A pregnant woman sits on a thin cot in the steaming tropics. A charcoal fire smolders beneath her. The hot vapors envelop her, raising her body temperature. She sweats constantly.

A torture treatment? Actually it's medicine, and very good medicine from all accounts. It's a practice called "mother roasting," common among native Cambodians.

Sweating provides a certain level of protection against infections. Sure, an antibiotic may be more effective. But many expectant mothers have never heard of antibiotics. So most of them put their trust in the ancient rituals and practices that have been part of their culture for hundreds of years.

This is a conundrum western heath care workers face when working in other cultures. Often, patients won't even let their treatment be augmented by modern medicines. Instead, they rely on herbal and natural remedies such as Saint John's wart, palmetto palm leaf and various teas. But it can become frustrating when a health care worker finds a culture using a folk remedy that is indisputably harmful.

Such is the case Carolyn D'Avanzo encountered through her work among Cambodian refugees. D'Avanzo, an associate professor in the School of Nursing, first began working in refugee camps during the 1980s. She was appalled by the conditions she saw, including a lack of medical care.

There also was a practice among pregnant women she found especially disturbing: Many of them deliberately drank a strong, home-brewed alcohol during and after their pregnancy.

"They really believed it was medicinal," D'Avanzo says. "In fact, the older women would force the alcohol on the younger women. There was a lot of negative treatment if the younger women didn't comply."

D'Avanzo's interest in the Cambodian population led her to do extensive research on what happened to refugees once they reached the United States and France. She also took a closer look at whether Cambodian women continued to drink in their new homes.

Prenatal education
"The answer depends on what population I examined," she says. "For example, more of the Cambodian women who emigrated to France were ingesting alcohol during the first trimester of their pregnancy than their counterparts in the United States. However, by the third trimester, the trends had reversed themselves. Fewer of the women in France were drinking alcohol than those in the U.S."

In France, the health care system requires pregnant women to enroll in prenatal care by the 15th week of their pregnancy. If they do not, they are denied government health care benefit checks that are related to pregnancy and child care. In France, the women learn about the dangers of alcohol consumption during and after pregnancy.

In the United States there are no such requirements for prenatal care. As a result, many of the women who begin their pregnancies following the old folk medicine continue to do so throughout their pregnancy.

Subtle cultural factors also play a role. Cambodians emigrating to the United States tend to settle in Cambodian communities, such as the one in Lowell, Mass., where D'Avanzo found many of her research subjects. In these communities, the old ways are cultivated and pushed on the young. In France things are different.

"They are settled by the French government, and they don't end up in Cambodian neighborhoods," D'Avanzo says. "The French are also big on making these people French. The people are taught to abandon their previous culture and embrace French culture. By the second generation, these people are French for all intents and purposes."

The women who do drink during pregnancy usually ingest vodka, which is similar in taste and appearance to the traditional homemade but more potent "Mekong Whiskey" they are used to.

"These women are ingesting anywhere from one to five ounces of alcohol at a time, three to four times a day," D'Avanzo says. "If you factor in a low caloric intake and the physical smallness of the women, you see that this can be quite significant."

The effects of alcohol intake during and after pregnancy are well documented. Every time a pregnant woman takes a drink of alcohol, there is a cessation of fetal breathing movement. It also can lead to fetal alcohol syndrome, mental retardation, low birth weight and developmental problems. In nursing mothers, the alcohol can taint breast milk, which in turn causes cognitive or growth retardation in babies that won't be evident for years.

D'Avanzo hopes to use her research to educate Cambodian emigres and social and heath care workers.

"This is a case where the commonly accepted cultural treatment is most definitely a detriment," she says. "We have to work to bridge this gap between what people believe and what is true. It's not easy, but perhaps with this evidence in hand, it will make the case more strongly."