‘Since It’s a Pleasure to Save Somebody’s Life, I Do This’

Health development efforts to decrease maternal and neonatal morbidity and mortality in South Asia have included a role for trained and/or traditional birth attendants since the late 20th century. Birth attendants are typically older women, who assist not only during birth but who also can provide counsel during pregnancy and lactation. Based on an ethnographic case study, focused on a jhuggi-jhopri (squatter) settlement in New Delhi, this chapter differentiates between two types of birth attendants. Traditional birth attendants are women who have learned their skills and knowledge, typically from elder women relatives, through apprenticeship. Their tools of practice include herbal knowledge as well as ‘modern’ medical kits they may have received through health education efforts (for example, scissors to cut the umbilical cord). In contrast, trained birth attendants are older women who were recruited through local health organizations (both governmental and non-governmental) and trained by biomedical practitioners to provide frontline care. This chapter examines both traditional and trained birth attendants’ perspectives on assisting local mothers, examining how local mothers view traditional versus trained birth attendants and, in turn, how this may affect their birth experiences

Indigenous Midwives and the Biomedical System among the Karamojong of Uganda: Introducing the Partnership Paradigm

Certainly there can be no argument against every woman being attended at birth by a skilled birth attendant. Currently, as elsewhere, the Ugandan government favors a biomedical model of care to achieve this aim, even though the logistical realities in certain regions mitigate against its realisation. This article addresses the Indigenous midwives of the Karamojong tribe in Northeastern Uganda and their biosocial model of birth, and describes the need British midwife Sally Graham, who lived and worked with the Karamojong for many years, identified to facilitate “mutual accommodation” between biomedical staff and these midwives, who previously were reluctant to refer women to the hospital that serves their catchment area due to maltreatment by the biomedical practitioners there. This polarisation of service does not meet that society’s needs. We do not argue for the provision of a unilateral, top-down educational service, but rather for one that collaborates between the biosocial model of the Karamojong and the biomedical model supported by government legislation. We show that such a partnership is practical, safer, and harnesses the best and most economical and effective use of resources. In this article, we demonstrate the roles of the Indigenous midwives/traditional birth attendants (TBAs) and show that not only is marriage of the two systems both possible and desirable, but is also essential for meeting the needs of Karamojong women. The TBA is frequently all the skilled assistance available to these women, particularly during the rainy season when roads are impassable in rural South Karamoja. Without this skilled help, the incidence of maternal and infant mortality would undoubtedly increase. Ongoing training and supervision of the TBA/Indigenous midwife in best practices will ensure better care. We offer a way forward via the Partnership Paradigm (PP) that lead author Sally Graham designed in conjunction with the Indigenous midwives and biomedical staff with whom she worked, the development and characteristics of which this article describes.

Integrating Traditional Medicine and Healing into the Ghanaian Mainstream Health System: Voices From Within

In this study, I employed interpretive ethnographic qualitative design to explore perceptions of and proposals from traditional healers, biomedical practitioners, and health care consumers regarding integrating traditional medicine and healing in Ghana. Data were gathered through focus groups, in-depth individual interviews, and qualitative questionnaires and analyzed thematically. The results revealed positive attitudes toward integrating traditional medicine in Ghana and a discursive discourse of power relations. The power imbalance between biomedical and traditional practitioners regarding what integrative models to adopt is sanctioned by formal education and institutional structure. As a result, multiple approaches for integration were made, including patient co-referrals, collaborations between biomedical and traditional medical practitioners, and creating a unit for traditional medicine and healers at the outpatients’ department for patients to choose either biomedicine or traditional medicine. Incorporating aspects of traditional healing in the training of biomedical practitioners and creating a space for knowledge sharing were also proposed. These integrative models reflected the distinctive interests of healers and biomedical practitioners. Considering these findings, I recommended policy options for consideration toward achieving an integrative health care system in Ghana.

Trantrace: a reliable, traceable, and collaborative solution to streamline the translation of emerging biomedical resources

BackgroundPrecision medicine is gaining popularity in routine health care, which heavily relies on the interpretation of emerging biomedical databases and professional guidelines. Translation of those biomedical materials, that is crucial to deliver research discovery to health interventions in non-native English-speaking countries, remains a large amount of work for biomedical practitioners.ResultsWe presented an application called Trantrace to facilitate the routine of large-scale long-running translation. Especially for the case that many people joined multiple translation projects, it has a rigorous task division and cooperation process: assignment, translation, review, release, and iteration. Trantrace empowers users to build own projects with different permissions, version control all the translation operation without specific skills, and further improve the translation efficiency through real-time task management tools.ConclusionsBy providing a working platform for collaborative translation and enabling long-time version correction, the Trantrace contributes towards the creation of a multilingual biomedical knowledge commons, which would be a valuable aid for personalized therapies. The source code is freely accessible at https://github.com/sgi-drylab/trantrace.

