The research team, led by Yesika Natali Fernández-Ortiz of the Institute of Public Health at Pontificia Universidad Javeriana in Bogotá, used a concurrent mixed-methods design that combined a structured household survey with ethnographic fieldwork. In 2022, six surveyors recruited from within the community, selected by traditional authorities and trained by the researchers, administered questionnaires to 819 individuals across 161 households, a participation rate of 78.1 percent of the total population of 1,049. Because internet connectivity in the region is limited, the surveyors used mobile devices equipped with offline software and GPS devices to record household locations. Interviews were conducted in Spanish and, where necessary, in Tikuna, the community’s own language. The team also carried out two field stays during 2022, one in the rainy season and one in the dry season, conducting fourteen semi-structured interviews with healers, midwives, community leaders, teachers, and health professionals, alongside participant observation and a social cartography workshop.

The technical findings reveal a health system that exists mostly on paper for the Arara. Although 97.9 percent of respondents were formally affiliated with Colombia’s General System of Social Security in Health, actual use of Western services was low. The nearest hospital with primary care capacity lies in Leticia, roughly 20 kilometers away by boat, and 97.3 percent of respondents who did receive institutional care had to travel there to get it. Departmental data show that Amazonas has 12 service sites, 137 beds, and just two mobile units for a vast, river-dispersed territory, with no public ambulances recorded in the dataset and a workforce skewed toward generalists rather than specialists. Sixteen percent of respondents said they would not seek Western care even for serious health problems, and only 10.6 percent attended routine medical appointments or check-ups.

What the numbers describe, the qualitative accounts explain. Traditional healers in Arara do far more than treat symptoms; they maintain what the community understands as balance between territory, spirits, and people. Their treatments include medicinal plant infusions and baths, prayers, smoke rituals, dietary restrictions, spiritual dances, and cleansing of the surrounding environment. Illness itself is categorized differently than in biomedicine. Alongside headaches, which 35.3 percent of respondents reported, and respiratory infections at 19.8 percent, the community recognizes conditions with spiritual origins, including spiritual harm or bewitchment, a condition called pecho abierto or open chest, and pérdida del cigarrillo, the loss of a baby’s spiritual protection after a fall or shock. A former Curaca, a traditional Magüta authority, told the researchers that the elders’ remedy was always found within the community, not in the city.

The survey also mapped the social architecture of traditional medicine, and it turned out to be gendered in unexpected ways. Among respondents aged 14 and older, 94 percent attributed importance to traditional healers and midwives, with no statistically significant difference between women and men. But participation in the traditional system followed distinct gendered patterns: 12.1 percent of women identified as midwives compared with 2.1 percent of men, and women were also more likely to be apprentice midwives, while men predominated as prayer healers and showed a non-significant tendency toward bonesetting. Education mattered too. Individuals with higher educational attainment were more likely to resort to pharmacies or self-care, whereas use of both health institutions and traditional healers was more frequent among those with lower educational levels, a counterintuitive pattern that suggests Western schooling does not simply displace traditional health beliefs.

Then came COVID-19, and the community’s response became a natural experiment in medical pluralism. Traditional healers interpreted the virus’s arrival through dreams, receiving a vision that the virus was destined mainly for whites or settlers and would not seriously affect Indigenous peoples, a reading that shaped early perceptions of the threat. Yet the community did not reject biomedical prevention outright. Among residents aged 12 and over, 76.9 percent wore face masks in public, 63.5 percent practiced regular hand washing, and 47.8 percent followed quarantine measures. These were layered with traditional practices: 23.5 percent used herbal remedies, 19.7 percent used vapor treatments with medicinal plants, and 14.9 percent observed community diets, collective restrictions that suspended dances and football matches and closed the community to outsiders. One traditional medical leader described the settlement filled with incense smoke that protected those inside it.

