Combining the use of alternative and complementary therapies and orthodox medicine is an increasing phenomenon. This thesis examines the implications of mixing and matching plural healing modalities against a backdrop of patient and practitioner responsibilities. From an anthropological perspective, the predominant use of qualitative methodology is an integral part of this research project. Central to this study is the views of a variety of participant categories - patients who use both alternative and orthodox healing methods; non-medical alternative and complementary practitioners; medical doctors who integrate orthodox and CAM therapies into their daily practise; and orthodox general practitioners. Interviews with these participants took place over an eighteen-month timeframe and involved face-to-face interviews, telephone interviews, and focus group research. Social constructionist theory, which forms part of the compendium of interpretive theoretical approaches adopted under the medical anthropology paradigm, has been used in order to expose the beliefs patients and practitioners hold about their own responsibilities, and those of the other participant categories. This study reveals a palimpsest of complex, contradictory and competing discourses in relation to patient and practitioner expectations and responsibilities. One important finding relates to the significance of neo-liberal and individualistic ideologies. This thesis concludes that the rhetoric from complementary and alternative practitioners, and their integrative colleagues, is heavily imbued with ideas about self-responsibility, particularly in relation to patient lifestyle choices and therapeutic compliance. Patients and orthodox general practitioners share some of these views but in general adopt a more collective approach to health care responsibilities. While patients are prepared to accept some responsibility for their illnesses and health keeping practises, they express strong reliance towards the orthodox health model as well as those doctors who practise integrative medicine. However the same cannot be said of their attitudes towards CAM modalities where considerable ambivalence is evident towards both practitioners and the therapies themselves. The role of the state, and its responsibilities for the structure of the health care system in New Zealand, is also clearly influential in the construction of belief systems. This is especially so because the rhetoric underlying neo-liberal and individualistic discourses now permeates the direction of health policies. Increasing levels of surveillance, both at bureaucratic and individual levels, also attests to the influence of neo-liberalism and individualism. This study exposes the tensions between the rhetoric of self-responsibility and the lived experiences of patients and health practitioners, which in many cases is more collective in its focus than is initially apparent.

This paper focuses on what people in Saga, a village on the periphery of Niamey, the capital of Niger, do in the face of illness. With limited economic assets and in a context of medical pluralism, to which therapeutic alternatives do they turn? And what factors are determinant in the choice that they make? Saga is an old village, which has become increasingly integrated into the expanding urban community of Niamey. It can be described as a semi-urban area in which elements of both rural and urban Niger are present. The therapeutic field in Saga is, as in all of Niger, characterised by medical pluralism. A number of therapeutic alternatives exist side by side. They range from ‘western’ or hospital medicine provided by the local public dispensary, the private confessional dispensary and by the unlicensed sale of medicine by ambulant vendors to ‘traditional’ treatments, such as Islamic medicine practised by marabouts and ‘traditional’ healing using herbal remedies and spirit possession rituals. This paper is about the various institutions and actors of ‘modern’ medicine in Saga, namely on the public dispensary, on the confessional dispensary and on the informal sale of pharmaceuticals. To better understand the quest for therapy in Saga this paper focuses on everyday practices of therapy seeking, on the actual and everyday choices people make in the face of illness.Special attention is paid to the therapeutic alternatives and to the relation between therapy seeker and therapy provider in what may be called the therapeutic encounter. It is argued that socio-economic factors as well as social relations, personal experiences and perceptions of trust are central to the therapeutic recourse taken. Furthermore, it is suggested that the ‘quest for therapy’ can and should be seen as a ‘quest for relief’.

No description available.

