Medical Pluralism By Yusuf Abdu Misau

Medical pluralism

Dr. Yusuf Abdu MisauMBBS(ABU), MPH(UM), PhD Student(UM)

Department of Social and Preventive Medicine,

University of Malaya

Acknowledgement I wish to acknowledge A/P Nabilla Al-Sadat for

permission to use her slides in this presentation

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Case Study

Mr A is a 32 year old man in your community who has been complaining of headaches for the last one month.

Discuss his process of seeking help for his problem

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What is Medical pluralism?

“Prior to the emergence of biomedicine as the dominant system of healing, endowed with monopolistic powers by favor of most western states, many other forms of

healings had flourished”.

Porter 1989


What is Medical pluralism?

Medical pluralism is the adoption of more than one medical system, or the simultaneous integration of both orthodox medicine with complementary and alternative medicine (CAM)


Components of a Health Care/ Medical systemA medical system has two inter related

aspects: A cultural aspect- includes certain

basic concepts, theories, normative practices and shared modes of perception


A social aspect- including its organization into certain specified roles and rules governing relationships between these roles in specialized settings (such as a hospital or a doctor’s office)


Components of a Health Care/ Medical system

The three sectors of health care Kleinman: Three overlapping sectors of health care

1. The popular sector

2. The folk sector

3. The professional sector

Its own ways of explaining and treating ill health Defining who is the healer and who is the patient Specifying how healer and patient should interact


The popular sector The lay, non-professional, non-specialist domain Ill health is first recognized and defined here Health care activities are initiated All therapeutic options that people utilize without any

payment and without consultation. Includes self-treatment Advice given by non-professional Healing in a self help group


The popular sector The MAIN PLAYER- the real site of PHC (70-90% of

health care takes place within this sector) The family- usually the women (mothers/grandmothers) Both patient and healer share similar assumptions about

health and illness Includes a set of beliefs about health maintenance ‘correct’ behavior for preventing ill health Food, use of amulets


The popular sectorThe individuals who tend to act as a source of health

advice more often than others Those with long experience of a particular illness Those with extensive experience The paramedical professions –consulted informally Doctors spouses Hairdressers, salesmen, bank tellers, religious teachers Organizers of self help group Members of healing cults/ churches


The folk sector

Healers specialize in forms of healing that are either sacred or secular or a mixture of both

Not part of the official medical system

Example: Secular, technical experts : bone setters,

midwives, tooth extractors, herbalists, Boka (Nigeria)

Spiritual healers, clairvoyants, shamans, bomohs


The folk sector Most folk healers share the basic cultural values and

world view of the communities in which they live including beliefs about the origin, significance and treatment of ill health

Approach is holistic Balance between people and their social, natural and

supernatural environments


The folk sector Characteristics:

Little formal training Informal networks Frequent involvement of the family in diagnosis

and treatment


Advantages Frequent involvement of

the family in healing rites

Most effective PHC -Can influence the society

Healing takes place in a familiar setting

Not separated by class, economic position

Doctors tell what has happened , folk healers tell why

Docs tend to place the patients ill health in a limited temporal frame and to localise it to a particular part of the body


Limitations Training- little formal

training Born into a healing

family etc Open to abuse Techniques used may be

dangerous

Therefore, important to view them in a balanced way, avoid over idealization and over criticism

Arcadian view vs barbaric view


The Professional Sector = medical system The organized, legally sanctioned profession Modern, western, scientific medicine, allopathy,

biomedicine Medical and para-medical professionals An expression of the values and social structure of the

society from which it arises


The medical profession Based on a body of specialized knowledge (the

content) not easily acquired Has a collegial organization

Maintain control over their field of expertise Promote their common interests Maintain monopoly of knowledge Protect themselves from competition Monitor the competence and ethics

Hierarchies of knowledge and power


Alternative and complementary medicine Overlaps both folk and professional sectors Examples: acupuncturists, homeopaths,

chiropractors, osteopaths, herbalists, naturopaths, hypnotists, massage therapists, meditation experts

Rapidly growing in popularity


Issue Integration of TCM into the medical system (WHO-

1978) Definition of traditional medicine –not clear Assumption of the efficacy not justified – egs inability

to cure malaria, cholera, yellow fever and etc Could be part of the problem Success stories in MCH, AIDS prevention, treatment

of mental illness etc


Summarizing…… Medical pluralism is a wide range of therapeutic

options available for the alleviation and prevention of physical discomfort or emotional distress

Professional sector -Official Medical system comprises of Medical, nursing and allied professions

Folk and the popular sector Influences the choices of health seeking behavior Public health implications


Brainstorm…….

In your view, how has medical pluralism impact on public health governance of your society?

Your ability to trash this effectively, reflects your understanding of this lecture and vice versa



REFERENCES1. Cecil G Helman. Culture, Health and Illness. Wright

20002. David Armstrong. Outline of Sociology as Applied to

Medicine. Butterworth Heinemann. 1994.3. Graham Scambler (ed). Sociology as Applied to

Medicine. Saunders 2003.4. Rachel E. Spector. Cultural Diversity in Health and

Illness. Pearson Prentice Hall 2004.5. E. Gartly Jaco (ed). Patients, Physicians, and Illness.

A Sourcebook in Behavioural Science and Health. The Free Press 1979.

Medical Pluralism By Yusuf Abdu Misau

Health & Medicine

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