A co-designed curriculum for cultural safety training of Colombian health professionals: sequential-consensual qualitative study.

Background: Although traditional and cultural health practices are widely used in Colombia, physicians are not trained to address intercultural tensions that arise in clinical practice. Cultural safety encourages practitioners to examine how their own culture shapes their clinical practice and to respect their patients' culture. It requires inviting patients of non-dominant cultures to co-design culturally safe health care. We co-designed a curriculum for cultural safety training of Colombian health professionals. Methods: A sequential-consensual qualitative study defined the learning objectives of the curriculum. Semi-structured questionnaires and focus groups explored the opinions of traditional medicine users, medical students, and intercultural health experts to inform the content of the curriculum. Deliberative dialogue between key intercultural health experts settled the academic content of the curriculum. A member-checking strategy modified and approved the final version. Results: Seven traditional medicine users, six medical students, and four intercultural health experts participated in the study. The stakeholders defined five learning objectives: (a) culturally unsafe practices: acknowledge the intercultural tensions and its consequences; (b) cultural awareness: examine their attitudes, beliefs, and values, and how they shape their professional practice; (c) cultural humility: listen and learn from the patients' traditional practices; (d) cultural competence: describe current pedagogical approaches to address intercultural tensions; and (e) cultural safety: discuss with patients to reach an agreement on their treatment. Conclusion: This study integrated the perspectives of different stakeholders and proposed new applications of cultural safety that are relevant to other countries. Researchers and educators can use these results to inform future cultural safety initiatives.

Contexte: Bien que les pratiques traditionnelles et culturelles en matière de santé soient largement utilisées en Colombie, les médecins ne sont pas formés pour faire face aux tensions interculturelles qui peuvent surgir dans le contexte clinique. La sécurité culturelle encourage les praticiens à s'interroger sur les façons dont leur propre culture influence leur pratique clinique et à respecter la culture de leurs patients. Elle exige qu'ils invitent leurs patients de cultures non dominantes à co-concevoir des soins de santé culturellement sûrs. Nous avons co-conçu un programme de formation en sécurité culturelle pour les professionnels de santé colombiens. Méthodes: Les objectifs d'apprentissage du programme ont été définis sur la base d'une étude qualitative séquentielle-consensuelle. Par le biais de questionnaires semi-structurés et de groupes de discussion, nous avons exploré les opinions d'utilisateurs de la médecine traditionnelle, d'étudiants en médecine et d'experts en santé interculturelle dans le but de définir le contenu du cursus de façon éclairée. Son contenu académique a été finalisé à la suite d'un dialogue délibératif entre les principaux experts en santé interculturelle. Une vérification par les membres a permis de modifier et d'approuver la version finale. Résultats: Sept utilisateurs de la médecine traditionnelle, six étudiants en médecine et quatre experts en santé interculturelle ont participé à l'étude. Les parties prenantes ont défini cinq objectifs d'apprentissage : (a) pratiques culturellement non sécuritaires : reconnaître les tensions interculturelles et leurs conséquences; (b) prise de conscience culturelle : examiner leurs attitudes, croyances et valeurs, et la manière dont elles façonnent s pratiques professionnelles; (c) humilité culturelle : écouter et apprendre des pratiques traditionnelles des patients; (d) compétence culturelle : décrire les approches pédagogiques actuelles sur la question des tensions interculturelles; et (e) sécurité culturelle : discuter avec les patients pour parvenir à un terrain d'entente sur leur traitement. Conclusion: Cette étude intègre les perspectives de différentes parties prenantes et propose de nouvelles applications de la sécurité culturelle qui seraient également pertinentes dans d'autres pays. Les chercheurs et les enseignants peuvent utiliser ces résultats pour alimenter des initiatives futures en matière de sécurité culturelle.

Overview of traditional medicine in the Muisca Reserve of Cota, Colombia: A cross-sectional study. / Panorama de la medicina tradicional en el Resguardo Muisca de Cota, Colombia: estudio transversal.

