Importance of Traditional Medicine

On December 9, 1997, then the President Fidel V. Ramos signed into law Republic Act no. 8423
or the Traditional and Alternative Medicine Act, which created the Philippine Institute of Traditional and
Alternative Health Care (PITACH), an attached agency of the DOH. This is government recognition of
the important role played by traditional medicine in providing cures to ailments and in contributing to the
health and well-being of the Filipinos. Traditional medicine is very important for the following reasons:

1. Medicinal plants are cheap alternatives to expensive medicines, particularly for the poor.

2. It is the final resort for those who have incurable diseases.

3. Traditional medicine is a more holistic approach to treatment. It is said that “Western medicine treats
the diseases while traditional medicine treats the person”

4. The albularyo and hilot play, to some extent, the role of doctors in rural areas.

In the hierarchy of healers and specialists in Philippine folk medicine, the albularyo may be
referred to as the "general practitioner," knowledgeable in most of the folkloric modalities,
usually especially versed in the use of medicinal herbs.

Albularyo (arbularyo, hilot) is a medicine person or a healer in the Philippines. Nowadays it is

still an alternative help or even only source of help for sick people in rural areas of the country.

Most of these healers consider their healing craft as God-given, a calling from a supernatural
being, and consequently, their healing practices are profusely infused with prayers and religious
rituals, performed through mediation with the Holy Spirit.

Usually rural-based, they are also present in the urban and suburban communities, albeit in small
scattered niches, serving burgis alternative needs, the impoverished or the urban-transplanted
rural folk.

The Albularyo
In the rural areas, by tradition and because of chronic economic constraints, the albularyos are
the GENERAL PRACTITIONERS, the primary dispensers of health care.

Often lacking in formal education, his skills are based on and honed from hand-me-down
practices and lore, with a long period of understudy or apprenticeship with a family elder or a
local healer.

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque

Years of patience and study bring the healer into a familiarity with the lore, rituals and
modalities of diagnosis and healing, the prayers, bulong and orasyon, and the use of herbal
medicinal plants.

APPLICATION TO NURSING

To develop understanding whenever you encounter them apply this:

A cknowledge

L isten

Be aware of and sensitive to the cultural needs of clients.

Understand the social and cultural reality of the client, family, and community, develop expertise to
implement culturally acceptable strategies to provide nursing care, and identify and use resources
acceptable to the client

Let them to do their practices as long as it is safe to the client like :

 Use of Protective Objects

 Protective objects can be worn or carried or hung in the home- charms worn on a string or chain
around the neck, wrist, or waist to protect the wearer from the evil eye or evil spirits.
 Use of Substances .

It is believed that certian food substances can be ingested to prevent illness.

 E.g. eating raw garlic or onion to prevent illness or wear them on the body or hang them in the
home.
 Religious Practices
 Burning of candles, rituals of redemption etc..

Advise them and make friend with them for them to refer in case of untoward effects and reactions of
their practice.

Respect and appreciation for the individuality and diversity of patients beliefs, values, spirituality and
culture regarding illness, its meaning, cause, treatment, and outcome.

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque

You must always be there to guide them , educate and train them for their improvement (Traditional
healers must be taught why, what, when and how to report unusual symptoms in their patients to
local officials,)

Open lines of communication between traditional healers and the medical community could
tremendously improve surveillance. Health officials must include traditional healers in their
educational outreach to doctors and must be trained to know what information they should
request from healers.

Traditional healers

Traditional healers are often the first and last line of defence against the most contagious and
debilitating diseases that plague their lives.
Practitioners such as Albularyo remain central to the lives of many. The World Health
Organization (WHO) estimates that 80 per cent of people regularly seek their services.
Yet healers, for the most part, are not officially recognized by governments.
Some patients, preferring the healers, may disregard their doctor’s advice or take herbal
medicines that could have dangerous interactions with pharmaceuticals. By working with these
healers, doctors would be gaining allies who live in the patient’s own community.
Traditional healing is linked to wider belief systems and remains integral to the lives of most
Africans. People consult traditional healers whether or not they can afford medical services

Doctors trained in the Western sciences largely focus on the biomedical causes of disease, while
traditional beliefs take a more HOLISTIC APPROACH

Unlike modern medicine that only heals the physical body, Hilot encompasses an internal method
that heals man from the inside to the outside; implementing a holistic approach and staying true to
their tradition that they heal, not just sickness, but man himself. Balancing the four elements that
affect both the physical and spiritual aspect of man plays a very large role in this.

