What is Medical Pluralism?
One of the questions that influenced the decision to choose the question related to medical pluralism is: why do indigenous and mestizo populations in the Americas shy away from a medical system designed to alleviate the afflictions and ills they suffer?
Medical pluralism is a perfect answer to this question. Medical pluralism can be described as situation where health and illness, science and experience, ethics and aesthetics, values ??and morals, economics and politics, rights and duties, public and private are intertwined (Redvers, 2018). In medical pluralism, what is problematic is not a type of medication (the Western one) but the legitimacy of the one who provides it (the doctor). Early historians and anthropologists who studied medical pluralism wrote about it, as if about equal and peaceful coexistence of medical systems, but soon realized that there was no equality. On the contrary, subordinate medical systems exist hierarchically. For example, biomedicine is almost universally considered the most prestigious and best, but popular and alternative forms of treatment are often marginalized.
How concept of medical pluralism may help us understand and respond to potentially problematic and negative health seeking behaviors?
To answer this question, it is important to demonstrate how different ethnic groups seek and obtain medication. We will start with Western societies. In Western societies the crisis of the bio-medicine model manifested itself in the last decades of the 20th century for reasons that are fundamentally associated with the high costs of health and prevention systems. The profitability imperatives require that consultations, at least in the field of public health, be increasingly brief, which inevitably affects the patient / patient relationship (In Micozzi, 2011). On the other hand, the so-called family doctors, who knew the families and followed them for years, have decreased alarmingly. The graduates of the universities prefer to follow more prestigious careers (research or private sector) discarding the general medicine, not very prestigious and not very profitable. Hence, an “art” that in the West had developed over the centuries a qualitative relationship with patients (ability to listen on the part of the doctor, interest in the environment, familial, relational and professional of the patient), gave way to a technology that, in the name of efficacy, leaves aside subjective aspects of the patient, which passes from the position of subject to the object of a clinical observation.
In Latin America, the poverty and marginalization of rural populations, the absence of social health systems, the isolation of the peoples and the poor quality of medical care all exacerbate the problems faced by “bio-medicine” (Bala, 2007). In most Latin American countries, newly-received physicians must carry out a “year of provinces” that is sometimes reduced to a few months, and settle in inhospitable areas. The majority reluctantly complies with this obligation – I am aware of personal experience in Ecuador – and patients perceive this discomfort, which is aggravated by the inevitable rotation of the “doctors” (Incayawar, Bouchard, Wintrob, Bartocci & World Psychiatric Association (2010) . Rural patients are rightly considered ill-treated by a third-category medicine, whose protocol is incomprehensible for linguistic reasons, hence the urgency of training bilingual health personnel.
How Medical Pluralism Helps Us Understand Healthcare-seeking Behavior
Bivins (2010) gives us an ethnography of these young doctors and shows that medicines are not rejected because they are incompatible with traditions, but because they are expensive. When they are given away, they are used, says Bivins (2010), referring to the Aguaruna of the Peruvian Amazon rainforest.
On the contrary, Bathum (2007), specialist of the Aymara peoples, affirms that “medicines and treatments that cost money should not be given away or free since it is considered that what is free is not effective but timed out “. On the other hand, Virtanen (2012) insists on the contrast between the natives of the Acre River region (Brazil) they go by boat to the city to consult the doctor, and the whites, who make the trip in the opposite direction to visit the shaman. The natives prefer the remedies of whites, “sweeter”, to “del mato”, which “hurt a lot”. These examples reveal the complexity of the problem and the ambiguity (and not rejection) of bio-western medicine.
The expression consecrated in sociological and anthropological studies on health in intercultural situations, is that of “bio-medicine” to designate the scientific discipline that emerged in the West from the last decades of the eighteenth century. Pasteur promotes a true medical and biological revolution. Microbial contagion and the possibility of preventing it by introducing a number of these germs into the human body are difficult ideas to accept because they defy common sense. Specifically, this means that “invisible animals” can move and cause illness and death. In Pindilig (Ecuador) the Indians did not believe in these theories of the doctors, not so much because the microbes were invisible – the damages transmitted by the sorcerers are also invisible – but because they could not admit, for example, that a mother could contaminate her children. children or that a tuberculous could not drink from the same glass as the others. The old theories of the miasmas were more compatible with the beliefs in the “airs.”
