Medicine beyond the stethoscope

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As we progress with the ‘Anthropological gleanings’ series, this week’s article focuses on the medical anthropology; it’s study area, historical background and the practical approaches. As discussed in the previous articles also, anthropological studies are done under two main study areas as cultural anthropology and physical anthropology. Medical anthropology is a sub field of study that comes under the main subject of cultural anthropology and studies the socio-cultural aspects related to diseases, illnesses and the medical as well as non-medical treatment systems.

What is medical anthropology?

Senior Lecturer at University of Sri Jayewardenepura Prof. Jayantha Jayasiri, upon the request of Ceylon Today, spoke exemplifying the subject field of medical anthropology and its practices; 

“In anthropology we study the humans, their socio-cultural behaviours and the changes that have and will have taken place at some point of the evolution of the humans. Particularly in cultural anthropology, much of our focus is put upon the socio-cultural aspect and how those aspects affect or influence humans. Likewise, in medical anthropology we study diseases and the diseased, illnesses and the various methods of treatments and medicines, under the light of culture and society. We try to comprehend how these two aspects are accountable in diversifying the sense of diseases and cures among different and various cultural contexts.” In simple terms, medical anthropology studies, “Human health and disease, health care systems, and bio-cultural adaptation.”

This study draws upon social, cultural, biological, and linguistic anthropology to better understand those factors which influence health and wellbeing, the experience and distribution of illness, the prevention and treatment of sickness, healing processes, the social relations of therapy management, and the cultural importance and utilisation of pluralistic medical systems. Also, it attempts build-up comprehensive hypotheses on how the health of individuals, families, larger social formations and environment are affected by the different inter-relations between humans and other species; cultural norms and social institutions; micro and macro politics; and forces of globalisation as each of these affects local worlds

The origin of the subject field

“The origin of medical anthropology as a specific field of study runs few decades back. In fact, the first standard use of the word ‘medical anthropology’ is recorded in 1940s in discussing about philosophical studies of health and illnesses. The emergence of medical anthropology is in association to ‘ethno-medicine’. It is the, ‘study or comparison of the traditional medicine based on bioactive compounds in plants and animals and practiced by various ethnic groups, especially those with little access to western medicines.’  Medical practitioners and researches had gathered much information about various theories and rituals that prevailed in different communities about illnesses. Anthropologist, Rivers in his publication, Medicine, Magic and Religion demonstrates that most of the rituals and witchcraft had looked very convincing and logical to the indigenous people, though they might look completely illogical to the western societies. This idea had been reiterated by other contemporary anthropologists such as Evan Pritchard too,” shared post-graduate student, Department of Anthropology, University of Sri Jayewardenepura, Amila Nuwan Sri Shan.

Along with these studies, some researches were enthusiastic in studying the universality of the psychological theories and concepts that were brought forth by Sigmund Freud, and it motivated the world to consider the psychological aspect in health related researches.

So, having had all these knowledge systems, anthropologists understood the importance of studying the aforementioned aspects under an academic light and thus brought about the new sub-filed of cultural anthropology, medical anthropology.

Local healthcare system through an anthropological eye

Prof. Jayasiri, in speaking about the healthcare system in Sri Lanka from an anthropological perspective, mentioned that several milestones in evolution of the health system can be identified.

“According to the studies that have been conducted in the local context, we know that we have had a well-developed system of healthcare and medicine from a very early period of the history. The initial stages of this healing systems run to the times even before the arrival of King Vijeya to Sri Lanka. According to the folklore, the first evidences about people’s concern in understanding and treating the diseases and illnesses are found in the times of King Maha Sammatha. It has been mentioned that some medical treatments and witchcraft have done to cure some illness of his concubine. ‘Mahindagamanaya’ (the arrival of Arahat Mahinda) is another milestone. With that the local traditional healthcare system took another great change, and was nourished by the Indian practices of healing and sanitation. Then we can observe the changes that took place during the colonial period with the intrusion of Portuguese, Dutch and British. They introduced the allopathic or the western system of medicine where diseases are treated with drugs, radiation and surgery,” he briefed.

