a Duke Global Health Institute, Duke University , Durham , NC , USA.
Glob Public Health. 2018 Apr;13(4):503-517. doi: 10.1080/17441692.2016.1207197. Epub 2016 Jul 14.
Although approximately one half of Guatemalans are indigenous, the Guatemalan Maya account for 72% of the extremely poor within the country. While some biomedical services are available in these communities, many Maya utilise traditional medicine as a significant, if not primary, source of health care. While existing medical anthropological research characterises these modes of medicine as medically dichotomous or pluralistic, our research in a Maya community of the Western Highlands, Concepción Huista, builds on previous studies and finds instead a syncretistic, imbricated local health system. We find significant overlap and interpenetration of the biomedical and traditional medical models that are described best as a framework where practitioners in both settings employ elements of the other in order to best meet community needs. By focusing on the practitioner's perspective, we demonstrate that in addition to patients' willingness to seek care across health systems, practitioners converse across seemingly distinct systems via incorporation of certain elements of the 'other'. Interventions to date have not accounted for this imbrication. Guatemalan governmental policies to support local healers have led to little practical change in the health-care landscape of the country. Therefore, understanding this complex imbrication is crucial for interventions and policy changes.
虽然大约有一半的危地马拉人是土著人，但危地马拉的玛雅人占该国极度贫困人口的 72%。虽然这些社区提供了一些生物医学服务，但许多玛雅人将传统医学作为重要的、如果不是主要的医疗保健来源。虽然现有的医学人类学研究将这些医学模式描述为医学上的二分法或多元化，但我们在高地西部的一个玛雅社区——康塞普西翁·胡伊斯塔的研究建立在前人的基础上，发现了一种融合的、交织的当地卫生系统。我们发现生物医学和传统医学模式之间存在显著的重叠和相互渗透，最好将其描述为一个框架，在这个框架中，两种环境中的从业者都采用其他环境中的元素，以最好地满足社区的需求。通过关注从业者的视角，我们证明，除了患者愿意跨卫生系统寻求护理外，从业者还通过纳入“其他”系统的某些元素来跨越看似不同的系统进行交流。迄今为止的干预措施没有考虑到这种交织。危地马拉政府支持当地治疗师的政策并没有给该国的医疗保健格局带来实质性的变化。因此，了解这种复杂的交织关系对于干预措施和政策变革至关重要。