Regulating traditional healers

The gulf between modern and traditional practitioners has narrowed somewhat in the past
decade. WHO advocates incorporating safe and effective traditional medicine into primary
health-care systems.

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque

Traditional healers are already a trusted source of health information and treatment.
Given appropriate skills and means, they are well placed to play a bigger role in combating
Philippines major diseases.

Collaboration between healers and doctors

 There is growing realization that it is possible for traditional and Western practitioners
TO WORK TOGETHER TO IMPROVE PATIENTS’ WELL-BEING, especially when it
comes to developing new medications, reporting new cases of contagious diseases and
finding ways to ensure that patients stick to their prescribed treatments.
 Traditional healers can be particularly effective in monitoring disease outbreaks.
 They live within communities and are likely to be the first to know if any new disease
surfaces

Healers boost patient compliance

 Traditional healers are already a trusted source of health information and treatment.
Given appropriate skills and means, they are well placed to play a bigger role in
combating Philippines major diseases.
 Traditional medical persons were, for instance, herbalists, diviners, spiritual or faith
healers, traditional midwives, and birth attendants, who worked well with other staff and
were willing to contribute to PHC. Skills were taught in promotion of :
 Traditional healers are a valuable resource in PHC.

Traditional Medicine

Traditional medicine is defined by the World Health Organization (WHO) as “medicine that refers
to health practices

There are illnesses that can be cured or remedied by traditional medicine. These practitioners,
the hilot and the albularyo, are usually sought after not only by people in the rural areas, but also by those
in the urban areas.

Albularyo

The albularyo uses plants to cure illnesses. Studies have proven that the plants used by the albularyo do
contain substances which can cure various illnesses. These plants are called medical plants or herbs.
According to Michael L. Tan, an anthropology professor from the University of the Philippines, the term
albularyo is misleading

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque

It is a Spanish-Filipino word which means “herbalist”. In western countries, medicinal plants are usually
small herbs, but Tan claims that in the Philippines, medical plants include both herbs and forest trees.

In addition to traditional practitioners, many licensed health experts nowadays recommended medicinal
plants for the treatment of a large number of ailments and diseases, including some serious ones.

Hilot

The hilots assist in giving birth, provide cure for spains and muscle pains, and even give
on family matters. The skills of hilots are recognized by many people, including the authorities of the
Department of Health (DOH). The DOH conducts training for hilots to enriched their knowledge and
improved their skills.

Categories of Herbal Drugs

The World Health Organization (WHO) categorizes medical uses of herbal drugs as:

Those supported by clinical data. This category includes medical indications that are well-establish in
some countries and that have been validated by clinical studies documented in standard scientific
literatures collected from around the world.

Those described in official pharmacopoeias and in traditional systems of medicine. This category is
well-establish in some countries and is included in official pharmacopoeias or national monographs.

Those described in folk medicine not yet supported by experimental data or clinical data. The
appropriateness of this category is not yet assessed due to a lack of scientific data to support the claims
and this should be carefully considered in light of alternative therapeutic applications.

DOH List of Medical

The Department of Health (DOH) is promoting ten “scientifically-validated herbal medicinal

plants”, partly because of the “high cost of synthetic medicines.” But the DOH warns that these medicinal
plants must be taken only in the proper dosages. They can be harmful if used the wrong way or taken in

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque

excess of the recommended dosage. Nine medicinal plants and ailments they cure are the following:

Lagundi- (five-leafed chasted tree)-

For cough,asthma,and fever

Sambong (blumelab camphor) for kidney stones, and edema or manas and hypertention.

