Patient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in Guatemala
Abstract Background Up to one half of the population in Africa, Asia and Latin America has little access to high-quality biomedical services and relies on traditional health systems. Medical pluralism is thus in many developing countries the rule rather than the exception, which is why the World Hea...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2017-08-01
|
| Series: | Journal of Ethnobiology and Ethnomedicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13002-017-0170-y |
| _version_ | 1819179890952372224 |
|---|---|
| author | Martin Hitziger Mónica Berger Gonzalez Eduardo Gharzouzi Daniela Ochaíta Santizo Regina Solis Miranda Andrea Isabel Aguilar Ferro Ana Vides-Porras Michael Heinrich Peter Edwards Pius Krütli |
| author_facet | Martin Hitziger Mónica Berger Gonzalez Eduardo Gharzouzi Daniela Ochaíta Santizo Regina Solis Miranda Andrea Isabel Aguilar Ferro Ana Vides-Porras Michael Heinrich Peter Edwards Pius Krütli |
| author_sort | Martin Hitziger |
| collection | DOAJ |
| description | Abstract Background Up to one half of the population in Africa, Asia and Latin America has little access to high-quality biomedical services and relies on traditional health systems. Medical pluralism is thus in many developing countries the rule rather than the exception, which is why the World Health Organization is calling for intercultural partnerships to improve health care in these regions. They are, however, challenging due to disparate knowledge systems and lack of trust that hamper understanding and collaboration. We developed a collaborative, patient-centered boundary mechanism to overcome these challenges and to foster intercultural partnerships in health care. To assess its impact on the quality of intercultural patient care in a medically pluralistic developing country, we conducted and evaluated a case study. Methods The case study took place in Guatemala, since previous efforts to initiate intercultural medical partnerships in this country were hampered by intense historical and societal conflicts. It was designed by a team from ETH Zurich’s Transdisciplinarity Lab, the National Cancer Institute of Guatemala, two traditional Councils of Elders and 25 Mayan healers from the Kaqchikel and Q’eqchi’ linguistic groups. It was implemented from January 2014 to July 2015. Scientists and traditional political authorities collaborated to facilitate workshops, comparative diagnoses and patient referrals, which were conducted jointly by biomedical and traditional practitioners. The traditional medical practices were thoroughly documented, as were the health-seeking pathways of patients, and the overall impact was evaluated. Results The boundary mechanism was successful in discerning barriers of access for indigenous patients in the biomedical health system, and in building trust between doctors and healers. Learning outcomes included a reduction of stereotypical attitudes towards traditional healers, improved biomedical procedures due to enhanced self-reflection of doctors, and improved traditional health care due to refined diagnoses and adapted treatment strategies. In individual cases, the beneficial effects of traditional treatments were remarkable, and the doctors continued to collaborate with healers after the study was completed. Comparison of the two linguistic groups illustrated that the outcomes are highly context-dependent. Conclusions If well adapted to local context, patient-centered boundary mechanisms can enable intercultural partnerships by creating access, building trust and fostering mutual learning, even in circumstances as complex as those in Guatemala. Creating multilateral patient-centered boundary mechanisms is thus a promising approach to improve health care in medically pluralistic developing countries. |
| first_indexed | 2024-12-22T22:05:38Z |
| format | Article |
| id | doaj.art-6c43626c644541e896267843ef482550 |
| institution | Directory Open Access Journal |
| issn | 1746-4269 |
| language | English |
| last_indexed | 2024-12-22T22:05:38Z |
| publishDate | 2017-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Ethnobiology and Ethnomedicine |
| spelling | doaj.art-6c43626c644541e896267843ef4825502022-12-21T18:10:59ZengBMCJournal of Ethnobiology and Ethnomedicine1746-42692017-08-0113111310.1186/s13002-017-0170-yPatient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in GuatemalaMartin Hitziger0Mónica Berger Gonzalez1Eduardo Gharzouzi2Daniela Ochaíta Santizo3Regina Solis Miranda4Andrea Isabel Aguilar Ferro5Ana Vides-Porras6Michael Heinrich7Peter Edwards8Pius Krütli9Section of Epidemiology, University of ZurichSwiss TPH, Epidemiology and Public HealthSurgical Oncologist, Head of Education and Research, Instituto de CancerologíaUniversidad del Valle de GuatemalaUniversidad del Valle de GuatemalaUniversidad del Valle de GuatemalaDepartment of Anthropology, University of WyomingResearch Cluster Biodiversity and Medicines/Centre for Pharmacognosy and Phytotherapy, UCL School of PharmacySingapore-ETH CentreETH Zurich, TdLabAbstract Background Up to one half of the population in Africa, Asia and Latin America has little access to high-quality biomedical