Traditional Faith Healers Research Articles

Reasons for Delay in Fungating Breast Cancer Presentation at a Tertiary Care Facility of Pakistan

Background and objective: Breast cancer is a treatable disease resulting in complete cure. Late presentation is not uncommon in third world countries. The factors leading to delay in reporting to the hospital must be studied. The objective of this research was to identify the factors responsible for late presentation of fungating breast cancer patients at a tertiary care hospital of Pakistan.Methods: It was a descriptive, cross-sectional study conducted at Jinnah hospital Lahore from January 2020 to December 2022. A total of 56 respondents were selected through non-probability purposive sampling technique. A pre-tested structured questionnaire was administered, data were gathered after taking informed consent and data confidentiality was ensured. The collected data were analyzed using SPSS version 23. The stage 1 and 2 carcinoma breast patients are excluded from the study. The sample size was calculated by using WHO calculator.Results: A total of 56 cases of fungating breast growths were included in the present study carried out for a period of two years. Among 56 cases the mean age of patients was 45+9 years. The study found that the reasons leading for the delay in seeking treatment were poor socioeconomic status, belief in traditional faith healers, cultural myths, reliance on alternative medicine, fear of medical procedures, resistance from family members, and lack of accessibility.Conclusion: The delayed presentation of breast cancer leading to fungating growth is a significant concern that needs to be addressed. By identifying the reasons for delayed presentation, healthcare providers and policymakers can develop targeted interventions to improve early detection and prompt treatment, eventually improving the prognosis and quality of life of breast cancer patients.Key Words: delayed presentation, fungating breast cancer, reasons, tertiary care facility.

Pathways to care and barriers in treatment among patients with Dissociative disorders

IntroductionDissociative disorder patients often present with sudden and embarrassing symptoms, and it is difficult for the patient and care giver to understand initially, recognize the need for help and reach for appropriate treatment timely. This can result in high risk of engaging in dangerous behaviors such as self-harm and suicidal acts, impaired global functioning, and poor quality of life. Knowledge about the types of barriers which are there in treatment seeking, can help in planning strategies for their removal and to facilitate the treatment process. MethodsCross-sectional study among patients (n=133) with Dissociative disorders which were recruited from January 2023 to June 2023 in a tertiary care hospital. Pathways to care and barriers in treatment for Dissociative disorders were assessed by interviewing patients using semi-structured proforma. The Dissociative Experience Scale and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)) were used to assess disease severity and impact of illness on various domains of life respectively. Group comparison was made to assess differences in social- clinical profile of patients choosing different modalities of treatment. Results133 patients of Dissociative disorders with mean age 29.6±9.2, showed their first-choice of help seeking from general practitioner/ neurologist (40.6%), traditional faith healers (35.3%), psychiatrist (18.1%) and 5.2% preferred alternative treatments. This trend changed with 2nd and 3rd contact of help seeking with greater preference for psychiatrist in their 2nd (n=45, 33.8%) and 3rd (n=69, 51.8%) contact. The median duration of untreated illness was 56 weeks (IQR 24–182 weeks). Social-clinical profile of patients varied with their choice of treatment, having lower education level (P = 0.013), longer duration of untreated illness (p=0.003), more severity of symptoms (p=0.032) and greater disability scores(p=0.002) in patients whose first treatment choice was traditional faith healers. More than 70% patients faced availability barriers, stigma, unawareness about mental illness and influence of others in treatment of choice as barriers in initiating and continuing treatment. ConclusionPatients with Dissociative disorders seek treatment from a multitude of healthcare providers including traditional faith healers, general physicians, and alternative medicine practitioners before reaching psychiatrist and undergoes various barriers in treatment. There is need to implement necessary measures for sensitization and awareness about Dissociative disorders to prevent prolonged and undue delays in initiation of appropriate management.

Development, standardization, and contextualization of qualitative tools for possible use in the assessment and valuation of snakebite envenomation.

