TY - BOOK

T1 - Traditional Medicine in Developing Countries

T2 - A Study of Conceptualizations and Utilization in Rural Nepal

AU - Thorsen, Rikke Stamp

PY - 2015

Y1 - 2015

N2 - People use traditional medicine to meet their health care needs in developing countries andmedical pluralism persists worldwide despite increased access to allopathic medicine.Traditional medicine includes a variety of treatment opportunities, among others, consultationwith a traditional healer or spiritual healer and self-treatment with herbal medicine ormedicinal plants. Reliance on traditional medicine varies between countries and rural andurban areas, but is reported to be as high as 80% in some developing countries. Increasedrealization of the continued importance of traditional medicine has led to the formulation ofpolicies on the integration of traditional medicine into public health care. Local levelintegration is already taking place as people use multiple treatments when experiencingillness. Research on local level use of traditional medicine for health care, in particular the useof self-treatment with medicinal plants, is however scarce. Thus, this thesis contributes tounderstanding the extent of traditional medicine use as well as why people use it in rural areasin developing countries. This is important for the formulation of inclusive health care policieswhich can address the health care needs of people.Using Nepal as a case, the specific objectives of this thesis are; 1) to quantify the reliance ontraditional medicine for health care as well as study the determinants of this reliance in ruralNepal; 2) to increase the understanding of why people use traditional medicine for health carein rural Nepal. A mixed methods research design was employed and data were collected in2012 through 54 semi-structured interviews, 10 group discussions and a household survey in571 households. Data collection took place in three sites in Nepal representing differences inaccess to health care and medicinal plants as well as in livelihoods and ethnicities of thepopulations.The three papers in this thesis address traditional medicine within the pluralistic medicalfields of Nepal from different levels of analysis. The first paper consider the various treatmentopportunities available to people and contributes to increasing the understanding of howpeople conceptualize these and how treatment seeking practices are interpreted andexperienced differently among people. The second paper quantifies reliance on traditionalmedicine and medicinal plants whereas the third paper addresses one specific form oftraditional medicine and explores self-treatment with medicinal plants and the various waysthis treatment is used to fulfill health care and social needs.The findings show that traditional medicine plays an important role in health care in ruralareas in Nepal due to its continued utilization as well as through the ways traditional medicineis conceptualized and used to fulfill health care and social needs. Using the concept oftherapeutic landscapes, this study suggests that the value of traditional medicine to people andthe ways they conceptualize treatments which are “traditional” reflect otherconceptualizations than the “modern/traditional” dichotomy. People conceptualizedtreatments through notions related to time and place, positioning treatments on spectrumsranging from home treatments to city treatments as well as from past to present. Through theirconceptualizations and practices of treatment seeking people engaged in creating andsustaining pluralistic therapeutic landscapes variously influenced by everyday contexts andstructural constraints.This study found that traditional medicine was used as a treatment in 31% of illness episodesduring a one month recall period and self-treatment with medicinal plants was the mostimportant type of traditional medicine used as it was used in 22% of illness episodes. Overall,78% of households reported to sometimes use self-treatment with medicinal plants to treat illhousehold members. Importantly, this study points to the potential under-reporting of selftreatmentwith medicinal plants as many treatments with medicinal plants were reported ascommon sense treatments rather than as self-treatment with medicinal plants. This studyfound that being rich was a significant determinant of both use of traditional medicine andself-treatment with medicinal plants. This study hence questions the often held assumptionthat poor people are most reliant on traditional medicine. Other determinants of traditionalmedicine use included age, gender of household head, education and having a chronic illnessas well as whether someone in the household held knowledge about medicinal plants.Self-treatment with medicinal plants was used in various ways reflecting the various healthcare and social needs, this treatment was intended to fulfill. Self-treatment with medicinalplants was used in five main ways; as the preferred, the pragmatic, the convenient, thecompelled and the auxiliary treatment. Prevalence of use and ways of using self-treatmentwith medicinal plants varied among sites reflecting differences in social and health care needsas well as everyday realities and people’s experiences of social development or the lackthereof.This thesis expands understandings of the relations between access to various types of healthcare and use of traditional medicine. It questions often held assumptions about the availabilityof traditional medicine and about medicinal plants being easily accessible, showing that therewas little access to traditional healers and Ayurvedic medicine in the sites and that manypeople considered medicinal plants less accessible than other types of treatment.Finally, this thesis points out the need for policy makers to address both the currentinequitable access to allopathic medicine and to providers of traditional medicine as well ashow to enable people’s practices of self-treatment with medicinal plants in order to fulfilltheir varied health care and social needs.

