Common themes in the literature on traditional medicine in Papua New Guinea

A review of the literature on traditional medical practices and beliefs in Papua New Guinea (PNG) was conducted in order to provide context and background information for the Department of Health's National Policy on Traditional Medicine for Papua New Guinea. The literature review examined accounts that refer to all 19 provinces and 50 different cultural groups. PNG is renowned for its cultural diversity and it was evident in the literature review that many beliefs and practices are specific to particular cultural groups. Many cultural groups adopt unique practices based on their own specific explanations of illness. At the same time, the review identified a number of commonalities in concepts of health and illness, treatment-seeking behaviour and reactions to the introduction of western medicine among Papua New Guineans from different geographic areas. Both the diversity and the commonalities provide context and background for the National Policy that was approved by the National Executive Committee in March 2007 and officially launched in April 2009. The commonalities are pertinent to the policy on a national level while the diversity must be considered when the policy is implemented at the local level. Summarizing the commonalities between different cultural groups illuminates central belief and behaviour constructs relating to health and illness. Ideas and similarities in practice or perceptions relating to traditional medicine in PNG that are common across a number of provinces are the subject of this paper. The most common features include a belief in the power of sorcery, which is universal, the importance of adherence to customary law and the healing power of herbs and incantation. These findings are a working draft of the expected norms of traditional medicine in PNG, which can be tested and refined during the process of implementing the National Policy, which, it should be noted, explicitly excludes the use of sorcery.

[Sequence of a trance: psychopathological disorders following religious experiences]

The more frequent psychopathological alteration after religious experiences are the dissociative disorders and trance. It's not frequent to see this clinic in private practice or hospitals in Buenos Aires. To do this revision we went to religious sites where the trance and possession status are frequent, in order to observe their clinic and the methods to induce them. We made a bibliographic revision about trance.

CONCLUSION

In Buenos Aires city the dissociative disorders and the trance are less diagnosed than in other sites. The trances that we saw were totally induced.

Proteus rebound: reconsidering the "torture of nature"

Though Carolyn Merchant has agreed that Francis Bacon did not advocate the "torture of nature," she still maintains that "the very essence of the experimental method arose out of human torture transferred onto nature." Her arguments do not address serious problems of logic, context, and contrary evidence. Her particular insistence on the influence of the torture of witches ignores Bacon's skepticism about witchcraft as superstitious or imaginary. Nor do the writings of his successors sustain her claim that they carried forward his supposed program to abuse nature. We should be wary of metaphorical generalizations that ignore the context of the metaphor, the larger intent of the writers, and the fundamental limitations of such metaphors as descriptions of science. There are no scientific methods which alone lead to knowledge! We have to tackle things experimentally, now angry with them and now kind, and be successively just, passionate, and cold with them. One person addresses things as a policeman, a second as a father confessor, a third as an inquisitive wanderer. Something can be wrung from them now with sympathy, now with force; reverence for their secrets will take one person forwards, indiscretion and roguishness in revealing their secrets will do the same for another. We investigators are, like all conquerors, discoverers, seafarers, adventurers, of an audacious morality and must reconcile ourselves to being considered on the whole evil.

Dissociative experience and cultural neuroscience: narrative, metaphor and mechanism

Approaches to trance and possession in anthropology have tended to use outmoded models drawn from psychodynamic theory or treated such dissociative phenomena as purely discursive processes of attributing action and experience to agencies other than the self. Within psychology and psychiatry, understanding of dissociative disorders has been hindered by polemical "either/or" arguments: either dissociative disorders are real, spontaneous alterations in brain states that reflect basic neurobiological phenomena, or they are imaginary, socially constructed role performances dictated by interpersonal expectations, power dynamics and cultural scripts. In this paper, we outline an approach to dissociative phenomena, including trance, possession and spiritual and healing practices, that integrates the neuropsychological notions of underlying mechanism with sociocultural processes of the narrative construction and social presentation of the self. This integrative model, grounded in a cultural neuroscience, can advance ethnographic studies of dissociation and inform clinical approaches to dissociation through careful consideration of the impact of social context.

