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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