A REVIEW ON SCOPES, METHODS AND RATIONALE OF INTEGRATIVE APPROACH IN SIDDHA MEDICINE WITH BIOMEDICINE

In India, according to WHO 2018 statistics, there were 63% of death occurred due to Non-communicable diseases (NCDs), in which Cardiovascular diseases were leading cause of death 27%, followed by Cancer 9%, Chronic respiratory disease 11%, Diabetes 3% and other NCDs 13%. This indicates that NCDs needs to become a priority in controlling and preventing. Therefore, the only effective intervention may be at controlling and preventing NCDs disease is Integrative Medicine. Integrative Medicine is a medical practice synthesizing Traditional medicine and Biomedicine preventive measures and treatment interventions. Autonomy of patients may end in no benefit out of their ignorance to select between the treatment options available in a country like India where Seven Recognized medical systems are available as a platter. Siddha system of medicine is one of the traditional medicines of India, practiced in the southern part of the country. This study aims at providing Health care system under one roof, in order to save public money, time and health as an existing model as co-location in Tamil Nadu. This can be achieved through assessing feasible areas of integration in the Siddha system of medicine with biomedicine. So the study deals with the utilization of Siddha system of medicine, scientific validation of Siddha medicines, Siddha medicine research undertaken by biomedical practitioners and some government policies supporting mainstreaming of Siddha.

A REVIEW ON SCOPES, METHODS AND RATIONALE OF INTEGRATIVE APPROACH IN SIDDHA MEDICINE WITH BIOMEDICINE

In India, according to WHO 2018 statistics, there were 63% of death occurred due to Non-communicable diseases (NCDs), in which Cardiovascular diseases were leading cause of death 27%, followed by Cancer 9%, Chronic respiratory disease 11%, Diabetes 3% and other NCDs 13%. This indicates that NCDs needs to become a priority in controlling and preventing. Therefore, the only effective intervention may be at controlling and preventing NCDs disease is Integrative Medicine. Integrative Medicine is a medical practice synthesizing Traditional medicine and Biomedicine preventive measures and treatment interventions. Autonomy of patients may end in no benefit out of their ignorance to select between the treatment options available in a country like India where Seven Recognized medical systems are available as a platter. Siddha system of medicine is one of the traditional medicines of India, practiced in the southern part of the country. This study aims at providing Health care system under one roof, in order to save public money, time and health as an existing model as co-location in Tamil Nadu. This can be achieved through assessing feasible areas of integration in the Siddha system of medicine with biomedicine. So the study deals with the utilization of Siddha system of medicine, scientific validation of Siddha medicines, Siddha medicine research undertaken by biomedical practitioners and some government policies supporting mainstreaming of Siddha.

Traditional healers’ and biomedical practitioners’ perceptions of collaborative mental healthcare in low- and middle-income countries: A systematic review

Access to mental healthcare in low- and middle-income countries (LMICs) is one of the greatest challenges in public health today. One suggestion for improving accessibility is through collaboration between biomedical practitioners and traditional healers. This paper reviews studies of traditional healers’ and biomedical practitioners’ perceptions of collaboration. We conducted a systematic review of online databases, selected journals, and reference lists for relevant studies. Eligible papers were assessed using a tool designed for this review for quality and study characteristics, and qualitative data demonstrating participants’ views were extracted. A total of 14 papers from seven countries were included. The published literature on this topic is relatively homogenous and studies are of variable quality. The findings suggest that, despite differing conceptualisations of mental illness causation, both traditional healers and biomedical practitioners recognise that patients can benefit from a combination of both practices and demonstrate a clear willingness to work together. There are concerns about patients’ safety and human rights regarding traditional methods and some healers are sceptical about the effectiveness of Western psychiatric medication. Despite keeping the inclusion criteria open to all LMICs, 13 of the studies were conducted in Africa, seven of which were in South Africa. This limits the applicability of the findings of this review to the wider LMIC context. The paper concludes with recommendations for research and practice.