The recurrence of an illusion: the concept of "evil" in forensic psychiatry

The author notes an increased interest in the concept of "evil" in the fields of psychiatry and psychology. In particular, there is some interest in defining and testifying about evil. It is argued that evil can never be scientifically defined because it is an illusory moral concept, it does not exist in nature, and its origins and connotations are inextricably linked to religion and mythology. Any attempt to study violent or deviant behavior under the rubric of this term will be fraught with bias and moralistic judgments. Embracing the term "evil" into the lexicon and practice of psychiatry will contribute to the stigmatization of mental illness, diminish the credibility of forensic psychiatry, and corrupt forensic treatment efforts.

Doctors' attitude towards people with mental illness in Western Nigeria

INTRODUCTION

It had been suggested that those more knowledgeable about mental illness are less likely to endorse negative or stigmatizing attitudes. This study aimed to evaluate the attitude of doctors in Nigeria towards the mentally ill.

METHODS

Medical doctors (n = 312) from eight selected health institutions in Nigeria completed various questionnaires on knowledge and attitude towards people with mental illness.

RESULTS

Beliefs in supernatural causes were prevalent. The mentally ill were perceived as dangerous and their prognosis perceived as poor. High social distance was found amongst 64.1% and the associated factors include not having a family member/friend with mental illness (OR 7.12, 95% CI 3.71-13.65), age less than 45 years (OR 2.33, 95% CI 1.23-4.40), less than 10 years of clinical experience (OR 6.75, 95% CI 3.86-11.82) and female sex (OR 4.98, 95% CI 2.70-9.18).

CONCLUSION

Culturally enshrined beliefs about mental illness were prevalent among Nigerian doctors. A review of medical curriculum is needed and the present anti-stigma campaigns should start from the doctors.

Confronting HIV/AIDS in a South African village: the impact of health-seeking behaviour

Much social science research on HIV/AIDS focuses on its impact within affected communities and how people try to cope with its consequences. Based on fieldwork in rural South Africa, this article shows ways in which the inhabitants of a village react to illness, in general, and the role their reactions play in facilitating the spread of communicable diseases such as HIV/AIDS. There is potentially a strong connection between the manner in which people respond to illness in general, and actual transmission of infection. By influencing the way villagers react to episodes of ill health, folk beliefs about illness and illness causation may create avenues for more people to become infected. This suggests that efforts to combat the HIV/AIDS pandemic cannot succeed without tackling the effects of folk beliefs. Therefore, in addressing the problem of HIV/AIDS, experts should focus on more than disseminating information about cause and transmission, and promoting abstinence, safe sex, and other technocratic fixes. Our findings suggest that people need information to facilitate not only decision-making about how to self-protect against infection, but also appropriate responses when infection has already occurred.

The new and improved learning community at Johns Hopkins University School of Medicine resembles that at Hogwarts School of Witchcraft and Wizardry

BACKGROUND

In July 2005, a learning community was created at Johns Hopkins University School of Medicine (JHUSOM) to foster camaraderie, networking, advising, mentoring, professionalism, clinical skills, and scholarship--The Colleges. The cultural and structural changes that emerged with the creation of this program have resulted in JHUSOM bearing a resemblance to J. K. Rowling's fictional Hogwarts School of Witchcraft and Wizardry.

AIMS

This manuscript will describe the similarities between these two revered schools, and highlight the innovations and improvements made to JHUSOM's learning environment.

DESCRIPTION

The intense, stressful, and lengthy professional training required to achieve competency in the practice of medicine and in the practice of witchcraft (albeit fictional) have meaningful parallels.

CONCLUSION

The supportive learning environment at these two schools should afford the next generation of graduates to have an even more enriching experience than those who have come before them.

Chikotsa--secrets, silence, and hiding: social risk and reproductive vulnerability in central Mozambique

In this article, I examine pregnancy narratives and patterns of reproductive health seeking among women of fertile age in central Mozambique. I map the interplay between gendered economic marginalization, maternal risk perceptions, and pregnancy management strategies. By interpreting my data in light of Shona illness theories, I illuminate the ways that embodied experiences of reproductive vulnerability, risk perceptions, and social inequalities are linked: women attribute the most serious maternal complications to human- or spirit-induced reproductive threats of witchcraft and sorcery. This construction of reproductive vulnerability as social threats related to material and social competition significantly influences prenatal health seeking. Data reveal the structural and cognitive gap between biomedical constructions of risk and lay social threat perceptions. Plural health care systems are strategically utilized by women seeking to minimize both social and biological harm. On-the-ground ethnography shows that maternal health initiatives must take this plurality into full and accommodative account to achieve viable improvements in reproductive care and outcomes.

