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La isquemia intestinal aguda es una emergencia vascular provocada por fenómenos oclusivos y no oclusivos de la circulación mesentérica arterial y venosa, de difícil diagnóstico y pronóstico ominoso. Su incidencia va en aumento paulatino con el decurso de los años, asociada fundamentalmente al envejecimiento de la población. La tasa de mortalidad es elevada a pesar de los avances en el campo de la imagenología. Suele diagnosticarse de forma tardía, cuando está establecido el daño isquémico intestinal de carácter irreversible. El elemento imprescindible e indispensable lo constituye el tiempo que trascurre hasta la cirugía, por lo que su diagnóstico sigue siendo un reto clínico. El tratamiento exige medidas médicas intensivas, al igual que cirugía de revascularización y resección del intestino necrosado. Por desdicha, el examen físico y los hallazgos de laboratorio no son sensibles ni específicos para su diagnóstico. Teniendo en cuenta estos elementos, se presenta el caso de una paciente de 38 años con clínica difusa de vómitos, diarrea y dolor abdominal progresivo, que requirió intervención quirúrgica de urgencia con diagnóstico transoperatorio de isquemia mesentérica aguda. Durante su estancia hospitalaria se relaparotomizó en dos ocasiones, mantuvo soporte ventilatorio e inotrópico por fallo multiorgánico en la Unidad de Cuidados Intensivos, mostrando una adecuada evolución posquirúrgica. El objetivo de esta presentación es enfatizar en la clínica como elemento fundamental para abordar de forma correcta esta entidad en un medio hospitalario de limitados recursos diagnósticos imagenológicos, al abordar conceptos teóricos recientes y facilitar una adecuada actuación en la toma de decisiones.
Acute intestinal ischemia is a vascular emergency caused by occlusive and non-occlusive phenomena of the mesenteric arterial and venous circulation of difficult diagnosis and ominous prognosis. Its incidence is gradually increasing over the years, mainly associated with the ageing of the population. The mortality rate is high despite advances in the field of imaging. It is usually diagnosed late, when irreversible ischemic intestinal damage is established. The essential and indispensable element is the time that elapses until surgery, so its diagnosis continues to be a clinical challenge. Treatment requires intensive medical measures, as well as revascularization surgery and resection of the necrotic intestine. Unfortunately, physical examination and laboratory findings are neither sensitive nor specific for its diagnosis. Taking these elements into account, the authors present the case of a 38-year-old female patient with diffuse symptoms of vomiting, diarrhea and progressive abdominal pain that required emergency surgery with intraoperative diagnosis of acute mesenteric ischemia. During her hospital stay, she underwent re-laparotomy twice, maintained ventilatory and inotropic support due to multi-organ failure in the Intensive Care Unit, showing an adequate post-surgical evolution. The objective of this presentation is to emphasize in the clinic as a fundamental element to correctly address this entity in a hospital environment with limited imaging diagnostic resources by addressing recent theoretical concepts and facilitating adequate action in decision-making.
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INTRODUCTION: Academic fraud is any behavior that gives a student an undeserved advantage over another student. Few studies have explored the causes of and possible solutions to academic fraud in Latin America. We aim to map the knowledge of stakeholders in a Colombian faculty of medicine about the factors that facilitate and prevent academic fraud. METHODS: Fuzzy cognitive mapping. We will use the approach proposed by Andersson and Silver to generate fuzzy cognitive maps representing stakeholder knowledge. This process consists of ten steps: (1) definition of the research question; (2) identification of participants; (3) generation of ideas; (4) rationalization of ideas; (5) organization and connection of ideas; (6) weighing; (7) pattern grouping; (8) list of links and digitization; (9) combination of maps and network analysis; and (10) deliberative dialogue. To draw the maps, we will invite medical students, interns, resident physicians, master's students, and professors in the faculty of medicine. Four medical students will receive training to facilitate the sessions. Participants will identify the factors contributing to academic fraud and their causal relationships. We will use a combination of network analysis and graph theory to identify the chains of factors with greatest influence on academic fraud. CONCLUSION: The maps will serve to discuss strategies to reduce academic fraud in the Faculty of Medicine and to identify factors that could be addressed in other contexts with similar problems. This research will allow the students who facilitate mapping sessions to learn about research techniques, fuzzy cognitive mapping and academic fraud. Study registration: Registered in OSF Registries on August 2nd, 2022. Registration number: osf.io/v4amz.
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Docentes , Aprendizaje , Humanos , Colombia , Fraude , CogniciónRESUMEN
A 2017 randomised controlled trial in Guerrero State, Mexico, showed supporting Indigenous traditional midwives on their own terms improved traditional childbirths without inferior maternal health outcomes. This narrative evaluation complements the trial to document participant experience of safer birth in cultural safety, transformative dynamics and implementation issues of the intervention. Stories came from 26 traditional midwives, 28 apprentices, 12 intercultural brokers and 20 Indigenous women who experienced the intervention. Their accounts indicate the intervention revitalised traditional midwifery and consolidated local skills through traditional midwife apprentices and intercultural brokers to support safe birth. According to the stories, communities reintroduced traditional perinatal care and reported positive health impacts for mothers, children, and other adults, which contributed to early collaboration with official health services. Challenges included remuneration and disinterest of younger apprentices and brokers. The intervention seems to have improved interaction between traditional and Western services, setting the stage for further intercultural dialogue.
