Beki Grinter

Local Health Systems

In C@tM, empirical, ICT4D, research, wellness informatics on April 26, 2010 at 12:43 pm

Browsing Ghana’s Ashesi University College website I found the following course.

Sociology: Traditional Medicine
The course is intended to throw light on the structure, function and practice of Africa traditional medicine and its relationship with modern (scientific/western) medicine. By the end of this course, students will be conversant with African traditional medicine and attempts made to incorporate it in primary health care. The course will:

  • Give an insight into African Traditional Medicine
  • Elucidate the pattern of articulation between different persuasions/types of traditional medicinal practice.
  • Determine the nature of interrelationships between traditional and modern medicine.

This caused me to reflect on a question I asked at the CHI WISH workshop in the session on addressing disparities health systems for low income contexts. The panel was composed of a number of speakers who work in African contexts and so I asked them how they integrated indigenous systems of medicine/health and wellness practice into their research.

I asked the question, because I think it’s one that has not received enough attention. And yet, it’s going to turn out to be crucial. It shows itself to be crucial in the United States, because not everyone responds to the medical establishment in the same way. Public Health researchers argue that culturally focused interventions and information are crucial to having people take up and apply the knowledge in their daily lives. It’s even as simple as making nutrition advice relevant to the food consumption practices and traditions of a particular community.

The answers I got were interesting. One that most interested me was that I learnt that South Africa is integrating indigenous medicine into the offerings of the health service. I can’t find a good reference for this, but I did learn that part of it is to also prevent illegal and harmful medications being sold. The others focused on seeing is as part of the context of health and wellness, part of the overall picture of what it means to be in good health. And as yet, I do not hear any conversation about integrating these types of practices into Health ICTs. And it’s not just the practices themselves, it’s the people, organizations, and institutions that indigenous medicine has that also need to be integrated in to be holistic and representative.

I can’t help thinking that this will be an area which presses very hard on the definition of health. And it may challenge us to design systems that we don’t entirely agree with because that’s what the end-user wants. And of course it’ll counter generalisable solutions. Health is cultural and local, and indigenous medical systems and all that they imply highlight this property of health.

  1. I agree – it’s depressing how frequently the assumptions of Western medicine seem to be carried along for the ride unthinkingly with Western technologies. I’ve spent some time looking at a variety of non-Western medical approaches, including pushing some friends who are active practitioners of such to apply for grant funding from Nokia (& others), but it’s been a bit of an uphill battle.

    In China you’re starting to see more technological interventions in TCM, but I’ve found the work in health ICTs is nearly invariably remarkably reductionist and non-holistic (should that even be a word?). For example, I was proposing a more holistic system to some colleagues in a meeting, and one agreed with me… and then suggested we should build a system into a cellphone to weigh the food one was about to eat. So much for holistic.

  2. not unique at all to developing regions. this is something that medical practitioners anywhere can’t ignore, as many “alternative” treatments (whether ethnically traditional for you or not) have interactions with “conventional” treatments. (i think the silicon valley cultures project at sjsu did some work on this with IFTF quite a while ago.)

    the discussion i think is worth having – especially about developing regions – is the question of what you bother trying to facilitate. the question, as with much developing regions work, is resources and you have to think about opportunity costs.

    say what you want about western ideas of health and disease, but the germ theory has a lot of corollaries that reduce a lot of avoidable causes of early mortality. if there is wide agreement[*] that that’s a worthwhile goal, well, maybe ignoring some traditional medicine ideas (which have been less effective by definition, if mortality goes down) held by some fraction of people is not so bad.

    [*] this is a $64K stakeholder question of course.

    when you get down to second-order effects (eg now everybody’s dying from cancer and chicken mcnuggets) then questions like this clearly come into play. “can you be healthy with a high BMI” is perhaps the question du jour here.

    in between… if you’re working on health services, you do have to deal with people’s desires for alternative treatments, both for traditional as well as economic reasons (and then of course there are people who think westerners are out to wipe out non-westerners through medical treatment). but do you actually facilitate it when you’re pretty sure it’s not the most effective treatment? in the US context, we’re often paying for treatment and can choose practitioners based on their openness to our ideas. so, sure. in other contexts where the ratio of medical services can be orders of magnitude lower, often grossly underfunded, and basically aimed at reducing early mortality… how much time and effort do you spend accomodating people’s individual desires, vs using that same time and effort dealing with people who will be more “compliant”?

    anybody who wants to talk about whether more culturally integrative health ICTs are really the high order bit in developing regions should really go and hang out for a while in some of the places where they’re getting deployed. i’m not saying it’s irrelevant at all, but i would claim that the resource questions change its relevance.

  3. to be clear, i’m also not saying there’s a right answer here and that, y’know, people should “open their eyes” or somesuch. and i’m quite aware of the implicit assumptions about power in the above note. what i’m suggesting is that one’s personal prioritization of inclusiveness for the sake of inclusiveness and for accomodation of individual differences might change with more exposure.

    my own position about power/agency wrt designers is that at the end of the day the designer ends up deciding what to do and the (technical) reality is that responsibility can’t be fully abdicated to “the users” no matter how “participatory” you’d like to be.

  4. I think there’s more here than being participatory. There are many many instances when people are (already) doing their own health management. We try to train that out of people over here (in the first world, especially the U.S.), but anyone with a chronic illness has learned to manage their own health to some extent. Anyone with many doctors managing a single condition is probably brokering between them. And to different degrees, we manage day to day health conditions on our own (like a cold in the U.S.). The specific cultural context in which we do this has a huge impact on what things we self-manage and how we self-manage and who we go to for help (what medicines are understood by the person who is sick? what expertise is available to them? how hard (or expensive) is it to find a doctor, etc etc). Viewed from that perspective, I think that any successful system needs to consider how people transition from self management through management with the support of others (non-doctors, alternative practitioners and so on) all the way to situations where interventions are being handled by “medical professionals.”

  5. […] This post was mentioned on Twitter by MikeMcDonough, Beki Grinter. Beki Grinter said: traditional medicine and health ICTs […]

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