Filipino attitudes toward pain medication: a lesson in cross-cultural care

Information about cultural patterns presented in this article and others in this series represents generalizations, which should not be mistaken for stereotypes. Cultural generalizations will not fit every patient, but awareness of broad patterns can give practitioners a starting point from which to provide appropriate care. The information on Filipino symptom management in this essay is taken from R Cantos and E Rivera's chapter in Culture and Nursing Care: A Pocket Guide, edited by J G Lipson, S L Dibble, and P A Minarek and published by University of California, San Francisco, Nursing Press (1996). One of the comments I frequently hear in my nursing classes is that there is a tendency among Filipino nurses to undermedicate their patients who are having pain. I am told that if a physician prescribes a range of dosages, they will often choose to administer the lowest dose. One evening, I decided to ask the Filipino students in my class if that were really the case and, if so, why. Many of them agreed with the statement and offered me a number of explanations, including that pain medication is scarce in the Philippines, so they are trained to use as little as possible to make it go further. Among other reasons is that stoicism is highly valued and, for Catholic Filipinos, suffering is an opportunity to demonstrate virtue. A few minutes into the discussion, I noticed tears falling from the eyes of one of the Filipino students. When I asked Cecilia what was wrong, she quietly explained that her mother had died of cancer a year earlier. Because she was a nurse, the hospice had arranged for her to administer the strong dosages of medication necessary to ease her mother's pain. Cecilia did so, but automatically cut the dosages in half before giving the medication. She certainly did not want her mother to become a drug addict. Besides, her mother never complained about not getting enough medication. Now, through the class discussions, she realized that her long-ingrained habits and attitudes toward pain medication had caused her mother needless suffering. Her mother was dying; “addiction” was a meaningless concept at this point in her life. But her mother was gone, and there was nothing she could do to make up for it.1