<p>This study describes and analyses understanding ‘illness’ among clients and</p><p>leaders of the spiritual tradition Candomblé in Rio de Janeiro. The study</p><p>focuses on the individuals’ narratives of illness and of healing rituals within</p><p>the cult. Particular attention is given to the consultation ritual called jogo de</p><p>búzios, which is one of the main practices of finding the reason for the illness</p><p>as well as its cure. The emphasis in this study is on the necessity to look at</p><p>medical pluralism, the socio-individual context of illness and narrativity as an</p><p>intersubjective practice. The conclusion is reached that illness within</p><p>Candomblé ideology can be understood as disequilibrium in a person’s</p><p>lifeworld.</p><p>The individual is approached from within the plurimedical context of</p><p>both biomedical and Candomblé healing tradition in Rio. Here it is argued that</p><p>the person creates meaning of the illness in relation to different aspects of his</p><p>lifeworld. The individual’s lifeworld includes the urban context of Rio de</p><p>Janeiro; therefore a brief discussion is developed about how this context</p><p>influences the individual meaning production of the illness. The Candomblé</p><p>house is described with its social structure and other elements that are</p><p>important for understanding how the cult might work for the clients as an</p><p>alternative and/or complementary medical treatment.</p><p>The study progressively introduces and analyses the lifestories of the</p><p>individuals that approach the Candomblé cult in order to seek treatment. It</p><p>also is concerned with stories of the Candomblé leaders and their view on the</p><p>phenomenology of the Body, the Self and the social milieu of the person.</p><p>Finally, the study emphasises the importance of studies that focus on the</p><p>individual’s interpretation of the relations between the Self and the Body, and</p><p>the individual’s understanding of medical knowledge and practice.</p>

<p>This paper focuses on what people in Saga, a village on the periphery of Niamey, the capital of Niger, do in the face of illness. With limited economic assets and in a context of medical</p><p>pluralism, to which therapeutic alternatives do they turn? And what factors are determinant in the choice that they make? Saga is an old village, which has become increasingly integrated into the expanding urban community of Niamey. It can be described as a semi-urban area in</p><p>which elements of both rural and urban Niger are present. The therapeutic field in Saga is, as in all of Niger, characterised by medical pluralism. A number of therapeutic alternatives exist side by side. They range from ‘western’ or hospital medicine provided by the local public dispensary, the private confessional dispensary and by the unlicensed sale of medicine by ambulant vendors to ‘traditional’ treatments, such as Islamic medicine practised by marabouts and ‘traditional’ healing using herbal remedies and spirit possession rituals. This paper is about the various institutions and actors of ‘modern’ medicine in Saga, namely on the public dispensary, on the confessional dispensary and on the informal sale of pharmaceuticals. To better understand the quest for therapy in Saga this paper focuses on everyday practices of</p><p>therapy seeking, on the actual and everyday choices people make in the face of illness.Special attention is paid to the therapeutic alternatives and to the relation between therapy seeker and therapy provider in what may be called the therapeutic encounter. It is argued that socio-economic factors as well as social relations, personal experiences and perceptions of trust are central to the therapeutic recourse taken. Furthermore, it is suggested that the ‘quest for therapy’ can and should be seen as a ‘quest for relief’.</p>

This study describes and analyses understanding ‘illness’ among clients and leaders of the spiritual tradition Candomblé in Rio de Janeiro. The study focuses on the individuals’ narratives of illness and of healing rituals within the cult. Particular attention is given to the consultation ritual called jogo de búzios, which is one of the main practices of finding the reason for the illness as well as its cure. The emphasis in this study is on the necessity to look at medical pluralism, the socio-individual context of illness and narrativity as an intersubjective practice. The conclusion is reached that illness within Candomblé ideology can be understood as disequilibrium in a person’s lifeworld. The individual is approached from within the plurimedical context of both biomedical and Candomblé healing tradition in Rio. Here it is argued that the person creates meaning of the illness in relation to different aspects of his lifeworld. The individual’s lifeworld includes the urban context of Rio de Janeiro; therefore a brief discussion is developed about how this context influences the individual meaning production of the illness. The Candomblé house is described with its social structure and other elements that are important for understanding how the cult might work for the clients as an alternative and/or complementary medical treatment. The study progressively introduces and analyses the lifestories of the individuals that approach the Candomblé cult in order to seek treatment. It also is concerned with stories of the Candomblé leaders and their view on the phenomenology of the Body, the Self and the social milieu of the person. Finally, the study emphasises the importance of studies that focus on the individual’s interpretation of the relations between the Self and the Body, and the individual’s understanding of medical knowledge and practice.

