Correction; there is a rather huge body of research on this issue emerging from countries across Africa, Asia and the Americas. AND; this research has actually had impact on e.g. how health planners approach care-takers. Think about the whole discussion about exclusive breastfeeding. This focus was informed by studies in countries that showed that women thought that breastfeeding was harmfull to children when they had diarrhea.

I agree that local explanatory models of diarrhoea might contradict clinical definitions. But some studies have also showed that local and traditional practices of diarrheoa management might actually be very usefull and could be intergrated into health practitioners' routines. I did a qualitive study in Vietnam on this and found that ethnic minority mothers performed rehydration with herbal concoctions - this could be directly adopted by doctors who could praise mothers instead of critisize them for not taking care of children. I find that there is a strong moral imperative for researchers to keep highlighting these strenghts of local health practices to the clinical world, to try and make them understand about the importance of local worlds - and not just clinical worlds!

Dear Thile, I work with the health-disease-cure, the perceived level of communities. Working with the social representations of this process, and ethnographic method to study local communities. In general, here in Brazil, and in my research, there is a huge gap between the biomedical categories and local categories. Because of this, many health projects do not reach the desired success. However, I do not understand the health professionals a concern with this issue. The issue you bring is of high relevance and would like to exchange information with you. Thank you.

Thank you Thilde, I totally agree with you and would like to continue seeing the infusion of local knowledge that is found beneficial into the clinical realm. I agree there are a large body of studies attempting to unearth local perceptions and am grateful that you could direct us to the "Breast-feeding" example! From my experience thus far, I somehow feel that researchers like me have often tended to downplay beneficial local practice and knowledge and spend more time highlighting its deficiencies. A high level of misconception regarding proper health care and practice still exists in especially rural regions because the communities potentially feel the weight of a "top-down" approach to awareness generation and are resistant or grow resistant to it. I thought of this whilst initiating diarrheal surveillance for a water purification intervention study I manage wherein families are encouraged to self-report diarrhea in children, there are cases where the mother/care-taker is convinced that the child has had diarrhea, but we lay down the WHO classification and eventually classify the child as not having diarrhea. I just wondered if we are missing a cue or two!

Thank you Maria for your response, I feel the same as you when you say that many health programs/ interventions do not reach desired success because of a gap (however small) between biomedical and local knowledge. Even if the information is present and incorporated into clinical/health practice, somehow there is a possible deficiency in the way we present this knowledge back to the local communities (attitudinal problem) that makes them resistant to it. I would like to hear more of your work.

Dear Mark, I worked more closely in addressing the perception of the health-illness-healing in community Saco do Mamanguá, Paraty, Rio de Janeiro. My work on the line will experience this process. Did not publish much, but there is a publication that I and my advisor present in environmental event. This dissertation won the Rodrigo Melo Franco, IPHAN as rescue intangible heritage, at the regional level of the state of Rio de Janeiro, Brazil. But the staff of public and community health in Brazil did not give a lot of credit, and therefore not published. See the article I'll put on my page (Study of symbolic representations of health / disease / healing in the community Saco do Mamanguá.) If you send me your email I can send you all the work, but is in Portuguese. Sorry! My english is bad. Thank you!

Thank you Maria, believe me English is not a barrier here. I will look at that article on your page it does sound interesting. As you can see, I havent published much myself. I will send you my e mail id for future use, I may not be able to understand the Portuguese, but just in the hope that I may, and that we can work together on something.