Snakebite envenoming, a neglected tropical disease (NTD), is an important public health problem that is responsible for more than 1 lakh deaths annually across the world. However, the majority of the data in this regard is from health institutions and data from community settings are scarce. The aim of the current study was to develop valid and reliable qualitative tools for assessing the burden of snakebites and the health-seeking behavior of the community. The tools developed thus will serve in creating a community connection and thereby strengthen primary care teams engaged in managing snakebites at the primary care level. A four-step design was used; (a) review of the available literature on the burden of disease, tools used to assess the burden, and the guidelines on snakebite (b) development, laying out, and contextualization of questions/items for the tools (c) pilot testing and establishment of validity. A focus group discussion guide, key informant interview schedule for health professionals, community leaders, and traditional faith healers were matured for the implementation. A reliable and valid qualitative tool was developed to discern the speculations related to snakebites and its management in rural field settings.

Sister Deborah by Scholastique Mukasonga

Reviewed by: Sister Deborah by Scholastique Mukasonga Edward Ousselin SCHOLASTIQUE MUKASONGA Sister Deborah Paris. Gallimard. 2022. 160 pages. BORN IN RWANDA in 1956, Scholastique Mukasonga moved to Burundi in 1973 (already because of anti-Tutsi persecution) before eventually settling in France in 1992. Many members of her extended family were killed during the 1994 Rwandan genocide. She published her first book, Inyenzi ou les cafards (Eng. Cockroaches, 2016), in 2006. Since then, much of her written work, including Notre-Dame du Nil (2012), has revolved around late twentieth-century Rwandan history and its multiple tragedies. In 2016 she started exploring new fictional ground with Cœur tambour. Her latest novel continues that trend by introducing African American (and Protestant) missionaries into Rwanda during the 1930s, when it was still a Belgian (and Catholic) colony. More than just another missionary sent to colonial Africa by a Western country, the title character, who is linked by her name to one of the few female prophets in the Bible, quickly takes on the attributes of both a spiritual healer and a messianic messenger. While the charismatic Sister Deborah is ostensibly subordinate to the leader of this unusual group of missionaries, the Reverend Marcus, she tends to overshadow him among the mostly female local converts, to whom she announces the imminent arrival of an unexpected savior, a Black woman destined to establish in Rwanda a blessed, prosperous realm ruled by women. An updated and rather ironic version of this imported messianic message is provided in the novel's epigram—"I met God; she's Black"—which serves as a nod to today's Black Lives Matter movement. Sister Deborah's narrative voice is framed by that of Ikirezi, a sickly village girl who seems to find healing, inspiration, and divine guidance through her contact with the Black prophet from America. Much later, after the African American missionaries have been expelled from Rwanda by the Belgian military, Ikirezi will roughly follow Sister Deborah's trajectory but in [End Page 63] the opposite direction, by moving to the United States and becoming a professor, known as Miss Jewels, at Howard University. As for the erstwhile female prophet once revered (or feared) as Sister Deborah, she will eventually end up as a traditional faith healer, under the name of Mama Nganga, in one of the slums of Nairobi, Kenya. Years later, the news of her fiery end reaches Miss Jewels and leads to the conclusion to this brief novel. At one level, Mukasonga's latest novel is merely the fictional account of a cargo cult's brief flowering and bloody demise. As such, it reflects the surprising forms of syncretism that resulted from the enforced propagation of Christianity during the colonial era and the necessarily more discreet resistance of African religious traditions. At another level, Sister Deborah is an allegorical retelling of the broader encounters and exchanges between rural Africans and (somewhat) idealistic African Americans, in spite of the misgivings and stereotypes held by each group. Edward Ousselin Western Washington University Copyright © 2023 World Literature Today and the Board of Regents of the University of Oklahoma

Free Papers Compiled

Background:Faith healers are one of the most socially acceptable way to try to cure mental illness in India. It has been estimated that 80 % of rural and particularly of the lower socio-classes patients still visit faith healers not only for their personal and social problems, but also for their psychiatric problems. Thus their knowledge, attitude, and perception toward mentally illnesses is of enormous significance. The public opinion about mental illness is broadly compatible with the scientific understanding, but is it the same with the traditional healers has not been assessed in India.Aims:To study the knowledge, attitude and perceptions towards mental illness in traditional faith healers in TelanganaMethods:Faith healers from Telangana were interviewed with a semistructured proforma for sociodemographic details and scales administered were Mental Health Knowledge Questionnaire MHKQ, Attitude Scale for Mental Illness (ASMI), Public Perception of Mental Illness Questionnaire. The data was analysed using SPSS.Results:Preliminary results suggest that that faith healers have poor knowledge and considerable stigma towards mental illness.Conclusion:Our study indicates there is a dire need for psychiatrists to engage with and create awareness of mental illness among faith healers which will indirectly help in better management and outcome in patients dealing with mental illness.