Community-based study on knowledge, attitude and practice on the mode of transmission, prevention and treatment of the Buruli ulcer in Ga West District, Ghana

Buruli ulcer disease (BUD), a devastating tropical disease caused by Mycobacterium ulcerans, occurs in more than 80% of the administrative districts of Ghana. To elucidate community perceptions and understanding of the aetiology of BUD, attitudes towards Buruli patients and treatment-seeking behaviours, we conducted a survey with 504 heads of households and seven focus group discussions in Ga West District, Ghana. Although 67% of participants regarded BUD as a health problem, 53% did not know its cause. Sixteen per cent attributed the cause to drinking non-potable water, 8.1% mentioned poor personal hygiene or dirty surroundings, and 5.5% identified swimming or wading in ponds as a risk factor. About 5.2% thought that witchcraft and curses cause BUD, and 71.8% indicated that BU sufferers first seek treatment from herbalists and only refer to the hospital as a last resort. The main reasons were prospects of prolonged hospital stay, cost of transport, loss of earnings and opportunity associated with parents attending their children's hospitalization over extended period, delays in being attended by medical staff, and not knowing the cause of the disease or required treatment. The level of acceptance of BUD sufferers was high in adults but less so in children. The challenge facing health workers is to break the vicious cycle of poor medical outcomes leading to poor attitudes to hospital treatment in the community. Because herbalists are often the first people consulted by those who contract the disease, they need to be trained in early recognition of the pre-ulcerative stage of Buruli lesions.

South African Zulu widows in a time of poverty and social change

Interviews were carried out with 16 South African Zulu widows. Much of what the widows had to say seemed like what one might hear from widows in economically developed countries, but there were also striking differences. All the widows lived in poverty, and for some their grief seemed much more about the poverty than about the husband's death. Most widows observed a year of traditional ukuzila mourning practices, which made them a threat to others and which is difficult to carry out in the social upheaval of modern South Africa. Widowhood was in some cases a struggle with witchcraft--as cause of the death or as an accusation directed at the widow.

Women's aggressive use of genital power in Africa

Anthropology has long recognized the inadvertent polluting power of the male and female genitals. In his important discussion of Yoruba beliefs in female power and witchcraft, Raymond Prince (1961) recognized that African women know very well that they can direct the power that can emanate from their own genitals, and in some extreme situations their threats to loosen this power are strongly persuasive. Only a few others have recognized the aggressive use of female genital power. Further research in this area has important implications for understanding African ideas of sexuality.

[Double ritual murder by the Satanist cult members based on the casuistry of the Forensic Medicine Department in Katowice]

In recent years, an increased activity of various sects, especially Satanist ones, has been observed in Poland. This is associated with an increase in the number of various crimes, including offences against life and health. The ideology of Satanism came to Poland in the early eighties of the last century, along with heavy metal music and its variants. In 1999, two cases of the murders of a 21-year-old woman and a 19-year-old man committed by Satanist cult members during their ritual mass were reported at the Forensic Medicine Department in Katowice. In the report, the authors present some issues associated with Satanism, the circumstances of these two murders and the results of medico-legal examinations of the victims.

