This may reflect the fact that family problem is not a medical diagnosis and sickness and bad luck are also categorized differently in medical terminology. Navajo nurses and nursing assistants who knew the purpose of the interview and who spoke Navajo translated for non-English—speaking patients. Finally, patients were asked about the interaction between conventional medicine and native healers: The time of their last visit to a native healer, the reasons for the visits, and satisfaction with these visits was recorded. Cost was the main barrier to using native healers.
Methods Between June 23, , and September 1, , consecutive adult patients seen in the ambulatory care clinic at a rural IHS hospital were interviewed. Further research is needed to elucidate how extensive native healer use is across various areas of the Navajo reservation, what patients' expectations of their various health care providers are, their view of the success of the care provided, and how conventional care and native healer care can interact with each other to increase the overall effectiveness of care provided to the patient. To determine the prevalence of native healer use, the reasons for use, cost of use, and the nature of any conflict with conventional medicine. Table 2 also summarizes the most common reasons for visits to a native healer and the frequency of concomitant use of a medical provider. To improve understanding of the use of native healers and its interaction with conventional medicine, an interview was conducted of Navajo IHS patients to determine the prevalence of use, reasons for use, characteristics of those who use native healers, cost of care, and whether native healer care conflicts with care provided by conventional physicians. However, no inquiry was made about the type of native healer sought or the type of ceremony performed since the native healer consultant advised that such questions might be considered intrusive. From the patients' medical charts, the number of outpatient visits, inpatient stays made to the hospital in the last year, and the reasons for the visits were recorded. Use of conventional medicine at other locations in the last year was inquired about and the number of visits and the reasons for these visits were recorded. Despite its location on the edge of the reservation and the access that patients have to other nongovernmental health care facilities, almost 47, outpatient visits were made to the hospital during the fiscal year. Barriers to seeking native healer care Medical care provided by the IHS is free, with the exception of certain procedures such as cosmetic surgery and certain items such as dentures. The longer ceremonies can last as long as 9 days with different chants and rituals performed throughout, and can take years of apprenticeship to learn. For diseases such as diabetes, native healer care was viewed as an adjunct rather than a substitute for medical provider care. Cost was the main barrier to seeking native healer care. The cost may vary for several reasons, particularly regarding the type of ceremony performed and the complexity of the ceremony. While these patients still believed in traditional Navajo medicine, they stated that they could not find a trustworthy practitioner; one patient stated, "There are a lot of quacks out there," applying the term quacks to those masquerading as native healers. Although the Indian Health Service provides extensive health care service to Navajo people, the role of native healers, or medicine men, has not been quantitatively described. Patients who saw native healers for arthritis and diabetes mellitus commonly consulted a medical provider in addition. As with many other subpopulations in the multicultural society that composes the United States, the use of alternative medicine is common among Navajo patients. Costs are a conservative estimate as they may exclude such customary expenses as transportation, feeding all those who participate in a ceremony, and costs of materials needed such as buckskin or herbs. The age and sex distributions of subjects are similar to that of all patients seen at the Crownpoint Healthcare Facility, Crownpoint, NM, between June 23, , and September 1, Navajo nurses and nursing assistants who knew the purpose of the interview and who spoke Navajo translated for non-English—speaking patients. More than one third of patients stated they would use native healers more often except for the cost. No patient saw a native healer for upper respiratory tract infections, health care maintenance, pregnancy, or allergies. The Navajo Nation Research Board, which acts as the institutional review board for research involving the Navajo tribe, reviewed and approved the study. Statistical analysis The demographic characteristics of the population, prevalence and frequency of native healer use, and reasons for visits to medical providers and native healers were described using percentages for dichotomous variables and the mean and SD for continuous variables.
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