Enduring Without Cure: What My Grandmother Taught Me About Culture and Care
In this post, I share the story of my grandmother, whose decision to stop seeking treatment for a chronic condition—her inability to bend her right leg—challenged my assumptions about healthcare and healing. Through our conversations, I began to understand how her choice was shaped by cultural values, everyday resilience, and deep mistrust in the medical system. As part of a narrative medicine project, writing about her helped me see the importance of cultural competency in patient care. This reflection is not just about illness—it's about listening, understanding, and honoring the choices people make in context.
Sanjay Balasubramanian
11/5/20243 min read
As part of a narrative medicine project, I was asked to interview someone I knew about their experience with illness. I chose my ammam, my grandmother in India. What began as a personal assignment quickly unfolded into a reflection on culture, trust, and how people define health across borders.
My grandmother lives with a condition that prevents her from bending her right leg—a limitation that developed gradually and never fully resolved. She sought care, at first. There were hospital visits, consultations, medications. But none of it helped. Eventually, she stopped trying. The chase for a cure became exhausting, fruitless.
“In the US, people care about looking good and feeling comfortable. But here, survival and getting through the day is what matters most,” she told me.
In that moment, I began to understand: her decision wasn’t just personal—it was cultural.
A Culture of Quiet Endurance
In her village, it was common to see elderly individuals navigating life with chronic pain, lingering illnesses, or physical disabilities. To them, spending hard-earned money to “fix” something they had already adapted to felt unnecessary, even reckless. The prevailing mindset wasn’t about optimizing health but managing what you had. Perfection was a luxury few could afford. Endurance became the default.
This philosophy wasn’t just spoken—it was lived. Each time I visited India, it was woven into the conversations around me. On humid afternoons, my ammam and mama would sit on the porch. My mama would lean back in his chair and laugh,
“It has been five years since I’ve gone to the hospital!”
Ammam would nod with quiet pride:
“Why should we? We manage just fine.”
To them, hospitals weren’t places for routine care—they were for emergencies, last resorts. Seeking medical help for anything less than a crisis felt like surrendering a hard-won battle against life itself. That resistance wasn’t rooted in ignorance—it was a cultural badge of strength.
Ayurveda, Karma, and the Ethos of Self-Reliance
Health in India is deeply shaped by ancient systems like Ayurveda, which emphasizes harmony, prevention, and natural healing over immediate intervention. It draws on herbs, diet, and mindfulness to treat the person as a whole—not just the symptom. Even in modern communities, these principles remain strong.
The belief in karma further shapes how illness is perceived. Suffering is often viewed not merely as misfortune, but as a consequence of past actions—a perspective that fosters acceptance rather than a frantic search for cures. Hindu philosophy reinforces this, seeing the body as a temporary vessel and spiritual balance as the greater priority.
Together, these beliefs instill a kind of stoic pragmatism. Endure. Adapt. Carry on.
The Erosion of Trust
But there was another layer to my grandmother’s story—one rooted in mistrust.
“Doctors and hospitals here only care about money,” she said. Not once, but many times during our conversation. Her tone was firm, colored by years of disappointment.
And sadly, she wasn’t alone in feeling this way.
A deeper look revealed just how entrenched corruption is in parts of India’s healthcare system. A 2003 study found that 42% of bribes in India were linked to basic health services. The problem extended from hospitals to medical schools, ambulances, even mortuary practices. One physician remarked:
“You know a profession is corrupt when its practitioners surprise the public more when they refuse bribes than when they accept them.”
This is not to discredit the many dedicated healthcare workers across India. But for someone like my ammam, the damage was done. She didn’t trust the system, and that mistrust became part of her treatment decision—choosing to endure rather than risk more harm.
Why This Matters: Culture and Competency in Care
My grandmother’s story is not just about a single medical decision. It’s a call to action for healthcare providers and systems around the world.
Narrative medicine reminds us that patients aren’t just cases—they are people shaped by culture, belief, and lived experience. Her refusal of care wasn’t illogical. It made perfect sense within her cultural and social reality.
Her right leg may no longer bend, but she has bent her life around it. She adjusted her movements, restructured her day, and continues to manage her household with remarkable resolve. To her, this adaptation isn’t a compromise—it’s a victory.
For those of us in medicine or public health, this reinforces a critical point: cultural competency isn’t optional. We must learn to see beyond symptoms. We must understand the stories patients carry—their fears, philosophies, and deeply personal calculations of risk and trust.
Because sometimes, enduring pain is not about resilience alone. It’s about survival in a system that no longer feels safe to trust.
And for my ammam, like so many others, adapting to her burden felt safer than risking everything for a cure wrapped in uncertainty and disillusionment.