Acceptation of Folk Medicine and its "secrets" in a Swiss Burn Centre

Abstract

In Switzerland 'Secret' is a folk medicine called upon for burns. It has belonged to UNESCO's intangible cultural heritage since 2012. It is supposed to ease pain and accelerate the healing process of burns. As the practice is widely used in the population, this observational study investigated the opinion of caregivers and patients from the National Burn Center of Lausanne. Qualitative observational study based on a survey including ten questions aimed at identifying the professionals' perception of the phenomenon. Questions were developed from repeated encounters in the burn center. Data collection took five months. Thirty-six healthcare professionals (HP) and 12 selected patients (or parents for minors) discharged after burns were interviewed on a voluntary basis: all of the HPs knew about 'Secret' from the workplace, and 26 from home: 33 were convinced that it might be useful and reduce pain. The perceived efficiency of the practice (36 respondents) differs depending on professional category and personal experience. Only one HP considered the practice to be dangerous. The nurses and auxiliary nurses expressed that it should be used more widely. The 12 patients considered it as a complementary step, not a replacement for medical care. Health professionals globally considered this practice safe and helpful. The patients were interested in using parallel approaches and were careful about their expectations. This openness is probably an indication that HPs believe that acceptance of the culture and beliefs of patients and their families might positively affect response to treatment, whatever the burn size.
Copyright © 2019 Euro-Mediterranean Council for Burns and Fire Disasters.

Full text

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ACCEPTATION OF FOLK MEDICINE AND ITS “SECRETS” IN A SWISS
BURN CENTRE
PERCEPTION DE LA MÉDECINE TRADITIONNELLE ET DE SON “SECRET” DANS
UN CTB SUISSE
Kasser S.,1  Applegate L.A.,1 Hirt-Burri N.,1 Jafari P.,1 de Buys Roessingh A.,2
Raffoul W.,1* Berger M.M.2,3 *
1 Service of Plastic, Reconstructive & Hand Surgery and Unit of Regenerative Therapy, Lausanne University Hospital, CHUV,
Lausanne, Switzerland
2 Service of Pediatric Surgery, Lausanne University Hospital, CHUV, Lausanne
3 Service of Adult Intensive Medicine and Burns, Lausanne University Hospital, CHUV, Lausanne, Switzerland
SUMMARY. In Switzerland ‘Secret’ is a folk medicine called upon for burns. It has belonged to UNESCO’s intangible cultural
heritage since 2012. It is supposed to ease pain and accelerate the healing process of burns. As the practice is widely used in the
population, this observational study investigated the opinion of caregivers and patients from the National Burn Center of Laus-
anne. Qualitative observational study based on a survey including ten questions aimed at identifying the professionals’ perception
of the phenomenon. Questions were developed from repeated encounters in the burn center. Data collection took ve months.
Thirty-six healthcare professionals (HP) and 12 selected patients (or parents for minors) discharged after burns were interviewed
on a voluntary basis: all of the HPs knew about ‘Secret’ from the workplace, and 26 from home: 33 were convinced that it might
be useful and reduce pain. The perceived efciency of the practice (36 respondents) differs depending on professional category
and personal experience. Only one HP considered the practice to be dangerous. The nurses and auxiliary nurses expressed that it
should be used more widely. The 12 patients considered it as a complementary step, not a replacement for medical care. Health
professionals globally considered this practice safe and helpful. The patients were interested in using parallel approaches and
were careful about their expectations. This openness is probably an indication that HPs believe that acceptance of the culture and
beliefs of patients and their families might positively affect response to treatment, whatever the burn size.
Keywords: folk medicine, burn care, pain management
RÉSUMÉ. Il existe en Suisse une médecine traditionnelle dénommée « secret » dédiée aux brûlures (supposée avoir des eets
analgésiques et cicatrisants) inscrite au patrimoine immatériel de l’UNESCO depuis 2012. Dans la mesure où elle est très
largement utilisée, nous avons conduit une étude observationnelle sur l’opinion qu’en ont les soignants et les patients du CTB
national de Lausanne. Nous avons utilisé un questionnaire à dix items, développé après des entretiens plus informels. Trente six
professionnels et 12 patients (ou parents quand le patient était mineur), interrogés après leur sortie, ont volontairement participé
à l’étude. Tous les professionnels avaient entendu parler de « secret » soit au travail soit chez eux (26). Trente trois étaient per-
suadés de son utilité analgésique, 1 seul le considérant comme dangereux. Cette opinion varie selon la catégorie professionnelle
et l’expérience personnelle, les inrmières et aide- soignantes estimant qu’il devrait être plus largement utilisé. Les patients
estimaient que « secret » était un adjuvant ne devant pas remplacer la prise en charge médicalisée. Les professionnels considé-
raient que « secret » est simple et utile. Les patients étaient intéressée par cette approche parallèle, tout en gardant une certaine
retenue quant à ce qu’ils pouvaient en attendre. Cette ouverture d’esprit suggère que les professionnels pensent que la prise en
compte de la culture et des croyances des patients et de leur famille peut promouvoir l’ecacité du traitement conventionnel,
quelle que soit la surface brûlée.
Mots-clés : médecine traditionnelle, soins aux brûlés, analgésie
* Considered as senior co-last authors
 Corresponding author: Sophie Kasser, Plastic, Reconstructive & Hand Surgery, University Hospital of Lausanne, CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzer-
land. Tel.: +41 77 463 11 81; email: kassersophie@gmail.com
Manuscript: submitted 10/09/2019, accepted 10/09/2019

