Curing the Disease, Healing the Dis-ease By Angelito B. Meneses Ethnography Paper Dr.

Maria Mangahas World Ethnography College of Anthropology University of the Philippines-Diliman

Abstract This is a narrative account of an unexpected disease which occurred during my search for a topic for an ethnographic writing project in my World Ethnography course. It also happened at the peak of my interest and aggressiveness to engage in spirituality research for social work practice. This ethnographic inquiry is called an autopathography, a neologism that is inspired by or that focuses on a disease or disorder that afflicts the author. This is a tale of appendicitis and how I make sense of the experience being myself as the patient. I have been hospitalized three times. The first time was in 2000 due to the inflammation of my liver. The second was in 2006 due to the removal of my gall bladder. And the most recent one is in August 2013 due to appendectomy. In this paper, the narrative includes my recollection of my fathers malady of appendicitis and how he changed for the better after the surgery that happened a long time and my personal recollection of my own experiences of hospitalization prior to the recent one. The account covers only the three-day period of my stay in the hospital. The description is written subjectively to magnify the experience of a patient in a medical treatment. The account does not intend to expose medical malpractices and ethical issues; it is just so happen that these were encountered. The experience highlights three main points: the first is the patient as a warrior- a warrior who does not hurt people but tolerate hardships and suffering in order to live. The second is the doctor within every patient who can heal himself. Somehow, it challenges the old notion of the doctor knows best or the issue of total compliance to the treatment. It surfaces an alternative to this 1

old notion which puts emphasis on the participation of the patient in the process of treatment. The third is the importance of the concept of hope in which the patients last defence as he struggles for life in the most helpless and desperate situations. When a patient is engaged in a medical treatment, he brings with him the totality of the disease. The patient pathological problems can be cured medically by medical practitioners. However the patients psychosocial and spiritual concerns are equally important to address . Thus, the implication of this auto-ethnographic write up to social work practice in general and medical social work in particular is to develop creative approach, not limiting hospital social services only to classifying patients for financial support, but to deal with the empty hours in the life of the patient. On the one hand, empty hours can breed the patients psychological and spiritual malfunctioning. On the other hand, these empty hours may be utilized to bring out the warrior within the patience. In reflection, my experience being the patient brought me to this golden insight: if you treat the person, not the disease, you will win no matter what the outcome. And I believe this may aptly apply to the social work practice.

(autopathography, ethnography, appendicitis, patient, warrior, medical social work, doctor, hope, empty hours)

Introduction Inside every patient is a doctor who can heal him. -Hippocrates The strongest of all warriors are these two Time and Patience. - Leo Tolstoy, War and Peace

I have a personal recollection of an emergency situation that happened in 1992. I can still recall, we were like sailing in the stormy seas ferried by a Sarao 1988-model passenger jeepney as we traversed the long stretch of winding and rutted road which that time seemed enormous waves

bouncing us up and down into the mountains. My father was in severe pain. He was lying listless on the passenger seat and I could see the grimaces on his face every time the vehicle produced sudden jerks. We would want to hurry up but we could not demand the driver to speed up because of the road condition. We were rushing to bring our father to the nearest hospital because of complaints of intense abdominal pain surmounted by a feeling of nausea and vomiting. The absence of a doctor and medical facilities in our town which is situated in the interior part of Ilocos Sur made the residents difficult to access medical care and treatment in times of emergencies. We were fortunate enough that in the absence of an ambulance, the driver granted our plea to transport my father to the hospital. My father endured the pains and hardships for about five hours of the trip until we finally reached the Regional Medical Center in San Fernando, La Union. And after almost 48 hours of patiently waiting he was operated with already a ruptured appendix. Leo Tolstoy in War and Peace knew it when he wrote that the two most powerful warriors are patience and time. The strongest warriors are not the soldiers in the battlefield, not the boxers in the ring or the heroes in the action film but a patient who possessed these two powerful warriorspatience and time. In the passage found in Proverb 16:32 said a similar theme He who is slow to be angry is better than a man of war, and he who has control over his spirit than he who takes a town . I witnessed how my father when he experienced illness and dis-ease brought about by disease had eventually turned into a powerful warrior because he learned to have control over his spirit. He gained important lessons in life and then on he stopped addictive vices like smoking and drinking alcohol and become health conscious to live a longer life. I always wonder why a patient is called a patient and I thought the term patient is oxymoronic to being ill because of the meaning it signifies to the person experiencing pain and suffering because of disease. The New Webster Dictionary defines patience as the capacity to put up with pain, troubles, difficulties and hardships without complaint or ill temper. What are the different pains and hardships the patient has to endure and put up without complaint? What