Introduction: The Muisca Indigenous people in Cota, Colombia, has committed to reviving and strengthening their traditional culture, including the ancestral knowledge associated with their traditional medicine. Objective: To explore the occurrence of traditional medicine and factors associated with its use among the Muisca people in Cota, Colombia. Methods: A participatory cross-sectional study applied a questionnaire to 471 Muisca mothers who had at least one child over 10 in April 2019. The 44 questions inquired demographic, social, and cultural factors of participants and their knowledge, use and practice of traditional medicine. We used the Mantel-Haenszel procedure to measure the associations using Odds Ratio and 95% confidence intervals. Results: 66.2% (312/471) of the mothers knew at least three cases of traditional diseases; 56.8% (267/470) had and used medicinal plants; 15.8% (73/462) had practiced traditional self-care for flu, menstruation and postpartum; and 11.8% (54/458) reported that they had gone to midwives, bonesetters and healers. Four factors had a significant association (p < 0.05) with traditional medicine: consumption of three traditional foods; having traditional gardens and plants; living within the reservation; and parents born in a municipality of indigenous influence. Conclusions: The study showed that the permanence of traditional medicine is strongly associated with traditional food, agricultural vocation and the possession and use of medicinal plants. The results suggest that the strategy for the recovery of traditional medicine could focus on promoting a stronger link between indigenous identity, territory, food and health.

Introducción: La población del Resguardo Indígena Muisca de Cota, Colombia, se encuentra en un proceso de fortalecimiento cultural. Ahora busca la recuperación de sus saberes ancestrales relacionados con la medicina tradicional. Objetivo: Explorar la ocurrencia de la medicina tradicional y factores asociados con su vigencia en el resguardo indígena Muisca de Cota, Colombia. Métodos: Estudio transversal participativo con los miembros del resguardo. Para este estudio se aplicó en abril de 2019 un instrumento de 44 preguntas a 471 madres de familia que tenían por lo menos un hijo mayor de diez años. A través de él se indagaron algunos factores demográficos, sociales y culturales. Además, se plantearon preguntas relacionadas con conocimiento, uso y práctica de medicina tradicional. Usamos el procedimiento de Mantel-Haenszel para establecer las asociaciones mediante el Odds ratio e intervalos de confianza del 95%. Resultados: El 66,2% (312/471) de las madres conocía al menos tres casos de enfermedades tradicionales, el 56,8% (267/470) tenía y usaba plantas medicinales, el 15,8% (73/462) practicaba cuidados tradicionales de la gripa, la menstruación y el puerperio, y el 11,8% (54/458) reportó que han acudido a parteras, sobanderos y curanderos. El consumo de tres alimentos tradicionales, la tenencia de huertos y plantas tradicionales, tener la vivienda dentro del resguardo y padres nacidos en un municipio de influencia indígena, fueron los principales factores asociados con la prevalencia de la medicina tradicional (p < 0,05). Conclusiones: El estudio mostró que la permanencia de la medicina tradicional está fuertemente asociada a la alimentación tradicional, a la vocación agrícola y a la tenencia y uso de plantas medicinales. Los resultados sugieren que la estrategia de recuperación de la medicina tradicional podría enfocarse en promover un mayor vínculo entre identidad indígena, territorio, alimentación y salud.

Panorama de la medicina tradicional en el Resguardo Muisca de Cota, Colombia: estudio transversal / Overview of traditional medicine in the Muisca Reserve of Cota, Colombia: a cross-sectional study

INTRODUCCIÓN: La población del Resguardo Indígena Muisca de Cota, Colombia, se encuentra en un proceso de fortalecimiento cultural. Ahora busca la recuperación de sus saberes ancestrales relacionados con la medicina tradicional. OBJETIVO: Explorar la ocurrencia de la medicina tradicional y factores asociados con su vigencia en el resguardo indígena Muisca de Cota, Colombia. MÉTODOS: Estudio transversal participativo con los miembros del resguardo. Para este estudio se aplicó en abril de 2019 un instrumento de 44 preguntas a 471 madres de familia que tenían por lo menos un hijo mayor de diez años. A través de él se indagaron algunos factores demográficos, sociales y culturales. Además, se plantearon preguntas relacionadas con conocimiento, uso y práctica de medicina tradicional. Usamos el procedimiento de Mantel-Haenszel para establecer las asociaciones mediante el Odds ratio e intervalos de confianza del 95%. RESULTADOS: El 66,2% (312/471) de las madres conocía al menos tres casos de enfermedades tradicionales, el 56,8% (267/470) tenía y usaba plantas medicinales, el 15,8% (73/462) practicaba cuidados tradicionales de la gripa, la menstruación y el puerperio, y el 11,8% (54/458) reportó que han acudido a parteras, sobanderos y curanderos. El consumo de tres alimentos tradicionales, la tenencia de huertos y plantas tradicionales, tener la vivienda dentro del resguardo y padres nacidos en un municipio de influencia indígena, fueron los principales factores asociados con la prevalencia de la medicina tradicional (p < 0,05). CONCLUSIONES: El estudio mostró que la permanencia de la medicina tradicional está fuertemente asociada a la alimentación tradicional, a la vocación agrícola y a la tenencia y uso de plantas medicinales. Los resultados sugieren que la estrategia de recuperación de la medicina tradicional podría enfocarse en promover un mayor vínculo entre identidad indígena, territorio, alimentación y salud.