“Thus we have to understand that the incumbent health system didn’t appear out of blue but developed over time with the influence of many health systems. So, we can’t simply ignore the traditional healing systems. We should rather gather knowledge of various health systems such as ayurvedic, homeopathy, and acupuncture and so on, and approach the maladies with a multi-dimensional, multi-disciplinary system.”

Talking further on the topic, Sri Shan described that there had been very progressive aspects in the traditional medical and healing systems too. “We can’t say that the ancient systems were totally ignorant and illogical. Though they might not be identified in scientific terms, the ancient communities have had an understanding of origins and spreading of communicable as well as non-communicable diseases. For an instance, there had been various sorts of thahanchi (restrictions) like Pattini Desathiya (two weeks of travel ban) when someone is infected with a contagious disease such as small pox, chicken pox and so on. Those diseases were called deiyange leda or ammavarunge leda. In such cases, other people also were communicated that there was the risk of a disease by hanging mango or khomba branches before the house.

“Those practices, actually, have been more effective than imposing laws as we do now, because people used to observe them as rituals. In fact, people embrace things with a cultural aspect quicker and easier. Therefore, we can try to implement such tactful methods in controlling pandemics such as COVID-19 as medical anthropologists,” he furthered.

According to him, even during the early periods, western medical practitioners and researchers have sought assistance from anthropologists when the health systems were taken to distant countries such as Africa. The indigenous communities of those countries already had had certain ways and means of understanding, diagnosing and treating diseases and sicknesses. Hence the allopathic system of medicine had be changed and modified to fit in to those communities. “Anthropologists can contribute to the modern health systems too in the same token,” Sri Shan added.

Preserving the traditional knowledge

“As discussed before, we have a rich traditional knowledge system of health and sanitisation. As medical anthropologists we attempt to research those systems in all primitive, rural and urban communities and gain the beneficial aspects of them and adapt to match the new knowledge systems in the world,” said Prof. Jayasiri

“In our traditional medicine, the people had also paid attention to the psychology of the diseased or the sickened person. There had been various witchcrafts such as deva madu, yak madu and so on, which were hold when someone was severely sick. Daha ata sanniya is also such practice. The psychology of the patient called aathuraya was addressed by these practices and was convinced that the gods would bless them and thus they would recover soon. That would strengthen them mentally. Therefore, we can understand that these superstitious practices hadn’t been just illogical, silly practices but mental therapies to ameliorate the healing process. Apart from these large-scale events, there had been common practices such as tying an enchanted string or a metal object called surey around the neck with the same intention,” he explained.

“These practices were totally ignored by the western medical practices, but now the World Health Organisation (WHO) itself says that the psychology plays a vital role in the healing process of a person.” He further mentioned that these practices can be encoded in performing arts even and preserve them to the future.

Speaking to Ceylon Today, Sri Shan further elaborated how medical anthropology can be utilised as a tool to protect local medicine. “Taking the recent COVID-19 outbreak as an example, we can observe how people turned to traditional medicine in masses, though we think that the present society doesn’t believe in them. So, as a result many local medical practitioners as well as fake personas emerged with various medications and treatments for COVID-19, and only a few were taken through an ayurvedic testing. One main reason for that is, all these local medications have to obtain permission through the ayurvedic testing, but sometimes the teachings of these two systems clash. So, it’s very difficult to regulate these drugs. Nonetheless, if we establish a system to test and analyse them, with the help of medical anthropologists who are facilitated with the knowledge about traditional healthcare systems, we can actually regulate and manipulate local medicines for the betterment of the society. 

It is the responsibility of the medical anthropologists to gain a sound knowledge of all these systems of health as well as the various roles played by medical practitioners, nursing officers and local doctors and so on, and utilise that knowledge to aware people and make a good impact on the society, Prof. Jayasiri added.

Concluding the discussion, Sri Shan, on behalf of the Department of Anthropology of University of Sri Jayewardenepura, invited all the students of anthropology as well as the other stakeholders to join with them through the official Facebook page Anthropology crew of University of Sri Jayewardenepura or the university website, since they are planning to conduct many events and programmes regarding the subject in future.

By Induwara Athapattu