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Navajo Use of Native Healers. Catherine Kim, MD, MPH; Yeong S. Kwok, MD Archives of Internal Medicine. 1998; 158:2245-2249. NAVAJO traditionally received treatment for illness from native healers or "medicine men." As in a conventional medical care system, many different types of practitioner exist. Native healers have been the focus of extensive ethnographic study but the prevalence and frequency of use of native healers among Navajo have not been described. The Navajo are also eligible for extensive free health care services through the Indian Health Service. It is not clear if conventional medical care provided by IHS physicians conflicts with the recommendations of native healers. To improve understanding of the use of native healers and its interaction with conventional medicine, an interview was conducted of Navajo IHS patients to determine the prevalence of use, reasons for use, characteristics of those who use native healers, cost of care, and whether native healer care conflicts with care provided by conventional physicians. Between June 23, 1997, and September 1, 1997, consecutive adult patients seen in the ambulatory care clinic at a rural IHS hospital were interviewed. The hospital is a 39-bed hospital located on the eastern edge of the Navajo reservation in New Mexico. 47,000 outpatient visits were made to the hospital during the 1992 fiscal year. Eligibility was limited to consenting patients 18 years or older who did not have cognitive or physical impairment that prevented completion of the interview. An interview rather than a self-administered questionnaire was necessary because many eligible participants cannot read or cannot speak English and therefore require a translator. The overall response rate among eligible individuals was 99%. Results: Sixty-two percent of individuals interviewed had used a native healer at least once in their lifetime and 39% had used a native healer during the last year. Those who had seen a native healer in the past averaged 2 visits per year although the number of visits ranged widely. Among those who had used a native healer at some time but not during the past year had a mean time of 11 years elapsed from their last visit although the number of years also ranged widely. Table 2 summarizes the most common reasons for visits to a native healer and the frequency of concomitant use of a medical provider. These reasons overlapped with the most common reasons for seeing a medical provider, such as arthritis, depression/anxiety, back pain, and diabetes mellitus, but certain complaints such as family problems and insomnia were much more common reasons for visits to native healers than medical providers. Patients who saw native healers for arthritis and diabetes mellitus commonly consulted a medical provider in addition. Those who consulted a native healer for depression/anxiety and arthritis were less likely to also consult a medical provider, and medical providers were never consulted for "sickness," "blessing," "bad luck," or family problems. Dissatisfaction was reported infrequently for both medical provider and native healer use; roughly 10% of patients reported they were dissatisfied with care. Twenty patients (6.6%) reported being dissatisfied with the medical treatment of arthritis, but only 7 (2.3%) reported seeking native healer care due to dissatisfaction. Six patients (2%) reported being dissatisfied with the native healer treatment of arthritis, and 5 (1.6%) reported seeking medical care because of this. Dissatisfaction with the treatment of other complaints occurred only 1% of the time for both medical providers and native healers. Satisfaction with conventional medical care did not correlate with use of native healers. Perceived conflict in medical provider and native healer instructions occurred infrequently. Twenty-one patients stated that their medical provider and the native healer gave them conflicting recommendations. When faced with conflicting advice, 15 patients stated they attempted to follow both sets of advice, 1 patient followed the medical provider's advice only, and 5 patients followed the native healer's advice only. Barriers to Traditional Treatment: Medical care provided by the IHS is free, with the exception of certain procedures such as cosmetic surgery and certain items such as dentures. In contrast, the cost of visiting a native healer was reported to vary from $1 to $3000, with an average cost per visit of $388. The average annual cost of native healer use as a proportion of the patient's self-reported annual income was 0.21, or roughly one fifth. Cost was cited by 108 patients (36%) as the reason for not seeking native healer care more frequently and was the most common barrier to native healer care. Costs are a conservative estimate as they may exclude such customary expenses as transportation, feeding all those who participate in a ceremony, and costs of materials needed such as buckskin or herbs. Cost charged to the patient did not correlate with the patient's income.
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