Thesis (M.Phil.) --University of Limpopo, 2012 / An exploratory study was conducted on the ethnomedical aspects of rural communities in the Limpopo Province with emphasis on the use of cultural practices, values and belief systems to meet primary health care needs. The study explored the use of indigenous medical knowledge for remedial, preventive and protective health care. Qualitative and quantitative data were collected through interviews and questionnaire administration with 240 research respondents purposely selected from four communities of the Northern Sotho in the Limpopo Province. The research findings show that the Northern Sotho culture is composed of a wealth of indigenous knowledge, practices, values and belief systems that were developed by the people themselves with the objective of maintaining good health. The study respondents have extensive experience and knowledge about the elements responsible for much of the diseases that afflict them. For this reason, they have developed cultural belief systems and values that lessen the risks for contracting disease. Susceptibility to disease is lessened by knowledge about cosmological factors, disease etiologies, heeding of cultural taboos, moral behaviour, hygiene, healthy diet, drinking of clean water and proper sanitation and waste removal. Immunization against disease is accomplished through administration of indigenous plant medicines dispensed by traditional health practitioners. Instances of self-medication were encountered in 18% of the respondents. The respondents apply simple home remedies for prevention and remedial purposes. Treatment is meant for simple ailments such as flu, cough, diarrhea, snakebites, fever, measles and mumps. The medicines administered for self-medication are prepared in the household by the patient, his/her parent or a family member. Traditional health practitioners are consulted for preventive, protective and remedial care by 52% of the respondents and their families. Traditional health practitioners provide holistic remedial care through administration of medicines prepared from the indigenous plant materials such as bulbs, roots, leaves and bark of trees. The indigenous health care mechanisms of the Northern Sotho address basic elements of primary health care such as fostering self-care and self-reliance, community participation and the use of traditional medical practices for the maintenance of good health. It is recommended that the indigenous knowledge of preventive, protective and remedial care should be incorporated into Primary Health Care Programs to promote the WHO principle that communities should plan and implement their own health care services. Scientific validation of the health benefits derived from the consumption or utilization of medicinal plants should be encouraged.

Last summer we officially launched the Journal of Ethnobiology and Ethnomedicine, published by BioMedCentral, with the aim of establishing a serious, peer-reviewed, open-access online journal that focuses on the multidisciplinary, interdisciplinary, and transdisciplinary fields of ethnobiology and ethnomedicine, drawing on approaches and methods from both the social and biological sciences. The strong start vindicates the widely held belief that the journal responds to a real need within the research community. The success of the journal has been most gratifying. The steady influx of submissions of high scientific standards illustrates the strong demand for a dynamic, proactive, and open-minded scientific journal in these research areas. Our aim has been to dedicate JEE to the "scientific communities" worldwide, particularly those in the developing countries.

Ethnobiology is a multidisciplinary field of study that draws on approaches and methods from both the social and biological sciences. Ethnobiology aims at investigating culturally based biological and environmental knowledge, cultural perception and cognition of the natural world, and associated behaviours and practices. Ethnomedicine is concerned with the cultural interpretations of health, disease and illness and also addresses the health care seeking process and healing practices. Research interest and activities in the areas of ethnobiology and ethnomedicine have increased tremendously in the last decade. Since the inception of the disciplines, scientific research in ethnobiology and ethnomedicine has made important contributions to understanding traditional subsistence and medical knowledge and practice. The Journal of Ethnobiology and Ethnomedicine (JEE) invites manuscripts and reviews based on original interdisciplinary research from around the world on the inextricable relationships between human cultures and nature, on Traditional Environmental Knowledge (TEK), folk and traditional medical knowledge, as well as on the relevance of the above for Primary Health Care (PHC) policies in developing countries.

