European Society for Oceanists 2015 Conference

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Session Detail (parallel)

The clinical way: exploring biomedicine and public health in the Pacific

Coordinator(s)

Barbara Anne Andersen, Jessica Hardin

Session presentation

The history of colonialism in Oceania is a history of medicine: of research and extraction of biological specimens, of experimental public health governance, of the disciplining of the “native” body and the destruction of traditional healing practices. The category of traditional medicine is a creation of colonial history and knowledge production and for many, hospital medicine is considered other, a technology of “white people” and the urban elite.

The clinic is a space where social relationships and knowledges are negotiated by Pacific peoples and their interlocutors. In the clinic, individual futures are imagined while narratives of familial and national health are shaped. The panel will explore clinics, hospitals, and other everyday engagements with biomedicine, as spaces where the politics of aid, knowledge, humanitarianism, and development unfold. This includes interactions between nurses, patients, healers, physicians, and bureaucrats in the objectification of health, illness, and wellness. While global health supra-organizations define health agendas for the region, this panel explores the priorities of Pacific peoples through an investigation of the clinic.

Possible topics could include:
• mass immunization and awareness campaigns
• maternal and child health practices and their impact on gender and the family
• population control, family planning, and safe sex
• infrastructures, logistics, supply chains, and health system management
• doctors, nurses, and community health workers as national elites
• pharmaceutical markets and emerging markets for “traditional” medicines
• noncommunicable disease awareness and outreach campaigns
• differences between private, public, church, and NGO health services
• mental, spiritual, and cultural well-being as public health priorities

Paper submissions are closed

Accepted papers

“The people are still undecided”: Between Western medicine and “old bush medicine” in colonial Fiji

Jacqueline Leckie (University of Otago)

So wrote Native Medical Practitioner (NMP) Filipi Vulaono to Dr David Hoodless, principal of the Fiji School of Medicine, in 1944. Hoodless was also the Medical Superintendent of Fiji’s Mental Hospital, formerly known as the Public Lunatic Asylum since 1884, and subsequently to be renamed as St Giles Psychiatric Hospital. By the mid-twentieth century European doctors there were enthusiastic about transforming this predominately custodial institution into a clinic and would harness new biomedical technologies such as shock treatments, psychotropic drugs, and biomedical tests in their mission. On the eve of Fiji’s independence in 1970, the Secretary of Health could confidently claim, “medicine in Fiji is on the march”.

Meanwhile NMPs and indigenous nurses continued to be responsible for primary health care, including dealing with ‘psychiatric crises’. This paper explores this and the ambivalent role of indigenous medical personnel during the colonial era. They had to negotiate between local communities, the state and medical authorities. The path to the clinic was equally complicated for indigenous Fijians and perhaps, most so when dealing with mental distress and disorder. Non-Christian and Christian spiritual beliefs were integral to indigenous understandings of mental illness and became entangled with clinical answers to madness in Fiji. To explore this, the paper addresses religious insanity — which, even when tamed within the clinic, remained a diagnosis over which the people were undecided.

The Paradoxes of Development Initiatives and Healthcare Paradigms and Infrastructures in the Samoan Islands

John Patu (University of Hawai'i-Manoa)

In one of his most recent rantings, the Prime Minister of Samoa had denounced family planning based not only on religious stances but on effects of stunting population growth. Counterintuitive to development initiatives in 'developing' countries, which normally advocate for population control, Tuila'epa's statement reveals several contradictions about development and health infrastructures in Samoa.

This paper seeks to explore the paradoxes of local pragmatic concerns over development schemes and the impacts on health paradigms and health infrastructure in Samoa and American Samoa as the local populations have transitioned from traditional healing practices towards Western institutions. Family planning as a mechanism of population control, though packaged as necessary to development, has been scapegoated as a hindrance to development itself. Given Samoa's relatively stagnant population growth due to primarily unilateral outward migration, the contradictions become more salient. Donor aid is being poured in to build hospitals, yet the necessary staffing required to operate them is deficient. Money invested in providing scholarships to train healthcare professionals who opt to leave for better paying jobs overseas furthers the brain drain problem. Low-paying wages and salaries for medical professionals contribute to the deficiency of hospital and clinical staffing. Despite the increased reliance on foreign mechanisms of health delivery, much of the population still rely (at least partially) on traditional healing institutions and practices, including the local taulasea (healers) who have have organized their own formal association. What this paper ultimately seeks to address is how adequately 'the clinical way' tackles these development problems in the face of the many contradictory trends.

