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Alternative or Traditional Medicine?

: A Patients Perspective on CAM


Juan Carlos Belliard & Rosa Reyes

Agenda
Relevance of T/CAM Key medical anthropological issues The patients perspective

Medical Anthropology
Culture: shapes the way people perceive and organize ideas about health and illness. (Basch, 1999)

History of Medicine
2000 B.C. Here, eat this root! 1000 A.D. That root is heathen. Here, say this prayer! 1500 A.D. That prayer is superstition. Here, drink this potion! 1940 A.D. That potion is snake oil. Here, swallow this pill! 1985 A.D. This pill is ineffective, take this antibiotic! 2000 A.D. That antibiotic doesnt work anymore. Here, eat this root!

Kleinmans Typology of Health Sectors

Popular Folk Professional

Understanding & Treating illness


Illness vs. Disease Causation (explanatory models) The sick role The total drug effect Symbols & values

Illness vs. Disease

Disease Biological Organ specific Diagnostic testing

Illness Socio-cultural construct Patients perception

Folk Illnesses Culture-bound Syndromes

Syndromes from which members of a particular group claim to suffer and for which their culture provides an etiology, a diagnosis, preventive measures and regimens of healing. (Rubel, 1977)

The total drug effect


the drug itself the recipient the prescriber the physical setting

The Sick Role


Agreed upon illness Privileges Responsibilities

Medical Pluralism

Relevance of complimentary medical systems


Globally: 80% of worlds populations depend on traditional medicine for health security. Locally: access to healthcare issues; health disparities (healthy people 2010)

Complementary, Alternative Medicine (CAM)

Folk

Suburban

Botanicas & Religious Syncretism

Herbal Use Study at SACHS


Research Objectives

Understand Herbal use patterns Learn what herbs are used most Assess patient-provider communication regarding herbal use

Do you believe that natural herbs can cure?

percent

Have you used herbs?

percent

Do you use prescription drugs?

percent

Do you have confidence in doctors and/or modern healthcare providers?

percent

Do you feel comfortable speaking English to your doctor?

percent

Which of the following do you or your family use to treat illness?

percent

Do you have confidence in doctors and/or modern healthcare providers?

percent

How often do you tell your physician or healthcare provider about your herb use?

percent

Why Patients use Complementary and Alternative Medicine (CAM)

2/3 use CAM to treat specific conditions and for overall wellness Gain a sense of control over their illness Maintain hope

L.E.A.R.N. Model of Cultural Competency


Listen to the patient's perspective Explain and share one's own perspective Acknowledge differences and similarities between these two perspectives Recommend a treatment plan Negotiate a mutually agreed-on treatment plan

Health World View Questions


1.What do you call your illness? What name does it have? 2.What do you think has caused the illness? 3.Why and when did it start? 4.What do you think the illness does? How does it work?
(Kleinman in Fadiman, 1997)

Health World View Questions


(Continued...)
5.How severe is it? Will it have a short or long course? 6.What kind of treatment do you think you should receive? What are the most important results you hope to receive from this treatment? 7.What are the chief problems the illness has caused? 8.What do you fear most about the illness?
(Kleinman in Fadiman, 1997)

Uncritical acceptance

vs

Uninformed skepticism