title: Can Andean medicine coexist with biomedical healthcare? A comparison of two rural communities in Peru and Bolivia.
abstract: BACKGROUND
  It is commonly assumed that indigenous medical systems remain strong in developing countries because biomedicine is physically inaccessible or financially not affordable. This paper compares the health-seeking behavior of households from rural Andean communities at a Peruvian and a Bolivian study site. The main research question was whether the increased presence of biomedicine led to a displacement of Andean indigenous medical practices or to coexistence of the two healing traditions.
  
  
  METHODS
  Open-ended interviews and free listing exercises were conducted between June 2006 and December 2008 with 18 households at each study site. Qualitative identification of households' therapeutic strategies and use of remedies was carried out by means of content analysis of interview transcriptions and inductive interference. Furthermore, a quantitative assessment of the incidence of culture-bound illnesses in local ethnobiological inventories was performed.
  
  
  RESULTS
  Our findings indicate that the health-seeking behavior of the Andean households in this study is independent of the degree of availability of biomedical facilities in terms of quality of services provided, physical accessibility, and financial affordability, except for specific practices such as childbirth. Preference for natural remedies over pharmaceuticals coexists with biomedical healthcare that is both accessible and affordable. Furthermore, our results show that greater access to biomedicine does not lead to less prevalence of Andean indigenous medical knowledge, as represented by the levels of knowledge about culture-bound illnesses.
  
  
  CONCLUSIONS
  The take-home lesson for health policy-makers from this study is that the main obstacle to use of biomedicine in resource-poor rural areas might not be infrastructural or economic alone. Rather, it may lie in lack of sufficient recognition by biomedical practitioners of the value and importance of indigenous medical systems. We propose that the implementation of health care in indigenous communities be designed as a process of joint development of complementary knowledge and practices from indigenous and biomedical health traditions.
authors: Centre for Development and Environment, University of Bern, Hallerstrasse 10, 3012 Berne, Switzerland. sarah-lan.stiefel@cde.unibe.ch
authors: Sarah-Lan
authors: SL
authors: Mathez-Stiefel
authors: Ina
authors: I
authors: Vandebroek
authors: Stephan
authors: S
authors: Rist
mesh_terms: D000328:Adult; D001688:Biological Products; D001838:Bolivia; D003469:Culture; D003906:Developing Countries; D005191:Family Characteristics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006295:Health Resources; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008519:Medicine, Traditional / Q000706:statistics & numerical data*; D008875:Middle Aged; D036801:Parturition; D010342:Patient Acceptance of Health Care; D010568:Peru; D011203:Poverty; D011247:Pregnancy; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D055815:Young Adult
chemical_list: D001688:Biological Products