Dealing with dichotomies in health care: Case reports.

Dichotomies with respect to medical orientations and public health have been common in the past and even in the present probably orchestrated by the traditional versus modern medical concepts that became eternal arena for disquiet in the healing world of many countries. In public health, the so-called technology tradition was especially dominant which assumed the power of technology and the paternalistic 'managerial mode' regarding disease control programs. Such a 'managerial perversion' has demolished the positivity of primary health care as well as the social determinants framework. It is important to consider cultural background, the belief systems and perceptions of the people in shaping the health behaviour of the people. We are presenting here two case reports on distinct scenarios in order to show the conceptual problems with respect to the notion of dichotomies and the linkages with health. These are based on our empirical explorations using qualitative methodologies. The first case is on non-communicable diseases in a tribal society in Kerala and the second one on utilization of Traditional Complementary and Alternative Medicine (TCAM) among palliative cancer patients from a district in Kerala. It is seen that as new problems emerge or when people struggle with diseases as presented in the two case reports, they tend to depend on the positivity of the deeply entrenched cultural artefacts in combination with modern systems and they tend to bridge the dichotomies rationally instead of viewing them retrograde. It is necessary to examine the reasons for engaging in such syncretic health behaviour which could be popular realizations on the positive and negative features of both health orientations. This approach of the people could be used effectively for managing such health problems in the community.