Medical Pluralism: Understanding Diverse Health Seeking Approaches

This essay examines medical pluralism, focusing on how diverse populations, particularly indigenous and mestizo communities in the Americas, approach healthcare. It explores the complexities of integrating Western biomedicine with traditional practices, highlighting issues such as the high costs of Western medicine, the absence of social health systems in Latin America, and the importance of interculturality in healthcare. The essay also addresses the historical context of biomedicine, the role of cultural beliefs in health practices, and the need for dialogue between doctors and patients. Ultimately, it advocates for encouraging interculturality to allow both Western and indigenous medical models to operate without discrimination, emphasizing the importance of understanding and respecting diverse health seeking behaviors.

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Medical Pluralism
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Introduction
One of the questions that influenced the decision to choose the question related to
medical pluralism is: why do indigenous and mestizo populations in the Americas shy away from
a medical system designed to alleviate the afflictions and ills they suffer?
Medical pluralism is a perfect answer to this question. Medical pluralism can be
described as situation where health and illness, science and experience, ethics and aesthetics,
values and morals, economics and politics, rights and duties, public and private are intertwined
(Redvers, 2018). In medical pluralism, what is problematic is not a type of medication (the
Western one) but the legitimacy of the one who provides it (the doctor). Early historians and
anthropologists who studied medical pluralism wrote about it, as if about equal and peaceful
coexistence of medical systems, but soon realized that there was no equality. On the contrary,
subordinate medical systems exist hierarchically. For example, biomedicine is almost universally
considered the most prestigious and best, but popular and alternative forms of treatment are often
marginalized.
How concept of medical pluralism may help us understand and respond to potentially
problematic and negative health seeking behaviors?
To answer this question, it is important to demonstrate how different ethnic groups seek
and obtain medication. We will start with Western societies. In Western societies the crisis of the
bio-medicine model manifested itself in the last decades of the 20th century for reasons that are
fundamentally associated with the high costs of health and prevention systems. The profitability
imperatives require that consultations, at least in the field of public health, be increasingly brief,
which inevitably affects the patient / patient relationship (In Micozzi, 2011). On the other hand,

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the so-called family doctors, who knew the families and followed them for years, have decreased
alarmingly. The graduates of the universities prefer to follow more prestigious careers (research
or private sector) discarding the general medicine, not very prestigious and not very profitable.
Hence, an "art" that in the West had developed over the centuries a qualitative relationship with
patients (ability to listen on the part of the doctor, interest in the environment, familial, relational
and professional of the patient), gave way to a technology that, in the name of efficacy, leaves
aside subjective aspects of the patient, which passes from the position of subject to the object of
a clinical observation.
In Latin America, the poverty and marginalization of rural populations, the absence of
social health systems, the isolation of the peoples and the poor quality of medical care all
exacerbate the problems faced by "bio-medicine” (Bala, 2007). In most Latin American
countries, newly-received physicians must carry out a "year of provinces" that is sometimes
reduced to a few months, and settle in inhospitable areas. The majority reluctantly complies with
this obligation - I am aware of personal experience in Ecuador - and patients perceive this
discomfort, which is aggravated by the inevitable rotation of the "doctors" (Incayawar,
Bouchard, Wintrob, Bartocci & World Psychiatric Association (2010) . Rural patients are rightly
considered ill-treated by a third-category medicine, whose protocol is incomprehensible for
linguistic reasons, hence the urgency of training bilingual health personnel.
Bivins (2010) gives us an ethnography of these young doctors and shows that medicines
are not rejected because they are incompatible with traditions, but because they are expensive.
When they are given away, they are used, says Bivins (2010), referring to the Aguaruna of the
Peruvian Amazon rainforest.

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On the contrary, Bathum (2007), specialist of the Aymara peoples, affirms that
"medicines and treatments that cost money should not be given away or free since it is
considered that what is free is not effective but timed out ". On the other hand, Virtanen
(2012) insists on the contrast between the natives of the Acre River region (Brazil) they go by
boat to the city to consult the doctor, and the whites, who make the trip in the opposite direction
to visit the shaman. The natives prefer the remedies of whites, "sweeter", to "del mato", which
"hurt a lot". These examples reveal the complexity of the problem and the ambiguity (and not
rejection) of bio-western medicine.
The expression consecrated in sociological and anthropological studies on health in
intercultural situations, is that of "bio-medicine" to designate the scientific discipline that
emerged in the West from the last decades of the eighteenth century. Pasteur promotes a true
medical and biological revolution. Microbial contagion and the possibility of preventing it by
introducing a number of these germs into the human body are difficult ideas to accept because
they defy common sense. Specifically, this means that "invisible animals" can move and cause
illness and death. In Pindilig (Ecuador) the Indians did not believe in these theories of the
doctors, not so much because the microbes were invisible - the damages transmitted by the
sorcerers are also invisible - but because they could not admit, for example, that a mother could
contaminate her children. children or that a tuberculous could not drink from the same glass as
the others. The old theories of the miasmas were more compatible with the beliefs in the "airs."
In France, at the end of the 19th century, the doctor Pierre Janet, discoverer of the
"subconscious", treated several patients of rural origin who had developed phobic pathologies
due to the terror inspired by the "microbes" (Hacking, 2002). Recently the most fanciful
conceptions about the transmission of HIV indicate that these apprehensions are not exclusive of

