Malagasy ombiasy

Domain XI · Traditional medicine & indigenous healing · Madagascar

What it is

Ombiasy is the general Malagasy term for the traditional healer. Pierlovisi and Pourchez also name herbalists, masseurs, traditional midwives, soothsayers and astrologers, plus mediums who communicate with spirits through tromba or bilo possession or through sikidy divination. They stress that…

Format

• Engagement and cultural assessment (sessions 1-2). Goal: the client's (and family's) definition of the problem, causes, help already sought, and expectations. Tools: core CFI (16 questions, four domains), Informant Version with a family member (17 questions), selected supplementary modules. Move on…
• Formulation and differential (sessions 2-3). Goal: separate culturally normative experience (e.g. recognised tromba mediumship) from disorder, and screen for risk and medical causes. Move on when a working formulation is shared with the client and the risk picture is clear.

Who practises it, and how they are trained or regulated

• State structures. Madagascar legalised traditional medicine by decree in 2007 (the authors cite Article 2 of decree n° 2007-805); Improved Traditional Remedies were allowed into public health centres from 2006. The Pharmacopoeia and Traditional Medicine Service of the Ministry of Public Health has worked since 2008 on integration. Healers register only through a local association belonging to the national…
• Practical meaning. Registration shows state recognition, but most healers are unregistered, and lack of a card is not evidence of illegitimacy within the community; the law lacks precise criteria for telling legitimate healers from "charlatans".
• Version followed: the account of Malagasy healing in Pierlovisi and Pourchez (2014; fieldwork in Southeast Madagascar, April to June 2013, as part of a UNESCO project), read alongside Madagascar's official recognition of traditional medicine (decree n° 2007-805) and its registration structures; the psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI) and its supplementary modules.…

Evidence status, as the guide reports it

• Ongoing therapy and integration (typically weekly, length set by the presenting disorder). Goal: treat any disorder with standard evidence-based therapy, help the client make sense of healing experiences, and revisit the explanatory model as it changes; the CFI modules can be repeated during…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• silent disengagement. Working: the family returns or keeps contact.
• reluctance to criticise a respected healer; signs of injury. Working: the client can describe their boundaries.
• stopping prescribed medication on a helper's advice; new physical symptoms. Working: the prescriber has a full list.
• shame or conflict between church and ancestral obligations. Working: the client describes how the two fit or clash for them.
• siding with one helper against another; curiosity that turns into extracting secret knowledge. Working: the client corrects you freely.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.