Mental health issues among indigenous communities and the role of traditional medicine.

INTRODUCTION: Mental health in indigenous communities is a relevant issue for the World Health Organization (WHO). These communities are supposed to live in a pure, clean and intact environment. Their real condition is far different from the imaginary; they are vulnerable populations living in difficult areas, exposed to pollution, located far from the health services, exposed to several market operations conducted to extract natural resources, facing criminal groups or illegal exploitation of land resources. These factors may have an impact on mental health of indigenous population. METHODS: We reviewed all papers available on PubMed, EMBASE and The Cochrane Library until December 2018. We focused on those factors affecting the changes from a traditional to a post-modern society and reviewed data available on stress-related issues, mental distress affecting indigenous/aboriginal communities and the role of Traditional Medicine (TM). We reviewed articles from different countries hosting indigenous communities. RESULTS: The incidence of mental distress and related phenomena (e.g. collective suicide, alcoholism and violence) among indigenous populations is affected by political and socio-economic variables. The mental health of these populations is poorly studied and described even if mental illness indicators are somewhat alarming. TM still seems to have a role in supporting affected people and may reduce deficiencies due to poor access to medical insurance/coverage, psychiatry and psychotherapy. It would be helpful to combine TM and modern medicine in a healthcare model to face indigenous populations' health needs. CONCLUSION: This review confirms the impact of societal changes, environmental threats and exploitation of natural resources on the mental health of indigenous populations. Global Mental Health needs to deal with the health needs of indigenous populations as well as psychiatry needs to develop new categories to describe psychopathology related to social variance as recently proposed by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5).

Ethnopharmacologic survey of medicinal plants used to treat human diseases by traditional medical practitioners in Dega Damot district, Amhara, Northwestern Ethiopia.

BACKGROUND: One of the services that plants provide for human beings is their wider medicinal application. Although it is not fully assessed, the practice and wider use of traditional medicine is frequent in Ethiopia. Studies conducted previously are confined to the perceptions of modern and traditional health practitioners about traditional medicine. A total of 45 informants were selected purposefully from the study area. For collecting the data, semi-structured interviewees, observation and field walks were employed from August 10 to September 30/2014. To summarize the information, descriptive statistical methods were applied. RESULTS: Sixty species of medicinal plants distributed in 42 families were collected and identified applied locally for the treatment of 55 human disorders. The most commonly treated ones were evil eye, malaria, wound, peptic ulcer disease and rabies. According to this study, leaves were the commonly used plant parts (36.5%) and 39% of the preparations were decoctions. Oral route, 43 (44%) was the commonly used route of application whereas most (54.8%) remedies were administered only once. Fourteen percent of preparations caused vomiting in addition most (40.4%) of the formulations was contraindicated for pregnant patients. Only seventeen percent of the formulations possessed drug food interactions. Most preparations were stored within clothes, 31 (29.8%). There exists a high (ICF = 0.8) evenness of plant use among healers for treating respiratory problems. Alliumsativum (FI = 0.75) for evil eye, Phytolacca dodecandra (FI = 0.8) for rabies and Croton macrostachyus (FI = 0.78) for treating malaria were medicinal plants with highest fidelity levels showing consistency of knowledge on species best treating power. This study also documented that drought, overgrazing and firewood collection are major threats. CONCLUSION: Dega Damot district is loaded in its medicinal plant diversity and indigenous knowledge though plants are highly affected by drought, overgrazing and firewood collection. Therefore awareness activities must be created among the district's population by concerned governmental and nongovernmental organizations about the value of medicinal plants and conservation of these plants. The healing potential and associated adverse issues of the claimed medicinal plants should be assessed before proposing for a broader utilization.

Indigenous injury outcomes: life satisfaction among injured Maori in New Zealand three months after injury.