important lessons can I glean from my personal experience being the patient and what are the implications of these learning to the practice of my profession as a social worker?

Here is the tale... You treat a disease, you win; you lose. You treat a person, I guarantee you, you'll win no matter what the outcome. Hunter Patch Adams (from the movie Patch Adams, 1998)

Prelude to being a patient It was a Monday when I started to feel the pain in my lower right abdomen. I was doing fieldwork in Zambales for a possible ethnography project on Atang, a ritual performed by the Ambala Aytas during planting and harvesting season. The following day the pain started to gnaw at me. In the evening, the pain gobbled me whole that when I wake up in the morning I felt nauseated. But I discarded what I was feeling and tried to tolerate the painful sensation. However, I decided to go to St. Josephs College for my class on Human Rights and Social Work scheduled at 1:15 PM to 4:00 PM. I was trying to manage the pain by making myself busy in front of the computer convincing myself that it was just a strain as a result of hiking in my fieldwork. I took out my food for lunch from the school canteen. I chose tocino and bopis as my viand placed in a paper plate wrapped with plastic. I ate very quickly while in front of the computer finalizing the questions for a unit test. After that meal, the pain became intense and I started to feel like vomiting. I met with my students and administered the test and delivered my lecture though I was feeling weak. In the evening I started to have a feverish feeling and I complained to my wife that I am suffering from pain in the lower part of abdomen.

The resistance to be a patient I only have a short sleep because of the pain and fever the whole night. Jen, my wife decided to bring me to the doctor. I was hopeful that the pain will soon disappear when I get enough rest. At

first I thought my liver problem was recurring. My wife is persistent to know the truth behind the pain. She suspected that I have an infection. She checked the internet for the nearest clinic where we can go for check up. We ended up visiting Healthway Medical Center located at SM North, a five minute drive away by a tricycle from our apartment at Bago Bantay. I was attended by Dr. Arellano, a tall, handsome, neat-looking and in the mid-thirties gastroenterologist. He looked for an obturator sign. The right obturator muscle also runs near the appendix. Dr. Arellano asked me to lie down with my right leg bent at the knee. He went on to move my bent knee left and right looking for a sign of abdominal pain. I felt pain but it was tolerable. His diagnosis was inconclusive. He recommended that I must be admitted for further observation. I asked if I can get through with this by medication like taking antibiotics. He explained that appendicitis is not elective or a choice when to be operated or when not to be operated. Surgery is the only treatment if the appendix is inflamed. He explained further that in cases of rupture it may lead to death. I was a bit resistant in the idea of surgery because I was pre-occupied with the anxieties patients normally worried about like the expenses. I asked how much will it cost for an appendectomy. The doctor indirectly answered by telling the case of his wife who was just operated through laparoscopic and the cost amounted to one hundred thousand pesos. I glanced at my wife and her stare was telling me not to take chances. Mapapalitan ang pera ang buhay hindi na her reminder resonated. Saan po ako ma-admit just in case? I asked Dr. Arellano. He asked me where I live. Dr. Arellano is affiliated to the Quezon City General Hospital and Medical Center and Veterans General Hospital. He recommended us to the QCGHMC because there is no pay ward at the Veterans Medical Hospital. We agreed and settled to go the QCGHMC and Dr. Arellano immediately made an endorsement letter for direct admission. He instructed us to proceed to the emergency and to tell the admission officer that my doctor is Dr. Siao.

