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Integration of Traditional Healers/Practices
Literature Review Abstracts

Conducted a community-based interview study of 65 Asians (aged 19-70 yrs) and a questionnaire study of 40 health professionals in Scotland to examine the role of traditional medicine in the context of health care within the Asian community. Results indicate that, among Asians, knowledge of herbal remedies, the Asian healer, and cultural concepts was high. Ss frequently used culinary ingredients to treat common diseases such as abdominal discomfort, earache, and toothache, while the use of metal-based medications was rare. Among health professionals, awareness of Asian medicine was low. None had encountered morbidity resulting from its remedies; 50% felt that such remedies should be encouraged unless shown to be harmful. (35 ref) (© 1997 APA/PsycINFO, all rights reserved)

Boyden YL. Przestrzelski D.
Management Decisions. Taking Charge: Tailoring Care to Culture... American Indian Health Care Coordinator.
RN, 58(8):15-6, 1995 Aug.

Del Castillo, Ramon R.
Effective management strategies when incorporating curanderismo into a mainstream mental health system. (folk healing).
Dissertation Abstracts International: Section B: the Sciences & Engineering. Vol 60(4-B), Oct 1999, 1524.

As America approaches the year 2000 and beyond, coupled with the challenges of a growing and diverse population, public administrators will be asked to do more with less. The Congress in American government will continue to grapple with the question of health and mental health care for all of its citizens; therefore, it is useful to include all relevant modalities of health and mental health care in the debate. Additionally, in order to insure effectiveness and prudent expenditure of the public's dollars, as health and mental health care providers attempt to incorporate alternative methods of treatment into its health and mental health care systems, associated management strategies that accompany these innovations should also be analyzed. There is a paucity of literature regarding management problems and strategies associated with incorporating what is considered to be a non-traditional form of mental health treatment into mainstream systems. This research is exploratory in nature, utilizing the topical life history approach with both curanderas/os (indigenous healers) and public administrators and managers. These public servants were involved in the implementation of curanderismo, defined as the practice of spiritual folk medicine, generally used in Indian and Mexican-American communities as it was implemented in a publicly funded mental health system. This dissertation asks the question what management strategies are effective when incorporating curanderismo into a publicly funded mental health system. The actual research demonstrates those strategies used by Southwest Denver Community Mental Health, a publicly funded mental health center, now consolidated under the Mental Health Corporation of Denver, as curanderismo was first introduced into the system, followed by a process of institutionalization. Analyzing the findings of this research through the eyes of organizational innovation, this research outlines those management strategies that were effectively implemented that eventually resulted in the institutionalization of curanderismo into the system, both as a treatment modality and as educational strategy. The findings of this research demonstrate that the incorporation of curanderismo into a mainstream mental health system was successfully accomplished. Some of the management strategies that were learned include the building of a solid infrastructure to support alternative mental health programming, the demonstration of effective leadership, a strong minority voice, the introduction of intermediaries who play key roles in the process of institutionalization and cultural competency.

Elder NC. Gillcrist A. Minz R.
Use of Alternative Health Care by Family Practice Patients [see comments].
Comment in: Arch Fam Med 1997 Mar-Apr;6(2):155-6
Archives of Family Medicine. 6(2):181-4, 1997 Mar-Apr.

In recent years, the use of alternative medicine has become more acknowledged in the United States. Many different practices are encompassed by the terms alternative, unorthodox, or complementary medicine, and their use by the population is just now being defined. The number of established family practice patients also using alternative medicine is not yet known. To help answer this question, a survey of family practice patients concerning their use of alternative medicine was performed in 4 family practices in a large community in the western United States. Volunteers from the survey respondents attended a focus group to discuss more fully their use of alternative medicine. Questionnaires were completed by 113 family practice patients. Fifty percent (57/113) of patients had or were using some form of alternative medicine, but only 53% (30/57) had told their family physician about this use. No significant difference in the percentage who used alternative medicine or who told their physician about it was attributable to gender, educational level, age, race, or clinic attended. The main reason given for using alternative medicine, alone or in combination with care from a family physician, was a belief that it would work. Many of those who worked in combination with a family physician spoke of acceptance and control, but those who did not work with their physician mentioned traditional medicine's limitations and narrow-mindedness. Family physicians need to be aware that many of their patients may be using alternative health care. Open and nonjudgmental questioning of patients may help increase physician knowledge of this use and lead to improved patient care as physicians and patients work together toward health.

