Conference Programme, Abstracts & Papers

Session 6A - Ethnographic Perspectives on Health, Illness and Disease
Chair: Angela Fenwick

llness Representations: An Empirical Analysis on the Impact of Belief in the Supernatural in the Tribal Context of Orissa
Mamata Mishra
Department of Humanities and Social Sciences, Indian Institute of Technology, Kanpur, India

This paper seeks to demonstrate the importance of community approaches in order to find out issues of illness in the framework of social representations theory. The discussion is divided into two sections: it examines how lay people make sense of illness; and highlights the significance of supernatural forces in generating the meanings of illness. Research questions in these studies have focused on the importance of community knowledge, cultural beliefs and practices for the study of illness.
The present study was carried out among a primitive community of the Bondos of the state of Orissa, India. Open ended interviews were undertaken and the result finds that meanings of illness are basically generated from everyday experiences and shared knowledge. Precisely it usurps that socio-cultural approach is more relevant in studying the concept of illness in a community. Interestingly the study finds that beliefs in supernatural forces play a predominant role in generating the meanings of illness in the tribal context. It explores that the evil spirit and the evil eye were attributed to many of the causes of illness in the studied community. The local term for the evil spirit was used as duma (dead soul). Accordingly the fever which was thought to be caused by the evil spirit was called as duma jwara in this community. Similarly, many other terms such as sani, rahu, gurang, pangan, dagoi etc.were used by the Bondos to define their causes of illness. The ritual (biru) was followed to propitiate the evil forces depending on the beliefs. Each of these beliefs will be discussed in detail in the paper
Understanding this will help to know how the choices of treatment is largely dependent on the supernatural beliefs. The implication of this paper is to provide guidelines for designing effective community intervention programs in order to manage illness at the grass root level.

Palu: A Metaphor in Peoples' Everyday Life in Abidjan
Stefanie Granado
Swiss Tropical Institute, Basel and Institute of Social Anthropology, University of Basel, Switzerland

The study focuses on palu (short-form of the French word paludisme, i.e. malaria), the local term for malaria in the city of Abidjan (Côte d’Ivoire, West Africa). Palu seems to refer to a commonly known malaise which does not cause further worry but one that is widely discussed in public. My aim was to explore why this illness gains so much importance in everyday life. In order to examine this, the study combines a classic ethnographic approach (Medical Anthropology) with locally adapted semi-structured EMIC interviews (Cultural Epidemiology) (n=160). Furthermore, we chose a comparative approach looking at a slum and a better-off area.
Although health providers and patients apparently use the same term, namely palu, the interpretations of the local population differ from the biomedical view. Abidjan’s inhabitants do not perceive palu simply as an illness transmitted by mosquitoes. My data rather point out that palu became an embodied metaphor for adversities women and men are exposed to in Abidjan’s everyday life. Palu is used to express this daily risks of urban life for which people have little means to cope. However, the metaphor does not only stand for a certain bodily experience. It rather implies an instruction for action on how to face and treat these adversities. That means that an embodied experience, expresses as verbal image not only social, psychological, political and economic misery, but makes it treatable. Palu offers a spectrum of possible practices for the parties involved and enables them to act against it by using a wide range of cures.
Of course, people in Abidjan are very conscious of the fact that they cannot overcome structurally caused health risks in their environment with the diagnosis and treatment of palu. However, palu as physical complaint can at least be treated with therapeutic means. Palu as metaphor is thus a strategy to make the harsh urban life in Abidjan understandable and treatable.

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The Politics and Poetics of Immigrant Tuberculosis: Making Sense of a "Social Disease" in Contemporary France
Janina Kehr
Ecole des hautes études en sciences sociales, Paris, France and Humboldt University, Berlin, Germany

The proposed paper, which is based on anthropological fieldwork in 2005 in Saine-Saint-Denis, a northern suburb of Paris, analyzes the tensions public health professionels meet when treating tuberculosis among immigrants and the ways they cope with and explain the mulitple contradictions inherent in their everyday work.
Definig tuberculosis as a “social disease”, public health professionals attribute the causes of this disease to the socioeconomic contexts their patients live in, which are often characterized by poor housing conditions as well as political and economic precarity. They state that eradicating tuberculosis would need an eradication of inequality, reiterating therewith their definition of tuberculosis as being of social and political rather than purely bacterial nature. Yet at the same time they judge the curing of social inequality at large impossible - which nevertheless is seen as the only way to lastingly heal tuberculosis. In their everyday practice they therefore try to work pragmatically with this inherent contradiction and to treat their patients at best, for example by working with social workers. Doing this, public health professionals open up a space of (il)limited politics of treatment, which oscillate between the awareness of the causes and the treatment of the effects of tuberculosis. They act in this space which is ambiguous in two ways, being located between the sanitary and the social as well as between the utopy of action and the pragmatics of everyday work, between a desire to act and the impossibility of action in regard to the larger social and political living contexts of their patients, mainly immigrants.
I argue that public health professionals are well aware of everyday contradictions within their work and reflect them. At the same time they pragmatically practice public health, they make sense of the failures of public health policy, which does not meet its objectives of curing tuberculosis among immigrants. French republicain ideals of equality of treatment are thus shown to not be functionning in practice, in spite of public health rhetoric which defines the tuberculosis control programm as targeting marginal populations.