Allopathic Health Research Articles

Framing the allopathic approach to health and disease labels through patient narratives during the COVID‐19 pandemic first wave in Ecuador: An understudied and underutilized tool in health care practice and delivery

AbstractPresented in this article is a search for folk, popular, and professional health care labels through patient narratives. Fieldwork was done in the Ecuadorian communities of Santa Rosa and Pano during the first wave of COVID‐19. The results emphasize the utility of studying labels to better understand what communities experience in health crises, the opportunities to improve allopathic health care delivery and engagement with the folk and popular sectors. Both communities had adapted labels that were familiar to them from prior health experiences and served to inform their personal medical care during the pandemic. Meanwhile, in Pano, an Indigenous predominant community, people had inherited labels for plants and pandemics in both the Kichwa and Spanish language, and those provided a vocabulary of hope to the people. In Santa Rosa the labels demonstrated the grief and difficult times the community had experienced with the limited health resources available.

Integrating traditional and allopathic child health: A healthcare transformation opportunity.

Numerous forums both domestically and internationally have discussed integration of allopathic and traditional healthcare. In South Africa, using traditional child healthcare is popular practice. If properly controlled, integrating this aspect of traditional child-health with allopathic healthcare may be advantageous to communities that use both healthcare systems. Allopathic and traditional healthcare remain separate organisations in South Africa despite efforts and discussions to integrate them. The study sought to explore the integration of traditional and allopathic child healthcare from the perspectives of children's caregivers and traditional healthcare practitioners. The study was conducted in a semi-urban area in the city of Tshwane. An exploratory qualitative research study was conducted using semi-structured interviews to collect data from 11 traditional healthcare practitioners and 15 children's caregivers who were sampled using snowball and convenient sampling respectively. The participants expressed their understanding of the usage of traditional healthcare practitioners in the care of children as well as their support for integration, and further indicated its necessity. Religion and its effects in health-seeking behaviour were cited as a factor in why there has not been greater integration between the two healthcare systems. The undocumented and undisclosed use of traditional healthcare potentially hinders the delivery of therapeutic healthcare. As such, integrating the two systems is essential to ensure patients' safety. This article highlights understanding of culture congruence and safe child healthcare that may be brought forward by the integration of the two healthcare systems.

A mathematical model to study herbal and modern treatments against COVID-19

Abstract In this paper, we propose a two-group deterministic COVID-19 model which takes into account educational campaigns and the fact that people infected with COVID-19 may choose either modern (allopathic) medicine, traditional medicine or may combine the two modes of treatment. The model is analysed in the case where modern medicine is the only mode of treatment and when traditional medicine is taken as an adjuvant (or another mode of treatment). We prove in the first case that the model has a disease-free equilibrium (DFE), globally asymptotically stable when the control reproduction number is less than one and whenever it is greater than one, we prove the local asymptotic stability of the endemic equilibrium. In the second case, we prove that, misconceptions in the population lead to a backward bifurcation phenomenon, which makes the control of the disease more difficult. We derive using the Lyapunov method that a threshold T $\mathcal{T}$ ensures the global asymptotic stability of DFE in some cases when its value is less than one. Both models are fitted using daily COVID-19 cumulative cases reported from January to February 2022 in South Africa. We found a control reproduction number less than one, meaning that COVID-19 will be eliminated. Comparison of the two models fits highlights that misconceptions should be taken into account to accurately describe the dynamics of COVID-19 in South Africa. Numerically, we prove that educational campaigns should focus on preventive measures and both traditional and allopathic medicine health care systems should complement each other in the fight against COVID-19.

Effects of COVID-19 pandemic on provision and use of maternal health services in Allada, southern Benin: a local health system perspective.

