Question 4:

How do anthropologists interpret the relationship between Western and indigenous models of health and healing? Discuss with reference to at least two ethnographic examples.

Matriculation number: 1002122

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Introduction

Different varieties of models of health and healing have come into an increasing degree of contact over the last 120 years, facilitated by broad economic and socio-cultural trends such as globalization and the construction of world views of healthcare standards and organization (Keane,
2010: 235-236. Whyte & Geest, 1988: 9-11). That is to say, that through the growth of the mass media and global markets in pharmaceuticals as well as the establishment of world health organizations and projects, such as WHO, models of health and healing (especially the Western model based in the clinical institutions of biomedicine) have been transmitted around the world.
Localized concepts of health, and consequently, the cultures, societies and bodies of which those concepts are a vital part, are increasingly understood and shaped through their relationship with foreign models of health and healing. Indeed, Whyte & Geest (1988: 8) argue that Western and indigenous medicines ‘contextualise’ one another. The critical point, however, is that medical anthropologists have found that this relationship is not symmetrical. The interaction of Western and indigenous models of health and healing is structured by power relations of various sorts which usually result in the enforcement of Western health imperatives on an indigenous population - often through the emphasis on social constructions such as the ‘naturalness,’ modernity or efficacy of a certain Western medical practice or substance. Further, it seems that a significant disjuncture exists between the Western image of the healthy body, as determined by biomedical science, and the definitions of health to which many indigenous peoples ascribe.
Medical anthropologists have approached and interpreted this trend (unravelling the notion of the superiority of the Western model of health as they go) through three main avenues of close analysis. Firstly, through gendered bodies - studies in this vein tend to focus on health beliefs and practices which are linked with concepts of sex and gender i.e. menstruation, menopause, breastfeeding (Britton, 1996. Rapp, 1995. Tapias, 2006. Creyghton, 1992 etc). Secondly, through diseased bodies - focusing upon the transmission of infectious diseases and the methods of intervention that are deemed necessary to ‘control’ and treat outbreaks of such diseases (Martin,
2001. Silva, 1997. Nations & Monte, 1996. Bourgois, 2002. Parker, 2001 etc.). The focus upon infectious disease is especially interesting because it is within this realm that potent examples of
Western biomedical interventions into indigenous cultures can be seen. Thirdly and lastly, that of bodies and medicines - referring to the field of pharmaceutical anthropology in which medicines themselves and the placement of individuals or groups of individuals in relation to the processes of production, distribution and use of pharmaceuticals produced by Western biomedicine (Whyte &
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Geest, 1988. Rekdal, 1999. Etkin, 1992. etc.) The main body of this essay will be devoted to a full discussion of the ways in which each of these three fields of study throw light upon the (unequal) interactions of biomedicine and indigenous models of health and healing.

Gendered bodies

Medical anthropologists working within the framework of feminist theory have produced a wealth of ethnographic research relating to the ways in which Western biomedicine as a highly prestigious set of institutions of healthcare has the power to define women’s health needs (Inhorn,
2006:348-349). This process of defining women’s health needs and tailoring intervention campaigns and therapeutic treatments according to the Western model of health and heling occurs throughout the world irrespective of the socio-cultural contexts in which women live and which shape their health concerns. Indeed, Inhorn has pointed out, for example, that in North America the large majority of healthcare research is carried out by the NIH a state funded institution which
“focuses heavily on discrete physiological processes, organ systems, pathologies and therapeutic interventions” thus neglecting “the sociocultural matrix in which women’s ills develop and, including the context of poverty, patriarchy and other life stresses.” (2006:349)
Through Margaret Lock’s comparison of the women’s experience of menopause as understood by Japanese and North American models of health it becomes apparent that the “sociocultural matrix” referred to by Inhorn can be highly influential in the ways women experience their bodies. (Rapp, 1994: 529-530) Lock’s findings show that whereas Western biomedicine pathologizes menopause (essentially treating this stage in women’s lives as a hormone defficiency requiring therapeutic treatments) Japanese women’s experiences of menopause is not even considered to coincide with many of the physiological symptoms that are commonly associated with menopause in Western biomedicine i.e. hot flushes and mood swings. Lock suggests that the absence of these symptoms may be as a result of a combination of local social and dietary factors.
This leads to highly problematic conclusion that a disjuncture exists between Western biomedicine and women’s experiences of illness and health within their immediate cultural environment.
Disjunctures such as these, and their impacts on communities in regions where Western biomedical practices have intervened in local means of healthcare, have been further documented by two ethnographic studies I will now focus upon. Maria Tapias’ research in Punata, Bolivia into the culture surrounding arrebato in, an illness purported to be passed from mother to child through the mother’s breast milk according to the mother’s emotional state and Carolyn Fishel Sargent’s
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research into childbirthing practices of Bariba women in Benin, West Africa. (Tapias, 2006. Sargent
1989). In both these cases deeply entrenched belief systems concerning maternity and childcare come into direct conflict with the biomedical advice distributed by healthworkers about the benefits of breastfeeding and hospitalized childbirth respectively.
In the former case, mothers are blamed for the ill-health of their children - the failure to control their anger, stress and sorrow is seen to lead to the transmission of these emotions through the mothers breast-milk to the child causing illness which manifests itself as violent diarrhea
(Tapias, 2006:88-90). Tapias interprets this as a means of socially reproducing gender roles - that is the role of the mother as the disciplined and submissive primary care-giver of children. In the second case, Sargent shows that child-birth in Benin is considered a powerful and mystical ritual event which women are expected to willfully confront without the intervention of Western medicine. (Inhorn, 2006: 357) Both of these deeply-embedded socio-cultural values ‘clash’ with
Western models of health and healing which emphasizes the ‘naturalness’ of breastfeeding and encourages the increased medicalization of pregnancy and childbirth.
The results observed by both anthropologists was varying degrees of resistance among the indigenous communities to the uptake of practices related to health and motherhood which are based on the Western model of health and healing. Thus, anthropologists have placed the interaction between Western and indigenous models of women’s health and healing within larger macrostructures of patriarchy and ethnocentrism - women’s bodies and their health is determined in narrow Western biomedical terms. As a result, the healthcare ‘targeted’ towards women from a
Western biomedical perspective often does not address their most pressing concerns (e.g. financial difficulties which is Tapias found to be the greatest cause of anxiety among the women of Punata) and is not absorbed into their local practices of healthcare. This feature of interactions between
Western and indigenous models of health and healing - that is the tensions between indigenous and
Western beliefs systems about healthcare - is pervasive in ethnographic research on this topic and will be discussed further throughout the course of this essay.

