Clinical Briefs
With Comments from John La Puma, MD, FACP
Curanderismo Use by Hispanic Patients
August 2001; Volume 4; 94-95
Source: Padilla R, et al. Use of curanderismo in a public health care system. Arch Intern Med 2001;161:1336-1340.
"Curanderismo (the healing’) is a centuries-old synthesis of Mexican Indian culture and beliefs. To evaluate the rate of use of curanderismo among Hispanic subjects seeking medical care at the Denver Health Medical Center, Denver, CO, we conducted a survey of 405 Hispanic subjects attending outpatient primary and urgent care clinics at Denver Health Medical Center, the public hospital system for Denver. The main outcome measure was independent predictors of use of curanderos. Of the 405 subjects, 118 (29.1%) (95% confidence interval [CI] 20.9-37.3) had been to a curandero at some time in their lives. Of all the subjects, 91.3% knew what a curandero was. Univariate analyses demonstrated an association between those who had been to a curandero and level of income, level of education, and whether the subject was bilingual. The results of fitting a stepwise logistic regression model revealed an independent association with subjects who had been to a curandero and level of household income (> $20,000 vs. < $10,000), with an odds ratio (OR) of 2.19 (95% CI 1.20-4.01) (P = 0.01), and level of education (post-high school vs. elementary school), with an OR of 3.16 (95% CI 1.45-6.86) (P = 0.004). Many Hispanic patients who receive their health care at a public hospital system use the services of curanderos. This potentially has important implications for their health care."
Comment
The authors review the ancient but still current "folk healing" tradition, which began in South America among native American tribes and is centered upon their beliefs of harmony with nature, spirit, and self. Curanderos and curanderas are spiritually chosen designates who "were given the power to heal the wounded spirit and cure the supernatural illness." Curanderos have inherited the role of the native American shamans who came before them, and much before the invading Spaniards. Most curanderos and curanderas are elders in the community, are not full-time practitioners, and are not expected to treat major medical illness. The authors cite a study of 16 curanderos which showed that "the setting for their practice is often their home. They generally use prayer, massage, herbs, and reassurance to treat their patients. In addition, curanderos frequently share their patients’ social class, background, language, and religion."
Headache, empacho (pseudointestinal obstruction), nervios, and susto (fright) each were the cause of the visit to the curandero for more than 20% of subjects (who could name more than one reason for a visit); back pain, kidney problems, and diabetes registered less than 5% each. Because most subjects did not tell their physicians of these visits, it’s also possible that they didn’t tell their physicians of these symptoms—some of which could indicate serious pathology.
This study is useful, not because it indicates that curanderos can be curative or even therapeutic (it doesn’t), but simply because many Hispanics remain medically indigent. As health care coverage becomes tighter, this population will continue to rely upon traditional methods of care. Most of their methods are benign, and some are likely to be highly beneficial—indeed, some already have been shown to be.
Recommendation
Ask your Hispanic patients who are indigent whether they see a curandero or use any treatments prescribed by anyone else. More often than you think, the answer will be yes.
August 2001; Volume 4; 94-95
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