To assess the effects of the COVID-19 pandemic on the provision and use of maternal health services in southern Benin from a local health system perspective. We conducted a qualitative study from April to December 2021 in a health district in southern Benin. We interviewed health workers involved in antenatal, delivery, postnatal and family planning care provision, alternative and spiritual care providers, administrative staff of the district hospital, community health workers, adolescents and women who had given birth in the past six weeks in public health centers were interviewed. The World Health Organization health systems building blocks framework was used to guide the thematic analysis from a local health system perspective. The COVID-19 pandemic changed the lines of command and the institutional arrangements in the local health systems leadership; it put the interpersonal relationships in the health care provision team under stress and reduced the overall revenues of the district hospital. The motivation of allopathic health workers was undermined. Communities underutilized maternal health services in the COVID-19 period. Plausible causes included negative patient perceptions of COVID-19 measures taken at the public health facility level as well as well as fear of being forcibly vaccinated against COVID-19 in the health facilities. In times of health crises, appropriate local health system governance that integrates providers' concerns into effective guidelines is critical to reach and maintain a sufficient level of work motivation to ensure quality maternal health services.

Unit costs for allopathic and AYUSH outpatient care in public facilities in Urban Delhi, India.

The National Health Policy, 2017, suggests pluralism in health care with the integrated delivery of AYUSH and allopathic care at public facilities. Information on unit cost of outpatient visits for both types of care at public facilities is useful to guide the policies on health-care delivery. The costs in 2019-20 were estimated for each type of care at allopathic urban primary health center (UPHC) and AYUSH facilities using top-down methodology and adding out-of-pocket expenditures (OOPE) incurred to reflect true costs. Data from national health survey, annual government budgets, and reports were used. The average cost of an outpatient visit for allopathic care was ₹325 at a UPHC and ₹189 in a homeopathic dispensary and ₹692 in an Ayurvedic dispensary. While OOPE per visit at UPHC was ₹177, no OOPE was incurred at AYUSH facilities. The government expenditure per visit for allopathic care at UPHC at ₹148 was the lowest compared to any type of AYUSH care. The cost per facility for allopathic UPHC was higher than both Ayurvedic and homeopathic dispensaries. Unani dispensaries were least cost-effective, both in terms of cost per visit and cost per facility. Costs per visit at a facility are impacted by footfalls. For Ayurveda, despite lower facility costs as compared to UPHC, per visit costs were higher due to low utilization. Improving evidence-based utilization of AYUSH care is critical for the success of the government policy of mainstreaming AYUSH care at low cost.

A qualitative study on traditional healers' perceptions and management of epidermolysis bullosa.

Epidermolysis bullosa (EB) is a rare, incurable genodermatosis causing blisters that can result in multisystemic complications and death. Limited data exists on EB in South Africa. Research indicates that the majority of African patients consult traditional health practitioners (THPs) before seeking allopathic healthcare. This study aims to understand THPs belief systems, experiences, perceptions and management of EB patients and their families in the social and cultural context to improve the healthcare of EB patients. The study setting is Nelson Mandela School of Medicine, Durban, and Grey's hospital, Pietermaritzburg, KwaZulu-Natal. Qualitative in-depth interviews were conducted with 10 THPs. A non-probability, purposive sampling method was used. A two-site qualitative study was guided by interpretative phenomenological analysis. Guba's trustworthiness framework was used to ensure rigour. Three male and seven female THPs were interviewed, including sangoma, inyanga and umthandazi. The integration presented five global themes: (1) THP practices, (2) perceptions of THP, (3) experiences of THP with patients with EB, (4) diagnosis and management plans of THP and (5) vision and role of THPs. There were multiple divergent perspectives among the THPs with the shared African worldview. Understanding THPs belief systems and therapeutic options is crucial for holistic patient management. Knowledge exchange can promote safe healthcare practices and facilitate collaboration between traditional and allopathic health practitioners. This is the first study to explore THPs perceptions and practices regarding EB, a rare disease.

Pulmonary tuberculosis vs. Tindzhaka and Mafularha: A mixed methods inquiry of traditional healers' perceptions of tuberculosis in rural South Africa.

