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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.

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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.

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