Revisiting the Navajo way: lessons for contemporary healing

Given the paradox of the success of modern medical technology and the growing patient dissatisfaction with present-day medicine, critics have called for a reevaluation of contemporary medical practice. This paper offers a phenomenological analysis of traditional Navajo healers and their ceremonies to highlight key aspects of healing. A phenomenological view of medical practice takes into account three key features: the lifeworld, the lived body, and understanding. Because of their closeness to a phenomenological view, traditional Navajo mythology and healing practices offer insight into the healing process. Contemporary physicians can appreciate the phenomenological elements of Navajo healing ceremonies, including the Mountain Chant. Navajo healers help patients make sense of their illnesses and direct their lives accordingly, an outcome available to contemporary practitioners, who are also gifted with the benefits of new technologies. By examining scientific medicine, Navajo healing practices, and phenomenology as complementary disciplines, the authors provide the groundwork for reestablishing a more therapeutic view of health.     

The efficacy of traditional medicine: current theoretical and methodological issues

The efficacy of traditional medicine is an issue that continues to vex medical anthropology. This article critically examines how the efficacy of traditional medicine has been conceived, operationalized, and studied and argues that a consensus remains elusive. Efficacy must be seen as fluid and shifting, the product of a negotiated, but not necessarily shared, understanding by those involved in the sickness episode, including physicians/healers, patients, and members of the community. Medical anthropology needs to return to the field to gather more data on indigenous understandings of efficacy to counteract the biases inherent in the utilization of biomedical understandings and methods characteristic of much previous work.     

Medicinal plants used by latino healers for women’s health conditions in New York City

This paper examines the use of medicinal plants by Latino healers in New York City to treat various women’s illnesses. Eight Latino healers collaborated on the study through consultations with female patients who had one of the following conditions as diagnosed by biomedically trained physicians: uterine fibroids, hot flashes, menorrhagia, or endometriosis. The study identified a total of 67 plant species prescribed by the healers in the form of mixtures or as individual plants. Voucher specimens were collected from local botánicas and identified by specialists at The New York Botanical Garden. Studies of immigrant traditional healers and the plants they use in an urban setting can provide interesting ethnobotanical data and information to assist in diagnosing conditions and contributing to treatment of patients from Latino as well as non-Latino communities.     

Traditional healing and its discontents: efficacy and traditional therapies of neuropsychiatric disorders in Bali

In a discussion of patients suffering from obsessive-compulsive disorder (OCD) and/or Tourettes's Syndrome (TS), in Bali, Indonesia, traditional healing and psychiatric perspectives are used to highlight the power and weakness of each to treat these conditions. Given they are drawn from the same culture, should not indigenous explanatory models provide meaning and be more efficacious at relieving the suffering of people with OCD and TS-like symptoms? What if they provide an understandable meaning for patients but these meanings have no efficacy? Ethnographic data on Balinese models for illness are presented. Multiple data sources were used to frame the complex Balinese traditional healing systems. Forty patients were interviewed regarding their utilization of traditional healers, and healers were observed treating patients and interviewed regarding their treatment regimens and explanatory models. Traditional explanatory models for illness provide an understandable and integrated system of meaning for these disorders but are not successful in relieving symptomatology. Neurobiological approaches, traditional healing, and ethnographic methods are compared and contrasted to highlight the strengths and weaknesses of each in relation to issues of exegesis and efficacy.     

Disease concepts and treatment by tribal healers of an Amazonian forest culture

Background

The extensive medicinal plant knowledge of Amazonian tribal peoples is widely recognized in the scientific literature and celebrated in popular lore. Despite this broad interest, the ethnomedical systems and knowledge of disease which guide indigenous utilization of botanical diversity for healing remain poorly characterized and understood. No study, to our knowledge, has attempted to directly examine patterns of actual disease recognition and treatment by healers of an Amazonian indigenous culture.

