care; 2) community members take a greater responsibility for their health outcomes as compared to English communities; 3) increased value placed on direct communication, active listening and presence in the relationship between patient and provider; 4) the tendency to delay care until later in the course of illness; 5) community members’ caution in using mainstream treatments and desire to use natural products when possible; 6) aversion to legal action and 7) expression of appreciation for health care provided to them.
The information from these interviews and thematic analysis was used to develop an online continuing education program on culturally appropriate health care for Anabaptist populations.
Dawn Garrett-Wright is a psychiatric nurse practitioner at Medical Center Psychiatry-Bowling Green, Kentucky, and a professor in the School of Nursing at Western Kentucky University.
Understood or Misunderstood? How the Amish are Framed in the Literature of Healthcare Ethics
James L. Benedict, PhD
Differences in cultural values between Amish communities and modern healthcare systems can lead to misunderstanding and conflict when Amish patients seek care. When this conflict is particularly acute, it may come to the attention of ethics consultants and/or committees. The rapidly expanding field of healthcare ethics has generated a great deal of literature in recent decades. Some of this literature addresses specific cases involving Amish patients. The purpose of this study was to review the literature of healthcare ethics to determine the ways in which issues and cases involving Amish patients are framed and discussed. In addition, an attempt was made to identify the ways in which Amish culture and the culture of healthcare are prone to clash, and some ways these conflicts may be addressed.
James L. Benedict is scholar in residence at the Center for Healthcare Ethics, Duquesne University, and a pastor in the Church of the Brethren.
B. Papers: Patient Agency and Choice in the Realm of Health and Medicine
Toward a Better Understanding of Amish Healthy Living: Associations between the Amish Lifestyle, Immune Profiles, and Protection from Allergic Diseases
Christine Seroogy, MD
Asthma and other allergies are immune-mediated diseases that have been increasing worldwide in westernized areas at a rate suggestive of environmental pressures. Exposure to a farming lifestyle during pregnancy and infancy is associated with protection against allergic diseases. The environmental and lifestyle factors that contribute to protection from allergic diseases and how these factors influence the early life developing immune system in a manner that protects against allergies remains poorly defined. Finding the “key ingredients” would lead to a paradigm shift approach to prevent asthma and allergies for the millions of children at risk for these high burden diseases.
Recent studies from our group and others showed that the Amish are particularly protected from developing allergies and asthma. I will present our survey that focused on allergic diseases prevalence, dietary and dairy farm characteristics from Wisconsin Amish (n=439) and Old Order Mennonite (n=79) families and our pilot immune study (in collaboration with a birthing center in LaFarge, Wisconsin) to characterize immune system function of Amish newborns compared to non-Amish Wisconsin farm newborns. I will also provide an overview of our ongoing study designed to prospectively follow Amish, non-Amish/farm-exposed, and non-Amish/non-farm rural children from birth to 2 years of age.
Christine Seroogy is an associate professor in the department of pediatrics at the University of Wisconsin School of Medicine and Public Health. The interest of her research laboratory is the cellular and molecular mechanisms that modify immune responses and its study population is infants and children since the foundation for allergic disease is established early in life. Seroogy earned her medical degree from the University of Minnesota and completed her residency at the Harvard University Children's Hospital in Boston, Massachusetts.
The Choice of Health Care Providers among Old Order Amish in a Pennsylvania Valley
Gretchen Schafft, PhD*
Shereen Abdel-Nabi, PhD
In a central Pennsylvania valley, about 200 Old Order Amish families reside and have access to all different kinds of health care agents. Virtually none has commercial or government health insurance, but relies solely on their savings and the Amish welfare fund. Many families feel that requesting money for health care from community resources is embarrassing, so try very hard to manage health care costs prudently. Among this population, who is consulted about self-identified health issues, what social and economic factors influence their choices, and what barriers stand in the way of using various forms of health care? As anthropologists, we use qualitative mixed methods in this research and subaltern theory and ideas about cultural dissonance.
The definition of “health care provider” is open for discussion. Regulatory agencies and most medical schools do not regard folk knowledge or non-regulated or nonscientific knowledge as sufficient to provide care to persons seeking to improve or maintain their health status. Thus, most licensed medical providers would not consider herbalists, faith healers, naturopaths, or indigenous medical corps personnel legitimate health care providers. Chiropractors, indigenous midwives, and massage therapists, although licensed, might also fall outside the realm of professionally recognized medical practitioners. Yet, the Amish may choose among these varied practitioners when they are ill or want reassurance. Most frequently, they “mix and match” these practitioners to meet specific physical, psychological, and economic considerations.