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Introduction: The Muisca Indigenous people in Cota, Colombia, has committed to reviving and strengthening their traditional culture, including the ancestral knowledge associated with their traditional medicine. Objective: To explore the occurrence of traditional medicine and factors associated with its use among the Muisca people in Cota, Colombia. Methods: A participatory cross-sectional study applied a questionnaire to 471 Muisca mothers who had at least one child over 10 in April 2019. The 44 questions inquired demographic, social, and cultural factors of participants and their knowledge, use and practice of traditional medicine. We used the Mantel-Haenszel procedure to measure the associations using Odds Ratio and 95% confidence intervals. Results: 66.2% (312/471) of the mothers knew at least three cases of traditional diseases; 56.8% (267/470) had and used medicinal plants; 15.8% (73/462) had practiced traditional self-care for flu, menstruation and postpartum; and 11.8% (54/458) reported that they had gone to midwives, bonesetters and healers. Four factors had a significant association (p < 0.05) with traditional medicine: consumption of three traditional foods; having traditional gardens and plants; living within the reservation; and parents born in a municipality of indigenous influence. Conclusions: The study showed that the permanence of traditional medicine is strongly associated with traditional food, agricultural vocation and the possession and use of medicinal plants. The results suggest that the strategy for the recovery of traditional medicine could focus on promoting a stronger link between indigenous identity, territory, food and health.
Introducción: La población del Resguardo Indígena Muisca de Cota, Colombia, se encuentra en un proceso de fortalecimiento cultural. Ahora busca la recuperación de sus saberes ancestrales relacionados con la medicina tradicional. Objetivo: Explorar la ocurrencia de la medicina tradicional y factores asociados con su vigencia en el resguardo indígena Muisca de Cota, Colombia. Métodos: Estudio transversal participativo con los miembros del resguardo. Para este estudio se aplicó en abril de 2019 un instrumento de 44 preguntas a 471 madres de familia que tenían por lo menos un hijo mayor de diez años. A través de él se indagaron algunos factores demográficos, sociales y culturales. Además, se plantearon preguntas relacionadas con conocimiento, uso y práctica de medicina tradicional. Usamos el procedimiento de Mantel-Haenszel para establecer las asociaciones mediante el Odds ratio e intervalos de confianza del 95%. Resultados: El 66,2% (312/471) de las madres conocía al menos tres casos de enfermedades tradicionales, el 56,8% (267/470) tenía y usaba plantas medicinales, el 15,8% (73/462) practicaba cuidados tradicionales de la gripa, la menstruación y el puerperio, y el 11,8% (54/458) reportó que han acudido a parteras, sobanderos y curanderos. El consumo de tres alimentos tradicionales, la tenencia de huertos y plantas tradicionales, tener la vivienda dentro del resguardo y padres nacidos en un municipio de influencia indígena, fueron los principales factores asociados con la prevalencia de la medicina tradicional (p < 0,05). Conclusiones: El estudio mostró que la permanencia de la medicina tradicional está fuertemente asociada a la alimentación tradicional, a la vocación agrícola y a la tenencia y uso de plantas medicinales. Los resultados sugieren que la estrategia de recuperación de la medicina tradicional podría enfocarse en promover un mayor vínculo entre identidad indígena, territorio, alimentación y salud.
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Medicina Tradicional , Plantas Medicinales , Niño , Colombia , Estudios Transversales , Femenino , Humanos , Encuestas y CuestionariosRESUMEN
INTRODUCCIÓN: La población del Resguardo Indígena Muisca de Cota, Colombia, se encuentra en un proceso de fortalecimiento cultural. Ahora busca la recuperación de sus saberes ancestrales relacionados con la medicina tradicional. OBJETIVO: Explorar la ocurrencia de la medicina tradicional y factores asociados con su vigencia en el resguardo indígena Muisca de Cota, Colombia. MÉTODOS: Estudio transversal participativo con los miembros del resguardo. Para este estudio se aplicó en abril de 2019 un instrumento de 44 preguntas a 471 madres de familia que tenían por lo menos un hijo mayor de diez años. A través de él se indagaron algunos factores demográficos, sociales y culturales. Además, se plantearon preguntas relacionadas con conocimiento, uso y práctica de medicina tradicional. Usamos el procedimiento de Mantel-Haenszel para establecer las asociaciones mediante el Odds ratio e intervalos de confianza del 95%. RESULTADOS: El 66,2% (312/471) de las madres conocía al menos tres casos de enfermedades tradicionales, el 56,8% (267/470) tenía y usaba plantas medicinales, el 15,8% (73/462) practicaba cuidados tradicionales de la gripa, la menstruación y el puerperio, y el 11,8% (54/458) reportó que han acudido a parteras, sobanderos y curanderos. El consumo de tres alimentos tradicionales, la tenencia de huertos y plantas tradicionales, tener la vivienda dentro del resguardo y padres nacidos en un municipio de influencia indígena, fueron los principales factores asociados con la prevalencia de la medicina tradicional (p < 0,05). CONCLUSIONES: El estudio mostró que la permanencia de la medicina tradicional está fuertemente asociada a la alimentación tradicional, a la vocación agrícola y a la tenencia y uso de plantas medicinales. Los resultados sugieren que la estrategia de recuperación de la medicina tradicional podría enfocarse en promover un mayor vínculo entre identidad indígena, territorio, alimentación y salud.