Tsaang gubat (wild tea)- for diarrhea

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 Yerba Buena (mint) for body pain

Alkapulko(ringworm bush) for skin diseases caused by fungi such as ringworm or buni, tinea flava
or an-an, and scabies or galis aso.

Ampalaya (bitter gourd) for diabetes mellitus

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque

 Bawang (garlic) for high cholesterol level

Niyug-niyogan (Burma creeper, Chinese honey suckle) for intestinal worm.

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque

 Ulasimang bato or pancit- pancitan(peperomia) for high uric acid level that causes arthritis and
gout.

While the Department of Health only endorses ten medicinal plants, there are other plants which have
yet to be “scientifically-validated”.

Some of these are luya or ginger,which is supposedly good for sore throat,

banaba or queen’s flower, which is good for diabetes as it lowers blood sugar.

According to Michael Tan, some local communities have their own products such as SLK cough
syrup, which is concoction made from sampalok leaves, luya, and kalamansi.

In addition, there is also ABC (abukado, bayabas, caimito) leaves which are use for diarrhea

Note: IT IS BETTER TO CONSULT TO an ALBULARYO OR HILOT’S THAN TO QUACK

DOCTORS!!!!!!!!

Quackery

Quackery affects the lives of many types of people the easily persuaded and wise, the rich and
poor, the various races and religions. It sells questionable and sometimes, useless products and services.
Due to high cost of medical services and increasing number of diseases cases every year, people are
forced to resort to quackery.

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque

 Instead of resorting to quackery, consumers must be informed about traditional medicine that is
cheaper and scientifically-proven. There are many medical plants that available and affordable to the
Filipino consumers. Consumers must be wary of quackery and aware of traditional medicine.

Quackery

Quacks are people who perform healing procedures or prescribe remedies for illnesses even
without formal education and licenses. Some of them sell their own products to treat ailments and
diseases. While some of them deliberately deceive their “patients” about their ability to treat illnesses,
other practice their “craft” with full trust in their competence but openly discuss their limitations.

Quackery involves the use of methods or remedies to cure diseases that are not scientifically
accepted. Questionable ideas, as well as questionable products and services are therefore trademarks of
quackery.

Nowadays, quackery has taken on a broader definition. It is “anything involving over promotion
in the field of health”.

Possible Effects of Medical Quackery

 A person who is terribly ill may die in the hands of a quack.

 A sick person who goes to a quack for treatment instead of doctor may only be prolonging his or
her illness.
 Even if no actual healing has been done, the patient gets well merely by his or her faith, either in
the quack or in the remedies given. The phenomenon is called the placebo effect.
 Money is wasted since a patient’s condition will not improved under a quack.
 The patient’s family may only get false hopes if the quack assures them of the patient’s complete
healing.
 The best defense against quackery is to seek the advice of a medical specialist.

How to Identify Medical Quacks

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque

  Some of them utilize advertisements to promote their products. In other cases, people come to
know about their services by word of mouth.
 Most of them perform their services in their own homes. A few go to them patient’s homes for
their treatment.
 Some claim to have secret formulas which cannot be obtained from drugstores.
 Some of them perform their services without regard for sanitation. They use apparatuses and
other materials that have not been sterilized.
 Some utter vague prayers or incantations while treating their patients.
 Most of them use the same procedure or medicinal formula for all kinds of illnesses.

Who are the usual Victims of Medical Quackery?

 suffer from serious ailments or diseases, like cancer, heart problems, etc;
 are afraid of doctors or those who refuse to undergo surgery, although they have been advise to
do so by doctors;
 suffer from severe pains; and
 usually put a high premium on vanity.

Health Fads

Health fads or consumer craze or consumer myths refer to beliefs about health that gain instant
popularity, stay on briefly, and then die down eventually.

Here are some examples:

1. Some supplementary foods like unproven herbal drinks or energy drinks that give extra strength and
increase the body’s resistance to diseases.