INTRODUCTION: The Muisca Indigenous people in Cota, Colombia, has committed to reviving and strengthening their traditional culture, including the ancestral knowledge associated with their traditional medicine. OBJECTIVE: To explore the occurrence of traditional medicine and factors associated with its use among the Muisca people in Cota, Colombia. METHODS: A participatory cross-sectional study applied a questionnaire to 471 Muisca mothers who had at least one child over 10 in April 2019. The 44 questions inquired demographic, social, and cultural factors of participants and their knowledge, use and practice of traditional medicine. We used the Mantel-Haenszel procedure to measure the associations using Odds Ratio and 95% confidence intervals. RESULTS: 66.2% (312/471) of the mothers knew at least three cases of traditional diseases; 56.8% (267/470) had and used medicinal plants; 15.8% (73/462) had practiced traditional self-care for flu, menstruation and postpartum; and 11.8% (54/458) reported that they had gone to midwives, bonesetters and healers. Four factors had a significant association (p < 0.05) with traditional medicine: consumption of three traditional foods; having traditional gardens and plants; living within the reservation; and parents born in a municipality of indigenous influence. CONCLUSIONS: The study showed that the permanence of traditional medicine is strongly associated with traditional food, agricultural vocation and the possession and use of medicinal plants. The results suggest that the strategy for the recovery of traditional medicine could focus on promoting a stronger link between indigenous identity, territory, food and health.

Safe birth in cultural safety in southern Mexico: a pragmatic non-inferiority cluster-randomised controlled trial.

BACKGROUND: Available research on the contribution of traditional midwifery to safe motherhood focuses on retraining and redefining traditional midwives, assuming cultural prominence of Western ways. Our objective was to test if supporting traditional midwives on their own terms increases cultural safety (respect of Indigenous traditions) without worsening maternal health outcomes. METHODS: Pragmatic parallel-group cluster-randomised controlled non-inferiority trial in four municipalities in Guerrero State, southern Mexico, with Nahua, Na savi, Me'phaa and Nancue ñomndaa Indigenous groups. The study included all pregnant women in 80 communities and 30 traditional midwives in 40 intervention communities. Between July 2015 and April 2017, traditional midwives and their apprentices received a monthly stipend and support from a trained intercultural broker, and local official health personnel attended a workshop for improving attitudes towards traditional midwifery. Forty communities in two control municipalities continued with usual health services. Trained Indigenous female interviewers administered a baseline and follow-up household survey, interviewing all women who reported pregnancy or childbirth in all involved municipalities since January 2016. Primary outcomes included childbirth and neonatal complications, perinatal deaths, and postnatal complications, and secondary outcomes were traditional childbirth (at home, in vertical position, with traditional midwife and family), access and experience in Western healthcare, food intake, reduction of heavy work, and cost of health care. RESULTS: Among 872 completed pregnancies, women in intervention communities had lower rates of primary outcomes (perinatal deaths or childbirth or neonatal complications) (RD -0.06 95%CI - 0.09 to - 0.02) and reported more traditional childbirths (RD 0.10 95%CI 0.02 to 0.18). Among institutional childbirths, women from intervention communities reported more traditional management of placenta (RD 0.34 95%CI 0.21 to 0.48) but also more non-traditional cold-water baths (RD 0.10 95%CI 0.02 to 0.19). Among home-based childbirths, women from intervention communities had fewer postpartum complications (RD -0.12 95%CI - 0.27 to 0.01). CONCLUSIONS: Supporting traditional midwifery increased culturally safe childbirth without worsening health outcomes. The fixed population size restricted our confidence for inference of non-inferiority for mortality outcomes. Traditional midwifery could contribute to safer birth among Indigenous communities if, instead of attempting to replace traditional practices, health authorities promoted intercultural dialogue. TRIAL REGISTRATION: Retrospectively registered ISRCTN12397283 . Trial status: concluded.

