| This thesis is about the introduction of traditional and alternative health care practices into Cuba's official, government-supported health care system. More specifically, I ask to what degree and how have traditional and alternative treatments been integrated into the official health care system; and how has the relationship among biomedicine, traditional, and alternative medicine been affected and directed by contemporary Cuban culture, politics, and economics at individual, local, national, and global levels.; Data collected for this thesis were accumulated over 12 months of fieldwork in Havana between September 1998 and February 2000. Research was conducted as a participant observer in a clinic; and through semi-structured and unstructured interviews with patients, doctors, policy makers, medical professors, and practitioners within the unregulated, unofficial health care sector.; This thesis develops an image of pluralistic health care in Cuba as I saw it. From this image a model of form, function, and meaning in pluralistic health care is developed. Within this model, levels of influence and constraining and innovative factors interact in a dynamic fashion to produce new experiences at the level of the individual. Macro-level factors are discussed, including Cuba's official policy on alternative and traditional medical practices, the international and national dialogues that create and negotiate boundaries within which health care is to be practiced, and how changes in health care policy and practice continue to serve to maintain the political ideologies of the Cuban government. Microlevel factors such as the doctor-patient relationship, and local and individual experiences within the health care systems, are used to illustrate how explanatory models of illness direct and influence Cuban treatment-seeking behaviours.; This thesis also explores questions pertaining to the persistence and increased popularity in the unofficial health care sector despite the fact that much of its materia medica has been incorporated into the official sector. It is argued here that certain cultural ideals and historical influences affect the acceptance, rejection, or ambivalence toward the incorporation of traditional and alternative medical practices into a previously monopolistic system. This issue is contextualized within larger beliefs and experiences within the everyday lives of Cubans living in a changing Cuba. |
