RESUMO
Problem: The Colombian government provides health services grounded in the Western biomedical model, yet 40% of the population use cultural and traditional practices to maintain their health. Adversarial interactions between physicians and patients from other cultures hinder access to quality health services and reinforce health disparities. Cultural safety is an approach to medical training that encourages practitioners to examine how their own culture shapes their clinical practice and how to respect their patients' worldviews. This approach could help bridge the cultural divide in Colombian health services, improving multicultural access to health services and reducing health disparities. Intervention: In 2016, we conducted a pilot cultural safety training program in Cota, Colombia. A five-month training program for medical students included: (a) theoretical training on cultural safety and participatory research, and (b) a community-based intervention, co-designed by community leaders, training supervisors, and the medical students, with the aim of strengthening cultural practices related to health. Evaluation used the Most Significant Change narrative approach, which allows participants to communicate the changes most meaningful to them. Using an inductive thematic analysis, the authors analyzed the stories and discussed these findings in a debriefing session with the medical students. Context: Cota is located only 15 kilometers from Bogota, the national capital and biggest city of Colombia, so the small town has gone through rapid urbanization and cultural change. A few decades ago, inhabitants of Cota were mainly peasants with Indigenous and European traditions. Urbanization displaced agriculture with industrial and commercial occupations. One consequence of this change was loss of cultural health care practices and resources, for example, medicinal plants, that the community had used for centuries. Impact: A group of 13 final-year medical students (ten female and three male, age range 20-24) participated in the study. The medical students listed four areas of change after their experience: increased respect for traditional health practices to provide better healthcare; increased recognition of traditional practices as part of their cultural heritage and identity; a desire to deepen their knowledge about cultural practices; and openness to incorporate cultural practices in healthcare. Lessons Learned: Medical students reported positive perceptions of their patients' cultural practices after participating in this community-based training program. The training preceded a positive shift in perceptions and was accepted by Colombian medical students. To the best of our knowledge, this was the first documented cultural safety training initiative with medical students in Colombia and an early attempt to apply the cultural safety approach outside the Indigenous experience.
Assuntos
Competência Cultural/educação , Educação de Graduação em Medicina/organização & administração , Medicina Tradicional/estatística & dados numéricos , Serviços de Saúde Rural/organização & administração , Estudantes de Medicina/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Colômbia , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Medicina Tradicional/psicologia , Pesquisa Qualitativa , Adulto JovemRESUMO
RESUMEN. El artículo parte de las reflexiones de la investigación de Doctorado Grupalidad curadora. Descolonialidad de saberes-prácticas campesinas y afroindígenas en Montes de María (Caribe colombiano); interesada, desde una perspectiva descolonial, por aquellos saberes para curar que fueron excluidos por la ciencia moderna y colonial, silenciando el potencial que entraña la comunidad. Nos centramos en las prácticas cotidianas como curar con plantas que utilizan las mujeres campesinas en las comunidades San Francisco, Medellín y Villa Colombia (Ovejas-Sucre). Las herramientas y técnicas fueron el mapeo de saberes y prácticas comunitarias, entrevistas colectivas, observaciones y recorridos comunitarios por las veredas y las huertas; también el diario de campo, como herramienta de apoyo para el registro y la descripción. El método de análisis cualitativo de la información, privilegió el punto de vista de la experiencia de las mujeres. Los aportes descoloniales orientaron nuestras reflexiones y el análisis del material de campo sobre los saberes y prácticas de cura. En el conocimiento silenciado que reside en las prácticas cotidianas de las mujeres campesinas estarían las claves para curar los dolores de la guerra en los territorios colombianos; lo que justifica una reflexión y un aprendizaje para la academia, en particular, para la Psicología Comunitaria.
