Prior the 1950's, poliomyelitis was a problem for the American population. Without a treatment, people began to invent remedies to prevent, cure, or soothe this ailment. African Americans used the Asphidity bag as a home remedy to ward off polio. The Asphidity bag was a compilation of various herbs and pungent substances that were thought to ward off disease. The remedy began in the Appalachian Mountains in the 18th and 19th century, became popular with African Americans of the deep-south in the 20th century, and has now changed forms again in the 21st century. Today, the African American Asphidity bag has been transformed into a Ziploc bag of pill bottles from the pharmacy that is utilized by patients to verify medication lists with their healthcare provider. The Asphidity bag is representative of African American generational healthcare and how it has evolved from roots and berries, animal and human rituals, and tribal medicine men, to African Americans leading the health care revolution into the 21st century. There are many African American cultural traditions that have affected my personality and behavior. Witnessing these traditions and their effect on the health of African Americans has influenced my view on ethics, and therefore my future nursing practice.
"Ethnomedicine is: local or indigenous knowledge and methods for caring for, healing, and managing human lives and livestock" (African Journal, 10/01/2009 to present, p. 1-100). The Asphidity bag was a collection of pungent herbs, often including ginseng, pokeweed and yellow root (Kirkendall, 2010). It was used by my mother's family in the delta region of Mississippi during the 1940's. My mother states "The bag smelled terrible and all of my 12 brothers and sisters had to wear the bag tied to a string hanging around our neck. I can remember wearing the bag at age five to ward off polio and children dying from polio" (E. Woods, personal communication, February 6, 2012). The smell was terrible; however the shortcoming of not wearing the bag was contracting polio. The wisdom of the older generation was not questioned because elders knew of other home remedies that worked. My mother did not have a choice in wearing the Asphidity bag. The thinking behind the Asphidity bag was to keep insects, rodents, or other kids away that could possibly transmit the disease. Many people of my mother's generation remember the foul stench of the bag. They remember the horrible smell; they remember polio; they remember the stories that their parents and elders told them about the debilitating diseases that the Asphidity bag was believed to prevent. Although the effectiveness of this remedy is uncertain, it did provide peace of mind to parents that their children and families would not be devastated by polio. The small bag provided hope that children would live a long healthy life to later take care of their parents if the parents were to become infirmed.
The bag was also a knowledge transfer tool. The Asphidity bag remedy was taught to the next generation along with the stories of past relatives, cooking skills, methods of garden and field work, and disciplinary approaches. The bag was not only a defense against polio; it was a community tool of communication. The Asphidity bag was the topic of many community conversations because of the effect polio had on families until mass immunizations occurred in the 1960's. The impact of the polio vaccine was not apparent until the mid- 1950's when it was developed by Jonas Salk, MD (National Museum of American History, Smithsonian Institute, n.d.). The vaccine lowered the use of the Asphidity bag but failed to demolish it due to cultural beliefs. It is common for African Americans to relate culture and spirituality.
Strong beliefs in God, prayer, and spirituality are foundations of African American culture and also have affected the healthcare of African Americans. Most African Americans ask for someone to pray or mention their name in church when sick. Prayer for the ill has taken place for numerous years. Even those that are not religious are coerced into accepting prayer for themselves from others because people explore alternative methods of healing when acutely ill. Even those that do not have a strong belief in God will turn to prayer and alternative therapies. As a student nurse, I know that healthcare has a variety of components. These components concern emotional spirituality and the physical treatment of an illness. African Americans believe that a strong spiritual presence can aid you through sickness as well as help you gain prosperity. The Asphidity bag is a true symbol of African American folklore that is valued as a long standing tradition of home medicine. It is one of many southern traditions that have helped to shape my personality and identity as an African American.
The Asphidity bag has left an indelible mark on my personality and lifetime memories. I discovered this fact in nursing school through personality testing and reflecting on experiences to date. I asked myself: could it be that the Asphidity bag had a role in how I scored on the MBTI personality test? Could the stories about the bag and polio have altered my perception of the world and how I interact with the people around me? People build a multitude of experiences and memories as they proceed through life that influences their reaction to various stimuli. The stories of the Asphidity bag, my family, and interaction with others have helped me to develop into the person that I am today. Because the Asphidity bag affected all my relatives that came before me; it had to have an impact on how I perceive and judge the world around me.
Healthcare comes in many different forms and practices. Asphidity bags, red yeast rice, cupping, garlic, and various teas are several home remedies that have debatable effectiveness. However, those that use these remedies perceive them to be effective; Perception is reality. Perception is developed from "the ways of becoming aware of things, people, happenings, or ideas" and when "people differ systematically in what they perceive… then it is only reasonable for them to differ correspondingly in their interests, reactions, values, motivations, and skills" (The Myers and Briggs Foundation, n.d.). It is only necessary to believe that Asphidity bag-like cures will work to experience their healing power.