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Introduction
Alternative medicine options are popular in Switzer-
land, mainly because patients appreciate a global, holistic ap-
proach complementary to traditional medicine for their treat-
ment plans and rehabilitation. Many patients that have been
treated in the Burn Centre of the CHUV, which admits ap-
proximately 200 patients per year, have contacted alternative
medical practices for healing, without any exact data being
available. Following a positive popular ballot about comple-
mentary medical practice acceptance by insurers in Switzer-
land (2009), the Lausanne Faculty of Biology and Medicine
introduced a course on alternative medical practices into the
core teaching. In 2012, the use of this Folk Medicine was regis-
tered in the UNESCO Intangible Cultural Heritage List which
was submitted by two Swiss States, Fribourg and Jura.1,2 It
is more openly discussed and debated in the French-speak-
ing western part of Switzerland ranging from Delémont in the
Jura to Geneva, including Fribourg and Valais. Now that this
phenomenon is more openly discussed, other neighbouring
countries such as France and Italy are gently emerging with
anecdotes of their own experiences.
In French these healers are known as the “faiseurs de
Secret” (‘Secret Makers’), and by various other names, such
as “barreurs de feu”, “panseurs de Secret” and “coupeurs
de feu” (in English these would translate to ‘barriers against
re’, ‘Secret healers’, and ‘re cutters’ respectively).1 The fact
that they are categorized as ‘healers’ implies that they do not
have diplomas for their art and there is no organisation or as-
sociation established to control or validate their procedures.
In general, these people are considered to have a gift that
was transmitted to them, and they want to help others freely.
These healers are of all ages but more often 50 years old or
above, from all regions, even though rural regions seem to
have a more authentic connotation. They can either perform
the healing technique as a classical consultation, or simply by
telephone. They are not paid, however they appreciate simple
thank you gestures and updates on the outcome of their pa-
tients following any intervention. Even though this altruism
is inspired by Christian practices and association with Saints,
it is not necessarily related to religious beliefs. Moreover, the
Catholic Church disapproves of healers using prayers and that
this practice is not strictly performed by clergy members.
Secrets are formulas or prayers that have to be repeat-
ed with a certain intention. Multiple pathologies are involved,
such as warts, muscle strain, sciatic nerve, migraine, eczema,
psoriasis, zooster, earache, angina, stress, hemorrhoids, hem-
orrhages and burns: there is even a free app with direct access
to the list of “Secret Healers” in Switzerland and France.3 Sev-
eral prayers for burns have been published, one by the Abbé
Julio in 1907 (St. Maurice, Valais, Switzerland),4 and another
more thorough one by Derivaz and Clerc in 2014.5
The aim of this observational study was to investi-
gate the opinion and degree of acceptation for this practice by
medical staff and patients in the Hospital.
Methods
The interviews were based on a survey that was created
by the authors, not validated by any authority, as no such inves-
tigation has yet been carried out to our knowledge. It was based
on informal discussions, and addressed the worries that had been
raised previously in the Centre. Informed consent was waived by
the Ethics Committee, considering the absence of any medical
information and the type of questions, and the fact that the partic-
ipants were free to answer or refuse to participate.
Participants
Healthcare professionals (HPs) were selected on a
voluntary participation basis. The study beneted from the
support of the head-nurses and the medical doctors (MDs)
from both the Intensive Care (hereafter “ICU”) and Plastic,
Reconstructive and Hand Surgery (hereafter “Plastics”) ser-
vices. The inclusion criterion for the professionals was their
employment for at least six months in one of the two services.
Patients were selected by WR and AdBR from the ambulant
consultation of the plastic surgery follow-up of burn patients,
based on their interest in the question and their free will to par-
ticipate. The inclusion criteria were that they had a previous
stay in the burn centre, a minimum of 15 years of age and were
able to speak French, German or English and remember their
experience in burn care. Two parents of burned children were
included because their child was underage.
Caregiver questionnaire
Have you heard about ‘secret’?
What is ‘secret’ for you?
Concerning ‘secret’ at work, do you think…. Multiple choices
Concerning ‘secret’ at home, do you think…. Multiple choices
Have you ever talked about it with patients or their relatives?
Do you think ‘secret’ is used by the Swiss population?
Do you think ‘secret’ helps the healing of a burn?
Do you think ‘secret’ can help small/big burns?
Do you think that ‘secret’ is useful for pain?
Do you think that ‘secret’ is a type of alternative medicine?
Patient/relative questionnaire
Have you heard about ‘secret’ in your family?
Have you or a relative ever called a ‘secret’ provider?
Have you or a relative called about the burn that brought you to the burn
centre?
Did you ever talk about it with the healthcare team?
What is ‘secret’ for you?
Do you think that medical care and ‘secret’ could be associated in the burn
centre?
Do you think that ‘secret’ can help for any severity of burn?
Do you think it is useful for pain?
Do you think it can help globally for burn?
Table I - Questions asked to professionals and to patients

