Traditional healers' practices are widespread around the world, yet their diagnostic skills have rarely been investigated. This exploratory study examines whether yachactaitas (Quichua healers) in the Andes identify cases of psychiatric illness in their communities. For over 18 months, ten yachactaitas participated in the identification of 50 individuals with the condition known as llaqui. Medical and psychiatric evaluation indicated that most of those so diagnosed had a DSM-III-R mental disorder. None of the participants with llaqui was considered healthy in biomedical or psychiatric terms. It is suggested that yachactaitas might indeed identify general psychiatric cases in their communities, and that this might be useful for screening purposes.

BackgroundMental health is neglected in most parts of the world. For the Indigenous Peoples of Latin America, the plight is even more severe as there are no specific mental health services designed for them altogether. Given the high importance of mental health for general health, the status quo is unacceptable. Lack of research on the subject of Indigenous Peoples' mental health means that statistics are virtually unavailable. To illustrate their mental health status, one can nonetheless point to the high rates of poverty and extreme poverty in their communities, overcrowded housing, illiteracy, and lack of basic sanitary services such as water, electricity and sewage. At the dawn of the XXI century, they remain poor, powerless, and voiceless. They remain severely excluded from mainstream society despite being the first inhabitants of this continent and being an estimated of 48 million people. This paper comments, specifically, on the limited impact of the Pan American Health Organization's mental health initiative on the Indigenous Peoples of Latin America.DiscussionThe Pan American Health Organization's sponsored workshop "Programas y Servicios de Salud Mental en Communidades Indígenas" [Mental Health Programs and Services for the Indigenous Communities] in the city of Santa Cruz, Bolivia on July16 - 18, 1998, appeared promising. However, eleven years later, no specific mental health program has been designed nor developed for the Indigenous Peoples in Latin America. This paper makes four specific recommendations for improvements in the approach of the Pan American Health Organization: (1) focus activities on what can be done; (2) build partnerships with the Indigenous Peoples; (3) consider traditional healers as essential partners in any mental health effort; and (4) conduct basic research on the mental health status of the Indigenous Peoples prior to the programming of any mental health service.SummaryThe persistent neglect of the Indigenous Peoples' mental health in Latin America raises serious concerns of moral and human rights violations. Since the Pan American Health Organization' Health of the Indigenous Peoples Initiative 16 years ago, no mental health service designed for them has yet been created.

Mental disorders are highly prevalent worldwide, yet mental health care is scarce or inappropriate, especially in developing countries. The majority of the 450 million patients with mental disorders around the world are not receiving even the most basic mental health care. In developing countries, 76.3-85.4% of serious cases receive no treatment. Unfortunately, the unnecessary suffering is likely to worsen, as the global burden of disease attributable to psychiatric and substance use disorders is expected to rise in the coming decade.This chapter unveils some important traditional healers' contributions. Among them are the following: (i) the role their psychosocial and clinical skills have played in the implementation of community and public health treatment programs for physical illness; (ii) their facilitation of culturally competent clinical care; and (iii) their limited, although effective, participation in unique collaborations with psychiatric treatment personnel. It also highlights their role in diminishing stigma related to mental illness and the reintegration of prison inmates and children soldiers into their communities.This chapter urges that the contributions of traditional healers should be welcomed in a world characterized by serious biomedical workforce shortages, limited funding, global mental health service inequalities and enormous unmet needs for mental health services. THE GLOBAL BURDEN OF MENTAL ILLNESSDuring the past two decades, research on illness prevalence in countries around the world has shown that mental disorders are highly prevalent worldwide, and mental health care is Psychiatrists and Traditional Healers Edited by Mario Incayawar, Ronald Wintrob and Lise Bouchard Ó 2009 John Wiley & Sons, Ltd scarce or inappropriate, especially in developing countries (Alarcon, 2003;Desjarlais et al., 1995). Until recently, the true magnitude and social impact of mental disorders was literally unknown. The landmark Global Burden of Disease study, conducted by the World Health Organization, and the World Bank, in conjunction with Harvard University, (Murray et al., 1996) found that four of the ten leading causes of disability through the world, for persons age five and older, are mental disorders. Together, mental disorders (including suicide) account for 15.4% of the overall burden of disease from all causes; second only to cardiovascular conditions (18.6%) and slightly more than the burden associated with all forms of cancer (15%). Respiratory conditions (4.8%) and even infectious and parasitic diseases (2.8%) are far behind. However, despite the worldwide public health importance of psychiatric disorders and their associated higher rates of disability, they are undertreated compared with physical illnesses in high-, low-and middle-income countries alike (Ormel et al., 2008).The four most pervasive psychiatric disorders worldwide are unipolar major depression, bipolar disorder, schizophrenia and obsessive-compulsive disorder. The main message of the Global Burden of Disease study is that the impa...