Foster, P M
Ritual Healing: An African-Centered Model of Psychotherapeutic Intervention Based on Ndepp, Candomble and Urban Baptist Ritual
Dissertation Abstracts International

The project demonstrating excellence is an original contribution to the newly emerging field of ethnopsychology and seeks to integrate key elements of traditional African healing with Western approaches to psychotherapeutic intervention. The model draws heavily from healing rituals and practices emanating from three African cultural and religious traditions: Ndepp (Rufisque, Senegal), Candomble (Bahia, Brazil) and (afro-) Baptist (U.S.A.). The model proposes five phases of intervention which are thematically and procedurally centered around therapeutic rituals: the Rite of Inclusion, the Rite of Expiation, the Rite of Immolation, the Rite of Transfiguration and the Rite of Passage. The five phases of intervention also involve the culturally competent use of techniques drawn from Western models of psychotherapy. The model expands on the group approach to intervention and requires the participation of (extended or reconstructed) family and community in the therapeutic process, and extends the meaning of "therapeutic use of self" in clinical practice. Drawbacks of the model include its focus on cultural practices that may be unfamiliar to Western consumers of therapeutic services, and the labor- and resource intensive design. Strengths of the model include its experiential and ritual focus, cultural specificity and applicability to a clinically diverse client population.

Kahn, Marvin W; Delk, John L.
Developing A Community Mental Health Clinic on The Papago Indian Reservation.
International Journal of Social Psychiatry. Vol. 19(3-4), Fal 1973, 299-306.

Describes the establishment of the first mental health facility serving the Papago Indian Tribe of Arizona. The success of the clinic was founded on several policies determined during planning:

1. Communication with other agencies serving the Papagos was encouraged.
2. Papagos were employed as staff members when possible and they were encouraged to develop professional skills.
3. Papago medicine men were used as paid consultants on cases involving traditional Papago beliefs.
4. Tribal approval and support was viewed as essential.

These policies have resulted in general acceptance of the clinic and widespread use of its facilities. Demographic and symptomatic characteristics of 73 clients seen during the 1st 15 mo of operation are presented.

Kim C. Kwok YS.
Navajo Use of Native Healers.
Archives of Internal Medicine. 158(20):2245-9, 1998 Nov 9.

Background: Although the Indian Health Service provides extensive health care service to Navajo people, the role of native healers, or medicine men, has not been quantitatively described.

Objective: To determine the prevalence of native healer use, the reasons for use, cost of use, and the nature of any conflict with conventional medicine.

Methods: We conducted a cross-sectional interview of 300 Navajo patients seen consecutively in an ambulatory care clinic at a rural Indian Health Service hospital.

Results: Sixty-two percent of Navajo patients had used native healers and 39% used native healers on a regular basis; users were not distinguishable from nonusers by age, education, income, fluency in English, identification of a primary provider, or compliance, but Pentecostal patients used native healers less than patients of other faiths. Patients consulted native healers for common medical conditions such as arthritis, depression, and diabetes mellitus as well as "bad luck." Perceived conflict between native healer advice and medical provider advice was rare. Cost was the main barrier to seeking native healer care.

Conclusions: Among the Navajo, use of native healers for medical conditions is common and is not related to age, sex, or income but is inversely correlated with the Pentecostal faith; use of healers overlaps with use of medical providers for common medical conditions. Patients are willing to discuss use of native healers and rarely perceive conflict between native healer and conventional medicine. This corroborates other research suggesting that alternative medicine is widely used by many cultural groups for common diseases.

Ma GX.
Between Two Worlds: The Use of Traditional and Western Health Services by Chinese Immigrants.
Journal of Community Health. 24(6):421-37, 1999 Dec.

