Can Andean medicine coexist with biomedical healthcare? A comparison of two rural communities in Peru and Bolivia

ABSTRACT: BACKGROUND: It is commonly assumed that indigenous medical systems are strong in developing countries because biomedicine is physically inaccessible or financially not affordable. This paper compares the health-seeking behavior of households from rural Andean communities at a Peruvian and a Bolivian study site. The main research question was whether the increased presence of biomedicine led to a displacement of Andean indigenous medical practices or to coexistence of the two healing traditions. Methodology: Interviews were conducted between June 2006 and December 2008 with 18 households at each study site. Qualitative identification and analysis of households' therapeutic strategies and use of remedies was complemented by quantitative assessment of the incidence of culture-bound illnesses in local ethnobiological inventories. RESULTS: Our findings indicate that the health-seeking behavior of Andean households is independent of the degree of availability of biomedical facilities in terms of quality of services provided, physical accessibility, and financial affordability, except for specific practices such as childbirth. Preference for natural remedies over pharmaceuticals coexisted with biomedical healthcare that was both accessible and affordable. Furthermore, our results show that greater access to biomedicine does not lead to less prevalence of Andean indigenous medical knowledge, as represented by the levels of knowledge about culture-bound illnesses. CONCLUSIONS: The take-home lesson for health policy-makers from this study is that the main obstacle to improved use of biomedicine in resource-poor rural areas might not be infrastructural or economic alone. Rather, it may lie in lack of sufficient recognition by biomedical practitioners of the value and importance of indigenous medical systems. We propose that the implementation of health care in indigenous communities be designed as a process of joint development of complementary knowledge and practices from indigenous and biomedical health traditions.     

Patterns of Knowledge and Use of Medicinal Plants in Santiago Camotlán,Oaxaca, Mexico

Medicinal plants continue to play an important role in healthcare, both in Mexico and around the world. We investigated the relationship between various sociodemographic factors, such as age, economic activity, years of schooling, socioeconomic levels, gender, and language proficiency, and the knowledge and frequency of medicinal plant use in Santiago Camotlán, Sierra Norte of Oaxaca, with a mainly Zapotec population. In a first stage, we interviewed specialists in depth and collected and identified plants for a catalogue of the medicinal plant flora (90 species). With this catalogue, we then interviewed a sample of the general population and the specialists on knowledge and frequency of use. The relationship between the sociodemographic variables and knowledge was analyzed by multiple regression. To explore differences of knowledge within the population, we identified three groups with a two-step cluster analysis; the results were compared statistically with a Kruskal-Wallis non-parametric test and then a post hoc Dunn’s test to see if all the differences between groups were significant. Age and occupation explained 54% of the variation of knowledge. Medicinal plant knowledge in the region persists mainly because of the necessity to treat the diseases that the “doctor does not cure,” the culture-bound syndromes, and the most common ailments, malfunctions of the digestive system.     

Feeding of Arapaima sp.: integrating stomach contents and local ecological knowledge

The giant arapaima (Arapaima sp.) has been described as a fish of change in Amazonia because of its important role in the conservation of floodplains, food security and income generation for rural communities. Nonetheless, despite the cultural, ecological and economic importance of arapaima, data on diet are scarce. Aiming to expand knowledge about arapaima diet in western Amazonia, scientific knowledge was integrated with the knowledge of local dwellers. During the low-water period (September 2018) and the falling-water period (June 2019), arapaima stomachs were collected from 11 floodplain lakes in the middle Juruá River. All fishes were measured [TL (total length)] and sexed. Food items from each stomach were categorized as fishes, invertebrates, plants and bone remains and weighed. Also, in the latter period, experienced local fishers were interviewed about arapaima feeding. This integrated approach revealed that young arapaima eat fish and invertebrates but adult arapaima eat fish of a wide range of species, which were mainly of low and intermediate trophic positions. This study reports the first case of cannibalism for arapaima and also shows that during the low-water period, many individuals had empty stomachs or only some small fish-bone remains and/or plant material. Arapaima sex and TL had no influence on the absence of prey in stomach contents. Overall, it can be concluded that local people had consistent ethnobiological knowledge of arapaima feeding ecology that could be useful within management projects in the region.     

