It is known that there is a severe shortage of qualified surgeons in
all developing Countries, especially in vast rural areas.
Desperate local Authorities have been experimenting with various
projects in order to be able to provide minimal Healthcare Services for
these people.
One of the latest trends is to employ local traditional health
providers, euphemized to clinical officers. They are cheap, rapidly
trained and already reside in the community. In developing Countries this
translates into applying natural healers, shamans, curer-magicians, etc
[1] [2] [3] [7] [10] [11] [12] [14]
Up to now they were only assigned to secondary supportive health
tasks, mainly screening, informing, referring to Specialists, etc [5]
[7] [10] [11] [15]
Results are poor, they do not seem able even to prevent diseases
like tuberculosis, malaria, HIV/AIDS, or recognize others like
schizophrenia, depression, autism. [1] [4] [5] [7] [8] [11] [13]
There should be no surprise. Cultural, scientific and educational
gaps are enormous.
Some healers do not even agree between themselves, let alone with
Western doctors! [9]
Some even only accept plants as teachers! [6]
I was astonished to read that these "clinical officers" , after
briefly attending some operating theatres for a few months(!) are awarded
licence to perform caesarean sections, and, I suppose, also emergency
hysterectomies for a ruptured uterus.
Many years of formal education and supervised practice in Obstetrics
and Gyneacology have been established for a good reason: to provide the
best possible care to women!
Any shortcuts in training are unethical and dangerous!
Attempting to compare caesarean sections performed by Specialists in
Obstetrics and Gyneacology to those performed by express-trained shamans
is equally unethical and dangerous.
Although this review has serious limitations (which have been
admitted by the Authors), is inconclusive, and any increases in maternal
and perinatal mortality have been vaporized by statistical analysis, it
creates a risky precedent.
In the future, any express-trained shaman, self-taught natural
healer, stage magician or exorcist could dream of comparing his clinical
results to those achieved by trained physicians!
They could only declare that they are cheaper and more available to
distant rural areas, to start practising their charlatanisms!
Undoubtedly, if the Authors still believe that their scientific quest
is legitimate, they should proceed to a large randomized controlled trial,
comparing surgical short term and long term results.
I challenge them, this time to perform this trial using their own
patients, in Birmingham, and not unfortunate African women.
Would they dare have half of the women chosen from NHS Hospitals in
Birmingham operated by non medical personnel?
Are they prepared to having half of the women chosen from NHS
Hospitals in Birmingham operated through a vertical abdominal incision?
(as in their review)
I also think that Ammalife and Birmingham Women's NHS foundation
should have spent their money more wisely.
A single surgeon, properly funded, can operate successfully on
thousands of patients each year, and be responsible for a whole busy
Hospital! [16]
I suggest that next time Ammalife and Birmingham Women's NHS
foundation decide to offer funds to help African women find better
healthcare, they should consider providing logistic support for Aira
Hospital or any other similar project.
[1 ] Genetics and congenital malformations: interpretations,
attitudes and practices in suburban communities and the shamans of
ecuador.
Paz-Y-Mi?o C, S?nchez ME, Sarmiento I, Leone PE.
Community Genet. 2006;9(4):268-73.
[2 ] Chronic illness and Hmong shamans.
Helsel D, Mochel M, Bauer R.
J Transcult Nurs. 2005 Apr;16(2):150-4.
[3 ] Shamans in a Hmong American community.
Helsel DG, Mochel M, Bauer R.
J Altern Complement Med. 2004 Dec;10(6):933-8.
[4 ] Conflicting perspectives on shamans and shamanism: points and
counterpoints.
Krippner SC.
Am Psychol. 2002 Nov;57(11):962-78.
[5 ] Shamans and conventional care: are we prepared?
Plotnikoff GA, Numrich C, Yang D, Wu CY, Xiong P.
HEC Forum. 2002 Sep;14(3):271-8.
[6 ] The concept of plants as teachers among four mestizo shamans of
Iquitos, northeastern Peru.
Luna LE.
J Ethnopharmacol. 1984 Jul;11(2):135-56.
[7 ] Biomedical colonialism or local autonomy? Local healers in the
fight against tuberculosis.
