I walked into the kitchen of my friend Jodie (not her real name), a forty-something year old woman whose house I visit regularly. She was sitting on the floor sniffling, and I noticed a motley assortment of medicines on the table, including amoxycillin, vitamin C supplements, alka-seltzer, rehydration salts, and aspirin tablets. She hadn’t been feeling well, apparently, and wanted to know from me what she should take to get better. I scratched my stubble. I thought about the research proposal I had been writing with a certain anthropology professor. I mentioned that when I got sick, my mother just told me to get lots of rest and drink plenty of liquids. She, in a very characteristically Emberá way, raised her eyebrows and made an inquisitive “mmm” sound.
“Do you think that’s true?” I said.
“I don’t know,” was her response. I knew exactly what that meant, so I followed up with,
“Or does one need to take pills?”
“You have to take pills,” she immediately said, nodding enthusiastically. “If not, how will you get better?”
I live with a group of Panamanian indigenous people called the Emberá. Their inclusion in the modern world has only really taken place over the past 50 years, more or less in Jodie’s lifetime. And for someone who studies anthropology, learning about the worldviews of people who straddle that line between tradition and modernity is very interesting. One is constantly wondering what are the pre-modern aspects of their culture and worldview, what are the aspects which have been adopted from more modern influences, and what aspects represent the convergence of the two. I have been developing a research proposal on the perspective Jodie revealed to me about the way she understands illness and getting better, and whether it is a “truly” Emberá perspective, or an invention of drug companies and Panamanian doctors.
This isn’t just Jodie. I’ve noticed, while living with the Emberá as a Peace Corps volunteer, living day in and day out in a small village for almost two years now, that all the people I know have the same attitude. The Emberá don’t “sleep off” a headache or treat a cold with plenty of rest and liquids like my mother prescribed. The first question I’m asked when I say I don’t feel well or have a headache is “what are you going to take?” And if I say I don’t plan on taking any medications, I get laughter as a response. It seems like a typically Emberá responde to illness, injury, discomfort, to seek some kind of treatment for their symptoms. I notice this mostly because of my personal attitude, which is that only after I’ve been scraped up, burnt, bruised, and infected with three different parasites, unable to leave my bed for a week, will I go see the doctor. You can see the contrast.
But it brought to mind exerpts from Where There Is No Doctor: A Village Health Care Handbook, a seminal tome which has been an authoritative and invaluable resource for several decades for anyone working in a rural, underdeveloped area. It not only contains hundreds of pages on how to identify and treat common afflictions and infections with available resources, but it emphasizes over and over that reliance on and excessive prescription of modern medicines can do more harm than good.
This is not to say that someone with malaria doesn’t need cloroquine. Not at all. But those with little education or a different understanding of disease won’t necessarily make the distinction between disease and symptom, won’t know that Pepto Bismol doesn’t cure diarrhea, it only put a temporary plug in it. Or that some common problems are self-limiting, and will go away just as easily without the use of antibiotics. But belief in the power of modern pharmaceuticals, and the advertising campaigns of GlaxoSmithKline, as well as medical practitioners doling out medicines in order to buy respect and appreciation from their patients, sometimes create an environment where people constantly seek out pills and injections that they would be just as well without. It is a drug addiction of a different sort.
But I wonder where it came from in this instance. It is wholly possible that this need to seek out pills at the first sign of a cough is a very new phenomenon for the Emberá, something brought on by the influence of Panamanian culture, where this kind of mentality is pervasive. It could have a lot to do with greedy pharmaceutical companies doing their best to get even the most remote jungle dwelling indians hooked on their products – lets not forget Nestle’s shameless and aggressive campaigns to get poor Africa mothers to spend their money on powdered milk for their babies when it was well known that this would only make them more sick and malnourished, and breast milk is all one every needs to raise a healthy child.
But honestly, the Emberá are a group with such a strong repertoire of botanical cures and traditional medicine, with herbal medicines for everything from headaches and fevers to seducing several wives and encouraging lazy dogs to hunt, that it’s arguable that this kind of attitude, mentality towards illness and getting better has been embedded in Emberá culture since pre-modern times, and what once was manifested in the need to go see the shaman or cook up an herbal remedy now manifests as “You need to take pills if you want to get better.”
So I’ve written a research proposal to try and get money to go and tape record some conversations and other anthropological type activities, to supposedly uncover which it is (I was applying for scholarships for grad school and needed a research topic). Because it is actually a problem, not only where I live, but everywhere in the world. People who have limited resources don’t need to be spending their money on pills at the drop of a hat when they could just sip some chicken soup and relax. They are the losers in this situation. So it would be interesting to figure out, at least in the case of the Panamanina Emberá, whether or not this mindset is an indigenous one, developed over centuries of living in a dense jungle environment where illnesses are plentiful and precarious, or whether it was the poking and prodding of the drug dealer on the corner, the outside influence of Panamanian doctors and flashy packaging that wrapped the minds of the Emberá around the hypnotic fizz of the alka-seltzer tablet. Because you can unlearn what you’ve learned, and an ounce of prevention is worth a case of Pepto Bismol.
(Unless, of course, you have to teach 2nd grade English in a school that has no functioning latrine. Then an ounce of Pepto Bismol is worth its weight in gold.)