Although awareness of tuberculosis (TB) is high in South Africa, delays in TB testing or treatment persist. Even those with symptoms of TB often delay testing, with one study in Mpumalanga revealing a median allopathic care-seeking delay of four weeks. We sought to understand how traditional healers perceived TB symptoms among their patients, if they treated the disease, and what (if any) illnesses they defined as being traditional may have overlapping presentation with TB in South Africa. Nineteen traditional healers completed an in-depth interview (IDIs); 133 completed a quantitative survey about their treatment practices. IDIs focused on lung diseases treated, disease causation, treatment, and prognosis. Survey questions investigated diagnosis of lung ailments, including those treated by the allopathic health system and those by traditional healers. Traditional healers reported that they could differentiate between TB and traditional illnesses, like Tindzhaka and Mafularha, that presented with similar symptoms. Few (7.5%) believed they could treat TB, but the majority (72.9%) believed they could successfully treat Tindzhaka and Mafularha. Tindzhaka and Mafularha are interconnected illnesses that are reportedly caused by breaking social rules around death, sex and using the belongings of someone who recently passed away. Both, if not treated, are considered fatal. While we have no definitive data, traditional healers may be contributing to delays in the diagnosis and treatment for people with active TB by incorrectly diagnosing TB as Tindzhaka or Mafularha. Overcoming issues of trust and compensation, while respecting different forms of knowledge, are some of the challenges we face in successfully engaging with healers.

Uniting behind a common goal: Collaboration between traditional healers and allopathic health care workers to improve rural snakebite care.

Snakebite envenoming is an acute medical emergency which affects hundreds of thousands of people worldwide, primarily in remote rural areas of low-and middle income countries in the Global South. A considerable proportion of snakebite patients turn to traditional healers (THs) for help, driven by a number of push and pull factors. These include socio-cultural factors, geographical proximity, and the absence or inaccessibility of overstretched and often costly allopathic healthcare services. Although traditional healers and allopathic healthcare staff share a common focus -the recovery and well-being of their patients- both systems operate largely in parallel to each other with collaborations being an exception rather than the rule. This is to the detriment of snakebite patients, who frequently find themselves being caught-up in the dualism between the two separate systems. Given the right circumstances, snakebite patients could benefit from elements of care from both modalities. Here, we have reviewed the role of THs in snakebite care and explored how their integration into the formal healthcare system could improve the implementation and outcome of care. The effective recruitment of THs to aid in disease control and treatment efforts in diseases other than snakebite underscores the potential benefits of this strategy. Carefully devised proof of concept studies are needed to test our hypothesis that collaborations between the formal healthcare sector and THs are feasible and improve outcomes in snakebite care.

Snakebite Treatment in Tanzania: Identifying Gaps in Community Practices and Hospital Resources.

Snakebite envenoming causes more than 140,000 deaths annually and at least triple this number of disabilities. The World Health Organization classified snakebite as a Neglected Tropical Disease in 2017 and developed a strategy to halve death and disability from snakebite by 2030. To achieve this goal, snakebite victims need to receive safe and effective treatment. This descriptive, cross-sectional study surveyed student health professionals (N = 312) in Dar es Salaam, Tanzania, and was designed to identify major gaps in community practices and hospital resources for snakebite treatment. Participants reported using traditional community practices (44%, 95% confidence interval (CI) = 39–50%), allopathic practices (7%, 95% CI = 5–11%), or a combination of both (49%, 95% CI = 43–54%) to treat snakebite. Harmful practices included tight arterial tourniquets (46%, 95% CI = 41–52%) and wound incisions (15%, 95% CI = 11–19%). Many participants (35%, 95% CI = 29–40%) also turned to traditional healers. Students who treated snakebite injuries within the last 5 years (N = 69) also reported their general experiences with snakebite in hospitals. Hospitals often lacked essential resources to treat snakebite victims, and 44% (95% CI = 30–59%) of snakebite victims arrived at a hospital only three or more hours after the bite. A significant percentage of snakebite victims experienced lasting damage (32%, 95% CI = 20–47%) or death (14%, 95% CI = 7–25%). Snakebite outcomes could likely be improved if hospitals were universally and consistently equipped with the essential resources to treat snakebite victims, such as antivenoms. Educational interventions aimed at communities should focus on discouraging tourniquet use and tampering with the wound. Collaboration between the allopathic and traditional health system could further boost snakebite outcomes because traditional healers are often the first health workers to see snakebite victims.