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229
Questionnaire
(Table I) shows the questions that the healthcare pro-
fessionals and patients were asked. The questionnaire aimed
to collect the opinion of the participants, as well as their
knowledge and expectations. The surveys were used as a basis
for a semi-structured interview with each subject, all conduct-
ed by the same person. These interviews, conducted face-to-
face (with professionals) or over the phone (with patients),
contained the same further explanations for each question and
exploitation of more in-depth questions. Each interview lasted
20 minutes for healthcare professionals and 10 minutes for
patients.
Statistical analysis
The answers to direct questions were given scores
and summarized. Fisher test was used to analyze categorical
variables. We considered a p value <0.05 as signicant.
Regarding efcacy, meaning the ability to produce a
result, in their professional environment 25 HPs thought that it
was efcient, but perception differed by service: 17/21 (81%)
of the Plastics were positive compared to only 7/11 (64%) in
the ICU (Fig. 2).
Table II - Characteristics of the health professional survey participants
ASSC = assistant nurse, physio = physiotherapist
Physician Nurse ASSC Physio Total
Male/female 7 / 4 3 / 11 0 / 6 1 / 4 11 / 25
Swiss 8 10 2 5 25
Plastics 7 8 2 4 21
ICU 4 6 4 1 15
Age 20 to 29 1 5 1 2 9
Age 30 to 44 8 6 3 2 19
Age 45 to 55 0 3 1 1 5
Age over 55 2 0 1 0 3
Results
This study was carried out between November 2013
and March 2014. Two additional patient interviews were con-
ducted in March 2018. The data are presented with the number
of positive responses to each of the questions. Results of in-
terviews with the healthcare professionals were also subdivid-
ed into subgroups to have a better perception of the diversity
(profession, sex and nationality).
Healthcare professionals
Altogether 36 HPs agreed to participate: 47 profes-
sionals either refused, were absent, or had not worked long
enough to participate (13 in Plastic and 34 in the ICU). The
professionals included 11 MDs, 14 nurses, 5 physiotherapists
and 6 auxiliary nurses of different nationalities (Table II). Of
these, 25 were Swiss citizens, while the others were 10 Eu-
ropean Union citizens and one Canadian. All the HPs were
already aware of ‘Secret’ in their work experience, but only 26
had heard of it through family and friend circles. Moreover,
33 of the HPs thought that the use of ‘Secret’ is useful, useful
meaning serving some intended purpose (Fig. 1). A total of 33
also believed that this practice helps reduce pain.
Fig. 1 - Professional (A) and personal (B) opinion on the general usefulness
of ‘Secret’
Fig. 2 - Professional (A) and personal opinion (B)
on the general efcacy of ‘Secret’