The thesis focuses on changing medical beliefs and practices in Bani Ghazl, a village of 631 inhabitants in the ~ugariyya district of North Yemen. The analysis of medicine is first placed in a broad ethnographic context, with a presentation of the economic and political experience of the Hugariyya in this century. The medical data suggest that traditionally, great emphasis was put on personal responsibility for the prevention of illness and promotion of health. This orientation remains but is supplemented by simultaneous use of western medicine, which does not emphasize personal responsibility but rather reliance on the extra-household cures of specialists. That one set of symptoms can have many explanations in the community is discussed. Finally, the influence of a new economic and religious elite on village medical practice is discussed.

This dissertation is based upon research of an emergent ethnomedicine in a botanically rich area, the Western Cape of South Africa. It examines the interface between ethnobotany and medical anthropology by investigating the biological and social factors related to the knowledge, use and trade of medicinal plants by Cape bush doctors. Incredible syncretism was observed in the identity formation of this homogenous urban group of healers who combined elements of a globally recognized eco-religion and sociopolitical movement Rastafari with several South African cultures through knowledge of medicinal plants. By rejecting colonial principals, including capitalistic biomedical systems, bush doctors have crafted a niche acquiring knowledge and herbal remedies for the treatment of common ailments. Transmission amongst Rastas and trail-and-error experimentation with herbs emphasize that plant knowledge is situational and arises through relationships. From an estimated 200 bush doctors in the Cape, 62 almost exclusively middle-aged coloured males were interviewed. They declared their mission was 'to heal all people' through a reintroduction of KhoiSan healing traditions, an indigenous ancestry largely rejected by coloureds during apartheid. An ethnobotany of bush doctors revealed that of 192 species, 181 were medicinal and included various herbs important to most South African cultural groups. This largely herbaceous pharmacopeia is narrow compared to the region's high biodiversity and thirty-three species were identified as conservation priorities. The presence of bush doctors at transportation hubs as herbal hawkers creates a diversified economy through cultivation of relationships with primarily disadvantaged coloured and black consumers. The consumption, trade and sale of local plants by bush doctors represent efforts to embody the landscape; it reasserts coloured links to indigeneity, renews respect for their heritage and affords rights to resources. By evoking tradition within their tolerant philosophy, leaders of this emergent ethnomedicine develop a racially equitable and ecologically sustainable platform for health care evidenced by medicinal plant gardens in townships and transmission of diverse ethnomedical knowledge. Bush doctors are legitimized through the performance of transmission. This phytomedicinal knowledge reifies an ideology, repositioning coloureds in a moderate stance between colonial biomedicine and traditional African ethnomedicines, but also creates a unified South African medicine.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Cervical cancer is the primary cause of cancer deaths among Haitian women; however, the social context of cervical cancer among Haitian immigrant women has not been systematically examined. The ways in which women assign meaning to this disease, understand its causality and situate it within the broader context of gynecological health are poorly understood. Further, Haitian immigrant women's perceptions of disease risk, including knowledge and understanding about Human Papillomavirus (HPV), the primary etiologic factor in cervical cancer, have not been explored. Few studies have assessed health behaviors, including culturally mediated feminine hygiene practices, among Haitian immigrant women, which may negatively impact gynecological health. This exploratory study examines these dimensions of gynecological health using ethnographic methods including participant observation, observation, informal and semistructured interviewing and surveys. Ethnographic data contextualize this disease in larger cultural and historical contexts. In addition, these data informed the construction of a 92-item survey, ensuring content validity of the personal questions women were asked about feminine hygiene practices and the agents they use. This survey, administered to 246 women in Little Haiti, Miami, represents an application of medical anthropology to epidemiologic research. Each survey respondent also was evaluated for cytology and sexually transmitted infections (STIs), including HPV, using a self-sampling medical device. Quantitative analysis of survey data indicates that prevalent STIs (Chlamydia) are significantly associated with feminine hygiene practices; however, HPV infection and cervical cancer are not associated with the practices. The practices are likely underreported in the survey sample. Qualitative analysis reveals that women's constructions of gynecological health are inseparable from cultural beliefs that emphasize feminine hygiene. Beliefs guide behaviors, which include vaginal douching and intravaginal washing, using plant-based therapies, imported commercial products and chemical compounds. These practices serve the purpose of not only cleaning, but also drying and tightening the vaginal environment for increased sexual pleasure of male partners. Attempts to preserve relationships, and reduce the chance that partners will take mistresses, occur through maintaining intimate hygiene and, in some cases, by other ethnomedical means.

