In Medicine, to Find Evidence Is to Believe
Tita A. Listyowardojo
Let’s say that Indonesia will indeed have a single national health insurance system by 2014, will the health behaviors of society change accordingly? Will there be more people claiming their right to medical services? Or will society still look at health care, or Western medicine as many perceive it, as a back-up treatment when alternative medicine does not work?
The railway therapy, in which people lie down along railway tracks in the belief that it would cure various illnesses, was said to be an outcome of the flawed Indonesian healthcare system. But there are many who have access to health care, for example through Jamkesmas (the health insurance scheme for the poor), who still prefer to see a dukun, or traditional healer, rather than doctors. I was one of them. Although my family could afford good doctors and medication, I used to go to a sinse, a Chinese medicine man, for medical advice.
Research in social sciences has shown that beliefs significantly influence people’s behaviors. Having a background in psychology, I, too, have analyzed and observed how beliefs can direct my attitudes and behaviors. For example, as a child and teenager, I often got my ankles twisted. Instead of going to a doctor, I would prefer to go to a sinse. He would use green mud and special massage techniques to make my ankles go back to normal within just three days. It worked every time. I once tried to go to a doctor and was advised to walk with crutches for weeks while taking painkillers. I never went back to doctors for sprained ankles ever since.
Also, when a doctor said my left knee cap had “moved from its place” because it caused me frequent pain when I was 12, I asked for a “second opinion” from another medicine man. This time, the powder he gave did not work so I decided to follow the doctor’s advice. So I ended up wearing a knee masker to prevent too much movement on the knee. I was supposed to wear it continuously for a couple of years. Instead, I wore it on and off for only six months. I hated the masker because it was shown very obviously outside my long school skirt and my schoolmates would look strangely at it.
Because 12 was also the age when I was at the peak of actively practicing my religion, I started to leave the dukun and turned to God for a cure. It was during this period that I made a decision to stop wearing the knee masker and let God take control. Since then, I never got my knee checked again by a doctor or a medicine man and the pain never came back. It could be that six months were enough to cure it, or maybe that a miraculous healing happened. Maybe growing up helped it to cure itself, or maybe my belief denied the pain. I did not bother to find out how my knee was cured.
Believing “the alternative” without evidence, of course, can be very dangerous. A doctor friend of mine once told me about a time she needed to amputate the right leg of a 6-year-old boy. The boy fell into a ditch while cycling because he was trying to avoid a motorcycle coming his way. The lower limb of his right leg became red and swollen. His parents took him to a medicine man because they thought the leg was broken. The medicine man agreed and wrapped it very tightly with bamboos, leaving the boy in even more in pain.
After 10 days, the parents took the boy, who was unconscious by then, to the emergency room, where my friend was in charge. When the bamboos were taken out, they saw that the leg was black, reeking and had worms. No broken bones were found. It could be that the limb was only swollen because it hit a hard surface. The diagnosis was vascular compromise and amputation was suggested as the only way to save the child’s life.
Now, after I have become much more familiar with evidence-based medicine, I always try to look for evidence before choosing a treatment or following doctors’ advice. I do not think that all treatments from medicine men are incorrect. There can be some historical, traditional reasoning behind them that makes sense, but I would like to see some evidence before believing that a treatment can work.
In a culture that does not really encourage the questioning of authorities or experts, people are easy to base their medical decisions on their beliefs. Changing a culture may take decades, but hopefully the government’s initiative to achieve the national insurance scheme by 2014 can stimulate a greater cultural awareness that favors evidence-based medicine.