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230
If we consider potential benets by burn size, 26 of
the HPs thought that the effect might be strongest on small
burns compared to 12 for large surface burns (Fig. 3). There
was a signicant difference (p=0.013) in opinion among the
professions: only 4/11 MDs responded positively compared
to 22/25 other professionals. When asked if ‘Secret’ had no
effect, only four out of the 36 HPs (3 MDs, 1 nurse) replied
that there was no real effect (p= 0.025) (Fig. 4).
Utility questions were broken down as follows: 1)
Does ‘Secret’ help the overall healing of the burn? 2) Does
‘Secret’ help the patient with burn pain management? Four-
teen HPs thought that ‘Secret’ would aid healing, and nine
didn’t know (Fig. 5A). A large number (33 HPs) thought that
‘Secret’ was very useful for pain management with no differ-
ence between groups (Fig. 5B).
Fig. 3 - Caregiver opinion on the efcacy of ‘Secret’ according to the size of
the burn (A) small (B) large
Fig. 5 - Professional opinion on ‘Secret’ helping: (A) the overall healing
process, (B) patient pain management
Fig. 4 - Professional (A) and personal (B) opinion
on the absence of effect
When HPs were asked whether ‘Secret’ helps to keep
hope, 31 were positive. Twenty-four of the HPs thought that
allowing the use of ‘Secret’ helped to integrate the family
in the overall health care process and treatment progression
of the patient. Thirty-one of the healthcare professionals be-
lieved this was related to cultural tradition (data not shown).
Only one HP thought the practice was dangerous
(Fig. 6), with nine stating that it should remain outside of the
hospital setting: there was a strong difference of opinion be-
tween men and women on this question, seven out of 11 men
and two out of 25 women (p = 0.01). Along the same lines,
19 HPs thought that ‘Secret’ should be used on a larger scale
(Fig. 7). There was an important difference of opinion on this
question between men and women, with seven out of 11 men
replying positively, and only two out of 25 women. Eighteen
of all the interviewed HPs believed that this practice is widely
used when one of their family members or acquaintances has
been involved in a burn accident. It was reported that 23 HPs
had discussed this subject with their patients and families, and
it was not usually them that introduced the subject into the
discussion.

Annals of Burns and Fire Disasters - vol. XXXII - n. 3 - September 2019
231
Patients and relatives
The 12 patients and relatives (eight men, four wom-
en, all < 65 years) included in the study were all Swiss. Eleven
of them had called upon ‘Secret’ following burn injuries that
had led them to the Burn Center. One patient had to be exclud-
ed from the interviews due to language incompatibility. Six
patients had discussed this intervention with the healthcare
professionals and two of these had appreciated the possibility
to discuss it more in detail during their treatment. When asked
about pain management, six patients thought the use of ‘Se-
cret’ helped diminish their pain and ve thought it helped the
overall efcacy of healing of their burn.
When asked about the overall benets of this prac-
tice, half of the patients/relatives thought that there was a good
global effect on burn wound healing and half did not have an
opinion on the matter. We asked if the patients thought that
‘Secret’ might be useful on a smaller or larger burn wound:
8/12 thought that it was effective for small burns, and 7/12
thought it might also work for large surface burns: all the oth-
ers answered that they did not know.
Discussion
This study attempted to examine the importance and
impact of the use of ‘Secret’ in the Lausanne Burn Centre.
Although limited to qualitative questionnaires and to a volun-
tary participation, we have shown that the phenomenon is well
known and tolerated in the medical setting by most healthcare
professionals, patients and their families. It is not considered
dangerous; most of the healthcare professionals even consider
it useful. Some believe in these practices, whereas others con-
sider it to merely have a sort of placebo effect.
Concerning the practice at hand, its clinical benet
might be linked to the mystery in which it is shrouded. The issue
of efcacy remains uncertain among the healthcare profession-
als. On one hand, the opinions of professionals and patients were
in agreement, but on the other hand, contradictory answers were
collected regarding efcacy of the practice on different sizes of
burn wounds (Fig. 3). The most notable divergence in opinion
was observed when dealing with professionals from the Plastic
Surgery and the Intensive Care Services. Addressing the benets
of this practice, in the eyes of most HPs these consist of pain re-
lief (Fig. 5), renewed hope for the patient, and a greater involve-
ment of the patient’s family.
On the healthcare side, caregivers do not think that
‘Secret’ might be dangerous (Fig. 6) or that it should remain
outside hospitals, rather half of them think it should be used
more often (Fig. 7). It is notable that the caregiver profession
(nurse, MD, auxiliary nurse, physiotherapist) has an inuence
on their opinion regarding efcacy and utility.
On the patient side, the survey shows that they wel-
come this kind of intervention, mainly in the hope it will re-
duce overall pain and aid a more rapid recovery. Most feel that
they benet from it. However, it is clear that for most inter-
viewed patients the practice of ‘Secret’ is merely a comple-
mentary step towards their well-being, which cannot replace
conventional medical care. The practice can be qualied, as
one healthcare professional said, as: “an option to be oered
once the patient is already being taken care of. It is free, and
if it can help without harming, it improves the patient mood.”
Furthermore, it has been discovered that patients seek advice
from members of the medical staff. Given the limited num-
ber of patients interviewed, it was not possible to determine if
age or origin plays a signicant role in the noted differences
of opinion. Nevertheless, the fact that 11 out of 12 patients
called for ‘Secret’ portrays that the practice is well established
in popular tradition, and it is important to have general courses
in Medical studies to raise awareness of Alternative Medicine
Practices.
Fig. 6 - Professional (A) and personal (B) opinion on the dangerousness of
the use of ‘Secret’
Fig. 7 - Professional opinion on whether ‘secret’ should be used more often

