Medical Pluralism By Yusuf Abdu Misau


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describes forms of medical care alternatives existing in any giving society

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Medical Pluralism By Yusuf Abdu Misau

  1. 1. Medical pluralism Dr. Yusuf Abdu Misau MBBS(ABU), MPH(UM), PhD Student(UM) Department of Social and Preventive Medicine, University of Malaya
  2. 2. Acknowledgement <ul><li>I wish to acknowledge A/P Nabilla Al-Sadat for permission to use her slides in this presentation </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  3. 3. Case Study <ul><li>Mr A is a 32 year old man in your community who has been complaining of headaches for the last one month. </li></ul><ul><li>Discuss his process of seeking help for his problem </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  4. 4. What is Medical pluralism? <ul><li>“ Prior to the emergence of biomedicine as the dominant system of healing, endowed with monopolistic powers by favor of most western states, many other forms of healings had flourished”. </li></ul><ul><li>Porter 1989 </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  5. 5. What is Medical pluralism? <ul><li>Medical pluralism is the adoption of more than one medical system, or the simultaneous integration of both orthodox medicine with complementary and alternative medicine (CAM) </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  6. 6. Components of a Health Care/ Medical system <ul><li>A medical system has two inter related aspects: </li></ul><ul><ul><li>A cultural aspect- includes certain basic concepts, theories, normative practices and shared modes of perception </li></ul></ul>01/19/10 Medical pluralism_Yusuf Misau
  7. 7. <ul><ul><li>A social aspect- including its organization into certain specified roles and rules governing relationships between these roles in specialized settings (such as a hospital or a doctor’s office) </li></ul></ul>Components of a Health Care/ Medical system 01/19/10 Medical pluralism_Yusuf Misau
  8. 8. The three sectors of health care <ul><li>Kleinman: Three overlapping sectors of health care </li></ul><ul><ul><li>The popular sector </li></ul></ul><ul><ul><li>The folk sector </li></ul></ul><ul><ul><li>The professional sector </li></ul></ul><ul><li>Its own ways of explaining and treating ill health </li></ul><ul><li>Defining who is the healer and who is the patient </li></ul><ul><li>Specifying how healer and patient should interact </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  9. 9. 01/19/10 Medical pluralism_Yusuf Misau POPULAR SECTOR
  10. 10. The popular sector <ul><li>The lay, non-professional, non-specialist domain </li></ul><ul><li>Ill health is first recognized and defined here </li></ul><ul><li>Health care activities are initiated </li></ul><ul><li>All therapeutic options that people utilize without any payment and without consultation. Includes </li></ul><ul><ul><li>self-treatment </li></ul></ul><ul><ul><li>Advice given by non-professional </li></ul></ul><ul><ul><li>Healing in a self help group </li></ul></ul>01/19/10 Medical pluralism_Yusuf Misau
  11. 11. The popular sector <ul><li>The MAIN PLAYER- the real site of PHC (70-90% of health care takes place within this sector) </li></ul><ul><li>The family- usually the women (mothers/grandmothers) </li></ul><ul><li>Both patient and healer share similar assumptions about health and illness </li></ul><ul><li>Includes a set of beliefs about health maintenance </li></ul><ul><li>‘ correct’ behavior for preventing ill health </li></ul><ul><li>Food, use of amulets </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  12. 12. The popular sector <ul><li>The individuals who tend to act as a source of health advice more often than others </li></ul><ul><ul><li>Those with long experience of a particular illness </li></ul></ul><ul><ul><li>Those with extensive experience </li></ul></ul><ul><ul><li>The paramedical professions –consulted informally </li></ul></ul><ul><ul><li>Doctors spouses </li></ul></ul><ul><ul><li>Hairdressers, salesmen, bank tellers, religious teachers </li></ul></ul><ul><ul><li>Organizers of self help group </li></ul></ul><ul><ul><li>Members of healing cults/ churches </li></ul></ul>01/19/10 Medical pluralism_Yusuf Misau
  13. 13. 01/19/10 Medical pluralism_Yusuf Misau The folk sector
  14. 14. The folk sector <ul><li>Healers specialize in forms of healing that are either sacred or secular or a mixture of both </li></ul><ul><li>Not part of the official medical system </li></ul><ul><li>Example: </li></ul><ul><ul><li>Secular, technical experts : bone setters, midwives, tooth extractors, herbalists, Boka (Nigeria) </li></ul></ul><ul><ul><li>Spiritual healers, clairvoyants, shamans, bomohs </li></ul></ul>01/19/10 Medical pluralism_Yusuf Misau
