Social science & medicine. Part B, Medical anthropology最新文献

Analysis is made of medical beliefs and practices in two Melanesian societies, both on Bougainville island. Sorcery and supernatural sanctions remain important as causes of illness and hence forms of social control in the absence of superordinate political authority. Distinctions between symptoms and illness are often ambiguous and throughout Melanesia this provides some flexibility in classification, diagnosis and cure. Among both groups described in this paper, most illnesses are described as either ‘illness without cause’, which is rarely serious and never attributed to sorcery or the actions of spirits, or ‘illness of the settlement’ which is more serious. Some serious illnesses which respond to modern medicine may now be classified as ‘illness without cause’. ‘Illness of the settlement’ may be caused by sorcery or spirits, which may follow breaches of social norms. Attributions to sorcery are of growing significance, especially in Siwai which is more firmly incorporated into a wider society and economy. There are a variety of traditional medical practitioners with both physical and spiritual skills and ‘traditional’ cures are constantly changing. Since the war. European medicine and practitioners have supplemented traditional practitioners to produce, especially in Siwai, a dual hierarchy of alternatives. This modern system has only slightly affected local beliefs about illness. Because modern medical practices are viewed by both groups as means for treating symptoms, the two systems enable a flexibility and diverisity of response, encouraging complementarity rather than competitiveness.

A seminar with basic health workers of four Indian groups in Ecuador serves as an example for the participatory evaluation of Primary Health Care (PHC)-programmes. Discussions in small groups, interpretation of visual aids derived from research data on health care utilization and practical evaluation exercises with the participants favoured the perception of opportunities and limitations which exist in the actual PHC-schemes. Main topics of discussion were: health impacts of socio-cultural change, community support of health workers, links with the hierarchy of the health care system, differential use of traditional and modern medicine, planification of future programmes. The final discussion with health officials was important for the mutual conscientization. The need for the involvement of communities and PHC-workers in the evaluation of regular programmes is stressed.

This paper considers ethnographic approaches to the study of health-care choice making in medically pluralistic settings. It focuses on the ways in which different methodological orientations may lead to varying explanations for the non-use of Western-style medical treatment, having dissimilar implications for policies concerning the delivery of health services in such settings. Several approaches are evaluated in terms of their utility for determining the relative effects of endogenous, culturally derived influences, as compared with exogenous, primarily accessibility-related factors, as constraints on the choice of a physician's treatment. Results of the application of a cognitively-oriented decision modeling approach in a rural Mexican community are described, and the comparative advantages of this approach are emphasized.

The prevalence of intestinal parasitism in seminomadic pastoralists affected by river basin and irrigation developments is studied in relation to cultural and ecological factors. Five ethnic groups representing six cultural-ecological situations are studied in the Awash Valley of eastern Ethiopia. Sanitation level and other parasite transmission parameters in each of the six study populations are assessed by using a simplified semiquantitative system of scoring for variables. Results are examined to analyze the occurrence of infection in pastoralists largely continuing their traditional way of life and in tribesmen who settled in and around irrigation schemes and became farmers or farm laborers, and to evaluate some disease control measures. Prevalence of infection in the indigenous peoples is compared with that in migrant farm laborers from the Ethiopian highlands and the physical and cultural environment of the schemes and the Awash flood plains is examined to assess disease hazards created by the new farms and to make recommendations for parasitic disease control.

This paper describes the modern and traditional methods and techniques used in induced abortion in Bangladesh, and the physiological problems faced by the abortion seekers. It observes that social prestige and economic security are the main issues associated with induced abortion. This paper also discusses the opinions people gave for and against induced abortion, and argues for partial liberalization of abortion laws in Bangladesh due to the failure of contraceptives.

This paper examines some of the many dimensions of meaning that psychotropic drugs can have for those that use them on a long-term basis. It aims to shed light on the problem of psychological dependence on these drugs, and the different forms this dependence can take. To put this study in context, some of the recent literature on psychotropic drug use is reviewed, before reporting the findings of the pilot-study. From this data a classification of chronic users into three different ‘types’—called ‘Tonic’. ‘Fuel’ and ‘Food’—has been developed, each of which embodies a different perspective on psychotropic drugs, their symbolic meanings, and modes of usage. It is hoped this classification will be useful to clinicians and others working in this field.

The prime concern of this paper is twofold: to investigate how the people of Berekuso, a rural community in Ghana, classify diseases; and to examine the extent to which this classification affects the utilization of existing health care facilities. Previous research on this topic has been conducted by identifying beliefs and behaviour at the same point in time, thus confounding beliefs with behaviour. In this study, however, a two-phase interview survey of a systematic sample of households was adopted. It was found that the basis of the disease classification system is what is believed to be the cause or source of a disease. This is because the diagnosis of the cause of a disease is the most important aspect of therapy. Using the cause as the main distinguishing factor, diseases are classified into three main types—diseases which are believed to be caused by natural agents, those which are believed to be caused by supernatural agents, and those whose causes embrace both natural and supernatural agents. This classification counters some previous assertions that Africans, and preliterate people generally, classify diseases only in supernatural terms. The study revealed that the way diseases are classified affects utilization behaviour. In this regard, the knowledge of the cause of a disease allowed a fairly accurate prediction of what health care facility would be used.

This paper deals with the concepts of ‘ripe’ and ‘unripe’ in Ayurvedic medicine. These concepts express the notions of health and sickness; and I examine the ways in which they were interpreted and applied by Ayurvedic practitioners in S. Gujarat. The concepts of ‘ripe’ and ‘unripe’ describe the state of the food-juice, though they also apply to the relative maturity of the stools and the condition of the tongue. I show how these concepts are derived from the classical sources, particularly the Caraka Samhita. though I suggest that the emphasis they receive today may in part be due to later Ayurvedic texts. The present practice of Ayurveda has also been influenced by the impact of cosmopolitan medicine, and I consider how the interpretation of the Ayurvedic theories has been affected by Western anatomy and physiology, particularly in the account of digestion, and the role of ‘unripe’ food-juice in causing disease.

On the basis of first-hand experience in an Ayurvedic hospital I describe some of the different approaches that were used to rid the body of ‘unripe’ food-juice, depending on the severity of the symptoms. I illustrate this part of the paper with a schematic account of the treatment of ‘heart disease’. I thereby hope to demonstrate how the conceptual physiology of $\text{A}$yurveda has been combined with Western anatomy. I also show how the properties of some plant drugs (as described in the Ayurvedic sources) were interpreted, and I examine some of the contexts in which these drugs were used. Among the Vaidyas I knew the concepts of ‘ripe’ and ‘unripe’ were interpreted in terms of the vernacular classification of ‘perfect’ and ‘imperfect’ foods. I discuss this analogy in some detail, and consider the different levels at which it was applied.