Differences in physical growth of Aymara and Quechua children living at high altitude in Peru

Physical growth of Amerindian children living in two Aymara and three Quechua peasant communities in the Andean highlands of southern Peru (altitude 3,810–3,840 m) was studied, taking into account differences in the microclimate, agronomic situation, and sociodemographic variables. Anthropometric measurements were taken in 395 children aged under 14 years of age in a sample of 151 families in these communities, who were surveyed for sociodemographic variables as well. Data on the land system were available for 77 families. In comparison with reference populations from the United States (NCHS) and The Netherlands, stature, weight, head circumference, and midupper arm circumference (but not weight for stature) in the sample children were reduced. Growth retardation increased after the age of 1 year. Stature and weight in the present sample were very similar compared with previously published data on growth of rural Aymara children living near Lake Titicaca in Bolivia. Head circumference, midupper arm circumference, and weight for stature were significantly larger in Aymara children compared with Quechua children. Land was significantly more fragmented in Aymara compared with Quechua families, but amount of land owned was not different. Perinatal and infant mortality was elevated in Aymara vs. Quechua communities. Most families in Aymara communities used protected drinking water. One Quechua community had a severe microclimate, grim economic outlook, and weak social cohesion. Children in this community showed significant reductions in weight and midupper arm circumference compared with their peers in the other communities. We conclude that (presumably nutritionally mediated) intervillage and Aymara-Quechua differences in childhood physical growth existed in this rural high-altitude population in Peru and were associated with microclimate and the village economy, sociodemographic factors, and differences in the land system. © 1993 Wiley-Liss, Inc.     

Knowledge of rabies among rural community in Chengalpet district,India

The objective of the present study is to assess the knowledge about rabies among the general population of a rural area in Chengalpattu district of Tamilnadu. A cross-sectional study was conducted among 361 participants belonging to Paranur village of Chengalpattu district. A pre-tested questionnaire was utilized to gather information on socio-demographic factors, knowledge about rabies, treatment-seeking behavior, and anti-rabies vaccine use among participants with history of dog bite. Among the 361 participants, only 49.5 % were aware of local wound-management procedures, despite the fact that 68% had sufficient knowledge about rabies. The present study highlights. significant association between knowledge regarding rabies with demographic variables such as gender, age, education and occupation Although more than half of the study population had adequate knowledge on rabies, one-fourth of them had no knowledge on first-aid treatments or vaccines at the time of dog bite. This study highlights the need to promote knowledge regarding wound care and post-exposure prophylaxis at the event of a dog bite.     

Traditional Knowledge and Management of <Emphasis Type="Italic">Feijoa (Acca sellowiana)</Emphasis> in Southern Brazil

Traditional Knowledge and Management of Feijoa (Acca sellowiana) in Southern Brazil. This paper investigates traditional knowledge of the use and management of Acca sellowiana in southern Brazil. Fifty-six informants from three rural communities were assigned to one of four subgroups (“maintainers,” “managers,” “cultivators,” or “users”) based on their responses regarding management and use of A. sellowiana. Traditional knowledge related to use of this species is widespread among rural residents, but traditional knowledge related to management is fragmented depending on whether one uses, manages, or cultivates the species. Knowledge held in rural communities suggests that A. sellowiana could play an expanded role in local economies as well as biodiversity conservation. We suggest that participatory research could stimulate greater local use as well as on-farm conservation of A. sellowiana.     

Elder knowledge and sustainable livelihoods in post-Soviet Russia: finding dialogue across the generations

Russia's indigenous peoples have been struggling with economic, environmental, and socio-cultural dislocation since the fall of the Soviet Union in 1991. In northern rural areas, the end of the Soviet Union most often meant the end of agro-industrial state farm operations that employed and fed surrounding rural populations. Most communities adapted to this loss by reinstating some form of pre-Soviet household-level food production based on hunting, fishing, and/or herding. However, mass media, globalization, and modernity challenge the intergenerational knowledge exchange that grounds subsistence practices. Parts of the circumpolar north have been relatively successful in valuing and integrating elder knowledge within their communities. This has not been the case in Russia. This article presents results of an elder knowledge project in northeast Siberia, Russia that shows how rural communities can both document and use elder knowledge to bolster local definitions of sustainability and, at the same time, initiate new modes of communication between village youth and elders.     

Modernization, stress, and blood pressure: new directions in research.

The relationship between modernization and blood pressure has been formally examined in anthropology for some 3 decades. A prominent hypothesis to account for the increase in blood pressure in more modernized (or economically developed) communities is the stressful nature of cultural and social change. Research has progressed from hypothesizing that culture change is stressful to trying to operationalize theoretical models of what it is about culture change that is stressful and in turn relating those more precise variables to blood pressure variability within and between communities. Here, I selectively review the literature on modernization and blood pressure, especially the research literature that explicitly uses models of the stress process to guide that research. The most interesting results have been obtained when the use of the stress model has been informed by careful ethnographic work. This has enabled researchers to adapt models of the stress process to be culturally appropriate in local populations. In addition, incorporating an explicit model of culture, especially one that is sensitive to intracultural diversity, has led to new hypotheses regarding the modification of the effects of stressors by social and cultural context. I conclude with a discussion of recent innovations in ethnographic methods, specifically the cultural consensus model, and the use of those methods in operationalizing relevant variables in culturally appropriate and sensitive ways. The utility of combining these methods in the study of modernization and blood pressure is illustrated by recent research in Brazil.     

