Beyond medical pluralism: characterising health-care delivery of biomedicine and traditional medicine in rural Guatemala

Abstract

Although approximately one half of Guatemalans are indigenous, the Guatemalan Maya account for 72% of the extremely poor within the country. While some biomedical services are available in these communities, many Maya utilise traditional medicine as a significant, if not primary, source of health care. While existing medical anthropological research characterises these modes of medicine as medically dichotomous or pluralistic, our research in a Maya community of the Western Highlands, Concepción Huista, builds on previous studies and finds instead a syncretistic, imbricated local health system. We find significant overlap and interpenetration of the biomedical and traditional medical models that are described best as a framework where practitioners in both settings employ elements of the other in order to best meet community needs. By focusing on the practitioner's perspective, we demonstrate that in addition to patients' willingness to seek care across health systems, practitioners converse across seemingly distinct systems via incorporation of certain elements of the 'other'. Interventions to date have not accounted for this imbrication. Guatemalan governmental policies to support local healers have led to little practical change in the health-care landscape of the country. Therefore, understanding this complex imbrication is crucial for interventions and policy changes.

Traditional, complementary, and alternative medical cures for HIV: rationale and implications for HIV cure research

“…To overcome these barriers in recruitment, researchers may use the local traditional framework and culturally familiar concepts in recruitment and education (Corneli et al, 2006; Cox, 2000; Hoyler, Martinez, Mehta, Nisonoff, & Boyd, 2016; Nations & de Souza, 1996) while being mindful of maintaining an evidence-based framework of biomedicine. Researchers can collaborate with locally respected leaders and traditional healers to develop an appropriate message and to use interactive techniques, such as story-telling and drawings (Corneli et al, 2006; Ndebele, Wassenaar, Munalula, & Masiye, 2012).…”

In Sickness and Health: Views on Child Health From a Mayan Village

“…In an area where health resources are scarce, the medicinal properties of these herbs become a first line of treatment. Hoyler et al (2018) also found the common use of herbs for the treatment of gastrointestinal disorders. In addition, these herbs are sold in the city and provide the families with a source of income.…”

“…Collaboration between shamans and Western-trained clinicians was recommended to deliver holistic care (Hatala et al, 2015). These collaborations, noted in a qualitative study, included traditional healers incorporating biomedical practices and referring patients to biomedical practitioners (Hoyler, Martinez, Mehta, Nisonoff, & Boyd, 2018). It also included biomedical practitioners incorporating traditional medicine and referring individuals to traditional healers when faced with culture bound syndromes (Hoyler et al, 2018).…”

“…These collaborations, noted in a qualitative study, included traditional healers incorporating biomedical practices and referring patients to biomedical practitioners (Hoyler, Martinez, Mehta, Nisonoff, & Boyd, 2018). It also included biomedical practitioners incorporating traditional medicine and referring individuals to traditional healers when faced with culture bound syndromes (Hoyler et al, 2018). Historically, traditional healers and biomedical practitioners have worked in a two-tiered system (Glittenberg, 1994).…”

‘These people who dig roots in the forests cannot treat HIV’: Women and men in Durban, South Africa, reflect on traditional medicine and antiretroviral drugs

“…Proponents point out that TM is important to cultural belief systems, particularly in Africa (Xaba, 1998; Ashforth, 2005), and is viewed as essential for treating health problems biomedicine cannot cure (Mander et al, 2007). Others highlight that TM and biomedicine are complementary, not antithetical, to each other (Xaba, 1998): biomedicine has appropriated elements of TM (Hampshire & Owusu, 2013), such as acupuncture and homeopathic remedies, whereas THPs have used biomedical terminology, referenced germ theory, and referred patients to biomedical practitioners (Hoyler, Martinez, Mehta, Nisonoff, & Boyd, 2016). Additionally, the effects of globalisation are reflected in the flow of traditional and biomedicines between diasporic and communities of origin across national and continental borders (Kane, 2012; Germond & Cochrane, 2010), suggesting that the two medical systems influence each other.…”