Orthodox Medical Services Research Articles

Perception of Clergymen on the Care and Stigmatization of Persons with Mental Illness in Nigeria

Objectives: This study was designed to investigate clergymen's training, knowledge, perception and experience of mental illness.
 Methods: The study adopted both quantitative and qualitative study designs conducted among a total of 148 student population of the Nigerian Baptist Theological Seminary Ogbomoso. The stratified random sampling technique was used for the quantitative approach using the (Community Attitudes towards Mental Illness (CAMI) scale and the socio-demographic questionnaire while purposive sampling of the respondents was used for the qualitative approach. Data collated for the quantitative technique was analyzed using the Statistical Packages for the Social Sciences (SPSS) version 21.
 Results: The Focused Group Discussions (FGDs) and Key Informant Interviews (KII) respondents believe that all mental illnesses are traceable directly or indirectly to spiritual factors, that certain sociocultural discriminations exist and that the local church is a healing community. The Community Attitudes towards Mental Illness (CAMI) benevolence subscale reveals that 76.4% of them want tax money to be spent on treating mental illness although 57.4% view mental hospitals as prisons. The Social restrictiveness subscale showed that 46.6% did not agree to engage women with a previous history of mental illness as babysitters and 37.2% did not agree to have them as neighbours. On the community mental health ideology subscale; about 70.3% have them live in neighbourhoods although 82.4% of them feel the mentally ill are awkward.
 Conclusions: With improved mental health knowledge; the Baptist clergymen may ensure referral to orthodox medical services, encourage compliance and banish discrimination against the mentally ill crucial for the WHO scale up program in Nigeria.

English

Both World Health Organization (WHO) and Kenya government have recognized the role of herbal traditional medicinal practice in primary health management due to the observation that 80% of the rural communities consult traditional healers before they go for the orthodox medical services. The traditional herbal practice remains familiar and artitional, thus least developed and hence the patients do not get the best values for their input in the services. The research strategies executed by researchers have never focussed on the plight of the patients but covered phytochemical, pharmacological and no clinical evaluations. Effectively, the data so far available remain less useful than should have been to the development of herbal traditional practices. The current project thus aimed at focussing on the establishment of a research strategy that used observational studies to establish the possibility for designing a rigorous clinical trials of herbal medical practice involving participation of three herbalists, patients, one orthodox medical doctor, a plant taxonomist and a phytochemist with the objectives of proofing and validating the practice, using principles of biomedical and bioscience in Gem and Seme sublocations in Siaya and Kisumu Districts, respectively in Nyanza province, Kenya. Through the ethnobotanical field survey, the taxonomist identified 95 plant species used by the herbalists. Through literature review it was found that 100% of the plants are used by other herbalists in East Africa to treat human and animal ailments while 30% of the species had received phytochemical and pharmacological evaluations, thus validating their therapeutic values. About 10% of these species had been used in clinical studies. The observation indicate that the herbalists have reasonable potentials for management of the diseases despite their ignorance on the literature data on these plants as well as modern medical practical procedures. The inclusion of modern diagnosis of diseases by a medical doctor and medical laboratory tests improved the rate of the healing outcome by 20% when the healing rate was compared with that observed for the treatment of patients before the intervention through this project. The results so far indicate that it is practicable to implement a rigorous clinical trial in which both herbalists, patients and researchers collaborate. Such strategies shall not only give critical data for validation of herbal traditional medicinal practice but be useful for prospection for phytochemicines based on indigenous knowledge and also be used for the improvement and management of the practice. Key words: Ethnobotany, pharmacology, phytochemistry, herbalist, patients, malaria, diarrhoea, Got Ramogi.

Cultural beliefs and attitudes: The psychosocial and economic problems associated with goiter and thyroidectomy in an African population

Objective: To evaluate the effects of cultural beliefs and attitudes on goiter and thyroidectomy and assess their psychosocial and economic implications on patients. Patients and Methods : In a 3-year period, between January 2008 and December 2011, a total of 65 patients were randomly selected and interviewed by using an interviewer administered questionnaire in our surgical outpatient department. Standard expressions and explanations in English and local dialects were used. Results: The patients consisted of 60 females and 5 males with a male to female ratio 1:12. Age range was 20-69 years. Major ethnic groups were Yoruba 60%, Ibo 20%, and Hausa 8%. Most of the patients, 72% believed goiter was caused by poison from witchcraft/devil and only 10% have the true knowledge of causes of goiter. In 60%, the most common psychosocial problem was exploitation by the traditional healers (THs), 15% were withdrawn and 12% were apprehensive. About 88% could not afford surgical bill until 2-7 months after initial hospital attendance. Failure of trado-medical treatment and cosmetics were the reasons for advancement in 44 patients for seeking orthodox medical services. In 16 patients, thyroidectomy was successful because neighbors encouraged them to come to hospital, while in 9 patients, it was a result of health education (HE) from electronic media, and in 3 patients, it was because of toxicity and malignant transformation. Formal education had some influence on the attitudes of patients toward goiter and modified their behavior and cultural beliefs. Conclusion: Goiter is believed by some patients to be one of psychic and psychosomatic disorders as a result of cultural beliefs and attitudes. Hence, trado-medical treatments are sought to cure it to no avail. This eventually inflicts a lot of psychosocial and economic problems on patients. HE and medical services need to be improved upon.

