Lepowsky M
Department of Anthropology, University of Wisconsin, Madison 53706.
Soc Sci Med. 1990;30(10):1049-63. doi: 10.1016/0277-9536(90)90291-y.
Research on a remote and culturally conservative Papua New Guinea island before and after the introduction of biomedical primary health care in the form of government aid posts shows that beliefs in the supernatural causation of serious illness and death by sorcery, witchcraft or taboo violation remain largely unchanged after a decade. Most islanders first seek treatment from traditional healers who can identify and combat the underlying supernatural causes of illness. A healer, traditional or modern, must be greatly trusted by patient and kin due to fears of sorcery and witchcraft attack, and aid post orderlies, from a different cultural and linguistic group, find it difficult to gain the confidence of the community. Orderlies and other health care providers should not present themselves as being in competition with traditional healers but concentrate on earning the trust of community members. Individuals from the local community should be offered training as aid post orderlies and primary health care workers. The islanders' hierarchy of resort to medical treatment is variable, and biomedicine and traditional healing have not assumed complementary functions. Traditional theories of disease causation and treatment are part of indigenous religious beliefs and thus highly resistant to change. Acceptance of biomedical treatment can occur without rejection of supernatural theories of disease causation. The rate of acceptance may vary among ethnic groups within the same country or region due to underlying cultural or religious differences. The constraints of inter-ethnic differences and of traditional beliefs concerning health and illness within which the health system must function in this case are found in many multi-ethnic developing countries.
在巴布亚新几内亚一个偏远且文化保守的岛屿上，以政府援助站形式引入生物医学初级卫生保健前后的研究表明，在十年后，关于严重疾病和死亡由巫术、魔法或违反禁忌等超自然原因导致的信念基本保持不变。大多数岛民首先会寻求传统治疗师的治疗，他们能够识别并对抗疾病潜在的超自然原因。由于担心遭受巫术和魔法攻击，患者及其亲属必须高度信任治疗师，无论是传统治疗师还是现代治疗师，而来自不同文化和语言群体的援助站护理员很难获得社区的信任。护理员和其他医疗保健提供者不应将自己视为与传统治疗师竞争，而应专注于赢得社区成员的信任。应向当地社区的个人提供培训，使其成为援助站护理员和初级卫生保健工作者。岛民寻求医疗治疗的层级各不相同，生物医学和传统治疗并未发挥互补作用。传统的疾病因果关系和治疗理论是本土宗教信仰的一部分，因此极难改变。接受生物医学治疗并不一定会排斥疾病因果关系的超自然理论。由于潜在的文化或宗教差异，同一国家或地区内不同种族群体的接受率可能会有所不同。在这种情况下，卫生系统必须在其中运作的族裔差异以及关于健康和疾病的传统信仰的限制，在许多多民族发展中国家都存在。