The Triage at the ER Triage aims to promote the safety of patients by ensuring that timing of care and resource allocation is requisite to the degree of illness or injury. An effective triage system classifies patients into groups according to acuity of illness or injury and aims to ensure that the patients with life threatening illness or injury receive immediate intervention and greatest resource allocation (LeVasseur et al, 2001) The ER lacked the warmth of acceptance. Medical personnel dont greet the patients with enthusiasm. Their authority was superimposed in the tones of their voices including the security guards and the men who appeared to be cleaners and assistants as they standby at the receiving counter. I observed a play of power situated in this medical institution. Patients are seen as patients who are in dire need of help. Those who are clients or patients are considered powerless in the human services agencies. The guards and institutional workers can freely interview the relatives of the patients brought in the emergency room. They asked for instance what happened and then immediately provided unsolicited laymans diagnoses. I observed that there was no sense of urgency in the emergency room. Patients and relatives were anxiously waiting for immediate medical attention. Emergency is supposed to be a situation that requires immediate action. But I only saw two female doctors doing the rounds in a (estimate) 15-bed emergency room. In the ER medical personnel and patients meet as strangers. We walked through the lines of patients waiting for their turns to the admitting counter. The emergency room has turned out to be the typical government agencies where service users have to queue patiently to get the service; here patients were treated with unnecessary delays and it seemed that patients were not in dreadful conditions. There was panic among the patients and their relatives. But the medical personnel seem to be emotionally detached from the condition of the patients. It seemed that they dont feel their malady. We proceeded to the admitting section and showed the endorsement letter. The man gestured his right hand pinpointing to the direction inside the ER. I understood what he wanted to

communicate. Just get inside. Maybe it is a norm in the ER to communicate nonverbally to the queries posed by the patients. Communication was done impersonally and mechanistically. We handed the endorsement to the lean man sitting at the receiving desk. The man was wearing a blue hospital shirt, imprinted on the left side is the name Jay Padilla, MD. I supposed that he is a student doctor assigned in the ER for he did not introduce himself. His round big eyes scanned the letter and started to fill up the admission form. He then passed the completed form to the admitting section where the macho man who appeared to be boastful received it and double checked the entries. Sino ang doctor nito? the man asked with an authority in his voice. Si Dr. Siao, sir the intern replied. Payward ba to? Yes sir. Siguraduhin mo baka mamaya magalit na naman itong pasyente he finished with a side comment. I was asked to wait for an emergency doctor right in front of the admitting section. I took my time of waiting to observe the activities going on in the emergency room. There were some plastic and pieces of paper litters on the floor. Four security guards were on duty. The two lady guards were positioned at the entrance while the other two men guards were standing beside the staff in the admitting section. The guards on duty were free to sit down and to talk to and share some banter with other hospital personnel. Several men who appeared to be workers of the hospital were also there standing by and randomly offered assistance to the arriving patients. A taxi pulled over at the entrance and a woman hurriedly jumped out to call for emergency attention. In a normal pace, hospital workers brought a gurney to transport the unconscious patient to the ER. I observed that the medical personnel have not shown concern by hurrying up. For patients emergency means urgent or hurry up the process. I assumed that those who worked in the ER over time must become hardened or jaded by what they do. The assistance seemed to be mechanical and not done with concern. The woman who brought the patient to the emergency room was very distress. The man 7

who was sitting on the bench and who appeared to be a tricycle driver because of the morning towel hanging on his right shoulder started to interview the woman. Anong nangyari? he asked. Di ko po alam bigla na lang natumba at nawalan ng malay Tumama ba ang ulo sa semento? the lady guard butted in. Baka naman nagdadalantao siya? asked by another man. Di po menopause na po siya. While I was standing at the admitting counter waiting for emergency doctor, a small, stinking woman approached the counter and showed several papers. Nobody from the staff even the lady guard who was standing right in front of her tried to assist her. Perhaps at a glance, the woman was evaluated to be a chronic patient or a pauper. The woman turned to me for assistance asking to whom and where to submit the papers. I gestured (with the authority of a social worker) to the staff to assist the woman and only then a staff gave her an admitting form to fill up. Only after 20 minutes elapsed that a petite lady in a doctor suit emerged from the ER and attended to me for the triage. In triage, the patient situation is evaluated and the next steps will be taken to initiate medical treatment. She asked me the same questions Dr. Arellano has asked earlier. She took down all the necessary paperwork for my immediate admission.

The Perioperative Patient The perioperative refers to the period encompassing the preoperative, intraoperative and the postoperative experience for surgical patient. The preoperative begins with a plan to carryout surgery and ends with the actual transfer of the patient to the operating room, the intraoperative phase covers the period of the actual surgical procedure, and the postoperative phase begins with the transfer of the patient out of the OR to recovery, and continues through the healing process to the time of discharge from the physicians care (OBrien, 2002). The triage doctor gestured to walk us to the nurse station in the payward section for proper endorsement. We took the elevator up to the fourth floor. Doctors and other medical personnel were also inside the lift. They greeted each other and talked about birthdays, vacations and patients. 8

The triage doctor informally introduced me as Dr. Siaos patient. They nodded and smiled at me as if they were saying I am in good hands with Dr. Siao. Then I later learned that the name Dr. Siao is a big name in appendectomy and surgeries. I was brought to Room 431. The room is approximately 10 x 5 meters wide, furnished with a queen-sized hospital bed, food table, 7 cubic feet refrigerator, a cupboard, and a 24 inch LG TV hanged on the wall and a bench for visitors. The toilet is beautifully tiled and clean. It complied to the accessibility law for persons with disability, the door is wide enough to open and rails are fixed on the wall near the toilet and the bath. The ceilings are equipped with fire sprinklers and alarm in compliance with the DRRM law. Dr. Arellano and a lady doctor came in at around 6:30 in the evening to check my condition. He ran a test for Rovsings sign by applying hand pressure to the lower left side of my abdomen. The pain I felt upon the release of pressure was not tolerable indicative of the presence of Rovsings sign. It was only then that Dr. Arellano concluded that my condition was appendicitis. And I was scheduled for surgery. A male nurse who appeared to be gay came in at 7:30 in the evening. He put on my intravenous drip. He stayed for a moment to reiterate the instruction of the doctor not to eat or drink in preparation for surgery and to explain the other procedures I will have to go through. In preparation he said I will be doing several laboratory tests. ECG for heart problem, CBC for potassium, X-ray for lungs condition to prevent pneumonia, urine test for any kidney-related diseases. Kukunan po namin kayo ng dugo para ma-determine kung sapat ang potassium sa dugo ninyo. He explained. I asked him Para saan iyong potassium?...paano kung kulang? he explained that low potassium in the blood is detrimental to the patient in surgery. If I lack it, I will be supplied with it to correct my potassium deficiency before surgery. Before the nurse ended the procedural briefing, he instructed my wife to shave my pubic hair and buy two pieces adult diaper which I will wear during and after my operation. I asked why 9

there is a need to shave my pubic hair and wear diapers. I recalled when I was operated in St. Lukes Medical Hospital for gall bladder, I was not asked to shave my pubic hair. I asked if I can choose to shave or not. The nurse reluctantly replied that it is the procedure in all surgeries. He explained that I might urinate during the surgery because half of my body will be numbed. Bubuksan po kasi ang bituka at dapat malinis. I wanted to ask many questions but the nurse seemed to have a time limitations. The next day a rank and file hospital employee came to bring me to the radiology department for my X-ray. Hospital staff and employees deployed at the pay ward are respectful for they address me with sir. I asked his name as he pushed my wheelchair to the X-ray room in the third floor. Dodoy po he answered politely. He also asked what my illness was. I told him that I was up for surgery because of appendicitis. Buti na lang po payward kayo he quipped. Kung sa charity ward kayo delikado ang lagay niyo. He continued. I asked him what made him said so. Kasi kung sa charity ward ka, kumbaga sa high school third year ang titira sa iyo referring metaphorically to the class of surgery. I told him that my doctor is Dr. Siao and I asked if he knew her. He said Dr. Siao is a popular name in surgery. Dodoy has been working here for two years and he has exposed to the hospitals established norms and patients behaviour. I asked how much he is getting paid for his work. Maliit lang sir he hesitated then continued kulang kulang 8 thou po. Then he went on to compute his gross earnings naiuuwi ko po mga 6 thou nakaltasan na yon . Then he told me about his grandmother who is presently under his care. He spends all his earnings to provide the necessary care for his lola. Dodoy was thankful for his work even though he was just a high school graduate. That brief time of conversation with Dodoy was empowering and anxiety dispelling. A male medical technologist wearing thick eyeglasses and quiet shy came with a lady assistant to extract blood sample for my CBC. I complimented him for a painless insertion of syringe into my veins and efficiently finished it. He broke his lips for a smile for the praise. One by one doctors and nurses came in at random to explain the procedures. I spent the rest of my time answering queries from the nurses and doctors doing their rounds and routines. A 10

