ABSTRACT HEALTHCARE USE PATTERNS IN DOMINICA: ETHNOMEDICAL INTEGRATION IN AN ERA OF BIOMEDICINE by Seann Dinnon Regan The power and influence of globalization and the worldwide dominance of biomedicine profoundly impact ethnomedical practices throughout the world. However, ethnomedicine still plays a prominent role in providing medical care to many people. In Dominica, widespread ethnomedical knowledge and traditional plant use as well as a biomedical healthcare system with inadequate infrastructure combine to create a situation of medical decision making. This research investigates how Dominicans make healthcare use decisions and seeks to better understand the state of medicine in Dominica. The results of this research reveal a complex blend of medical practices in the everyday lives of Dominicans and support the notion that biomedicine and national healthcare campaigns could benefit from greater collaboration, understanding, and integration with ethnomedicine. HEALTHCARE USE PATTERNS IN DOMINICA: ETHNOMEDICAL INTEGRATION IN AN ERA OF BIOMEDICINE A thesis presented to the faculty of the Geography Department of Miami University In partial fulfillment of the requirements for the degree of Master of Arts by Seann Dinnon Regan 2010 Advisor: ____________________ Dr. Thomas Klak Reader: _____________________ Dr. José Amador de Jesús Reader: _____________________ Dr. Marcia England Reader: _____________________ Ms. Robbyn Abbitt TABLE OF CONTENTS TABLE OF CONTENTS ........................................................................................................... II LIST OF FIGURES ................................................................................................................. IV ACKNOWLEDGEMENTS........................................................................................................ V DEFINITIONS OF KEY TERMS ............................................................................................ VI CHAPTER 1 ...............................................................................................................................1 INTRODUCTION ......................................................................................................................1 CHAPTER 2 ...............................................................................................................................6 LITERATURE REVIEW ............................................................................................................6 Perspectives from Medical Geography, Anthropology, and Spatial Epidemiology................................................ 6 Access to Healthcare .......................................................................................................................................... 9 Conceptualization of Disease ........................................................................................................................... 12 CHAPTER 3 ............................................................................................................................. 16 DOMINICA: COUNTRY BACKGROUND ............................................................................. 16 Historical Context ............................................................................................................................................ 16 Ethnomedicine ................................................................................................................................................. 19 Colonial medicine ............................................................................................................................................ 21 Population ....................................................................................................................................................... 23 Current health issues ........................................................................................................................................ 25 Current Structure of Biomedicine in Dominica.................................................................................................. 28 Current Structure of Ethnomedicine in Dominica .............................................................................................. 32 CHAPTER 4 ............................................................................................................................. 35 METHODS ............................................................................................................................... 35 Study Participants ............................................................................................................................................ 36 Research Techniques ........................................................................................................................................ 39 Analysis ........................................................................................................................................................... 41 ii CHAPTER 5 ............................................................................................................................. 43 DATA ANALYSIS AND DISCUSSION .................................................................................. 43 Use patterns ..................................................................................................................................................... 45 Perspectives on Medicine ................................................................................................................................. 47 Education......................................................................................................................................................... 50 Generational Differences ................................................................................................................................. 55 Participant Observation ................................................................................................................................... 59 Accessibility and Medicine ............................................................................................................................... 61 Affordability ..................................................................................................................................................... 64 Availability ...................................................................................................................................................... 65 CHAPTER 6 ............................................................................................................................. 68 CONCLUSION ......................................................................................................................... 68 REFERENCES ......................................................................................................................... 71 APPENDIX: ............................................................................................................................. 76 iii LIST OF FIGURES Figure 3-1: Map of the Caribbean region ...................................................................................................... 17 Figure 3-2: Ethnomedicine for sale in Roseau ............................................................................................... 19 Figure 3-3: Map of the Kalinago/Carib Territory .......................................................................................... 21 Figure 3-4: Dominican population 2010........................................................................................................ 24 Figure 3-5: Cases of diabetes in Dominica 1995 – 2006 ................................................................................ 26 Figure 3-6: Cases of malnutrition in Dominica 1995 – 2006 .......................................................................... 27 Figure 3-7: Cases of hypertension in Dominica 1995 – 2006 ......................................................................... 28 Figure 3-8: Health centers in Dominica ........................................................................................................ 30 Figure 3-9: Three tiered structure of biomedicine in Dominica ...................................................................... 31 Figure 3-10: Common ailments and ethnomedical treatments ........................................................................ 32 Figure 3-11: Humoral framing in Dominican ethnomedicine ......................................................................... 34 Figure 4-1: Interview population .................................................................................................................. 37 Figure 4-2: Interview locations ..................................................................................................................... 40 Figure 5-1: Medical decision making ............................................................................................................ 44 Figure 5-2: Medical use practice over the previous year (N=29) .................................................................... 46 Figure 5-3: Medical use practice over the last month (N=29) ........................................................................ 46 Figure 5-4: Perspectives of medicine (N=29) ...............................................................................................