Comparison of health conditions treated with traditional and biomedical health care in a Quechua community in rural Bolivia
Tóm tắt
The objective of the present study was to reveal patterns in the treatment of health conditions in a Quechua-speaking community in the Bolivian Andes based on plant use data from traditional healers and patient data from a primary health care (PHC) service, and to demonstrate similarities and differences between the type of illnesses treated with traditional and biomedical health care, respectively. A secondary analysis of plant use data from semi-structured interviews with eight healers was conducted and diagnostic data was collected from 324 patients in the community PHC service. Health conditions were ranked according to: (A) the percentage of patients in the PHC service diagnosed with these conditions; and (B) the citation frequency of plant use reports to treat these conditions by healers. Healers were also queried about the payment modalities they offer to their patients. Plant use reports from healers yielded 1166 responses about 181 medicinal plant species, which are used to treat 67 different health conditions, ranging from general symptoms (e.g. fever and body pain), to more specific ailments, such as arthritis, biliary colic and pneumonia. The results show that treatment offered by traditional medicine overlaps with biomedical health care in the case of respiratory infections, wounds and bruises, fever and biliary colic/cholecystitis. Furthermore, traditional health care appears to be complementary to biomedical health care for chronic illnesses, especially arthritis, and for folk illnesses that are particularly relevant within the local cultural context. Payment from patients to healers included flexible, outcome contingent and non-monetary options. Traditional medicine in the study area is adaptive because it corresponds well with local patterns of morbidity, health care needs in relation to chronic illnesses, cultural perceptions of health conditions and socio-economic aspects of health care. The quantitative analysis of plant use reports and patient data represents a novel approach to compare the contribution of traditional and biomedical health care to treatment of particular health conditions.
Tài liệu tham khảo
Bastien JW: Exchange between Andean and Western medicine. Social Science & Medicine 1982, 16: 795-803. 10.1016/0277-9536(82)90232-5
WHO (World Health Organization): Traditional medicine – growing needs and potential. WHO Policy Perspectives on Medicines 2002, 2: 1-6.
Cox PA: Will Tribal Knowledge Survive the Millennium? Science 2000, 287: 44-45. 10.1126/science.287.5450.44
Bastien JW: Healers of the Andes: Kallawaya herbalists and their medicinal plants. Salt Lake City: University of Utah Press; 1987.
Alba JJ: Entre la pervivencia y la muerte: los campo jampiris de Campero. Estudio diagnóstico de los recursos tradicionales de salud en las comunidades Quechuas de la provincia Campero. Santa Cruz, Bolivia: Editora El País; 1996.
Sagaseta J: Jampi makikunanchiqpi kasan (la medicina está en nuestras manos). La Paz, Bolivia: Salud Tiraque; 1996.
Pestalozzi HU, Torrez MA: Flora ilustrada altoandina. La Paz, Bolivia: Herbario Nacional de Bolivia; 1998.
Sikkink L: Ethnobotany and exchange of traditional medicines on the Southern Bolivian Altiplano. High Altitude Medicine and Biology 2000, 1: 115-123. 10.1089/15270290050074260
Vandebroek I, Calewaert JB, De Jonckheere S, Sanca S, Semo L, Van Damme P, Van Puyvelde L, De Kimpe N: Use of medicinal plants and pharmaceuticals by indigenous communities in the Bolivian Andes and Amazon. Bulletin of the World Health Organization 2004, 82: 243-250. [http://www.scielo.br/pdf/bwho/v82n4/v82n4a05.pdf]
Browner CH, Ortiz de Montellano BR, Rubel AJ: A methodology for cross-cultural ethnomedical research. Current Anthropology 1988, 29: 681-702. 10.1086/203688
Baer RD, Bustillo M: Susto and mal de ojo among Florida farmworkers: emic and etic perspectives. Medical Anthropology Quarterly n.s 1993, 7: 90-100. 10.1525/maq.1993.7.1.02a00060
Etkin NL: Perspectives in ethnopharmacology: forging a closer link between bioscience and traditional empirical knowledge. Journal of Ethnopharmacology 2001, 76: 177-182. 10.1016/S0378-8741(01)00232-X
Gottlieb OR, de MB, Borin MR, de Brito NRS: Integration of ethnobotany and phytochemistry: dream or reality. Phytochemistry 2002, 60: 145-152. 10.1016/S0031-9422(02)00088-2
Vandebroek I, Thomas E, Ametrac : Las plantas medicinales para la atención primaria de la salud. El conocimiento de ocho medicos tradicionales de Apillapampa, Bolivia. Cochabamba, Bolivia: Indústrias Gráficas Serrano; 2003.
McClatchey W, Winter K: Publication of ethnobotanical research in local languages. Ethnobotany Research & Applications 2005, 3: 279-282. [http://www.ethnobotanyjournal.org/]
Gessler MC, Msuya DE, Nkunya MHH, Schär A, Heinrich M, Tanner M: Traditional healers in Tanzania: the perception of malaria and its causes. Journal of Ethnopharmacology 1995, 48: 119-130. 10.1016/0378-8741(95)01294-N
De Lucca M, Zalles J: Flora medicinal Boliviana. Diccionario Enciclopédico. Cochabamba-La Paz, Bolivia: Editorial Los Amigos Del Libro; 1992.
Bourdy G, DeWalt SJ, Chávez de Michel LR, Roca A, Deharo E, Muñoz V, Valderrama L, Quenevo C, Gimenez A: Medicinal plants uses of the Tacana, an Amazonian Bolivian ethnic group. Journal of Ethnopharmacology 2000, 70: 87-109. 10.1016/S0378-8741(99)00158-0
Arrázola S, Atahuachi M, Saravia E, López A: Diversidad florística medicinal y potencial etnofarmacológico de las plantas de los Valles Secos de Cochabamba – Bolivia. Revista Boliviana de Ecología y Conservación Ambiental 2002, 12: 53-85.