BACKGROUND: Maori, the indigenous population of New Zealand, experience numerous and consistent health disparities when compared to non-Maori. Injury is no exception, yet there is a paucity of published literature that examines outcomes following a wide variety of injury types and severities for this population. This paper aims to identify pre-injury and injury-related predictors of life satisfaction three months after injury for a group of injured Maori. METHODS: The Maori sample (n = 566) were all participants in the Prospective Outcomes of Injury Study (POIS). POIS is a longitudinal study of 2856 injured New Zealanders aged 18-64 years who were on an injury entitlement claims' register with New Zealand's no-fault compensation insurer. The well-known Te Whare Tapa Wha model of overall health and well-being was used to help inform the selection of post-injury life satisfaction predictor variables. Multivariable analyses were used to examine the relationships between potential predictors and life satisfaction. RESULTS: Of the 566 Maori participants, post-injury life satisfaction data was available for 563 (99%) participants. Of these, 71% reported satisfaction with life three months after injury (compared to 93% pre-injury). Those with a higher injury severity score, not satisfied with pre-injury social relationships or poor self-efficacy pre-injury were less likely to be satisfied with life three months after injury. CONCLUSIONS: The large majority of Maori participants reported being satisfied with life three months after injury; however, nearly a third did not. This suggests that further research investigating outcomes after injury for Maori, and predictors of these, is necessary. Results show that healthcare providers could perhaps put greater effort into working alongside injured Maori who have more severe injuries, report poor self-efficacy and were not satisfied with their pre-injury social relationships to ensure increased likelihood of satisfaction with life soon after injury.

"Our culture is medicine": perspectives of Native healers on posttrauma recovery among American Indian and Alaska Native patients.

American Indian and Alaska Native (Native) people experience more traumatic events and are at higher risk for developing posttraumatic stress disorder compared with the general population. We conducted in-depth interviews with six Native healers about their perspectives on traumatic injury and healing. We analyzed the interviews using an inductive approach to identify common themes. We categorized these themes into four categories: causes and consequences of traumatic injury, risk factors, protective factors, and barriers to care. The implications of our study include a need for improving cultural competence among health care and social services personnel working with Native trauma patients. Additional cumulative analyses of Native healers and trauma patients would contribute to a much-needed body of knowledge on improving recovery and promoting healing among Native trauma patients.

Health status among prehistoric Eskimos from Point Hope, Alaska.

Using the protocol outlined in The Backbone of History: Health and Nutrition in the Western Hemisphere (BBH) (Steckel and Rose. 2002a. The backbone of history: health and nutrition in the Western Hemisphere. Cambridge: Cambridge University Press), this project compares the Mark I Health Index (MIHI) scores of the Ipiutak (n = 76; 100BCE-500CE) and Tigara (n = 298; 1200-1700CE), two samples of North American Arctic Eskimos excavated from Point Hope, Alaska. Macroscopic examination of skeletal remains for evidence of anemia, linear enamel hypoplasias (LEH), infection, trauma, dental health, and degenerative joint disease (DJD) was conducted to assess differences in health status resulting from a major economic shift at Point Hope. These data demonstrate that despite differences in settlement pattern, economic system, and dietary composition, the MIHI scores for the Ipiutak (82.1) and Tigara (84.6) are essentially equal. However, their component scores differ considerably. The Ipiutak component scores are suggestive of increased prevalence of chronic metabolic and biomechanical stresses, represented by high prevalence of nonspecific infection and high frequencies of DJD in the hip/knee, thoracic vertebrae, and wrists. The Tigara experienced more acute stress, evidenced by higher prevalence of LEH and trauma. Comparison of overall health index scores with those published in BBH shows the MIHI score for the Ipiutak and Tigara falling just above the average for sites in the Western Hemisphere, adding support to the argument that the human capacity for cultural amelioration of environmental hardships is quite significant.

War's long shadow: masculinity, medicine, and the gendered politics of trauma, 1914-1939.

War is an inherently traumatizing experience, and during the First World War more than 15,000 Canadian soldiers were diagnosed with some form of war-related psychological wounds. Many more went unrecognized. Yet the very act of seeking an escape from the battlefield or applying for a postwar pension for psychological traumas transgressed masculine norms that required men to be aggressive, self-reliant, and un-emotional. Using newly available archival records, contemporary medical periodicals, doctors' notes, and patient interview transcripts, this paper examines two crises that arose from this conflict between idealized masculinity and the emotional reality of war trauma. The first came on the battlefield in 1916 when, in some cases, almost half the soldiers evacuated from the front were said to be suffering from emotional breakdowns. The second came later, during the Great Depression, when a significant number of veterans began to seek compensation for their psychological injuries. In both crises, doctors working in the service of the state constructed trauma as evidence of deviance, in order to parry a larger challenge to masculine ideals. In creating this link between war trauma and deviance, they reinforced a residual conception of welfare that used tests of morals and means to determine who was deserving or undeserving of state assistance. At a time when the Canadian welfare state was being transformed in response to the needs of veterans and their families, doctors' denial that "real men" could legitimately exhibit psychosomatic symptoms in combat meant that thousands of legitimately traumatized veterans were left uncompensated by the state and were constructed as inferior, feminized men.

