The Experience of Colombian Medical Students in a Pilot Cultural Safety Training Program: A Qualitative Study Using the Most Significant Change Technique.

Problem: The Colombian government provides health services grounded in the Western biomedical model, yet 40% of the population use cultural and traditional practices to maintain their health. Adversarial interactions between physicians and patients from other cultures hinder access to quality health services and reinforce health disparities. Cultural safety is an approach to medical training that encourages practitioners to examine how their own culture shapes their clinical practice and how to respect their patients' worldviews. This approach could help bridge the cultural divide in Colombian health services, improving multicultural access to health services and reducing health disparities. Intervention: In 2016, we conducted a pilot cultural safety training program in Cota, Colombia. A five-month training program for medical students included: (a) theoretical training on cultural safety and participatory research, and (b) a community-based intervention, co-designed by community leaders, training supervisors, and the medical students, with the aim of strengthening cultural practices related to health. Evaluation used the Most Significant Change narrative approach, which allows participants to communicate the changes most meaningful to them. Using an inductive thematic analysis, the authors analyzed the stories and discussed these findings in a debriefing session with the medical students. Context: Cota is located only 15 kilometers from Bogota, the national capital and biggest city of Colombia, so the small town has gone through rapid urbanization and cultural change. A few decades ago, inhabitants of Cota were mainly peasants with Indigenous and European traditions. Urbanization displaced agriculture with industrial and commercial occupations. One consequence of this change was loss of cultural health care practices and resources, for example, medicinal plants, that the community had used for centuries. Impact: A group of 13 final-year medical students (ten female and three male, age range 20-24) participated in the study. The medical students listed four areas of change after their experience: increased respect for traditional health practices to provide better healthcare; increased recognition of traditional practices as part of their cultural heritage and identity; a desire to deepen their knowledge about cultural practices; and openness to incorporate cultural practices in healthcare. Lessons Learned: Medical students reported positive perceptions of their patients' cultural practices after participating in this community-based training program. The training preceded a positive shift in perceptions and was accepted by Colombian medical students. To the best of our knowledge, this was the first documented cultural safety training initiative with medical students in Colombia and an early attempt to apply the cultural safety approach outside the Indigenous experience.

Plantas que curan y descolonialidad. prácticas cotidianas comunitarias de las mujeres, en Montes de Maria / Plantas que curam e decolonialidade. práticas cotidianas comunitárias das mulheres, em Montes de Maria / Plants that cure and decoloniality: practices of everyday life communitary of women, in Montes de Maria

RESUMEN. El artículo parte de las reflexiones de la investigación de Doctorado Grupalidad curadora. Descolonialidad de saberes-prácticas campesinas y afroindígenas en Montes de María (Caribe colombiano); interesada, desde una perspectiva descolonial, por aquellos saberes para curar que fueron excluidos por la ciencia moderna y colonial, silenciando el potencial que entraña la comunidad. Nos centramos en las prácticas cotidianas como curar con plantas que utilizan las mujeres campesinas en las comunidades San Francisco, Medellín y Villa Colombia (Ovejas-Sucre). Las herramientas y técnicas fueron el mapeo de saberes y prácticas comunitarias, entrevistas colectivas, observaciones y recorridos comunitarios por las veredas y las huertas; también el diario de campo, como herramienta de apoyo para el registro y la descripción. El método de análisis cualitativo de la información, privilegió el punto de vista de la experiencia de las mujeres. Los aportes descoloniales orientaron nuestras reflexiones y el análisis del material de campo sobre los saberes y prácticas de cura. En el conocimiento silenciado que reside en las prácticas cotidianas de las mujeres campesinas estarían las claves para curar los dolores de la guerra en los territorios colombianos; lo que justifica una reflexión y un aprendizaje para la academia, en particular, para la Psicología Comunitaria.

