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RHO archives : Topics : Harmful Traditional Health Practices
Annotated Bibliography
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Working together: Western medicine and traditional healers
Ahmad, K. Namibian
government to prosecute healers. Lancet 357(9253):371 (February
3, 2001). Available at: www.thelancet.com/journal/vol357/iss9253/news.
T he government of Namibia is arresting traditional healers who recommend
that HIV-positive people have sex with virgin minors to "cure" their infection.
A rise in child rape has been attributed to this misguided belief. Namibia
has the most HIV cases in the world; AIDS is the number-one killer in the
country.
Anonymous. Working with traditional health
practitioners. AIDS ACTION (46):1 (October 1999).
Although Western medicine has the power to mitigate HIV and its effects,
many infected people have no access to these benefits. However, in non-industrialized
countries, research indicates that as many as four out of five people visit
traditional practitioners. This article outlines some successful models
for collaboration to improve HIV prevention and treatment, and advocates
for increased access to Western medicine.
Anonymous. Valuing healers. AIDS ACTION
(46):2 (October 1999).
Traditional health practitioners are often powerful members of their communities,
with the ability to educate the public as well as other healers. Their understanding
of local belief systems enables them to translate information into effective
explanations and motivation. Their "whole person" approach is especially
useful for dealing with HIV and AIDS. And because of their influence, it
is important they have the correct information about HIV/AIDS.
The Asclepion, Indiana University at Bloomington.
Ancient medicine
viewed in terms of the health care system. Available at: www.indiana.edu/~ancmed/evidence.HTM.
This webpage provides information about understanding medicine through the
ages and across cultures. Kleinmans framework of the three sectors of health
practices is outlined: The popular sector includes all non-professional,
non-specialist, popular-culture management of health and illness. The vast
majority of all health care worldwide happens here, provided by patients
themselves, families, and friends. The professional sector is composed of
organized, socially-approved healers and institutions; and the folk sector
is composed of non-professional, specialist healers of both sacred and secular
natures, including traditional doctors, self-help movements, shamans, pop-psychologists,
and folk healers. The author also briefly describes Kleinmans Patient
Explanatory Model.
Cadelina, F.V. Induced abortion in a province
in the Philippines: the opinion, role, and experience of traditional birth
attendant and government midwives. In: Mundigo, A.I. et al., eds. Abortion
in the Developing World. London, United Kingdom: Zed Books (1999).
Despite legal, social, and religious disapproval, an estimated 500,000 women
in the Philippines undergo illegal abortions each year. Research in one
province indicates that although most midwives and birth attendants disapprove
of abortion, some still provide information and referrals to illegal providers,
both traditional and Western. Some midwives and attendants are directly
involved in providing abortions, through traditional methods involving herbs
and abdominal massage.
Green, E.C. Involving healers. AIDS ACTION
(46)3 (October 1999).
Increasing recognition of the potential for traditional healers to prevent
and control STIs and HIV/AIDS has led to a growth in STI/HIV/AIDS-prevention
programs in Africa. These programs have enabled traditional healers to improve
their capacity to diagnose, treat, and provide counseling. Policy and program
recommendations for collaborating with traditional healers include: (1)
select healers for training through a fair and democratic system, (2) work
with healers who are respected in their communities, (3) do not require
membership in an association, and (4) encourage healers to promote sexual
abstinence for youth and fidelity for married couples.
Green, E.C., Zokwe, B., and Dupree, J.D. The experience
of an AIDS prevention program focused on South African traditional healers.
Social Science and Medicine 40(4):503–515 (1995).
Beginning in 1992, a novel HIV/STI-prevention program trained traditional
healers, who in turn trained "second-generation healers," who then trained
"third-generation healers." Twenty-eight original healers started a process
that enabled 1,510 healers to be trained within ten months. Evaluation results
were generally positive, including the finding that the "second-generation
healers" appeared to be as well trained as the first, in terms of knowledge
of HIV/AIDS and ability to promote condoms. One limitation was recognized
in the fact that healers do not organize themselves beyond the local level,
which limits the possibilities of widespread collaboration among healers.
Hojer, B. The community-health services interface:
the critical issue for AIDS prevention. In: Caldwell, J. et al., eds.
Resistances to Behavioural Change to Reduce HIV/AIDS Infection in Predominantly
Heterosexual Epidemics in Third World Countries. Canberra, Australia:
Australian National University (1999).
The author presents an overview of the roles of different health providers
in Kenya and Zambia, including traditional healers and public- and private-sector
professionals. Research indicates that private-sector professionals and
various types of traditional healers already play a major role in treating
STIs in both countries. Focus-group findings reveal that the public generally
prefers a combination of Western and traditional treatments for STIs, because
they value the complete "body cleansing," a combined approach provides.
