"We are like co-wives": Traditional healers' views on collaborating with the formal Child and Adolescent Mental Health System in Uganda
"We are like co-wives": Traditional healers' views on collaborating with the formal Child and Adolescent Mental Health System in Uganda
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DOI：
10.1186/s12913-018-3063-4
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发表时间：
2018-04-10
影响因子：
2.8
通讯作者：
Engebretsen, Ingunn Marie S.
中科院分区：
文献类型：
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作者：
Akol, Angela;Moland, Karen Marie;Engebretsen, Ingunn Marie S.
背景资料：儿童和青少年期精神疾病的早期识别和管理有助于避免成年后的衰弱性精神疾病，但直到最近，对儿童和青少年心理健康的关注一直很低。精神病患者经常向传统治疗师咨询，在乌干达，接受传统治疗师治疗的患者中高达60%患有中度至重度精神病。在乌干达，难以获得CAMH护理造成了治疗差距，可以通过加强传统治疗师和生物医学卫生系统之间的合作来弥补。本研究的目的是探讨传统的治疗师的意见，他们与生物医学卫生系统的合作，以通知实施战略，以改善获得CAMH服务在Ugand.Methods：在2015年11月进行了深入的采访，有目的地选择了20个传统的治疗师。一个半结构化的访谈指南被用来探讨：1）传统治疗师与儿童和青少年精神疾病的经验; 2）他们愿意与正式的卫生系统合作;和3）他们的看法，临床医生的愿意与他们合作。访谈以当地语言进行，并进行了录音。数据进行了分析，使用专题analysis.Results：传统治疗师描述了几个经验管理儿童和青少年的精神疾病，他们归因于精神和身体的原因。精神上的解释是祖先的灵魂不快乐、现代宗教和巫术的结果，而提到的身体原因包括药物滥用和发烧。没有一名传统治疗师接待过诊所转诊的病人，尽管所有人都曾因非精神健康原因将病人转诊到诊所。传统治疗师对生物医学保健系统表示不信任，认为他们的治疗在减轻精神痛苦方面优于医学疗法上级。他们表示愿意与生物医学提供者合作。然而，传统治疗师认为，临床医生无视他们，不愿意与them.Conclusion：传统治疗师和生物医学卫生系统之间的合作，以改善获得CAMH服务在乌干达的潜力存在，但破坏了相互之间的不信任和传统治疗师和临床医生之间的竞争。
Background: Early identification and management of mental illness in childhood and adolescence helps to avert debilitating mental illness in adulthood but the attention given to Child and Adolescent Mental Health (CAMH) has until recently been low. Traditional healers are often consulted by patients with mental illness and in Uganda, up to 60% of patients attending traditional healers have moderate to severe mental illness. Poor access to CAMH care in Uganda creates a treatment gap that could be met through enhanced collaboration between traditional healers and biomedical health systems. The aim of this study was to explore traditional healers' views on their collaboration with biomedical health systems so as to inform the implementation of strategies to improve access to CAMH services in Uganda.Methods: In-depth interviews with 20 purposively selected traditional healers were conducted in November 2015. A semi-structured interview guide was used to explore: 1) The experiences of traditional healers with mental ill-health in children and adolescents; 2) their willingness to collaborate with the formal health system; and 3) their perception of clinicians' willingness to collaborate with them. Interviews were conducted in local languages and tape recorded. Data were analysed using thematic analysis.Results: Traditional healers described several experiences managing children and adolescents with mental illness, which they ascribed to spiritual and physical causes. The spiritual explanations were a consequence of unhappy ancestral spirits, modern religions and witchcraft, while physical causes mentioned included substance abuse and fevers. No traditional healer had received a patient referred to them from a medical clinic although all had referred patients to clinics for non-mental health reasons. Traditional healers expressed distrust in biomedical health systems and believed their treatments were superior to medical therapies in alleviating mental suffering. They expressed willingness to collaborate with biomedical providers. However, traditional healers believe clinicians disregard them and would not be willing to collaborate with them.Conclusion: Potential for collaboration between traditional healers and biomedical health systems for improving access to CAMH services in Uganda exists, but is undermined by mutual mistrust and competition between traditional healers and clinicians.