In many Indigenous communities, traditional midwives support mothers during pregnancy, childbirth, and some days afterwards. Research involving traditional midwives has focused on training them in Western techniques and redefining their role to support Western care. In Guerrero state, Mexico, Indigenous mothers continue to trust traditional midwives. Almost half of these mothers still prefer traditional childbirths, at home, in the company of their families and following traditional practices. We worked with 30 traditional midwives to see if supporting their practice allowed traditional childbirth without worsening mothers' health. Each traditional midwife received an inexpensive stipend, a scholarship for an apprentice and support from an intercultural broker. The official health personnel participated in a workshop to improve their attitudes towards traditional midwives. We compared 40 communities in two municipalities that received support for traditional midwifery with 40 communities in two municipalities that continued to receive usual services. We interviewed 872 women with childbirth between 2016 and 2017. Mothers in intervention communities suffered fewer complications during childbirth and had fewer complications or deaths of their babies. They had more traditional childbirths and fewer perineal tears or infections across home-based childbirths. Among those who went to Western care, mothers in intervention communities had more traditional management of the placenta but more non-traditional cold-water baths. Supporting traditional midwifery increased traditional childbirth without worsening health outcomes. The small size of participating populations limited our confidence about the size of this difference. Health authorities could promote better health outcomes if they worked with traditional midwives instead of replacing them.

Maternal health and Indigenous traditional midwives in southern Mexico: contextualisation of a scoping review.

OBJECTIVES: Collate published evidence of factors that affect maternal health in Indigenous communities and contextualise the findings with stakeholder perspectives in the Mexican State of Guerrero. DESIGN: Scoping review and stakeholder fuzzy cognitive mapping. INCLUSION AND EXCLUSION: The scoping review included empirical studies (quantitative, qualitative or mixed methods) that addressed maternal health issues among Indigenous communities in the Americas and reported on the role or influence of traditional midwives before June 2020. The contextualisation drew on two previous studies of traditional midwife and researcher perspectives in southern Mexico. RESULTS: The initial search identified 4461 references. Of 87 selected studies, 63 came from Guatemala and Mexico. Three small randomised trials involved traditional midwives. One addressed the practice of traditional midwifery. With diverse approaches to cultural differences, the studies used contrasting definitions of traditional midwives. A fuzzy cognitive map graphically summarised the influences identified in the scoping review. When we compared the literature's map with those from 29 traditional midwives in Guerrero and eight international researchers, the three sources coincided in the importance of self-care practices, rituals and traditional midwifery. The primary concern reflected in the scoping review was access to Western healthcare, followed by maternal health outcomes. For traditional midwives, the availability of hospital or health centre in the community was less relevant and had negative effects on other protective influences, while researchers conditioned its importance to its levels of cultural safety. Traditional midwives highlighted the role of violence against women, male involvement and traditional diseases. CONCLUSIONS: The literature and stakeholder maps showed maternal health resulting from complex interacting factors in which promotion of cultural practices was compatible with a protective effect on Indigenous maternal health. Future research challenges include traditional concepts of diseases and the impact on maternal health of gender norms, self-care practices and authentic traditional midwifery.

Efecto y seguridad de un tratamiento ambulatorio de medicina tradicional para el asma en 26 pacientes de Cota, Colombia: una serie de casos / Effect and safety of an outpatient traditional medicine treatment for asthma in 26 patients from Cota, Colombia: a case series

The prevalence, morbidity and costs of asthma care have increased worldwide. This study describes the effect and safety of an outpatient medical treatment with traditional medicine for asthma, through a retrospective case series with patients admitted to outpatient consultation from 1995 to 2015 in Cota, Colombia. Analyzing 26 cases with a clinical diagnosis of asthma, during the treatment 34.6% (9/26) did not present episodes of uncontrolled asthma and 61.5% (16/26) were classified as controlled asthma in their last consultation of control. 88.4% (23/26) of the patients reported no adverse reactions and the three reported were mild. The results allow to generate hypotheses about the effectiveness and safety of an outpatient treatment based on the incorporation of resources from traditional medicine. These observations could beexplored with experimental studies to determine their long-term effectiveness, safety and low cost.