2. Organic or natural foods are better than regular foods available in stores.

3. Wearing a copper bracelet can alleviate pain or cure diseases.

Possible Effects of Following Health Fads

Like medical quackery, health fads may also be a waste of money or a detriment to one’s health.
Here are some of the possible effects:

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque

1. These can lead to spending money on less important or unnecessary products.

2. These can lead to wasteful spending on usually overpriced specialty products.

3. These can lead to spending so much on worthless forms of therapies.

4. These can cause harm to the body.

Transcultural nursing is an essential aspect of healthcare today.

CULTURAL ASSESSMENT TOOLS

Berlin and Fowkes (1982) suggested the mnemonic, LEARN, in conducting a cultural assessment.
This mnemonic represents the following 5 steps:

L isten
E xplain
A cknowledge
R ecommend
N egotiate

The first step is to listen to the patient’s perception of the presenting problem. The nurse then explains his or her perception of the
patient’s problem, whether it is physiological, psychological, spiritual, and/or cultural. The next step is to acknowledge the similarities
and differences between the two perceptions. At times it is easier for the nurse to acknowledge cultural differences, than to acknowledge
and focus on similarities that the nurse and the patient have in common. In order to provide a culturally relevant treatment regimen, it is
important for nurses and all healthcare team members to recognize differences, but build on similarities. The fourth step focuses
on recommendations, which must involve the patient. Finally, the nurse works to negotiate a treatment plan, recognizing that it may be
beneficial to incorporate selected aspects of the patient’s culture into the patient-centered plan.

Buddhist Patients and Health Care:

Nine Practical Points for non-Buddhist Providers

1. Buddhism places strong emphasis on "mindfulness," so patients may

request peace and quiet for the purpose of meditation, especially during crises.
2. Some Buddhists may express strong, culturally-based concerns about modesty:
for instance, regarding treatment by someone of the opposite sex.
3. Some Buddhists are strictly vegetarian in refusing to consume any meat or
animal by-product. For such patients, even medications that are produced using
animals are likely to be problematic.
4. The importance of mindful awareness of all of life's experience may affect
patients' or family members' decisions about pain medications, out of worry
that analgesicsmay unduly cloud awareness. Clinicians should be very specific
in discussion of the use of any drug that may affect awareness, however it

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 should be noted that moderate use of analgesics might actually enable a patient
who is struggling with pain to achieve greater concentration and "mindfulness"
under the circumstances. Non-pharmacological pain management options are
often attractive. In some cases, Buddhists may refuse analgesics, but this should
not be assumed by staff to mean a desire for suffering --in fact, Buddhism
focuses on the relief of suffering, yet some patients may prefer clarity of
consciousness to drugs that may reduce mental alertness.
5. Patients or families may pray or chant out loud repetitiously. This is often
done quietly, and any noise concerns in a hospital can usually be negotiated
easily. Patients may use a string of beads during prayer. Families sometimes
wish to place a picture of the Buddha in the patient's room. Requests to burn
incense or candles can be handled by suggesting alternatives, such as placing
flowers in the room or setting up a small electric light.
6. In end-of-life care, Buddhists may be very concerned about safeguarding their
awareness/consciousness. Clarification of the patient's wishes about the use of
analgesics in the days and hours before death is strategically important for
developing an ethical pain management plan.
7. As a patient approaches death, medical and nursing staff should minimize
actions that might disturb his/her concentration or meditation in preparation
for dying. In Buddhist tradition, death is conceived as a time of crucial
"transition," with karmic implications. Near the time of death, a Buddhist
patient's family may appear quite emotionally reserved and even keep their
physical distance from the patient's bed --this is sometimes the custom for the
purpose supporting the patient's desire to concentrate without distraction on the
experience of dying.
8. After the patient has died, staff should try to keep the body as still as possible
and avoid jostling during transport. Buddhism teaches that the body is not
immediately devoid of the person’s spirit after death, so there is continued
concern about disturbing the body. Such belief may also be an impediment to
discussion of organ donation.
9. Families may request that, after a patient has died, the patient's body be kept
available to them for a number of hours, for the purpose of religious rites. All
such requests should be negotiated carefully, maximizing the opportunity for
accommodation in recognition of the religious significance.

