Mission accomplishments: OMT, respect for traditions earn DOs goodwill abroad

Dixie Tooke-Rawlins, DO, needed the shaman to stop. The patient, a Haitian in her early 20s, lay in her one-room shack nearly comatose. Her forehead glistened with sweat. Gripping bunches of long, brown leaves in both hands, the thin and graying shaman leaned over her in fervent ritual.

The leaves rustled as the shaman shook them several inches above the woman, slowly moving them from her head to her feet and back. All the while he recited a rhythmic, angry-sounding Creole chant. Then suddenly he’d stop, pull his hands to his chest and thrust them outward with a shout, as though repelling an intruder.

Just minutes earlier, the sick woman’s neighbor had retrieved Dr. Tooke-Rawlins from her nearby medical clinic in La Playa in the Dominican Republic. “The woman obviously was very sick,” recalls Dr. Tooke-Rawlins, the dean and executive vice president of the Edward Via Virginia College of Osteopathic Medicine–Virginia Campus (VCOM-VC) in Blacksburg. “But as I watched the healer’s animated ritual, it was so scary that I thought, ‘How am I going to get into the middle of this?’ I wanted to be respectful and let him conclude, but I didn’t know how long he would continue.”

Dr. Tooke-Rawlins told the neighbor, who acted as interpreter, that she needed to examine the woman. “There was a brief, animated exchange between my interpreter and the shaman,” Dr. Tooke-Rawlins says. “But he finally backed away, stood against the wall and let me examine her.”

The woman, who had recently given birth to her second child, had contracted a postpartum infection and was septic. “I said, ‘We’ve got to get her to the hospital right away,’ ” Dr. Tooke-Rawlins remembers. When the interpreter relayed the physician’s advice to the ill woman’s husband, he refused to consider going to the clinic. But the interpreter continued to press her point, and after a few minutes the husband relented.

At the clinic, Dr. Tooke-Rawlins provided the woman with intravenous fluids and antibiotics and transferred her to a hospital, and she eventually recovered. Afterward, Dr. Tooke-Rawlins asked the interpreter what she said to change the husband’s mind. “She told him that if his wife dies, he’ll have to take care of their three children by himself,” Dr. Tooke-Rawlins says. The interpreter also told Dr. Tooke-Rawlins that the husband was convinced the shaman played a vital role in his wife’s recovery.

This story illustrates the dual perspective on healthcare in many developing countries: the people’s persistent reliance on traditional healing coupled with a growing acknowledgment of Western medicine’s benefits.

A generation or so ago, the husband might well have held firm in his refusal to take his wife to the clinic. But increasing exposure to Western culture and people’s experience with good outcomes at medical missions have helped build bridges between Western and traditional medicine.

Volunteers from osteopathic medical schools such as VCOM-VC and osteopathic medical organizations such as DOCARE International have put a priority on reaching out to the underserved in developing countries. Osteopathic physicians’ respect for traditional healing methods—plants, mineral-based medicine, prayers, chants—along with their osteopathic manipulative treatment skills, have helped the profession maintain successful medical missions worldwide.

In the 10 years that Dr. Tooke-Rawlins has been going on medical missions, mostly to Central America, she has witnessed people’s suspicions of Western medicine give way to trust. While many people have retained beliefs in spiritual healing and the healing power of plants, she says, they’ve abandoned primitive practices, such as appeasing evil spirits.

Nevertheless, pockets of resistance remain. There are people in remote areas of El Salvador, for instance, who continue to believe in devil worship, Dr. Tooke-Rawlins says. “These people remain very suspicious of Western medicine, and we will never see them at the missions.”

Osteopathic medicine’s advantage

Physicians on missions report that people in developing countries embrace manual medicine. In Honduras and El Salvador, where Dr. Tooke-Rawlins often provides OMT to resolve muscular pain, she sees that the treatment provides added benefits.

“It’s not only that OMT works, but also that we’re touching the patients that’s so important,” she says. “They’re so appreciative—there’s something giving about touching. It helps to build trust, and that is very important if you need to do more complex treatments.”

In some counties, such as Haiti, massage therapies are an integral component of medical care. “Being a Haitian myself, I know that Haitians will not be satisfied with a patient-doctor interaction if the physician does not lay hands on them,” says Sidney Coupet, DO, MPH, a general internist in Danville, Pa., and the founder and director of Doctors United For Haiti (DUFH), which establishes medical missions in the country. “If you don’t show that form of comfort to them, they won’t feel as if they’ve been to a healer.”

In his work in Haiti, Dr. Coupet has found it essential to partner with local health care professionals and community leaders while also reaching out to traditional healers. Half the population typically will see a natural healer before seeing a Western-trained physician, he says.

“So one of the things DUFH does in rural Haiti is seek out alternative healers and ask them to join us as we see patients,” Dr. Coupet says. “We try to be open with the healers, emphasizing that we’re all here to serve patients. And we ask them when they see patients with diseases they know they cannot treat to refer them to us immediately. It doesn’t make sense for patients with life-threatening diseases to lose time seeing someone who can’t help them.”