nurse asked me if I have already urinated or defected. Ilang beses po siguro po sa tingin niyo mga dalawang baso po ang dami I am not there to count how many times I will urinate. Was it a test of my cognitive ability? From time to time a doctor will enter. Doctors who come in usually say their names for proper identification. Nurses and other personnel do not. At 10:00 in the evening, Dr. Siao came to see me and to explain the possible complications of appendectomy. Recuperating time will be two weeks. She told me she was just waiting for the clearance. At 11: 45 PM a nurse came to apply Betadine to the area in my abdomen where the incision will be done and I was clothed in a surgical suit. Then I was yanked in a bed and brought to the operating room at 12:15 in the morning. I was ushered in the operating room. Several persons were present wearing different uniforms. A stout lady was wearing pink suit. Most of the men were wearing blue overalls. A small man stood beside my bed and started to flip the papers. Then asked me questions related to what was written in the entry. Anong full name mo? he asked as he fixed his eyes on the paper. Angelito Meneses I answered softly. Spell your surname. I spelled it. What is your birthdate? I thought this was his way to test my cognitive stability. The next man who came beside me introduced himself as the anaesthesiologist. He asked just one question if I have other ailment. I said none and I proceeded to tell him that I already have undergone laparoscopic gall bladder surgery in 2008. He explained to me that he will administer regional anesthesia that means the lower half of the body will be paralyzed. He will do it by injecting the anesthesia in the spinal. My body started to tremble because of the cold circulating in the operating room. Nerve block is another call for regional anesthesia. The procedure will take the following: the nerve block is explained to the patient, consent for the block is obtained, standard monitoring is applied, patient is sedated, area to be blocked is cleaned with chloraprep, and local anesthesia is given. Next the desired nerves are located using anatomical landmarks or ultrasound to place a needle attached to a nerve stimulator as close to the desired nerve as possible. Local anesthetic is injected and all sensations going to that area are taken away. 11

They removed my diaper and exposed my private parts. I protested loudly in my mind because I could not speak out to assert to respect my privacy during the operation. I felt my privacy was violated when I overheard their giggles. The light slowly faded away and I finally passed out of consciousness. I was looking at my body being operated on. I was wondering why I am separated from my body. Then I woke up in the recovery room feeling dizzy, nauseated and weak. I could not move my lower extremities. But I knew I was completely awake because I could hear people conversing in Ilocano in the recovery room.

Discharge For me a hospital is one place to avoid for staying especially for an extended period of time. It is literally a boring and anxiety- causing place to stay when one is ill. If it could have reflected the authentic historical and etymological meaning of its name then I would stay longer for complete recovery and healing. But today, especially public hospitals have deviated its real meaning as friendliness and hospitable reception where patients are not treated as patients but guests. I asked Dr. Siao if I can go home in three days. She said my case will allow me for an early discharge. And we settled our hospital bills and clearances. Since our cash on hand was not enough to shell out for the total amount of the bills, my wife wrote a promissory note. My wife bought pastries from Red Ribbon for the nurses as token of gratitude for their nursing care. Nurses are also subjected to mistreatment by the administration. One lady nurse used the terms boljak and sita to describe the put downs they usually experienced from the higher ups. They were also shocked to see the amount of my hospital bills especially with the professional fees and which we shared the same sentiments that PFs cannot be properly taxed. Dodoy fetched me from my room by a wheelchair. He barked for a cab at the taxi stand and endorsed us to the driver. I handed 100 peso bill which Dodoy hesitated to accept. But I insisted

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telling him it is my sincere appreciation for his friendliness and assistance during my brief stay in the hospital.