Treatment patterns during the pandemic confirmed where trust lay. Of the 223 people who reported having contracted COVID-19, 80.3 percent identified the illness through symptoms alone, without laboratory testing, and about 80 percent refused diagnostic tests when health workers went house to house, with some believing the tests themselves could transmit the virus. Among the infected, 40.8 percent relied exclusively on traditional healers, 36.8 percent combined traditional medicine with support from family and friends, and only 5.4 percent used treatments based solely on Western medicine. Hospitals were perceived as places of death rather than healing, with one community leader stating bluntly that intubation was what killed patients. Vaccination revealed a more negotiated picture: 87.2 percent of the population received at least one vaccine dose, but only 70.8 percent completed the full schedule, as fears circulated on WhatsApp that the vaccine contained a chip or could transform people into animals, and traditional authorities recommended limiting the number of doses.

The researchers are careful about what these findings do and do not show. They document meanings, preferences, and constraints rather than a fully developed service-level integration between the two systems. High formal affiliation with the Colombian health system, they conclude, does not translate into trust or routine use of biomedical services. The authors trace this mistrust to a longer colonial and postcolonial history in which official systems privileged biomedicine as modern and scientific while Indigenous knowledge was stigmatized as backward. Colombian law, including Law 21 of 1991 ratifying ILO Convention 169, formally recognizes Indigenous medical practices, and initiatives such as the Indigenous and Intercultural Health System, SISPI, aim to articulate them with the national system, but structural barriers, institutional racism, and mutual distrust have kept these efforts largely normative rather than operational.

What emerges instead is what medical anthropologists call intermedicality: a selective, negotiated, community-mediated relationship between therapeutic systems rather than a binary choice. The Arara did not treat biomedical care, home remedies, and ritual practice as mutually exclusive; they combined them according to the meaning of the illness, the perceived appropriate response, and the practical conditions of access and trust. Crucially, Indigenous authorities acted as gatekeepers and mediators, determining when public health measures became acceptable and when vaccination teams could enter the community. This suggests that vaccine hesitancy in Indigenous settings cannot be reduced to misinformation alone; it is also bound up with cultural autonomy, historical grievances, and the legitimacy of outside intervention.

The study’s implications are direct. The authors argue that intercultural health must be understood not as an abstract principle but as a lived practice grounded in respect, negotiation, and genuine recognition of Indigenous knowledge. That would mean health services that are not only geographically accessible but capable of engaging with local understandings of illness and community authority, stronger local primary care capacity, better communication between traditional leaders and health institutions, and training that prepares health professionals to work respectfully within Indigenous realities. The researchers also acknowledge limitations: the survey instrument was adapted from tools designed for a mestizo-Western population, the qualitative component relied on a small number of interviews, and the study captured community perspectives far more deeply than those of health providers. Even so, the Arara case delivers a clear message to global public health: in Indigenous territories, formal coverage on paper means little without trust, and trust is built through the community’s own authorities, not around them.

Subject of Research: The interaction and coexistence of traditional and Western medicine in an Indigenous Tikuna community in the Colombian Amazon, including health-seeking behavior and responses to COVID-19.

Article Title: Integration of traditional and Western medicine in the Arara community, Colombian Amazon

Article References: Fernández-Ortiz, Y. N., Amaya-Lara, J. L., Ariza-Ruiz, L. K., Barrera-Aguilera, D. C., Vivas-Sánchez, P., & Mejía-Rocha, M. M. (2026). Integration of traditional and Western medicine in the Arara community, Colombian Amazon. Discover Social Science and Health, 6(1), Article 96. https://doi.org/10.1007/s44155-026-00428-0

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00428-0

Keywords: traditional medicine, Western medicine, Indigenous health, Colombian Amazon, Tikuna, COVID-19, vaccination, intercultural health, medical pluralism, health-seeking behavior, medical anthropology, public health policy

The study, authored by Melissa Louise M. Prieto, Gamaliel P. Galigao, Ana Rica S. Navarra-Cruz, Louise Gabriel R. Jimenez, and Gideon Lasco, was published in the August 2026 issue of the journal Acta Medica Philippina under the title “Sari-sari Stores as Community Pharmacies? A Qualitative Exploration of Sari-sari Stores Selling Medicines in the Philippines.” Drawing on ethnographic interviews with fourteen sari-sari store owners, known locally as tinderas, the researchers set out to understand why these small shops sell medicines, what they sell, to whom, and where their informal role in community health begins and ends. The result is a portrait of an informal care network that operates in the shadows of the formal health system, shaped by poverty, distance, convenience, trust, and necessity.