Methods

The establishment of traditional medicine clinics, operated and directed by elder tribal shamans in two remote Trio villages of the Suriname rainforest, presented a unique investigational opportunity. Quantitative analysis of clinic records from both villages permitted examination of diseases treated over a continuous period of four years. Cross-cultural comparative translations were articulated of recorded disease conditions through ethnographic interviews of elder Trio shamans and a comprehensive atlas of indigenous anatomical nomenclature was developed.

Results

20,337 patient visits within the period 2000 to 2004 were analyzed. 75 disease conditions and 127 anatomical terms are presented. Trio concepts of disease and medical practices are broadly examined within the present and historical state of their culture.

Conclusion

The findings of this investigation support the presence of a comprehensive and highly formalized ethnomedical institution within Trio culture with attendant health policy and conservation implications.     

Onchocerca parasites and Wolbachia endosymbionts: evaluation of a spectrum of antibiotic types for activity against Onchocerca gutturosa in vitro

Background

In the Dominican Republic, a Latin American country with filariasis-endemic areas, more than 63,000 people have lymphatic filariasis and more than 400,000 people are at risk of future infection. In this paper, we explore the health beliefs, health-seeking behaviors and self-care practices of women with lymphoedema in filariasis-endemic areas to better understand the needs of women when developing lymphoedema morbidity control programs.

Methods

Qualitative data were collected through semi-structured interviews of 28 women, 3 focus group discussions with 28 women, field notes and photographs.

Results

Women described exhaustive and expensive attempts at seeking a cure for their lymphoedema. Family members were influential in providing women with initial care seeking referrals to indigenous healers credited with influence over physical, mental, spiritual and supernatural properties of illness. When indigenous treatments proved to be ineffectual, the women sought care from trained healthcare providers. Most healthcare providers incorrectly diagnosed the edema, failed to adequately treat and meet the needs of women and were viewed as expensive. Most women resorted to self-prescribing injectable, oral, or topical antibiotics along with oral analgesics as a standard practice of self-care.

Conclusion

Healthcare providers must understand a woman's cultural perspectives of illness, her natural networks of support and referral, her behavioural practices of care-seeking and self-care and the financial burden of seeking care. In the culture of the Dominican Republic family members and traditional healthcare providers are influential advisors on initial health-seeking behaviors and self-care practices. For this reason family-oriented interventions, support groups for women and their families, community education and training on simple, low cost lymphoedema management techniques for indigenous healers are viable ways to influence the early detection, diagnosis and treatment of women with lymphoedema. The extensive use of injectable, oral and topical antibiotics by indigenous healers and women without medical supervision suggests a need for health education messages related to the risks of such practices.     

Circle of healing: traditional storytelling, part three

Southcentral Foundation had to overcome several organizational and procedural hurdles when developing their Circle of Healing program. Among these hurdles was finding a way to credential Alaska Native healers so the Foundation could be reimbursed for their services and pay the healers, and so the healers could work in the hospital along with the staff delivering Western and alternative medical treatment. Southcentral Foundation chose to develop a process for certifying Alaska Native healers as tribal doctors. Rita Blumenstein is the first such person to be certified. Lisa Dolchok is the second. An important strength of Lisa’s presentation is that she helps us broaden our understanding of healing from an Alaska Native perspective. So often we equate healing with curing, and while it can have this dimension, Lisa reminds us there is much more to it. She echoes LouAnn Benson’s presentation in asserting that healing can address illness of the spirit or wounds to the soul.     

