South American Indians between traditional and modern health services in rural Ecuador.

Resumen

This study measured actual use by 4 Ecuadorean Indian populations of traditional and modern health services in terms of their opinions and attitudes towards the services. Interviews were conducted with 727 heads of households belonging to 2 highland groups of Quichua and 2 lowland groups of Quijos and Achuar. The interview questionnaire contained questions about the perceived morbidity of the population and actions taken in case of illness and included 30 tracer questions. For 3670 episodes of ill health during the 2 weeks preceding the interview, 50.1% reported self-treatment at home, 26.8% used modern healers, 10.2% traditional healers, and 12.9% drug sellers. The distribution of healers if the 1st treatment proved unsuccessful was very similar. 49.6% reported that, given a free choice, they would prefer modern health services. Analysis of the consistency of use of particular types of healers indicates that people suffering from "infectious diseases" and "painful conditions" consistently preferred to use modern health services, while people with "psychosomatic conditions" or "folk diseases" used traditional healers or home treatment. The patient's age, sex, primary school education, or material assets were not consistently associated with the use of modern or traditional services, but secondary education and the accessibility of modern services were directly correlated with use of modern services. A strong tendency to shop around for healers was noted, and only a minority of the 697 persons answering questions on confidence had a consistently positive attitude toward traditional or modern healers. The main reasons cited for not using modern health services were their lack of cultural, geographic, and financial accessibility. Respondents living close to modern services had higher esteem for traditional healers, while those dependent on traditionalhealers had higher esteem for modern services. The study results indicate that more modern services are needed and should be geared to the specific cultural and environmental features of the populations served.