Exegesis and Implications The very least you can do in your life is figure out what you hope for. And the most you can do is live inside that hope. Not admire it from a distance but live right in it, under its roof. Barbara Kingsolver in Animal Dreams

Critical illness is a fact of life. Even those of us who enjoy decades of good health are touched by it eventually, either in our own lives or in those of our loved ones (Martensen, 2008). Being the patient is not a matter of choice. It is just a matter of time when a person becomes a patient. I have been a patient several times. In 2000, I was confined at Mary Chiles Hospital for an inflamed liver and recurred in 2005 after my volunteer work in Pakistan. In 2008 while serving as a volunteer in Mongolia, I was medically evacuated for a gall bladder surgery at St. Lukes Medical Center. The third of row, on August 8, 2013, I was admitted for appendicitis and went through another surgery at the Quezon City General Hospital and Medical Center. What good do these diseases bring? My fathers experience indicated a change of lifestyle. He threw away his old habits and vices he was obsessed about. When he did this the dis-eases were also healed. The removal of my gallbladder, though considered a minor surgery, brought radical changes in the way I look at life now. The absence of my gallbladder had taught me to give extra care for the other organs that are still functioning and in return they will sustain my life and existence (Meneses, 2013). I did, though the efforts were not enough because I failed to learn to be a strong warrior like what my father did to defeat the self-defeating attitude towards well being. The removal of my appendix is an incision ritual to remove some of the vestigial information I have stuck in my heart and head. Knowledge is like appendix, it may have found useful in the past but may not be applicable at present that if it is not removed it can be fatal like the inflamed appendix. The paternalistic Doctor knows best is an appendix to be removed in patient care . The doctor in very

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patient must be recognized. Cousins (2005) mentioned a quote from Albert Schweitzer, the famed medical missionary, who wrote of his fellow physicians: We are at our best when we give the doctor who resides within each patient a chance to go to work. Schweitzer talked about the important spiritual dimension of healing that only the person who is diseased and dis-eased can ever cure. In social work we are at our best when we give the social worker who resides within each client a chance to go to work. It is similar to the insight put forward by one of the precursors of social workJane Addams when she said: May I warn you against doing good to people, and trying to make others
good by law. One does good, if at all, with people, not to people. In other words patients are people. Patients are ought to be treated as persons with dignity and worth.

Patients expectations of the attitude and behaviour of the medical personnel toward them are another important factor that may affect their anxiety and overall hospital experience. Power plays horizontally and vertically in the health care institutions; patients are not in control and treated as passive recipients of care. This is an appendix to be removed in medical care. The doctor-patient relationship should be defined in the bounds of empowerment. Empowerment and a sense of control should transform older ethical norms of how doctors and patients ought to behave with each other. The medical model should be discredited in favour of models that privilege a patients autonomy (Martensen, 2008). My life in the hospital became meaningful when I encountered Dodoy who shared his life to me and whom I also shared my life. The doctors and nurses were more concern on the medical procedures than listening to the patients stories. Relationship with them was mechanical and economical dealing with the pathological condition. I spent most of my time in empty hours during my three days of confinement in the hospital because nobody wanted to listen. Doctors time was spent at an exact calculation for a specific task. The doctor comes in and goes out after at a maximum of 5 minutes. Nurses come in to monitor my blood pressure, to inject antibiotic into my intravenous, to check my body temperature, to ask if I already farted and defected. If doctors and nurses can only do the curing, then a social worker must come forward for the healing part filling up