Ortega Martos AM.
Hist Cienc Saude Manguinhos. 2010 Dec;17(4):909-924.
[8 ] From the stage to the laboratory: magicians, psychologists, and
the science of illusion.
Lachapelle S.
J Hist Behav Sci. 2008 Fall;44(4):319-34.
[9 ] Rivalry and diversity among Thai curer-magicians.
Golomb L.
Soc Sci Med. 1986;22(6):691-7.
[10 ] The role of ethnography in STI and HIV/AIDS education and
promotion with traditional healers in Zimbabwe.
Simmons D.
Health Promot Int. 2011 Feb 22.
[11 ] 'Whether you like it or not people with mental problems are
going to go to them': a qualitative exploration into the widespread use of
traditional and faith healers in the provision of mental health care in
Ghana.
Ae-Ngibise K, Cooper S, Adiibokah E, Akpalu B, Lund C, Doku V, Mhapp
Research Programme Consortium.
Int Rev Psychiatry. 2010;22(6):558-67.
[12 ] HIV/AIDS and traditional healers: a blessing in disguise.
Meel BL.
Med Sci Law. 2010 Jul;50(3):154-5.
[13 ] Traditional Healers (mor pheun baan) in Southern Thailand: The
Barriers for Cooperation With Modern Health Care Delivery.
Suwankhong D, Liamputtong P, Runbold B.
J Community Health. 2011 Jun;36(3):431-7.
[14 ] Traditional healers in Riyadh region: reasons and health
problems for seeking their advice. A household survey.
Al-Rowais N, Al-Faris E, Mohammad AG, Al-Rukban M, Abdulghani HM.
J Altern Complement Med. 2010 Feb;16(2):199-204.
[15 ] Walking apart but towards the same goal? The view and
practices of Tongan traditional healers and western-trained Tongan mental
health staff.
Vaka S, Stewart MW, Foliaki S, Tu'itahi M.
Pac Health Dialog. 2009 Feb;15(1):89-95.
Rapid Response:
Shamans performing caesareans?
Dear Editor,
It is known that there is a severe shortage of qualified surgeons in
all developing Countries, especially in vast rural areas.
Desperate local Authorities have been experimenting with various
projects in order to be able to provide minimal Healthcare Services for
these people.
One of the latest trends is to employ local traditional health
providers, euphemized to clinical officers. They are cheap, rapidly
trained and already reside in the community. In developing Countries this
translates into applying natural healers, shamans, curer-magicians, etc
[1] [2] [3] [7] [10] [11] [12] [14]
Up to now they were only assigned to secondary supportive health
tasks, mainly screening, informing, referring to Specialists, etc [5]
[7] [10] [11] [15]
Results are poor, they do not seem able even to prevent diseases
like tuberculosis, malaria, HIV/AIDS, or recognize others like
schizophrenia, depression, autism. [1] [4] [5] [7] [8] [11] [13]
There should be no surprise. Cultural, scientific and educational
gaps are enormous.
Some healers do not even agree between themselves, let alone with
Western doctors! [9]
Some even only accept plants as teachers! [6]
I was astonished to read that these "clinical officers" , after
briefly attending some operating theatres for a few months(!) are awarded
licence to perform caesarean sections, and, I suppose, also emergency
hysterectomies for a ruptured uterus.
Many years of formal education and supervised practice in Obstetrics
and Gyneacology have been established for a good reason: to provide the
best possible care to women!
Any shortcuts in training are unethical and dangerous!
Attempting to compare caesarean sections performed by Specialists in
Obstetrics and Gyneacology to those performed by express-trained shamans
is equally unethical and dangerous.
Although this review has serious limitations (which have been
admitted by the Authors), is inconclusive, and any increases in maternal
and perinatal mortality have been vaporized by statistical analysis, it
creates a risky precedent.
In the future, any express-trained shaman, self-taught natural
healer, stage magician or exorcist could dream of comparing his clinical
results to those achieved by trained physicians!
They could only declare that they are cheaper and more available to
distant rural areas, to start practising their charlatanisms!