Because they have little familiarity with medical terminology, Amish patients are more likely to judge empirical results of treatment as the primary evidence of adequate care. Linguistic considerations are also important. If a layer of medical terminology is placed on top of formal English usage, the comprehension of the licensed medical person’s definitions and instructions may not be fully understood by those seeking help and add discomfort to the practitioner–patient interaction. A careful diagnosis and a treatment plan may be a luxury that few Amish can afford. By choosing lower-cost health care on the continuum of practitioners, Amish patients may better maintain their independence at the risk of missing a critical diagnosis and treatment.
Gretchen E. Schafft is Public Anthropologist in Residence at American University in Washington, DC.
Understanding How One Amish Mother and Her Child Experience “English” Health Care—A Case Study
Judy Stavisky, MPH, MEd
Health care administrators and medical providers continually strive to offer care that is more culturally appropriate for diverse patients. Are there special considerations that need to be recognized when treating an Amish child?
Sharing the experience of an Amish mother and her child, who have sought traditional medical care on several occasions, may inform further research on how to provide more acceptable and accessible care to Amish children.
What factors might influence a member of the Amish community to seek English medical care for non-emergencies? What are the barriers the Amish may face when trying to access an unfamiliar health care system?
If health care providers would like to encourage more Amish to consider traditional health care, there is a need to take a closer look at how that care may be perceived and experienced from another point of view.
My presentation will focus on observations I have collected over five years, via a personal relationship with one Amish family. As a trained public health professional, I observed how challenging English medical care can be for the Amish—the difficulty in making medical appointments, waiting rooms with televisions and few appropriate books for Amish children, logistically complicated follow-up care recommendations.
While my observations are limited to one family, my insights may be applicable to a range of health care settings and invite more rigorous study. Discussion will include practical ways to improve the experience of Amish mothers and children if and when they seek English health care.
Judy Stavisky has a long health care and social justice career. As senior program officer at the Robert Wood Johnson Foundation, Stavisky managed a $100 million portfolio expanding access to health care for vulnerable families. She recently coauthored Do It Better! How the Kids of St. Francis de Sales Exceeded Everyone’s Expectations, chronicling the journeys of refugees to Philadelphia. Stavisky earned graduate degrees from Yale School of Public Health and Chestnut Hill College.
C. Papers: Interpreting Contemporary Amish Culture
The Role of Ex-Amish Memoir in Breaking the Culture of Silence on Sensitive Subjects
Sabrina Völz, PhD
Although gender roles have been treated in the literature on the Amish for years, related sensitive topics that have become focal points of research inquiry in the fields of women’s and gender studies—such as sex education, sexuality, abuse, and incest—have remained on the periphery. Current Amish studies scholarship on these subjects fills only a small number of pages of books and journals and has primarily focused on explaining Amish practices to outsiders instead of creating empathy for the victims and awareness of Amish practices that lead to inappropriate behavior or the violation of human rights.
In this presentation, I analyze the struggles of young Amish women to come to terms with their own identities and break the silence on sensitive topics. The memoirs of ex-Amish women Saloma Miller Furlong and Emma Gingrich provided the basis for this study. Themes such as the female body, dating rituals, sexuality, and sexual abuse have been treated. Moreover, I will show the challenges and benefits of examining the experiences of ex-Amish women filtered through their life narratives and uncover the extent to which the “culture of silence” contributes to their dissatisfaction and/or traumatization.
Ex-Amish memoirs, albeit subjective, open new perspectives for differentiated analyses of Amish ways of knowing and living. Scholars, caregivers, and medical personnel have a responsibility to victims and survivors of abuse and other trauma not only to listen openly to their stories, but also to give them the public acknowledgement they deserve, enter into a discussion with the willing, and think about our responsibility to hear all the voices, especially those of the marginalized.
Sabrina Völz is a post-doctoral researcher and senior lecturer in English and North American studies at Leuphana University of Lüneburg, in Germany. Her current project began with a 2012 interview of Ira Wagler about his memoir and blossomed into an interdisciplinary conference on the Plain people in 2015. She has coedited two conference proceedings, including The Plain People: Contemporary Perspectives and Future Prospects, which appeared as a special issue of the American Studies Journal in 2017. Völz also coedits the American Studies Blog (http://blog.asjournal.org/).