La prevalencia, morbilidad y costos de atención del asma se ha incrementado en el mundo. Este estudio describe el efecto y la seguridad de un tratamiento médico ambulatorio con recursos de la medicina tradicional para el asma, mediante una serie de casos retrospectiva con pacientes admitidos a consulta externa de 1995 a 2015 en Cota, Colombia. Analizando 26 casos con diagnóstico clínico de asma, durante el tratamiento el 34,6% (9/26) no presentó episodios de asma no controlada y el 61,5% (16/26) fueron clasificados como asma controlada en su última consulta de control. El 88,4% (23/26) de los pacientes no reportó reacciones adversas y las tres reportadas fueron leves. Los resultados permiten generar hipótesis acerca de la efectividad y seguridad de un tratamiento ambulatorio basado en la incorporación de recursos de la medicina tradicional. Estas observaciones podrían ser exploradas con estudios experimentales, para determinar su efectividad, seguridad y bajo costo a largo plazo.

[Cultivation and use of medicinal plants and association with reporting of childhood asthma: A case-control study in the Bogotá savanna]. / Cultivo y uso de plantas medicinales y su asociación con el reporte de asma infantil: estudio de casos y controles en la Sabana de Bogotá.

INTRODUCTION: The prevalence of childhood asthma has increased in recent years. The World Health Organization has called for conducting research exploring the role of traditional medicine and medicinal plants in respiratory disease control. OBJECTIVE: To identify the relationship between the prevalence of childhood asthma and traditional care of the respiratory system, including cultivation and use of medicinal plants. METHODS: We conducted an observational, analytic, case-control study that included children 2 to 14 years old who used official health services in eight municipalities near Bogota between 2014 and 2015. Cases were children diagnosed with asthma. We randomly selected the controls among the remaining patients of the same healthcare facilities. We applied an 18-question survey. The Mantel-Haenszel procedure identified significant associations using 95% confidence intervals. RESULTS: We surveyed the caretakers of 97 cases and 279 controls in eight municipalities. Some 23.4% (88/376) and 37.9% (142/375) reported using traditional remedies for fever control and common cold management, respectively. 8.8% (33/376) reported following traditional care during a common cold, 30.4% (114/375) reported growing medicinal plants at home, and 45% (166/369) reported using medicinal plants for health purposes in their household. Multivariate analysis showed that having and using medicinal plants at home is associated with a lower reporting of asthma (odds ratio 0.49; 95% confidence interval: 0.25 to 0.99). CONCLUSIONS: Cultivating and using medicinal plants at home is associated with a lower reporting of childhood asthma. Researchers should consider the therapeutic, environmental, and cultural properties of medicinal plants to prevent respiratory diseases.

INTRODUCCIÓN: La prevalencia de asma infantil ha aumentado en los últimos años. La Organización Mundial de la Salud invita a buscar evidencia científica en las medicinas tradicionales y el uso de plantas medicinales, como contribución al control de las enfermedades respiratorias. OBJETIVOS: Identificar la relación entre prevalencia de asma infantil y cuidados respiratorios tradicionales, incluyendo el cultivo y uso de plantas medicinales. MÉTODOS: Estudio observacional, analítico con diseño de casos y controles en niños (de 2 a 14 años) atendidos por servicios estatales de salud en ocho municipios vecinos a Bogotá durante 2014 y 2015. Fueron casos quienes recibieron diagnóstico de asma y se seleccionaron los controles aleatoriamente entre los demás usuarios de las mismas instituciones. Aplicamos un cuestionario con 18 preguntas. La prueba de Mantel-Haenszel identificó asociaciones significativas usando el Odds ratio e intervalos de confianza del 95%. RESULTADOS: Encuestamos a los acudientes de 97 casos y 279 controles en ocho municipios. El 23,4% (88/376) reportó el uso de remedios caseros para controlar la fiebre y el 37,9% (142/375) para manejar la gripe. El 8,8% (33/376) reportó cumplir con todos los cuidados del frío durante la gripe; 30,4% (114/375) tiene plantas medicinales sembradas en su vivienda y 45% (166/369) reportó uso de plantas medicinales para el cuidado de la salud en el hogar. El análisis multivariado mostró que la tenencia y uso de plantas medicinales en la vivienda se asoció con menor reporte de asma (Odds ratio: 0,49; intervalo de confianza 95%: 0,25 a 0,99). CONCLUSIONES: Cultivar y usar plantas medicinales en los hogares está asociado con menor reporte de asma infantil. Conviene considerar las propiedades terapéutica, ambiental y cultural de las plantas medicinales para la prevención de enfermedades respiratorias.