Diseased bodies

Medical anthropologists such as Kalinga Silva (1997) and Marylin Nations (1996) have performed discourse analysis and ethnographic studies (respectively) into the interactions between communities and interventionist biomedical campaigns in the midst of global pandemics i.e. malaria and cholera respectively. These studies have taken issue with many of the same critical
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points made by feminist anthropologists (as discussed above) in terms of the lack of sensitivity of
Western biomedicine to the nuances of localized socio-cultural factors which influence the ways in which biomedical health campaigns are interpreted and reacted to by the groups they are targeted towards. In the former of the two studies Silva deals with peasant discourse surrounding virulent outbreaks of malaria in Sri Lanka (Silva, 1997:202-209). Silva’s finding’s were that the peasant communities of Sri Lanka gradually took on the Western term for malaria (i.e. malariyawa) and the association with mosquito bites - to the extent that some members of these communities seemed to believe that the disease was entirely separate to the seasonal fevers they had experienced and categorized according to their own indigenous traditions prior to extensive DDT spraying campaigns in the aftermath of the 1934-35 outbreak.
As a result, Silva has identified a attitude of “selective conformity” (Silva, 1997:210) to the anti-malaria campaigns taking place in the region through which the local community takes on biomedical medicines and practices for as long as the direct and immediate health benefits are obvious, i.e. taking medications until symptoms disappear as opposed to taking the full course, and retaining indigenous traditions to combat health concerns that are not seen to be addressed by biomedical campaigners, i.e. burning of traditional herbs in order to repel mosquitoes (Silva,
1997:210).
This lack of faith in the efficacy of Western medicines and the relevance of biomedical practice to their everyday experience may be interpreted as a response to the ways in which the discourse surrounding the disease has been ‘hijacked’ by politically motivated groups. To name but two examples of the many identified by Silva: colonial rulers took on malaria eradication programmes in order to protect their plantation labour forces and the Sinhalese nationalist agenda made malaria eradication a central part of their campaign for the redevelopment of the northern dry zone (Silva, 1997:202 & 207-8). Thus, having changed hands from one political elite to another the eradication programmes lost much of their connection to the impact of malaria upon the everyday lives of the peasantry.
The latter example shows a similar trend taken to a greater extreme, one in which campaigns aiming towards controlling the transmission of cholera in favela communities in Brazil have resulted not only in resistance to the absorption of health and hygiene imperatives dictated by the
Western biomedical model of health but outright offense at many of the campaigning methods that were put into place. According to Nations this is exemplified by one patients cry of “I am not dog, no!” upon being tested positive for cholera (Nations, 1996: 1013), which within a wider tendency
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among the favela communities to ridicule, make light of or explicitly deny the existence of the disease (Nations, 1996: 1014) indicated the attachment of some kind of negative cultural meaning to the disease and the public health campaigns implemented to control it.
66 Much of the cause of such a marked negative response can be traced to the language, imagery and metaphors utilized by health workers and in the literature and posters circulated by these campaigns. By utilizing imageries of warfare (i.e. “battling the disease”) and by constant reference to the lack of proper hygiene in the favelas the campaign materials feed “into pre-existing stereotypes, equating poor people with degrading and humiliating cultural images and then playing on these potent metaphors to link the poor directly to cholera.” (Nations, 1996:1017)
These two examples provide further evidence for the argument that Western biomedicine, by focuses almost exclusively on physiological symptoms, therapeutic treatments and epidemiological data without consideration of wider systems of economic and political exploitation and oppression that may prevent adequate healthcare from reaching those who need it.