The medicines that tinderas reported selling were overwhelmingly those associated with what they considered common illnesses: headaches, diarrhea, fever, colds, and stomachaches. The inventory consisted almost entirely of familiar over-the-counter products such as paracetamol, mefenamic acid, ibuprofen, and loperamide. Crucially, the stores generally stocked non-prescription medicines and frequently sold them in very small quantities, a practice known in the Philippines as tingi-tingi, in which goods are purchased piecemeal in amounts matched to what a customer can afford at that moment. This retail logic, in which a customer might buy two tablets rather than a full box, mirrors the broader economics of the communities these stores serve, where household budgets are often stretched across days and small expenditures must be timed to daily cash flow.

What emerges from the interviews is that proximity is not an incidental feature of these transactions but their defining rationale. Distance was a major factor in why store owners chose to sell medicines at all: in communities without a nearby pharmacy, keeping common medicines within reach can spare residents the considerable cost and time of traveling to town. Store hours extend the same logic into the temporal dimension. One tindera reported keeping her store open until midnight, which means that medicines remain available even after a nearby pharmacy has closed for the day. In effect, the sari-sari store functions as a form of after-hours, last-mile pharmaceutical access that no formal institution in these areas currently provides, filling gaps that are both geographic and temporal.

The researchers argue that tinderas also occupy a distinctive informational position within their neighborhoods. Serving as what they describe as the eyes and ears of their communities, store owners repeatedly encounter the same people day after day. Through these repeated interactions they learn which medicines people ask for, what customers can afford, and what their neighborhoods tend to need. Some of the tinderas interviewed began selling medicines only after noticing demand from the people around them, which suggests that the supply of medicines through these channels is not imposed from above but grows organically out of observed community need. The store adapts to the community rather than the other way around, a dynamic that stands in sharp contrast to the standardized protocols of formal pharmaceutical retail.

This adaptability has limits, and the study is careful to map them. The tinderas do not see themselves as doctors or pharmacists, and this self-understanding translates into concrete boundaries of practice. Eleven of the fourteen store owners interviewed simply refuse to sell antibiotics and other prescription medicines, instead advising customers to seek care directly from healthcare professionals when their conditions appear to require it. This finding complicates any simplistic narrative of informal medicine sales as inherently dangerous. The tinderas in the study appear to operate according to an implicit triage system, offering remedies for minor, self-limiting complaints while recognizing and referring conditions that exceed their competence. The researchers describe the sari-sari store as a kind of community myopticon, a vantage point from which the health needs of a neighborhood become visible through everyday interactions, raising questions about who is close enough to notice when people need medicine, who can make it available, and who is present when formal healthcare is beyond reach.

There is, however, another boundary that cannot be negotiated by custom or goodwill: the law. Strictly speaking, the sale of pharmaceuticals through sari-sari stores is illegal in the Philippines unless the outlet is duly licensed by the Food and Drug Administration. The researchers note, though, that the regulatory landscape contains layers of liminality, including special considerations for geographically isolated and disadvantaged areas, known as GIDAs, and categories of medicines not captured in the relevant FDA circular. In other words, the practice occupies an ambiguous legal zone in which the letter of the law, the realities of rural access, and the limits of regulatory coverage do not fully align. It is precisely this ambiguity, the researchers suggest, that policy must confront rather than ignore.

