Good medicine

for health personnel

Healing Practices in the South Pacific: (ed.) Elaine D.

F. Parsons. Published by Uni versity of Hawaii Press. ISBN 0 939154-41-2. Price $22.50.

The contributions of this study all emanate from the discipline of social anthropo logy. The focus of the book is not just to delineate health practices in Pacific Islands but to analyse the world view which gives rise to those health prac tices.

Although certain similarities are found in belief patterns, such as the influence of spirits in certain illnesses, the book re flects the diversity of the Pacific Islands societies in both belief and practice.

As the book brings out, perceptions of what constitutes health vary considerably from culture to culture. It is a social construction which has mean ing for the participants who interact in a particular social group.

The definition of health for Pacific Islanders differs from the Western concept.

In the former more emphasis is put on the social and psychological or spiritual rather than the physical. In Tonga, health is synonymous with har mony in relationships both within families and the com munity as a whole, both with living and dead members.

In Samoa, likewise, health is interpreted as the balance which should exist both physicl ly and socially. But this concept of social equilibrium is not a universal paradigm throughout the Pacific. For in Tuvalu health is defined as physical strength, especially for men.

Pacific Islanders classify sick ness according to type. Spirit sickness is differentiated from “real” or physical sickness.

In the Cook Islands, the breakdown of social relations results in a particular type of sickness, spirit sickness. Con versely, sickness, both physical and psychological, interpreted as social dislocation can be

used as a means of social control.

Sick people or their relatives can be admonished for antiso cial behavior. Injuries from acci dents come under another category of sickness.

Since contact with Euro peans, there is a further dicho tomy between Western sicknes ses and indigenous illnesses. It is therefore logical to Pacific Islanders that indigenous heal ing practices and western medi cal practice will differ. The latter has not been superimposed on the other.

There are several examples in the Pacific where “traditio nal” healing practices are con tinuing to develop alongside western practices.

Indigenous attitudes to health differ from western concepts not only in definition but in views of what constitutes the causes of ill health. The major difference between western medical personnel and Pacific healers is that the latter search for the fundamental or under lying causes of sickness and these can be found in family or community discord.

Maoris, for instance, believe that ill health results from “wrong living,” that is, the breaking of tapu. But physical causes are also considered. Of the physical elements, food and weather are mostly considered.

It is not simply that bad food can lead to digestive problems.

There is also the belief that food is the major contributor to blood. Blood is considered very important to good health, parti cularly because it is regarded as the material inheritance.

Various foods can have di verse effects in line with western naturopathic belief. For inst ance, in Vanuatu it is believed that certain foods can lead to coughing and heart ailments. It is generally thought, however, that adverse weather is more likely to cause ailments. Rain and cold weather cause colds; too much sun is weakening.

But nowhere is there any

evidence among the eleven ex cerpts of the various different island societies that lack of hygiene leads to disease.

The germ theory of disease is practically non-existent. Pacific Islanders appreciate clean appearances but the concept of hygiene is foreign to them. For instance, Tikopians have words which mean “clean” or “dirty.”

These, however, denote visible appearances only.

Although these islanders bathe twice daily, they do not avoid contaminated food or wash their hands before prepar ing or eating food.

Treatments for illnesses vary among the islands. Yet there are some healing practices which are common. The skills of massage, manipulation, bone setting and even surgery are common.

Massage is used for many ailments including muscular dis comfort and indigestion. It is also used for general well being.

Like the Chinese, Pacific Islan ders believe that the value of massage is that it circulates the blood. However, there are cases where massage has been used inappropriately, with dire results as in appendicitis.

Herbal remedies are also common although there is much variety in types of herbs used, preparation techniques and uses to which herbs are put. Laxatives and poultices are commonly used in the belief that in certain illnesses, such as hepatitis, the body should be rid of impurities.

In certain areas of the Pacific, as in the Cook Islands, illness is classified as either hot or cold.

Consequently the treatment is related to this dichotomy. Hot illnesses are treated with plants having cold properties, such as hibiscus, and vice versa.

Spirit sickness, of course, re quires different treatment.

Prayer and supplication to the spirits is resorted to which means consultation with spirit mediums. These ascertain the cause of the ailment which may

relate to social disruption in the family or community.

The various treatments prac tised in the Pacific span from medieval beliefs, such as the efficacy of blood letting, to concepts only now being grasped by modem medical practitioners.

The latter involves the power of group therapy, family in volvement and interpersonal relations in the healing process.

The islanders, for their part, are both pragmatic and eclectic in seeking treatments. They value western antibiotics for their speed in alleviating dis comfort. On the other hand, they do not trust western medi cal doctors to help in spirit sickness.

A claim is made in the pre face of the book that indi genous views on ill health and the belief patterns from which they arise should be incorpo rated in health education schemes. Further work is needed to achieve this syn thesis.

It is difficult for islanders to accept new practices, such as hygiene, if they do not accept the paradigm and principles which form the base of these practices.

Hence, it is crucial that west ern medical personnel under stand the world views which give rise to certain healing prac tices. Increased sensitivity to belief systems is needed for these are essential to doctor/ patient relationships.

The problem for the islands is not only to accept new practices but to accept a new paradigm and world view also. If the germ theory of disease could be built into the islanders’ paradigms without becoming distorted, much could be gained.

The book, Healing Practices in the South Pacific, is a rich mine of information. It is essen tial reading for medical person nel working in the Pacific, and useful also for Pacific scholars and development assistance

officers.

Sandra Rennie.