Sedimented sites: viewing the health system in PNG from the ground up

Katherine Lepani (Australian National University)

Drawing on ethnographic research on the interface between culture and HIV in the Trobriand Islands of Papua New Guinea, this paper reflects on health facilities as social spaces where other work apart from service delivery gets done. As a starting point, I query the meaning of “integrated services” in primary health care, the juxtapositions and contradictions in the way health issues are identified, prioritised, and made procedural, and how this appears in the physical infrastructure of district health centres. I consider the relational practices of service delivery and the co-location of other forms of social practice that inhabit facilities as people access health services. A notable conjunction is the presence of doba in the TB ward. These bundles of dried banana leaves are the exchange valuables Trobriand women make in preparation for sagali mortuary distributions. At times spaces within health facilities are transformed into sites of heightened productivity for social projects, like sagali, which demonstrate vitality and regeneration. These sites are animated as well by abrupt and uneven inputs of resources, equipment, and personnel, and irregular flurries of activity involving scoping visits, community consultations, and workshops that deliver global agendas about health and well-being. Nostalgic recollections of a bygone era, and unfulfilled expectations about the benefits of modernity, shape people’s relationships to these unstable yet familiar and sedimented sites of public health, which comprise deep colonial histories and physical evidence of development forestalled while also holding prospects for revitalisation.

Anthropology, Brokerage and Collaboration in the development of a Public Ethnopsychiatry: Tongan Lessons for Global Mental Health

Mike Poltorak (University of Kent)

The Global Mental Health (GMH) movement has revitalised questions of the translatability of psychiatric concepts and the challenges of community engagement in countries where knowledge of the biomedical basis for psychiatric diagnosis is limited or challenged by local cultural codes. In Tonga, the local psychiatrist Dr Puloka has successfully established a publically accessible psychiatry that has raised admission rates for serious mental illness and addressed some of the stigma attached to diagnosis. On the basis of historical analysis and ethnographic fieldwork with healers, doctors and patients since 1998, this article offers an ethnographic contextualization of the negotiations entailed and reception of three key interventions during the 1990s that included collaboration with traditional healers and the formulation of hybrid terms. Dr Puloka’s use of medical anthropological and transcultural psychiatry research, informed a community engaged brokerage between the implications of psychiatric nosologies and local needs. As such it reveals deficiencies in current polarised positions on the GMH project and offers suggestions to address current challenges of the Global Mental Health movement.

Yamatji women negotiating breast cancer knowledges in the clinic and beyond

Melanie Dembinsky (University of Liverpool)

A multitude of competing information and knowledges surrounding causes and prevention about breast cancer are present in Yamatji country, Western Australia. Biomedical, subjugated and embodied knowledges all exist in Yamatji country and compete for recognition. Focusing on several Aboriginal communities in Yamatji country, data gathered between 2010 and 2011 and on subsequent shorter annual trips provides ethnographically rich, thick description of how Yamatji women negotiate these knowledges in the clinic and beyond. While biomedical knowledge dominates public health campaigns to increase breast awareness among Australian Aboriginal and Torres Strait Islander women, the women themselves often perceive this knowledge as less trustworthy and valid than knowledge passed on to them by other Aboriginal and Torres Strait Islander women. I argue that Yamatji value experiential knowledge over other types of knowledge. Through the process of negotiating different knowledges, Yamatji shape their own explanations of breast cancer, and engage oftentimes in medical pluralism both for explanations of breast cancer causation, as well as treatment options, which in turn highlights the colonial legacy of medicine as a form of surveillance and control and at the same time an opportunity for cultural continuity.

