MEDICINE AND CUTURE The effect of cultural changes can be largely seen in the domain of medicine.

Despite the growing use of modern medicine in these areas, traditional medical systems in these areas still persist and exert a significant amount of influence on the state of health and on medical decisions and outcomes in developing societies. Modern medicine in these areas has been established not by displacing indigenous medicine but more so by increasing the medical options made available to the populations. For example, Saunders observes that among the Spanish speaking population adoption of modern medicine does not necessarily mean giving up of old medical ways, and this can be true of any population. It has been argued that modern medicine can more effectively serve populations in developing areas by merging both traditional and modern medical practices. However, these two approaches are dichotomized both by the practitioners and populations. COGNITIVE INFLUENCES ON CHOICE OF MEDICAL TREATMENT Definition of disease: The type of disease influences to a large extent the choice of treatment. People in developing areas tend to distinguish the kind of illnesses that can be cured by the physician from those that will respond only to the therapy of the local healers. For example, Goulds pointed out in his study in northern India that modern medicine tended to be utilized for critical incapacitating dysfunctions (pneumonia, typhoid fever) whereas, indigenous healers were sort to for chronic incapacitating dysfunctions (enlarged liver, asthma). Gould further concluded that, since perceptions, interpretations and manifestations of diseases varied; a disease that sort the treatment of modern medicine in one community may not be viewed the same way in another. He also stated that the personal relationships of medical choices must not be understated. According to Lieban, the course of an illness, the outcome of previous treatment for the same condition and a variety of other factors may cause a patient to redefine it and shift from one medical system to the other. Erasmus observes that in Ecuador, people have more confidence in a physicians treatment of illness with modern names, but they do not always classify their symptoms according to those names until a physician is consulted at an advanced stage of the illness. Gratifications of treatment: Gonzalez distinguishes between 2 categories of healing techniques- medicines and practices. She defines medicine as any substance applied or introduced into the body, which is believed by some specialist and/or the sick person to change the existing state of the body in the direction of better health while a practice, is any act undertaken by the sick one or someone else, which may or may not directly involve the body, but which is believed to have an effect on the health. In her opinion, people in developing areas have used modern therapy primarily for the effectiveness of its medicine, which is widely recognized as superior to indigenous medicines. However, Western therapeutic remedies such as rest, change of climate etc seem unconvincing

to the people in these areas. At the same time, an indigenous medical practice in which ritual plays a role has significant popular appeal. Gonzalezs distinction however, does not accommodate cases for physicomechanical procedures such as surgery etc. The influence of tradition: Erasmus stressed that traditions are not blinders that keep individuals from seeing the benefits in changing their behavior. He has been highly critical of the weight that some writers have given to prior cultural conditioning as an impediment to modernization. Even uneducated, illiterate people will act to maximize their expectations and will take advantage of new alternative means. However, he also states that peoples readiness to discard their old customs for new ones if they can readily perceive the benefit of doing so, he also points out that when cognitive situations are not conducive to such perceptions, it is not surprising that people continue their traditional activities or add new practices while still retaining their old ones. Roemer states that some anthropologists tend to exaggerate the grip of tradition and to underestimate the receptivity of people to change in their medical behavior if they experience new measures that help them. Factors that influence the effectiveness of medicine and lack of indigenous forms Most illnesses eventually end in spontaneous recovery. When therapy is sort from both a physician and a healer, if a physician cures it a healer may get the credit for it. Purposes as well as results of modern medicine may be misperceived.

When the advantages of modern medicine are not convincingly apparent, traditional medical beliefs provide a ready frame of reference. These beliefs are linked to other patterns of behavior such as magic, religion and traditional social values. OTHER INFLUENCES Fatalistic attitudes toward illness: Medical efforts to cure an illness may cease if the patient believes that it cannot be cure. For e.g. if the patient believes that the disease is beyond the capability of man or caused by a greater force etc. Symbolic significance of medical phenomena: People may respond to medical systems on the basis of what they represent as well as what they do. Modern medicine on the one hand may be viewed as a sign of higher social status but when ethnic pride comes into play traditional practices may be viewed higher. Loyalty may even be shown to certain illnesses considered beyond the competence of modern medicine. Therapeutic styles: The manner of therapy as well as its substance may influence peoples choice of practitioners.

Social factors: