 |
Traditional
Medicine in a Global Economy |
Traditional, folk or vernacular systems of medicine rely largely on oral tradition and apprenticeship for the teaching of their tenets and the training of their practitioners (Hufford 1988; O'Connor 1995). Traditional medicine is dynamic, and not static, because it is located within a large national context in which the forces of the politically dominant culture have penetrated over
time (Romanucci-Ross 1983). In the "little tradition" of folk medicine, knowledge of health and illnesses is not codified, but is widely shared between users and practitioners (Press 1978:72). Traditional medical systems articulate theories of disease etiology and remediation within a larger cultural framework of moral, ethical, religious, and supernatural concerns. The underlying causes of illnesses are generally seen as some kind of imbalance or lack of harmony in the body, the social environment, the spiritual world or the cosmos. A complex, multi-causal view of illness etiology and appropriate therapeutics allows the sufferer to bring the maximum number of resources to bear on his complaint and provides a rationale not only for treatment but for efforts at prevention, such as protective amulets, blessings and pilgrimages, good diet and exercise (Hufford 1988)
Traditional medical systems are more open than other systems and their therapeutics, therefore, are more likely to include substantial inputs of biomedicine in their repertoires. Religious and charismatic healing belongs to the folk medical system because therapy is effected by means of prayers to, and faith in, a supernatural being.1 Traditional health care conventions in
Trinidad have sprung mainly from the folk medical systems of India and Africa where immigrant laborers were uprooted and transplanted to the sugar plantations in the New World.
I apply the classification "popular or alternative medicine" to medical systems relying significantly on print and other forms of media and frequently having formal organizations and curricula for participant instruction or practitioner training (e.g. naturopathy or chiropractic) (O'Connor 1995). The alternative medicine sector, of which the "health food movement" is the best example, has enjoyed steady growth over the past 20 years in developed countries (Hufford 1988). Some commentators believe this trend signifies an important change in values, a reaction against a materialistic age, a desire to return to a more "natural" lifestyle, and a belief that a state of total health is achievable through personal preventive actions. Others view the movement more narrowly as an expression of dissatisfaction with the scientific and technological dominance of modern science (Murray and Shepherd 1993).
The official health care system is referred to by a range of terms, of which some very common ones include "biomedicine," "scientific medicine," "modern medicine," "orthodox medicine," "regular medicine,' "conventional medicine," "organized medicine," and "cosmopolitan medicine." The officially sanctioned medical system is based on Western science and technology, and it is the form of medicine that is controlled by the ruling class. In keeping with the scientific tradition, its practitioners have striven to separate themselves from broader social and cultural concerns and influences. Its concepts and
methods have become universal in application and are not altered significantly by different ecological environments. Its practitioners discount religious, metaphysical, and philosophical considerations from their explanatory models of disease and dysfunction (O'Connor 1995). Though scientific medicine has its roots in traditional. practice, its practitioners are "rather embarrassed" by it (Vaskilampi and MacCormac 1982:v).
Basically, there are two systems of health care in the developing world: one is traditional and the other is Western in derivation. Modern medical services constitute the politically dominant form of health care in Trinidad's health care program. Perhaps the most distinctive feature of the growth of health services in Third World countries, like Trinidad, is that these
services have been promoted by affluent capitalistic countries (Banerji 1984). The increasing commercialization of health-related products (Banetji 1984) and the demonstrated power of science and technology (Singer 1989) beamed through
satellite television stations are convincing people of the magic of western medicine. At the national level,
[t]he modern system of medicine enjoys the approval, cooperation, and protection of the country's legal system and other supporting social institutions: government licensing and regulatory bodies, third-party payment systems, preferred access to federal and private and research monies, high prestige social status and their concomitant benefits, including professional associations with substantial lobbying power and professional publications with influential reputations for authority. (O'Connor 1995: 5)
The state-supported modern medical system,
which tends to be synonymous with a monopolistic medical "establishment"
and a doctor-dependent, hospital-based, curative health care
model, does not generally recognize, cooperate with, or adjust
to the traditional medical systems (Good et al. 1979:141). The
two exist side by side, yet remain functionally unrelated in
any
organizational sense. There is the belief that with the recognition
of traditional medicine and the political commitment to humanistic
health care reform, better use of scarce resources for the common
good can be made. Techniques and medications of modern practice
are increasingly filtering down to local healers. Folk, popular
and orthodox medical practices may coexist,
compete and intermingle with one another within a single community,
nation or region. Indeed, many traditional or popular health
beliefs may be supported, reinforced or rejected by biomedical
explanations. The combined use of both types of
expertise provides an optimal broad-spectrum response to health
problems. "Medical pluralism offers a variety of treatment
options that health seekers may choose to utilize exclusively,
successively, or simultaneously" (Stoner 1986:46). People
may try a variety of practitioners and treatments, from the same
or different systems, until a cure results. In many societies
(see,
e.g. Morsy 1993), the continuing process of negotiation takes
place as patients seek therapies and etiologies consistent with
their understandings of illness. Patients may accept some aspects
of the scientific health care system as presented to them by
a government physician, and they may supplement this with information
gathered in consultation with traditional healers (see Staino
1981). The systems differ in availability, quality of care, levels
of technology, and social adaptability; yet, ideally, both are
intended to serve the same population in need.
Traditional or local medicine still remains an important source
of medical care in the developing countries even though it is
not officially recognized by the government health care programs
(Jaspan 1969; Kleinman 1980). It persists in urban as well as
rural settings despite the availability of allopathic health
services. I have found in Trinidad, however, that its general
persistence is decreasing in importance over generations, particularly
among socially isolated nuclear families. In traditional medical
systems worldwide, afflictions which beset body and mind can
be explained in both naturalistic and supernaturalistic
terms. When a wound does not heal, when a sickness does not respond
to treatment, and when the normally expected and predictable
does not happen, other explanations beyond the organic are sought
(Hughes 1978). The rise in status of
folk healing systems in capitalistic countries is contingent
upon gaining "acceptance from strategic elites who are seeking
solutions to the contradictions of capitalistic-intensive medicine
and/or by patients who demand forms of treatment neglected by
orthodox medicine" (Baer 1984:3).
Dr. Kumar Mahabir is a medical anthropologist and president of the Association of Caribbean Anthropologists.