Medical Anthropology Quarterly these chapters stand alone in presenting two of the most consequential problems of illicit drug use. Singer concludes his ...
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these chapters stand alone in presenting two of the most consequential problems of illicit drug use. Singer concludes his analysis of illicitdrug-use dynamics by providing a clear recommendation on how current efforts to monitor drug epidemics can be improved. Noting that, “Ethnography is especially useful for the detection of emergent drug use practices and the monitoring of the diffusion of drug-related behaviors because it is a highly porous approach that imposes little in the way of research control over the domain of study” (pp. 232–234), this chapter elaborates “ethnoepidemiology,” the marriage of ethnography and epidemiology. Although this is not a new solution, it is discussed in detail, well situated within the current efforts of the National Institute on Drug Abuse, and serves as an effective illustration for students of applied medical anthropology. In sum, this book covers an enormous amount of material with only one minor shortcoming. Although the crack epidemic of the 1980s is discussed in detail in chapters 7 and 8, it is less prominent within the larger history of illicit drugs in America. However, despite this, Singer’s analysis of the “sociohistoric and cultural contexts” that have shaped illicit-drug-use patterns in the United States delivers. Furthermore, as an effective example of CMA, this book successfully introduces important social, cultural, political–economic, criminal justice, and health factors of illicit drug use. Finally, recognizing that “new drugs, old drugs in new forms, new drug combinations, new ways of using drugs, new drug-using populations, and new drug use environments will continue to appear over time” (p. 235), this work introduces a significant concept to the field: drug-use dynamics. As a solid presentation of the historical and modern problems of illicit drug use in America, students and researcher will learn much from this work.
Tribal Health and Medicines. A. K. Kalla and P. C. Joshi, eds. New Delhi, India: Concept Publishing, 2004. xxi + 447 pp. Satish Kedia Department of Anthropology The University of Memphis Sunil Khanna Department of Anthropology Oregon State University This edited volume, based on papers presented at a workshop entitled “Emerging Issues in Tribal Health and Medicines,” reports on recent ethnomedical research conducted among tribal groups in India, whose population of 67.7 million constitutes the largest such concentration in the world. The collection reflects the tradition of postindependence anthropological work in India, which challenges the exotic and romanticized images of tribal communities so common in the works of colonial anthropologists, and focuses on topics such as ethnic revitalization, self-determination, tribe– state relationships, environmental resources allocation, and health and medical practices. The volume’s 30 chapters are divided into five parts. Part 1, “Clinical and Biogenetic Aspects,” examined health issues among tribal societies from a biomedical perspective, using a variety of methodologies. For example, overview chapters by G. K. Kshatriya and S. S. Rath employ ethnodemographic and medical characteristics surveys, whereas those by P. D. Sharma and S. S. Gusain on tribal children utilize anthropomorphic measurements. This section establishes the need to address mental and physical health problems among tribal communities and demonstrates that doing so would benefit the general population in terms of knowledge gained and misinformation corrected. M. Gupta’s chapter argues about how the national health care system has never taken tribal health seriously, particularly in terms of addressing neurological disorders such as epilepsy. In his chapter
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on mental health issues, R. K. Chadda notes that although many tribal people face the same psychological difficulties as the general population, they are not given equal public attention. P. Paliwal’s chapter contends that traditional ethnomedical systems and lack of knowledge are key contributing factors for the spread of HIV/AIDS among Indian tribes. Like many contributors to this volume, Paliwal urges that health intervention campaigns need to combine Western biomedicine with local healing practices to abate such epidemics, which are as much the result of superstition and poor education as of abject poverty and isolation. Part 2, “Demographic and Ecological Aspects of Tribal Health,” includes a mix of research reviews and fieldwork-based ethnographies on the reproductive health, ecology, and diet of tribal communities. The authors in this section paint a bleak picture of health care resources in the tribal communities and suggest that the situation is exacerbated by the inaccessibility of biomedical facilities even for those willing to use such services (such as the Moyon, as documented by L. Moyon, and tribal groups in Ladakh, as discussed by V. Bhasin). As V. Subramanyam observes in a study of the Khond and Gadaba tribes, economic development has offered little respite to tribal people, despite its positive impact on many other communities in India. In fact, the growing market and cash economy has limited their access to many traditional diet staples such as cereals, and magicoreligious beliefs have prohibited their intake of a variety of nutrients. D. Tewari’s chapter is an overview of tribal health status, particularly high infant and child mortality rates. Research by Sachdeva et al. on the reproductive health of women in the Kolam and Thoti tribes suggests that prenatal programs would reduce mortality rates. But there are other health risks for tribal women: Moyon documents the impacts of overwhelming domestic work on Moyon women as well as on their offspring.
