The Amish

History of the Amish

The Amish are direct descendants of the Anabaptist (or Protestantism) movement that happened in 16th

century Europe. Another well known group of people in this area who are descendants of the Anabaptist movement are the Mennonites and the Old Order Mennonites.

Information from Wikipedia

Anabaptists

Mennonites

Old Order Mennonites

Conservative Mennonites

HutteritesAmish

Plain Folk

Originating in the 1530s, the term Anabaptist means "one who baptizes over again” – Online Etymology Dictionary.

Anabaptists rejected infant baptism as practiced by Magisterial Protestants and the Roman Catholic Church. Feeling baptismal candidates must be able to make their own confessions of faith, they required the professed believer to be baptized again even if the believer was baptized as an infant.

This belief system caused the sect to be persecuted, and they eventually fled Europe to North America during the 17th and 18th centuries.

Today, Amish settlements are divided into rural parishes, consisting of 30 to 50 families in each district. Religious leaders are chosen from their own religious community. No regional or national church hierarch exists to govern internal church affairs.

Information from Wikipedia.

The Amish settle in North America

Sometime after 1693, the Amish separated themselves from the Anabaptist movement. In the 17th and 18th centuries, the Amish and related groups immigrated to North America. Today, most Amish live in only 28 of the 50 United States, and including the Province of Ontario, Canada.

The Amish Patient

Initial Contact with an Amish Patient

While in public, the Amish avoid eye contact with the “English” (outsiders), displays of affection, and exhibit a meek, almost inconspicuous behavior. They are unassertive, nonaggressive and avoid confrontational speech.

In the one on one clinical setting, you can expect your patient to be open, honest, frank, and not hesitate to maintain eye contact.

The husband and wife are typically equal partners when making decisions. When in public, the wife generally defers to her husband.

Information from “Guide to Culturally Competent Health Care”

Greet with a handshake and smile

Using first names is appropriate

Direct eye to eye contact is also appropriate within the provider - client relationship

The spokesperson may not be the primary decision maker

Communicating with the Amish

Amish are bi-lingual. Expect all your patients that are school age or older to be fluent in English and Deitsch (Pennsylvania German).

The culture is highly contextual. Less emphasis on verbal communication is common, and more emphasis is placed on inherent, unspoken understandings between individuals.

Although the Amish are fluent in written and spoken English, be aware that due to their filtered exposure to the outside world, what we understand as common knowledge may not be known to the Amish.

Information from “Guide to Culturally Competent Health Care”

English is the primary written and spoken language

Be aware of your non-verbal communication

Because of disparities of terminology, clarify the patient’s statement of symptoms

Do not use slang, idioms or colloquial (informal) expressions

Health and Conditions

High Risk Health Issues

Most major health concerns are due to farm and traffic accidents.

Transportation related injuries involving large farm animals are the largest group, followed by falls from ladders and down haymow openings.

Alcohol and drug abuse is thought to occur at low rates, however few statistics can be found.

To help prevent farm related accidents, encourage close observation of children operating farm machinery and animal powered transportation.

Ask about substance abuse tactfully when other family members are not present.

Information from “Guide to Culturally Competent Health Care”

Health ConditionsBelow is a list of genetic health conditions common to the Amish. These conditions are generally attributed to a limited gene pool.

Limb-girdle muscular dystrophy Ellis-van Creveld syndrome Dwarfism Polydactylism Cartilage hair hypoplasia Glutaric aciduria Manic-depressive disorder Pyruvate kinase deficiency Hemophilia B

Limb-girdle Muscular Dystrophy

The term "limb-girdle" is used to describe these disorders because the muscles most severely affected are generally those of the hips and shoulders.

A person with LGMD generally has difficulty walking, going both up and down stairs, raising from a chair or a squatting position. Difficulty bending over and falling on a regular basis are also common. Difficulty lifting certain objects is also a common.

The disease causes loss of movement or a dependence of a scooter/wheelchair within a 20 to 30 year timeframe.

Although exercise and physical therapy are advised to maintain as much muscle strength and joint flexibility as much as possible, there are few studies that are able to detail the effectiveness of exercise. Physical therapy and exercise may prevent the development of the disease.

All information from Wikipedia, sources verified from references.

Ellis-Van Creveld Syndrome

It involves numerous anomalies including post-axial polydactyly, congenital heart, pre-natal tooth eruption, fingernail dysplasia, short-limbed dwarfism, short ribs, cleft palate, and malformation of the wrist bones.

The condition itself is not treatable, but many of the complications can be treated.

Information from Wikipedia and NY Times Health, sources verified from references.

DwarfismDisproportionate dwarfism is characterized by one or more body parts being relatively large or small in comparison to those of an average-sized adult, with growth variations in specific areas being apparent.

In cases of proportionate dwarfism, the body appears normally proportioned, but is unusually small. Historically, the term midget was used to describe "proportionate dwarfs"; however, this term is now often regarded as offensive.

Hypotonia, or low muscle tone, is common in dwarfs, but intelligence and lifespan are usually normal.

All information from Wikipedia, verified from references.

Polydactylism

The extra digit is usually a small piece of soft tissue that can be removed.

Occasionally it contains bone without joints; rarely it may be a complete, functioning digit.

The extra digit is most common on the ulnar (little finger) side of the hand, less common on the radial (thumb) side, and very rarely within the middle three digits.

Information from Wikipedia, verified from references.