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232
The search for a scientic and/or rational explanation
for the assumed benets of ‘Secret’ leads directly to the notion
of stress. Burn patients and their families experience a severe
state of mental distress, considering issues like death, mutila-
tion or permanent handicap. The healer appears in this context
as an alternative source of hope, whose positive effect also
works on the patient’s loved ones. By attenuating the family’s
stress, the healer reduces the family’s anguish, which largely
impacts the patient himself.6 Analysis of the effects of stress
must be conducted on two essential levels: dealing with pain
and wound healing. Regarding pain, it has been proven that
treatment with a sedative anxiolytic potentiates the pharmaco-
logical effects of opiates.7 Therefore, it would be possible to
associate the healer’s role in perceived pain reduction in the
context of anxiety and stress for the patient and Healthcare
Professional. Moreover, some observed reductions in pain in-
tensity remain unexplained and need research.
Regarding wound healing, evidence shows a strong
link between stress and tissue repair, particularly for ulcers and
chronic wounds.8 Circulating cortisol and epinephrine levels
have a direct incidence, via vasomotor effects, tissue biology
and infectious agents.9 The patient’s belief in ‘Secret’s’ bene-
cial effects and the fact that the patient or family reaches out to
Folk Medicine increases condence, which might drastically
reduce the stress level.10.11 This reduction in the patient’s stress
could help to achieve optimal and more rapid wound healing.
It has been shown that adequate pain treatment after hernia
repair leads to increased production of metalloproteinase in
the wound, with reduction of inammation and a more rapid
closure.8 Similar observations have been made for hypnosis,
which is used in the Centre.12
Help is expected from the healers, not in a strictly
medical area, but without transferring all hope in this option.
In his M.D. Thesis conducted in High Savoy,13 Dr. Nicolas
Perret showed that in a population believing in ‘Secret’ and
accepting the healer’s intervention, pain reduction could be
observed for 87% of patients (reduction of 45 ± 15% for 30%
of the group and >60% for 57% of the group).
Focusing the patient’s attention on something other
than their pain, by means of alternative reality for example,
has also shown a signicant reduction in their pain and stress
levels,14 speeding up their recovery and shortening their stay
in the hospital. These elements all show that trust and con-
dence reduce stress and pain. “The placebo effect encourages
us not to use a placebo, but to work with non-specic factors
that can modulate any therapeutic process. All practitioners
must know how to potentiate specic factors of a therapeutic
action by a quality patient-doctor relationship, which can in-
duce complementary non-specic factors” as stated in French
by Guy-Coichard and Boureau.15
‘Secret’ is fairly well accepted among the general
population and, as shown by this survey, also by profession-
als: this is not necessarily the case among doctors, as shown
by the necessity of the centre’s leading team to justify the
practice in the local medical journal in 2005.16
Our study has important limitations. Firstly, the ques-
tionnaire is not validated but developed within the service,
based on recurrent questions that were asked within the HPS
group. Secondly, the population sample is small, but cannot
be extended due to the service side: answers were based on a
voluntary population. Finally, the study did not aim to address
the efcacy of ‘Secret’, which may be addressed with a pro-
spective study.
Conclusion
The Burn Centre admits patients that have suffered a
traumatic event and who are in a deep state of stress, anguish
and pain. In these extreme conditions, it is not uncommon for
patients and their family to seek assistance outside the bound-
aries of Western medical care. Compared to the stressful and
highly technical ICU context, a form of care given over the
phone to a population who has lived immersed in these beliefs
is not an obstacle, but contributes to stress reduction. This pre-
liminary observation opens the door to future anthropologic
and medical investigations regarding the potential and over-
all use of similar phenomena and experience worldwide. We
would like to end this work by quoting two major statisticians.
Altman and Bland stated that: “While it is usually reasonable
not to accept a new treatment unless there is positive evidenc-
es in its favor, when issues of public health are concerned
we must question whether the absence of evidence is a valid
enough justication for inaction”.17
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Conict of interest. No nancial support or other conict of
interest relevant to this article is reported by the authors.
Acknowledgements. The Authors would like to acknowledge the
support of the burn patients interviewed and the entire team of
the Lausanne Burn Centre.