Crossing the border

This is the Walgreens of the barrio, proclaimed Steve Quintana, sweeping his arm across the interior of his House of Mother Nature botanica in Jamaica Plain, where statues of saints line the shelves, glass cases are filled with amulets and charms, and racks are stocked with packets of herbs and oils.

The botanica is where Latin American and Caribbean immigrants go in search of herbal remedies used by their mothers and grandmothers back home. It is doctor's office, pharmacy, and therapist's couch rolled into one. "Here you can find anything that has to do with religion or healing," said Quintana, dressed in white from the cap on his head to his loose-fitting pants -- garb denoting his position as a Santeria priest. "The ceremonies that are done have been done for ages. We save people's lives. It is the work of doctors."

A dozen doctors, nurses, and health advocates listened intently to Quintana's sprightly overview of Santeria, an Afro-Cuban religion that merges Roman Catholicism with the West African traditions of Yoruba. They were there not out of idle curiosity, but to learn about the cultural and medicinal uses of herbs in their patients' communities.

The unconventional lecture and one 20 minutes earlier at a Haitian market where a voodoo priest dispensed treatments for colic, cramps and bad bosses were part of an "herbal tour" of Boston organized by the Boston University School of Medicine. The tour was just one example of the growing intersection between Western medicine and healing traditions imported by immigrants from increasingly diverse countries and cultures.

"You can't deliver high-quality care if you don't have an understanding of cultural and health beliefs," said Dorcas Grigg-Saito, executive director of the Metta Health Clinic in Lowell.

That understanding can help physicians catch potential bad interactions between prescription drugs and herbal medicines, increase compliance with Western medicine, and identify patients' cultural views of disease and treatment, said Linda Barnes, a medical anthropologist and professor of pediatrics at the BU School of Medicine. Mainstream doctors can also learn about new treatment methods from immigrants, she said.

A few years ago, beliefs such as those central to Santeria or voodoo might have been dismissed by Western health care providers, waved away as folk traditions with no place in modern medicine. But, an increasing number of health care providers are learning the value -- and necessity -- of integrating an understanding of immigrant practices into routine patient care, Barnes said. For the last three years, Barnes has been overseeing the Boston Healing Landscape Project, a BU initiative that examines the cultural and religious beliefs of new immigrants, and how those practices are changing the medical landscape in the Boston area.

So far, the project has studied the spiritual beliefs of Sudanese immigrants, the cultural attitudes toward "sadness" among Brazilian women, and the role of botanicas in Latino communities. The goal is not only to learn about immigrant health practices but to give mainstream medical practitioners a better grasp of their patients' cultural prism.

"No clinician goes into a clinical session with a patient in a vacuum. We are all formed by our own cultures," Barnes said. "We want to help clinicians become more aware of the attitudes they may have."

In a practical setting, that can translate into something as simple as a doctor who asks patients about their beliefs, rather than dismissing them as superstitions, said Barnes, who offered the example of a patient who believes her illness was triggered by "mal de ojo" -- an evil eye.

"It is a way of talking about the effects of anger and envy. You can feel that, and if you feel it often enough, it affects you. [The patients] are feeling the emotional effects of someone's ill will," explained Barnes, who believes it is also important for doctors to demystify certain potentially harmful medical myths.

"It's as simple as saying to a patient: What are all the things you think could be affecting you? What do you think will help with that?"

Many immigrants seek the help of folk healers, herbal medicine and other traditional brands of treatment long before turning to mainstream doctors and health-care settings, Barnes said. Language barriers, fear of cultural misunderstanding or lack of knowledge about the health-care system often discourages newcomers who speak no English, or who are in the country illegally.

"When they go to a hospital, they are asked for their Social Security number, so there is a problem right there," said Quintana, who often serves as a liaison between immigrants and mainstream doctors. "So they come here when they need something to do with spirituality or healing. Here, they don't have to give an ID, or say where they are from."

Cultural sensitivity is also a key component at the Metta clinic, which is part of the Lowell Community Health Center network. The clinic is molded to fit the needs of Cambodian and Laotian patients, and offers Western medical treatments, along with the services and counsel of Buddhist monks, acupuncturists, herbalists, and a Kru Khmer, a traditional Cambodian healer.

The majority of the staff is bicultural, as well as bilingual, offering patients a comfort level they may not feel in other settings, said Grigg-Saito. It is not uncommon, for instance, for Metta patients to be referred to the nearby Buddhist temple for a water blessing.

"When the physicians and nurse practitioners are open to understanding that kind of medicine, patients are more likely to talk about that tradition," Grigg-Saito said. "It's a critical component."

But, health-care providers are doing more than merely accommodating the beliefs of newcomers. They are also learning from those traditions, said Elizabeth Barnett, an associate professor of pediatrics at Boston Medical Center and a doctor who works with newly arrived refugees.

Just as "grandma's chicken soup" is the standard home remedy for a cold in some cultures, an herbal tea or hot drink could be the prescription in another.

Erol Josue, a voodoo priest at the Meli Melo Market in Dorchester, suggests black-eyed peas for infections, and mint leaves for stomach problems.

When an audience of care givers filled the market's narrow aisles one day last month, Josue held a rough-hewn wood chair above his head. This, he explained, can be used to disperse the power of an enemy. If someone is on your back all the time, like an unreasonable boss, you simply seat that negative spirit on the chair and take that person's power away. The doctors and nurses nodded enthusiastically, warming quickly to the notion of giving a psychic timeout to a bad boss. When the group left the market a few minutes later, the shelves had been nearly emptied of the doll-sized chairs.