This study examined the use of traditional and Western health services by Chinese immigrants, as well as the cultural and socioeconomic factors affecting health-seeking behaviors and health service utilization patterns among the study population from the perspectives of consumers and Chinese health care providers. Two instruments were used for data collection. The first, a consumer instrument, was designed for interviews of service recipients; the second, a health provider instrument, was designed to elicit information from traditional and Western providers. A few topics in the former instrument were cross-examined from the perspectives of health care providers. The investigation employed a combination of qualitative and quantitative research methods for data collection. Qualitative ethnographic methods used included:

1. participant-observation,
2. face-to-face interview, and
3. case study.

To complement the qualitative data, structured quantitative survey were conducted with all selected informants. A total of 105 informants participated in the study: 75 Chinese consumers and 30 Chinese health professionals. The latter group was composed of Western physicians and traditional practitioners. Results revealed several patterns of health-seeking and service utilization behaviors among the Chinese of Houston and Los Angeles. These included high rates of self-treatment and home remedies (balanced diets and other alternative medicines); medium rates of utilization of integrated Western and traditional health services, including travel to country of origin for care; and low rates of exclusive utilization of Western or traditional Chinese treatments.

Marbella AM. Harris MC. Diehr S. Ignace G. Ignace G.
Use of Native American Healers Among Native American Patients in An Urban Native American Health Center.
Archives of Family Medicine. 7(2):182-5, 1998 Mar-Apr.

To gain an understanding of the prevalence, utilization patterns, and practice implications of the use of Native American healers together with the use of physicians, we conducted semistructured interviews at an urban Indian Health Service clinic in Milwaukee, Wisc, of a convenience sample of 150 patients at least 18 years old. The mean age of patients was 40 years, and the sex distribution was 68.7% women and 31.3% men. Thirty tribal affiliations were represented, the largest groups being Ojibwa (20.7%), Oneida (20.0%), Chippewa (11.3%), and Menominee (8.0%). We measured the number of patients seeing healers and gathered information on the types of healers, the ceremonies used for healing, the reasons for seeing healers, and whether patients discuss with their physicians their use of healers. We found that 38.0% of the patients see a healer, and of those who do not, 86.0% would consider seeing one in the future. Most patients report seeing a healer for spiritual reasons. The most frequently visited healers were herbalists, spiritual healers, and medicine men. Sweat lodge ceremonies, spiritual healing, and herbal remedies were the most common treatments. More than a third of the patients seeing healers received different advice from their physicians and healers. The patients rate their healer's advice higher than their physician's advice 61.4% of the time. Only 14.8% of the patients seeing healers tell their physician about their use. We conclude that physicians should be aware that their Native American patients may be using alternative forms of treatment, and they should open a respectful and culturally sensitive dialogue about this use with their patients.

Moore LJ. Boehnlein JK.
Treating Psychiatric Disorders Among Mien Refugees from Highland Laos.
Social Science & Medicine. 32(9):1029-36, 1991.

The Mien, a Southeast Asian hill people, have immigrated to various countries throughout the world since the mid-1970s. They have brought their ancient culture with them, including beliefs and practices related to health, illness, and healing. During the last several decades they have suffered much war-related trauma, including extensive human, material and symbolic losses. This report describes our clinical experience with Mien refugees in the Indochinese Psychiatric Program of the Oregon Health Sciences University. We discuss symptom presentation among this group of patients, diagnostic and treatment issues, and the impact of cultural health beliefs upon illness and treatment. Major depression and post-traumatic stress disorder have been the most commonly encountered psychiatric diagnoses, usually revealed through somatic symptoms. Not only must clinicians take careful medical and psychiatric histories, but they must also be alert to the high probability of an extensive history of trauma. Clinical improvement in response to psychotropic medications has been limited. As a result, psychosocial and psychotherapeutic approaches to treatment have been developed and expanded and now are commonly employed, effectively combining support and education in the creation of a holding environment that includes both individual and group formats. Two case histories are presented which describe symptom presentation, health belief systems and therapeutic issues involved in treating Mien patients. They also illustrate that traditional and Western healing approaches can co-exist in the optimal care of these patients.

Reissland N. Burghart R.
Active Patients: The Integration of Modern and Traditional Obstetric Practices in Nepal.
Social Science & Medicine. 29(1):43-52, 1989.