INTRODUCTION: The Muisca Indigenous people in Cota, Colombia, has committed to reviving and strengthening their traditional culture, including the ancestral knowledge associated with their traditional medicine. OBJECTIVE: To explore the occurrence of traditional medicine and factors associated with its use among the Muisca people in Cota, Colombia. METHODS: A participatory cross-sectional study applied a questionnaire to 471 Muisca mothers who had at least one child over 10 in April 2019. The 44 questions inquired demographic, social, and cultural factors of participants and their knowledge, use and practice of traditional medicine. We used the Mantel-Haenszel procedure to measure the associations using Odds Ratio and 95% confidence intervals. RESULTS: 66.2% (312/471) of the mothers knew at least three cases of traditional diseases; 56.8% (267/470) had and used medicinal plants; 15.8% (73/462) had practiced traditional self-care for flu, menstruation and postpartum; and 11.8% (54/458) reported that they had gone to midwives, bonesetters and healers. Four factors had a significant association (p < 0.05) with traditional medicine: consumption of three traditional foods; having traditional gardens and plants; living within the reservation; and parents born in a municipality of indigenous influence. CONCLUSIONS: The study showed that the permanence of traditional medicine is strongly associated with traditional food, agricultural vocation and the possession and use of medicinal plants. The results suggest that the strategy for the recovery of traditional medicine could focus on promoting a stronger link between indigenous identity, territory, food and health.
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Humanos , Femenino , Niño , Plantas Medicinales , Medicina Tradicional , Estudios Transversales , Encuestas y Cuestionarios , ColombiaRESUMEN
BACKGROUND: Available research on the contribution of traditional midwifery to safe motherhood focuses on retraining and redefining traditional midwives, assuming cultural prominence of Western ways. Our objective was to test if supporting traditional midwives on their own terms increases cultural safety (respect of Indigenous traditions) without worsening maternal health outcomes. METHODS: Pragmatic parallel-group cluster-randomised controlled non-inferiority trial in four municipalities in Guerrero State, southern Mexico, with Nahua, Na savi, Me'phaa and Nancue ñomndaa Indigenous groups. The study included all pregnant women in 80 communities and 30 traditional midwives in 40 intervention communities. Between July 2015 and April 2017, traditional midwives and their apprentices received a monthly stipend and support from a trained intercultural broker, and local official health personnel attended a workshop for improving attitudes towards traditional midwifery. Forty communities in two control municipalities continued with usual health services. Trained Indigenous female interviewers administered a baseline and follow-up household survey, interviewing all women who reported pregnancy or childbirth in all involved municipalities since January 2016. Primary outcomes included childbirth and neonatal complications, perinatal deaths, and postnatal complications, and secondary outcomes were traditional childbirth (at home, in vertical position, with traditional midwife and family), access and experience in Western healthcare, food intake, reduction of heavy work, and cost of health care. RESULTS: Among 872 completed pregnancies, women in intervention communities had lower rates of primary outcomes (perinatal deaths or childbirth or neonatal complications) (RD -0.06 95%CI - 0.09 to - 0.02) and reported more traditional childbirths (RD 0.10 95%CI 0.02 to 0.18). Among institutional childbirths, women from intervention communities reported more traditional management of placenta (RD 0.34 95%CI 0.21 to 0.48) but also more non-traditional cold-water baths (RD 0.10 95%CI 0.02 to 0.19). Among home-based childbirths, women from intervention communities had fewer postpartum complications (RD -0.12 95%CI - 0.27 to 0.01). CONCLUSIONS: Supporting traditional midwifery increased culturally safe childbirth without worsening health outcomes. The fixed population size restricted our confidence for inference of non-inferiority for mortality outcomes. Traditional midwifery could contribute to safer birth among Indigenous communities if, instead of attempting to replace traditional practices, health authorities promoted intercultural dialogue. TRIAL REGISTRATION: Retrospectively registered ISRCTN12397283 . Trial status: concluded.