Music-based healing is utilized as a healing tool in many cultural contexts around the world. This thesis examines the cultural practice of music therapy in the context of the larger discipline of medicine in the United States through an ethnographic study of music therapists in the Greater Atlanta area. It contextualizes this data with research in medical ethnomusicology that explores cross-cultural traditions of music in healing rituals. It also connects music therapy to the observation that forces of globalization are strongly correlated with an increase in rates of inequality, poverty, stress, and disease. This thesis discusses how Atlanta-area music therapists use music healing with patients suffering from physical and mental disease and how economic stratification impacts access to music therapy. It is concerned with deeper and not immediately evident processes taking place in music therapy, such as the role of music as a medium and facilitator in healing.

In August 2008, a biomedical intervention providing free drugs to school aged children to treat two endemic diseases –schistosomiasis haematobium and soil-transmitted helminths - in Morogoro region, Tanzania, was suspended after violent riots erupted. Parents and guardians rushed to schools to prevent their children taking the drugs when they heard reports of children dying in Morogoro town after receiving treatment. When pupils heard these reports, many of those who had swallowed the pills began to complain of dizziness and fainted. In Morogoro town hundreds of pupils were rushed to the Regional Hospital by their parents and other onlookers. News of these apparent fatalities spread throughout the region, including to Doma village where I was conducting fieldwork. Here, protesting villagers accused me of bringing the medicine into the village with which to “poison” the children and it was necessary for me to leave the village immediately under the protection of the Tanzanian police. This thesis, based on eleven months fieldwork between 2007 and 2010 in Doma village and parts of Morogoro town, asks why was this biomedical intervention so vehemently rejected? By analysing local understandings and responses to the mass distribution of drugs in relation to the specific historical, social, political, and economic context in which it occurred, it shows that there was a considerable disjuncture between biomedical understandings of these diseases, including the epidemiological rationale for the provision of preventive chemotherapy, and local perspectives. Such a disjuncture, fuelled by the reports of fatalities and the pupil’s fainting episodes brought about considerable conjecture both locally and nationally, that the drugs had been faulty, counterfeit, or hitherto untested on humans. Among many of the poorer inhabitants of Morogoro town, there was suspicion that this had been a covert sterilization campaign. From an official perspective, such conjecture was dismissed as mere rumour, proliferated by “ignorant” people. However, from an anthropological perspective, these ‘rumours’ reveal profound local anxieties including a pervasive fear that poor Africans are being targeted for covert eugenics projects by governments in the industrialized world. The thesis also shows that many of the assumptions embedded in global policies seeking to control neglected tropical diseases are mistaken. Indeed, it is suggested that it is unlikely that schistosomiasis haematobium and soil-transmitted helminths will be controlled so long as policy makers persist with the idea that one policy, designed by staff working for the World Health Organisation – with minor modifications added in Dar es Salaam - can be rolled out uniformly, irrespective of the political, social and economic context in which the programme occurs.

This study examines the unique cultural practices related to disease prevention and health maintenance within a Holmes County, Ohio Amish community. This research focuses on the many options for healthcare within this community and the decisions behind their use. By engaging with these Amish community members to discuss their methods of managing health, the non-Amish medical professionals who treat Amish patients can learn cultural understandings of health within the community. As we learn that there are useful techniques to health beyond the dominant biomedical model, it is valuable to incorporate more traditional methods into our existing healthcare in to boost compliance and comfort for those seeking medical help.

Considering the changes the Lake Atitlan, Guatemala region has undergone in the last several years, ODIM (Organization for the Development of the Indigenous Maya) seeks to understand the needs of the San Juan La Laguna and San Pablo La Laguna communities, and to provide competent, culturally-aligned care that is affordable to the Indigenous Maya of this region. Using mixed-methods approaches that incorporate interviews, surveys, graphic anthropology, and evaluation methods, this study investigated (1) the formal and informal health care services (including those offered by ODIM) and how and why they are utilized by local Guatemalans, (2) Guatemalan perceptions and experiences of health, wellbeing, and illness to understand how they might influence health related behavior, and (3) community health care needs and how ODIM can fill those needs. These objectives served to inform key stakeholders of current gaps in healthcare services, provide feedback regarding the ODIM health services and programs, and provide insight into the current health needs in order to ameliorate the burden of disease and illness around Lake Atitlan, Guatemala. This study produced a comprehensive community health profile, and it discusses the current state of health care, explains the local perspectives of health care, and gives direct feedback and recommendations to ODIM's community health programs.