There is a mounting recognition that culture profoundly shapes human pain experience. The 28 million indigenous people of the Andes in South America, mainly the Quichua (Inca) people, share a distinctive culture. However, little is known about their pain experience and suffering. The aim of the present study was to explore how Quichua adults perceive, describe, and cope with the pain. An exploratory qualitative/descriptive study was conducted with a convenience sample of 40 Quichua adults, including 15 women and 25 men, in the Northern Highlands of Ecuador. Data were collected through structured interviews of approximately 3 h, using a Quichua questionnaire called "The Nature of Pain" [Nanay Jahua Tapuicuna]. The interviews covered the notions of causation of pain, vulnerability to pain, responses to pain, aggravating factors, frequent locations of pain, types of pain, duration, characteristics of pain, control of pain, pathways to care, and preventive measures of pain. Basic descriptive analyses were performed. The Quichuas' pain experience is complex and their strategies to cope with it are sophisticated. According to the Quichuas, emotions, life events, co-morbid conditions, and spirits, among others factors play an important role in the origin, diagnosis, and treatment of pain. They strongly embrace biomedicine and physicians as well as Quichua traditional medicine and traditional healers. Family members and neighbors are also valuable sources of health care and pain control. The pathway to pain care that the Quichua people prefer is inclusive and pluralistic. The knowledge of the Quichua ethnographic "emic" details of their belief system and coping strategies to control pain are clinically useful not only for the health professional working in the Andes, some Quichua cultural characteristics related to pain could be useful to the culturally competent health practitioner who is making efforts to provide high-quality medical care in rural and multicultural societies around the world.

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There is an estimated 30 million indigenous peoples in South America. Most of them live in the Andes. Regional states and governments neglect their health care needs and exclude them from the conventional Western health services in general and mental health care in particular. This review first describes this population's current situation of social exclusion, poverty and poor health. The problem of mental health care inequities in the region is illustrated through the case of the Quichua people. Indeed, for the population of over 5 million Quichua people in Ecuador, there are no psychiatric services. There are no culturally sensitive services offered in the Quichua language. The doctor–Quichua patient communication is poor and interactions are loaded with prejudice. The review provides a rationale for the Quichuas' reluctance to seek medical doctors in Ecuador. Finally, traditional healers' contribution to the mental health care of indigenous peoples is stressed, as well as their preference for a form of medical pluralism, mainly combining both traditional Quichua medicine and Western medicine. Woeful inequalities and inaccessibility to psychological and biomedical psychiatric care still widely affect the children of the sun in the Pacific Rim.

The clinical encounter with a patient who is suffering from chronic pain and a psychiatric disorder is challenging. This can become a clinical conundrum if the patient has a different cultural background than the physician and says he or she has a mysterious culture-bound syndrome. This chapter discusses a Quichua-Inca illness experience called Jaki, a frequent condition that is well-known by millions of Quichua patients in the Andes, South America. Biomedically trained doctors usually dismiss it as a condition without any medical importance experienced by superstitious and primitive people. In contrast, Jaki patients believe it is a complex and threatening illness that could lead to death. They recognize four types of Jaki and believe the causes are related to “evil spirits” and that proper treatment should address them. The author conducted a transcultural psychiatry study showing that most Jaki patients are suffering from depression, anxiety, somatoform disorders, psychological factors affecting a physical condition, and adjustment disorders. Jaki patients are suffering indeed from comorbid chronic pain and psychiatric disorders. The chapter concludes with clinical recommendations for the practitioner who is willing to avoid racial bias, improve cultural competency, and offer culturally sensitive and better quality medical care.