The interaction of death, sorcery and coronial/forensic practices within traditional indigenous communities

The investigation of death in traditional indigenous communities often involves 'men of high degree' performing rituals and procedures to ascertain whether sorcery has been involved. If this is the case then the perpetrator must be identified and suitable retribution or compensation sought. In Central Australia investigations into such deaths occur in 'sorry camps' which consist of temporary meeting camps distant from facilities and amenities. Delays in the issuing of autopsy reports may unnecessarily prolong the time that tribal members have to spend in these camps, and wording of standard autopsy reports may not assist tribal concerns over matters such as sorcery. An initiative in South Australia, following discussions with Aboriginal elders in the Anangu Pitjantjatjara tribal lands, has been to issue a one page provisional report as soon as possible after completion of the autopsy, listing the likely cause of death. This is sent to Aboriginal authorities through local health clinics. In addition, a statement that 'no sticks, stones, bones or other foreign objects were found within the body that would implicate another person in the death' is also included to inform tribal members that no physical evidence of magical interference with the body has been detected. Relatively minor alterations in standard forensic/coronial reporting practices may significantly assist certain groups whose cultural requirements may be under-appreciated and incompletely understood by investigating authorities.

Interesting in- and outpatient attendances at Hogwarts Infirmary and St Mungo's Hospital for magical maladies

Ailments afflicting wizarding folk are underreported in the muggle world. The recent integration of muggles and magical folk with the return of You-Know-Who (aka He Who Must Not Be Named) may result in a similar affliction of inhabitants of both worlds. We describe interesting maladies afflicting muggles and wizarding folk alike, arising from the use and misuse of magic. We also provide a basic glossary of magical ailments, and describe their muggle corollaries. Further studies will hopefully result in the development of immunity against the unforgivable curses.

Electrocution attributed to supernatural forces in the Niger delta region of Nigeria: a report of three cases

BACKGROUND

Accidental deaths from electrocution in this environment are sometimes related to charm and witchcraft caused by one's enemies. The aim of this article is to highlight the problems of beliefs and accidental electrocution.

METHOD

We report three cases of accidental electrocution which was believed to be associated with traditional beliefs of witchcraft and charm.

RESULTS

Autopsy findings in two cases showed characteristic electric burns (the joule burn which is the area of entry) without obvious organ changes. The third case revealed no burn but investigation of the scene of incidence and other sources of information are consistent with a diagnosis of electrocution.

CONCLUSION

Post mortem examination can assist to dispel misconception and unnecessary belief on cause of death in our community.

Commodity fetichismo, the Holy Spirit, and the turn to Pentecostal and African Independent Churches in Central Mozambique

Pentecostal and African Independent Churches have rapidly spread throughout central Mozambique in the aftermath of war and in the midst of a recent structural adjustment program that has hastened commoditization of community life and intensified local inequalities. This extraordinary expansion signals a shift away from reliance on "traditional" healers to treat persistent afflictions believed to have spiritual causes. Survey data and illness narratives collected from recent church recruits and local residents during research in 2002 and 2003 in the city of Chimoio reveal that healers have increased fees and tailored treatments to clients searching for good fortune in ways that have alienated many other help seekers in this changing social environment. While traditional healing has been celebrated in the international health world, community attitudes are less generous; many healers are increasingly viewed with suspicion because of their engagement with malevolent occult forces to foment social conflict, competition, and confrontation for high fees. Church healing approaches offer free and less divisive spiritual protection reinforced by social support in a new collectivity. One vital source of church popularity derives from pastors' efforts to tap the already considerable community anxiety over rising healer fees and their socially divisive treatments in an insecure environment.

Medical anthropology and Ebola in Congo: cultural models and humanistic care

Seldom have medical anthropologists been involved in efforts to control high mortality diseases such as Ebola hemorrhagic fever (EHF) This paper describes the results of two distinct but complementary interventions during the first phases of an outbreak in the Republic of Congo in 2003. The first approach emphasized understanding local peoples cultural models and political-economic explanations for the disease while the second approach focused on providing more humanitarian care of patients by identifying and incorporating local beliefs and practices into patient care and response efforts.

[BUDDA SYNDROME/Hmam Budda]

Hmam Budda is one of the widest spread "culture specific symptom presentations" in Tigrigna, the largest ethnic group in Eritrea. According to the understanding of the Tigrigna Budda is a female or male person who has inherited or acquired the supernatural gift and ability to take over people's body and soul. Mental disorders that are closely associated with possession phenomena are often attributed to Budda. The case study presents a first description of Hmam Budda by using a clinical vignette that was indigenously interpreted (emic approach). The traditional concepts of explaining and approaching mental distress and their meaning in the encounter with main stream psychiatry are discussed.