RESUMO. O artigo parte das reflexões de pesquisa de doutorado Grupalidade Curadora. Descolonialidade dos saberes-práticas camponesas e afroindígenas em Montes de Maria (Caribe colombiano), interessada, a partir de uma perspectiva descolonial, esses saberes para curar que foram excluídos pela ciência moderna e colonial, silenciando o potencial envolvido na comunidade. Focalizamos as práticas cotidianas como curar com plantas usadas pelas mulheres camponesas nas comunidades San Francisco, Medellín e Villa Colombia (Ovejas-Sucre). As ferramentas e técnicas eram mapeamento de saberes e práticas comunitárias, entrevistas coletivas, observações e visitas comunitárias pelos caminhos e hortas; também o diário de campo, como ferramenta de apoio ao registro e descrição. O método de análise qualitativa da informação privilegiou o ponto de vista e a experiência das mulheres. Aportes descoloniais orientaram nossas reflexões e a análise do material de campo sobre os saberes e práticas de cura. No conhecimento silenciado que reside nas práticas cotidianas, haveria as chaves para curar as dores da guerra nos territórios colombianos; o que justifica uma reflexão e um aprendizado para a academia, em especial, para a Psicologia Comunitária.
ABSTRACT. This article originates from the PhD research Groupality curator: Decoloniality of peasant and afro-indigenous knowledge/practices in Montes de Maria (Colombian Caribbean); from a decolonial perspective, it is interested on the knowledge of cure that were excluded by modern/colonial science. Ando as a consequence, it has silenced the potential of the community. The central point of our study are the practices of everyday life related to cure with medicinal plants that are employed by peasant women in the communities of San Francisco, Medellin and Villa Colombia (Ovejas-Sucre). The tools and techniques we used were mapping community knowledge and practices, collective interviews, observations, trips along the countryside roads and vegetable gardens, and, finally, a field diary—as support tool for registration and description. The method of qualitative analysis of information privileges the point of view and experience of woman. The decolonial contributions enabled us to direct our reflections and analyses of the field material toward knowledge and practices of cura. In the silenced knowledge that resides in the practices of everyday life of peasant women would be the keys to heal the pains of war in the Colombian territories; which justifies a reflection and learning for the academy, in particular, for Community Psychology.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Plantas Medicinais , População Rural , Fitoterapia/psicologia , Psicologia Social , Mulheres/psicologia , Bruxaria/psicologia , Pesquisa Científica e Desenvolvimento Tecnológico , Povos Indígenas , Acontecimentos que Mudam a Vida , Medicina Tradicional/psicologiaRESUMO
Background: Home remedies (HRs) are described as foods, herbs, and other household products used to manage chronic conditions. The objective of this study was to examine home remedy (HR) use among Blacks with hypertension and to determine if home remedy use is correlated with blood pressure and medication adherence. Methods: Data for this cross-sectional study were obtained from the TRUST study conducted between 2006-2008. Medication adherence was measured using the Morisky Medication Adherence Scale, and HR use was self-reported. Multivariable associations were quantified using ordinal logistic regression. Results: The study sample consisted of 788 Blacks with hypertension living in the southern region of the United States. HR use was associated with higher systolic (HR users 152.79, nonusers 149.53; P=.004) and diastolic blood pressure (HR users 84.10, nonusers 82.14 P=.005). Use of two or more HRs was associated with low adherence (OR: .55, CI: .36-.83, P= .004). Conclusion: The use of HR and the number of HRs used may be associated with medication nonadherence, and higher systolic and diastolic blood pressure among Blacks with hypertension. Medication nonadherence is of critical importance for individuals with hypertension, and it is essential that health care providers be aware of health behaviors that may serve as barriers to medication adherence, such as use of home remedies.