In many Indigenous communities, traditional midwives support mothers during pregnancy, childbirth, and some days afterwards. Research involving traditional midwives has focused on training them in Western techniques and redefining their role to support Western care. In Guerrero state, Mexico, Indigenous mothers continue to trust traditional midwives. Almost half of these mothers still prefer traditional childbirths, at home, in the company of their families and following traditional practices. We worked with 30 traditional midwives to see if supporting their practice allowed traditional childbirth without worsening mothers' health. Each traditional midwife received an inexpensive stipend, a scholarship for an apprentice and support from an intercultural broker. The official health personnel participated in a workshop to improve their attitudes towards traditional midwives. We compared 40 communities in two municipalities that received support for traditional midwifery with 40 communities in two municipalities that continued to receive usual services. We interviewed 872 women with childbirth between 2016 and 2017. Mothers in intervention communities suffered fewer complications during childbirth and had fewer complications or deaths of their babies. They had more traditional childbirths and fewer perineal tears or infections across home-based childbirths. Among those who went to Western care, mothers in intervention communities had more traditional management of the placenta but more non-traditional cold-water baths. Supporting traditional midwifery increased traditional childbirth without worsening health outcomes. The small size of participating populations limited our confidence about the size of this difference. Health authorities could promote better health outcomes if they worked with traditional midwives instead of replacing them.
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Entorno del Parto , Asistencia Sanitaria Culturalmente Competente , Pueblos Indígenas , Partería , Parto/etnología , Complicaciones del Embarazo/epidemiología , Adulto , Análisis por Conglomerados , Femenino , Instituciones de Salud , Parto Domiciliario , Humanos , Salud Materna/etnología , México/etnología , Seguridad del Paciente , Embarazo , Encuestas y CuestionariosRESUMEN
OBJECTIVES: Collate published evidence of factors that affect maternal health in Indigenous communities and contextualise the findings with stakeholder perspectives in the Mexican State of Guerrero. DESIGN: Scoping review and stakeholder fuzzy cognitive mapping. INCLUSION AND EXCLUSION: The scoping review included empirical studies (quantitative, qualitative or mixed methods) that addressed maternal health issues among Indigenous communities in the Americas and reported on the role or influence of traditional midwives before June 2020. The contextualisation drew on two previous studies of traditional midwife and researcher perspectives in southern Mexico. RESULTS: The initial search identified 4461 references. Of 87 selected studies, 63 came from Guatemala and Mexico. Three small randomised trials involved traditional midwives. One addressed the practice of traditional midwifery. With diverse approaches to cultural differences, the studies used contrasting definitions of traditional midwives. A fuzzy cognitive map graphically summarised the influences identified in the scoping review. When we compared the literature's map with those from 29 traditional midwives in Guerrero and eight international researchers, the three sources coincided in the importance of self-care practices, rituals and traditional midwifery. The primary concern reflected in the scoping review was access to Western healthcare, followed by maternal health outcomes. For traditional midwives, the availability of hospital or health centre in the community was less relevant and had negative effects on other protective influences, while researchers conditioned its importance to its levels of cultural safety. Traditional midwives highlighted the role of violence against women, male involvement and traditional diseases. CONCLUSIONS: The literature and stakeholder maps showed maternal health resulting from complex interacting factors in which promotion of cultural practices was compatible with a protective effect on Indigenous maternal health. Future research challenges include traditional concepts of diseases and the impact on maternal health of gender norms, self-care practices and authentic traditional midwifery.
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Partería , Atención a la Salud , Femenino , Instituciones de Salud , Humanos , Masculino , Salud Materna , México , EmbarazoRESUMEN
The prevalence, morbidity and costs of asthma care have increased worldwide. This study describes the effect and safety of an outpatient medical treatment with traditional medicine for asthma, through a retrospective case series with patients admitted to outpatient consultation from 1995 to 2015 in Cota, Colombia. Analyzing 26 cases with a clinical diagnosis of asthma, during the treatment 34.6% (9/26) did not present episodes of uncontrolled asthma and 61.5% (16/26) were classified as controlled asthma in their last consultation of control. 88.4% (23/26) of the patients reported no adverse reactions and the three reported were mild. The results allow to generate hypotheses about the effectiveness and safety of an outpatient treatment based on the incorporation of resources from traditional medicine. These observations could beexplored with experimental studies to determine their long-term effectiveness, safety and low cost.
La prevalencia, morbilidad y costos de atención del asma se ha incrementado en el mundo. Este estudio describe el efecto y la seguridad de un tratamiento médico ambulatorio con recursos de la medicina tradicional para el asma, mediante una serie de casos retrospectiva con pacientes admitidos a consulta externa de 1995 a 2015 en Cota, Colombia. Analizando 26 casos con diagnóstico clínico de asma, durante el tratamiento el 34,6% (9/26) no presentó episodios de asma no controlada y el 61,5% (16/26) fueron clasificados como asma controlada en su última consulta de control. El 88,4% (23/26) de los pacientes no reportó reacciones adversas y las tres reportadas fueron leves. Los resultados permiten generar hipótesis acerca de la efectividad y seguridad de un tratamiento ambulatorio basado en la incorporación de recursos de la medicina tradicional. Estas observaciones podrían ser exploradas con estudios experimentales, para determinar su efectividad, seguridad y bajo costo a largo plazo.
