EASA, 2006: EASA06: Europe and the world
Bristol, UK, 18/09/2006 – 21/09/2006
Ethnographies of medical encounters between Europe and Asia
Location Queens 1.18
Date and Start Time 19 Sep, 2006 at 11:30
Cross-cultural transactions between European and Asian medical systems entail complex processes of transfer, adaptation and integration. We invite contributions that specifically use ethnographic methods to elucidate the complexity of medical encounters between Europe and Asia.
Cross-cultural transactions between European and Asian medical systems entail complex processes of transfer, adaptation and integration. Only recently, they have become the object of academic inquiry in medical anthropology and social sciences in general. Whereas the medical sciences are usually most interested in the practical application of medicine, such as in clinical trials, and issues of efficacy, standardisation and quality control of Asian traditional medicine, anthropologists look for social and cultural constructions in these encounters between West and East, Europe and Asia. Thus, in Europe we experience a growing interest in Asian medicines and the testing of their efficacy through clinical trials modelled on biomedical standards. Yet, at the same time, market demands foster a commodification of authentic Asian or Oriental medicines in Europe, transforming them into important techniques for wellness, esoteric and other therapeutic means that are usually removed from their original philosophical roots and emic empirical frameworks. Ayurvedic massage, acupuncture and more recently Tibetan medicine thus became alternative medicines in the West, or so-called CAMs (complementary alternative medicine). On the one hand, market demands in Europe also shape Asian medical production policies and techniques influencing local medical contexts, but on the other, biomedicine dominates both European and Asian medical contexts in various ways. We would like to encourage contributions that specifically use the method of ethnography to elucidate the complexity of these medical encounters between Europe and Asia.
Chair: Mona Schrempf, Geoffrey Samuel
Discussant: Elisabeth Hsu, University of Oxford
The social construction of competence: an ethnography of a clinical encounter in a Delhi slum
This paper is part of a larger study on health systems reform in poor urban neighbourhoods in India, Indonesia and Thailand, with three components to it: a longitudinal household study of disease burden and resort to treatment; a household economic survey; and a desk study of the existing regulatory mechanisms of private practice.
In most poor urban neighbourhoods the world over, health service is provided by 'nonqualified' medical practitioners. This is particularly so in the context of Delhi where these 'quacks' make regular headlines in the media in the aftermath of fatal accidents caused by misdiagnoses, and the Delhi government conducts raids in an attempt to shut their 'clinics'. But the fact remains that most of these 40,000 'quacks' continue to practice, albeit in many cases in clinics that bear no signboards or placards. They have their own associations and they constitute the backbone of the 'health service' for the urban poor.
In the medical and social science literature these practitioners appear as 'quacks' and have over the years invited a growing body of criticism. While some of this literature suggests social and economic reasons for their existence and why patients resort to them rather than turn to qualified and often 'free' state-run institutions, little exists by way of an ethnography of the actual encounter between patient and practitioner in this context.
The present study uses ethnography of such clinical encounters to understand why poor patients resort to such practices and what ensues in such settings.
The paper discusses the social construction of competence in a context with obvious inconsistencies and clear indications of a lack of understanding of conditions (like polio, for instance) and the use of diagnostics. Whether the prescription is medically correct or appropriate is moot. While the accent is clearly on client satisfaction, and pragmatic concerns of ensuring a continuing (and sustained) patient base are apparent, there are also larger issues involved - of perceived competence, knowledge and ability to perform 'as a doctor' in a provider-patient setting - that drive the practitioner to perform. Use of detailed narrative analysis shows that the practitioner's main concern is to ensure that the key actors involved are satisfied with the treatment.
An ethnographically grounded understanding of the motivations guiding this treatment seeking behaviour and the dynamics underlying the interactions in these clinics is crucial. This is particularly so if there is to be a regulatory framework that would work to protect patients in poor urban neighbourhoods against iatrogenic events when utilizing the private health delivery system.
Continuities and discontinuities in Chinese medical practice in Edinburgh
Based on ethnographic research carried out in several Chinese medical practices in the city of Edinburgh, this paper will discuss various themes associated with diaspora studies and Chinese medicine, such as: the relationship between the homeland and the diaspora community, the ways in which Chinese medicine articulates a specific sense of social identity and the ways in which this is challenged by displacement. The research will also consider continuities and discontinuities between the traditional setting and Chinese medical practice in the Edinburgh clinics. In terms of continuity the paper will discuss the transmission of medical knowledge as it relates to practitioners in each of the clinics. The paper will consider the extent to which Chinese medicine is represented and practiced in a uniform way within the diaspora community. It will also consider the relationship with the homeland with respect to importation of traditional medicinal compounds and raw ingredients. A further area of discussion will be the effects of the hegemonic dominance of biomedicine in terms of epistemological issues within clinical practice and the ways in which the institution of Chinese medicine in the UK is being transformed by present government policy direction toward statutory self regulation of practitioners of complementary and alternative medicines.
The challenge of authenticity: exploring the role of language and identity in conducting an ethnographic study of Chinese medicine (TCM) provision and use in Chinese-community based settings in the UK
In this paper I explore challenges encountered during the course of fieldwork in Chinese-community based Chinese medicine (TCM) clinics in the UK. Utilising a reflexive and phenomenological approach I situate 'practitioner-research' as contentious inter-disciplinary approach to anthropology at home. The parallel process is justified with attention to the UK heath service research framework and previous ethnographic studies, which highlight participant observation as the heart of the method. The various means through which observations are rendered participant are discussed, including an analysis of research relationships as co-producers of ethnographic direction. The organizational categorisation of TCM as either Chinese traditional 'ethnic' or complementary and alternative medicine in the UK is an emergent issue; part revealed and part constructed during fieldwork.