RESUMO. O artigo parte das reflexões de pesquisa de doutorado Grupalidade Curadora. Descolonialidade dos saberes-práticas camponesas e afroindígenas em Montes de Maria (Caribe colombiano), interessada, a partir de uma perspectiva descolonial, esses saberes para curar que foram excluídos pela ciência moderna e colonial, silenciando o potencial envolvido na comunidade. Focalizamos as práticas cotidianas como curar com plantas usadas pelas mulheres camponesas nas comunidades San Francisco, Medellín e Villa Colombia (Ovejas-Sucre). As ferramentas e técnicas eram mapeamento de saberes e práticas comunitárias, entrevistas coletivas, observações e visitas comunitárias pelos caminhos e hortas; também o diário de campo, como ferramenta de apoio ao registro e descrição. O método de análise qualitativa da informação privilegiou o ponto de vista e a experiência das mulheres. Aportes descoloniais orientaram nossas reflexões e a análise do material de campo sobre os saberes e práticas de cura. No conhecimento silenciado que reside nas práticas cotidianas, haveria as chaves para curar as dores da guerra nos territórios colombianos; o que justifica uma reflexão e um aprendizado para a academia, em especial, para a Psicologia Comunitária.

ABSTRACT. This article originates from the PhD research Groupality curator: Decoloniality of peasant and afro-indigenous knowledge/practices in Montes de Maria (Colombian Caribbean); from a decolonial perspective, it is interested on the knowledge of cure that were excluded by modern/colonial science. Ando as a consequence, it has silenced the potential of the community. The central point of our study are the practices of everyday life related to cure with medicinal plants that are employed by peasant women in the communities of San Francisco, Medellin and Villa Colombia (Ovejas-Sucre). The tools and techniques we used were mapping community knowledge and practices, collective interviews, observations, trips along the countryside roads and vegetable gardens, and, finally, a field diary—as support tool for registration and description. The method of qualitative analysis of information privileges the point of view and experience of woman. The decolonial contributions enabled us to direct our reflections and analyses of the field material toward knowledge and practices of cura. In the silenced knowledge that resides in the practices of everyday life of peasant women would be the keys to heal the pains of war in the Colombian territories; which justifies a reflection and learning for the academy, in particular, for Community Psychology.

Purging and the body in the therapeutic use of ayahuasca.

Ayahuasca is a psychoactive plant mixture used in ceremonial contexts throughout Western Amazonia. Its use has expanded globally in recent decades and become popular among westerners who travel to the Peruvian Amazon in increasing numbers to experience its reportedly healing effects. Through a review of relevant literature on Amazonian shamanism, combined with the authors' ethnographic data from shamanic tourism contexts of the Peruvian Amazon and neo-shamanic networks in Australia (collected between 2003 and 2015 - with a total of 227 people interviewed or surveyed, including healers and participants), we demonstrate that purging has been integral to the therapeutic use of ayahuasca across and beyond Amazonia. Therapeutic approaches to ayahuasca point to combined modulations of the gut and the mind, and the bodily and the social, that are expressed through discourse about healing and the body. Relating ethnographic evidence to recent scientific studies that connect the gut to emotional health, we do not approach the gut as merely biological ground on which cultural meanings are imposed, but rather as simultaneously physical and cultural. Based upon our analysis, we argue that ayahuasca purging should not be dismissed as a drug side effect or irrational belief but reconsidered for its potential therapeutic effects.

Traditional methods for managing illness in newborns and infants in an Arab society.

AIM: This study explored self-management practices in relation to traditional methods for managing illness in newborns and infants and the implications of these practices on infant health. BACKGROUND: Self-medication with folk remedies is believed to have short- and long-term impacts on well-being. Little is known about how mothers in Arab societies used their traditional beliefs and practices in self-managing their newborns' and infants' health. METHODS: Data were collected from five focus groups using open-ended questions with 37 mothers. Participants were selected using snowball sampling and were recruited from four different cities in Jordan between June 2016 and August 2016. ETHICAL APPROVAL: All identifying information regarding the study participants has been omitted, and this study was approved by the Academic Research Committee at the University of Jordan. FINDINGS: Mothers were more willing to try herbal remedies, traditional massage and certain foods to self-manage their infants' health. Folk remedies were not restricted to traditions handed down through generations, but included a representation of newly emerged trends towards 'safety' or 'nature'. CONCLUSIONS: While the use of folk remedies have been handed down generations as customs, today, virtual support groups and social media provide modern resources for folk remedies' promotion in care and self-management. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing and health policymakers can use our findings for planning and developing strategies and health policies that increase public awareness about adverse health effects associated with herbal remedies. Such strategies are likely to be facilitated through partnerships between nursing and midwifery education institutions, antenatal clinics and social media in the region.

