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.