Cartilage–hair hypoplasia

Cartilage–hair hypoplasia (CHH), also known as McKusick type metaphysealchondrodysplasia, is a rare form of short-limbed dwarfism due to skeletal dysplasia. (Wikipedia)

Cartilage-hair hypoplasia is a disorder of bone growth characterized by short stature (dwarfism) with other skeletal abnormalities; fine, sparse hair (hypotrichosis); and abnormal immune system function (immune deficiency) that can lead to recurrent infections. (U.S. National Library of Medicine, National Institutes of Health)

Glutaric aciduria

Glutaric acidura is an inherited disorder that interferes with the body's ability to break down proteins and fats to produce energy. Incompletely processed proteins and fats can build up in the body and cause the blood and tissues to become too acidic .

Babies with glutaric acidemia GA1 often are born with unusually large heads (macrocephaly). GA2 may include brain malformations, an enlarged liver (hepatomegaly), a weakened and enlarged heart (dilated cardiomyopathy), fluid-filled cysts and other malformations of the kidneys, unusual facial features, and genital abnormalities. GA2 may also cause a characteristic odor resembling that of sweaty feet.

Affected individuals may have difficulty moving and may experience spasms, jerking, rigidity or decreased muscle tone and muscle weakness.

Information from U.S. National Library of Medicine, National Institutes of Health, and Wikipedia

Manic-depressive disorder

Bipolar disorder — sometimes called manic-depressive disorder — is associated with mood swings that range from the lows of depression to the highs of mania.

Although bipolar disorder is a disruptive, long-term condition, moods swings can be kept in check by following a treatment plan. In most cases, bipolar disorder can be controlled with medications and psychological counseling (psychotherapy).

All information from the Mayo Clinic

Pyruvate kinase deficiency

Pyruvate kinase deficiency is an inherited lack of the enzyme pyruvate kinase, which is used by red blood cells. Without this enzyme, red blood cells break down too easily, resulting in low levels of these cells (hemolytic anemia).

Symptoms or signs include anemia, a yellowing of the whites of the eyes (icterus), fatigue, lethargy, jaundice, and pale skin (pallor).

Treatment for patients with severe anemia may need blood transfusions. Removing the spleen (splenectomy) may help reduce the destruction of red blood cells. However, this does not help in all cases. In newborns with dangerous levels of jaundice, the health care provider may recommend an exchange transfusion.

Information from U.S. National Library of Medicine, National Institutes of Health.

Hemophilia B

Hemophilia B is a hereditary bleeding disorder caused by a lack of blood clotting factor IX. Without enough factor IX, the blood cannot clot properly to control bleeding.

Symptoms can include: Bleeding into joints and associated pain and swelling, blood in the urine or stool, bruising, excessive bleeding following circumcision, gastrointestinal tract and urinary tract hemorrhage, nosebleeds, prolonged bleeding from cuts, tooth extraction, and surgery, or spontaneous bleeding.

Treatment includes replacing the defective clotting factor.

Information from U.S. National Library of Medicine, National Institutes of Health.

NutritionAs you would expect of an agrarian culture, most Amish grown their own produce, raise their own meat, and provide for their own dairy products.

Typical meals consist of meat; potatoes, noodles or broth; a cooked vegetable; bread; something pickled; cake or pudding; and coffee or milk.

Snacks and meals are usually high in fat and carbohydrates. Common snacks are large cookies, ice cream, pretzels and popcorn. Obesity is especially common among women.

When discussing weight control, suggest reducing portion size, decreasing the amount of sugar used in baking, limiting fatty meats, and changing or altering food preparation practices.

Information from “Guide to Culturally Competent Health Care”

Pregnancy and Child Bearing

For the Amish, children are considered gifts from God. Birth control is considered interfering with the will of God and should be avoided. The average number of live births within an average Amish family is seven.

Although rare, some Amish women use intrauterine devices. Be respectful of Amish values to encourage conversation. When discussing the subject of birth control, use an indirect approach, such as, “I’d be happy to answer any questions you have”.

Amish women are interested in all aspects of perinatal care, and often attend prenatal classes with their husbands. Because Amish reject many forms of technology, inform Amish couples prior to showing any videos, so they can choose to attend or not.

Most Amish women prefer home births and

choose lay midwifes who promote child-bearing as a natural part of the life cycle. Many Amish husbands choose to be involved, however they are not likely to show affection either verbally or physically.

Pregnancy and Child Bearing continued

The Amish woman giving birth quietly cooperates, and seldom verbally expresses discomfort. Sometimes Amish women will use herbal remedies to promote labor.

It is important to respect and be knowledgeable about Amish healthcare practices. This information is important because it will alert healthcare staff to the possibility of simultaneous treatments that may or may not be harmful.

A few days after giving birth, the mother will resume her family role managing or doing housework, cooking, and child care.

When hospitalized, the family may want the patient to spend the least allowable time in the hospital. Encourage the extended, immediate family to help care for the newborn.

Information from “Guide to Culturally Competent Health Care”

• Be sensitive to Amish values and beliefs concerning birth control in order to encourage discussion

• Be aware of alternate or homeopathic healthcare practices that may or may not be harmful

• Involve extended, immediate family to help mother and newborn

Spirituality and Death

Death and Serious Illness

Families are expected to care for the elderly and sick in the home. A wake-like sitting up through the night is expected of family members for the seriously ill and the dying.

As in any family, grief and loss are profoundly felt, however verbal and facial expressions may seem muted as to indicate resigned acceptance of the suffering.

In the hospital setting, attempt to make private arrangements for family members to spend the night.

Information from “Guide to Culturally Competent Health Care”

Lack of external or displayed emotion does not indicate a lack of caring.

Make arrangements for family members to stay overnight in the hospital.

Accept varied or alternate forms of grieving from the Amish.

Source Credits

Sources:

The effects of religious beliefs on the health care practices of the Amish.

http://www.ncbi.nlm.nih.gov/pubmed/3446212

The Child Welfare Training Institute

http://www.cwti.org/RR/Amish.pdf

Amish.Net

http://www.amish.net/faq.asp

Photo Credits