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Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Plantas Medicinales , Asma/tratamiento farmacológico , Medicina Tradicional , Seguridad , Estudios Retrospectivos , Resultado del Tratamiento , Colombia , Atención Ambulatoria , Asistencia Sanitaria Culturalmente CompetenteRESUMEN
INTRODUCTION: The prevalence of childhood asthma has increased in recent years. The World Health Organization has called for conducting research exploring the role of traditional medicine and medicinal plants in respiratory disease control. OBJECTIVE: To identify the relationship between the prevalence of childhood asthma and traditional care of the respiratory system, including cultivation and use of medicinal plants. METHODS: We conducted an observational, analytic, case-control study that included children 2 to 14 years old who used official health services in eight municipalities near Bogota between 2014 and 2015. Cases were children diagnosed with asthma. We randomly selected the controls among the remaining patients of the same healthcare facilities. We applied an 18-question survey. The Mantel-Haenszel procedure identified significant associations using 95% confidence intervals. RESULTS: We surveyed the caretakers of 97 cases and 279 controls in eight municipalities. Some 23.4% (88/376) and 37.9% (142/375) reported using traditional remedies for fever control and common cold management, respectively. 8.8% (33/376) reported following traditional care during a common cold, 30.4% (114/375) reported growing medicinal plants at home, and 45% (166/369) reported using medicinal plants for health purposes in their household. Multivariate analysis showed that having and using medicinal plants at home is associated with a lower reporting of asthma (odds ratio 0.49; 95% confidence interval: 0.25 to 0.99). CONCLUSIONS: Cultivating and using medicinal plants at home is associated with a lower reporting of childhood asthma. Researchers should consider the therapeutic, environmental, and cultural properties of medicinal plants to prevent respiratory diseases.
INTRODUCCIÓN: La prevalencia de asma infantil ha aumentado en los últimos años. La Organización Mundial de la Salud invita a buscar evidencia científica en las medicinas tradicionales y el uso de plantas medicinales, como contribución al control de las enfermedades respiratorias. OBJETIVOS: Identificar la relación entre prevalencia de asma infantil y cuidados respiratorios tradicionales, incluyendo el cultivo y uso de plantas medicinales. MÉTODOS: Estudio observacional, analítico con diseño de casos y controles en niños (de 2 a 14 años) atendidos por servicios estatales de salud en ocho municipios vecinos a Bogotá durante 2014 y 2015. Fueron casos quienes recibieron diagnóstico de asma y se seleccionaron los controles aleatoriamente entre los demás usuarios de las mismas instituciones. Aplicamos un cuestionario con 18 preguntas. La prueba de Mantel-Haenszel identificó asociaciones significativas usando el Odds ratio e intervalos de confianza del 95%. RESULTADOS: Encuestamos a los acudientes de 97 casos y 279 controles en ocho municipios. El 23,4% (88/376) reportó el uso de remedios caseros para controlar la fiebre y el 37,9% (142/375) para manejar la gripe. El 8,8% (33/376) reportó cumplir con todos los cuidados del frío durante la gripe; 30,4% (114/375) tiene plantas medicinales sembradas en su vivienda y 45% (166/369) reportó uso de plantas medicinales para el cuidado de la salud en el hogar. El análisis multivariado mostró que la tenencia y uso de plantas medicinales en la vivienda se asoció con menor reporte de asma (Odds ratio: 0,49; intervalo de confianza 95%: 0,25 a 0,99). CONCLUSIONES: Cultivar y usar plantas medicinales en los hogares está asociado con menor reporte de asma infantil. Conviene considerar las propiedades terapéutica, ambiental y cultural de las plantas medicinales para la prevención de enfermedades respiratorias.
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Asma , Medicina Tradicional , Plantas Medicinales , Adolescente , Asma/tratamiento farmacológico , Asma/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Colombia , Pradera , HumanosRESUMEN
Problem: The Colombian government provides health services grounded in the Western biomedical model, yet 40% of the population use cultural and traditional practices to maintain their health. Adversarial interactions between physicians and patients from other cultures hinder access to quality health services and reinforce health disparities. Cultural safety is an approach to medical training that encourages practitioners to examine how their own culture shapes their clinical practice and how to respect their patients' worldviews. This approach could help bridge the cultural divide in Colombian health services, improving multicultural access to health services and reducing health disparities. Intervention: In 2016, we conducted a pilot cultural safety training program in Cota, Colombia. A five-month training program for medical students included: (a) theoretical training on cultural safety and participatory research, and (b) a community-based intervention, co-designed by community leaders, training supervisors, and the medical students, with the aim of strengthening cultural practices related to health. Evaluation used the Most Significant Change narrative approach, which allows participants to communicate the changes most meaningful to them. Using an inductive thematic analysis, the authors analyzed the stories and discussed these findings in a debriefing session with the medical students. Context: Cota is located only 15 kilometers from Bogota, the national capital and biggest city of Colombia, so the small town has gone through rapid urbanization and cultural change. A few decades ago, inhabitants of Cota were mainly peasants with Indigenous and European traditions. Urbanization displaced agriculture with industrial and commercial occupations. One consequence of this change was loss of cultural health care practices and resources, for example, medicinal plants, that the community had used for centuries. Impact: A group of 13 final-year medical students (ten female and three male, age range 20-24) participated in the study. The medical students listed four areas of change after their experience: increased respect for traditional health practices to provide better healthcare; increased recognition of traditional practices as part of their cultural heritage and identity; a desire to deepen their knowledge about cultural practices; and openness to incorporate cultural practices in healthcare. Lessons Learned: Medical students reported positive perceptions of their patients' cultural practices after participating in this community-based training program. The training preceded a positive shift in perceptions and was accepted by Colombian medical students. To the best of our knowledge, this was the first documented cultural safety training initiative with medical students in Colombia and an early attempt to apply the cultural safety approach outside the Indigenous experience.