Traditional medicinal plant knowledge and use by local healers in Sekoru District, Jimma Zone, Southwestern Ethiopia

The knowledge and use of medicinal plant species by traditional healers was investigated in Sekoru District, Jimma Zone, Southwestern Ethiopia from December 2005 to November 2006. Traditional healers of the study area were selected randomly and interviewed with the help of translators to gather information on the knowledge and use of medicinal plants used as a remedy for human ailments in the study area. In the current study, it was reported that 27 plant species belonging to 27 genera and 18 families were commonly used to treat various human ailments. Most of these species (85.71%) were wild and harvested mainly for their leaves (64.52%). The most cited ethnomedicinal plant species wasAlysicarpus quartinianus A. Rich., whose roots and leaves were reported by traditional healers to be crushed in fresh and applied as a lotion on the lesions of patients ofAbiato (Shererit). No significant correlation was observed between the age of traditional healers and the number of species reported and the indigenous knowledge transfer was found to be similar. More than one medicinal plant species were used more frequently than the use of a single species for remedy preparations. Plant parts used for remedy preparations showed significant difference with medicinal plant species abundance in the study area.     

Do Doctors Undertreat Pain?

Routinely, physicians discount patients' pain reports and provide too little analgesia too late. Critics call them callous, sadistic, and Puritanical, but the causes of these clinical practices are different — namely, a psychological need to distance themselves from the pain they encounter and inflict, and more subtly, a peculiar concept of pain acquired in medical training.
Physicians learn to think of pain as a symptom to observe and explore in diagnosing and monitoring disease — not as a complaint to relieve quickly or fully. Moreover, pain-relief is regarded as subordinate to, and competing with efforts to cure or maintain the life of a patient. This training, I suggest, gives physicians a new, clinical concept of pain at odds with their prior, lay concept of pain whose manifestations standardly call for sympathetic efforts at relief.
The conceptual nature of this difference is obscured by thinking of pain as a solely private sensation, rather than as a sensation with public and social aspects (a la Wittgenstein). Although suppressed in certain clinical circumstances, these standard public and social aspects are shown in the very tests used in clinical pain research.
This clinical pain concept is rooted in Medicine conceived as preeminently curative and life-prolonging. Physicians are, however, themselves undermining this professional self-definition (by treating AIDS and Alzheimer's patients; by no longer pressing their patients to 'fight to the end'; by collaborating with non-medical healers). Accordingly, pain-relief may gain greater therapeutic status, and, so too, the ordinary concept of pain that medical training has suppressed.     

Do doctors undertreat pain?

Routinely, physicians discount patients' pain reports and provide too little analgesia too late. Critics call them callous, sadistic, and Puritanical, but the causes of these clinical practices are different — namely, a psychological need to distance themselves from the pain they encounter and inflict, and more subtly, a peculiar concept of pain acquired in medical training.
Physicians learn to think of pain as a symptom to observe and explore in diagnosing and monitoring disease — not as a complaint to relieve quickly or fully. Moreover, pain-relief is regarded as subordinate to, and competing with efforts to cure or maintain the life of a patient. This training, I suggest, gives physicians a new, clinical concept of pain at odds with their prior, lay concept of pain whose manifestations standardly call for sympathetic efforts at relief.
The conceptual nature of this difference is obscured by thinking of pain as a solely private sensation, rather than as a sensation with public and social aspects (a la Wittgenstein). Although suppressed in certain clinical circumstances, these standard public and social aspects are shown in the very tests used in clinical pain research.
This clinical pain concept is rooted in Medicine conceived as preeminently curative and life-prolonging. Physicians are, however, themselves undermining this professional self-definition (by treating AIDS and Alzheimer's patients; by no longer pressing their patients to 'fight to the end'; by collaborating with non-medical healers). Accordingly, pain-relief may gain greater therapeutic status, and, so too, the ordinary concept of pain that medical training has suppressed.     

Continuing medical education about AIDS--a needs assessment.