Socio -demographic predictors of patients′ satisfaction

Background: Health care market is widely becoming competive as a result of various alternative orthodox therapies in circulation. Therefore, to ensure continuous patronage of orthodox medical care market, there is need to improve patient,s satisfaction with orthodox medical services. Objective: To find out the relationship between patients' socio -demographic characteristics and satisfaction with the hope that this knowledge may facilitate better understanding of patient's expectation. Materials and Methods: In a descriptive cross -sectional survey using a random sampling technique (wherein all eligible and consenting participants were enrolled), a self -administered questionnaire was used to obtain information from the eligible and consented respondents on their self -rated level of satisfaction with the hospital personnel, the quality of care received, the comfort at the facility, and the prescribed medications in a subsidized eye clinic wherein patients pay half of the regular fees. Results: The study population consisted of 320 participants (178 males and 142 females) with a mean age ± SD of 53 ± 14.9 years. There was a significant association between the overall satisfaction and all the variables except marital status and monthly income. Age and place of domicile were found to be independent predictors of satisfaction. Respondents living outside Ibadan were 2.5 times more likely to be satisfied with care than those living in Ibadan while patients who were younger than 40 years of age were 16 times less likely to be satisfied with care compared to patients aged 70 years and above. Conclusion: Health care practitioner should be aware that socio -demographic characters may significantly influence how patients rate their health care experiences and as such should put these into consideration when attending to their patients.

Stop The Trench Wars

The authors say in their article that the placebo effect largely depends in a patient’s expectation and contextual factors, such as empathy and attention. The influence of the doctor’s expectations on the result has not been confirmed thus far. In my opinion, naturopathic remedies meet these requirements in a special manner. On the one hand, patients have great confidence in complementary treatment approaches. Most naturopathic remedies provide much opportunity to deal with patients empathetically because even when taking the history, much emphasis is placed on subjective well-being, and many therapeutic methods entail attentive physical contact between patient and practitioner. By contrast, patients are often resentful towards scientific orthodox medicine and in particular towards the pharmaceutical industry—as has been shown by the fear of the H1N1 vaccine. Empathy and attention may also be in short supply in medical everyday practice, which is characterized by numerous technical investigations, quality assured documentation, and guideline conform treatment. Among further aggravating factors are discount contracts leading to substitution with cheaper drugs—a cheaper price creates negative expectations, as was mentioned in the article. I am all the more surprised that the authors in their article declare the placebo effect an important tool in the context of orthodox medical treatment but declare it as questionable in the context of complementary approaches and even class it as “deceiving the patient.” We should end these entrenched wars between complementary medicine and orthodox medicine and should enhance the high technical and scientific standard of our orthodox medical services with the positive placebo characteristics of tried and tested naturopathic treatment methods. With regard to the placebo attributes, these are often superior to orthodox medicine.

A randomized experiment of the effects of including alternative medicine in the mandatory benefit package of health insurance funds in Switzerland

The present investigation focuses on the following questions: 1. Are complementary medical services paid for by a health insurer used in addition to orthodox medical services, or as substitute for them?; 2. If health insurers include complementary medical services in the basic cover, what will be the effect on costs?; 3. If complementary medical services as included in the basic cover, what will be the effect on the policyholders' subjective state of health? A randomized experiment was set up in which 7500 members of Switzerland's biggest health insurance fund, Helvetia, were offered free supplementary insurance for alternative medicine for 3 years. This simulated a situation in which the experimental group had access to the full range of complementary medical treatments under their health insurance policies. The remaining members in the scheme (670,000) people) formed the control group. To evaluate the effect on costs, we analysed the health insurer's cost and benefits data. In addition, a survey was carried out among random samples of subjects from the experimental group and from the control group using the 36-Item Short-Form Health Survey (SF-36) to examine the effects of including complementary medicine on subjective state of health. The analysis of the cost data shown that subjects used alternative in addition to orthodox medical services. It is also clear that alternative medical treatments are given in combination with orthodox medicine; less than 1% of the experimental group used exclusively alternative medical services. However, as only a very small percentage of experimental subjects (6.6%) took advantage of complementary medicine, no significant impact on overall health costs can be inferred. On the other hand, multiple regressions show that use of complementary medicine has a greater effect on treatment costs than sex, age or language region. Neither at the beginning nor the end of the experiment were any significant differences noted in the scales of the SF-36 between the experimental and the control group. Nor did multiple regressions reveal any effects on subjects' state of health due to the inclusion of complementary medicine in the basic insurance cover.

