Public Attitudes Towards Traditional Medicine in Dermatological Care Within Blantyre, Malawi

Skin Conditions and Traditional Medicine

dermatology, skin conditions, traditional medicine, ethnomedicine, Blantyre, Malawi, semi-structured interviews, decolonising medicine, health equity, health literacy

This study aims to understand how people in Blantyre, Malawi recognise and manage common skin problems, and what role traditional medicine plays in their care. The main question it aims to answer are: * How do people recognise and treat common skin conditions * What can we learn from traditional knowledge to improve skin education and care Participants will take part in a study lasting 30 minutes. They will be asked about their experiences and where they seek help. Some participants may also choose to have a photograph of their skin condition taken to help create educational artwork. Photographs will not include identifiable features.

This is an 8-week study through which is intended to conduct a review of the use of traditional medicine in dermatologic care through interviews with patients and traditional healers. The findings would allow equitable knowledge exchange about presentations of skin conditions on black skin and treatment approaches that center African knowledge systems. The project will include the creation of a series of drawings depicting skin conditions on darker skin. Reference photographs will be collected from consenting individuals in Malawi and the UK. These images will not contain identifiable facial features and other identifying marks such as tattoos. The artwork will support knowledge exchange and public engagement by improving the visual representation of skin conditions on darker skin. Within Western medical education, in lectures and medical textbooks, there is a lack of teaching and images depicting the presentation of skin conditions on darker skin. This is a problem because diagnosis is dependent on the pattern recognition skills of the clinician, therefore, a lack of exposure to images of darker skin increases the chance of misdiagnosis. In various countries in sub-Saharan Africa, there are few dermatologists in the region and healthcare workers in the primary sector are not sufficiently trained to manage common skin conditions. The knowledge generated in Western countries informs practices in sub-Saharan Africa with little adaptation to suit the local needs of the population. This also holds true for the medical training in these countries, which upholds medical racism because the curricula are not decolonised. Apart from the direct practice of dermatology, healthcare workers are also responsible for improving the health literacy of their population. The chief investigator spoke to a doctor currently practising in Malawi, who mentioned that black skin is mostly depicted in books focusing on tropical medicine, while other medical books depict white skin. The intention of this study is to conduct interviews exploring this topic and create drawings that depict skin conditions on darker skin. It is important to understand the approaches that local cultures use to manage common skin conditions, which range from recognition to treatment strategies. This includes the use of traditional medicine - ethnobotanical practices and healers - that are more easily accessible than the local dermatologists, whose access tends to be limited to the private sector. This study will have a particular focus on how laypeople/the public engage with dermatology. There is a need for the development of programs and resources that incorporate Western biomedical knowledge with local indigenous ways of knowing. This research is important to bring visibility, as a lack of prioritisation of black skin health in Western countries directly translates to the experience of people dealing with skin conditions in African countries. The artwork created through this study will be publicised through websites such as the Malawi Medical Humanities Network and presented at conferences in Malawi and Scotland. Findings will be summarised through a journal article and contribute to the academic discourse. This should inspire further research, dermatology resources and curriculum change.

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