Page 190 - Creating Spiritual and Psychological Resilience
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“To Do No Harm” Spiritual Care and Ethnomedical Competence   159

            being  applied.  Ethnomedical  competence (EC)  is  the  capacity  to  dis-
            cern appropriate blends of techniques that meet public health needs
            for particular situations. Appropriate blends are ones that deliver sub-
            stantial benefits while doing minimal harm (including minimization
            of  costs).  While  maintaining  an  evidence-informed  stance  on  effec-
            tiveness and safety, EC views Western and non-Western techniques as
            equally respected partners.



                    Box 1: CultiVating EthnomEdiCal CompEtEnCE

               1. Utilize literature review, anthropology, and related disciplines in order
                 to arrive at a more accurate view of affected persons, preliminary thera-
                 peutic goals, and list of possible interventions.
               2. With  the  community,  learn  about  local  idioms  of  distress,  negotiate
                 mutually agreeable goals, and prepare to exercise maximal flexibility
                 consistent with those goals. Balance cultural power so that all parties
                 collaborate  in  democratic  and  symmetrical  learning  environments.
                 Consider utilizing a consultant with ethnomedical experience to pro-
                 vide perspective and cultural skill sets.
               3. Study  applicable  culturally  embedded,  local  healing  interventions.
                 Ascertain how culturally embedded interventions are (or are not) being
                 utilized.
               4. Take  a  step  back  to  view  the  entire  field  of  possible  interventions
                 (Western, local, and nonlocal/non-Western) and choose a set of inter-
                 ventions on the basis of feasibility, efficacy, “doing no harm,” and cost.
               5. Work within a plan of integrated services. Expand program monitor-
                 ing/evaluation terms and outcome studies so that the measured param-
                 eters take local signs of distress into account.


              Why  even  bother  to  create  so  many  categories  with  new  terminol-
            ogy? These categories aspire to take into account the increasing academic
            critique  (Jayawickrama,  2006;  Shah,  2006,  2007a;  Summerfield,  2005)
            against the individual-focused, pathology-oriented, psychological proto-
            cols that are applied by outsiders coming to Asian disasters with the intent
            of doing good. Many Asian-centric relief authorities prefer psychosocial
            conceptualizations of trauma intervention in order to respect the dynamic
            relationship between psychological states and social realities—recogniz-
            ing that strengths and vulnerabilities in either will coinfluence the other.
            Psychosocial  programs  show  “commitment  to  nonmedical  approaches
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