Monday, May 28, 2012

Traditional Medicine vs. Modern Medicine

I think every volunteer (health and english teaching) faces this issue of tradition vs. modern at least once in their service. As American citizens, we grew up in a culture that values the MD degree, prescription drugs, and a certain faith in science. Often, alternative medicine is seen as a fad and not bearing up to the scrutiny that modern medicine has passed. Coming to Cambodia, we’re faced with a completely different culture.
Modern medicine in Cambodia is not entirely the same as modern medicine in America. The basics are the same in that you are supposed to have an individual that has gone to school to earn a degree. They make decisions based on facts that have been tested scientifically.  Some differences are: there are very few doctors, most health professionals earned their degree after one year of studying, villagers more often visit the local pharmacy for medicine rather than a health center. Pharmacies are a major provider of modern medications to Cambodians. Pharmacies range from modern stores like U-care which provide quality drugs from countries like France and a cardboard box of a variety of medications doled out of a neighbor’s home (her provider is a son who works at a health center).

Traditional medicine is widely practiced in Cambodia. In my experience many Cambodians believe that spirits can adversely affect health among many other things like types of food you eat. There are some common practices that some people may categorize as religious, but I think these practices are also critical, from a Cambodian perspective, for their health. For example, putting food on the family altar, wearing ghost beads, being coined. Many of these activities have a superstitious nature to them and their purpose to protect general wellbeing. Horoscopes also play a large role in health. My host mother was told that this year she would get sick often and she has been sick with headache, what seems to be a strained ligament, diarrhea, and dizzyness. To counteract these illness (caused by illfortune) my mother has been through a number of blessing ceremonies in the past month. These blessings are traditional medicine in a way. In addition to blessings, my mother also visits a Khmer traditional healer. I’m not sure what the healer did to her, but she also provided a mixture of herbs that seemed to act like a hot pack and my mother also boils khmer medicine (herbs and bark) to drink each day.

Both modern and traditional medicine is used by almost every Cambodian I’ve met. In Cambodia, it almost seems like modern medicine and traditional medicine work together. My host mother spent a lot of time and money on traditional remedies, but she also takes acetaminophen for her pain. I think this causes some confusion when Cambodians opt to use modern medicine. Often, Cambodians may intrinsically trust providers of medication even though they are handed a medley of random pills in a plastic bag. This is similar to Khmer healers, whose validity is more based on lineage and reputation.  On the other hand, Cambodians often distrust modern medical practitioners especially when modern medicine does not show an effect immediately or does not give the desired affect.

I think, most often, people are just confused about what works and what doesn’t. The older generation is more likely to recommend traditional remedies and Health Center staff sometimes directly contradict those recommendations. For example, after giving birth a traditional remedy is drinking urine and sleeping on a bed that is heated by hot coals. In a country that is already hot, this can be extremely dangerous if the mother is not properly hydrated. It is hard for a young woman to disregard her elders and tradition in order to follow a midwife.  As a PCV, we’re taught to accept cultural practices, but also to teach Cambodians new information. The relationship between traditional and modern medicine is one of the more difficult areas to tread. How do you show cultural sensitivity and help people change simultaneously? Sometimes you can compromise. Tell the new mothers that they can practice tradition, but stay hydrated when they are on the hot bed.   However, this can also be difficult because you are essentially condoning a potentially dangerous practice.

I don’t have an answer for this issue, but I think what most people would say is that if your community trusts you then they will listen. Unfortunately, it’s difficult to build a relationship of trust with every single person you encounter at the health center. And, it's hard to know how far you can push your trust when trying to change traditions.

Wednesday, May 23, 2012

COS conference/Snobby people

Our last all K4 PCV training has come and gone. We celebrated on a boat that went in circles on the Mekong. I think in most of my major life experiences things come to an end with a graduation. A day where everyone tries to forget all the teasing, bullying, and gossiping that went on and we all pat each other on the back for making it this far. This conference was partly like that. While this conference did affirm that I know some truly understanding and kindhearted people it also showed me that sometimes we all just tolerate too much. Sometimes people are just real assholes and the only way to stop them is to just stop associating with them. But, I think that's a step most people hesitate to take.

It's good to be nice to people. It's good to have patience with people. But, if you're nice and kind to people that blatantly use and discard other human beings like they're trash then you're condoning that behavior. I just can't pretend to be comfortable with that kind of behavior anymore.

On an unrelated topic, one of my friends is doing fundraising for an event to raise awareness about violence against women (actually not totally unrelated). She tabled outside one of the largest and most popular supermarkets in Phnom Penh and had some interesting encounters. A few of her stories really struck me because they were really unexpected. The basic progression of these stories is like this: person is passing table, friend asks person to donate to help her cause, person says that they worked in Cambodia for x period of time already or they volunteered and they don't need to donate because of that. When I heard that I just thought "what??"

As a volunteer, who has lived and worked in a small village for 2 years, I still actively donate to my friends projects and charities. I supported a friend biking for HIV and I donate to local NGOs that I think have great potential. It's always small, definitely no more than 20 dollars, but I feel good doing it. I choose my donations extremely carefully these days so I know it will have an impact. I have never thought that volunteering in Cambodia would somehow exempt me. It impacts how much I donate, but I've never thought "Oh, I've helped enough."

One moment that sort of highlights the attitude of these individuals is the point in the conversation where my friend shares the little tidbit about how she's lived here for two years. While there are some expats in Cambodia who have lived here many years, the majority of volunteers and development workers will probably not have been here as long as 2 years. It's at this point of the conversation where the proud smile of the person who has just declared that they've worked here for 6 months or volunteered every summer crumbles. Time for them to eat some humble pie.

I think it's ok to be proud that you've lived here for 6 months or volunteered for a long time. But there are some people who come here and feel like they're the next messiah and then there are people who come here and remember that they're here to help people.