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OBJECTIVES: Old Order Amish define their existence as "in" but not "of" the world, giving rise to a spiritual expression that is unique among Christian sects. The Healthcare professional - "of" the world, by definition - faces the daunting task of providing culturally sensitive services. METHODS: This article examines modifications to accommodate patient expectations of equality, and respect for the boundaries that must always exist. RESULTS: In recent years, a handful of authors have addressed the Healthcare of the Amish. CONCLUSIONS: Their work, and the experiences of the authors highlight the challenge of providing nursing, medical, and dental services to the Old Order Amish.
KEY WORDS: Culturally Sensitive Services; Healthcare; Old Order Amish; Sequestered Cultures; Spiritual.
The Old he Order is the most visible of Amish groups1, publicly identified by their plain dress and use of horse and buggy as primary mode of transportation (Hosteller, 1993). A splinter group during the 17tn century formation of the Anabaptists, they are both a sect (in their view) and a culture (in the view of those providing services), espousing fundamental Christian beliefs. Persecuted in Europe, many accepted the invitation of religious tolerance, and immigrated to Pennsylvania during the 18tn century. As their numbers grew, they migrated westward. Currently, there are over 175 settlements in North America, with a total population estimate exceeding 110,000. The largest settlements are located in Lancaster County, Pennsylvania, Holmes County, Ohio, and LaGrange County, Indiana, although smaller settlements dot the United States and Canada (Kraybill, 1989).
Separation from the "world" as Christians is imperative to Amish beliefs. Other core beliefs include loyalty to community and family over loyalty to self, commitment to physical labor, humility in interactions with others, a recognition of, and commitment to the church as authority and discipline (Hosteller, 1993; Kraybill, 1989; NoIt, 1992). Life on earth preludes heavenly rewards; although friends and family may grieve death, they also rejoice in the promise of eternal life (Bryer, 1979)
The practical aspects of Amish theology have been sorely tested in recent years. Amish traditionally farm. However, decreasing availability of affordable land and the poor financial return on small farms displace many young men into non-agricultural activities to support themselves and their families (Kraybill, 1989; 1994). Primary external sources of employment include...