Assuntos
Atitude Frente a Saúde/etnologia , Negro ou Afro-Americano , Hipertensão , Adesão à Medicação , Medicina Tradicional , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/etnologia , Hipertensão/psicologia , Modelos Logísticos , Masculino , Adesão à Medicação/etnologia , Adesão à Medicação/estatística & dados numéricos , Medicina Tradicional/métodos , Medicina Tradicional/psicologia , Medicina Tradicional/estatística & dados numéricos , Pessoa de Meia-Idade , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: This study explored motivation dynamics of medical students engaging with traditional medicine in Colombia. METHODS: We conducted a qualitative descriptive study as part of a larger participatory research effort to develop a medical education curriculum on cultural safety. Four final-year medical students participated in a five-month program to strengthen knowledge of traditional medicinal plants with schoolchildren in Cota, a municipality outside Bogota with a high proportion of traditional medicine users. Students and schoolteachers co-designed the program aimed to promote the involvement of school children with traditional medicine in their community. The medical students shared written narratives describing what facilitated their work and discussed experiences in a group session. Inductive thematic analysis of the narratives and discussion derived categories of motivation to learn about traditional medicine. RESULTS: Five key learning dynamics emerged from the analysis: (1) learning from/with communities as opposed to training them; (2) ownership of medical education as a result of co-designing the exercise; (3) rigorous academic contents of the program; (4) lack of cultural safety training in university; and (5) previous contacts with traditional knowledge. CONCLUSIONS: We identified potential principles for engaged cultural safety training for medical students. We will use these in our larger training program. Our results may be relevant to other researchers and medical educators wanting to improve the interaction of medical health professionals in multicultural settings with people and communities who use traditional medicine. We expect these professionals will be better prepared to recognize and address intercultural challenges in their clinical practice.
Assuntos
Competência Cultural/psicologia , Medicina Tradicional , Motivação , Estudantes de Medicina/psicologia , Adulto , Colômbia , Competência Cultural/organização & administração , Diversidade Cultural , Currículo/normas , Educação Médica , Feminino , Humanos , Masculino , Medicina Tradicional/métodos , Medicina Tradicional/psicologia , Pediatria/educação , Pediatria/métodos , Fitoterapia/métodos , Fitoterapia/psicologia , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Faculdades de Medicina/organização & administração , Adulto JovemRESUMO
Purpose: The purpose of the study is to understand the meaning of folklore as a health patterning modality and to uncover its unique characteristics in the life-health process. Design: Hermeneutic phenomenological. Method: Max van Manen's methodology was used for this study. The sample was selected from the Afro-Caribbean American community in the United States. The criterion for selection was that participants used folklore healing practices for health and well-being on an ongoing basis. In-depth interviews were done. Purposive sampling with networking was done based on whether the participants used folk healing on a regular basis. Themes of the meaning of folklore healing practices were identified from participants' verbatim data. Findings: The meaning of folklore healing practices was interpreted as phenomena with six interconnected essential themes. Additionally, Barrett's nursing theory of power as knowing participation in change was used to reflect and understand the findings from a nursing perspective. Conclusion: The research findings have implications for nursing science, and the knowledge gleaned from the study may be applied to nursing practice.
Assuntos
Folclore/psicologia , Acontecimentos que Mudam a Vida , Medicina Tradicional/normas , Adulto , Idoso , Feminino , Hermenêutica , Humanos , Masculino , Medicina Tradicional/métodos , Medicina Tradicional/psicologia , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estados Unidos , Índias Ocidentais/etnologiaRESUMO
Ayahuasca is a psychoactive plant mixture used in ceremonial contexts throughout Western Amazonia. Its use has expanded globally in recent decades and become popular among westerners who travel to the Peruvian Amazon in increasing numbers to experience its reportedly healing effects. Through a review of relevant literature on Amazonian shamanism, combined with the authors' ethnographic data from shamanic tourism contexts of the Peruvian Amazon and neo-shamanic networks in Australia (collected between 2003 and 2015 - with a total of 227 people interviewed or surveyed, including healers and participants), we demonstrate that purging has been integral to the therapeutic use of ayahuasca across and beyond Amazonia. Therapeutic approaches to ayahuasca point to combined modulations of the gut and the mind, and the bodily and the social, that are expressed through discourse about healing and the body. Relating ethnographic evidence to recent scientific studies that connect the gut to emotional health, we do not approach the gut as merely biological ground on which cultural meanings are imposed, but rather as simultaneously physical and cultural. Based upon our analysis, we argue that ayahuasca purging should not be dismissed as a drug side effect or irrational belief but reconsidered for its potential therapeutic effects.