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.

Bridging Western and Indigenous knowledge through intercultural dialogue: lessons from participatory research in Mexico.

Indigenous communities in Latin America and elsewhere have complex bodies of knowledge, but Western health services generally approach them as vulnerable people in need of external solutions. Intercultural dialogue recognises the validity and value of Indigenous standpoints, and participatory research promotes reciprocal respect for stakeholder input in knowledge creation.As part of their decades-long community-based work in Mexico's Guerrero State, researchers at the Centro de Investigación de Enfermedades Tropicales responded to the request from Indigenous communities to help them address poor maternal health. We present the experience from this participatory research in which both parties contributed to finding solutions for a shared concern. The aim was to open an intercultural dialogue by respecting Indigenous skills and customs, recognising the needs of health service stakeholders for scientific evidence.Three steps summarise the opening of intercultural dialogue. Trust building and partnership based on mutual respect and principles of cultural safety. This focused on understanding traditional midwifery and the cultural conflicts in healthcare for Indigenous women. A pilot randomised controlled trial was an opportunity to listen and to adjust the lexicon identifying and testing culturally coherent responses for maternal health led by traditional midwives. Codesign, evaluation and discussion happened during a full cluster randomised trial to identify benefits of supporting traditional midwifery on maternal outcomes. A narrative mid-term evaluation and cognitive mapping of traditional knowledge offered additional evidence to discuss with other stakeholders the benefits of intercultural dialogue. These steps are not mechanistic or invariable. Other contexts might require additional steps. In Guerrero, intercultural dialogue included recovering traditional midwifery and producing high-level epidemiological evidence of the value of traditional midwives, allowing service providers to draw on the strengths of different cultures.

What motivates medical students to learn about traditional medicine? A qualitative study of cultural safety in Colombia.

OBJECTIVES: This study explored motivation dynamics of medical students engaging with traditional medicine in Colombia. METHODS: We conducted a qualitative descriptive study as part of a larger participatory research effort to develop a medical education curriculum on cultural safety. Four final-year medical students participated in a five-month program to strengthen knowledge of traditional medicinal plants with schoolchildren in Cota, a municipality outside Bogota with a high proportion of traditional medicine users. Students and schoolteachers co-designed the program aimed to promote the involvement of school children with traditional medicine in their community. The medical students shared written narratives describing what facilitated their work and discussed experiences in a group session. Inductive thematic analysis of the narratives and discussion derived categories of motivation to learn about traditional medicine. RESULTS: Five key learning dynamics emerged from the analysis: (1) learning from/with communities as opposed to training them; (2) ownership of medical education as a result of co-designing the exercise; (3) rigorous academic contents of the program; (4) lack of cultural safety training in university; and (5) previous contacts with traditional knowledge. CONCLUSIONS: We identified potential principles for engaged cultural safety training for medical students. We will use these in our larger training program. Our results may be relevant to other researchers and medical educators wanting to improve the interaction of medical health professionals in multicultural settings with people and communities who use traditional medicine. We expect these professionals will be better prepared to recognize and address intercultural challenges in their clinical practice.

Traditional medicine used in childbirth and for childhood diarrhoea in Nigeria's Cross River State: interviews with traditional practitioners and a statewide cross-sectional study.

