Cultural consultation for cancer: astrocytoma in a Cambodian adolescent

Although Western medicine helps people understand disease and death in scientific terms, patients often explain their illnesses very differently. The explanations held by patients and their families from 'foreign' cultures can be bewildering to the clinician. In treating immigrant patients, particularly those with terminal illness, it is essential to understand their own explanations. Clinically applied medical anthropology considers how the patient's culture shapes his understanding of disease. In an effort to apply an anthropological approach to the pediatric setting, a cultural consultation service was developed at the Royal Children's Hospital in Melbourne. This service involved a team which included a psychiatrist (with anthropological training), an anthropologist, and several Southeast Asian community members. One patient for whom the service consulted was an adolescent Cambodian boy with glioblastoma multiforme, stage IV. This case is analyzed in the light of the culturally determined problems in management and the culturally embedded meaning of the illness. The patient's belief in ancestral and house spirits as well as his belief in the Theravada Buddhist doctrine of karma is examined. The case demonstrates how belief in such religious phenomena does not necessarily preclude compliance with Western health care.