public health

[OPINION] On folk medicine and pandemic response

Mark Laurenz Handayan
[OPINION] On folk medicine and pandemic response

Illustration by DR Castuciano

'Filipinos living on the peripheries...not only experience challenges in accessing medical resources, but also experience cultural differences in their perception of health care'

It is not new knowledge that the COVID-19 pandemic has resurfaced the country’s preexisting inequities in health care, livelihood, and access to essential services. As the public health crisis worsened, individuals mainly living below the poverty line suffered the most from the plummeting economy and poor governance. The inherent social inequalities also heightened the vulnerability of the Filipino poor to misinformation, hence increasing their risk of contracting the disease. 

This inefficiency of the current administration to communicate science effectively has led to a general distrust among Filipinos towards public health initiatives.

Despite several attempts to promote health protocols for COVID-19, it cannot be denied that the technical jargon, misleading statistics, and confusing quarantine restrictions have impeded public understanding of these protocols. An average Filipino without a background in sciences would not be able to comprehend them.

This phenomenon becomes even more pronounced with our Manila-centric concept of development. Filipinos living on the peripheries, far from the urban areas of Metro Manila, not only experience challenges in accessing medical resources, but also experience cultural differences in their perception of health care. Folk medicine remains their primary source of health intervention.

It is no coincidence, then, that vaccine hesitancy is more prevalent in the outskirts of towns, where access to functioning health facilities is scarce. The 2018 Dengvaxia controversy also remains a part of local conversations – making the objective to reach herd immunity by the end of the year a far-flung reality. 

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But is it ethical to put the blame on people whose utmost exposure to health care is folk healers? Clearly, there is a need to develop culturally relevant health promotion programs and medical curricula that would meld better with the sociological aspects of folk medicine.

The epistemic development of folk medicine 

Before the westernization of our medical practice, the babaylans in early Philippine civilization fulfilled the role of the community physician. The babaylans had extensive knowledge of medical botany and the ability to identify common illnesses based on the characteristics of accompanying pains, associated behaviors, and pulse beats. They then performed prayers and rituals to repel the “bad spirit” believed to cause these illnesses.

Learned patterns from past cases serve as points of reference for future medical judgments. This practice, accompanied by the babaylan’s knowledge in medical botany and the influence they wield because of religion and local beliefs, allows them to become effective healthcare providers in the community. It is an interweaving of inductive and deductive logic and involves a hierarchy of thoughts, which western medicine fails to acknowledge. 

These babaylans now take the form of contemporary folk healers such as the albularyo, manggagamot, and kumadrona, who act as primary healthcare providers in most rural municipalities. 

Traditional medicine during COVID-19

The practice of traditional medicine has become more apparent during this health crisis. Some have taken preventive measures against COVID-19 through practices such as pagpapalakas ng resistansya (strengthening one’s immunity/resistance), hilot (traditional massage), and tuob (steam inhalation). However, there is currently insufficient evidence on the use of steam inhalation, in particular, to prevent or treat COVID-19. In extreme cases, inhaling high-temperature steam may cause burns and irreversible pulmonary damage.

Still, folk medicine ought not to be painted as inferior to empirical science. Locals’ knowledge, attitudes, and practices regarding health are mere reflections of the inaccessibility of adequate, modern health care.

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Systemic issues

The further away a community is from health facilities such as clinics and hospitals, the bigger the gap is in medical confrontation.

The country’s problem lies in systemic issues including inequity in health care, neoliberal curricula, and poor investment in public health. It is also not a coincidence that residents of lower socioeconomic status are more prone to misinformation and are hesitant to be inoculated with the COVID-19 vaccine. In a study done by Lau et al. (2020), it was concluded that there is a need to develop contextually and culturally relevant health education as a vital response strategy to the pandemic, particularly in low-income settings.

To complicate things, the neoliberal curriculum taught in universities and medical schools prefer laboratory research and biological science. Empirical data (a concept mostly used in in traditional medicine) is immediately dismissed among western scientists.

However, despite their differences in thought styles, both clinical and folk medicine undergo the scientific method by recognizing patterns and predicting the progression of an illness through testing assumptions.

Bridging the gap between clinical and folk medicine

The lack of a historical perspective towards folk medicine should spark a discussion on reforming current medical curricula. Traditional and clinical medicine should not be seen as extremes, but as disciplines that share fundamental objectives. Dismissing notions of folk medicine further antagonizes clinical medicine in the eyes of people on the peripheries. Understanding the knowledge, attitudes, and practices of the population living below the poverty line is significant to effectively communicate public health responses that are culturally acceptable.

As a public health student, I have been reminded through countless lectures that diseases occur beyond the pathophysiological diagnosis of clinical medicine. It is naive to separate health from its social determinants, perhaps because biological imbalances are also manifestations of poor social structures.

There is a need, then, for the scientific community to reify modern medical biases against the scientific process of folk healers.

Investing in research on traditional health beliefs and practices could also provide a systematic explanation of its underlying phenomena. The traditional herbal medicine lagundi, for instance, is even undergoing clinical trials as a potential treatment against COVID-19. Simultaneously, the Department of Science and Technology (DOST) has also started inspecting the antiviral properties of tawa-tawa against the SARS-COV-2 virus. These milestones are significant steps in bridging the gap between folk and clinical medicine. 

If we want to change the status quo, the country needs to include more culturally relevant courses in our medical education. The issue with a curriculum heavily founded on western-oriented sciences and neoliberalism dismisses the nuances in our diverse population.

The feats of both folk and clinical medicine represent the triumph of science over death. Hence, it is our moral and cultural obligation as future healthcare providers to not be confined to the diseases we learn from textbooks, but to also identify our role as social actors in treating the illnesses of society. –

Mark Laurenz Handayan is a freshman BS Public Health Student from the University of the Philippines-Manila.