Perceptions, awareness on snakebite envenoming among the tribal community and health care providers of Dahanu block, Palghar District in Maharashtra, India.

India has remarkably the highest number of snakebite cases contributing to nearly 50% of the global snakebite deaths. Despite this fact, there is limited knowledge and awareness regarding the management practices for snakebite in the Indian population. The study aimed to explore the knowledge, awareness, and perception of snakes and snakebites, first aid, and treatment amongst the community and the frontline health workers in a tribal block of Dahanu, Maharashtra, India. A cross-sectional study was carried out from June 2016 to October 2018 in the Dahanu Block, Maharashtra. Perceptions, knowledge, awareness, and first-aid practices on the snakebites among the community were studied through focus group discussions (FGDs). Semi-structured questionnaires were used to assess the knowledge, awareness, and experience of the traditional faith healers, snake rescuers, frontline health workers on the snakebites and their management. A facility check survey was conducted using pre-tested questionnaires for different levels of the government health care facilities. Most of the tribal community was aware of the commonly found snakes and their hiding places. However, there was inadequate knowledge on the identification and classification of venomous snakes. Belief in a snake god, the perception that snakes will not come out during thunderstorms, change in taste sensation, the ability of tamarind seeds or magnet to reduce the venom effect were some of the superstitions reported by the tribal community. The application of a harmful method (Tourniquet) as the first aid for snakebite was practiced by the tribal community. They preferred herbal medicines and visiting the traditional faith healers before shifting the patient to the government health facility. The knowledge on the ability to identify venomous snakebites and anti-venom was significantly higher amongst nurses and accredited social health activists (ASHAs) than auxiliary nurse midwives (ANMs) and multi-purpose workers (MPWs) (p < 0.05). None of the traditional faith healers; but nearly 60% of snake rescuers were aware of anti-venom. Fifty percent of the medical officers in Dahanu block did not have correct knowledge about the Krait bite symptoms, and renal complications due to the Russell viper bite. Inappropriate perception, inadequate awareness, and knowledge about snakes and snakebites may predispose the tribal community to increased risks of venomous snakebites. Unproven and harmful methods for snakebite treatment practiced by the community and traditional faith healers could be dangerous leading to high mortality. Therefore, a multi-sectoral approach of community awareness, mapping of vulnerable populations, capacity building of health care facility, empowerment of health care workers (HCWs) could be useful for reducing the mortality and morbidity due to snakebite envenoming in India.

Family care for persons with severe mental illness: experiences and perspectives of caregivers in Uganda

BackgroundIn low-income settings with limited social protection supports, by necessity, families are a key resource for care and support. Paradoxically, the quality of family care for people living with Severe Mental Illness (PLSMI) has been linked to support for recovery, hospital overstay and preventable hospital readmissions. This study explored the care experiences of family members of PLSMI with patients at the national mental hospital in Kampala, Uganda, a low income country. This study was undertaken to inform the development of YouBelongHome (YBH), a community mental health intervention implemented by YouBelong Uganda (YBU), a registered NGO in Uganda.MethodsQualitative data was analysed from 10 focus groups with carers of ready to discharge patients on convalescent wards in Butabika National Referral Mental Hospital (BNRMH), Kampala. This is a subset of data from a mixed methods baseline study for YouBelong Uganda, undertaken in 2017 to explore hospital readmissions and community supports for PLSMI from the Wakiso and Kampala districts, Uganda.ResultsThree interrelated themes emerge in the qualitative analysis: a range of direct, practical care provided by the caregiver of the PLSMI, emotional family dynamics, and the social and cultural context of care. The family care giving role is multidimensional, challenging, and changing. It includes protection of the PLSMI from harm and abuse, in the context of stigma and discrimination, and challenging behaviours that may result from poor access to and use of evidence-based medicines. There is reliance on traditional healers and faith healers reflecting alternative belief systems and health seeking behaviour rather than medicalised care. Transport to attend health facilities impedes access to help outside the family care system. Underpinning these experiences is the impact of low economic resources.ConclusionsFamily support can be a key resource and an active agent in mental health recovery for PLSMI in Uganda. Implementing practical family-oriented mental health interventions necessitates a culturally aware practice. This should be based in understandings of dynamic family relationships, cultural understanding of severe mental illness that places it in a spiritual context, different family forms, caregiving practices and challenges as well as community attitudes. In the Ugandan context, limited (mental) health system infrastructure and access to medications and service access impediments, such as economic and transport barriers, accentuate these complexities.

