Description
Background: Medical pluralism, has long been prevalent in Latin America and the world; as biomedical care is increasingly available in areas where it was previously unfound, its interaction with traditional systems of medicine interact is largely understudied. Paraguay has a long history of medicinal plant use, and with modern increases in access to biomedical care, individuals often choose from one of four options to meet their health needs: biomedical care in hospitals, traditional care with médicas ñaná, self-treatment with pharmaceutical medication, or self-treatment with natural plant remedies. Purpose: This exploratory qualitative study aimed to understand the healthcare decision-making process among individuals in the community of Santa María de Fe, Misiones, Paraguay: how they choose between each source of care. Methods: Two phases of open-ended interviews were conducted with community members. The first phase elicited information about common illnesses in the community and preferences for different practices. The second phase used ethnographic decision modeling (EDM) where participants sorted illnesses based on their preferred source of care for each one and explained their decisions. Interviews were also conducted with health professionals. N=26 interviews were completed in Spanish, transcribed, coded with open descriptive coding, and analyzed with thematic analysis. Results: Coding revealed five themes: 1) Severity of Illness, 2) Knowledge, 3) Experiences, 4) Structural & Systemic Factors, and 5) Cultural Factors. Individuals demonstrate a strong individual-level understanding of health, preferring self-treatment as a first option whenever able; their decision to seek external care is often based on the severity and kind of illness, as well as their own knowledge about how to treat said illnesses. Many moderating factors shape the way individuals understand each source of care; these include previous positive and negative experiences with different treatments, the futility of going to the doctor due to lack of health infrastructure, and fears, taboos, and gender norms about medical practices. Conclusion: Both traditional and biomedical care serve important purposes in the health of the Santa María community and individuals integrate these systems in complex ways to meet their health needs. More formal endeavors towards integrative medicine could benefit the health of the community.