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peasant peoples, reluctant to modern life. The beliefs related to contagion and its vectors, as well
as their social implications, are of course a very important issue within this compact category of
bio-medicine, which needs to be qualified. In the region of Ayacucho, the fetid breath and farts
of humans "infect" bad habits (Snider, et al 2004). In the Potosi sinkholes, the gas that causes
silicosis is an emanation of the Uncle, the "owner" of the mine, while the breath of man makes it
live. In the terreiros of Bahia, in Brazil (Taylor, Kaplan, Hobgood-Oster, Ivakhiv, & York,
2008), the contamination of contagious diseases, characterized by skin lesions, it is a punishment
of the Omolu spirit, and healing involves a series of offerings and Afro-Christian rituals. The
darts sent to their enemies by the Yaguas shamans of the Orient of Peru, resemble the pathogens
and with good reason Jean-Pierre Chaumeil suggests deepening the "virological complex" (Pitot
& Loeb, 2002). The difference between indigenous conceptions and Western medicine lies in the
systems of associated representations.
On the other hand, the essential characteristic of bio-medicine is the rejection of religious
or supernatural explanations that cannot be proved rationally. This attitude, which is already
affirmed in the corpus of Hippocrates, is maintained despite the pressure of the Church, over the
centuries, as shown in the masterly book of Keith Thomas.
Based on these findings, it is apparent that the crisis of the hegemonic model of medicine
demands, as Redvers (2018) explains, "the return of cultures", not only in Latin America but also
in the United States. Increasingly insists on the need for dialogue between the doctor and the
patient, and the importance of anthropology as a discipline of cultural mediation. Unfortunately,
in many cases the lack of medical resources in marginal areas prevents true interaction. The
consequence is the development of local cures, "folk" and the use of home remedies. Extreme
resource justified by the impossibility of receiving help or panacea from the poor? For some

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researchers (Redvers, 2018). The Amerindian medical paradigm (contrary to that of bio-
medicine) operates an analogical relationship between the individual body, social and
cosmological ». For example, the Aymara population of Bolivia believes that abortions produce
hail and in order to stop them they "look for the culprit". The author gives us to understand the
"human" superiority of the Amerindian paradigm, forgetting without doubt that the emissary
goats were a veritable plague in Europe until today.
It is also evident that for medical pluralism to prevail, there is need for interculturality.
There should be crossbreeding of the indigenous and Western approaches. To achieve this, there
is need to address ethnocentrism. It should be noted that interculturality is not limited to relations
between members of Amerindian groups and biomedical personnel (DuBois, 2009). Overcoming
the limits of the ethnic, this asymmetric interaction occurs in diverse situations such as poverty,
social inequality or stigmatization. No group escapes these confrontations that always entail an
ethnocentric position that implies a hierarchy of the groups in presence. Hence, one cannot think
interculturality only in moral terms of respect, tolerance or cooperation. Interculturality in the
health / disease / care processes works in an unequal context at the same time cultural, economic,
social and even biological (much lower life expectancy among the subaltern classes).
Conclusion
The paper has demonstrated how medical pluralism encourages different people to seek
different approaches to their health needs. The analysis also revealed that although western
model is considered superior, alternative models also plays a crucial role especially in indigenous
communities and in poor communities. Consequently, it is suggested that interculturality should
be encouraged so as to allow both models to operate without discrimination

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List of References
Bala, P (2007) Medicine and medical policies in India: Social and historical perspectives.
Lanham: Lexington Books.
Bathum, M. E. (2007). Ayamara women healers: Health and community, University of
Wisconsin—Madison
Bivins, RE (2010) Alternative medicine?: A history. Oxford: Oxford University Press.
Hacking, I (2002) Historical ontology. Cambridge, Mass: Harvard Univ. Press.
In Micozzi, MS (2011) Fundamentals of complementary and alternative medicine, St. Louis,
Mo. : Saunders/Elsevier
Incayawar, M, Bouchard, L, Wintrob, R, Bartocci, G, & World Psychiatric Association
(2010) Psychiatrist and traditional healers: Unwitting partners in global mental health.
Chichester, UK: J. Wiley & Sons.
Pitot, HC, & Loeb, DD (2002) Fundamentals of oncology, New York: M. Dekker.
Redvers, N (2018) The science of the sacred: Bridging global indigenous medicine systems and
modern scientific principles, Berkeley, California : North Atlantic Books.
Snider, L, Cabrejos, C, Huayllasco ME, Jose TJ, Avery, A & Ango AH (2004). Psychosocial
Assessment for Victims of Violence in Peru: The Importance of Local Participation. Journal of
biosocial science, 36(4), 389–400. doi:10.1017/S0021932004006601
Taylor, B R, Kaplan, J, Hobgood-Oster, L, Ivakhiv, AJ, & York, M (2008) The encyclopedia of
religion and nature. New York: Continuum, pp. 249-271
Virtanen, P K (2012) Indigenous youth in Brazilian Amazonia: Changing lived worlds, New
York: Palgrave Macmillan.