Kaumatua Mana Motuhake: A study protocol for a peer education intervention to help Maori elders work through later-stage life transitions.

BACKGROUND: The Aotearoa/New Zealand population is ageing and numerous studies demonstrate with this phenomenon comes increases in non-communicable diseases, injuries and healthcare costs among other issues. Further, significant inequities exist between Maori (Indigenous peoples of Aotearoa/New Zealand) and non-Maori around poor ageing and health. Most research addressing these issues is deficit oriented; however, the current research project takes a strengths-based approach that highlights the potential of kaumatua (elders) by asserting mana motuhake (autonomy, identity and self-actualisation). We believe that the esteem of elders in Maori culture signals transformative potential. Specifically, this project utilises a 'tuakana-teina' (older sibling/younger sibling) peer-educator model, where kaumatua work with other kaumatua in relation to health and wellbeing. The objectives of the project are (a) to develop the capacity of kaumatua as peer educators, whilst having positive impacts on their sense of purpose, health and wellbeing; and (b) to enhance the social and health outcomes for kaumatua receiving the intervention. METHODS: The research is grounded in principles of Kaupapa Maori and community-based participatory research, and brings together an Indigenous community of kaumatua, community health researchers, and academic researchers working with two advisory boards. The project intervention involves an orientation programme for tuakana peer educators for other kaumatua (teina). The research design is a pre- and post-test, clustered staggered design. All participants will complete a baseline assessment of health and wellbeing consistent with Maori worldviews (i.e., holistic model). The tuakana and teina participants will be divided into two groups with the first group completing the intervention during the first half of the project and the second group during the second half of the project. All participants will complete post-test assessments following both interventions allowing comparison of the two groups along with repeated measures over time. DISCUSSION: The findings will provide an evidence base for the importance and relevancy of kaumatua knowledge to create contextually based and culturally safe age-friendly environments that facilitate engagement and participation by kaumatua for kaumatua. If the model is effective, we will seek to facilitate the dissemination and scalability of the intervention. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ( ACTRN12617001396314 ); Date Registered: 3 October 2017 (retrospectively registered).

The Use of Traditional and Complementary Medicine for Diabetes in Rural Guatemala.

OBJECTIVES: The global burden of type 2 diabetes mellitus is increasing, especially in Central America. In resource-limited settings, such as Guatemala, there are significant barriers to diabetes care and many Guatemalans use medicinal plants as treatment. The purpose of this study is to understand the use of medicinal plants in an indigenous population with diabetes in rural Guatemala. METHODS: Semi-structured interviews were conducted in communities around San Lucas Tolimán, Guatemala with people with diabetes, health promoters, and traditional healers. RESULTS: Out of the 55 people with diabetes interviewed, 35 (63.6%) had used medicinal plants, most frequently using Artemisia absinthium, Moringa oleifera, Carica papaya, and Neurolaena lobata. The majority of participants cited lack of access to medications as the reason for their use of medicinal plants. CONCLUSION: There is widespread use of medicinal plants in San Lucas Tolimán. More research is needed to understand the degree of glycemic control in these communities.

Enteric Fever in Cambodia: Community Perceptions and Practices Concerning Disease Transmission and Treatment.

Enteric fever is a systemic bacterial infection in humans that is endemic in Cambodia and for which antibiotic resistance is increasingly reported. To guide public health programs, this qualitative study sought to explore community perceptions on transmission and treatment. Participant observation was carried out in hospital settings, pharmacies, and at a community level in Phnom Penh. In-depth interviews 39 and one focus group discussion were carried out with blood culture-confirmed enteric fever patients and purposively selected key informants. Informants were theoretically sampled based on initial themes identified using abductive analysis. Nvivo 11 was used for thematic coding. An urgent need to address health literacy concerning the transmission of enteric fever was identified, as lay informants did not link the disease and its symptoms to bacterial contamination of foods and drinks but rather to foods considered "bad" following humoral illness interpretations. As a result, lay informants considered recurrence of enteric fever preventable with appropriate dietary restrictions and Khmer traditional medicines. This study also reveals pluralistic health-care-seeking behavior. For initial and mild symptoms, patients preferred home treatment or traditional healing practices; limited household finances delayed treatment seeking. When symptoms persisted, patients first visited drug outlets or private practitioners, where they received a mix of nonessential medicines and one or more antibiotics often without prescription or confirmation of diagnosis. Inappropriate use of antibiotics was common and was related to diagnostic uncertainty and limited finances, factors which should be addressed during future efforts to improve the uptake of appropriate diagnostics and treatment of enteric fever.

