Introduction

Respiratory Syncytial Virus (RSV) is a highly contagious seasonal virus that can cause respiratory infections in babies, children and adults. While RSV symptoms may appear identical to those of a common cold, complications can result in diseases such as bronchiolitis and pneumonia, resulting in 60,000-160,000 hospitalisations worldwide. As the world continues to become more and more interconnected, it is becoming important to understand different cultural perceptions regarding different types of diseases and treatment in order to effectively communicate towards a diverse range of patients in an empathetic manner, in addition to helping create spaces where people can access the style of healthcare best suited to their needs. This article will explore the different cultural perceptions and challenges faced by various communities across the world regarding RSV and the respiratory illnesses resulting from it.

Indigenous Communities

The term “indigenous” has a plethora of different meanings in different social and political contexts, but is usually used to describe ethnic groups that have inhabited a country or region prior to the arrival of another ethnic background, such as Australian Aborigines or Native Americans. Globally, indigenous populations often experience huge social, educational and political disadvantages compared to their non-indigenous counterparts and further face poorer health outcomes. 

RSV infections are a leading cause of hospitalisation cases for indigenous communities, with hospitalisation rates for RSV bronchiolitis for indigenous infants in the USA and Canada exceeding non-indigenous infants at a hospitalisation rate of 484/1000. Major risk factors that leave indigenous communities vulnerable to RSV include overcrowded living conditions caused by limited ownership of land and cultural practices of living with relatives and extended family members, which ultimately leads to the rapid spread of RSV among these communities. Moreover, many indigenous communities in places such as Northern Australia and Canada live in extremely remote areas, which results in difficulties with regard to promoting hygienic ways of living due to limited knowledge within the community, as well as overall physical and cultural barriers that prevent the spread of crucial treatment and prevention practices to indigenous populations.

Racism, whether subtle or overt, remains a major challenge within Indigenous healthcare, with indigenous patients being ten times more likely to experience medical discrimination compared to non-indigenous White patients. In particular, there is a lack of understanding shown towards traditional indigenous medicines and healthcare practices, despite a Seattle Indian Health Board study that 70% of urban Native American primary care patients preferred using traditional remedies. This has led to increased distrust of Western medicine among indigenous peoples, resulting in many feeling misunderstood by clinically trained doctors and nurses. Therefore, common recommendations to increase awareness about RSV among indigenous populations include incorporating indigenous medicine systems alongside Western medicine, in addition to creating culturally appropriate flipcharts and public health campaigns that allow community members to gain important medical insights through their own cultural lens.

African Culture

In many African countries, many people have limited access to healthcare, with a 2021 estimate showing that roughly 97 million Africans incur catastrophic healthcare costs, thereby causing huge challenges towards many Africans due to limited access to healthcare providers, as well as ridiculous out-of-pocket costs. As a result, many communities in Africa, especially those living in rural areas, greatly rely on traditional healers and herbalists for cures. Traditional medicines within African cultures are well-known for incorporating spiritual practices into treatment plans; ethnic groups such as the Yoruba combine both the physical and spiritual realms within traditional healthcare through various oracles and traditional healers. However, just like indigenous communities within the Western world, many African people face huge challenges due to a lack of clinical research by practitioners of Western medicine, in addition to the prevalence of biases held against traditional African healers by the educated African elite that stem from the colonial era. Ultimately, the side-lining of African healing practices leads to little awareness among Africans regarding the quality of their cultural treatments.

RSV in many African countries is a common occurrence in cold mountainous areas due to a higher degree of human indoor congregation. Moreover, rural populations are at a particularly high risk of contracting RSV due to close contact with livestock and farm animals. Generally, respiratory illnesses within African communities are treated with herbal extracts and decorations, with South African tribes such as the Southern Sotho and Zulu commonly utilising roots and leaves from plants such as sand acacia and black wattle to make respiratory medicines (SA). However, a 2020 Elsevier review of ethnobotanical usage in South Africa discovered that out of the 257 plants known for supposedly treating viral respiratory illnesses, only a single species was shown to develop RSV-inhibiting compounds after being modified into an extract, highlighting a lack of investigation regarding common African remedies.

Ultimately,  there needs to be greater research conducted on the quality of medicines associated with African alternative medicine systems, in addition to a thorough understanding of attitudes towards healthcare in different African cultures.

Asian Cultures

In Asia, many communities  perceive and manage RSV through the lens of both traditional medicine and modern healthcare systems. Common forms of alternative medicine in Asia include Traditional Chinese Medicine (TCM), which is associated with China and many East Asian countries, and Ayurveda, which is primarily found in South Asian countries such as India and Sri Lanka. The use of traditional medicine on its own or in tandem with Western medicine is prevalent in many Asian countries, with 60-75% of people in Mainland China, Japan, South Korea and Singapore using TCM at least once annually. Traditional medicine is often viewed as a source of national/cultural pride and clinically-trained physicians in countries such as China and India recommending traditional remedies as part of their treatment recommendations. Thus, in order to understand the perceptions and treatment practices for infections such as RSV in Asian communities, exploring the role of alternative medicine systems is imperative. 

Essentially, commonalities between many Asian alternative medical systems include treatments focusing more on the patient rather than the disease, in addition to an overall goal to maintain a balance between energies within the human body; the complementary balance of Yin-Yang (according to TCM) and the harmony between the three Doshas (combinations of the five elements outlined in Ayurveda) are necessary for a healthy and infection-free person. To maintain this balance, herbs and extracts are often used in Asian alternative medicines, with TCM alone containing over 10,000 herbal medicines and 100,000 recipes that have been continuously documented since ancient times. Traditional Chinese Medicinal Herbs (TCMH) have been found by a 2016 study on its effectiveness against RSV to have a positive effect on the prevention and treatment of the virus. Common TCMHs such as fresh ginger rhizomes have been found to effectively inhibit the replication of RSV through producing the protein Interferon beta-1a, allowing for a potential natural treatment that prevents the build-up of RSV in the immune system. Moreover, the manner in which TCM formulas and medicines are presented, which include regulatory dosages and detailed extract recipes, overall promote a holistic and multi-channelled approach against RSV in line with traditional beliefs regarding alleviating patient symptoms and balancing blood-drug concentration. Furthermore, herbs are increasingly utilised within many Asian countries to treat acute respiratory illnesses, with children in Saudi Arabia hospitalised for lower respiratory diseases associated with RSV complications such as bronchiolitis and pneumonia often being exposed to up to 24 different varieties of herbs, including fenugreek and olive oil.

However, despite the many benefits of Asian herbal remedies, there exist many challenges, such as improving the quantity and quality of medicinal herbs and formulas, providing sufficient training to practitioners of traditional medicine systems and overall regulation of traditional medicine specialists. Thus, healthcare practices in many Asian communities face the interplay between long-held traditional remedies and modern Western-style medicine.

Conclusion

There are a plethora of different cultural perceptions and treatment beliefs regarding RSV across the world, which include alternative medicine, herbal remedies and traditional healers. Many traditional medical systems have potential to be used alongside modern clinical practices to provide effective cures to different communities in a culturally familiar environment, fostering a sense of inclusion and acceptance. Nevertheless, it is imperative that further research be conducted regarding the regulation and overall quality of traditional medicines and the practitioners that utilise them.