By Agnes Nanyonjo, Emerging Voice from Uganda
A well-defined relationship exists between sick people, the society of the healthy in which they live and their care providers, at least in the sociological literature. In 1951, the term ‘sick role’ was coined by Talcott Parsons to describe this relationship. In his view, the ‘sick role’ is a state that entitles the sick person to certain rights and obligations. Among the rights is the need for the society to accept that a sick person is not to blame for his or her condition and as such he or she should be exempted from normal social roles. Regarding the obligations, it is the role of the affected person to seek health care from technically competent people whilst cooperating with them while seeking the care. As you can imagine, the concept has often been criticized. However, it is not without its merits.
In many low and middle income countries, people go to the formal health sector as a last resort, following a chain of consultations within the informal health sector including the so called ‘significant others’, traditional healers and self medication at home. Visiting a provider in the formal health sector should thus be seen as one step in a long journey of health seeking behavior even if it is only for a minor cold. Uganda, my own country, is no different in this respect.
There is a prevailing belief in may low income countries that drips are better than injections, injections are better than tablets and tablets are better than nothing at all. A middle income country like China is not all that different, I learnt during my stay in Beijing. While visiting a local health center, I was told that there is a huge demand for intravenous fluids among Chinese patients who believe that IV fluids get to the root cause of illness and address it.
By virtue of the obligation that the sick role exerts on the sick, many providers in the formal health sector feel pressurized to prescribe antibiotics to undeserving patients with the fear of letting them down and having nothing done for them. In many countries, providers in the formal health sector often have to cope with a huge workload; they have no quality time to counsel their patients. When this is coupled with the fear of doing or giving nothing, medicalization of everyday life events seems inevitable. For instance, sad jobless young people will continue to receive heavy doses of antidepressants whilst not being counseled about income generating activities. Also, patients afflicted with a minor ailment (e.g. a mild cough) who would have otherwise benefited from plenty of oral fluids and rest will continue to receive antibiotics which they are much safer without in the light of looming antibiotic resistance. Antibiotic resistance is increasingly becoming a global health concern, and nowhere more so than in LMICs.
To start dealing with this challenge, perhaps we can learn something from the Chinese health system too. The Chinese health system unlike many countries has a well developed traditional medicine system. Traditional Chinese Medicine (TCM) (see also here) is based on two abstract complementary but opposing forces – yin and yang – that shape life and the world in general, just like day and night, cold and hot or the moon and the sun. Another key concept is the energy called ‘qi’ which circulates throughout the body through several pathways. Its smooth circulation requires harmony and balance in order for a person to be in good health. Regardless of the basis of TCM, two things we know for sure: it has undergone years of research and it is practiced alongside western medicine in many Chinese hospitals today. We could witness that ourselves during our health center visit in a Beijing suburb. Traditional Chinese medicine hospitals are also covered by national health insurance in China. From our Chinese counterparts we learnt that there are over 1000 herbs available, ranging from sweet to sour ones. They are available for prescription in either a crude form or in a more refined form, or even as herbal teas. TCM also comprises other technologies such as acupuncture and moxibustion that can control pain. These technologies and traditional medicines extend the scope of care from which a sick person can find relief for his ailment even though there is no room for western medicine for the given ailment.
Given the prevailing belief that “getting something is better than getting nothing at all”, I believe that embracing traditional medicine, if well researched, can help patients and prescribers fulfill the obligation of the sick role which is trying to get well! Curbing the excessive use of antibiotics in low-income countries could be a nice spin-off.