From the Inside Out: Reflections of Amish Patterns and Traditions
Saloma Miller Furlong, BA
Most Old Order Amish communities do not consider self-reflection a virtue. When asked, most Amish people cannot answer the question of why musical instruments, dancing, or Christmas trees are not allowed in their communities. The answer to their children often is, “That’s just the way it is,” or “It’s too worldly.”
It is only after leaving an Amish community that I’ve had a chance to discover the source of some of the centuries-old traditions still practiced among the Amish today. The rituals performed at baptisms, weddings, and funerals are infused with meaning and help ensure the survival of the culture. These traditions will carry a person through the various stages of life—literally from the cradle to the grave.
Most people see the Amish traditions as inherently good. However, being bound to traditions without self-reflection has a down side. Children whose parents had a “strict” upbringing are often hard on their own children. Normally each set of parents is left to raise their children as they see fit without intervention from inside or outside their respective communities. When they are too harsh with their punishments, the children have nowhere to turn for help. If they internalize the pain, they often carry scars into adulthood and are prone to pass down the family patterns of behaviors to the next generation unwittingly.
The Amish have been reading about their own culture from those who write about them. Most of the literature has been positive, reflecting to them a model of a good society. I believe it is more helpful for the Amish to see themselves as people with flaws like the rest of humanity. Perhaps it is time to offer them more balanced views of their culture and life, so they can see themselves like their fellow humans… doing their best as pilgrims in this world, even as they struggle with their human frailties. Problems must first be recognized before they can be remedied.
Saloma Miller Furlong is the author of two memoirs: Why I Left the Amish and Bonnet Strings: An Amish Woman’s Ties to Two Worlds. Her story is featured in the PBS documentaries “The Amish” and “The Amish: Shunned,” which aired on American Experience in 2012 and 2014 respectively. She is writing a third book and lives with her husband, David, in Harrisonburg, Virginia.
Rearview Mirror: Reflections on What Shaped Me and What I Thought I Was Doing
Donald B. Kraybill, PhD
My presentation addresses the issues that shaped my social and intellectual formation, my intentions in my research and writing about Amish society, and my aspirations for the future of Amish studies.
Growing up on a farm in a Mennonite subculture undergoing rapid socio-cultural change in the 1950s and 1960s in Lancaster County, Pa., profoundly molded my early values and worldview. The ideas of the late nineteenth-century European sociologists undergirded my graduate studies. The burgeoning scholarship on ritual in everyday life by people like Erving Goffman convinced me of its centrality in all social life. However, it was Peter Berger’s work on the social construction of all values and beliefs and his books on modernity (especially The Homeless Mind: Modernization and Consciousness) that had the most profound impact on my thinking.
A new subfield, cultural sociology, which emerged in sociology in the 1980s and 1990s, became my intellectual home for my research and writing on the Amish. I tried to understand empathetically the social world view constructed by Amish societies. Two questions animated my work. First, how could I understand and explain the meaningful social worlds they had created. Second, what strategies did the Amish use to respond to the impact of modernization in the 20th century?
Finally, I place my “interpretive” research in the context of other modes of Amish research, respond to some criticisms of my research, and propose a vision for the future of Amish studies.
Donald B. Kraybill is senior fellow emeritus at the Young Center for Anabaptist and Pietist Studies at Elizabethtown College. He is the author, coauthor, and editor of numerous essays and many books on Amish culture and society. Kraybill was the founding editor of Young Center books in Anabaptist and Pietist Studies, a series published by Johns Hopkins University Press.
Joel E. Yeager, MD
LuAnne D. Yeager, MD
Drawing on their practice’s extensive experience working with members of Plain Anabaptist churches (Mennonite, Amish, and Brethren), family physicians Joel Yeager and LuAnne Yeager of Heritage Family Health will discuss effective means of establishing rapport and delivering primary care to this population. Topics will include preventive medicine, vaccination, issues in family medicine, and addressing payment and payment plans with non-insured Anabaptists. Audience members will be invited to share their experiences and questions.
Joel E. Yeager and LuAnne D. Yeager completed a three-year residency in family and community medicine at Penn State Hershey and Good Samaritan Hospital (Lebanon, Pa.). In 2011, they established Heritage Family Health in Newmanstown, Pa., a primary care practice operating on a direct-pay model. In addition to his medical degree, Joel Yeager also holds a master’s degree in counseling from Colorado Christian University.