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Competencia Cultural/educación , Educación de Pregrado en Medicina/organización & administración , Medicina Tradicional/estadística & datos numéricos , Servicios de Salud Rural/organización & administración , Estudiantes de Medicina/estadística & datos numéricos , Adulto , Actitud del Personal de Salud , Colombia , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Medicina Tradicional/psicología , Investigación Cualitativa , Adulto JovenRESUMEN
Indigenous communities in Latin America and elsewhere have complex bodies of knowledge, but Western health services generally approach them as vulnerable people in need of external solutions. Intercultural dialogue recognises the validity and value of Indigenous standpoints, and participatory research promotes reciprocal respect for stakeholder input in knowledge creation.As part of their decades-long community-based work in Mexico's Guerrero State, researchers at the Centro de Investigación de Enfermedades Tropicales responded to the request from Indigenous communities to help them address poor maternal health. We present the experience from this participatory research in which both parties contributed to finding solutions for a shared concern. The aim was to open an intercultural dialogue by respecting Indigenous skills and customs, recognising the needs of health service stakeholders for scientific evidence.Three steps summarise the opening of intercultural dialogue. Trust building and partnership based on mutual respect and principles of cultural safety. This focused on understanding traditional midwifery and the cultural conflicts in healthcare for Indigenous women. A pilot randomised controlled trial was an opportunity to listen and to adjust the lexicon identifying and testing culturally coherent responses for maternal health led by traditional midwives. Codesign, evaluation and discussion happened during a full cluster randomised trial to identify benefits of supporting traditional midwifery on maternal outcomes. A narrative mid-term evaluation and cognitive mapping of traditional knowledge offered additional evidence to discuss with other stakeholders the benefits of intercultural dialogue. These steps are not mechanistic or invariable. Other contexts might require additional steps. In Guerrero, intercultural dialogue included recovering traditional midwifery and producing high-level epidemiological evidence of the value of traditional midwives, allowing service providers to draw on the strengths of different cultures.
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Servicios de Salud del Indígena , Partería , Investigación Participativa Basada en la Comunidad , Atención a la Salud , Femenino , Humanos , México , Embarazo , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
OBJECTIVES: This study explored motivation dynamics of medical students engaging with traditional medicine in Colombia. METHODS: We conducted a qualitative descriptive study as part of a larger participatory research effort to develop a medical education curriculum on cultural safety. Four final-year medical students participated in a five-month program to strengthen knowledge of traditional medicinal plants with schoolchildren in Cota, a municipality outside Bogota with a high proportion of traditional medicine users. Students and schoolteachers co-designed the program aimed to promote the involvement of school children with traditional medicine in their community. The medical students shared written narratives describing what facilitated their work and discussed experiences in a group session. Inductive thematic analysis of the narratives and discussion derived categories of motivation to learn about traditional medicine. RESULTS: Five key learning dynamics emerged from the analysis: (1) learning from/with communities as opposed to training them; (2) ownership of medical education as a result of co-designing the exercise; (3) rigorous academic contents of the program; (4) lack of cultural safety training in university; and (5) previous contacts with traditional knowledge. CONCLUSIONS: We identified potential principles for engaged cultural safety training for medical students. We will use these in our larger training program. Our results may be relevant to other researchers and medical educators wanting to improve the interaction of medical health professionals in multicultural settings with people and communities who use traditional medicine. We expect these professionals will be better prepared to recognize and address intercultural challenges in their clinical practice.