Bourdy G, Chávez de Michel LR, Roca-Coulthard A: Pharmacopoeia in a shamanistic society: the Izoceño-Guaraní (Bolivian Chaco). Journal of Ethnopharmacology 2004, 91: 189-208. 10.1016/j.jep.2003.09.013
De Lucca MF: Plantas medicinales del Trópico Boliviano. Villa Tunari, Bolivia: Programa de Apoyo a la Estrategia de Desarrollo Alternativo en el Chapare (PRAEDAC); 2004.
Macía MJ, García E, Vidaurre PJ: An ethnobotanical survey of medicinal plants commercialized in the markets of La Paz and El Alto, Bolivia. Journal of Ethnopharmacology 2005, 97: 337-350. 10.1016/j.jep.2004.11.022
Thomas E, Vandebroek I: Guía de plantas medicinales de los Yuracarés y Trinitarios del Territorio Indígena Parque Nacional Isiboro-Sécure, Bolivia. Santa Cruz, Bolivia: Imprenta Sirena; 2006.
Rösing I: Introducción al mundo Callawaya. Curación ritual para vencer penas y tristezas. Cochabamba-La Paz, Bolivia: Editorial Los Amigos Del Libro; 1990.
Bastien JW: Cross cultural communication of tetanus vaccinations in Bolivia. Social Science & Medicine 1995, 41: 77-86. 10.1016/0277-9536(94)00297-7
Carod-Artal FJ, Vázquez-Cabrera CB: Estudio etnográfico sobre las enfermedades neurológicas y mentales entre los Urus-Chipayas del altiplano andino. Revista de Neurología 2005, 41: 115-125.
Bastien JW: Drum and stethoscope. Integrating ethnomedicine and biomedicine in Bolivia. Salt Lake City: University of Utah Press; 1992.
Alba JJ: Los jampiris de Raqaypampa. Cochabamba, Bolivia: Cenda; 1993.
Bruun H, Elverdam B: Los naturistas – healers who integrate traditional and biomedical explanations in their treatment in the Bolivian health care system. Anthropology & Medicine 2006, 13: 273-283. 10.1080/13648470600863605
Navarro G, Maldonado M: Geografía ecológica de Bolivia. Vegetación y ambientes acuáticos. Cochabamba, Bolivia: Centro de Ecología Simón I. Patiño-Departamento de Difusión; 2002.
Pedrotti F, Venanzoni R, Suarez Tapia E: Comunidades vegetales del valle de Capinota (Cochabamba, Bolivia). Ecología en Bolivia 1988, 11: 25-45.
Wood JRI: La guía "Darwin" de las flores de los valles Bolivianos. Bolivia: Darwin Initiative; 2005.
Fepade (Fundación Ecuménica Para el Desarrollo): Diagnostico del distrito Apillapampa. Cochabamba, Bolivia: Fepade; 1998.
Vandebroek I, Van Damme P, Van Puyvelde L, Arrazola S, De Kimpe N: A comparison of traditional healers' medicinal plant knowledge in the Bolivian Andes and Amazon. Social Science & Medicine 2004, 59: 837-849. 10.1016/j.socscimed.2003.11.030
Brandt de Oliveira R, Troncon LEA, Dantas RO, Meneghelli UG: Gastrointestinal manifestations of Chagas' disease. The American Journal of Gastroenterology 1998, 93: 884-889.
Panzera F, Dujardin JP, Nicolini P, Caraccio MN, Rose V, Tellez T, Bermúdez H, Bargues MD, Mas-Coma S, O'Connor JE, Pérez R: Genomic changes of Chagas disease vector, South America. Emerging Infectious Diseases [serial online] 2004, 10: 438-446. [http://www.cdc.gov/ncidod/EID/vol10no3/02-0812.htm]
Remez L: Children under age five account for half of all deaths in Bolivia, with diarrhea the main cause. International Family Planning Perspectives 1990, 16: 115-116. 10.2307/2133311
Los Tiempos.com[http://www.lostiempos.com/noticias/20-04-04/20_04_04_loc8.php]
Albarracin-Veizaga H, de Carvalho ME, do Nascimento EMM, Rodrigues VLCC, Casanova C, Barata JMS: Chagas disease in an area of recent occupation in Cochabamba, Bolivia. Revista de Saúde Pública [serial online] 1999, 33: 230-236. [http://creativecommons.org/licenses/by/2.0]
Roberts A, Kemp C: Chagas' disease (American Trypanosomiasis). Journal of the American Academy of Nurse Practitioners 2001, 13: 152-153.
PAHO: Bolivia. Health in the Americas 1998, 94-107. [http://www.paho.org/english/hia1998/Bolivia.pdf]
Little MA: Human populations in the Andes. The human science basis for research planning. Mountain Research and Development 1981, 1: 145-170. 10.2307/3673120
Roersch C: Plantas medicinales en el Sur Andino del Perú. Koenigstein, Germany: Koeltz Scientific Books; 1994.
Oths KS: Assessing variation in health status in the Andes: a biocultural model. Social Science & Medicine 1998, 47: 1017-1030. 10.1016/S0277-9536(98)00161-0
Leonard KL: African traditional healers and outcome-contingent contracts in health care. Journal of Development Economics 2003, 71: 1-22. 10.1016/S0304-3878(02)00131-1