  15. 15. The folk sector <ul><li>Most folk healers share the basic cultural values and world view of the communities in which they live including beliefs about the origin, significance and treatment of ill health </li></ul><ul><li>Approach is holistic </li></ul><ul><li>Balance between people and their social, natural and supernatural environments </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  16. 16. The folk sector <ul><li>Characteristics: </li></ul><ul><ul><li>Little formal training </li></ul></ul><ul><ul><li>Informal networks </li></ul></ul><ul><ul><li>Frequent involvement of the family in diagnosis and treatment </li></ul></ul>01/19/10 Medical pluralism_Yusuf Misau
  17. 17. Advantages <ul><li>Frequent involvement of the family in healing rites </li></ul><ul><li>Most effective PHC -Can influence the society </li></ul><ul><li>Healing takes place in a familiar setting </li></ul><ul><li>Not separated by class, economic position </li></ul><ul><li>Doctors tell what has happened , folk healers tell why </li></ul><ul><li>Docs tend to place the patients ill health in a limited temporal frame and to localise it to a particular part of the body </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  18. 18. Limitations <ul><li>Training- little formal training </li></ul><ul><li>Born into a healing family etc </li></ul><ul><li>Open to abuse </li></ul><ul><li>Techniques used may be dangerous </li></ul><ul><li>Therefore, important to view them in a balanced way, avoid over idealization and over criticism </li></ul><ul><li>Arcadian view vs barbaric view </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  19. 19. 01/19/10 Medical pluralism_Yusuf Misau THE PROFESSIONAL SECTOR
  20. 20. The Professional Sector = medical system <ul><li>The organized, legally sanctioned profession </li></ul><ul><li>Modern, western, scientific medicine, allopathy, biomedicine </li></ul><ul><li>Medical and para-medical professionals </li></ul><ul><li>An expression of the values and social structure of the society from which it arises </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  21. 21. The medical profession <ul><li>Based on a body of specialized knowledge (the content) not easily acquired </li></ul><ul><li>Has a collegial organization </li></ul><ul><ul><li>Maintain control over their field of expertise </li></ul></ul><ul><ul><li>Promote their common interests </li></ul></ul><ul><ul><li>Maintain monopoly of knowledge </li></ul></ul><ul><ul><li>Protect themselves from competition </li></ul></ul><ul><ul><li>Monitor the competence and ethics </li></ul></ul><ul><li>Hierarchies of knowledge and power </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  22. 22. Alternative and complementary medicine <ul><li>Overlaps both folk and professional sectors </li></ul><ul><li>Examples: acupuncturists, homeopaths, chiropractors, osteopaths, herbalists, naturopaths, hypnotists, massage therapists, meditation experts </li></ul><ul><li>Rapidly growing in popularity </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  23. 23. Issue <ul><li>Integration of TCM into the medical system (WHO- 1978) </li></ul><ul><li>Definition of traditional medicine –not clear </li></ul><ul><li>Assumption of the efficacy not justified – egs inability to cure malaria, cholera, yellow fever and etc </li></ul><ul><li>Could be part of the problem </li></ul><ul><li>Success stories in MCH, AIDS prevention, treatment of mental illness etc </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  24. 24. Summarizing…… <ul><li>Medical pluralism is a wide range of therapeutic options available for the alleviation and prevention of physical discomfort or emotional distress </li></ul><ul><li>Professional sector -Official Medical system comprises of Medical, nursing and allied professions </li></ul><ul><li>Folk and the popular sector </li></ul><ul><li>Influences the choices of health seeking behavior </li></ul><ul><li>Public health implications </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  25. 25. Brainstorm……. <ul><li>In your view, how has medical pluralism impact on public health governance of your society? </li></ul><ul><li>Your ability to trash this effectively, reflects your understanding of this lecture and vice versa </li></ul>01/19/10 Medical pluralism_Yusuf Misau
  26. 26. REFERENCES <ul><li>Cecil G Helman. Culture, Health and Illness. Wright 2000 </li></ul><ul><li>David Armstrong. Outline of Sociology as Applied to Medicine. Butterworth Heinemann. 1994. </li></ul><ul><li>Graham Scambler (ed). Sociology as Applied to Medicine. Saunders 2003. </li></ul><ul><li>Rachel E. Spector. Cultural Diversity in Health and Illness. Pearson Prentice Hall 2004. </li></ul><ul><li>E. Gartly Jaco (ed). Patients, Physicians, and Illness. A Sourcebook in Behavioural Science and Health. The Free Press 1979. </li></ul>01/19/10 Medical pluralism_Yusuf Misau