This project describes and analyzes explanatory models of Chagas disease among people in a highly endemic area of eastern Bolivia, and examines the role that cultural and structural factors play in shaping explanatory models of this disease. Dressler (2001) characterizes medical anthropology as divided between two poles; the constructivist, which focuses on the "meaning and significance that events have for people," and the structuralist, which emphasizes the relationships between the components of a given society. This project endeavors to synthesize structuralist and constructivist perspectives by understanding the interaction between structural processes and explanatory models of Chagas disease. The research took place in the spring of 2013, in collaboration with the Centro Medico Humberto Parra, a non-profit clinic servicing low income populations in Palacios, Bolivia and surrounding communities. Semistructured interviews (n=68) and consensus analysis questionnaires (n=48) were administered to people dealing with Chagas disease, and free lists of possible treatments were collected. Overall, participants largely accepted the biomedical model, but also emphasized the emotional and social aspects of Chagas disease. The consensus analysis procedure indicated a clear shared model of Chagas disease, with coherent social, vector, symptoms, and ethnomedical domains. Furthermore, the model differed between groups based on ethnicity, gender, income and occupation. Significant differences were found in cultural knowledge of the disease based on community of residence and occupation status, two clear markers of how people are tied into the global economy. In the interviews, participants associate their Chagas disease with structural factors including poverty, rural living and traditional housing. They describe substantial barriers to getting biomedical care for their disease despite the existence of a free treatment program in Bolivia. However, participants reported numerous ethnomedical treatments; the study identified 39 ethnomedical treatments for Chagas disease and 66 for its cardiac symptoms. In sum, explanatory models include structural processes that shape disease, and are in turn influenced by these processes. In Bolivia, although structural constraints limit the scope of biomedical treatment, ethnomedical approaches to the disease are in a process of dynamic growth. The methods used here for assessing the structural component of the explanatory model of Chagas disease can be replicated in future research on explanatory models or political economy of health.

This dissertation research utilizes anthropological methods to determine the degree to which the signs and symptoms female caregivers identify as causes of acute respiratory infections (ARIs) in under-fives in rural Ecuador correspond with Western biomedical categories. By employing both a semi-structured medical history questionnaire and more open-ended ethnographic methods such as in-depth informant interviews and focus group research, the researcher identifies the factors which determine timely health care-seeking behaviors of female caregivers in this case study. Economic factors such as the cost of medications and lost work hours were determined to be the primary financial obstacles for timely health care-seeking. Other barriers included limited and inconsistent hours at the health centers and transportation issues. Families of lower socioeconomic status were also more likely to have children suffering particular respiratory ailments. Childhood respiratory illness was identified as an outcome of poverty, which had the potential to reproduce itself through the negative effect of illness on household income. However, the research determined that there was an overall lack of recognition of the biomedical signs and symptoms of serious lower respiratory infections regardless of socioeconomic status. The model of ethnomedicine supports the finding that compliance with timely health care-seeking is limited without collaboration between healthcare professionals and communities to work towards beneficial and achievable goals that are joined by a common purpose. By understanding local cultural beliefs towards ARIs, healthcare professionals are in a better position to: (1) assess the accuracy or inaccuracy of ethnomedical beliefs and determine if there is a conflict in symptom recognition and care-seeking behavior with the biomedical model; (2) determine culturally-appropriate interventions or recommendations to address the health problems of the commu nity and identify barriers; and (3) work with existing community resources in order to foster effective health communication. This research finds that public health messages regarding ARIs be informed by ethnomedical knowledge of home treatments and beliefs. Moreover, health centers need to adhere to regular hours of operation and increase staff capacity to better meet the needs of their clients.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal