Therapeutic itineraries in rural and urban areas: a Portuguese study.

INTRODUCTION When people become ill they use strategies to solve their problem that include existing therapeutic resources in the community. Their choices are guided by the beliefs of local communities regarding the body, health and illness, and the therapeutic resources available. This study compares the uses of alternative and traditional treatments in a rural area and an urban area of the north of Portugal, investigating the differences and similarities in the behaviour of people when they become ill. METHODS This descriptive study provides interviews with two groups of adults, in a rural area (Alfandega da Fe and Miranda do Douro) and in an urban area (city of Porto), Portugal), with the aim of understanding the knowledge and uses of alternative and traditional therapists and treatments. RESULTS Approximately half of those in the urban area and almost all of those in the rural area knew of alternative therapists and treatments, the most known being bonesetters, acupuncturists and herbanarias (shops where people sell medicinal plants for teas) in the urban areas; and bonesetters, sorcerers (bruxos) and local healers (curandeiros) in rural areas. In relation to the use of these therapists and treatments, approximately 25% in the urban area and 75% in the rural area reported that they used such treatments. Bonesetters were the most used in both areas, followed by sorcerers and teas in the rural areas, and acupuncturists and teas in the urban areas. When asked about the reasons for using these therapists and treatments, the majority reported pain in the bones, muscle and joints, followed by psychological complaints in urban areas; and traditional diagnostics in rural areas for leaned souls (almas encostadas), fears or anxieties and visions etc. Most of the people who had used these treatments had not spoken to their family doctor about them because they believed 'doctors do not accept these medicines'. Approximately 80% in the two studied groups said they have been totally or partially satisfied with the treatments and the main reason was their effectiveness. The majority did not consider these treatments expensive. CONCLUSIONS We found differences in the use of the alternative and traditional diagnostics and therapeutic resources in the urban and rural areas studied. However, we also found similarities between the two areas, such as the use of bonesetters to deal with problem of muscular and joint pains, and the use of teas.