Assuntos
Catárticos/uso terapêutico , Emoções , Alucinógenos/uso terapêutico , Indígenas Sul-Americanos , Medicina Tradicional/métodos , Antropologia Cultural , Catárticos/administração & dosagem , Catárticos/farmacologia , Alucinógenos/administração & dosagem , Alucinógenos/farmacologia , Nível de Saúde , Humanos , Medicina Tradicional/psicologia , Saúde Mental/etnologia , Peru , FitoterapiaRESUMO
OBJECTIVES: The global burden of type 2 diabetes mellitus is increasing, especially in Central America. In resource-limited settings, such as Guatemala, there are significant barriers to diabetes care and many Guatemalans use medicinal plants as treatment. The purpose of this study is to understand the use of medicinal plants in an indigenous population with diabetes in rural Guatemala. METHODS: Semi-structured interviews were conducted in communities around San Lucas Tolimán, Guatemala with people with diabetes, health promoters, and traditional healers. RESULTS: Out of the 55 people with diabetes interviewed, 35 (63.6%) had used medicinal plants, most frequently using Artemisia absinthium, Moringa oleifera, Carica papaya, and Neurolaena lobata. The majority of participants cited lack of access to medications as the reason for their use of medicinal plants. CONCLUSION: There is widespread use of medicinal plants in San Lucas Tolimán. More research is needed to understand the degree of glycemic control in these communities.
Assuntos
Diabetes Mellitus Tipo 2/terapia , Medicina Tradicional/estatística & dados numéricos , Plantas Medicinais , População Rural/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Artemisia absinthium , Atitude do Pessoal de Saúde , Carica , Países em Desenvolvimento , Feminino , Guatemala , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Entrevistas como Assunto , Masculino , Medicina Tradicional/métodos , Medicina Tradicional/psicologia , Pessoa de Meia-Idade , Moringa oleifera , Fatores SexuaisRESUMO
Religiosity/spirituality can affect health and quality of life in myriad ways. Religion has been present since the first moments of our evolutionary history, whether it is understood as a byproduct or as an adaptation of our cognitive evolution. We investigated how religion influences medicinal plant-based local medical systems (LMSs) and focuses on how individual variation in the degree of religiosity/spirituality affects the structure of LMSs. The knowledge of people about their medical systems was obtained through the free-listing technique, and level of religiosity/spirituality was calculated using the Brazilian version of the Brief Multidimensional Measure of Religiousness/Spirituality. We employed a Generalized Linear Model to obtain the best model. Religiosity/spirituality is predictive of structural and functional aspects of medicinal plant-based LMSs. Our model encourages a discussion of the role of religion in the health of an individual as well as in the structure of an individual's support system. Religiosity/spirituality (and the dimensions of Commitment and Religious and Spiritual History, in particular) act to protect structural and functional elements of LMSs. By providing protection, the LMS benefits from greater resilience, at both the individual and population levels. We suggest that the socialization process resulting from the religious phenomenon has contributed to the complexity and maintenance of LMSs by means of the interaction of individuals as they engage in their religious observances, thus facilitating cultural transmission.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Medicina Tradicional/psicologia , Qualidade de Vida , Religião , Espiritualidade , Adaptação Psicológica , Adulto , Brasil , Etnobotânica , Etnofarmacologia , Feminino , Humanos , MasculinoRESUMO
Mexican immigrants have a rich history of traditional healers. This analysis describes the conditions for which Mexican immigrants seek treatment from sobadores, and delineates factors that influence seeking treatment from a sobador or a biomedical doctor. This systematic qualitative analysis uses interview data collected with 24 adult Mexican immigrants to North Carolina who had been treated by a sobador in the previous 2 years. Immigrants are engaged in medical pluralism, seeking care from sobadores and biomedical doctors based on the complaint and patient's age. Using a hierarchy of resort, adults seek treatment from sobadores for musculoskeletal pain not involving a fracture. Doctors are first consulted when treating children; sobadores are consulted if doctors do not provide culturally appropriate treatment. Mexican immigrants seek care that addresses their culturally determined health concerns. The need to improve access to culturally competent biomedical health care for vulnerable immigrant populations continues.