Anti-inflammatory properties of methanolic extract of "sikari laharo" (Periploca calophylla)

Inflammation, orchestrated in a series of cardinal signs is a pathophysiological condition that occurs during various clinical presentations. Periploca calophylla is a herbal plant which is used traditionally as an anti-inflammatory agent for a myriad of malaises in Nepalese countryside. The scientific research on the anti-inflammatory property of this plant is scanty, and if available elsewhere, its properties are not proven scientifically, except sporadic empirical evidence reported by the traditional faith healers. The main objective of this research was to establish a proof of concept on the anti-inflammatory property of P. calophylla based on the results obtained from a scientific experiment. Accordingly, Adult albino mice animal model was used for in vivo assessment of its property. Three different doses of 80% methanolic extract of the vine of P. calophylla (1.5 mg/ kg, 2 mg/kg, and 2.5 mg/kg) were administered intra-peritoneally to the animals of the test groups. Indomethacin (25 mg/ kg) and distilled water (3 mL/kg) were used as positive and negative controls, via the same route of administration. The anti-inflammatory property was evaluated by the Carrageenan-induced hind paw oedema model test, fresh egg albumin induced paw oedema test, formalin-induced paw oedema test, and haematology. Extract of P. calophylla (1.5 mg/kg) significantly (p&lt;0.01) inhibited inflammatory responses in all the evaluated tests in the animal model. The data obtained from this study indicated that the phyto-extract of P. calophylla possessed a significant amount of anti-inflammatory property. This justifies the empirical and traditional use of this plant as an anti-inflammatory agent. Isolation of the particular compound related to this property needs further experimentation and scientific investigation.

Toward Community Coverage on Self-Screening, Diagnosis, and Help-Seeking Behavior for Both Gender Victims of Intimate Partner Violence (IPV) in a Kenyan Setting: The Development of IPV-Brief Self-Screener (IPV-BSS) Version of the WHO-IPV Instrument.

Intimate partner violence (IPV) is a major public health concern. The prevalence of IPV in women in Kenya is in the range of 41% to 45% but has also been reported in 20% of men. The most widely used instrument for the screening and diagnosis of IPV is the World Health Organization-Intimate Partner Violence (WHO-IPV). However, it is lengthy for routine large-scale screening and is administered by a trained person, thus limiting the number it can reach for screening. There is therefore a need for a shorter screening version that can be self-administered to reach critical masses. Those who screen positive can then be subjected to the longer version. In addition, the short version should be culturally sensitive, can be used by either gender, can be used in busy clinical settings as the patients wait to be attended to, and can be used for large-scale community populations to raise awareness and promote help-seeking behavior. It should be applicable in similar cultural settings and is aligned to the longer version of the WHO-IPV instrument. This study aimed to develop such a tool. We administered the WHO-IPV to two groups: firstly, postnatal mothers attending postnatal clinics and secondly, men and women attending general clinics to which they had been referred. These referrals were by traditional healers (TH), faith healers (FH), and community health workers (CHW) who had been trained to screen for mental disorders using the Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG) master checklist. Using factor analysis of the scores, we came up with questions that had the highest predictive value for different types of IPV diagnosis and which could therefore be used for self-screening purposes. We call the tool the Intimate Partner Violence-Brief Self-Screener (IPV-BSS; Adapted by the Africa Mental Health Research and Training Foundation from the WHO-IPV).