OBJECTIVES: Examine factors associated with use of traditional medicine during childbirth and in management of childhood diarrhoea. DESIGN: Cross-sectional cluster survey, household interviews in a stratified last stage random sample of 90 census enumeration areas; unstructured interviews with traditional doctors. SETTING: Oil-rich Cross River State in south-eastern Nigeria has 3.5 million residents, most of whom depend on a subsistence agriculture economy. PARTICIPANTS: 8089 women aged 15-49 years in 7685 households reported on the health of 11,305 children aged 0-36 months in July-August 2011. PRIMARY AND SECONDARY OUTCOME MEASURES: Traditional medicine used at childbirth and for management of childhood diarrhoea; covariates included access to Western medicine and education, economic conditions, engagement with the modern state and family relations. Cluster-adjusted analysis relied on the Mantel-Haenszel procedure and Mantel extension. RESULTS: 24.1% (1371/5686) of women reported using traditional medicine at childbirth; these women had less education, accessed antenatal care less, experienced more family violence and were less likely to have birth certificates for their children. 11.3% (615/5425) of young children with diarrhoea were taken to traditional medical practitioners; these children were less likely to receive BCG, to have birth certificates, to live in households with a more educated head, or to use fuel other than charcoal for cooking. Education showed a gradient with decreasing use of traditional medicine for childbirth (χ(2) 135.2) and for childhood diarrhoea (χ(2) 77.2). CONCLUSIONS: Use of traditional medicine is associated with several factors related to cultural transition and to health status, with formal education playing a prominent role. Any assessment of the effectiveness of traditional medicine should anticipate confounding by these factors, which are widely recognised to affect health in their own right.

Lo que podemos hacer todos para respirar bien / What we can do to breathe well

A lo largo de un proceso de investigación realizado por la Secretaría de Salud del municipio de Cota en conjunto con el Centro de Estudios Médicos Interculturales, se identificó una serie de tradiciones que se mantienen vivas en nuestras comunidades y que pueden ser muy importantes para manejar mejor la salud respiratoria. Estos conocimientos ofrecen grandes ventajas al incluirlos en programas de salud pública, es decir, en acciones que buscan mejorar la salud de la población. Por eso estamos convencidos de que son muy valiosos y merecen ser recuperados y divulgados en este tipo de materiales. Entre las ventajas más sobresalientes podemos destacar tres. En primer lugar, los cuidados tradicionales utilizan recursos locales que resultan más fáciles de encontrar en el territorio de las comunidades beneficiadas y que representan un costo mucho menor en comparación con el de los recursos externos. Un ejemplo de esto son las plantas medicinales. Si cada hogar contara con un jardín de plantas medicinales básico, sería posible ahorrar muchos de los costos de los medicamentos de farmacia. En segundo lugar, estos cuidados tienen un arraigo cultural que constituye la intimidad de la vida comunitaria. La transformación cultural hacia una forma de vida más urbana e individualista ha tenido un fuerte impacto en el abandono de estas prácticas y conduce a la erosión del patrimonio inmaterial de muchos pueblos a lo largo del mundo.

Aproximación a la medicina tradicional colombiana. Una mirada al margen de la cultura occidental / Approximation to the Traditional Medicine in Colombia

En este artículo se realiza una aproximación a la medicina tradicional colombiana y a partir de ahí se encuentra un gran conocimiento que ha mantenido la salud de muchas de nuestras comunidades y que por la rigidez de nuestra cultura occidental desconocíamos. No estamos seguros de cuál será nuestro futuro, pero vemos aquí una puerta que espera ser abierta para ofrecernos ya sea nuevos saberes, como herramientas de trabajo, o simplemente su apoyo para hacer nuestras vidas más llevaderas. Para aproximarse a la medicina tradicionales necesario entender previamente que nos acercamos a un tipo diferente de conocimiento del que estamos acostumbrados en la formación médica de occidente, por lo tanto, es importante considerar los antecedentes que han suscitado dicho acercamiento y que han despertado el interés por reconocer y recuperar otras formas del actuar médico, en especial aquellas que atañen a los conceptos que se han manejado en la tradición de nuestros pueblos y que han tenido su origen y desarrollo muchos años antes de lo que hoy conocemos como medicina moderna.

In this article an approach to Colombian traditional medicine is made and from there we find a great knowledge that has maintained the health of many of our communities and that due to the rigidity of our western culture we were unaware of. We are not sure what our future will be, but we see here a door waiting to be opened to offer us either new knowledge, as work tools, or simply their support to make our lives more bearable. In order to approach traditional medicine, it is necessary to understand beforehand that we are approaching a different type of knowledge from what we are used to in Western medical training. Therefore, it is important to consider the background that has given rise to this approach and that has awakened interest in recognizing and recovering other forms of medical action, especially those related to the concepts that have been handled in the tradition of our peoples and that have had their origin and development many years before what we know today as modern medicine.