Effects of a multi route (oral and nasal) application of Lasunadya Ghrita (An ayurvedic formulation) in cases of primary depression: Inferences from a Non Randomized open label clinical trial

Mental diseases are rising globally. Depression is one among the most common mental disorders with an alarmingly high incidence in India. Mental health care in general is suboptimal in India on account of inadequate resources and lack of awareness. Pluralistic health care delivery model of India including its traditional health care services is less explored in case of mental health for its possibility of adding value to the net mental health care delivery. The objective of the study was to explore the efficacy of an ayurvedic formulation Lasunadya Ghrita (LG) in a multimodal application form in cases of depression and to compare its efficacy with conventional care composed of Escitalopram, Etizolam and Zolpidem (EEZ) provided in an allopathic psychiatric health care setting. Total 52 patients of depression allocated non randomly to Ayurveda LG group and to Allopathy EEZ group were followed up for 4 weeks and evaluated on the basis of HAM-D and SF-36 mean score changes of the participants on a pre and post basis and also for their intergroup comparisons. Statistically significant changes in mean HAM-D and SF-36 Score were observed in a pre-post comparison in both the groups. An intergroup comparison was non- significant for majority of HAM-D domains, barring a few showing the comparable effects of two treatment approaches. Ayurvedic treatment was effective in work and energy domain and gastrointestinal symptoms. Pre and post mean changes in HAM-D and SF-36 Score in two groups have shown significant changes in both the groups suggestive of their individual efficacy. Insignificant difference in most domain scores of HAM-D and SF-36 in an inter group comparison was suggestive of comparable efficacy of LG multi route application with EEZ allopathy care.

Integrating Traditional Healers into the Health Care System: Challenges and Opportunities in South Africa

Background: Traditional medicine is widely used around the world to prevent, manage and cure illnesses. For many people living in low- and middle-income countries, particularly in rural areas, traditional medicine is their primary source of health care. Traditional medicines are often used concurrently with treatment from allopathic providers, resulting in concerns related to toxicity, dosing, adherence, and retention in chronic disease treatments. This paper explores opportunities for integrating traditional healers into the allopathic health care system by analysing the challenges hindering integration in order to improve health outcomes for those who routinely oscillate between the two systems.
 Method: Qualitative interviews were conducted with 30 traditional healers in rural South Africa. Thematic data analysis, using a combination of deductive and inductive coding, was applied using Nvivo Data management software.
 Results: The study showed that collaboration between traditional healers and the health care system exists in an ad-hoc manner, primarily via health education (allopathic to healer), provision of protective materials to healers (e.g. latex gloves), and the referral of patients to the health system for tests and treatments not available to traditional providers. Despite these collaborative efforts, mistrust and a perceived lack of respect for traditional healer’s practices by allopathic providers make formal collaboration difficult. Traditional healers propose opportunities to improve relations including; trust building, bi-directional referral systems as well as improved resource and information sharing systems. 
 Conclusion: This study has identified potential for more formal linkages between the traditional and allopathic medical systems in SSA, as a means to support patients who ulitize both services for their healthcare needs. The lack of formal policy direction and guidelines has made it difficult to officially bring together these complementary systems that provide parallel services to the same patients and community.

Integrating Traditional Healers into the Health Care System: Challenges and Opportunities in South Africa

Background: Traditional medicine is widely used around the world to prevent, manage and cure illnesses. For many people living in low- and middle-income countries, particularly in rural areas, traditional medicine is their primary source of health care. Traditional medicines are often used concurrently with treatment from allopathic providers, resulting in concerns related to toxicity, dosing, adherence, and retention in chronic disease treatments. This paper explores opportunities for integrating traditional healers into the allopathic health care system by analysing the challenges hindering integration in order to improve health outcomes for those who routinely oscillate between the two systems.
 Method: Qualitative interviews were conducted with 30 traditional healers in rural South Africa. Thematic data analysis, using a combination of deductive and inductive coding, was applied using Nvivo Data management software.
 Results: The study showed that collaboration between traditional healers and the health care system exists in an ad-hoc manner, primarily via health education (allopathic to healer), provision of protective materials to healers (e.g. latex gloves), and the referral of patients to the health system for tests and treatments not available to traditional providers. Despite these collaborative efforts, mistrust and a perceived lack of respect for traditional healer’s practices by allopathic providers make formal collaboration difficult. Traditional healers propose opportunities to improve relations including; trust building, bi-directional referral systems as well as improved resource and information sharing systems. 
 Conclusion: This study has identified potential for more formal linkages between the traditional and allopathic medical systems in SSA, as a means to support patients who ulitize both services for their healthcare needs. The lack of formal policy direction and guidelines has made it difficult to officially bring together these complementary systems that provide parallel services to the same patients and community.