HIV, biomedicine and the way of the clinic in Fiji

Fabienne Labbé (Quebec Institute of Public Health)

Drawing from ethnographic research on the illness experience of HIV positive people in Fiji, this paper explores the social, cultural and structural realities underlying interruptions and refusals of medical follow-up by people living with HIV of indigenous Fijian origin. In mid-2013, 20% of the patients of the main HIV clinic located in Suva were considered by health authorities to be “lost to follow-up”, that is to say as having failed to visit the clinic for more than three months. People living with HIV and healthcare workers overwhelmingly cited the fear of being known to be HIV positive and transport costs to visit the clinic as the leading causes of these interruptions. People living with HIV also commonly evoked Fijian medicine and Christian healing as alternative therapies to which they turned to and which led them to interrupt, momentarily or permanently, the follow-up of their condition. Ethnographic analysis reveals, however, that the decision of people living with HIV to interrupt or to refuse biomedical care for their condition needs also to be understood in light of tensions in the health worker/ patient relationship and of dysfunctions of the healthcare system that profoundly impact the clinical experience of people living with HIV. This paper thus explores interruptions of medical follow-up by indigenous Fijians living with HIV as socially produced and as resulting from the complex negotiation by HIV positive people of multiple priorities and constraints.

Biomedical Tropes of the Body and Ngyiampaa Aboriginal Body-Imaginaries in Australia: constructive health care as possibility?

Daniela Heil (University of Newcastle)

Starting with critically exploring the borders and crossings of Australian biomedical realms and Ngyiampaa people’s participation within those realms in an all-Aboriginal community in central-Western New South Wales, Australia, this paper aims to make a contribution to developing health care practices that accommodate Ngyiampaa people’s tropes of “personhood” and “being in the world.” Whilst the practices of Indigenous and non-Indigenous health care providers continue to prioritise “disease problems of individuals” rather than the ways in which those problems have been produced and maintained, I illustrate the ways in which Ngyiampaa people work with the body-imaginaries of their personhood when their “health” is at stake. Arguing that incorporating Ngyiampaa body-imaginaries into health care practices is vital and necessary if improvements in “health” are to be achieved, the paper proposes to work with localised Aboriginal strategies — if health care is considered to be both constructive and meant to be a possibility.

Navigating Female Cancer Care: Illness Experience and the Politics of Healing in Tonga

Patricia Fifita (University of Hawai'i-Manoa)

This paper will focus on cancer health disparities in the Pacific through the lens of female cancer experience in Tonga. Drawing upon the intersections of health, culture and modernity, this paper will explore the ways that women, who have limited access to resources, navigate multiple and fragmented medical systems, including both Western biomedical and faito’o fakatonga (traditional Tongan medicine), in order to obtain treatment for cancer. Female cancer mortality rates in Tonga are increasingly high due to the late presentation of the disease. I will specifically analyze a collection of female cancer illness narratives that highlight barriers to care and help articulate structural tensions between biomedical health models and more locally meaningful concepts and understandings of health and illness. Biomedicine, although privileged as the dominant approach to cancer treatment, is limited due to the poorly resourced public health care system in Tonga. This paper will examine broader political and economic issues that contribute to inequalities in access to health care resources, including medical knowledge and services for cancer. I argue that the development of effective interventions for cancer in Tonga will require a multidisciplinary and holistic approach that incorporates local articulations of health and illness and also engages with current sociocultural, political and economic realities.

“They tried to ask the patients’ relatives to bring flowers instead of food”

Gaia Cottino (Università degli Studi di Genova)

The body is a negotiation land. In particular in those contexts where sizes and body ideals do not fit international standards and thresholds. In such cases bodies are medicalized and disciplined in order to impose the prominence of western optimal sizes on the locally appropriate ones.
This is the case of the Tongan population, who lives and embodies the contradictions of contrasting views: on the one side, those of supranational health agendas worried about the high BMI and NCDs rates and, on the other side, those of the everyday cultural practices and obligations. Through the example of the mediation role played by the capital’s main hospital nurses I wish to show the constant negotiation and creative permanent reformulation of knowledges, which significantly mirror local priorities.