Researcher positioning-in relation to Chinese and English language and identity-reflects and informs global tensions in the TCM development process. However, in the UK clinical context real language limitations furthered a phenomenological opportunity for analysis. The primacy of the body and 'medical gesture' affirmed by Levinas (1998) afforded a focus on the 'face to face' response in the immediacy of the treatment encounter. This raises ethical issues in the fields of health services research and professional Chinese medicine. The role of research in legitimising or illuminating particular Chinese medicine practices among medical and/or ethnic populations, alongside the cultivation of the academic practitioner-researcher in performing this role. Further implications include the value of ethnography in highlighting the essential plurality of Chinese medicine practices in the UK, and the importance of reflexivity in mirroring the use of culture and language as powerful organizational gesture. The analysis reminds as to the diversity of persons and languages represented in Chinese medicine research, resource and occupation. Ethnographic experience suggests a need for collaborative dialogue; acknowledging the challenge of professionalising authenticity in changing global social worlds.
Care itineraries of cancer patients in the centre of France (Auvergne)
This paper will propose an analysis of health care behaviours of cancer's patients living in Clermont-Ferrand (350.000 inhabitants), capital of Auvergne, a rural and central region of France. In this city, a national centre of cancer treatment, namely "Centre de Lutte Contre le Cancer" (CLCC), like the other centre in France provides very new biomedical care and treatment and makes research in new protocols. But the cancer patients of this region also use a diverse set of other different cares and treatments accessible around. We propose here an analysis of the health care behaviours from conventional treatments to Asiatic supportive cares.
We have done a participative ethnographic survey in the city of Clermont-Ferrand and its surroundings -note1- .
Since November 2005, we have been following health care itineraries of cancer's patients consulting clinics (generalists or healers ones): in medical services, in NGOs and in the city. With the help of direct observations and several formal and informal interviews, ill persons' following-up have been done, and meetings and training courses have been observed. Different places have been investigated : hospital services and surgeries, NGOs' offices, information cells on cancer and CAMs (institutional or not), well-being shops and natural stores, bookshops, etc.
In those care itineraries, we find a plurality of recourses, at different levels : nutrition and diets, fitness and body technics (relaxation, "eutonie", Qi cong), psychology and spirituality (oncopsychology, hypnosis, cult of saint) and training courses in "natural therapies". Those levels are involved in various degrees : first of all, as prophylaxis in order to escape to the disease, in a second time to support biomedical treatment or as an alternative for a part of biomedical treatment. Those recourses mix local and extra-local technics : asking for a "charmeur de secret" to cure radiotherapy burnings with going to the acupuncturist "to regulate energies".
The paper will focus on the specific use of asiatic/oriental references, cares or treatments existing in this city and on their uses by the cancer's patients. How these people are integrating tools, remedies, objects and/or ideas, philosophies and way of life, from Orient or other cultural origin ? And trough the exploration of the networks of these CAM's we will consider how information and knowledge are circulating. These questions will feed the current preoccupations of the very new French National Institute of Cancer (INCA) on the use of CAM's in France -note 2- , on which we will conclude.
-note 1 - We actually live in Auvergne, after spending more than 3 years in mountainside making our field for our doctorate thesis of ethnology ("Sickness and unfortunate events in Auvergne : healers, doctors and patients, from mountainside town to hospital", Marc Augé director, EHESS, Paris, 2001).
-note2- This research will be integrated to the very new European collective research project supported by INCA on a french regional and international comparison of the use of CAMs by cancer's patients (Normandy, Auvergne and PACA for France, and Belgium and Switzerland) and in association with three french research laboratories (GRIS, University of Rouen, CReSSS, University Paul Cézanne of Aix-Marseille3 and GETI, University of Paris 8), one from Belgium (Facultés universitaires Saint-Louis de Bruxelles) and with the Institut of anthropology and Sociology (IAS), University of Lausanne, Switzerland.
In Europe and America the rise of modern standard medicine on the European model and its reach into everyday life has contributed to a widespread interruption of the transmission of traditional remedies and recipes. The Wellcome Trust funded outreach film project, Asian Remedies, finds that Asian migrant communities and individuals yield an unforeseen depth and quality of information about traditional forms of healthcare.
Using innovative data collection techniques: combining interviews with arts and culinary workshops we have revealed the huge potential that lies in the collecting and recording of everyday ritual, recipes and techniques. Individual or community stories are captured on video, in sound recording, or developed through arts installations. In the fifty or so interviews that we have filmed, it is evident that when researching Asian individuals and communities in diaspora, it is necessary to define everyday health care practice broadly. Looking after your health in unfamiliar circumstances involves much more than deciding what illnesses you take to the GP and how you communicate the discomfort you feel. Nutrition, exercise, ritual and religion, figure very largely in the preservation of health.
People who find themselves in strange and uncomfortable environments are often deeply conservative about their daily practice, recreating activities from remote times and places. Sometimes there is a direct continuity of that practice, using the same foodstuffs, medicines and rituals that were learnt in their countries of origin, adapted to a new location. But often that practice has to be recreated, or imagined anew from personal or family memories for personal fulfilment or to sustain families and communities. Our film begins to document that tranformation.