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A Convivência Competitiva De Três Sistemas De Crenças E Práticas De Saúde. Da Mesma Forma, O Artigo De GB Fosu

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A Convivência Competitiva De Três Sistemas De Crenças E Práticas De Saúde. Da Mesma Forma, O Artigo De GB Fosu a convivência competitiva de três sistemas de da, pelos temas apropriados aos antropólogos crenças e práticas de saúde. Da mesma forma, enquanto profissionais e seu mercado de traba- o artigo de G. B. Fosu (“Perceptions of mental lho, mas, sobretudo, pela relevância das aborda- disorders in the context of social change”) gens conceituais que os artigos suscitam. sublinha a interpenetração de diferentes códigos interpretativos dos distúrbios mentais. Esta revista vale a pena ser lida por vários Maria Cecília de Souza Minayo motivos: pelas questões substantivas que abor- Escola Nacional de Saúde Pública/Fiocruz Drum and Stethoscope: Integrating and ethnomedicine represent philosophies of Ethnomedicine and Biomedicine in Bolivia. healing that are based on different premises. Joseph W. Bastien. Salt Lake City: University Doctors assume that the causative factors of of Utah Press, 1992. 266 p., ilus., biblio. disease are universal and can be discovered (Brochura) by scientific investigation. In contrast, ISBN 0-87480-386-1 ethnomedical systems vary by locality, since US$ 34.95 their healing practices are based on the traditions of a particular region and herbal Throughout South America, biomedical medicines on locally available plants. resources — physicians, trained nurses, Ethnomedical ideologies may include beliefs laboratories, hospitals with modern equipment about the proper relations of people to one — are concentrated in the larger centers, another and to the supernatural world, thus while rural areas, which are often remote and curing practices may aim at restoring balance difficult to reach, lack even the most basic in these relations through rituals prescribed by facilities for primary health care. Moreover, the healer. The interventions of traditional even in the cities, because of rapidly healers are often successful in restoring their increasing population, health care is spread patients’ well-being because they are rooted thin, and the best of it is only accessible to in the culture and traditions that healer and the middle and upper classes. patient share. In this book Bastien argues that, in relying Over a number of years Bastien has studied exclusively on biomedicine to provide for the the Kallawaya herbalists of highland Bolivia primary health care needs of developing who maintain a tradition of healing with countries, policy makers are neglecting the plants that goes back hundreds of years. potential contributions that traditional healers, According to Bastien these herbal specialists herbalists, ritual practitioners, and midwives employ more than a thousand medicinal could make to an integrated system of health plants, of which 25 to 30% are effective care. He points out that in Bolivia there is “at according to measurements made by least one midwife, shaman, and herbalist for biomedical methods. Kallawaya herbalists, every rural community with a population who travel widely over assigned trade routes, ranging from 200 to 1,000 in population, became renowned for their healing abilities compared to one physician per 7,000 in throughout the Andean countries, and even in population”. Europe. An aspiring herbalist would spend as Bastien does not advocate that attempts to long as 8 years in apprenticeship learning the broaden the benefits of biomedicine should be art from a master healer before undertaking abandoned. He believes that it is possible to cures on his own. After a period during which integrate biomedicine and ethnomedicine in an herbalists were persecuted by the biomedical economically and culturally appropriate establishment, they have recently gained new system of health care that serves people better respect, partly due to the current search for by preserving the advantages of both. medicinal plants and the international revival Admittedly, this is not easy, for biomedicine of interest in herbal medicine. 402 Cad. Saúde Públ., Rio de Janeiro, 9 (3): 395-404, jul/set, 1993 Since the Alma-Ata conference in 1978 expensive imported drugs. Not only can WHO and UNICEF have advocated basing herbalists identify plants with therapeutic systems of primary health care in developing value, they can describe from firsthand countries on community participation and the experience the effects of the plants they utilization of ethnomedicine. However, up to prescribe. the present this model has seldom been Bolivia, with its strong traditions of herbal implemented because of the resistance of and ritual healing, the isolation, both biomedically trained doctors and nurses who geographic and cultural, of rural communities, see ethnomedicine as a “second-class system” and lack of economic resources to deliver rooted in superstition and a threat to their modern medical technology to all its people, claim of exclusive authoritative knowledge. In would seem to be an appropriate country to Bastien’s view, the successful implementation implement the integrated model that Bastien of a system that combines all the resources advocates. However, he is able to point only available to a rural community requires that to isolated instances of true integration. Some both biomedical and ethnomedical herbalists have incorporated biomedical practitioners learn to respect and acknowledge practices in their treatments, and a few each other’s areas of expertise. doctors have collaborated with shamans and “The approach to integration advocated herbalists. A rural health program for the within this book is one of articulation or a department of Oruro designed by a medical modified autonomy model. This model anthropologist and a rural health educator advocates maintaining the ethnoscience and seems to have considerable success in training cultural integrity of ethnomedicine and local people as community health workers. accommodating folk knowledge of its Some of these health promoters find practitioners. This approach not only respects themselves in opposition with traditional and recognizes the value of ethnomedicine as healers, but the Ministry of Health has being linked to environmentally adaptive encouraged the selection of ethnomedical strategies, as well as deeply rooted beliefs, practitioners for training as health promoters, but also assists its practitioners in improving and one-fourth of the promoters in the Oruro their therapeutic efforts with biomedical project practice ethnomedicine as midwives, practices that are economically and herbalists, diviners, or shamans. environmentally adaptive, consonant with Medical anthropologists have found that cultural beliefs, and sensitive to their when patients have a choice of biomedical experiences of illness. Articulation implies a and ethnomedical health care they often do culturally sensitive understanding of the not depend exclusively on either, but choose ethnomedical system and its assumptions opportunisticaly, perhaps consulting both for (body concepts, cosmology, etiology, and the same complaint. It is left to the patient to ethnopharmacology), practices, and ecology of “integrate” these separate and often competing the region to which it is adapted. Knowledge tracks, sometimes inappropriately. At the level of these structural features is necessary in of the system, perhaps cooperation and mutual order to fit some technique from biomedicine respect is a more attainable goal than into the system” (pp. 39-40). integration. When a mysterious epidemic In order to attain these goals, more research recently broke out on the Navajo reservation is needed into ecological and cultural features in Arizona, traditional healers were the first to of ethnomedicine. Bastien points out that draw a connection between the disease and research in ethnomedicine should receive increased rodent population following a mild, government support not only because it wet winter, and alerted researchers from the contributes to the health care of rural Center for Disease Control. The disease populations, but because it may also serve the proved to be due to a hantavirus infection national economy by testing the spread by rodents. While Navajo medicine pharmacological properties of plant-based men and biomedical researchers operate in medicines that may effectively substitute separate spheres, the local ecological Cad. Saúde Públ., Rio de Janeiro, 9 (3): 395-404, jul/set, 1993 403 knowledge of the traditional healers was Bastien is a strong advocate for promoting important in identifying the source of respect for all those who work to preserve infection. While counseling caution and and improve people’s health and well-being, avoidance of rodents, the medicine men whether by conventional biomedical or allayed the fears of the people by prescribing ethnomedical methods of healing. such curing rituals as the Squaw Dance or Enemy Way. Drum and Stethoscope is a thought- Nancy M. Flowers provoking book, and should be required Department of Anthropology, Hunter College reading for public health professionals. City University of New York 404 Cad. Saúde Públ., Rio de Janeiro, 9 (3): 395-404, jul/set, 1993.
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