Undoubtedly, if the Authors still believe that their scientific quest
is legitimate, they should proceed to a large randomized controlled trial,
comparing surgical short term and long term results.
I challenge them, this time to perform this trial using their own
patients, in Birmingham, and not unfortunate African women.
Would they dare have half of the women chosen from NHS Hospitals in
Birmingham operated by non medical personnel?
Are they prepared to having half of the women chosen from NHS
Hospitals in Birmingham operated through a vertical abdominal incision?
(as in their review)
I also think that Ammalife and Birmingham Women's NHS foundation
should have spent their money more wisely.
A single surgeon, properly funded, can operate successfully on
thousands of patients each year, and be responsible for a whole busy
Hospital! [16]
I suggest that next time Ammalife and Birmingham Women's NHS
foundation decide to offer funds to help African women find better
healthcare, they should consider providing logistic support for Aira
Hospital or any other similar project.
[1 ] Genetics and congenital malformations: interpretations,
attitudes and practices in suburban communities and the shamans of
ecuador.
Paz-Y-Mi?o C, S?nchez ME, Sarmiento I, Leone PE.
Community Genet. 2006;9(4):268-73.
[2 ] Chronic illness and Hmong shamans.
Helsel D, Mochel M, Bauer R.
J Transcult Nurs. 2005 Apr;16(2):150-4.
[3 ] Shamans in a Hmong American community.
Helsel DG, Mochel M, Bauer R.
J Altern Complement Med. 2004 Dec;10(6):933-8.
[4 ] Conflicting perspectives on shamans and shamanism: points and
counterpoints.
Krippner SC.
Am Psychol. 2002 Nov;57(11):962-78.
[5 ] Shamans and conventional care: are we prepared?
Plotnikoff GA, Numrich C, Yang D, Wu CY, Xiong P.
HEC Forum. 2002 Sep;14(3):271-8.
[6 ] The concept of plants as teachers among four mestizo shamans of
Iquitos, northeastern Peru.
Luna LE.
J Ethnopharmacol. 1984 Jul;11(2):135-56.
[7 ] Biomedical colonialism or local autonomy? Local healers in the
fight against tuberculosis.
Ortega Martos AM.
Hist Cienc Saude Manguinhos. 2010 Dec;17(4):909-924.
[8 ] From the stage to the laboratory: magicians, psychologists, and
the science of illusion.
Lachapelle S.
J Hist Behav Sci. 2008 Fall;44(4):319-34.
[9 ] Rivalry and diversity among Thai curer-magicians.
Golomb L.
Soc Sci Med. 1986;22(6):691-7.
[10 ] The role of ethnography in STI and HIV/AIDS education and
promotion with traditional healers in Zimbabwe.
Simmons D.
Health Promot Int. 2011 Feb 22.
[11 ] 'Whether you like it or not people with mental problems are
going to go to them': a qualitative exploration into the widespread use of
traditional and faith healers in the provision of mental health care in
Ghana.
Ae-Ngibise K, Cooper S, Adiibokah E, Akpalu B, Lund C, Doku V, Mhapp
Research Programme Consortium.
Int Rev Psychiatry. 2010;22(6):558-67.
[12 ] HIV/AIDS and traditional healers: a blessing in disguise.
Meel BL.
Med Sci Law. 2010 Jul;50(3):154-5.
[13 ] Traditional Healers (mor pheun baan) in Southern Thailand: The
Barriers for Cooperation With Modern Health Care Delivery.
Suwankhong D, Liamputtong P, Runbold B.
J Community Health. 2011 Jun;36(3):431-7.
[14 ] Traditional healers in Riyadh region: reasons and health
problems for seeking their advice. A household survey.
Al-Rowais N, Al-Faris E, Mohammad AG, Al-Rukban M, Abdulghani HM.
J Altern Complement Med. 2010 Feb;16(2):199-204.
[15 ] Walking apart but towards the same goal? The view and
practices of Tongan traditional healers and western-trained Tongan mental
health staff.
Vaka S, Stewart MW, Foliaki S, Tu'itahi M.
Pac Health Dialog. 2009 Feb;15(1):89-95.
[16 ] http://www.airahospital.org/?page_id=20
Competing interests: No competing interests