Approaching the issue through the lens of medical anthropology, the authors recommend against blanket prohibitions and punitive enforcement measures. They argue that policies should take into account the economic and geographical barriers that shape access to medicine before imposing top-down restrictions on the only accessible source of relief available to many communities. In their view, there is genuine value in recognizing the role of sari-sari stores within the health system, and in accounting for the structural conditions, poverty, remoteness, and the cost of travel, that make these informal channels necessary in the first place. A regulatory response that simply criminalizes the practice would, on this reading, remove a functioning safety net without replacing it, leaving residents with nothing between their symptoms and a costly, hours-long journey to town.

The researchers are explicit that sari-sari stores are neither replacements for pharmacies nor substitutes for the country’s healthcare system. Instead, they argue, the sari-sari store occupies an ambiguous but necessary liminal space between the household and formal institutions, a space produced by the interaction of poverty, distance, convenience, trust, and necessity. It does not stand outside the healthcare system, nor simply beside it, but in an in-between zone where informal and formal systems of care meet, overlap, and compensate for one another’s gaps. The study’s contribution lies in making this zone visible, documenting through careful qualitative work a form of healthcare delivery that has been so embedded in everyday Filipino life as to become almost invisible.

Perhaps the most provocative implication of the research is what it reveals about the formal system itself. The familiar scene the researchers describe, a neighbor walking to the nearest sari-sari store, asking the tindera for a few tablets, paying piecemeal, and walking home, is ordinary enough to escape notice, yet behind it lies a larger story about proximity, affordability, and the distance between communities and institutional healthcare. The sari-sari store, as a venue for observing interactions among consumers, government, and the medical and pharmaceutical worlds, carries social, political, and economic relevance that extends far beyond its small storefront. Sari-sari stores, the study suggests, show what happens when the system is too far away, too costly, or simply unavailable to those who need it, and any serious effort to improve access to medicine in the Philippines will have to reckon with the informal infrastructures that communities have already built for themselves.

Subject of Research: The role of sari-sari stores as informal community pharmacies and their implications for medicine access in the Philippines

Article Title: The anthropological dimensions of sari-sari stores as liminal community pharmacies

Article References: The anthropological dimensions of sari-sari stores as liminal community pharmacies. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: sari-sari stores, Philippines, medical anthropology, medicine access, informal healthcare, community pharmacies, Ateneo de Manila University, Acta Medica Philippina, tingi-tingi, geographically isolated areas, pharmaceutical regulation, tinderas

The study was conducted by Bayla Ostrach, a medical anthropologist and family medicine researcher at Boston University School of Medicine, who carried out fieldwork at the only clinic then contracted with the Catalan public health system to provide full-spectrum abortion care. That single-clinic arrangement is itself a telling detail. Although abortion is, by policy, available through the public system in Catalunya, the actual delivery of services depends on a small network of contracted providers, meaning that patients in much of the region must travel to one facility to exercise a right that the law nominally guarantees everywhere. Using opportunistic and convenience sampling, Ostrach documented patient experiences directly within this setting, capturing the practical texture of access in a way that surveys and administrative data cannot.

Ethnographic methods of this kind are particularly well suited to studying abortion access because the barriers patients encounter are rarely formal or visible in policy documents. A waiting list that adds two weeks, a phone line that is difficult to reach, a health worker who implies that a medication regimen is the only appropriate option, or a comment that carries judgment—these are the frictions that accumulate into delay, and delay is the single most consequential variable in abortion care, since gestational age limits determine whether a patient can be treated at all. By embedding observation in the clinic and talking with patients as they moved through the system, the study was able to record these frictions as they occurred, rather than reconstructing them retrospectively.

The results converge on a central conclusion: years after liberalization, delays and obstacles persisted throughout the public health system. Participants described waiting periods and scheduling difficulties that pushed their care later into pregnancy, misinformation about what services were available and how to obtain them, and the continuing weight of abortion stigma, which manifested both in interactions with the health system and in patients’ own accounts of their decisions. Stigma, in this context, is not merely an emotional burden; it operates as a structural barrier, discouraging patients from asking questions, delaying their presentation for care, and shaping how providers communicate about options.