Bodies and medicines

The field of pharmaceutical anthropology analyses the interaction of different models of health and healing through the global market in pharmaceuticals (which is dominated by Western medicines) and the ways in which different perceptions of the potency of medicines are constructed within different cultural contexts. Thus, two areas of focus come to the fore: the relation of individuals and groups to the wider economic system of production, exchange and distribution of medicines and the interpretation and usage of a given medicine by individuals within a localized socio-cultural context. These two aspects (i.e. the micro socio-cultural structures and the macro economic structures which govern access to and usage of Western pharmaceuticals) are emphasized by Whyte and Geest as the fundamental basis which determines the way in which indigenous peoples take up the use of Western medicines. In other words, medicines are not produced by the individual, but once obtained by the individual can be self-administered in a more or less autonomous fashion allowing the patient to set up their own programme of self-care (Whyte &
Geest, 1988: 4-5).
Research such as that carried out by Nina Etkin in Hausa (1992) reinforces the aforementioned model by showing that notions such as primary and secondary effects which are so prominent in Western practices of dealing with medicines are socio-cultural constructions (Etkin,
1992:101) and thus within different cultural contexts primary and secondary effects may be
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‘switched around’ according to the effects that any particular socio-cultural group considers to be the desired effect. Indeed, notions of the effects and potency of any given drug can be constructed from a variety of indicators which have little to do with the usage for which the drug was designed.
For example, the bitter taste of some medications are considered by the Hausa to be dangerous or pregnant women (Etkin, 1992:102) - traditional bitter tasting medicines include: henna, indigo, cassia, and horseradish tree, some Western medicines with similar tastes are chloroquine, penicillin, chloramphenicol and are used by the Hausa to induce abortions. (Etkin, 1992:104)
Thus the work of Etkin, Whyte and Geest challenges the notion of medicines as “simply natural substances with biochemical properties” (Whyte & Geest 1988: 11) by demonstrating the ways in which Western pharmaceuticals are absorbed into indigenous cultures but with different values and meanings ascribe to them by these cultures.

Conclusion

Firstly, an evaluative point: It is not at all my intention to draw represent these differing fields of medical anthropological enquiry and their findings as entirely separate from one another.
In fact, quite the opposite, they are clearly superimposable. It is important to understand the conclusions of each of these three anthropological approaches in relation to each other and thus see the complex intersection and interplay of various kinds of socio-cultural traditions and power structures which take place within and around different medical belief systems, rituals and practices when they interact with one another.
In brief, then, the appropriation of Western biomedicine into indigenous cultures has not been complete. There exist two main reasons for this: traditions and practices of health and healing in most indigenous cultures preexist globalization which has transmitted the Western model of health and healing across the world. These indigenous medicinal traditions have deeply embedded meaning and cultural value and are not merely swept aside by the ‘modern’ medical techniques and practices. It seems that, instead, the most common result of interaction between Western and indigenous models of health and healing is some kind of partial assimilation of biomedicine into the indigenous model of health and healing involved. Secondly, it is also important to note that interactions between different models of health and healing have been revealed as fields in which the dynamics of power relations are often exposed be they political, economic or gender related (or as would most likely be the case, a complex combination of all of these). Biomedicine often neglects to fully analyze power relations such as these, as well as neglecting to study indigenous
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medical folklore. As a result biomedicine does not usually address all of the main health concerns of indigenous communities.

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Grosz, Elizabeth. 1994. Volatile Bodies: Towards a Corporeal Feminism. Indiana University Press

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Mol, Annemarie. 1998. Missing Link and Making Links: the Performance of Some Atherosleroses.
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Britton, Cathryn. 1996. Learning about “The Curse”: an Anthropological Perspectives on
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Etkin, Nina. 1992 ‘Side Effects’: Cultural Constructions and Reinterpretations of Western
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Nations, Marilyn and Monte Cristina. 1996. ‘I’m Not a Dog, No!’: Cries of Resistance against
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Rekdal, OB (1999) ‘Cross-Cultural Healing in East African Ethnography’ Medical Anthropology
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Silva, Kalinga Tudor. 1997. ‘Public Health’ for Whose Benefit? Multiple Discourses on Malaria in
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