The incidence of the acquired immunodeficiency syndrome (AIDS) among Latinos and African Americans nationally and in Los Angeles has risen substantially. No data exist to indicate which physicians (or groups of physicians) provide care to these groups, however. To better plan AIDS educational programs, efforts were made to identify those physicians whose offices were located in areas with high proportions of nonwhites. Many physicians in these areas--30% of all office-based primary care physicians in Los Angeles--were found to be graduates of international medical schools. A survey of a stratified random sample of international medical graduates revealed that compared with a random sample of United States medical graduates, they had a greater proportion of nonwhite patients, often of an ethnicity similar to theirs; practiced in areas with a greater proportion of Asians and lower family incomes; had fewer patients infected with the immunodeficiency virus (HIV) in their practices; and were more avoidant of such patients. As the incidence of HIV infection increases among minority groups, means need to be developed to ensure their access to counseling and screening, as well as treatment with the latest available agents. Options include imaginative and engaging approaches to continuing medical education for all physicians and the creation of separate public sector infrastructures to meet the HIV-related needs of these communities.     

Knowledge and practice of traditional healers in oral health in the Bui Division, Cameroon

Background

The extraction of the teeth by traditional healers in Cameroon is an established cultural practice in the central region of the Cameroon. Traditional healers (TH) use herbs and crude un-sterilized instruments and tools for the tooth extraction procedure. The present study investigates the knowledge and practices of traditional healers regarding tooth extraction and the management of its complications.

Methods

A cross sectional design utilizing semi-structured questionnaires was used to collect the data from traditional healers and their patients.

Results

Sixteen traditional healers (TH) were interviewed. All were male and the majority were between 25-35 years old. The most important reason given for the removal of a tooth was "if it has a hole". All reported using herbs to control bleeding and pain after extractions. Only 20% used gloves between patients when extracting a tooth and just over a third (31.3%) gave post-operative instructions. Eighty seven percent managed complications with herbs and 62.5% reported that they would refer their patients to a dentist whenever there are complications. Only a third (31.3%) was familiar with the basic anatomy of a tooth and more than half (56.3%) reported that tooth extractions are the only treatment for dental problems. One hundred and fifty patients were interviewed with a mean age of 29 years. More than two thirds were in the 21-30 year age group and just over half were male. Sixty six percent reported that they visited the TH because it is cheap, 93.3% were satisfied with the treatment they received while 95.3% reported said they never had a problem after an extraction.

Conclusions

Tooth extractions using medicinal plants is well established in Lekie division, Cameroon. Infection control during extraction is not the norm. Traditional healers are willing to co-operate with oral health workers in improving the oral health of their patients. Mutual cooperation, collaboration and integrating TH into primary oral health care services need to be increased.     

Physician communication skills and malpractice claims. A complex relationship.

We assessed the relationship between patients'' opinions about their physicians'' communication skills and the physician''s history of medical malpractice claims. The sample consisted of 107 physicians and 2,030 of their patients who had had an operation or a delivery. Although patients tended to give their physicians favorable ratings, they were least satisfied with the amount of explanations they received. Patients gave higher ratings to general surgeons and obstetrician-gynecologists and poorer ratings to orthopedists and anesthesiologists. Women and better-educated patients gave higher ratings on explanations and communication to physicians with fewer claims. Men and patients with less education, however, gave higher ratings on these dimensions to physicians with more claims. These findings suggest the need for physicians to tailor their communications to a patient''s individual needs. Improved communication between physicians and patients may result in fewer nonmeritorious malpractice claims while leading to less costly resolution of meritorious claims.     

Taking care of patients--does it matter whether the physician is a woman?

Researchers have recently begun to compare male and female physicians'' attitudes toward patients, medical knowledge, and practice styles. Although women start medical school with more "humanistic views," the conservative effect of medical socialization on both male and female students attenuates these differences. While some studies suggested that men are more scientifically knowledgeable, recent studies showed no significant differences in physicians'' medical knowledge. Male and female physicians also had comparable diagnostic and therapeutic behavior. In the intimate world of physicians and patients, however, there were notable differences. Women physicians seemed better able to communicate sensitivity and caring to patients, which may account for the common perception that women are more caring and empathic physicians. Medical educators may wish to study more closely female physicians'' communication styles to identify these behaviors and inculcate them into all physicians.     

Oaths for physicians--necessary protection or elaborate hoax?