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the empty hours. Kane (2003) acknowledges curing and healing as both essential to our well being since every sick person lives with both his physical disease and his simultaneous emotional experience of disease which I called dis-ease. Doctors are well trained to treat physical disease but they cant cure fear, anxiety or some other species of suffering because suffering exists outside the realm of the physically manageable. This brings us to consider spirituality as part of holistic healing. My hospital experience was beset with spirituality that occurred during the empty hours. Deep thoughts ran through my mind like what life is for if one day humans will all come to end? What is the purpose of purpose of life? During illness, patients come to contemplate upon their life. And they wait for someone who would listen. Spirituality according to Madeleine Leininger (1997), a nurse anthropologist, is the relationship with Supreme Being which directs ones belief and practices. The social worker can complement treating the disease which is curing with treating the person in dis-ease which is healing and the spiritual care. Finally, an important element alongside with healing or treating the person is hope which the patient can take hold on to surpass the suffering. Dr. Groopman (2005) narrated his own account on hope: Personal experience opened my mind. For some nineteen years after failed spinal surgery, I lived in a labyrinth of relapsing pain and debility. Then, through a series of chance circumstances, I found an exit. I felt I had been given back my life. I recognized that only hope gave me the courage to embark on an arduous and contrarian treatment program, and the resilience to endure it. Without hope, I would have been locked forever in that prison of pain.

Hope then is the translation of the time in Leo Tolstoys strongest warriors; the Hippocrates doctor within every patient; and the Patch Adams concept of treating the person to win. Because of hope, patients endure all the pains and difficulties to live a longer and happy life after.

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Hughes, N. (1992). Death Without Weeping: The Violence of Everyday Life in Brazil. University of California Press, Ltd. Oxford, England. Kane, J. (2003). How to Heal: A Guide for Caregivers. Helios Press. New York Leininger, M.M.(1997). Transcultural Spirituality: A Comparative Care and Health Focus. In M.S. Roach (Ed.), Caring from the Heart: The Convergence of Caring and Spirituality. Paulist Press.New York LeVine, S. (2008). The Saint of Kathmandu and Other Tales of the Sacred in the Distant Lands. Beacon Press. Boston. Lo, B. (2009). Resolving Ethical Dilemmas: A Guide for Clinicians. 4 th Ed. Lippincott Williams & Wilkins. China. Martensen, R. (2008). A Life Worth Living: A Doctors Reflection on Illness in a High-Tech Era. Farrar, Straus and Giroux. USA. Marini, I., M. Stebnicki. Eds. The Psychological and Social Impact of Illness and Disability. 6 th Ed. Springer Publishing Company. New York. Meneses, A. (2013). Knowing the True Taste of Water: A Volunteers Reflective Journey. Sara Nayan Publications. Quezon City. O Brien, M.E. (2003). Spirituality in Nursing: Standing on Holy Ground. 2 nd Ed. Jones and Bartlett Publishers. USA. Ofri, D. (2005). Incidental Findings: Lessons from My Patients in the Art of Medicine. Beacon Press. Boston. Russell, A. (2012). Love, Displacement and Ritual Excision. Medische Anthropologie. Retrieved from: http://tma.socsci.uva.nl/24_1/russell.pdf. Saleebey,D. Ed. (1997). The Strengths Perspectives in Social Work Practice. Longman Publishers. USA. Shostak, M. (1981). Nisa: The Life and Words of a !Kung Woman. Vintage Books. New York. Spradley, J.,D. McCurdy. (1972). The Cultural Experience: Ethnography in Complex Society. Waveland Press, Inc. United States of America. Sunstein, B.S., E. Strater. (2007). Fieldworking: Reading and Writing Research. 3 rd Ed. Bedford/St. Martins. USA. VanMaanen, J. (1998). Tales of the Field: On Writing Ethnography. University of Chicago Press, Ltd. USA. Turner, F. ed.( 1996). Social Work Treatment: Interlocking Theoretical Approaches. 4 th Ed. The Free Press. New York.

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