Page 190 - Creating Spiritual and Psychological Resilience
P. 190
“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