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Competencia Cultural/psicología , Medicina Tradicional , Motivación , Estudiantes de Medicina/psicología , Adulto , Colombia , Competencia Cultural/organización & administración , Diversidad Cultural , Curriculum/normas , Educación Médica , Femenino , Humanos , Masculino , Medicina Tradicional/métodos , Medicina Tradicional/psicología , Pediatría/educación , Pediatría/métodos , Fitoterapia/métodos , Fitoterapia/psicología , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa , Facultades de Medicina/organización & administración , Adulto JovenRESUMEN
BACKGROUND: Effective health care requires services that are responsive to local needs and contexts. Achieving this in indigenous settings implies communication between traditional and conventional medicine perspectives. Adequate interaction is especially relevant for maternal health because cultural practices have a notable role during pregnancy, childbirth and the postpartum period. Our work with indigenous communities in the Mexican state of Guerrero used fuzzy cognitive mapping to identify actionable factors for maternal health from the perspective of traditional midwives. METHODS: We worked with twenty-nine indigenous women and men whose communities recognized them as traditional midwives. A group session for each ethnicity explored risks and protective factors for maternal health among the Me'phaa and Nancue ñomndaa midwives. Participants mapped factors associated with maternal health and weighted the influence of each factor on others. Transitive closure summarized the overall influence of each node with all other factors in the map. Using categories set in discussions with the midwives, the authors condensed the relationships with thematic analysis. The composite map combined categories in the Me'phaa and the Nancue ñomndaa maps. RESULTS: Traditional midwives in this setting attend to pregnant women's physical, mental, and spiritual conditions and the corresponding conditions of their offspring and family. The maps described a complex web of cultural interpretations of disease - "frío" (cold or coldness of the womb), "espanto" (fright), and "coraje" (anger) - abandonment of traditional practices of self-care, women's mental health, and gender violence as influential risk factors. Protective factors included increased male involvement in maternal health (having a caring, working, and loving husband), receiving support from traditional healers, following protective rituals, and better nutrition. CONCLUSIONS: The maps offer a visual language to present and to discuss indigenous knowledge and to incorporate participant voices into research and decision making. Factors with higher perceived influence in the eyes of the indigenous groups could be a starting point for additional research. Contrasting these maps with other stakeholder views can inform theories of change and support co-design of culturally appropriate interventions.
Asunto(s)
Servicios de Salud Materna , Partería , Cognición , Femenino , Humanos , Masculino , Salud Materna , México , Parto , EmbarazoRESUMEN
BACKGROUND: Indigenous women in the southern Mexican state of Guerrero face poor maternal health outcomes. Living as they do at the very periphery of the Western health system, they often receive low-quality care from health services that lack human and financial resources. Traditional health systems remain active in indigenous communities where traditional midwives accompany women through motherhood. Several interventions have explored training birth attendants in Western birthing skills, but little research has focussed on supporting traditional midwives by recognising their knowledge. This trial supports traditional midwifery in four indigenous groups and measures its impact on maternal health outcomes. METHODS: The study includes four indigenous populations in the State of Guerrero (Nahua, Na savi/Mixteco, Me'phaa/Tlapaneco and Nancue ñomndaa/Amuzgo), covering approximately 8000 households. A parallel-group cluster-randomised controlled trial will compare communities receiving usual care with communities where traditional midwives received support in addition to the usual care. The intervention was defined in collaboration with participants in a 2012 pilot study. Supported midwives will receive a small stipend, a scholarship to train one apprentice, and support from an intercultural broker to deal with Western health personnel; additionally, the health staff in the intervention municipalities will participate in workshops to improve understanding and attitudes towards authentic traditional midwives. A baseline and a final survey will measure changes in birth and pregnancy complications (primary outcomes), and changes in gender violence, access to healthcare, and engagement with traditional cultural activities (secondary outcomes). The project has ethical approval from the participating communities and the Universidad Autónoma de Guerrero. DISCUSSION: Indigenous women at the periphery of Western health services do not benefit fully from the attenuated services which erode their own healthcare traditions. Western health service providers in indigenous communities often ignore traditional knowledge and resources, inadvertently or in ignorance, disrespecting indigenous cultures. Improved understanding between midwives and the official healthcare system can contribute to more appropriate referral of high-risk cases, improving the use of scarce resources while lowering costs of healthcare for indigenous families. TRIAL REGISTRATION: ISRCTN12397283 . Retrospectively registered on 6 December 2016.
Asunto(s)
Servicios de Salud del Indígena , Partería , Parto , Ensayos Clínicos Controlados Aleatorios como Asunto , Administración de la Seguridad , Femenino , Humanos , Salud Materna , México , Evaluación de Resultado en la Atención de Salud , Embarazo , Tamaño de la MuestraRESUMEN
OBJECTIVES: We aimed to implement participatory research to answer a question posed by four Kichwa indigenous communities in Andean Ecuador about what actionable factors are associated with childhood stunting, overweight and food insecurity among their people. DESIGN: We used mixed methods including household questionnaires, discussion groups with respondents of the questionnaires and anthropometric measurement of children (6 months to 12 years) from surveyed households. SETTING: The study involved four Andean indigenous communities transitioning from traditional to Western lifestyles. They subsist mainly on small-scale agriculture and have a rich cultural heritage including their traditional language. PARTICIPANTS: Anthropometric data were collected from 298 children from 139 households in four communities; all households completed the questionnaire. We held five discussion groups (6-10 participants each): three composed of mothers and two of farmers. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were stunting, overweight, food insecurity and their relationship with demographics, dietary habits and agricultural habits. RESULTS: Of 298 children, 48.6% were stunted and 43.3% overweight for age. Stunted children were more likely to live in households that sold livestock (ORa 1.77, 95% CIa 1.06 to 2.95) and with illiterate primary caretakers (ORa 1.81, 95% CIa 1.07 to 3.06), but were less likely to live in households with irrigation (ORa 0.47, 95% CIa 0.27 to 0.81). Overweight children were more likely to be male (ORa 1.87, 95% CIa 1.02 to 3.43) and live in a household that sold livestock (ORa 2.14, 95% CIa 1.14 to 4.02). Some 67.8% of children lived in a household with food insecurity, more frequently in those earning below minimum wage (ORa 2.90, 95% CIa 1.56 to 5.41) and less frequently in those that ate quinoa in the past 24 hours (ORa 0.17, 95% CIa 0.06 to 0.48). Discussion groups identified irrigation and loss of agricultural and dietary traditions as important causes of poor childhood nutrition. CONCLUSION: Many indigenous communities face tumultuous cultural, nutritional and epidemiological transitions. Community-based interventions on factors identified here could mitigate negative health outcomes.