AB - People use traditional medicine to meet their health care needs in developing countries andmedical pluralism persists worldwide despite increased access to allopathic medicine.Traditional medicine includes a variety of treatment opportunities, among others, consultationwith a traditional healer or spiritual healer and self-treatment with herbal medicine ormedicinal plants. Reliance on traditional medicine varies between countries and rural andurban areas, but is reported to be as high as 80% in some developing countries. Increasedrealization of the continued importance of traditional medicine has led to the formulation ofpolicies on the integration of traditional medicine into public health care. Local levelintegration is already taking place as people use multiple treatments when experiencingillness. Research on local level use of traditional medicine for health care, in particular the useof self-treatment with medicinal plants, is however scarce. Thus, this thesis contributes tounderstanding the extent of traditional medicine use as well as why people use it in rural areasin developing countries. This is important for the formulation of inclusive health care policieswhich can address the health care needs of people.Using Nepal as a case, the specific objectives of this thesis are; 1) to quantify the reliance ontraditional medicine for health care as well as study the determinants of this reliance in ruralNepal; 2) to increase the understanding of why people use traditional medicine for health carein rural Nepal. A mixed methods research design was employed and data were collected in2012 through 54 semi-structured interviews, 10 group discussions and a household survey in571 households. Data collection took place in three sites in Nepal representing differences inaccess to health care and medicinal plants as well as in livelihoods and ethnicities of thepopulations.The three papers in this thesis address traditional medicine within the pluralistic medicalfields of Nepal from different levels of analysis. The first paper consider the various treatmentopportunities available to people and contributes to increasing the understanding of howpeople conceptualize these and how treatment seeking practices are interpreted andexperienced differently among people. The second paper quantifies reliance on traditionalmedicine and medicinal plants whereas the third paper addresses one specific form oftraditional medicine and explores self-treatment with medicinal plants and the various waysthis treatment is used to fulfill health care and social needs.The findings show that traditional medicine plays an important role in health care in ruralareas in Nepal due to its continued utilization as well as through the ways traditional medicineis conceptualized and used to fulfill health care and social needs. Using the concept oftherapeutic landscapes, this study suggests that the value of traditional medicine to people andthe ways they conceptualize treatments which are “traditional” reflect otherconceptualizations than the “modern/traditional” dichotomy. People conceptualizedtreatments through notions related to time and place, positioning treatments on spectrumsranging from home treatments to city treatments as well as from past to present. Through theirconceptualizations and practices of treatment seeking people engaged in creating andsustaining pluralistic therapeutic landscapes variously influenced by everyday contexts andstructural constraints.This study found that traditional medicine was used as a treatment in 31% of illness episodesduring a one month recall period and self-treatment with medicinal plants was the mostimportant type of traditional medicine used as it was used in 22% of illness episodes. Overall,78% of households reported to sometimes use self-treatment with medicinal plants to treat illhousehold members. Importantly, this study points to the potential under-reporting of selftreatmentwith medicinal plants as many treatments with medicinal plants were reported ascommon sense treatments rather than as self-treatment with medicinal plants. This studyfound that being rich was a significant determinant of both use of traditional medicine andself-treatment with medicinal plants. This study hence questions the often held assumptionthat poor people are most reliant on traditional medicine. Other determinants of traditionalmedicine use included age, gender of household head, education and having a chronic illnessas well as whether someone in the household held knowledge about medicinal plants.Self-treatment with medicinal plants was used in various ways reflecting the various healthcare and social needs, this treatment was intended to fulfill. Self-treatment with medicinalplants was used in five main ways; as the preferred, the pragmatic, the convenient, thecompelled and the auxiliary treatment. Prevalence of use and ways of using self-treatmentwith medicinal plants varied among sites reflecting differences in social and health care needsas well as everyday realities and people’s experiences of social development or the lackthereof.This thesis expands understandings of the relations between access to various types of healthcare and use of traditional medicine. It questions often held assumptions about the availabilityof traditional medicine and about medicinal plants being easily accessible, showing that therewas little access to traditional healers and Ayurvedic medicine in the sites and that manypeople considered medicinal plants less accessible than other types of treatment.Finally, this thesis points out the need for policy makers to address both the currentinequitable access to allopathic medicine and to providers of traditional medicine as well ashow to enable people’s practices of self-treatment with medicinal plants in order to fulfilltheir varied health care and social needs.

UR - https://soeg.kb.dk/permalink/45KBDK_KGL/fbp0ps/alma99122698043005763

M3 - Ph.D. thesis

BT - Traditional Medicine in Developing Countries

PB - Department of Food and Resource Economics, University of Copenhagen

ER -