The relationship between Indigenous and allopathic health practitioners in Africa and its implications for collaboration: a qualitative synthesis

ABSTRACT Background There have been increasing calls for collaboration between Indigenous health practitioners (IHPs) and allopathic health practitioners (AHPs) in Africa. Despite this, very few successful systems exist to facilitate formal collaboration. Direct relationships between providers, and at a health systems level are crucial to successful collaboration, but the nature and extent of these relationships have yet to be adequately explored. Objective To explore the relationship between IHPs and AHPs in Africa, and to discuss the implications of this for future collaboration. Methods An interpretive qualitative synthesis approach, combining elements of thematic analysis, meta-ethnography, and grounded theory, was used to systematically bring together findings of qualitative studies addressing the topic of collaboration between Indigenous and allopathic health practitioners in Africa. Results A total of 1,765 papers were initially identified, 1,748 were excluded after abstract, full text and duplicate screening. Five additional studies were identified through references. Thus, 22 papers were included in the final analysis. We found that the relationship between Indigenous and allopathic health practitioners is defined by a power struggle which gives rise to lack of mutual understanding, rivalry, distrust, and disrespect. Conclusion The power struggle which defines the relationship between IHPs and AHPs in Africa is a hindrance to their collaboration and as such could partly account for the limited success of efforts to foster collaboration to date. Future efforts to foster collaboration between IHPs and AHPs in Africa must aim to balance the power disparity between them if collaboration is to be successful. Since this would be a novel approach, decision-makers and organisations who trial this power balancing approach to facilitate collaboration should evaluate resultant policies and interventions to ascertain their feasibility and efficacy in fostering collaboration, and the lessons learnt should be shared.

How Should Allopathic Physicians Respond to Native American Patients Hesitant About Allopathic Medicine?

American Indian (AI) and Indigenous peoples utilize traditional medicine/healing (TM/H) for health and well-being. Allopathic health care practitioners (HCPs) receive minimal training and education on TM/H and its application and integration into health care settings. Lack of knowledge and practice guidelines on how to navigate these 2 health care perspectives (allopathic and traditional) creates uncertainties in the treatment of AI and Indigenous peoples. Such conflicts can undermine patient autonomy and result in culturally incongruent practice. This article presents a case study showcasing suggestions for how HCPs can direct clinical decision making when working with AI/Indigenous patients who utilize TM/H. The article argues that health professions education institutions and HCPs must dedicate effort to expanding awareness of and education about TM/H to enhance the delivery of evidence-based and integrated clinical treatment for AI/Indigenous patients.

Throwing the bones to diagnose HIV: Views of rural South African traditional healers on undertaking HIV counselling and testing

ABSTRACT In 2018, nearly 800,000 HIV positive individuals in South Africa were unaware of their status. Traditional healers see patients who avoid health clinics, including those who refuse HIV testing. This manuscript details the results of a qualitative study to understand traditional healer perspectives on performing healer-initiated HIV counseling and testing HIV in rural South Africa. We conducted 30 structured in-depth interviews between April and June 2019 to elicit traditional healer attitudes towards partnering with local health services to perform HIV counseling and testing with their patients. Healers reported that while some patients are open about their HIV status, others lie about it due to stigma. This creates challenges with concurrent treatment, which healers believe leads to allopathic and/or traditional medication treatment failure. Most healers expressed both an interest and a willingness to perform HIV counseling and testing. Healers felt that by performing testing in the community, it would overcome issues related to HIV stigma, as well as a lack of confidentiality and trust with health care workers at the clinic. Trained traditional healers may be able to bridge the testing gap between “non-testers” and the allopathic health system, essentially “opening” thousands of new testing locations with little financial investment.