services and relies on traditional health systems. Medical pluralism is thus in many developing countries the rule rather than the exception, which is why the World Health Organization is calling for intercultural partnerships to improve health care in these regions. They are, however, challenging due to disparate knowledge systems and lack of trust that hamper understanding and collaboration. We developed a collaborative, patient-centered boundary mechanism to overcome these challenges and to foster intercultural partnerships in health care. To assess its impact on the quality of intercultural patient care in a medically pluralistic developing country, we conducted and evaluated a case study. Methods The case study took place in Guatemala, since previous efforts to initiate intercultural medical partnerships in this country were hampered by intense historical and societal conflicts. It was designed by a team from ETH Zurich’s Transdisciplinarity Lab, the National Cancer Institute of Guatemala, two traditional Councils of Elders and 25 Mayan healers from the Kaqchikel and Q’eqchi’ linguistic groups. It was implemented from January 2014 to July 2015. Scientists and traditional political authorities collaborated to facilitate workshops, comparative diagnoses and patient referrals, which were conducted jointly by biomedical and traditional practitioners. The traditional medical practices were thoroughly documented, as were the health-seeking pathways of patients, and the overall impact was evaluated. Results The boundary mechanism was successful in discerning barriers of access for indigenous patients in the biomedical health system, and in building trust between doctors and healers. Learning outcomes included a reduction of stereotypical attitudes towards traditional healers, improved biomedical procedures due to enhanced self-reflection of doctors, and improved traditional health care due to refined diagnoses and adapted treatment strategies. In individual cases, the beneficial effects of traditional treatments were remarkable, and the doctors continued to collaborate with healers after the study was completed. Comparison of the two linguistic groups illustrated that the outcomes are highly context-dependent. Conclusions If well adapted to local context, patient-centered boundary mechanisms can enable intercultural partnerships by creating access, building trust and fostering mutual learning, even in circumstances as complex as those in Guatemala. Creating multilateral patient-centered boundary mechanisms is thus a promising approach to improve health care in medically pluralistic developing countries.http://link.springer.com/article/10.1186/s13002-017-0170-yBoundary managementPartnershipsIntercultural healthIntegrative medicineTraditional medicineMayan medicine |
| spellingShingle | Martin Hitziger Mónica Berger Gonzalez Eduardo Gharzouzi Daniela Ochaíta Santizo Regina Solis Miranda Andrea Isabel Aguilar Ferro Ana Vides-Porras Michael Heinrich Peter Edwards Pius Krütli Patient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in Guatemala Journal of Ethnobiology and Ethnomedicine Boundary management Partnerships Intercultural health Integrative medicine Traditional medicine Mayan medicine |
| title | Patient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in Guatemala |
| title_full | Patient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in Guatemala |
| title_fullStr | Patient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in Guatemala |
| title_full_unstemmed | Patient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in Guatemala |
| title_short | Patient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in Guatemala |
| title_sort | patient centered boundary mechanisms to foster intercultural partnerships in health care a case study in guatemala |
| topic | Boundary management Partnerships Intercultural health Integrative medicine Traditional medicine Mayan medicine |
| url | http://link.springer.com/article/10.1186/s13002-017-0170-y |
| work_keys_str_mv | AT martinhitziger patientcenteredboundarymechanismstofosterinterculturalpartnershipsinhealthcareacasestudyinguatemala AT monicabergergonzalez patientcenteredboundarymechanismstofosterinterculturalpartnershipsinhealthcareacasestudyinguatemala AT eduardogharzouzi patientcenteredboundarymechanismstofosterinterculturalpartnershipsinhealthcareacasestudyinguatemala AT danielaochaitasantizo patientcenteredboundarymechanismstofosterinterculturalpartnershipsinhealthcareacasestudyinguatemala AT reginasolismiranda patientcenteredboundarymechanismstofosterinterculturalpartnershipsinhealthcareacasestudyinguatemala AT andreaisabelaguilarferro patientcenteredboundarymechanismstofosterinterculturalpartnershipsinhealthcareacasestudyinguatemala AT anavidesporras patientcenteredboundarymechanismstofosterinterculturalpartnershipsinhealthcareacasestudyinguatemala AT michaelheinrich patientcenteredboundarymechanismstofosterinterculturalpartnershipsinhealthcareacasestudyinguatemala AT peteredwards patientcenteredboundarymechanismstofosterinterculturalpartnershipsinhealthcareacasestudyinguatemala AT piuskrutli patientcenteredboundarymechanismstofosterinterculturalpartnershipsinhealthcareacasestudyinguatemala |