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Traditional and biomedical care pathways for mental well-being in rural Nepal.

Tony V Pham, Rishav Koirala, Brandon A Kohrt

International journal of mental health systems January 7, 2021 DOI: 10.1186/s13033-020-00433-z (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Qualitative study Peer reviewed
Sample size 124
Population 40 traditional healers, 79 general community members, and 5 physicians in Nepal
Topics Shamanism
Keywords Ethnopsychology Medical anthropology Mental health Spirituality Traditional medicine
Key findings Most participants endorsed both supernatural and medical causes of illness and sought care from healers, medical practitioners, or both. The authors report that care pathways and barriers depended on patient-, traditional healer-, and medical practitioner-specific attitudes, and that some community members duplicated care across multiple equally qualified medical providers before seeing a traditional healer, or vice versa. Participants favored a more collaborative, medically plural system but offered no consistent proposal; suggestions included biomedical training of traditional healers, two-way referrals, and open dialogue.

Abstract

There is increasing access to mental health services in biomedical settings (e.g., primary care and specialty clinics) in low- and middle-income countries. Traditional healing continues to be widely available and used in these settings as well. Our goal was to explore how the general public, traditional healers, and biomedical clinicians perceive the different types of services and make decisions regarding using one or both types of care. We conducted in-depth interviews using a pilot tested semi-structured protocol around the subjects of belief, traditional healers, and seeking care. We conducted 124 interviews comprising 40 traditional healers, 79 general community members, and five physicians. We then performed qualitative analyses according to a grounded theoretical approach. A majority of the participants endorsed belief in both supernatural and medical causes of illness and sought care exclusively from healers, medical practitioners, and/or both. Our findings also revealed several pathways and barriers to care that were contingent upon patient-, traditional healer-, and medical practitioner-specific attitudes. Notably, a subset of community members duplicated care across multiple, equally-qualified medical providers before seeing a traditional healer and vice versa. In view of this, the majority of our participants stressed the importance of an efficient, medically plural society. Though participants desired a more collaborative model, no consistent proposal emerged on how to bridge traditional and biomedical practices. Instead, participants offered suggestions which comprised three broad categories: (1) biomedical training of traditional healers, (2) two-way referrals between traditional and biomedical providers, and (3) open-dialogue to foster mutual understanding among traditional and biomedical providers. Participants offered several approaches to collaboration between medical providers and traditional healers, however if we compare it to the history of previous attempts, education and understanding between both fields may be the most viable option in low- and middle-income contexts such as Nepal. Further research should expand and investigate opportunities for collaborative learning and/or care across not only Nepal, but other countries with a history of traditional and complimentary medicine.

Comparable studies

Other qualitative studies on shamanism, most cited first.

Study Year Design Participants
"Plantas con madre": plants that teach and guide in the shamanic initiation process in the East-Central Peruvian Amazon. Curanderos, apprentices, and herbalists in East-Central Peru, including Mestizo,... 2011 Qualitative study n = 36
Purging and the body in the therapeutic use of ayahuasca Healers and participants in shamanic tourism contexts of the Peruvian Amazon and... 2019 Ethnography with literature review n = 227
The Globalization of Ayahuasca Shamanism and the Erasure of Indigenous Shamanism Western tourists and indigenous peoples in Iquitos, Peru 2016 Ethnography
Shamanism and Rock Art in Far Western North America Historic hunter-gatherer cultures of California and the Great Basin 1992 Ethnographic review and analysis
Working with “La Medicina”: Elements of Healing in Contemporary Ayahuasca Rituals Ayahuasqueros and Western participants in shamanic tourism in Iquitos, Peru 2012 Ethnography

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