Ethnomedicine: diverse trends, common linkages

Social learning, influence, and ethnomedicine: Individual, neighborhood and social network influences on attachment to an ethnomedical cultural model in rural Senegal

The preference in many parts of the world for ethnomedical therapy over biomedical alternatives has long confounded scholars of medicine and public health. In the anthropological literature cultural and interactional contexts have been identified as fundamental mechanisms shaping adherence to ethnomedical beliefs and health seeking behaviors. In this paper, we examine the association between individual, neighborhood, and social network characteristics and the likelihood of attachment to an ethnomedical cultural model encompassing beliefs about etiology of disease, appropriate therapeutic and preventative measures, and more general beliefs about metaphysics and the efficacy of health systems in a rural population in Eastern Senegal. Using data from a unique social network survey, and supplemented by extensive qualitative research, we model attachment to the ethnomedical model at each of these levels as a function of demographic, economic and ideational characteristics, as well as perceived effectiveness of both biomedical and ethnomedical therapy. Individuals' attachment to the ethnomedical cultural model is found to be strongly associated with characteristics of their neighborhoods, and network alters. Experiences with ethnomedical care among neighbors, and both ethnomedical and biomedical care among network alters, are independently associated with attachment to the ethnomedical model, suggesting an important mechanism for cultural change. At the same time, we identify an independent association between network alters' cultural models and those of respondents, indicative of a direct cultural learning or influence mechanism, modified by the degree of global transitivity, or 'connectedness' of individuals' networks. This evidence supports the long held theoretical position that symbolic systems concerning illness and disease are shared, reproduced, and changed through mechanisms associated with social interaction. This has potentially important implications not only for public health programming, but for the understanding of the reproduction and evolution of cultural systems more generally.

Biomedical and Folk Medical Concepts of Adult Onset Diabetes in Jamaica: Implications for Treatment

Adult onset diabetes is one of the five leading causes of death in Jamaica. Patients report that they are not adequately informed about the nature or the management of their illness. Structured questionnaires, in-depth interviews, free listing, pile sorts, and interactional tapings of doctor–patient appointments were methods used to collect data. Differences in doctor and patient explanatory models and cultural concepts concerning etiology, symptoms, treatment, and lifestyle changes such as diet and exercise often result in miscommunication. Broader social factors including social class differences and asymmetrical power relationships between doctor and patients, and economic factors such as costs of medical care and medication, transportation, and food impact on successful patient management of the illness.

Traditional Herbal Medicine in the Korean Community in Australia: A Strategy to Cope with Health Demands of Immigrant Life

The strands of medical social science based on such social theories as postmodernism and poststructuralism have tended to mystify what really affects health care use patterns including the simultaneous use of biomedicine and traditional medicine. The small amount of research on the use of traditional medicine among recent immigrants in the West which has been conducted has often tended to be dominated largely by interpretivist perspectives, which neglect the underpinning political-economic aspects of health and health care. The data for this article come from interviews with three different groups of Korean men (17 illegal/amnesty, 14 skilled and nine business migrants), using open-ended questions. Analysing the processes of adjustment to a new country and the constant involvement in hard manual work and long work hours, the article explores how Korean men in Australia make use of all the available resources to stay healthy. They have fully utilized the ‘freely’ available biomedical services under government subsidized Medicare although illegal migrants restrained themselves from using it until the time of obtaining legal status. However, Koreans have also utilized Korean traditional herbal medicine and acupuncture and other informal remedies despite their high cost, bearing in mind that health is a ‘capacity to work’ under the current environment.

['Biomedicine' in anthropological literature. The career of a concept between analysis and polemics]

During its career in North American social sciences and anthropology since the late 1960s the concept of 'biomedicine' acquired a large variety of meanings, sometimes even contradictory ones. Originating in research on biological and medical phenomena in technical areas like nuclear weapons, space flight, informatics or engineering, the term 'biomedical' entered politics and the social sciences, especially medical anthropology. Here it could mean medical research methods derived from biology as opposed to behavioural research or social sciences in general, the complex of Western health care n non-Western countries and the reductionism and alleged Cartesian dualism of its approach - the opposite of traditional, religious, holistic and psychic views and treatment of illness. Oscillating between the levels of anthropological research or analysis and of practical health care delivery, intra- and cross-cultural perspectives and affirmative and critical attitudes the term has to be carefully considered in any reading of past and recent literature. The rather ate German reception included replacing the term Schulmedizin born of older controversies on naturopathy, as well as naming the more somatic part of illness and medicine-as opposed to psychic or social aspects-and serving as the criticised object of many feminist and post-colonial studies on health.

Ethnicity, health and medical care: towards a critical realist analysis of general practice in the Korean community in Sydney

This paper investigates the use and provision of biomedicine among Korean-Australian men on the basis of interview data from all of the eight Korean-speaking doctors practising in the Korean community in Sydney in 1995. From the viewpoint of these general practitioners, an analysis is made of the processes Korean men go through in adjusting to a new country, being involved in constant hard manual work and long working hours, and explores how they make use of all available resources to stay healthy. The Korean men have fully utilized the 'freely' available medical services under government-subsidized Medicare, bearing in mind that health is a capacity to work under the current environment, although illegal migrants restrained themselves from using it until they obtained legal status. Korean-speaking medical practitioners have been able to provide their fellow Koreans with 'culturally appropriate' health care, with the key factor being the absence of a language barrier. The level of patient satisfaction is high, possibly due to the excellent understanding the doctors have of the social aspects of illnesses, although the doctors do not go beyond curative medicine in their practice. However, the increasing number of Korean-speaking doctors in the small Korean community means that there is competition for patients. Consequently, the medical care is highly entrepreneurial. Referral by Korean doctors to practitioners of Korean herbal medicine is also a notable feature of the health care sector of the Korean community, especially as this offers Korean patients 'satisfactory' health relief for problems that are not easily relieved by doctors in the biomedical system.

