Help-seeking strategies for epilepsy by previously untreated patients in northern Ecuador

Abstract

Two hundred and fifteen patients with epilepsy and 125 controls were given questions designed to elicit their help-seeking strategies for the condition. This was part of a large-scale medical intervention study in a rural area of a developing country (the provinces of E1 Carchi and Imbaburra, northern Ecuador). Local medical personnel were also surveyed. One hundred and forty-four patients and 98 controls were questioned again 12 months after they had been enrolled in the intervention programme to see if their attitudes and practices had changed. Over the study period, belief in medical remedies, particularly those offered by the study, rose significantly among both controls and patients. Control readiness to consult local healers for help and belief in their effectiveness also rose, whereas patient belief in healer help, already significantly less at baseline because of previous negative experiences, had declined still further. Though no patients treated were on antiepileptic treatment at baseline, 71% claimed to have sought the help of allopathic practitioners at some point in the past, 35% ‘many times’. Of these only 21% had ever been given antiepileptic drugs; some consultations were not at local health facilities. Thirty-two per cent of patients also claimed to have consulted traditional healers. The high number of patients claiming to visit doctors was not entirely confirmed in the medical evidence. Even this source, however, suggested more consulted doctors than expected from the observation that only 10% were on any kind of treatment at the start of the study (none on antiepileptic drugs). The conclusion was that people with epilepsy were anxious for help and had previously sought and been prepared to pay for treatment. Long-term treatment was not taken up despite the existence of local health facilities. This may be explained by a lack of information regarding treatments available and their nature, and by a failure to offer effective treatment, which itself may be due to the lack of training and experience in the treatment of epilepsy by local medical personnel.