Health care and consumer choice: Medical and alternative therapies

This paper reports on research conducted in a large Canadian city during 1994–1995. The study examines the motivations of patients who choose to seek care from one of five different types of practitioners: family physicians, chiropractors, acupuncturists/traditional Chinese doctors, naturopaths and Reiki practitioners. We use the Andersen socio-behavioural model to help explain why people choose orthodox medicine or a type of alternative care. The data are derived from face to face interviews with 300 patients: 60 from each of the five modes of treatment. The findings demonstrate that this model can explain the use of alternative as well as orthodox medical services. Patients choose specific kinds of practitioners for particular problems, and some use a mixture of practitioners to treat a specific complaint. The choice of type of practitioner(s) is multidimensional and cannot solely be explained either by disenchantment with medicine or by an “alternative ideology”.

Plants and Wart Cures in England from the Seventeenth to the Nineteenth Century: Some Examples

THE inadequacies of the orthodox medical services in the pre-modern period left a large proportion of the population dependent upon traditional folk medicine. This was essentially a mixture of commonsense remedies based on the accumulated experiences of nursing the sick, combined with inherited lore about the healing properties of certain substances, particularly plants. The salient point about these remedies was their eclecticism, drawing as they did upon whatever traditions or medicaments appeared both relevant and accessible at the time. This was inevitable in an era when thie onus of responsibility for healing rested largely with the patient, who was free to draw on his or her favourite remedies, which relied in the main on the use of indigenous herbs. Traditional folk medicine, however, also included certain types of ritual healing, in which prayers, charms or particular actions accompanied the practical remedy or even formed the sole means of treatment. Magical healing of this kind might sometimes be attempted by the patient himself, or on other occasions by a relation or the local wiseman or woman. The medieval church itself had recommended the use of prayers when healing the sick or gathering medicinal herbs, and this led to a weakening in the fundamental distinction between a prayer and a charm, encouraging the idea that there was virtue in the mere repetition of holy words. Medieval theologians also encouraged the use of prayers as an accompaniment to herb gathering, so the idea survived that these plants would be useless unless they were picked in a ritual manner. Moreover, there was often no clear distinction between the use of natural and supernatural remedies. Many, which would seem magical to modern eyes, were in fact based on contemporary assumptions about the physical properties of natural substances and were employed as a purely physical form of treatment at all levels of society. Nowhere is this conjunction of the practical and the magical remedy better illustrated than in the recorded cures for that unsightly viral skin infection known as warts. With regard to practical applications, the sap or juice of certain plants applied to warts was believed to clear them, particularly those that had a milky or acrid type of sap. In Lincolnshire, Huntingdonshire and Somerset, for example, warts were rubbed with the soft white inner skins of broad bean or runner bean pods; another method was to rub the warts with the juice from the leaves. Sources indicate these remedies existed until the end of the nineteenth century.' In Devon, the buttercup was known as 'wart flower' on this account, as were other plants such as the sun spurge (Euphorbia helioscopia) which was known as 'wartwort' as early as the mid-sixteenth century,2 and the petty spurge (Euphorbia peplus) called in Lincolnshire 'wart-grass' and 'wart-weed'.3 Dandelion sap was used in Derbyshire, Somerset and other counties4 to remove warts, as was the sap from the greater celandine (Chelidonium majus), red campion (Silene dioica), yellow toadflax (Linaria vulgaris) and the scarlet pimpernel (Anagallis arvensis).

HETERODOX PRACTITIONERS AND THE AVAILABILITY OF SPECIALIST ADVICE

The characteristics of the principal categories of more professional heterodox practice are examined. It is concluded that rheumatic diseases are one of the likeliest fields for conflcit between orthodox and fringe medicine. The distribution of manpower engaged in alternative systems of health care is compared with that of orthodox medical services. The limited data on utilization of unorthodox remedies are reviewed. Far from conflict ensuing, it is argued that dialogue must develop in order to submit procedures like manipulation to satisfactory clinical trial.