The inequalities of medical pluralism: Hierarchies of health, the politics of tradition and the economies of care in Indian oncology

Broom, Alex; Doron, Assa; Tovey, Philip

doi:10.1016/j.socscimed.2009.07.002

Cited by 74 publications

(57 citation statements)

References 27 publications

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“…In the following excerpt a leader from a mainstream church tried to explain the "disorientation" felt by villagers from a historical perspective illustrating the complex interplay of identity, culture and medicine that often characterises post-colonial societies [32]. …”

Section: Resultsmentioning

confidence: 99%

“…In a context of medical pluralism, understood as the more or less harmonious co-existence of cultural approaches to sickness and healing [32-34], it is of relevance to investigate the influence of religious beliefs on attitudes to ART. This study gathered FL's perceptions of the alternatives for treating HIV symptoms available in a rural Tanzanian ward.…”

Section: Introductionmentioning

confidence: 99%

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"Driving the devil away": qualitative insights into miraculous cures for AIDS in a rural Tanzanian ward

et al. 2010

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BackgroundThe role of religious beliefs in the prevention of HIV and attitudes towards the infected has received considerable attention. However, little research has been conducted on Faith Leaders' (FLs) perceptions of antiretroviral therapy (ART) in the developing world. This study investigated FLs' attitudes towards different HIV treatment options (traditional, medical and spiritual) available in a rural Tanzanian ward.MethodsQualitative interviews were conducted with 25 FLs purposively selected to account for all the denominations present in the area. Data was organised into themes using the software package NVIVO-7. The field work guidelines were tailored as new topics emerged and additional codes progressively added to the coding frame.ResultsTraditional healers (THs) and FLs were often reported as antagonists but duality prevailed and many FLs simultaneously believed in traditional healing. Inter-denomination mobility was high and guided by pragmatism.Praying for the sick was a common practice and over one third of respondents said that prayer could cure HIV. Being HIV-positive was often seen as "a punishment from God" and a consequence of sin. As sinning could result from "the work of Satan", forgiveness was possible, and a "reconciliation with God" deemed as essential for a favourable remission of the disease. Several FLs believed that "evil spirits" inflicted through witchcraft could cause the disease and claimed that they could cast "demons" away.While prayers could potentially cure HIV "completely", ART use was generally not discouraged because God had "only a part to play". The perceived potential superiority of spiritual options could however lead some users to interrupt treatment.ConclusionsThe roll-out of ART is taking place in a context in which the new drugs are competing with a diversity of existing options. As long as the complementarities of prayers and ART are not clearly and explicitly stated by FLs, spiritual options may be interpreted as a superior alternative and contribute to hampering adherence to ART. In contexts where ambivalent attitudes towards the new drugs prevail, enhancing FLs understanding of ART's strengths and pitfalls is an essential step to engage them as active partners in ART scale-up programs.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

"Driving the devil away": qualitative insights into miraculous cures for AIDS in a rural Tanzanian ward

et al. 2010

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“…5 This is relevant in multicultural societies in which medical pluralism characterizes the health-seeking pathways of many patients. 6,7 In such settings, Western physicians often face great challenges when implementing treatment for patients whose belief systems are rooted in worldviews different from their own (ie, as seen in a higher rate of treatment abandonment among indigenous patients 8 ). This is at least partially related to language barriers and differing cultural representations of the etiology of disease and corresponding expectations for appropriate healing.…”

Section: Introductionmentioning

confidence: 99%

Maya Healers' Conception of Cancer as Revealed by Comparison With Western Medicine

Berger-González

Gharzouzi

Renner

2016

JGO

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PurposeCultural diversity in clinical encounters is common, yet mental constructions regarding cancer that influence expected treatment are poorly studied for indigenous people. We explored Maya healers' conceptions, diagnosis, and treatment of cancer to remedy this problem.MethodsIn-depth structured interviews with 67 traditional Maya healers in Guatemala across Kaqchikel, Kiche', Mam, Mopan, and Q'eqchi' ethnolinguistic groups were conducted by using a transdisciplinary format. Analysis of qualitative data in categorized matrixes allowed for statistical examination of tendencies and the results were complemented by validation workshops with Maya representatives.ResultsMaya classification of diseases has broad categories of malignant diseases including cancer. Specific Maya terms might equate to particular cancer types, which would open new avenues for research. Notions of malignancy and metastasis were expressed by healers as core characteristics of cancer, a disease believed to be both material and spiritual. Resolution of and/or treatment for cancer is based on restoring physical, mental, emotional, and spiritual equilibrium of the patient and extending that equilibrium to his larger social circle.ConclusionMaya conceptions of cancer determine how traditional diagnostic tools are used and dictate treatment options that include the patient's social-spiritual support system. Official health care providers' understanding of these principles can improve implementation of culturally appropriate protocols that increase indigenous patients' compliance and reduce rates of treatment abandonment.

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“…In private spheres of decision making, such as households, where there are limited financial resources, women are more likely to access the cheapest form of treatment. For example, in India, where biomedical cancer care is expensive, women tended to use TCAH (41). In a recent study in Jordan of informal (family) care for people with mental health problems, it was found that issues of gender, reputation, stigma, and the cost of medicine led people to first access traditional medicine, then a biomedical general practitioner, and finally a mental health care service (19).…”

Section: Resultsmentioning

confidence: 99%

The right to traditional, complementary, and alternative health care

Stuttaford

Makhamreh

Coomans

et al. 2014

Global Health Action

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BackgroundState parties to human rights conventions and declarations are often faced with the seemingly contradictory problem of having an obligation to protect people from harmful practices while also having an obligation to enable access to culturally appropriate effective healing. As people increasingly migrate across the globe, previous distinctions between ‘traditional’ and ‘complementary and alternative medicine’ practices are being transcended. There are connections across transnational healing pathways that link local, national, and global movements of people and knowledge.ObjectiveThis paper contributes to the development of the concept and practice of the right to health in all its forms, exploring the right to traditional, complementary, and alternative health (R2TCAH) across different contexts.DesignThe paper draws on four settings – England, South Africa, Kenya, and Jordan – and is based on key informant interviews and a literature review undertaken in 2010, and updated in 2013. The paper begins by reviewing the international legal context for the right to health. It then considers legal and professional regulations from the global north and south.ResultsAdditional research is needed to establish the legal basis, compare regulatory frameworks, and explore patient and provider perspectives of regulation. This leads to being able to make recommendations on how to balance protection from harm and the obligation to ensure culturally appropriate services. Such an exploration must also challenge Western theories of human rights. Key concepts, such as individual harm, consent, and respect of the autonomy of the individual already established and recognised in international health law, could be adopted in the development of a template for future comparative research.ConclusionsExploration of the normative content of the right to health in all its forms will contribute to supporting traditional, complementary, and alternative health service users and providers in terms of access to information, non-discrimination, clarification of state obligations, and accountability.

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The inequalities of medical pluralism: Hierarchies of health, the politics of tradition and the economies of care in Indian oncology

Cited by 74 publications

References 27 publications

"Driving the devil away": qualitative insights into miraculous cures for AIDS in a rural Tanzanian ward

"Driving the devil away": qualitative insights into miraculous cures for AIDS in a rural Tanzanian ward

Maya Healers' Conception of Cancer as Revealed by Comparison With Western Medicine

The right to traditional, complementary, and alternative health care

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