Snakebite and its management in rural West Bengal: The unspoken truth

Background: Snakebite is a common medical emergency in tropical India where agriculture is a major source of earning livelihood. Snakebite has a significant impact on human health and economy. The situation worsens when the majority of snakebite victims adopt harmful practices such as application of tourniquets due to prevalent myths and misconceptions. Objectives: The objective of the study was to study the socio-demographic profile of the study population, to estimate the prevalence of snakebite in the study area, and to assess the knowledge and treatment seeking behavior of the study population regarding snakebite and its management. Materials and Methods: A total of 135 households of Muchisa village of West Bengal were selected by consecutive sampling and one adult member of the household was interviewed with a pre-designed schedule. Results: Majority of the study population were in the age group of 30–60 years (69.5%), females (52.6%), and Hindu (74.8%). Nearly 59.1% (100) of the population were educated up to primary level. Nearly 15.56% of the study population in our study gave a history of snakebite. Nearly 81.1% of study population correctly differentiated between poisonous and nonpoisonous snakebites based on signs and symptoms of the victim. When asked about why snakebite, the villagers said that snakebite when they were touched (57.04%) or hit (33.33%). About 57.78% of the population believed that snakebite can be managed by traditional faith healers (Ojha). The majority preferred tying a tourniquet/similar material above the bite mark. Conclusion: It is essential to communicate about the appropriate management of a snakebite victim to the communities at risk of snakebite.

Pathways to Care for Patients with Bipolar-I Disorder: An Exploratory Study from a Tertiary Care Centre of North India.

Introduction:Understanding the pathways to psychiatric care is important from a public health perspective. Only a few Indian studies have focused on this, particularly for severe mental disorders. The present study was planned to assess it in patients with Bipolar-I disorder (BD-I).Materials and Methods:Sixty-four patients with DSM 5 diagnosis of BD-I and their caregivers were included. A semi-structured interview proforma was used to gather information.Results:Psychiatrists were the first care provider in 43.8% of the cases, followed by traditional faith healers (32.8%) and general physician/neurologists (17.2%). The median duration of untreated bipolar disorder (DUB) was 21 days (1 day to 152 months). Relatively long DUB (3.5 ± 3.5 years) was found for 17.2% of the sample. The median duration of the first contact with a psychiatrist was 45 days and the interval between the contact with the first care provider and a psychiatrist was 90 days (1 day to 151 months). At the time of first treatment seeking, 64% of patients and caregivers had poor awareness regarding psychiatric treatment.Conclusions:Patients with BD-I seek help from psychiatrists, faith healers or other medical practitioners for multiple reasons. There is a need to sensitise the community and various service providers about early identification and optimum management of BD-I.

Incisioning by faith healer complicating fatal septicemia in human cobra bite: Medical science typically deviated by irrational belief

Unusual and intriguing snake bite features have fascinated people for thousand years. Snake bite poisoning is not a medical enigma. Yet, deep rooted social, religious and economic issues or lack of adequate and appropriate medical aid have curbed usage of scientific and specifically effective anti-venom therapy in many ways. Even salvageable cases visit traditional faith healer in notable scales before seeking medical therapy and thus complicating outcome. Incisioning by traditional village folk healer complicated death by septicemia of an illiterate Indian lady from agricultural background in instant cobra bite. Authors discuss incisioning and other folk therapies taking toll on treatable snake bite related human deaths worldwide.

Traditional faith healers as referral sources: A hospital-based descriptive study

Introduction: Mental illnesses are commonly linked with a higher disability and burden of disease than many physical illnesses. But despite that fact, it is a general observation that a majority of patients with mental disorder never seek professional help. To elaborate further, the widely prevalent magico-religious beliefs associated with mental illness and lower literacy, poses significant social obstacles in seeking appropriate health care for psychiatric patients. In general, mental illness is seen as related to life stresses, social or family conflicts and evil spirits and the concept of biological causes of mental illness is rare even among the educated. The idea that illness and death are due to malevolent spirits is common notion that is shared practically by all level of society from the so-called primitive to modern industrialized societies, thus indicating the strong influences of cultural background. When there is a magico- religious concepts of disease causation, there is tendency to consult indigenous healers. Therefore, the patients with mental illness often either visit or are taken to faith healers by their relatives. The objective of the study was to determine the various psychiatric cases that were referred by the traditional faith healers to the authors.&#x0D; Material and Method: This is a cross- sectional, hospital- based descriptive study, conducted at the Psychiatric outpatient department of Pokhara Om Hospital, Pokhara, Kaski, Nepal for the period of one year, from June 2016 to May 2017. The total of 35 cases, referred by the traditional faith healers was included in the study. Subjects of any age, any gender, any literacy level, any caste, from any locality and religious background were included in the study after their consent. Subjects who refused to consent were not included in the study. The psychiatric diagnosis was based on the complete history and examination and ICD- 10 DRC criteria.&#x0D; Results: Though the sample size is small, it is interesting to note that patients with various kinds of mental disorders were referred by traditional faith healers. There were patients suffering from neurotic disorders, psychotic disorders, mood disorders, seizure, substance use disorder, intellectual disability etc seeking the treatment from traditional faith healers. Among the cases referred, predominantly were female and neurotic cases. Most patients were educated.&#x0D; Conclusion: The study shows that patients with various mental disorders visit traditional faith healer. This area surely requires further in-depth look as traditional faith healers can be an important source of referral of psychiatric patients.

