Amish-Initiated Burn Care Project: Case Report and Lessons Learned in Participatory Research

Population-Wide Vaccination Hesitancy among the Amish: A County-Level Study of COVID-19 Vaccine Adoption and Implications for Public Health Policy and Practice

Spatially concentrated, vaccine-hesitant populations represent an ongoing challenge to public health policies that emphasize mass vaccination as a means to eradicating certain infectious diseases. Previous research suggests that Amish populations, which are spatially clustered and rapidly growing, may be undervaccinated. However, existing evidence is limited to local case studies in pre-COVID-19 contexts. Using a series of negative binomial regression models, we evaluated the association between county-level vaccination rates and the percentage of Amish in 356 Amish-populated counties in the United States from February 1, 2021 through October 31, 2022 while controlling for a set of covariates known to impact vaccination rates. Our findings suggest that, after adjusting for county-level characteristics, Amish-populated counties had approximately 1.6% (95% CI: 1.1%-2.0%; p < 0.001) lower rates of getting COVID-19 vaccines. Our findings underscore the failure of public health outreach efforts to convince Amish to accept COVID-19 vaccines. Prevailing public representations of the Amish-as an unproblematic people removed from public affairs and largely unaware of the "outside world"-may have helped Amish avoid societal pressure to vaccinate. Furthermore, because Amish are not as much "hard to reach" as "hard to vaccinate," we suggest service providers and policymakers avoid top-down approaches that target the Amish-including cultural competency strategies that work to reduce perceived boundaries-and instead give Amish space to either initiate bottom-up partnerships with health services or accept responsibility for undervaccination in public life.

The Amish health culture and culturally sensitive health services: An exhaustive narrative review

As the Amish population is growing, researcher and practitioner interest in the Amish health culture is also growing. This is largely due to demand from practitioners for population-specific cultural guidance. Once a small area of study, health-themed publications in Amish studies (n = 246) now account for approximately one-fourth of all peer-reviewed publications, and a sizeable percentage address the health culture, i.e. Amish beliefs, practices, attitudes, decision-making processes, financing, and values. In this article, we provide a first-ever exhaustive narrative review of the Amish health culture literature (addressing Amish health conditions elsewhere). Specifically, we address Amish use of modern medicine, complementary & alternative medicine, cultural norms for birthing and intercourse, support and care for the sick and aged, health knowledge, payment for services, barriers to service access, service provider effectiveness, health programming, and ethical conflicts. Our goal is to organize the literature, synthesize findings, identify orienting perspectives, and clarify research questions and directions. Following our synthesis, we reflect on the current state of Amish health culture research, drawing particular attention to strengths and limitations of the oft-used cultural competency paradigm, and recommending more rigorous social scientific theorization of the Amish health culture.

The management of paediatric burns with Burns and Wounds ointment and burdock leaves: a case series

OBJECTIVE

In the Amish community, natural therapies, such as Burns and Wounds (B&W) ointment and burdock leaves, are preferred over modern medicine when treating burn wounds. The primary aim of this case series is to highlight the use and clinical outcomes of this treatment for paediatric Amish patients.

METHOD

At the a paediatric burn centre, two patients were treated with B&W ointment and burdock leaves. The first patient was 11 months old with 17% total body surface area (TBSA) partial and full-thickness scald burns to her lower extremities. The second patient was 24 months old with 20% TBSA partial-thickness scald burns to the torso, bilateral upper extremities, neck and chin.

RESULTS

Soon after presentation to the hospital, both patients developed positive wound cultures and required cessation of ointment and burdock leaf therapy. Both patients ultimately underwent surgical interventions.

CONCLUSION

Managing burn wounds with B&W ointment and burdock leaves should be considered as an additional option for wound care in select cases. However, the efficacy of this therapy is limited and standard-of-care modern medical burn treatments should remain an option for these patients. It is critically important to build a mutually respectful relationship with Amish patients' community leaders, as this allows open communication and collaboration in patient care and increases the likelihood that Amish guardians will bring their children to a hospital when necessary.