An Examination of the Folk Healing Practice of Curanderismo in the Hispanic Community.

Curanderismo is a system of traditional folk practices and beliefs that address health and healing in the Hispanic community. Curanderismo serves a function in the daily lives of Hispanics worldwide, providing them access to culturally appropriate healthcare, and agency over their own, and their family's health. Cultural competency in the area of curanderismo is invaluable, as curanderismo is a folk resource that if acknowledged and embraced by nurses and healthcare practitioners can aid in healthcare delivery and increased healthcare utilization among Hispanic populations.

Traditional Knowledge of Gucchi, Morchella esculenta (Ascomycetes), in Doda District, Jammu and Kashmir, India.

The gucchi mushroom, Morchella esculenta, commonly known as the morel, is called thunthoo in the Bhaderwahi dialect spoken in District Doda of Jammu and Kashmir, India, and is an expensive food item that grows wild and is collected manually. Its nutritive and medicinal values are acknowledged. The farming community in the district traditionally collects the mushroom from forested areas through a well-managed community approach. Elders of families and communities have taught farmers how to identify the mushroom, recognize distribution patterns, and collect it. The knowledge and ability to differentiate M. esculenta from other poisonous wild mushrooms has also been inherited from the elders and community members. Women and children collect it from the outskirts of the forested areas and villages; men penetrate deeper into the dense forests in groups. It is either sold fresh to local shopkeepers or dried at home; the majority of gucchi collectors do the latter. Traditionally, the mushrooms are most commonly dried in the sun or the kitchen. The mushroom fetches a remunerative price and supplements the household incomes of the rural folk who collect it. Marketing gucchi has not been reported as a constraint. It has traditionally been used to overcome gastric problems and indigestion, as a tonic, to help heal wounds, and to reduce joint pain. Its medicinal uses are, however, restricted to only the hills and far-flung areas.

Indigenous medicine and biomedical health care in fragile settings: insights from Burundi.

This study contributes to the health policy debate on medical systems integration by describing and analysing the interactions between health-care users, indigenous healers, and the biomedical public health system, in the so far rarely documented case of post-conflict Burundi. We adopt a mixed-methods approach combining (1) data from an existing survey on access to health-care, with 6,690 individuals, and (2) original interviews and focus groups conducted in 2014 with 121 respondents, including indigenous healers, biomedical staff, and health-care users. The findings reveal pluralistic patterns of health-care seeking behaviour, which are not primarily based on economic convenience or level of education. Indigenous healers' diagnosis is shown to revolve around the concept of 'enemy' and the need for protection against it. We suggest ways in which this category may intersect with the widespread experience of trauma following the civil conflict. Finally, we find that, while biomedical staff displays ambivalent attitudes towards healers, cross-referrals occasionally take place between healers and health centres. These findings are interpreted in light of the debate on health systems integration in Sub-Saharan Africa. In particular, we discuss policy options regarding healers' accreditation, technical training, management of cross-referrals as well as of herb-drug interactions; and we emphasise healers' psychological support role in helping communities deal with trauma. In this respect, we argue that the experience of conflict, and the experiences and conceptualizations of mental and physical illness, need to be taken into account when devising appropriate public or international health policy responses.

And [They] Even Followed Her Into the Hospital: Primary Care Providers' Attitudes Toward Referral for Traditional Healing Practices and Integrating Care for Indigenous Patients.

Introduction/Importance: Given the promise of integrating traditional healing practices into primary care, we sought to examine the influence of primary care providers' racial concordance and Indigenous patients' ethnic salience on traditional healing treatment decisions. METHOD: Using a descriptive comparative design with an online clinical case vignette, we measured provider decision making via a 5-point Provider Acceptance of Traditional Healing-Referral and Consult questionnaire. Aggregated results of the main effects and interactional effects were analyzed using a 2 × 2 analysis of variance between-subjects design. RESULTS: The main effect for patient racial concordance on the dependent variable was significant, F(1, 89) = 5.71, p = .02. CONCLUSIONS: Provider-patient racial concordance does increase the providers' likelihood of consulting with and referring patients to traditional healing practices, regardless of the patient's ethnic salience. IMPLICATIONS FOR PRACTICE: All health care providers require training in traditional healing practices for Indigenous persons as guided by the cultural safety framework.

