ETHNOMEDICAL SYSTEMS AND HEALTH CARE SECTORS M1L5.1-5.

Objectives
Describe the major sectors of health care resources
popular, folk and professional.

L1- Illustrate popular sector as first level of recourse

symptom recognition, pain significance, decision-making

L2 Roles of folk ethnomedical practices

Culture in Alternative and Complementary Practices

L3 Diverse forms of Professional Medicine

Examine the cultural bases for the dominant professional sector, biomedicine. American Medicine: Historical and Contemporary Perspectives

Resources for Addressing Illness and Disease

Health Care Sectors (Kleinman)
Popular, Lay or Family Folk or Ethnomedical Professional

Medical Pluralism and Specialization

Popular Sector Health Resources

Primary source of all care- 80% Based in family, friends and community Major Implications
Self-Care and Hygiene Access to care resources, including Folk Practitioners Presentation for Care Culture and Symptoms Culture and Pain Responses Cultural Conceptualizations of the Body & Mind After care, diet and medication Natural Medicine--Folk and Spiritual Health Beliefs

Lay/Popular as Home Care

Health Maintenance and Restoration Primary physical care Home remedies, especially teas Old pharmaceuticals Over-the-counter Diet and activity Clothing, jewelry, amulets Basis of family and culture health traditions Decision making for other care resources

Cultural Influences on Health Seeking

Presentation for Care
Conceptualizations of maladies and concerns Access to resources Interpersonal influences Focus of what is normal, desirable ADL

Clinical and Public Health Implications

Culture and Symptoms

Relevance, concern Available responses/resources Idioms of Distress Language and the body Somatization

Cultural Conceptualizations of Body

Body concepts and levels
Physical, emotional, spiritual/soul, psychic, bioenergetic Individual, social and political bodies

Cultural conceptions of the body have important implications for health through: notions about normal bodily conditions and functions desirable diet and desirable body size and sha[e the nature and meaning of bodily by-products (e.g., feces, urine, blood, mucus) Activities done to body

Culture and Pain Responses

Anglo-American norms
Old and new

African American Hispanic American Native American Asian American

Ethnomedical Theories of Disease

Traditional Etiologies

Spirit Aggression Soul Loss Possession Sorcery, Bewitchment and Evil Eye
Culture Bound Syndromes and Indigenous Psychologies The Psychosocial Dynamics of Malevolence & Illness Psychosocial Environment of Well-being Popular-Folk Interface

Physical, Emotional and Supernatural Conditions

M1L5.2 Folk Sectors and Ethnomedicines

Folk Healers- what is in a word?
Variety of healers encompassed

Pre-Modern Universals of folk medicine

Shamanistic Healers Herbalism Midwifery

Globalization and Medicalization

Ethnomedical & Professional Traditions

American Folk Traditions

Herbalism Midwifery Native American Sources African American Voodoo and Preacher Traditions Curanderismo and Santeria Religious and Natural Healing Traditions

Ethnomedicine in American History

Historical Foundations: Syncretic and Local
Native American influences in herbology European imports-scarce and expensive

Pharmacopeias- Native American sources Diet and medicine in 19th Century America Professionalization of Medicines in the 20th Cent.
The AMA Medicine Wars and the Rise of Biomedicine

CAM Today- Complementary or Alternative?

Unconventional Medicine in Contemporary U.S.

The consumption of Unconventional Medicine

The Appeals of Alternative Medicine

Address biomedicines gaps and side-effects Address peoples concerns illness & sickness too Balance in life Participation in decision making Treatment alternatives Concern about everyday life impacts of malady

Conditions for which biomedicine is not normally effective

colds depression aches, chronic pain arthritis acne back problems skin conditions epstein barr virus Allergies tiredness cramps chronic fatigue syndrome stress related problems anxiety attacks pulled muscle allergies hives AIDS treatment side-effects

Advantages of alternative over biomedicine

Complementary- illness and sickness in addition to disease Involvement of the family system and community in diagnosis and treatment responsibilities of the family in both the sickness and healing processes facilitation of the healing processes through meaningful explanations by the healer the closeness and informality of healing relationships the status of the healer in the community the healers ability to influence behavior and to reinforce cultural values culturally relevant explanations of immediate and ultimate causes of health problems and appropriate treatment

Integrative Medicine
Biomedical Science and Alternative Medicine
Science or superstition? Forms of evidence?
Double Blind Clinical Studies as rare in biomedicine

Biomedicine as art and culture

Alternative or Complementary as Approaches

Numerous forms of clinical evidence

Summary: Syncretic Health Care Utilization

M1L5.3 Professional Healers

Doctors =Allopathic against symptoms
Biomedicine/M.D.s

Homeopathic- mimic symptoms, Law of Similars

Part of European Biomedicine

Naturopathic- Diverse traditions N.D. Osteopathic D.O.

Structural effects of body on Health Recuperative powers of the body, blood and nerves

Chiropractic D.C.
Misalignment or subluxation of spinal vertebrate as interfering with vital energies

Additional Professional Medicines

Ayurvedic Reiki Acupuncturists Traditional Chinese Medicine Tibetan Medicine

BiomedicineS*
The Cultures of Biomedicine Cultural Aspects of U.S. Biomedicine Auxiliaries to Biomedicine
Nursing Respiratory Therapists Laboratory Technicians

Health care Providers culture

Beliefs: Ideology of Materialism
Germ Ideology: cleanliness/handwashing

Practices: symptom suppression, immunizations, exams Technology: extreme reliance, lab results Symbolism (white coat) Communication styles Independence and personal responsibility Hierarchies

Nursing Culture
Long history of difference care Nurses have been viewed as assistants to doctors Power is miniscule in comparison to MD Maintain some autonomous, professional practice, beliefs, and responsibilities. Nursing remains distinct functionally and culturally, with its own specialized language, knowledge and practices.

American Biomedical Sociocultural System Characteristics

The Overall Context: Capitalism Medicine
Health as biggest business 13% GDP The crises in U.S. health care Infant survival/mortality rates 40+th internationally Mal-distribution of resources Lack of coverage Mis focus of attention (secondary, tertiary versus primary/prevention)

Development of modern medicine

Roots in war Roots in public heath and epidemic diseases Quinine treatment of malaria and diphtheria immunizations Discovery of penicillin (facilitates surgical intervention) The rise of antibiotics and immunizations The return of infectious diseases The persistence of chronic disease among moderns

Problems with American Biomedical Cultural System

Sociogenic disease American lack of cultural awareness
Considering cultural features to be personal

Mirrored in HCP lack of cultural dimensions of care behaviors and expectations Access Issues

Access: Common Problems in Health Care Delivery

Find appropriate providers, available, able/willing to receive patient Which kinds of specialist to see for problem and referral/availability Patient understanding of medical treatments Prejudice in services

Pathways of access to biomedical care

Work-related health benefits Private physicians Security net- nature of care

Medicine as social control (also see medicalization)

The oppression of medicine: Tuskegee Experiment 1932
Growing legal roles of medicine (certificates) Expansion of areas of care Increased control over treatment substances
Addiction, diet, stress prescriptions, tests, FDA natural product control Similar roles in sterilization

Impacts on other aspects of life through abortions, euthanasia, insanity defense

Summary
Multiple arenas of care Hierarchy of resort Predominance of Popular Sector Expansion of Biomedical Sector Complementary or Alternative as Approaches Persistence of Medical Pluralism