In France, at the end of the 19th century, the doctor Pierre Janet, discoverer of the “subconscious”, treated several patients of rural origin who had developed phobic pathologies due to the terror inspired by the “microbes” (Hacking, 2002). Recently the most fanciful conceptions about the transmission of HIV indicate that these apprehensions are not exclusive of peasant peoples, reluctant to modern life. The beliefs related to contagion and its vectors, as well as their social implications, are of course a very important issue within this compact category of bio-medicine, which needs to be qualified. In the region of Ayacucho, the fetid breath and farts of humans “infect” bad habits (Snider, et al 2004). In the Potosi sinkholes, the gas that causes silicosis is an emanation of the Uncle, the “owner” of the mine, while the breath of man makes it live. In the terreiros of Bahia, in Brazil (Taylor, Kaplan, Hobgood-Oster, Ivakhiv, & York, 2008), the contamination of contagious diseases, characterized by skin lesions, it is a punishment of the Omolu spirit, and healing involves a series of offerings and Afro-Christian rituals. The darts sent to their enemies by the Yaguas shamans of the Orient of Peru, resemble the pathogens and with good reason Jean-Pierre Chaumeil suggests deepening the “virological complex” (Pitot & Loeb, 2002). The difference between indigenous conceptions and Western medicine lies in the systems of associated representations.
Perspectives on Western Bio-medicine
On the other hand, the essential characteristic of bio-medicine is the rejection of religious or supernatural explanations that cannot be proved rationally. This attitude, which is already affirmed in the corpus of Hippocrates, is maintained despite the pressure of the Church, over the centuries, as shown in the masterly book of Keith Thomas.
Based on these findings, it is apparent that the crisis of the hegemonic model of medicine demands, as Redvers (2018) explains, “the return of cultures”, not only in Latin America but also in the United States. Increasingly insists on the need for dialogue between the doctor and the patient, and the importance of anthropology as a discipline of cultural mediation. Unfortunately, in many cases the lack of medical resources in marginal areas prevents true interaction. The consequence is the development of local cures, “folk” and the use of home remedies. Extreme resource justified by the impossibility of receiving help or panacea from the poor? For some researchers (Redvers, 2018). The Amerindian medical paradigm (contrary to that of bio-medicine) operates an analogical relationship between the individual body, social and cosmological ». For example, the Aymara population of Bolivia believes that abortions produce hail and in order to stop them they “look for the culprit”. The author gives us to understand the “human” superiority of the Amerindian paradigm, forgetting without doubt that the emissary goats were a veritable plague in Europe until today.
It is also evident that for medical pluralism to prevail, there is need for interculturality. There should be crossbreeding of the indigenous and Western approaches. To achieve this, there is need to address ethnocentrism. It should be noted that interculturality is not limited to relations between members of Amerindian groups and biomedical personnel (DuBois, 2009). Overcoming the limits of the ethnic, this asymmetric interaction occurs in diverse situations such as poverty, social inequality or stigmatization. No group escapes these confrontations that always entail an ethnocentric position that implies a hierarchy of the groups in presence. Hence, one cannot think interculturality only in moral terms of respect, tolerance or cooperation. Interculturality in the health / disease / care processes works in an unequal context at the same time cultural, economic, social and even biological (much lower life expectancy among the subaltern classes).
Conclusion
The paper has demonstrated how medical pluralism encourages different people to seek different approaches to their health needs. The analysis also revealed that although western model is considered superior, alternative models also plays a crucial role especially in indigenous communities and in poor communities. Consequently, it is suggested that interculturality should be encouraged so as to allow both models to operate without discrimination
List of References
Bala, P (2007) Medicine and medical policies in India: Social and historical perspectives. Lanham: Lexington Books.
Bathum, M. E. (2007). Ayamara women healers: Health and community, University of Wisconsin—Madison
Bivins, RE (2010) Alternative medicine?: A history. Oxford: Oxford University Press.
Hacking, I (2002) Historical ontology. Cambridge, Mass: Harvard Univ. Press.
In Micozzi, MS (2011) Fundamentals of complementary and alternative medicine, St. Louis, Mo. : Saunders/Elsevier
Incayawar, M, Bouchard, L, Wintrob, R, Bartocci, G, & World Psychiatric Association (2010) Psychiatrist and traditional healers: Unwitting partners in global mental health. Chichester, UK: J. Wiley & Sons.
Pitot, HC, & Loeb, DD (2002) Fundamentals of oncology, New York: M. Dekker.
Redvers, N (2018) The science of the sacred: Bridging global indigenous medicine systems and modern scientific principles, Berkeley, California : North Atlantic Books.
Snider, L, Cabrejos, C, Huayllasco ME, Jose TJ, Avery, A & Ango AH (2004). Psychosocial Assessment for Victims of Violence in Peru: The Importance of Local Participation. Journal of biosocial science, 36(4), 389–400. doi:10.1017/S0021932004006601
Taylor, B R, Kaplan, J, Hobgood-Oster, L, Ivakhiv, AJ, & York, M (2008) The encyclopedia of religion and nature. New York: Continuum, pp. 249-271
Virtanen, P K (2012) Indigenous youth in Brazilian Amazonia: Changing lived worlds, New York: Palgrave Macmillan.
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DuBois, TA (2009) An introduction to shamanism. Cambridge, UK: Cambridge University Press.
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