Cross-Cultural Ethnobiology in the Western Balkans: Medical Ethnobotany and Ethnozoology Among Albanians and Serbs in the Pešter Plateau,Sandžak,South-Western Serbia

An ethnobiological study concerning the medical ethnobotany and ethnozoology of two neighbouring communities of Serbians and Albanians living in the Pešter plateau (south-western Serbia) was conducted, the latter representing a diasporic community that immigrated to the area approximately three centuries ago. Sixty-two botanical taxa used in 129 plant-based remedies and 204 folk plant uses were recorded. In addition, 31 animal-derived remedies and 27 mineral or non-indigenous products were also documented. Approximately half of the recorded phytotherepeutical uses have been recorded for the first time in the ethnobotany of the Western Balkans and more than one-third of these uses have no correlation with Western evidence-based phytotherapy. Moreover, while both communities use approximately the same number of medicinal plants, two-thirds of the botanical taxa, but only one-third of plant folk medical uses are found in common among the two communities. These findings demonstrate that the two communities, although having lived in close proximity to each other during the past three centuries and in a relatively low biodiverse environment, have maintained or developed unique phytotherapeutical trajectories. The differences between the two folk medical biologies of these communities are reflective of the specific history of the Albanian diaspora, and of the complex processes of its cultural adaptation over the last three centuries.     

Operationalising Contemporary Rural Development: Socio-Cultural Determinants Arising from a Strong Local Fishing Culture

A transition to programmes adopting a governance-based approach in encouraging value-added and innovation in rural economies is often described as offering new opportunities for marginalised rural communities that have not benefited from top-down development policies. In practice, however, it is noted in Ireland and elsewhere in the EU that traditional fishers and farmers have been slow to engage in economic activities favoured by contemporary policies. I discuss how traditional small-scale fishing communities can be estranged from contemporary rural development policies that are focused primarily on providing high value-added service-oriented and processed goods. I approach the problem of poor integration of fishing communities by focusing on how contemporary rural development programmes - though shrouded in language of local participation, governance, and indigenisation - can fail to actively engage with indigenous socio-cultural identity and resources. Exploring how intricate human ecological relationships involving custom and local knowledge of physical resources are not readily commoditised, I raise questions in relation to some of the central claims of the governance and rural development model, such as that it has the capacity to empower and generate confidence through locally appropriate economic activity.     

Medicinal Plant Knowledge Among Lay People in Five Eastern Tibet Villages

Tibetans in five villages in the Mount Khawa Karpo area of the Menri (Meili Xueshan in Chinese) range, Northwest Yunnan, People’s Republic of China, were interviewed about their knowledge of a number of medicinal plants and their uses. There was large variation in people’s knowledge with significant differences among the villages and between men and women. Most of the reported knowledge focused on a small number of commercial plants and their uses. In comparison with Tibetan doctors, villagers generally knew fewer applications and focused on general health remedies. Many people collected medicinal plants for their own use as well as for sale, but also obtained medicinal plant remedies from markets and Tibetan doctors, and often used traditional Tibetan healthcare in conjunction with biomedical treatment.     

GEOGRAPHIC PATTERNS OF VARIATION IN OFFSHORE SPOTTED DOLPHINS (STENELLA ATTENUATA) OF THE EASTERN TROPICAL PACIFIC OCEAN

The spotted dolphin (Stenella attenuata), a species commonly associated with the tuna fishery, is widely distributed in the eastern tropical Pacific Ocean (ETP). Geographic patterns in morphological characteristics of this dolphin were evaluated for 36 skull measurements of 574 museum specimens allocated to 5° latitude-longitude blocks. A strong subdivision between northern and southern offshore populations was demonstrated using principal components, canonical variates and cluster (UPGMA and function-point) analyses of block means derived from standardized, sex-adjusted measurements. Classification functions derived from a stepwise multiple discriminant analysis correctly identified more than 87 percent of the specimens as being from either a northern or southern locality. These results support recognition of southern spotted dolphins as a separate management stock. Dolphins from a sample representing a far-western locality show similarities with those from the south. Patterns of geographic variation in morphology were evaluated using Mantel tests and matrix correlations; 17 of the 36 characters showed regional patterning and 18 exhibited local patterning. Morphological trends were also assessed with respect to 14 oceanographic measures that characterize environmental variability in the ETP. In general, clinal variation in morphology mirrors a north-south trend found in several environmental variables. Overall, the most striking associations between morphological and environmental variables involved Solar Insolation (Jan.). Sea surface temperatures also exhibited a strong association with morphological variables; the highest correspondence was found between width of the temporal fossa and sea surface temperature in July. In addition, the thickness of the oxygen minimum layer exhibited a pattern of variation that was statistically associated with 58 percent of the skull characters. The geographic patterns found for cranial morphology and environmental measures are strongly clinal and in general congruent, suggesting that oceanographic conditions in part determine trends in morphological characteristics of spotted dolphins.     

