Sorcery and penicillin: treating illness on a Papua New Guinea island.

Research on a remote and culturally conservative Papua New Guinea island before and after the introduction of biomedical primary health care in the form of government aid posts shows that beliefs in the supernatural causation of serious illness and death by sorcery, witchcraft or taboo violation remain largely unchanged after a decade. Most islanders first seek treatment from traditional healers who can identify and combat the underlying supernatural causes of illness. A healer, traditional or modern, must be greatly trusted by patient and kin due to fears of sorcery and witchcraft attack, and aid post orderlies, from a different cultural and linguistic group, find it difficult to gain the confidence of the community. Orderlies and other health care providers should not present themselves as being in competition with traditional healers but concentrate on earning the trust of community members. Individuals from the local community should be offered training as aid post orderlies and primary health care workers. The islanders' hierarchy of resort to medical treatment is variable, and biomedicine and traditional healing have not assumed complementary functions. Traditional theories of disease causation and treatment are part of indigenous religious beliefs and thus highly resistant to change. Acceptance of biomedical treatment can occur without rejection of supernatural theories of disease causation. The rate of acceptance may vary among ethnic groups within the same country or region due to underlying cultural or religious differences. The constraints of inter-ethnic differences and of traditional beliefs concerning health and illness within which the health system must function in this case are found in many multi-ethnic developing countries.