When 'chemo is failing'... 'the illness is indigenous'. Therapeutic pluralism and reclaiming agency: family cancer caregivers' experiences in Nairobi

This article explores therapeutic pluralism as a reclaiming of lay agency through (a) reframing illness and (b) generating options, in the context of palliative cancer care in urban Nairobi. Utilizing an interpretative phenomenological analysis (IPA) approach as a framework, data were drawn from individual interviews and focus group discussions with a total of 20 family caregivers of patients with advanced cancer in Nairobi Kenya. Findings show that therapeutic pluralism was largely collective - (family and community focused), rather than individual - (primary caregiver or patient) focused. Decisions on therapy choices were influenced by socio-cultural understandings of cancer propagated informally through family and community networks. Therapeutic pluralism in this context marks a reclaiming of agency as lay caregivers, family and community members collectively got involved in caring for ill members by sourcing for available therapeutic resources. Three implications for public health and specifically palliative healthcare interventions follow from the findings: (a) the need for a shift from patient-centred approaches to family and community inclusive approaches that encapsulate communities of care; (b)a recognition of the idea of cancer as a communal concern and (c) a call for engagement and knowledge exchange between healthcare professionals, cancer patients, family and community members about therapeutic pluralism and the necessity of addressing the current dichotomy between mainline professionals in healthcare institutions and traditional healers in light of the reality that both play key roles in primary healthcare.