Medical Pluralism in the Use of Sobadores among Mexican Immigrants to North Carolina.

Mexican immigrants have a rich history of traditional healers. This analysis describes the conditions for which Mexican immigrants seek treatment from sobadores, and delineates factors that influence seeking treatment from a sobador or a biomedical doctor. This systematic qualitative analysis uses interview data collected with 24 adult Mexican immigrants to North Carolina who had been treated by a sobador in the previous 2 years. Immigrants are engaged in medical pluralism, seeking care from sobadores and biomedical doctors based on the complaint and patient's age. Using a hierarchy of resort, adults seek treatment from sobadores for musculoskeletal pain not involving a fracture. Doctors are first consulted when treating children; sobadores are consulted if doctors do not provide culturally appropriate treatment. Mexican immigrants seek care that addresses their culturally determined health concerns. The need to improve access to culturally competent biomedical health care for vulnerable immigrant populations continues.

Combining Natural Ingredients and Beliefs: The Dayak Tribe's Experience Caring for Sick Children with Traditional Medicine.

Instead of seeking conventional health care, the Dayak tribe in Borneo, Indonesia, treats sick children at home with traditional medicine. The objective of this descriptive, qualitative study was to explore the Dayak tribe's use of traditional medicine to care for sick children. Comprehensive interviews were conducted with 10 caregivers, with collected data analyzed using content analysis. Key recurring themes identified were: 1) traditional medicine as first aid; 2) ease of access and cost-effectiveness; 3) traditional medicine was not always effective; 4) a combination of natural ingredients and beliefs; 5) the importance of "communicating" with plants; and 6) engagement with metaphysical forces. Health professionals should respect familial cultures' beliefs regarding the provision of health care at home. Furthermore, they need to develop competency in performing cultural assessments and providing information to these parents on the risks of not seeking professional emergency care for children with conditions that can't be handled at home with traditional medicine.

"There are more things in heaven and earth!" How knowledge about traditional healing affects clinical practice: interviews with conventional health personnel.

People with Sami and Norwegian background are frequent users of traditional folk medicine (TM). Traditional healing, such as religious prayers of healing (reading) and the laying on of hands, are examples of commonly used modalities. The global aim of this study is to examine whether health personnel's knowledge, attitudes and experiences of traditional healing affect their clinical practice. Semi-structured individual interviews (n=32) and focus group interviews (n=2) were conducted among health personnel in two communities in Northern Norway. The text data was transcribed verbatim and analysed based on the criteria for content analysis. Six themes were identified. The participants had acquired their knowledge of traditional healing through their childhood, adolescence and experience as health personnel in the communities. They all expressed that they were positive to the patients' use of traditional healing. They justified their attitudes, stating that "there are more things in heaven and earth" and they had faith in the placebo effects of traditional healing. The health personnel respected their patients' faith and many facilitated the use of traditional healing. In some cases, they also applied traditional healing tools if the patients asked them to do so. The health personnel were positive and open-minded towards traditional healing. They considered reading as a tool that could help the patients to handle illness in a good way. Health personnel were willing to perform traditional healing and include traditional tools in their professional toolkit, even though these tools were not documented as evidence-based treatment. In this way they could offer their patients integrated health services which were tailored to the patients' treatment philosophy.

An ethnographic study of salt use and humoral concepts in a Latino farm worker community in California's Central Valley.

