Competing models of illness and disease: the study of leishmeniasis in Campeche, Mexico

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1990
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Abstract
Health intervention programs often fail because the biomedical model and folk model of disease are in competition and are incongruous. There is a need for an integrated explanatory model of disease that accounts for both the clinical and cultural perspectives. The purpose of this study is to construct such a model. The parasitic disease, leishmaniasis, in Campeche, Mexico is the subject of this investigation. Five rural villages in the tropical forest of Southern Campeche were studied in order to determine the cultural perceptions of the disease. This research was conducted over a three month period in association with an ongoing investigation of leishmaniasis centered in the University of Yucatan, Merida. The construction of the integrated model requires that a folk model of the disease be developed first. This involves two processes. The introductory study sets forth the broader, cultural beliefs of health and illness in general. The second study develops a specific model of leishmaniasis encompassing the popular, family and expert models. The results of these investigations show that the concepts of strength, equilibrium, personal responsibility, and the etiological agent are prominent to the people's understanding of disease. The symptomatic severity is determined by the degree of incapacitation, pain, and life endangerment. Criteria for treatment success includes the rapidity of cure, painlessness, and ease of access to the treatment. Patient trust is also crucial to treatment choice. Therefore, herbal and self - administered treatments are preferred for all diseases. Leishmaniasis is considered to be severe given the associated economic loss, role strain, pain, and treatment availability. The biomedical model may be drawn from the ongoing medical investigations and the current literature. Biomedically, leishmaniasis is considered to be very mild and non-burdening. The synthesized model is constructed for the health intervention strategy. The disparities between the two competing models may be resolved by expanding the categories of the existing models or by bridging the two models with a new construct. The contrasting perceptions of the burden of illness is the greatest impediment to the intervention campaign. Therefore, the bridging mechanism proposed is a systematic scoring method that provides a standardized, repeatable measure of burden. This measure accounts for both models and may provide an evaluative mechanism for the intervention. The efficacy of the intervention may improve as the burden of leishmaniasis is clarified and refined, outlining the specific targets of the health care program. The process involved in the construction of these models may be utilized in the study of other diseases and the intervention attempts, particularly when the existing models of the disease are incongruous. This study emphasizes the relevance of anthropological inquiry to the health care intervention process.
Description
Bibliography: p. 155-164.
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Citation
Downe, P. J. (1990). Competing models of illness and disease: the study of leishmeniasis in Campeche, Mexico (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/11614
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