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Alternative or Traditional

Medicine?: A PatientsPerspective on CAM

Juan Carlos Belliard

&

Rosa Reyes

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Medical Anthropology

Culture: shapes the way people perceive andorganize ideas about health and illness.

(Basch, 1999)

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History of Medicine2000 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!

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Kleinmans Typology of HealthSectors

Popular

Folk

Professional

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Understanding & Treating illness

Illness vs. Disease Causation (explanatory models)

The sick role

The total drug effect

Symbols & values

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Illness vs. Disease

Disease Biological

Organ specific

Diagnostic testing

Illness Socio-cultural construct

Patients perception

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Folk IllnessesCulture-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)

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The total drug effect

the drug itself the recipient

the prescriber

the physical setting

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Medical Pluralism

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Relevance of complimentarymedical systems

Globally: 80% of worlds populationsdepend on traditional medicine for health

security.

Locally: access to healthcare issues; health

disparities (healthy people 2010)

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Complementary, AlternativeMedicine (CAM)

Folk

Suburban

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Botanicas & Religious Syncretism

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Herbal Use Study at SACHS

Research Objectives

Understand Herbal use patterns

Learn what herbs are used most

Assess patient-provider communicationregarding herbal use

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Do you believe that natural herbs can cure?

percent

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Have you used herbs?

percent

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Do you use prescription drugs?

percent

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Do you have confidence in doctors and/or modern

healthcare providers?

p

ercent

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Do you feel comfortable speakingEnglish to your doctor?

percent

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

percent

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Do you have confidence in doctors and/or

modern healthcare providers?

perc

ent

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

perc

ent

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Why Patients use Complementaryand 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

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L.E.A.R.N. Model of CulturalCompetency

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 treatmentplan

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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

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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)

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Uncritical acceptance vs Uninformed skepticism