Kamal, I.T. The traditional birth attendant: a
reality and a challenge. International Journal of Gynecology and
Obstetrics 63 (Suppl. 1):S43–S52 (December 1998).
This overview of traditional birth attendants (TBAs) includes a history,
documentation of their major global role in birth, and an acknowledgement
that despite their helpful approach, the quality of their service typically
needs to be upgraded through collaboration with Western medicine. The authors
review 40 years of experience as well as current efforts, including incentive
plans, national training programs, selection criteria, curricula, trainers,
methodologies, and certification.
Nakyanzi, T. Promoting collaboration. AIDS
ACTION (46)4 (October 1999).
THETA (Traditional and Modern Health Practitioners Together Against AIDS
and Other Diseases) is a Ugandan organization whose projects include clinical
trials to study the use of herbs to treat opportunistic infections, and
skills-building for traditional healers in STI/HIV counseling and education.
Local women are involved in programs as well, which include community education
and HIV-support groups. An evaluation revealed positive changes in the community's
understanding of HIV, and some changes in behavior, including increased
use of condoms.
Pick, S. et al. Pharmacists and market herb vendors:
abortifacient providers in Mexico City. In: Mundigo et al., eds. Abortion
in the Developing World. London, United Kingdom: Zed Books (1999).
In most states in Mexico, induced abortion is illegal with exceptions of
rape or life-threatening illness of the mother. Nevertheless, this qualitative
research found that pharmacy workers and herb vendors commonly provide a
range of identified drugs and herbs thought to cause abortion. Provider
disapproval of abortion did not seem to limit provision. Researchers found
these providers to have inadequate knowledge of the subject to fulfill this
medical provider role.
Population Council. Mali: Female genital
mutilation Excisors Persist Despite Entreaties. New York, United
States: FRONTIERS Project, The Population Council (1999).
Three programs that attempted to convince traditional FGM excisors to abandon
the practice were not successful, according to this study. Excisors were
not persuaded the practice is harmful. The report recommends interventions
that seek to reduce demand for FGM, rather than the supply.
Sharma, J.L. Involvement of practitioners of
traditional medicine in family welfare programmes. In: Rao, G.N., ed.
Family Planning: The Afro-Asian Scenarios. Research Monograph Series,
Volume 5. Thiruvananthapuram, India: Centre for Development Studies (1999).
Although some practitioners of traditional medicine and homeopathy are linked
to family planning and maternal health programs, the author argues that
these kinds of practitioners are an underutilized resource. Their services
could be useful for family planning education, distribution of contraceptives,
and provision of family welfare and maternal and child health services.
The report includes quantitative data.
The Patient Explanatory Model
Fadiman, A. The Spirit Catches You and You
Fall Down. New York: Noonday Press (1997).
The potential dangers of cross-cultural misunderstanding are portrayed in
this moving documentation of the disconnect between the United States medical
system and the immigrant family of Lia, an epileptic Hmong infant from Laos.
The author suggests that using the Patient Explanatory Model to create a
care plan that integrated the familys traditional health practices with
Western medicine could have helped both the doctors and the family better
care for Lia. Additional case studies explore reproductive health issues,
and demonstrate how emotions, language, seemingly benign routines (e.g.,
consent forms), and other culturally-based issued can affect fear, trust,
and understanding between patients and health care professionals.
Hallenbeck, J.
Fast Fact and Concept #26: The Explanatory Model. Milwaukee, Wisconsin:
End-of -Life Physican Education Resource Center, Medical College of Wisconsin
(October 2000). Available at: www.mywhatever.com/cifwriter/library/eperc/fastfact/146.htm.
This fact sheet contains a brief description of the patient explanatory
model. Also useful is an explanation of the Western medical model as a mechanistic
model, in which the body could be described as a type of machine, and the
medical practitioner as the mechanic who must tune it and fix or replace
malfunctioning parts. This approach is quite different from other cultural
health models, for example, those that describe illness as imbalance (e.g.,
hot/cold humors or Chinese Yin-Yang), or models that include spirits or
demons.
Hodgson, I. Culture,
meaning and perception: explanatory models and the delivery of HIV care.
Abstract MoPeD2772, XIIIth International AIDS Conference, Durban, South
Africa. (2000). Available at: www.brad.ac.uk/staff/ijhodgson/summaries/Publications/durban2000.htm.
The author proposes a specialized explanatory model that describes health
care workers' approach to HIV, based on three common culturally-based themes
that affect prevention and care efforts: "notions about the infected" (fed
by paranoia and fear); "just punishment" and the idea of good morals as
protection from infection; and anxiety about getting infected by patients.
The model, designed to foster high-quality health care, is portrayed as
a grid with personal safety along one axis and cultural safety along the
other. The ideal health worker is located in the zone that maximizes personal
safety and security, and also maximizes the skills needed to extend cultural
respect and support to individuals, especially around sexuality issues.