Catholic Patients and Health Care:

Eight Practical Points for non-Catholic Providers

1. Sacraments and blessings by a Catholic priest are highly important, especially

before surgery or whenever there is a perceived risk of death. The sacramental

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque

 requests most often made by patients are for "Sacrament of the Sick" (what
some Catholics may think of as "Last Rites"), Confession, and Holy
Communion (Eucharist) --the latter, however, does not have to offered by a
priest but may be offered by an authorized lay Catholic Eucharistic Minister.
2. If a patient is near death, there may be an urgent request for a Catholic priest
to offer "Sacrament of the Sick" (which some Catholics may call "Last Rites").
Even if the sacrament has already been offered, there may still be a request for
a priest to offer prayers and bless the patient.
3. Baptism: All requests for the sacrament of baptism should be relayed to a
Catholic priest, but in the case of an infant who is likely to die before a priest
can arrive, such an infant may be baptized by any person with proper intent --
the person would say, "[name of infant], I baptize you in the name of the
Father, and of the Son, and of the Holy Spirit," pouring a small amount of
water over the infant's head three times. A report of such an emergency baptism
should be made to the local Catholic parish priest.
4. Patients may request Holy Communion (Eucharist) prior to surgery. While a
Catholic priest or Eucharistic Minister would typically offer such a patient only
a tiny portion of a wafer, patents who are NPO (to have nothing by mouth)
should have this request approved by the care team as medically safe.
5. Some patients may keep with them religious objects, such as a rosary (a loop
of beads with a crucifix, used for prayer), a scapula (a small cloth devotional
pendant), or a religious medal. If patients request that such an object remain
with them during medical procedures, discuss the option of placing the object
in a sealed bag that can be kept on or near the patient. If an object is metal and
the patient is having a radiological procedure or test (like an MRI scan), ask the
patient or family if they can bring in a non-metal substitute.
6. Interruption of religious practices, such as regular attendance at Mass or
special observance of special holy days, may be highly stressful to Catholic
patients. Discuss contacting clergy and/or a hospital chaplain.
7. Patients may have moral questions about treatment decisions, often about the
withholding/withdrawing of life-sustaining treatment. Catholic teaching
does not generally require any treatment considered "extraordinary means," but
a priest may offer authoritative guidance in specific situations. Within families,
there may be diverse opinions about Catholic moral teaching, and differences
sometimes fall along age cohort lines because of the Second Vatican Council's
many changes, occurring in the 1960s.
8. Patients may request non-meat diets, especially during the late-winter time of
Lent (the 40 days before the festival of Easter).

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque

 Jehovah's Witness Patients and Health Care:
Seven Practical Points for non-Jehovah's Witness Providers

1. The most defining tenant for Jehovah's Witnesses in health care is the strict
prohibition (a scriptural injunction) against receiving blood (that is: red blood
cells, white blood cells, platelets, or plasma), be it by transfusion (even the
transfusion of a patient's stored blood), in medication containing or
manufactured using blood products, or in food.
2. Some blood fractions (such as albumin, immunoglobulin, and hemophiliac
preparations) are allowed, but patients are guided by their own conscience.
3. Organ donation and transplantation is allowed, but patients are guided by
their own conscience.
4. Jehovah's Witnesses are usually well prepared to work with health care
providers to seek all possible options for treatment that do not conflict with
religious concerns. It is very common for adults to carry at all times a card
stating religiously-based directives for treatment without blood.
5. Contrary to some popular misconceptions, faith-healing is not a part of
Jehovah's Witness tradition. Prayers are often said for comfort and
endurance.
6. Jehovah's Witness tradition does not teach that those who die experience an
immediate afterlife. It would be inappropriate to say to the family of a
deceased patient anything like, "He's in a better place now."
7. Jehovah's Witnesses do not celebrate birthdays or Christian "popular
holidays."