Establishing views of traditional healers and biomedical practitioners on collaboration in mental health care in Zanzibar: a qualitative pilot study

Background This qualitative pilot study aimed to establish views of traditional and biomedical practitioners towards collaboration between the two sectors on the treatment of people with mental illness in Zanzibar, Tanzania. Methods Six traditional healers (known as “waganga” in Swahili) and six nurses working in government secondary mental health services were invited to participate in a series of focus group discussions (FGDs). Two sets of FGDs took place approximately seven weeks apart. In each set, FGDs were conducted with traditional healers only, nurses only, and finally nurses and traditional healers together. FGDs were conducted in Swahili, audio-recorded and then translated to English by an independent translator and coded thematically using NVivo software. Results All participants expressed that they were in favour of collaboration between traditional and biomedical practitioners on mental healthcare. Opinions varied regarding what form this collaboration should take. For many nurses and healers, there was acknowledgement of the role of the other group in providing treatment for people with mental illness, with support for the idea of bi-directional referrals between the two sectors. For some nurses, the value of collaboration would be purely in the education of traditional healers in the recognition of mental illness, with subsequent referral to biomedical services. For some traditional healers, the idea of collaboration seemed to appeal in part because of a perceived opportunity to learn additional skills from biomedical practitioners. Both categories of participant expressed a belief that patients possessed by a jinn (a spirit) or those that had been bewitched needed treatment by traditional healers. On the other hand, those with what participants considered to be “mental illness” needed treatment at the hospital clinic. However, some nurses felt that that traditional healers might be able to provide helpful treatment for mental illness, as well as those suspected to be affected by jinn or witchcraft. There was agreement on the need to establish clear referral pathways between the two service providers. The creation of an office for traditional healers at the hospital was an area where there was disagreement among participants. Conclusions We conclude that there is a positive view of collaboration among traditional healers and nurses who participated, and a willingness to work towards actual collaboration. The results suggest that views vary as to what form this collaboration should take, with opinions differing between nurses, as well as between traditional healers. Additional work is needed in order to further explore the nature of potential collaboration and extend the research to the wider population of traditional and biomedical practitioners in Zanzibar, to include primary health care workers.

Pluralistic Tendencies in Healing Abantu Illness in the Contemporary South Africa

Ukuhanjwa illness was used as an example to understanding abantu illnesses. With attributional theory ukuhanjwa illness is attributed to spiritual and social causes rather than biomedical causes, whereby causal link is socially constructed between ukuhanjwa illness and entry into the body by familiars. Issues explored included conceptualisation of ukuhanjwa illness. The focus of the chapter is on the reasons for continued pluralistic tendencies in healing regardless of the expectation by the West that people should be focusing on the use of the fast evolving biomedical healing methods. The ethnographic study took place among the Southern Nguni people of OR Tambo District Municipality (ORTDM) in the Eastern Cape, South Africa. Data was collected using qualitative and ethnographic research methods amongst a sample group of 50 participants. The sample was composed of traditional healers, mothers of children who have experienced ukuhanjwa illness, elderly people (male and female), biomedical practitioners and nurses.

From parallel to partnership

Purpose In the USA, there has recently been an unprecedented convergence of complementary/alternative medicine (CAM) with mainstream biomedical care. This confluence may lead to a deeply rooted philosophical conflict. This qualitative study works to identify factors that health-care leaders can use, which will build a pathway to greater integrative practice between medical doctors and CAM practitioners – from parallel existence to partnership – by examining the tensions between biomedical medicine and naturopathic medicine. The purpose of this study is to offer short-term suggestions for partnership and long-term recommendations for better understanding. Design/methodology/approach An original qualitative study using semi-structured with CAM practitioners and biomedical practitioners. Findings Areas of conflict that are preventing synergy are identified and a pathway for health-care leaders to follow to create greater integration and partnerships is suggested. Research limitations/implications This is a qualitative and exploratory study that has significant limitations on generalizability. Practical implications This study suggest steps that both types of health-care practitioners can take to increase their success at working together on an individual level, a group level, an organizational level and on an industry-wide basis, as well as provide a specific pathway to create greater integrative practice for health-care leaders. Social implications The results indicate that stronger partnerships between different types of medical practitioners increase patient choice, patient satisfaction and outcomes. Originality/value Increasing interested in CAM modalities is driving more contact between CAM practitioners and biomedical practitioners. This contact is best established in partnership between practitioners rather than in parallel. This original research outlines the sources of conflict and provides recommendations for encouraging greater synergy.