Self care and health-seeking behavior of migrant farmworkers.

There are an estimated three million migrant and seasonal farmworkers (MSFW) in the United States. In addition to the inherent dangers of farm work, numerous factors place MSFW at even greater risk for work-related injuries. Little is known about how MSFW care for work-related injuries, and how the decision to seek professional care is made. A prospective survey using face-to-face structured interviews was used to explore the type and frequency of occupational injuries as well as self-care and health-care seeking practices of MSFW. Musculoskeletal injuries were the most commonly reported injuries, followed by injuries of the skin and chemical exposure. Self care with over-the-counter remedies was the predominant method of dealing with injuries, and, with the exception of chemical exposure, was found to be for the most part, appropriate. The reported use of alternative medicine or herbal remedies was low. Future research efforts should focus on ergonomic modifications and farmworker education to reduce or prevent musculoskeletal injuries. The number of reported chemical exposures and inappropriate treatment draw attention to the need for continued efforts for both primary prevention of exposure and optimal treatment once exposure occurs.

Injury prevention in Australian Indigenous communities.

Injury prevention in Indigenous communities in Australia is a continuing national challenge, with Indigenous fatality rates due to injury three times higher than the general population. Suicide and transport are the leading causes of injury mortality, and assault, transport and falls the primary causes of injury morbidity. Addressing the complex range of injury problems in disadvantaged Indigenous communities requires considerable work in building or enhancing existing capacity of communities to address local safety issues. Poor data, lack of funding and absence of targeted programs are some of the issues that impede injury prevention activities. Traditional approaches to injury prevention can be used to highlight key areas of need, however adaptations are needed in keeping with Indigenous peoples' holistic approach to health, linked to land and linked to community in order to address the complex spiritual, emotional and social determinants of Indigenous injury.

Non-fatal injuries among Pacific infants in Auckland: data from the Pacific Islands families first two years of life study.

AIMS: Child injury is the leading cause of mortality and morbidity in developed countries. While Pacific infant death rates are relatively high in New Zealand, little is known about non-fatal injury rates. We seek to describe maternally reported injury in Pacific infants aged between 0-24 months. METHODS: A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed. Maternal home interviews were conducted at 6 weeks, 12 months and 24 months postpartum and injury events were recalled. Marginal models using generalized estimating equations (GEEs) were used to analysis the longitudinal data. RESULTS: The inception cohort included 1398 infants at 6 weeks, 1241 infants at 12 months and 1161 infants at 24 months. The age-specific injury incidence per 1000 person-years exposure was estimated at 48 (95% CI: 23, 88) injuries for infants aged 0-6 weeks, 106 (95% CI: 88, 127) injuries for infants aged 7 weeks-12 months and 174 (95% CI: 151, 199) injuries for infants aged 13-24 months. In the multivariable GEE model, older infants (P < 0.001), infants who were male (P = 0.01), born to Pacific Island fathers and non-Pacific Island mothers (P < 0.001), and in higher or unknown income groups (P = 0.01) were significantly more likely to suffer injury events. No significant two-factor interaction with infant age was identified. CONCLUSIONS: Among Pacific infants, non-fatal injury is common and injury incidence rates are considerably higher than national levels. Male infants and those born into ethnically mixed families, where the father was of Pacific Island ethnicity and the mother was non-Pacific, were at increased relative risk of injury and might benefit from specific injury prevention targeting. However, given the high injury incidence levels found, we advocate that investigation and targeting of culturally appropriate prevention strategies for all Pacific families with young children is required to reduce injury rates for Pacific infants in New Zealand.

Damaged goods: return to sender. A review of the historical medical records of repatriated Chinese miners.