The ritual of taking an oath upon graduating from medical school is, with a few exceptions, a routine requirement for graduation. Albeit that many students believe that they have taken the Hippocratic Oath, this is virtually never the case. Very often students themselves write many of these oaths, and taking such an oath impresses the student as well as the public, who are potential patients. It sketches the ethically proper way for physicians to treat their patients. Such an oath is meaningful only when it is not coerced but in reality sketches the physicians' obligations toward patients, society, and each other. The question and problem of a coerced oath are discussed. It is concluded that students when first entering medical school know that such an oath will be a requirement for graduation, and because much of the time the persons taking the oath are writing it, I believe that coercion is not a factor. It is an unfortunate fact that throughout the nation students who are known to behave in ethically inappropriate ways are nevertheless allowed to graduate. Possible ways of addressing this troubling situation are discussed. Equally troublesome is the fact that we who administer the oath as well as the students who swear to it are aware that the system of medical care makes it extremely difficult and at times impossible to truly adhere to the full implications of this oath. According to the oath, physicians (in virtually all formulations) swear that social standing (and by implication economic factors) will not change the way in which patients are treated. This becomes impossible when uninsured patients are sent away at the front desk long before the physician can interact with them. Furthermore, the current fact that physicians often are confronted with not doing what they consider a necessary test (or prescribe what they think would be the best medication) raises the problem of either lying or suggesting to the patient that he/she do so--a fact that in the long run cannot help but damage the physician's veracity and the trust which patients put in their physicians. That virtually all codes of the American Medical Association (AMA) as well as the various specialties insist that physicians work toward universal access is stressed.     

An ethnobotanical survey of indigenous knowledge on medicinal plants used by the traditional healers of the Lwamondo area,Limpopo province,South Africa

The use of medicinal plants in the treatment and prevention of diseases is attracting the attention of scientists worldwide. Approximately 3000 plant species are currently used by an estimated 200,000 indigenous traditional healers in South Africa. The specific part of the plant used for medicinal applications varies from species to species, and from one traditional healer to another. This study was carried out to explore and record those plants and plant parts used for treating various human ailments by the traditional healers of the Lwamondo area in the Limpopo province, South Africa for medicinal purposes. Ethnobotanical data were collected from 30 traditional healers (24 females and 6 males) in the Lwamondo area of Venda, by means of a data capture questionnaire focusing on the local names of the medicinal plants, their medicinal uses, the plant parts used, and methods of preparation and of administering treatments to patients. The survey identified 16 medicinal plants from 7 families, with 14 genera, used to treat a range of ailments in the Lwamondo area. The Fabaceae family was the most commonly used plant family representing 43.8% of all the medicinal plants species recorded by this study, followed by the Varbenaceae family at 18.8%. The plant parts most frequently used were the roots (44.5%), followed by the leaves (25.9%), bark (14.8%), the whole plant (11%), and flowers (3.7%). Most of the traditional healers obtained their extracts by boiling the medicinal plants. The most often recurring ailment treated by healers was stomach problems, using 31.3% of all the medicinal plants reported in this study for preparing such treatments. The following medicinal plants were covered by this study: Annona senegalensis, Schkuhria pinnata, Diospyros mespiliformis, Piliostigma thonningii, Senna obtusifolia, Bauhinia galpinii. The rural communities of the Lwamondo area possess a wealth of information on medicinal plants and their applications. This ethnobotanical survey can help scientists identify for further research those plants whose medicinal properties may be useful in the development of new drugs.     