BACKGROUND: This article reports on the use of domestic or table salt for its perceived health effects and healing properties in a Latino farmworker community. It explores how contemporary salt usage beliefs can be seen to have roots in long-standing humoral theories of medicine and health. METHODS: This qualitative investigation comprised 30 in-depth individual interviews and five focus groups conducted in Spanish with Mexican and Central American immigrants in one small city in California's Central Valley (N = 61 total participants). Interviews and focus groups were audiotaped, translated into English and transcribed. Several researchers independently and iteratively read transcripts, developed and applied codes, and engaged in thematic analysis. RESULTS: Strongly emergent themes identified the importance of balance in health, and beliefs about the effects on salt on health. Valued for its culinary role, for bringing out the flavors in food, and used by people of all ages, salt use is part of a robust set of cultural practices. Salt was regularly mixed with foods in different combinations and ingested to restore balance, prevent disequilibrium or reduce vulnerability to diverse illnesses, promote rehydration, and address symptoms of exposure to extremes of temperature or physical or emotional stress. Statements made and practices engaged in by participants were highly suggestive of health and healing beliefs common to humoral belief systems based primarily on a hot-cold dichotomy in classifications of foods and healing behaviors. We evaluate these statements and practices in the context of the existing literature on historical and contemporary humoral beliefs in Latin American communities, in Mexico and Central America, and in the United States. CONCLUSION: Humoral theory is a useful framework for understanding contemporary rural Latino migrant farmworkers' perceptions of the importance of salt for their health.

Mexican Sobadores in North Carolina: Manual Therapy in a New Settlement Context.

Latino immigrants to the New Settlement area of the southeastern United States face structural and cultural obstacles to accessing the conventional health care system, and come from areas with long traditions of medical treatments from healers without professional training or licensure. Little is known about the use of such healers in New Settlement areas. This study focuses on sobadores, healers who use manipulative therapy. Goals were to describe sobadores practicing in North Carolina, including their background, conditions treated, and their understanding of the pathophysiology of their patients' conditions and how their treatments work. The paper also describes who sobadores treat and sobadores' understanding of where their treatment fits into patients' pursuit of relief from symptoms. This focused ethnography draws from in-depth, semi-structured interviews conducted with six sobadores from Mexico practicing in North Carolina. These sobadores appear to meet both structural and cultural needs for healthcare in the immigrant Latino population.

A Journey Toward Cultural Competence: The Role of Researcher Reflexivity in Indigenous Research.

This article highlights the personal journey of reflective development that a non-Aboriginal White researcher and health professional underwent to be "fully positioned" in the everyday lives of a rural Australian Aboriginal community in Western Australia. The article explains the researcher's personal development in areas important to building respect, building relationships, and ensuring reciprocity while undertaking Aboriginal research. The researcher reports on the reflective evaluation of her worldview. Understanding that judgment is a natural tendency, the researcher used reflexivity as a tool to examine and contextualize her judgments, presumptions, and preconceptions, which positioned her to be open to differing viewpoints and actively explore alternate perspectives. The researcher explores her evolutionary understanding that cultural competence is not a destination but a continual journey, and she details her knowledge development regarding the Aboriginal research paradigm, which requires that all the learning, sharing, and growth taking place is reciprocal and engages all parties actively.

The Use of Talking Circles to Describe a Native American Transcultural Caring Immersion Experience.

BACKGROUND: The Christine E. Lynn College of Nursing at the Florida Atlantic University is grounded in the Nursing as Caring theory. A transcultural caring immersion experience for nursing students is provided within the tribal community of the United Keetoowah Band of Cherokees. AIMS: The purpose of this study was to ascertain descriptions of nursing students' transcultural immersion experience. DESIGN: A qualitative descriptive approach was used via the Talking Circle method. The consensual qualitative research analytical approach was used to categorize participant responses. FINDINGS: Six themes emerged that are consistent with the Nursing as Caring theoretical key concepts: (1) persons are caring as diverse human beings, (2) persons care from a unique cultural perspective moment to moment, (3) persons are whole and complete in the moment when engaging with diverse others, (4) personhood is a process of living with meaningful purpose by diverse persons, (5) personhood evolves while caring for diverse others in nurturing relationships, and (6) connecting nursing as both a profession and a discipline occurs among unique and diverse persons. CONCLUSIONS: The findings from this study reveal the value of providing a transcultural caring immersion experience to students from a Nursing as Caring theoretical perspective.

Cultural competence in nursing Muslim patients.

Delivering high-quality care to Muslim patients involves having an awareness of the ramifications of the Islamic faith and Islamic beliefs. Nurses need to understand the implications of spiritual and cultural values for clinical practice. They should be aware of the need for modesty and privacy, the appropriate use of touch, dietary requirements and use of medications. This article reviews the key issues involved in delivering culturally competent care to Muslim patients.