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“To Do No Harm” Spiritual Care and Ethnomedical Competence 161
expectations and unsubstantiated assumptions (Norris & Alegría,
2006; Vega, 1992).
3. “Attempts from outside Aceh to ‘train’ various community leaders in
how they might respond to widespread psychological distress at a com-
munity level, using western constructs of community reconstruction
and development, may be misguided and will probably be unwelcome”
(WHO, 2005, p. 4).
4. “Standardized instruments are useful for evaluating outcomes in rela-
tion to standard psychosocial interventions, but they may not encompass
local constructions of mental distress, reasons for seeking traditional
healing, or definitions of successful treatment, which may be grounded
in spiritual cosmologies” (Patel, Kirkwood, & Weiss, 2005).
5. A Sri Lankan academic, Janaka Jayawickrama (2006), offers this analy-
sis: “… unplanned and uncoordinated humanitarian assistance without
a clear vision may create as much distress as the disaster. To catego-
rize affected communities as ‘traumatized’ and in need of psychologi-
cal or psychosocial support—and on the basis of assumptions that owe
nothing to the voices of the people themselves—is to miss important
opportunities to provide humanitarian assistance that will be valued by
recipients.”
Clearly, spiritual care interventions are vulnerable to the above pit-
falls, especially if the field of spiritual care pursues generalizability and
protocol-driven interventions. If, however, spiritual care aligns itself
appropriately with local traditions and holistic healers—while evolving
practice norms—it can stimulate highly relevant IPR, while minimizing
harm. With this in mind, what follows are relevant recommendations
from different sources:
Box 3: rECommEndations for utilizing rEligious,
spiritual, and traditional ViEws in disastEr
1. The religious construction of meaning surrounding the disaster may
mean that efforts to deal with psychological and social consequences
of the disaster in ways that are not consonant with such religious and
cultural values and beliefs (e.g., trauma-focused counseling, psychiatric
approaches) will be both ineffective and unacceptable. (WHO, 2005)
2. Authors Carballo, Heal, and Hernandez (2005, p. 398) observed
improved resilience in tsunami-affected populations utilizing spiritual
grounding and religious leaders. They suggest the following: “Some of