Muslim Patients and Health Care:

Twelve Practical Points for non-Muslim Providers

1. Muslim patients may express strong, religiously/culturally-based concerns

about modesty, especially regarding treatment by someone of the opposite sex.
A Muslim woman may need to cover her body completely and should always
be given time and opportunity to do so before anyone enters her room. Women
may also request that a family member be present during an exam and may
desire to keep on her clothes during an exam if at all possible. Muslim men
may find examination by a woman to be extremely challenging. Nudity is
emphatically discouraged. There should be no casual physical contact by non-

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque

 family members of the opposite sex (such as shaking hands). Some Muslims
may avoid eye-contact as a function of modesty.
2. Muslims may specifically request a diet in accordance with religious laws for
"Halal" food, though many Muslims simply opt for a vegetarian diet as a quiet
way to avoid religious prohibitions against such things as pork products or
gelatin. ("Halal" is not the same as "Kosher" --the latter refers to Jewish
tradition.) Forbidden foods are referred to as "Haraam."
3. Muslim dietary regulation can affect patients' use of medications, especially
drugs that have porcine origins or that contain gelatin or alcohol. The dietary
prohibition against alcohol has occasionally raised questions about Muslims'
use of alcohol-based handrubs in the hospital, but such handrubs should not
ultimately prove problematic, because they do not have an intoxicating effect
and are used for potentially life-saving hygiene --nevertheless, a patient or
family member's concern about this should be addressed thoroughly and
sensitively, perhaps with the input of an imam.
4. The act of washing is generally conceived as requiring running water, either
from a tap or (poured) from a pitcher. As a result, Muslim patients typically do
not feel truly cleaned by a sponge bath. Also, it is generally important that
Muslims wash--with running water--both before and after meals, and also
before prayers.
5. Muslim prayers are conducted five times a day. Patients may desire to pray by
kneeling and bending to the floor, but Islamic tradition recognizes
circumstances when this is not medically advisable. If patients are disturbed by
their inability to pray on the floor, advice should be encouraged from an imam.
6. Muslim patients may take suffering with emotional reserve and may hesitate to
express the need for pain management. Some may even refuse pain
medication if they understand the experience of their pain to be spiritually
enriching.
7. There may be a request that amputated limbs be made available for burial.
Details should be arranged through the patient’s/family’s funeral home.
8. Muslim tradition generally discourages the withholding or withdrawing of
life-sustaining therapy. However since decisions on this subject turn on the
particular circumstances of the patient and the complexities of medical
treatments, family members who are morally conflicted may wish to bring an
experienced imam into their discussion with physicians.
9. A family member may request to be present with a dying person, so as to
be able to whisper a proclamation of faith in the patient's ear right before death.
(Similarly, a husband may request to be present at a birth in order to whisper a
proclamation of faith in the ear of the newborn.)
10. After a death, the family may request to wash the patient and to position
his/her bed to face Mecca. The patient's head should rest on a pillow.

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque

 11. Burial is usually accomplished as soon as possible. Muslim families rarely
allow for autopsy apart from an order by a Medical Examiner. Some Muslims
may consider organ donation, especially with a sense of "saving life," but the
subject is open to a great difference of opinion within Islamic circles.
12. During the thirty-day month of Ramadan, Muslims refrain from food and
drink from dawn until sundown. Physicians should explore with patients
whether it is medically appropriate to fast while in the hospital, and if so,
investigate options for pre-dawn meals, for providing patients with dates and
spring water in the late afternoon (--a traditional way to break the daily fast),
and for delaying dinner until after sunset. While anyone who is ill is not
obligated to fast, the Ramadan observance can be powerfully meaningful to
patients if they can participate. The month of Ramadan shifts according to a
lunar calendar, and when it occurs during the summertime, longer days can
make the fast more physically stressful.

NURSING REVIEW: TRANSCULTURAL NURSING by Jonas Marvin Anaque