Somatisation and alexithymia in patients with high use of medical care and medically unexplained symptoms

Background and objective Few reports in the medical literature examine physician agreement on a standard assessment for somatisation in primary care patients. We describe somatising patients who were subjectively identified by family physicians and subsequently classified on the somatisation spectrum by a standard evaluation. We also examine the relation between somatisation and alexithymia.Method Responding to a brief verbal prompt, family physicians referred high-utilising patients 18 years old and older who had 'persistent medically unexplained symptoms for at least 6 months' (n = 72). Patients who agreed to participate in the study (n = 48) were assessed individually using a structured diagnostic interview and two measures of alexithymia.Results All participating patients met inclusion criteria for one of two abridged subtypes on the somatisation spectrum. Somatisation was not related to alexithymia.Conclusions Family physicians subjectively identified patients who had somatisation, with a high level of accuracy and without formal screening or diagnostic tests. Embedded in a disease-management system, especially an electronic version, a brief verbal prompt to physicians to identify patients on the somatisation spectrum could potentially realise considerable savings in physician time and medical system financial expenditures.     

Concepts of illness and treatment practice in a caboclo community of the Lower Amazon

Comparatively little has been written recently about the health consequences of social change and economic development in Amazonia. This study focuses on patterns of morbidity, treatment practices, and illness beliefs among caboclos of the Lower Amazon. It suggests that for these people traditional medicine is a salient marker of ethnic identity. An understanding of beliefs concerning disease etiology is critical to an appreciation of individual treatment choices in a plural medical system such as that found within the Lower Amazon region, where traditional healers can play a pivotal role in developing effective linkages to clinical services, [traditional healers, Amazonia, caboclos, medical pluralism]     

Traditional healers in Nigeria: perception of cause, treatment and referral practices for severe malaria

Malaria remains one of the main causes of mortality among young children in sub-Saharan Africa. In Nigeria traditional healers play an important role in health care delivery and the majority of the population depend on them for most of their ailments. The aim of this study was to investigate the perceptions of traditional healers regarding causes, symptoms, treatment of uncomplicated malaria and referral practices for severe malaria with a view to developing appropriate intervention strategies aimed at improving referral practices for severe malaria. A qualitative study was carried out in Ugwogo-Nike, a rural community in south-east Nigeria, which included in-depth interviews with 23 traditional healers. The traditional healers believed that the treatment of severe malaria, especially convulsions, with herbal remedies was very effective. Some traditional healers were familiar with the signs and symptoms of malaria, but malaria was perceived as an environmentally related disease caused by heat from the scorching sun. The majority of traditional healers believed that convulsions are inherited from parents, while a minority attributed them to evil spirits. Most (16/23) will not refer cases to a health facility because they believe in the efficacy of their herbal remedies. The few that did refer did so after several stages of traditional treatment, which resulted in long delays of about two weeks before appropriate treatment was received. The fact that traditional healers are important providers of treatment for severe malaria, especially convulsions, underlines the need to enlist their support in efforts to improve referral practices for severe malaria.     

Management of Obesity in Primary Care

SIMKIN-SILVERMAN, LAUREY R, RENA R WING. Management of obesity in primary care. Obesity is one of the most common presenting chronic medical conditions in primary care, yet it is not adequately treated. Physicians are often reluctant to counsel patients because of their limited training in treating chronic weight problems and negative attitudes toward obese patients. This study evaluated the feasibility of training physicians to provide weight control counseling to their patients. Eleven physicians were randomly assigned to either an obesity-counseling skills training group or to a control group. Physicians in the counseling skills group received training in behavioral and motivational weight control techniques using a five-step patient-centered model; they were also given patient materials for use in their practice. To evaluate pretraining to posttraining changes in physician counseling behavior, independent samples of patients with obesity were surveyed immediately after their visit to the physician's office. Physicians in both the counseling skills training and the control groups discussed weight with 42% to 47% of their patients at baseline. This increased to 89% in physicians who received training, whereas it remained at 42% in control physicians. Scores on a counseling measure also significantly increased from a mean of 2. 7 to 9. 9 in the counseling group, whereas scores in the control group remained low and stable (2. 3 and 1. 9, respectively). The training program was effective in improving the frequency and quality of counseling that physicians delivered to their patients with obesity. Future research is needed to evaluate the effect of physician counseling on the weight and physical activity level of their patients.