There was once a long standing belief that a bag filled with leaves and roots from the field could prevent or cure polio. It sounds silly but isn't that what we do today. A pharmaceutical company digs up roots in Africa or the Amazon, processes those roots to products, and we rub them on our chests, squeeze them into a pill, or apply them through the skin and say, wow, I feel better. We take our Ziploc bag of pills to the doctor so that he can verify the dose of medication that we are taking and the physician says I am going to increase your dose; however if we do not see any results, we might want to consider some alternative therapies. Bring in your bag of medication on your next visit and we will check your medical values again. The Ziploc bag of medication that grandma takes to the doctor is the Asphidity bag of the twenty first century.
I am learning that healthcare comes in many forms and that some of these remedies work and some do not work. However, I must respect all people, their cultural beliefs, and the customs that they grew up with. Living in a diverse region of the United States, I have seen kids turned upside down to cure them of nausea, Chinese cupping to cure pain syndromes, and blood-letting to release infection. These methods are not so different from the Asphidity bag. They are cultural healthcare practices that have been around for hundreds, if not thousands of years and millions of people have relied on their healthcare power.
The ANA Code of Ethics is fairly explicit in expectations for the actions of a nurse. However, ANA Code of Ethics Provision Two may be difficult to adhere to if my primary commitment is to the patient. The difficulty lies in allowing patients to uphold their cultural health care practices while I adhere to nursing standards and hospital policies. Many cultural practices are not acceptable in western health care environments under the Code of Ethics Provisions 1-9. Practices such as Cupping or Asphidity bags are no longer an acceptable means of treatment. However, the client's cultural practices are extremely important to healing physically and psychosocially. Many practices such as the use of an Asphidity bag would not be allowed in a U.S. clinic or hospital due to the smell alone. Provision Two of the ANA Code of Ethics states, "The nurse's primary commitment is to the patient… an individual, group, family, or community" (American Nurses Association, 2001). There is conflict with supporting the patients' cultural practices in a respectful manner and upholding standards set forth by the nursing governing organizations. On one hand, I need to care and support the patient's health and health practices; on the other hand, I need to fulfill my pledged duty to uphold the most basic regulations of nursing. My current solution as a student nurse is to watch how experienced providers deal with this issue and to formulate my own practices that are congruent with the rules and regulations of my state Board of Nursing and the ANA Ethical Provisions. As a nurse, I am going to support the client's health maintenance and recovery to the full extent of my practice.
The ANA Standards of Professional Performance would be easier to adhere to when performing nursing duties in relationship to client's cultural practices with the exception of Standard VIII . ANA Standard of Professional Practice Standard VIII , Resource Utilization, states "The nurse considers factors related to safety, effectiveness, and cost in planning and delivering patient care."(American Nurses Association [ANA], 2004) My ability to deliver patient care will be affected by cultural practices that are not congruent with the American standard of care. A modicum must be reached so that patients can adhere to cultural practices that fulfill their health care needs while receiving appropriate medical and nursing care.
The Asphidity bag represents many things in African American health care including home remedies, knowledge transfer, and the spiritual power of healing. However, the practical use of the bag in conjunction with western medicine creates a dilemma in nursing care for various ethnicities in the clinical setting. The difficulty lies in upholding nursing standards while respecting cultural traditions. The bag has evolved from a rural preventative measure for polio to a low tech method of tracking medication usage. Although western medicine is bound by rules, and regulations that provide a standard of care; my first duty as a nurse is to improve the health of clients through traditional and non-traditional sources of appropriate care.
African Journal of Traditional, Complementary & Alternative Medicines. (10/01/2009 to present). African Journal of Traditional, Complementary & Alternative Medicines, 6.
American Nurses Association. (2001). Code of Ethics for Nurses (American Nurses Association). Silver Spring, MD: American Nurses Association.
American Nurses Association. (2004). Scope and Standards of Nursing Practice (American Nurses Association). Silver Spring, MD: ANA.
Kirkendall, J. (2010). Kitchen accomplish tie on your asphidity bag and join the part - but keep your distance. LegalNews.com. Retrieved from www.legalnews.com/flintgenesee/1000965
National Museum of American History, Smithsonian Institute. (n.d.). What ever happened to Polio Timeline. Retrieved February 10, 2012, from http://americanhistory.si.edu/polio/timeline/index.htm
The Myers and Briggs Foundation. (n.d.). MBTI Basics. Retrieved February 9, 2012, from http://www.myersbriggs.org/ my-mbti-personality-type/mbti-basics