This paper describes the integration of modern and traditional obstetric practices in a provincial hospital in the Maithili-speaking area of southern Nepal. The doctors and nurses consciously distance themselves from the traditional practices of their obstetrical patients, whom they view as 'ignorant'; but because hospital resources are insufficient to impose the normative form of modern medical organization, patients and their relatives assert a more active role in providing hospital-based care. In consequence, mothers are delivered according to both modern, clinical as well as local cultural practices. Recent WHO policy has cast modern medicine as the agent in the integration of traditional healing within national health systems. This essay shows that in poor countries the powers of agency may not be exclusively in the hands of the medical profession. Patients, and others in their social networks, have become agents, constraining and negotiating the terms on which modern medicine is to be integrated within their traditional obstetric practices.

Skaer TL. Robison LM. Sclar DA. Harding GH.
Utilization of Curanderos Among Foreign-Born Mexican-American Women Attending Migrant Health Clinics.
Journal of Cultural Diversity. 3(2):29-34, 1996 Summer.

This study explores the parallel use of "folk healers" and modern medicine among foreign born, Mexican-American women attending migrant health clinics in rural, eastern Washington state. Face-to-face interviews (n = 434) revealed that 21.4% of the women had sought care from curanderos within the past five years. Statistically significant predictors of utilization included Spanish as the language of preference (odds ratio = 2.58), having resided in the U.S. from one to five years (odds ratio = 2.82), and having received medicine or medical care from Mexico within the prior five years (odds ratio = 9.22). Implications for providers working in cross-cultural settings are discussed.

Tabora BL. Flaskerud JH.
Mental Health Beliefs, Practices, and Knowledge of Chinese American Immigrant Women.
Issues in Mental Health Nursing. 18(3):173-89, 1997 May-Jun.

The purpose of this study was to describe the mental health beliefs and practices of Chinese American immigrant women. A two-part design using both qualitative and quantitative techniques was employed. The first step utilized focus group (n = 14) and key informant (n = 2) interviews to discover the beliefs, practices, and knowledge about mental health of this population. Content analysis was used to examine and condense the qualitative data. After completion of the qualitative component, 72 women were recruited to complete a set of questionnaires, which included a demographic questionnaire, culture and work subscale, and the mental health portion of the Health Behavior Scale of the Survey of Chinese American Mental Health (NRCAAMH, 1993). Pearson product-moment correlations and regression analysis were used to analyze the quantitative data. Content analysis found that the cultural value placed on the avoidance of shame, pragmatism that results in the use of both Western and traditional Chinese practitioners and treatments, and the inadequacy of Western-type services to meet the needs of the Chinese American immigrant population act as barriers to utilization of these services. These results are cross-validated by the quantitative findings. The importance of culture in determining the pathway to care was supported by the finding that higher levels of acculturation are related to greater use of mental health services.

Zubek EM.
Traditional Native Healing. Alternative or Adjunct to Modern Medicine?.
Canadian Family Physician. 40:1923-31, 1994 Nov.

Objective: To ascertain the extent to which family physicians in British Columbia agree with First Nations patients' using traditional Native medicines.

Design: Randomized cross-sectional survey.

Setting Family medicine practices in British Columbia.

Participants: A randomized volunteer sample of 79 physicians from the registry of the BC Chapter of the College of Family Physicians of Canada. Of 125 physicians contacted, 46 did not reply.

Main Outcome Measures: Physicians' demographic variables and attitudes toward patients' use of traditional Native medicines.

Results: Respondents generally accepted the use of traditional Native medicines for health maintenance, palliative care, and the treatment of benign illness. More disagreement was found with its use for serious illnesses, both for outpatients and in hospital, and especially in intensive care. Many physicians had difficulty forming a definition of traditional Native medicine, and were unable to give an opinion on its health risks or benefits. A significant positive correlation appeared between agreement with the use of traditional Native medicines and physicians' current practice serving a large First Nations population, as well as with physicians' knowing more than five patients using traditional medicine.

Conclusions: Cooperation between traditional Native and modern health care systems requires greater awareness of different healing strategies, governmental support, and research to determine views of Native patients and healers.

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