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Nrima - a particular Javanese value and its impact on healthcare
  1. Agnes Bhakti Pratiwi1,2,
  2. Retna Siwi Padmawati3,4,5,
  3. Dick L Willems2
  1. 1Department of Medical Education and Bioethics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
  2. 2Department of Ethics, Law, and Humanities, Faculty of Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  3. 3Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
  4. 4Center for Bioethics and Medical Humanities, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
  5. 5Bioethics Study Program, The Graduate School, Universitas Gadjah Mada, Yogyakarta, Indonesia
  1. Correspondence to Dr Agnes Bhakti Pratiwi, Department of Medical Education and Bioethics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; agnes.b.p{at}ugm.ac.id

https://doi.org/10.1136/jme-2023-109815

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    People in Java traditionally internalise the value of ‘nrima’. It is a verb, from the noun ‘trima’ in Javanese language (box 1). The closest word to ‘nrima’ in English is acceptance, although the meaning in local wisdom is deeper. Historically, the concept is known as ‘nrima ing pandhum’, which means a wholehearted, sincere and grateful acceptance of life events (usually unfortunate) that are given to us. This nrima attitude will result in resilience, perseverance and adaptability in facing adversity. Nowadays, it is commonly shortened to ‘nrimo’ or ‘nrima’. Nrima in daily life of Javanese is practised as accepting an event wholeheartedly, with a grateful feeling of an event or something that is (usually) unfortunate. Nrima involves accepting without protest and without being destructive, but not apathetic (continuing to try to overcome).1 2 Nrima can involve active reflection, reasoning and an attitude to turn something one initially thought was unacceptable into acceptance. However, nowadays nrima is often misinterpreted as deliberate, fatalistic and passive acceptance of a hardship, including health and disease.3 This misinterpretation of nrima has ethical relevance in the patient–doctor relationship.

    Box 1

    Description about the context and Javanese language

    About the context and Javanese language:

    • A local or regional language spoken by around 75.5 million people that is distinct from the national language (Bahasa Indonesia).

    • Mainly uses three different language levels that is informal, intermediate (semiformal) and formal (polite). Which level to use depends on the social relation of the people talking. For example, the informal language level is usually used to talk to people at the same or younger age, or lower …

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    Footnotes

    • Contributors ABP, RSP and DW conceptualised the article. ABP wrote the first draft. RSP and DW edited the article. All authors approved the final version.

    • Funding ABP received scholarship from Indonesia Endowment Fund for Education (LPDP) (201909222915503).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.