title: Alternative medicine: an ethnographic study of how practitioners of Indian medical systems manage TB in Mumbai.
abstract: BACKGROUND
  Mumbai is a hot spot for drug-resistant TB, and private practitioners trained in AYUSH systems (Ayurveda, yoga, Unani, Siddha and homeopathy) are major healthcare providers. It is important to understand how AYUSH practitioners manage patients with TB or presumptive TB.
  
  
  METHODS
  We conducted semi-structured interviews of 175 Mumbai slum-based practitioners holding degrees in Ayurveda, homeopathy and Unani. Most providers gave multiple interviews. We observed 10 providers in clinical interactions, documenting: clinical examinations, symptoms, history taking, prescriptions and diagnostic tests.
  
  
  RESULTS
  No practitioners exclusively used his or her system of training. The practice of biomedicine is frequent, with practitioners often using biomedical disease categories and diagnostics. The use of homeopathy was rare (only 4% of consultations with homeopaths resulted in homeopathic remedies) and Ayurveda rarer (3% of consultations). For TB, all mentioned chest x-ray while 31 (17.7%) mentioned sputum smear as a TB test. One hundred and sixty-four practitioners (93.7%) reported referring TB patients to a public hospital or chest physician. Eleven practitioners (6.3%) reported treating patients with TB. Nine (5.1%) reported treating patients with drug-susceptible TB with at least one second-line drug.
  
  
  CONCLUSIONS
  Important sources of health care in Mumbai's slums, AYUSH physicians frequently use biomedical therapies and most refer patients with TB to chest physicians or the public sector. They are integral to TB care and control.
authors.affiliation: McGill International TB Centre & Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, Canada H3A 1A2.
authors.forename: Andrew
authors.initials: A
authors.lastname: McDowell
authors.affiliation: McGill International TB Centre & Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, Canada H3A 1A2 madhukar.pai@mcgill.ca.
authors.forename: Madhukar
authors.initials: M
authors.lastname: Pai
mesh_terms: D000328:Adult; D000368:Aged; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D019468:Disease Management; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000628:therapy*
keywords: AYUSH; Cross-practice; Diagnosis; India; Private sector; Tuberculosis