After the Anglo-Boer (South African) War (1899-1902), there was a shortage of unskilled labor on the South African gold mines. Chinese men were imported to make up for the deficit. This article reviews the records of indentured Chinese mine workers examined for repatriation in 1905. The records tell of high proportions of social disorders, respiratory diseases, musculoskeletal disorders, opium addiction, and injury. These reflect the social and physical conditions to which these men were exposed in the mines.

Evaluation of a New Zealand indigenous community injury prevention project.

OBJECTIVE: To evaluate the Turanganui-a-kiwa Community Injury Prevention Project, based in a provincial town on the North Island of New Zealand with an extensive indigenous population (Maori). METHOD: The evaluation design was quasi-experimental and included process, impact and outcome measures. RESULTS: Process evaluation findings indicated that adopting an holistic lifespan approach to injury prevention was successful in this Maori community. The three main areas of activities were: child road safety; safer alcohol use in the road, sporting and home environments for young people and adults; and fire safety for older people. Significant increases in awareness of injury prevention initiatives were found among Turanganui-a-kiwa whanau (families) (p < 0.001). A large increase in the take-up of car restraints among Maori young children was demonstrated (pre 10%, post 74%). The safe alcohol dual message approach also resulted in significant increases in the number of respondents wearing protective equipment for sports (p < 0.05). The results of the fire safety initiative was that 120 kaumatua homes now have correctly installed smoke alarms and there is now a commitment from the Fire Service to maintain these alarms. Outcome evaluation findings showed that there was a significant decrease in hospitalization injury rates across the lifespan in Turanganui-a-kiwa (p < 0.05). CONCLUSION: Despite the challenges associated with conducting community injury prevention projects the conduct of this evaluation provides previously unknown information on an indigenous (Maori) injury prevention programme. The success of the programme would appear to be that the project was perceived as an intervention for Maori operating within a Maori framework which addressed Maori aspirations. IMPLICATIONS: As so little is known about injury prevention initiatives in indigenous populations, the findings presented in this article will provide important information for the future development of other indigenous injury prevention programmes.

Culture, health, and healing.

Americans are increasingly interested in and willing to participate in alternative or adjunctive healthcare, which is sometimes called complementary healthcare. Some believe this is because of wide-spread cultural diversity or an increasing awareness of options in health practice, while others contend it is a reaction to dissatisfaction with Western health practices. Diversity among cultures and subcultures has posed challenges for clinicians. This article addresses the impact of culture on health and healing, examining alternative health practices and their impact on chronic care, specifically chronic wound care.

Cuidado popular com feridas: representaçöes e práticas na comunidade de Säo Gonçalo, Cuiabá-MT / Popular care of wounds: representations and practices in the Säo Gonçalo community, Cuiabá-MT

Este trabalho é um estudo etnográfico desenvolvido junto aos moradores da comunidade de Säo Gonçalo, uma comunidade tradicional de pescadores e ceramistas do município de Cuiabá, estado de Mato Grosso. Teve como objetivo compreender o cuidado conferidas nesse contexto sócio-cultural. Como fundamentaçäo teórica adotou-se o conceito de cultura de Geertz e pressupostos da antropologia e da Teoria de Representaçöes Sociais. A coleta de dados foi realizada através de suvey e posterior coleta de narrativas de oito mulheres que foram as colaboradoras do estudo, utilizando técnicas de entrevista e observaçäo participante. A interpretaçäo dos dados possibilitou constatar que os moradores da comunidade de Säo Gonçalo têm modos peculiares de explicar as feridas, revelando uma concepçäo etiológica de multicasualidade - admitindo causas naturais, sociais e sobrenaturais - que orienta seus procedimentos terapêuticos. Sendo suas representaçöes baseadas em conceitos diversos e muitas vezes incongruentes ou opostos aos da medicina científica, suas práticas frequentemente se opöem-se àquelas preconizadas pelos profissionais pertencentes ao sistema oficial de saúde. Identifica-se assim, um hiato entre esses profissionais e a populaçäo, sendo possível inferir que este é gerado principalmente por barreiras linguísticas e culturais. Frente a estas constataçöes, discute-se a importância e a necessidade do estabelecimento de um diálogo intercultural entre esses dois grupos, o que poderá ser conseguido por meio de mudanças nos paradigmas que orientam o ensino, a pesquisa e a prática dos enfermeiros e demais profissionais da área de saúde