Asunto(s)
Abastecimiento de Alimentos/estadística & datos numéricos , Trastornos del Crecimiento/etnología , Sobrepeso/etnología , Características de la Residencia , Riego Agrícola , Animales , Estatura , Peso Corporal , Chenopodium quinoa , Niño , Preescolar , Investigación Participativa Basada en la Comunidad , Dieta , Ecuador/epidemiología , Conducta Alimentaria , Femenino , Grupos Focales , Humanos , Renta , Lactante , Alfabetización , Ganado , Masculino , Grupos de Población , Encuestas y CuestionariosRESUMEN
OBJECTIVES: Examine factors associated with use of traditional medicine during childbirth and in management of childhood diarrhoea. DESIGN: Cross-sectional cluster survey, household interviews in a stratified last stage random sample of 90 census enumeration areas; unstructured interviews with traditional doctors. SETTING: Oil-rich Cross River State in south-eastern Nigeria has 3.5 million residents, most of whom depend on a subsistence agriculture economy. PARTICIPANTS: 8089 women aged 15-49â years in 7685 households reported on the health of 11,305 children aged 0-36â months in July-August 2011. PRIMARY AND SECONDARY OUTCOME MEASURES: Traditional medicine used at childbirth and for management of childhood diarrhoea; covariates included access to Western medicine and education, economic conditions, engagement with the modern state and family relations. Cluster-adjusted analysis relied on the Mantel-Haenszel procedure and Mantel extension. RESULTS: 24.1% (1371/5686) of women reported using traditional medicine at childbirth; these women had less education, accessed antenatal care less, experienced more family violence and were less likely to have birth certificates for their children. 11.3% (615/5425) of young children with diarrhoea were taken to traditional medical practitioners; these children were less likely to receive BCG, to have birth certificates, to live in households with a more educated head, or to use fuel other than charcoal for cooking. Education showed a gradient with decreasing use of traditional medicine for childbirth (χ(2) 135.2) and for childhood diarrhoea (χ(2) 77.2). CONCLUSIONS: Use of traditional medicine is associated with several factors related to cultural transition and to health status, with formal education playing a prominent role. Any assessment of the effectiveness of traditional medicine should anticipate confounding by these factors, which are widely recognised to affect health in their own right.
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Diarrea/tratamiento farmacológico , Medicina Tradicional/métodos , Parto , Atención Prenatal/normas , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Análisis Multivariante , Nigeria , Embarazo , Factores de Riesgo , Autoinforme , Factores Socioeconómicos , Adulto JovenRESUMEN
A lo largo de un proceso de investigación realizado por la Secretaría de Salud del municipio de Cota en conjunto con el Centro de Estudios Médicos Interculturales, se identificó una serie de tradiciones que se mantienen vivas en nuestras comunidades y que pueden ser muy importantes para manejar mejor la salud respiratoria. Estos conocimientos ofrecen grandes ventajas al incluirlos en programas de salud pública, es decir, en acciones que buscan mejorar la salud de la población. Por eso estamos convencidos de que son muy valiosos y merecen ser recuperados y divulgados en este tipo de materiales. Entre las ventajas más sobresalientes podemos destacar tres. En primer lugar, los cuidados tradicionales utilizan recursos locales que resultan más fáciles de encontrar en el territorio de las comunidades beneficiadas y que representan un costo mucho menor en comparación con el de los recursos externos. Un ejemplo de esto son las plantas medicinales. Si cada hogar contara con un jardín de plantas medicinales básico, sería posible ahorrar muchos de los costos de los medicamentos de farmacia. En segundo lugar, estos cuidados tienen un arraigo cultural que constituye la intimidad de la vida comunitaria. La transformación cultural hacia una forma de vida más urbana e individualista ha tenido un fuerte impacto en el abandono de estas prácticas y conduce a la erosión del patrimonio inmaterial de muchos pueblos a lo largo del mundo.