The term “makeshift medicine” describes health care practices that people use when they have difficulty accessing insurance, providers, and treatment. It was coined by Patrick Kelly, a doctoral student in behavioral and social health sciences, along with his advisors Katie Biello, vice chair of behavioral and social sciences, and Jaclyn Hughto, assistant professor of epidemiology and behavioral and social sciences at the Brown University School of Public Health.
In a recent article in Nature Human Behavior, “Makeshift medicine is a response to US health system failures,” Kelly, Biello and Hughto present three case studies of demographics on the medical fringe: transgender individuals seeking gender-affirming care, people who inject drugs and self-treat skin and soft tissue infections (SSTIs), and people who self-manage abortions.
“The makeshift medicine framework involves the actions that people take to meet their health care needs when they’re pushed outside of the formal health care system,” Kelly said. “They might share community resources, such as antibiotics or the knowledge that comes with managing the self-treatment process. But practicing makeshift medicine may not always address the health problem. It may also exacerbate it.”
We talked with Kelly to discuss the makeshift medicine framework, and how people are finding ways to bridge the health care gap.
What inspired you to write about makeshift medicine?
I grew up low-income and didn’t have health insurance for a period during my childhood. There was a time when I needed medication and we had to depend on these pharmaceutical packs that a physician was able to give us kind of on the down-low, because we couldn’t afford it otherwise.
During research experiences as an undergraduate and master’s student of public health, I was confronted with the reality that people were having to make really tough decisions about their health, and this made me think of my experience in adolescence.
When I applied for the Ph.D. program at Brown, I began focusing on what people do when they have a health problem, but have little access to care. What are the cognitive processes driving your medical decisions when you cannot access formalized health care, or when you choose not to because doing so exposes you to discrimination or stigma or suboptimal care? And today we’re seeing policy being used to legislate people out of the formal health care system, pushing them to the edges of medicine.
So we created the makeshift medicine framework, which is helpful in providing a common language that allows us to think about a multifaceted issue. It’s a framework that can be applied to different health topics. With dentistry, for instance, there are people who are practicing on their own mouths, pulling their own teeth if they can’t afford dental insurance or if the insurance they do have doesn’t cover needed care.
How does the idea of makeshift medicine build on existing research into “common care” and “formal-informal healthcare systems”?
In medicine, there’s the vertical transfer of knowledge from the provider to the patient. But we’ve written out this idea that our peers can be a source of medical care. Victor Montori’s “common care” speaks to the sharing of knowledge and practices between peers. You can see examples of this in families who practice home remedies that are passed down through generations.