[Persistence of a magic-religious ritual to treat indigestion among patients attending a gastroenterology outpatient clinic]

INTRODUCTION

Knowledge of popular medicine is essential to the practice of integrated medicine. Empacho (stomach upset) is a known folk illness that has been the object of several studies, especially in Iberoamerica and among the Hispanic population in the United States. In the Autonomous Community of Valencia (Spain) a magic-religious ritual known as "trencar lenfit" (TE) is still performed. This ritual has no apparent equivalent among the numerous remedies described for this illness.

OBJECTIVES

To study the frequency and characteristics of the practice of TE among patients attending the gastroenterology outpatient clinic of a district hospital.

PATIENTS AND METHOD

The geographical area was the region of La Safor (Valencian Community) with three main nuclei (Gandia, where the hospital is situated, Oliva and Tavernes de Valldigna) and 28 smaller municipalities. Random interviews were performed in patients attending a second consultation over a period of 5 months.

RESULTS

Of 539 patients interviewed, 320 (59.4%) had undergone TE at some time in their lives and 25.0% had undergone this ritual in the previous 10 years. In 95.9% of cases, the person performing the ritual was a woman. Of the patients who had undergone TE, 40 (12.5%) knew how to perform the ritual, 35 of which were women (p < 0.0001). No significant differences were found between sexes but users were younger (51.8 +/- 15.9 versus. 55.5 +/- 17.7 years +/- SD, p < 0.05). Small municipalities and Oliva showed a frequency of 65.6% versus. 54.0% in Gandia and Tavernes (p < 0.005). Use was greater among natives of the Valencian Community (66.0%) compared with those from other parts of Spain (25.0%) (p < 0.0001). Patients who completed primary or secondary school showed greater use of TE (60.5% and 72.1%, respectively) than the illiterate (42.1%), those who had completed a 3-year higher education course (48.4%) and university graduates (36.0%) (p < 0.001). TE was more frequent among consumers of medicinal herbs than among non-consumers (69.0% versus. 54.3%) (p < 0.001). No relationship was found among TE and the use of alcohol, medication in general and smoking. However, an association was found between the use of psychotropic drugs (69.8% versus. 55.4%) (p < 0.005). No clear association was found with broad diagnostic group or with the functional/organic nature of the digestive disorder studied. Variables found to be significant on univariate analysis remained significant in multivariate analysis (logistic regression).

CONCLUSION

The present study confirms the high use of TE among patients attending the gastroenterology outpatient clinic of La Safor and their belief in this ritual. "Experts" in performing TE were widely available, and were almost exclusively women. The profile of maximal use of TE corresponds to a man or woman, aged less than 60 years, a native of the Valencian Community, with primary or secondary school education, residing in particular municipalities (usually small) and consumer of psychotropic drugs and medicinal herbs.

Help seeking behaviour of psychiatric patients before seeking care at a mental hospital

BACKGROUND

A wide range of professionals including psychiatrists, psychologists, general physicians, faith-healers and religious healers cater to the needs of mentally ill patients. Psychiatric facilities are available at general hospitals, office based practice and mental hospitals. Psychiatrists are preferred the least due to stigma. The present work reports on treatment options used by a group of psychiatric patients before visiting a mental hospital.

AIM

To study the help seeking behaviour of patients visiting a mental hospital.

METHOD

Patients attending psychiatric outpatient service at a mental hospital were asked specifically about various treatment facilities utilized by them before coming to the hospital and the reasons thereof.

RESULTS

A wide range of services was used by the subjects varying from professional care to faith healers. Trust, easy availability and accessibility, recommendations by the significant others and belief in supernatural causation of illness were the important reasons for choosing a particular facility. Thus sociocultural factors appeared to influence the help seeking behaviour.

CONCLUSION

A substantial number of patients suffering from severe mental disorders seek non-professional care. There is a need of studies in community to assess the help seeking behaviour of psychiatric patients and factors associated with it.

The involvement of families in Indian psychiatry

Ethnographic observations and interviews with psychiatrists at two general hospital psychiatric units in northern India reveal the extent of family involvement in the localized adaptation of biomedical psychiatry that occurs in these settings. By assuming many of the roles filled by auxiliary personnel in the USA, families maintain considerable control over many aspects of the psychiatric process: defining disorder, outpatient consultation, record keeping, admissions, inpatient care, discharge, and continuing care. The implications of these observations are considered in relation to theoretical concerns about biomedical hegemony, advantages and disadvantages of family involvement from an applied perspective, and the methodological adequacy of cross-cultural psychiatric epidemiology with respect to studies of "expressed emotion."

From illness to symbol and symbol to illness

This paper explores two aspects of the relationship between illness and social symbols: one in which illnesses become symbols; the other, in which symbols become implicated in processes that eventuate in illness. Illness is first discussed as a symbol of social beliefs, attitudes, norms, values, and other social phenomena conceptualized in relation to them. This symbolization is analyzed as it relates to various dimensions of illness that lend themselves to figurative thinking. The paper then turns to processes through which social symbols may generate illness. In this regard, ways in which social symbols may attract people to behavior that puts their health at risk are discussed. The paper concludes with an analysis of how the development of illness may be affected by the relationship between social symbols and somatization.