A Blend of Western and African Psychotherapy

Pritz (2002) defined psychotherapy as a systematic application of defined methods in the treatment of psychic suffering and psychosomatic complaints as well as life crises of various origins. Madu (2015), also defined psychotherapy as a process that enables people to express their feelings in a protected environment, to a person trained to listen with understanding and compassion. In the African context, psychotherapy is a culture-based treatment, which starts with the recognition that culture is highly relevant to people’s everyday behaviour (Grills, 2006). It includes social context, history, ethnicity and other issues that the client deems relevant. African Psychotherapy is therefore a holistic approach that encompasses the cultural, social, spiritual, psychological, and economic aspects of life. An estimate of 80% of Africans, seek traditional therapy and hence, the existence of both Western and African Psychotherapy, has posed a state of dilemma among the modern African psychotherapists as well as among the clients. The central argument of this paper is to look at how the Western and African Psychotherapies influence one another for the benefit of the black African. This paper is a systematic literature review on psychotherapeutic processes of African traditional and religious faith healers, the current western focused psychotherapy practices in Africa. The authors also used their own knowledge on the Africa Psychotherapy from both the Digo and the Kamba communities in writing this paper. The researchers hereby recommend a blended psychotherapy form, where the western, the traditional African, and the religious psychotherapeutic values are blended for the benefit of modern African clients.

Collaboration Between Biomedical and Complementary and Alternative Care Providers: Barriers and Pathways.

We examined the scope of collaborative care for persons with mental illness as implemented by traditional healers, faith healers, and biomedical care providers. We conducted semistructured focus group discussions in Ghana, Kenya, and Nigeria with traditional healers, faith healers, biomedical care providers, patients, and their caregivers. Transcribed data were thematically analyzed. A barrier to collaboration was distrust, influenced by factionalism, charlatanism, perceptions of superiority, limited roles, and responsibilities. Pathways to better collaboration were education, formal policy recognition and regulation, and acceptance of mutual responsibility. This study provides a novel cross-national insight into the perspectives of collaboration from four stakeholder groups. Collaboration was viewed as a means to reach their own goals, rooted in a deep sense of distrust and superiority. In the absence of openness, understanding, and respect for each other, efficient collaboration remains remote. The strongest foundation for mutual collaboration is a shared sense of responsibility for patient well-being.

Reasons associated with treatment non-adherence in schizophrenia in a Pakistan cohort.

non-adherence in patients with schizophrenia is the most common reason for a relapse of psychosis. In a cohort of participants in Pakistan who suffered a relapse of psychosis, we aimed to identify the principal factors associated with non-adherence, including any culture specific factors that might not be as significant in other jurisdictions. Semi-structured interviews were undertaken at four psychiatric hospitals in the Peshawar region in Pakistan with 55 participants (44 male and 11 female) diagnosed with schizophrenia, who had suffered a relapse of psychosis subsequent to treatment non-adherence. The five principal documented reasons for treatment non-adherence were: 1) alternative treatment pathway chosen with a traditional faith healers (n=53, 96.4%), 2) lack of insight (n=36, 65.5%), 3) poor economic status (n=33, 60.0%), 4) adverse effects of medications (n=33, 60.0%) and 5) utilising psycho-active substances as an alternative to psychotropic medications (n=27, 41.1%). A number of identified factors associated with a relapse of psychosis are potentially modifiable including the provision of a range of pharmacological options including second generation antipsychotic agents, long acting injectable antipsychotics and psycho-therapeutic interventions including psycho-education. These interventions should prove cost effective and be associated with reduced relapse rates of psychosis.

Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in Eastern and Southern Africa

ObjectivesThere are concerns that medical pluralism may delay patients’ progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with...

Scorpion Sting Envenomation

Scorpion sting envenomation is very common problem in rural India especially where the climate is hot and dry. Management techniques have improved tremendously over the time leading to reduced morbidity and mortality. Mortality is mainly when ignorant patients go to the traditional faith healers (Tantrics) and come late to the facility where better management is available. Indian red scorpion (Mesobhuthustamulus) is the main species in India. Autonomic storm caused by venom acting on sodium gated and other channels is the main cause of manifestations in a scorpion sting victim. Cardio-myopathy is the main cause for morbidity and mortality. Many grading systems have been suggested for categorizing and simplifying the treatment. The mainstay of treatment where systemic involvement is there are alpha-1 blocker Prazosin hydrochloride, Fluids and newly arrived purified anti-venom. Scorpion envenomation being a problem of rural remote areas and most patients being from lower socio-economic status, anti-venom use is limited. Hence the treatment of choice remains Prazosin hydrochloride. Risk factors, peculiarities of presentation and dose titration of Prazosin based on severity will be discussed as per personal experience and literature review.J Nepal Paediatr Soc 2016;36(3):284-287

A Community based cross sectional study of dog bites in children in a rural district of Tamil Nadu

Background: Worldwide dog bites are becoming a significant public health problem and the annual frequency of dog bite injuries in children is estimated to be 22 per 1000 children of which less than half of them are reported in medical facilities. Objective: To study the period prevalence of dog bites in children, its risk factors and treatment seeking behavior. Materials and Methods: The present cross sectional study was conducted in field practicing areas of rural health centre covering 4150 households in 34 villages involving 5841 children. Data was collected by trained medical interns and social workers. Collected data was entered and analyzed using EPI_INFO software (3.5.3). Result: The period prevalence of dog bites episodes in last one year is 17.9 per 1000 children. Most of bites happened in male children (51.5%), less than 10 years of age (56%), and children below poverty line (80%). Almost 78% of bites are unprovoked and the most common place of bites is in and around the house (70%). The most common site of bite is lower limb (53.6%) followed by upper limb (27.6%). The most common treatment source for bites is primary health centre followed by traditional faith healers. Almost 67% of wounds belonging to class 3 wounds but only 4% of dog bite victims received immunoglobulins. Conclusion: Period prevalence of dog bites is high and it is common in children belonging to poor socioeconomic conditions. In a country with very high population of unvaccinated dogs, health education program focusing on prevention of dog bites, correct methods of local wound treatment, vaccine, and rabies immunoglobulin’s are needed.

Pathways to Care for Medically Unexplained Symptoms at a Specialty Psychosomatic Clinic in South India in 2014

Background: A growing body of evidence suggests that patients with medically unexplained symptoms (MUS) tend to delay help seeking behaviours. Objectives: The aim of this study was to explore the pathway to care for patients with MUS at a specialty psychosomatic clinic. Materials and Methods: The clinic caters to patients with MUS referred from other departments or directly seeking treatment. After detailed assessment, diagnosis was made as per ICD 10 clinical descriptions, diagnostic guidelines, and management plan. The pathway of care for patients registered in this clinic was assessed, using a structured questionnaire. Results: Pathway-of-care information was available for 49 out of the 53 patients (92.5% of the sample) registered in the first 8 months of the clinic. The median age of the participants was 36 years, of them, 25 (51.0%) were female, 40 (81.6%) married, and 32 (65.3%) belonged to nuclear family. Thirty-three patients (67.3%) visited general practitioners, 13 (26.5%) had visited traditional practitioners and faith healers, 48 (98.0%) had made visits to specialists/ tertiary care centers, and nine (18.4%) had consulted psychiatrists before being referred to our center. The first point of contact was the general practitioner in the majority of the cases (55.1%). Patients had waited for a mean of 21.73 (± 36.55) months and taken 5.53 (± 3.86) consultations before referring to our clinic. Conclusions: Patients with medically unexplained somatic symptoms may undertake considerable number of consultations before being referred to psychiatric treatment services. This signifies the need to train more doctors, particularly general practitioners, to empower them to recognize and manage unexplained medical symptoms.