'This sickness is not hospital sickness': a qualitative study of the evil eye as a source of neonatal illness in Ghana.

Previous research has described the evil eye as a source of illness for pregnant women and their newborns. This study sought to explore the perceptions of the evil eye among mothers whose newborns had experienced a life-threatening complication across three regions of Ghana. As part of a larger, quantitative study, trained research assistants identified pregnant and newly delivered women (and their newborns) who had survived a life-threatening complication at three tertiary care hospitals in southern Ghana to participate in open-ended, qualitative interviews about their experiences in March-August 2015. All interviews were audio-recorded and transcribed verbatim into English and analysis using the constant comparative method of theme generation. A total of 37 mothers were interviewed, 20 about neonatal illnesses and 17 about maternal illnesses. Six of the 20 mothers interviewed about their newborn's illnesses spoke at length about the evil eye being a potential cause of newborn illness. The evil eye was described in a variety of terms, but commonalities included a person looking at a pregnant woman, her newborn baby, the baby's clothes and even the mother's food, causing harm, even unintentionally. Prevention required mothers covering themselves while pregnant and keeping the baby away from others until it was old enough to ward off the evil eye. Treatment required traditional medicine, yet some indicated that allopathic medicine could help. The evil eye appears to serve a social control mechanism, encouraging pregnant women to dress modestly, stay indoors as much as possible and behave appropriately. The evil eye is a pervasive, universally understood phenomenon across three regions of Ghana, even amongst a hospitalized population receiving allopathic health care for life-threatening complications of childbirth. Understanding the role of the evil eye in newborn illness attribution is important for clinicians, researchers and programmatic staff to effectively address barriers to care seeking.

Refusal of Vitamin K by Parents of Newborns: A Qualitative Study

ObjectiveDespite American Academy of Pediatrics recommendations, some parents refuse intramuscular (IM) vitamin K as prophylaxis against vitamin K deficiency bleeding for their newborns. The purpose of our study was to describe attitudes and perceptions of parents who choose to defer IM vitamin K for their newborns. MethodsUsing qualitative methodology, we conducted in-depth semi-structured interviews with parents of newborns in 3 hospitals in Connecticut and California. We used the grounded theory approach and the constant comparative method until saturation was reached. ResultsNineteen participants (17 mothers and 2 fathers) of 17 newborns were interviewed; 14 newborns did not receive IM vitamin K due to refusal by the parents, and for 3 newborns IM vitamin K administration was delayed due to initial hesitation by the parents. Four major themes emerged: 1) risk-to-benefit ratio, where parents refused IM vitamin K due to a perceived risk to their newborn from preservatives, for example; 2) “natural” approaches, which led to seeking oral vitamin K or increasing the mother's own prenatal dietary vitamin K intake; 3) placement of trust and mistrust, which involved mistrust of the medical and pharmaceutical community with overlapping concerns about vaccines and trust of self, like-minded allopathic and non-allopathic health care providers, the social circle, the internet, and social media; and 4) informed by experiences, reflecting hospital experiences with prior pregnancies and communication with health care providers. ConclusionsParents’ perception of risk, preference for alternative options, trust, and communication with health care providers were pivotal factors when making decisions about IM vitamin K.

A qualitative evaluation of health care in the Maroantsetra region of Madagascar.

Individuals in rural communities in Madagascar must frequently travel long distances, over difficult terrain, to obtain basic care. The quality of care is often inconsistent and inadequate. An exploratory mixed-methods study was conducted in select coastal communities in the Maroantsetra region of Madagascar to generate a more robust understanding of community and health care provider perceptions and how patients decide to seek health care, including the decision to use traditional medicine vs allopathic medicine. A total of 69 free-listing exercises and 21 facility assessments were conducted in eight communities. Symptoms most commonly reported as reasons to seek health care included headaches, fever and cough. Decisions to access allopathic health care facilities depended on the intersection of geographic and financial access to health care facilities, perceived severity of the illness and the availability and confidence in traditional plant-based medications. Traveling salespeople, staff at local stores and pharmacy workers very often lacked formal training. The decision to use allopathic medicine was determined by the perception of disease severity and when vulnerable populations, such as children and the elderly, were involved. Results provide insight into patterns, motivations and obstacles to health care utilization and decision making in the Maroantsetra region of Madagascar.

