Sangomas: problem or solution for South Africa's health care system.

We discuss the problems associated with legalizing traditional healers--Sangomas--for the South African health care system and their role in the management and treatment of HIV/AIDS and the resistance of professional medical organizations to recognize their contribution. We list some of the diseases and conditions that can be diagnosed and/or treated by traditional healers and the efficacy of the treatment. We conclude with the problem of Sangomas identifying witches within a community and how this may affect their legitimacy.

The political economy of health policy in Sub-Saharan Africa.

This paper discusses the health status of Sub-Saharan Africa focusing on infectious and parasitic diseases, HIV/AIDS, maternal and child health, famine, and political instability. Its contention is that Africa is stuck in the second stage of the demographic transition (high birth rate, low death rate) and the first stage of the epidemiological transition (deaths related to pestilence, famine, and war). Africa's lack of sustainable development is attributed to ineffective governmental policy and leadership. The prognosis is that the health and well-being of Africa's most vulnerable population, women and children, will improve when government shifts its attention from external funding and affairs to internal and concentrates on retaining Africa's 'talented tenth'; that the 'brain drain' and political instability has robbed Africa of its most talented young people, medical and science professionals, who are needed to provide primary care and development to a region with a high mortality rate, a low life expectancy, and a low per capita income.

Self-assessment of cultural attitudes and competence of clinical investigators to enhance recruitment and participation of minority populations in research.

Reduction of health disparities in the United States is a high priority. One means of effecting such a reduction is to enroll persons of groups that are subject to health disparities in clinical trials. One barrier to minorities enrolling in clinical research is distrust of the medical establishment based on past abuses and perceived discrimination. We hypothesized that another barrier is a lack of investigators' understanding and skill in effectively communicating with members of minority cultures. We therefore assessed the cultural competency of faculty and staff involved in clinical care and research at Creighton University Medical Center (CUMC). Thirty-seven faculty and staff members participated. We found that the majority are reasonably culturally competent, but there are areas in which proficiency can be enhanced and recruitment of participants in clinical research can be improved. Most CUMC faculty and staff respect and have reasonable knowledge of the several cultures of the patients for whom they provide care and with whom they conduct research. But there is a need for continued cultural sensitivity/competency training to enhance understanding of certain aspects of minority cultures, group and interpersonal relationships, perceptions of disease and wellness and to improve their access to minority communities.

Satisfaction with and perceived cultural competency of healthcare providers: the minority experience.

It is well known that nonwhite minority participation in clinical research is lower than their representation in the community. The goal of this study was to assess satisfaction of minority community members in Omaha with the care received and cultural competency of healthcare providers. We sought input from Omaha minority communities on how to improve the care they received and asked why they did not participate in healthcare research. Seventy-two minority members representing African Americans, Hispanic Americans, Native Americans, Sudanese, and Vietnamese; and eight whites were surveyed. The results of this study indicated that the majority of our respondents were satisfied with the care they received, but for a small percentage, language, communication and/or culture contributed to dissatisfaction. In addition, some respondents did not think the provider was culturally competent, i.e., not sufficiently knowledgeable about their racial, ethnic and/or cultural background. Some participants indicated that they preferred a provider of similar racial, ethnic and/or cultural background, and/or thought some diseases were better treated by a provider of the same racial, ethnic and/or cultural background. Regardless of the cultural competency of the provider, the overwhelming majority of our respondents (with the exception of African Americans) indicated a willingness to participate in healthcare research. In conclusion, this study found that satisfaction with healthcare providers was not associated with perceived cultural competency and that the cultural competency of the provider did not affect patient willingness to participate in healthcare research; however, we acknowledge that the Hawthorne effect may be in operation.