Assuntos
Emigrantes e Imigrantes/psicologia , Medicina Tradicional/psicologia , Americanos Mexicanos/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Adulto , Competência Cultural , Diversidade Cultural , Feminino , Gastroenteropatias/terapia , Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde , Nível de Saúde , Humanos , Infertilidade/terapia , Entrevistas como Assunto , Masculino , Massagem/psicologia , Pessoa de Meia-Idade , Dor Musculoesquelética/terapia , North Carolina , Pesquisa Qualitativa , Fatores SocioeconômicosRESUMO
O presente trabalho constitui uma pesquisa de cunho teórico, na qual é traçado um breve percurso histórico das práticas de cura tradicionais e se faz também uma discussão sobre sua permanência e eficácia na contemporaneidade, apesar dos avanços na área da ciência médica. Tendo em vista a importância crescente da subjetividade na medicina contemporânea, nossa hipótese visa salientar que a objetivação do sujeito doente, operada pelas práticas médicas, condena a subjetividade a um segundo plano e representa uma lacuna importante nas propostas terapêuticas do modelo biomédico. Nosso objetivo é interrogar o lugar das práticas tradicionais de cura nessa lacuna deixada pela medicina e no que tais práticas podem contribuir para o modelo médico.
Ce travail est une recherche théorique où l'on esquisse un bref parcours historique sur les pratiques traditionnelles de cure et on fait aussi un débat sur leur permanence et efficacité dans le monde contemporain, malgré les avancées dans le domaine de la médecine scientifique. En rendant compte l'importance croissante de la subjectivité dans la médecine contemporaine, notre hypothèse souligne que l'objectivation du sujet malade opérée par les pratiques médicales condamne à l'oubli la subjectivité et produit une lacune importante dans les démarches thérapeutiques du modèle biomédical. Notre objectif en est celui d'interroger la place des pratiques traditionnelles de cure dans cette lacune laissée par la médecine et comment ces pratiques peuvent-elles contribuer avec le modèle médical actuel.
Este trabajo esboza un camino histórico por las prácticas tradicionales de cura y, junto a esto, una discusión sobre la permanencia y la eficacia de estas prácticas en el mundo contemporáneo, a pesar de los progresos de la medicina científica. Considerando la importancia creciente de la subjetividad en la medicina contemporánea, nuestra hipótesis destaca que la objetivación del sujeto enfermo operada por las practicas medicales impone un olvido de la subjetividad y produce un vacío importante en las terapéuticas del modelo biomédico. Nuestra meta es investigar el lugar de las prácticas tradicionales de cura en este vacío de sentido de la medicina y se ellas pueden enseñar algo al modelo médico actual.
Abstract This article is a theoretical study featuring a brief historical outline of traditional healing practices and also a discussion on their persistence and efficiency in the contemporary world, despite the advances of scientific medicine. Given the increasing relevance of subjectivity in contemporary medicine, our hypothesis aims to emphasize that the objectivation of patients by medical practices eclipses the role of subjectivity and reveals an important deficit in the therapeutics of the biomedical model. Our aim is to understand the role of traditional healing practices and how they may contribute to the medical model.