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    Where the tom-tom beats.

    Brudon-Jakobovicz P

    World Health. 1984 Jul; 20-1.

    Cultural and sociological factors frequently hinder the acceptance and proper use of drugs among rural villagers in developing countries. These constraints must be recognized by the modern health community if efforts to make affordable drugs available in the context of primary health care (PHC) programs are to meet with success. In many countries, villagers have more confidence in their traditional curative system than in the modern medical system. The traditional system is embedded into and supported by villagers' culturally defined reality while modern medical practices, e.g., vaccinations and mosquito eradication programs, appear to be a series of bizarre behavioral acts having no culturally conceptualizable purpose. Traditional definitions of "being ill" may also differ from modern definitions of "being ill." In Indonesia, 45% of the people surveyed said that a person is ill only when that person cannot get up or is unable to work. If one is not ill, of course, there is no need to take medicine. Other cultural and social factors may interfere with the proper use of drugs. Sometimes drugs become status symbols, and drug taking becomes a way of identifying with the modern social system. Consequently villages often demand the most expensive drugs, in the fanciest packages, in the mistaken belief that these drugs are more effective than less expensive drugs. In Mali, for example, there is a strong preference for using injectable quinine salts to counter malaria rather than the less expensive, safer, and more effective chloroquine pills. The importance of these cultural constraints on the acceptance and proper use of drugs must be recognized by modern health personnel, and especially by village worker . Communication between the health worker and the villagers must be improved and efforts made to increase the villagers' confidence in the health care provided by local health centers. One way to increase the confidence level is to package drugs, distributed by the health centers, in such a way as to remove any suspicion that the drugs are a second rate product. The drugs should be presented in attractive packages, and directions for taking the pills should be clearly stated and carefully illustrated. Efforts should also be made to improve the villagers' understanding of why the drugs are being prescribed.
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