Alternative medicine use at Vila Central Hospital Vanuatu: a survey of the use of 'custom medicine' in patients and staff

A structured questionnaire was developed to assess the use of custom (traditional or herbal) medicine in 50 medical and 50 surgical inpatients and 50 staff at Vila Central Hospital, Vanuatu. Eighty-six percent of those interviewed had used custom medicine at least once, 60% within the last year. Twenty-one medical patients (42%) had used custom medicine for their current problem, 12% whilst in hospital. Eighteen surgical patients (36%) had used custom medicine for their current problem, 6% whilst in hospital. Fourteen of the staff (28%) interviewed had used custom medicine within the last year. Sixty-nine per cent of interviewees stated that custom medicine had improved their condition. Whilst custom medicine use was common across all attained education levels, there was a trend for those with higher levels of education to use less custom medicine. The most common form of custom medicine was leaf tea, followed by leaf applications, cutting, magic, massage and chanting. The majority of these were made/prescribed by local 'Klevas' (custom doctors). The cost of the 'medicine' was often substantial, generally many times the cost of a day in hospital. These findings indicate a high prevalence of custom medicine use within Vanuatu. Clinicians must be alert to the possibility of their patients using custom medicine even whilst in hospital and the potential for custom medicine to contribute to the clinical problems. Late presentation of patients to hospital is common in Vanuatu, and the use of custom medicine is partially a contributing factor to this. It also poses questions as to patient confidence in health services.