Local Knowledge and Conservation of Seagrasses in the Tamil Nadu State of India

Local knowledge systems are not considered in the conservation of fragile seagrass marine ecosystems. In fact, little is known about the utility of seagrasses in local coastal communities. This is intriguing given that some local communities rely on seagrasses to sustain their livelihoods and have relocated their villages to areas with a rich diversity and abundance of seagrasses. The purpose of this study is to assist in conservation efforts regarding seagrasses through identifying Traditional Ecological Knowledge (TEK) from local knowledge systems of seagrasses from 40 coastal communities along the eastern coast of India. We explore the assemblage of scientific and local traditional knowledge concerning the 1. classification of seagrasses (comparing scientific and traditional classification systems), 2. utility of seagrasses, 3. Traditional Ecological Knowledge (TEK) of seagrasses, and 4. current conservation efforts for seagrass ecosystems. Our results indicate that local knowledge systems consist of a complex classification of seagrass diversity that considers the role of seagrasses in the marine ecosystem. This fine-scaled ethno-classification gives rise to five times the number of taxa (10 species = 50 local ethnotaxa), each with a unique role in the ecosystem and utility within coastal communities, including the use of seagrasses for medicine (e.g., treatment of heart conditions, seasickness, etc.), food (nutritious seeds), fertilizer (nutrient rich biomass) and livestock feed (goats and sheep). Local communities are concerned about the loss of seagrass diversity and have considerable local knowledge that is valuable for conservation and restoration plans. This study serves as a case study example of the depth and breadth of local knowledge systems for a particular ecosystem that is in peril.     

Applying Cognitive Decision Theory to the Study of Regional Patterns of Illness Treatment Choice

This article argues for the utility of cognitive decision modeling in assessing regional patterns of health behavior and, when combined with the explanatory modeling approach, in describing and analyzing more effectively sources of intracultural variation in choice within a region. A decision model developed in two intensively studied communities in rural Costa Rica was used to predict treatment choice in a third one representative of the rapid social change occurring in the region. A subsequent analysis of the errors made in prediction pinpointed patterns of intracultural variation that were then investigated from the explanatory model perspective. The incorporation of these more qualitative data into the original decision model made it more sensitive to both the complexities of the decision context and the specifics of the individual illness experience while also enabling greater accuracy in the prediction of regional patterns of treatment choice.     

Traditional Knowledge and Management of Umbu (<Emphasis Type="Italic">Spondias tuberosa</Emphasis>, Anacardiaceae): An Endemic Species from the Semi–Arid Region of Northeastern Brazil

Traditional Knowledge and Management of Umbu ( Spondias tuberosa , Anacardiaceae): An Endemic Species from the Semi–Arid Region of Northeastern Brazil. Spondias tuberosa, or umbu, is an arboreal species that is important both as an alternative economic and subsistence resource for rural communities in the semi–arid, northeastern regions of Brazil. The aim of this work was to study the knowledge, uses, local gathering practices, and management systems of S. tuberosa that are part of the traditions of the communities in this region. An ethnobotanical survey was conducted in two stages in a rural community in the state of Pernambuco. In the first stage, all of the dwellings were visited and both the men and the women who were responsible for their house were interviewed. In the second stage, people who were identified as having a direct relationship with the resource were questioned more thoroughly about the species. Knowledge of S. tuberosa is equally distributed in the community; there are no significant differences in knowledge between men and women, or across age groups. The food category is the most important for both human and animal nourishment. The main forms of local management are tolerance and gathering of fruit. Fruit gathering is directly affected by, in order of importance, taste (sweet–sour), size, and quantity of fruit pulp. The usefulness of S. tuberosa contributes considerably to the tolerance of this species in both managed areas and as part of the native vegetation.     

Rural change and nature conservation in Africa: A case study from Swaziland

High population growth and deteriorating economic conditions imperil Africa's natural environment. Conservationists are trying to cope with the threat by working in rural communities. Yet it is unclear whether they can be effective when social and economic change in rural areas is so rapid. Northeast Swaziland provides a case study. The landscape has been transformed since the 1950s, and conservationists are the only people now giving nature conservation a high priority. Land uses incompatible with local nature reserves are supported because they provide jobs. Thus, conservationists find themselves facing a world where wildlife is increasingly devalued as the forces of change accelerate. This paper concludes: (1) conservationists must expand their influence into rural communities, (2) an integrated development and conservation plan is required for northeastern Swaziland, and (3) only the alleviation of poverty will secure the future of nature conservation in Swaziland as well as the rest of Africa.