Decolonising the mindsets, attitudes and practices of the allopathic and indigenous health practitioners in postcolonial society: An exploratory approach in the management of patients.

BackgroundThe indigenous health care system continues in the postcolonial era to be perceived by antagonists as a threat to Western medicine. It has been associated with ‘witchcraft’, actively discouraged and repressed through official government prohibition laws. Despite that, human immunodeficiency virus and acquired immunodeficiency syndrome (HIV and AIDS) patients consult both allopathic and indigenous health practitioners.AimThe study explored a collaboration model between allopathic and traditional health practitioners in the management of patients living with HIV and AIDS in postcolonial South Africa.SettingWe conducted six combined focus group discussions and four separate group discussions with each category of co-researchers.MethodsCombined and separate focus group discussions were conducted with community members, allopathic and indigenous health practitioners, applying the cyclical method in the decolonisation process. Their perceptions and experiences in the management of HIV and AIDS patients were explored, and finally decolonisation strategies suitable for collaboration in their context were identified.ResultsThe two health systems were rendering services to the same HIV and AIDS communities. Lack of communication created confusion. Collaboration was long overdue. A change in mindsets, attitudes and practices among practitioners was critical, with an acknowledgement that ‘neither health system is better than the other, but the two should be complementary, recognising that the culture and beliefs of patients influence their health-seeking behaviour’.ConclusionCo-researchers were committed to working together in the fight against HIV and AIDS infections. Their model for collaboration addresses the challenges of patients’ secrecy, treatment overdose and the abandonment of antiretroviral treatment. Through the application of a decolonisation process, their mindsets, attitudes and practices towards each other were changed, enabling the joint development of a custom model for collaboration between allopathic health practitioners and indigenous health practitioners in the management of patients living with HIV and AIDS.

Complementary and Alternative Medicine Provider Knowledge Discourse on Holistic Health

Complementary and alternative medicine (CAM) promises a wide array of therapies employed increasingly by consumers for disease prevention and health promotion. Despite this increasing use, however, CAM and biomedical paradigms are often not combined effectively in the US. The lack of coordination negatively impacts several aspects of patient care including CAM and biomedical provider-patient relationships and the practice of integrative medicine. The goal of this study is to understand how CAM providers position their knowledge and practice of holistic health within the healthcare landscape in the US. In-depth interviews with CAM providers (N=17) sampled from practices in the mid-Atlantic region of the US were analyzed for provider descriptions of holistic health. Discourse analysis of CAM provider interviews identifies the three themes employed by CAM providers to describe holistic health as comprising the: (a) epistemologies of legitimization and identity, (b) epistemologies of sense and intuition, and (c) epistemologies of environment and community. The three epistemologies define holistic health by organizing diverse knowledge foundations through reconciling and integrating differences, including diverse modes of evidence such as non-empirical forms of whole body experiences, and privileging the relational praxis through integrating the individual’s biological and sociocultural environment. The epistemologies illuminate how CAM knowledge and practice is positioned as alternative within the sociocultural context of the participants and reflect CAM providers’ challenges in carving out a distinct knowledge space reflecting their professional identity. CAM providers’ discourse encompasses the ontological and experiential-relational praxis to foreground health as a mutually constitutive, ongoing process of granting legitimacy to diverse sense-making ontologies of medicine within a continuum of provider-patient meaning-making. Theoretically, CAM knowledge of holistic health integrates the experiential praxis of the patient’s spiritual and physiological self and the relational praxis of the patient’s biological-sociocultural-epigenetic relationships in the conceptualization and delivery of health outcomes. The study findings recommend including CAM knowledge discourses to inform the epistemological foundations of basic medicine. Pragmatically, the study recommends support for efforts to include credentialing of CAM practitioner teaching within allopathic healthcare institutions, faculty development within existing allopathic health professional schools, and incorporation of CAM content in allopathic medical education and practice.