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MED examines religious healing practices used by Boston minorities

By David J. Craig

Last year when a 16-year-old Puerto Rican boy from Boston, whose family believed he was behaving obsessively and erratically, visited pediatrician Ken Fox, he recognized the boy's symptoms as early warning signs of schizophrenia.

	Ken Fox (left) and Linda Barnes, MED assistant professors of pediatrics, are investigating how ethnic minorities in Boston use religiously based healing practices, as part of the Boston Healing Landscape Project. Eugene Adams (right), a photographer hired as a consultant to the project, is helping graduate student researchers document the healing practices common in the area. Photo by Jason DeCrow (COM'02)

But when Fox, a MED assistant professor of pediatrics, attempted to discuss with the boy the possibility of visiting a psychiatrist instead of relying exclusively on prayer to heal himself, as members of his church had recommended, Fox says he inadvertently put the boy on the defensive.

"When I questioned him about the approach people in his church were telling him to take, it turned into a whole debate about his beliefs, which wasn't what I intended," he says. "We're out of touch now, and I feel that I blew it."

Bridging cultures

Boston doctors regularly treat patients who also use spiritual rituals and herbs for healing. But because most doctors have little knowledge of such practices, Fox says, discussing health-care options with those patients can be extremely challenging.

The Boston Healing Landscape Project (BHLP) is surveying the religiously based healing practices popular among African-Americans and members of African Diaspora communities in and around Boston in an effort to improve communication between doctors and patients. Launched this spring, the multi-institutional project is coordinating several studies that examine how minorities supplement or find alternatives to modern Western medicine. The information gathered will be integrated eventually into the BU School of Medicine's curriculum. Linda Barnes, also a MED assistant professor of pediatrics, is the project's principal investigator, and Fox is its coinvestigator.

Studies under way include an examination of how religious healers treat childhood asthma; how the spiritual traditions of Haitian immigrants affect women's health choices during pregnancy and in the year following the birth of their child; how the religious beliefs of African Diaspora groups contribute to the resilience but also to the social isolation of HIV-positive people of color and gay and lesbian people in those communities; and how hip-hop music affects the identity, spirituality, and health habits of young African-American women. Eventually BHLP will expand to study the healing traditions of other cultures in Boston, Barnes says.

The project is funded for three years by the Ford Foundation of New York and includes two graduate student researchers from Boston University and three from Harvard Divinity School. Each graduate student designed and is conducting one of the studies and is mentored by a physician from one of several health-care facilities, a scholar in the spiritual tradition he or she is studying, and a member of the community where that tradition is rooted.

"We hope to give doctors an added piece of preparation in building strong relationships with patients," says Barnes. "Doctors will be better clinicians if they know how to talk with families about things that they are doing for themselves and for their children."

By belief and necessity

That many area residents seek religiously based forms of healing is indicated by the number of local botanicas. These are shops that sell herbs as well as charms used in cleansing baths and other health-related rituals related to Santeria, a combination of Roman Catholic and West African religious traditions that originated in Cuba. BHLP researchers so far have counted more than 20 botanicas in Roxbury, Dorchester, and East Boston. And practicing in the area are religious healers such as Cuban santeros, Vietnamese monk shamans, Haitian mambos and oungans, Puerto Rican espiritistas, African-American root doctors, Irish charismatic priests, and Chinese herbalist-acupuncturists.

Local adherents of the Yoruba religion, which originates in Nigeria, make music praising Elegba, a deity who is the messenger of Yoruban gods, at a recent feast in Jamaica Plain. Yoruban priests in the area use spiritual rituals and herbs to heal members of their community. Photo by Eugene Adams

"These healers provide the primary forms of care for some people, partly because there are cultural and economic barriers to accessing modern health care, and partly because some of their practices are effective," says Barnes. "A family might choose not to visit a [Western] doctor at all because biomedical therapies are problematic to their cultural understandings of the body, the self, and what they understand healing to mean. Other people recognize that doctors are good at taking care of certain kinds of problems, and they balance that care with cultural-religious practices."

It is not known how many people in the United States use religious healing, however, or even which ones are practiced widely. In addition, there is little up-to-date information in medical literature about whether or not the religiously based healing practices used by the populations that BHLP is examining are effective. That's partly the result of Western medicine's demand that medical conditions and the effects of treatments be clearly quantifiable, Barnes says. But she says there is a bias in this country against healing practices associated in particular with ethnic minorities, and that the medical establishment has been more amenable to considering the potential efficacy of alternative health-care practices popular among middle- and upper-class white Americans than those commonly used by minorities.

"A lot of the practices we're interested in have gotten relegated to the heading of folk medicine, while the terms complementary or alternative medicine are used to refer to things used by European-Americans," says Barnes. "Folk medicine then gets lumped under the heading of voodoo, which has become the term to describe fake medicine and quackery."

Opening minds

Physicians traditionally have been taught that it is not part of their job to understand their patients' religious beliefs. But when Barnes discusses with doctors the healing practices of immigrants "under the broader heading of culture," she says, they tend to be receptive to the idea of learning about such practices in the interest of improving relationships with their patients.

It is important that doctors become comfortable discussing such matters, according to Fox, because patients often are reluctant to mention that they use alternative forms of care. They recognize that their own cultures' forms of healing go against the grain of doctors' training, and fear being judged or viewed as difficult patients. "They're not going to volunteer that kind of information," he says, "unless you show them that you're open to talking about it."

Demonstrating such openness, Fox says, can make patients more responsive to a doctor's suggestions. His experience working with ethnic minorities has taught him that people are surprisingly capable of combining health-care options from different cultures in a comfortable setting. "One of the things my teenage patient told me was that he thought doctors didn't listen well and that everything seemed too straightforward to them," Fox says. "I think that if I had done less advising at first and listened better, I might have reached him."

7 September 2001
Boston University
Office of University Relations