One of the study’s most striking findings concerns the form that stigma took within the publicly funded pathway itself. Participants reported pressure to undergo pharmacologic abortion—that is, medication-based termination rather than an aspiration or procedural method. Medication abortion is safe, effective, and appropriate for many patients, and its availability is an unambiguous good. The concern raised by the study is different: when patients are steered toward one method regardless of their clinical circumstances, gestational age, or personal preference, the pressure itself becomes a form of obstruction. Method choice in abortion care should reflect informed patient preference within clinical guidelines, and reports of systematic steering suggest that the public system’s delivery model, whatever its logistical rationale, was not consistently centering patient autonomy.

The study also documented the socioeconomic motivations that participants described for seeking abortion, particularly in the context of existing child-rearing responsibilities. Many patients were already parents, and their decisions were framed explicitly around the material realities of raising children—income, housing, work schedules, and the absence of adequate support. This finding aligns with a long line of research showing that the most common reasons women give for seeking abortion are financial and caregiving constraints rather than health complications or fetal indications. It also underscores a point that abortion access researchers have made repeatedly: the people most affected by delays and obstacles in publicly funded systems are those with the fewest private alternatives, and the most marginalized patients bear the brunt of every added barrier.

That distributional point is central to the study’s significance. The abstract notes that delays and obstacles appear to especially impact the most marginalized, and the single-contractor structure of Catalan abortion provision illustrates why. A patient with a car, flexible employment, and private resources can absorb travel costs, take time off, and, if necessary, pay for private care. A patient working hourly shifts, caring for children, or lacking documentation or funds cannot. When the public pathway is slow or opaque, the system effectively sorts patients by their capacity to navigate it, converting administrative friction into inequity. In this sense, the Catalan case is a warning for any health system that treats legal availability as equivalent to realized access.

The research also carries methodological and ethical weight. The study protocol was reviewed by the human subjects research board at Boston University School of Medicine and, under United States federal research regulations codified at 45 CFR 46, was determined exempt from further review, while still being conducted in accordance with those federal guidelines; all participants provided informed consent. The research was unfunded, and the author declares no competing interests. The article is published open access under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International license, and the version shared ahead of final publication is citable and carries a permanent digital object identifier, a practice that journals increasingly use to speed the dissemination of peer-reviewed findings.

For public health, the implications reach well beyond Catalunya. The global health community has long identified access to safe, high-quality abortion as a priority, and the study’s central lesson is that liberalization is a beginning, not an endpoint. A law changes what is permitted; a health system determines what is possible. Between the two lie waiting times, referral pathways, provider training, method availability, information quality, and the informal norms that shape clinical encounters. The Catalan experience shows that even where all of these operate within a framework of legality and public funding, they can still function as obstacles—and that closing the gap requires monitoring not just whether services exist, but how patients actually experience them.

The study’s conclusion is deliberately restrained but pointed: years after abortion liberalization, overall health system delays and obstacles persisted, even in an ostensibly ideal setting of legality and public funding. That phrase—ostensibly ideal—is the finding’s sharpest edge. If a wealthy European region with a universal health system, a liberalized law, and public financing still produces the delays, misinformation, and stigma documented here, then no jurisdiction can assume that legal reform alone delivers equitable access. What remains to be studied, and what the Catalan case now demands, is the systematic measurement of patient experience as a core indicator of abortion service quality, treated with the same seriousness as clinical outcomes. Until then, the gap between the law on the books and the care patients receive will continue to fall hardest on those with the least capacity to bridge it.

Subject of Research: Patient experiences navigating publicly funded abortion care in the Catalan public health system years after Spain's 2010 abortion liberalization

Article Title: Patient experiences in the Catalan public health system years after abortion liberalization

Article References: Ostrach, B. (2026). Patient experiences in the Catalan public health system years after abortion liberalization. Discover Social Science and Health. https://doi.org/10.1007/s44155-026-00486-4

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00486-4

Keywords: abortion access, abortion delays, abortion stigma, Catalonia, Catalunya, public health system, publicly funded healthcare, Spain abortion law, medication abortion, health equity, medical anthropology, reproductive health