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Part 3 (the largest section in the book), on the “Social and Cultural Aspects of Tribal Health,” emphasizes the breadth of pluralistic healing systems and the pervasiveness of magicoreligious practices among tribal communities, recognizing that all health care practices, including biomedicine, constitute socially produced ethnomedical systems. A. K. Sinha and B. G. Banerjee on personalistic disease theory among tribes, P. C. Joshi on tribal healers, A. P. Singh on Uttaranchal tribes’ traditional practices, and A. Ibata on Bon medicine among the Monpas offer the best examples of such an approach. For Singh, Uttaranchal folk healers educated on the scientific uses of local pharmacopoeia may be able to effect disease prevention, particularly in remote areas. O. Hemlata and P. K. Kumari, writing on the Manipur, and M. Das, researching the Rathwas, are more negative about the use value of traditional tribal practices; they urge greater intervention by alternatives such as biomedicine because, Das argues, “magico-religious methods [have] in reality no positive effect” (p. 300). Of special note in this section is D. Chao et al.’s focus on the psychosocial well-being of the Naga elderly, particularly because this topic in general is seldom researched, much less in the context of tribal India. Part 4, on “Tribal Medicines,” addresses the role of pharmacology in tribal medical practices. All five contributors to this section urge anthropologists and public health researchers to support the development and protection of “indigenous science,” particularly the employment of herbal medicines, in ways that may well ameliorate some of the disadvantaged circumstances in which local communities live. As A. K. Srivastava notes in his chapter, given the “widespread traditional use of medicinal plants by the rural poor and women folk, it is important that the plans for the conservation and sustainable use of these resources are gender sensitive [and] promote equity and social
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justice” (p. 349). B. Chaudhuri describes a six-part strategy for developing these tribal pharmacological resources so that the biodiversity characteristic of many tribal regions benefits local communities and not multinational corporations. For R. K. Kar, the wealth of knowledge accumulated about the use of local herbs may constitute the most cost-effective approach to health care in tribal regions. Chapters in part 5 on “Policy Aspects of Tribal Health and Medicines” suggest that policymakers should seek to integrate biomedical practice with indigenous healing systems to improve access to and utilization of health care among Indian tribal societies. For both P. C. Joshi and R. Chandra, such an approach will encourage greater acceptance of biomedicine among tribal societies as an important first step toward establishing pluralistic healing systems. In the two remaining chapters of this section, K. K. Ganguly warns against privatization initiatives, which might worsen the health status of tribal people, whereas R. Khanna and A. K. Kapoor advocate public–private partnerships to improve tribal health. They also encourage nongovernmental organizations and regional governments to regulate the practices of companies seeking to extract profit from tribal communities. The contributors to this collection seek to both document the health status and explore the implications of Indian tribal groups’ reliance on complex traditional ethnomedical systems, rather than “modern” biomedicine. This goal is only partially realized; the articles in the volume are uneven in terms of subject matter, intellectual commitment, and research methodology. Some attempt to probe the connection between clinical science and social science perspectives among tribal societies in India, whereas others focus more narrowly on the ecological dimensions of tribal health or historical interpretations of the relationship between tribes and nontribal healing traditions. An-
other difficulty with some of the chapters is a tendency to homogenize tribal ethnomedical beliefs and healing practices; the contributors might have examined these systems within specific historical and cultural contexts. In addition, some of the articles simply lack substantive discussion, as in A. Sharma’s chapter in part 3 on the impact of modernization on tribal groups, which simply offers a laundry list of practical advice without any empirical foundation. Although a few chapters offer dense reviews of the relevant literature and are almost overburdened with citations, others are more free-form, with a limited number of or no citations. Finally, the main quandary with the volume is the suggestion by some of the authors that “primitive” tribal healing practices are not effective for local populations and need to be supplanted by “better” biomedical methods, lacking an understanding of the complex cultural role played by ethnomedical systems in dealing with health and illness in any society. Despite the efforts of the editors and authors to impose formulaic themes such as “tribal systems of medicine,” “culture-specific patterns of health seeking behavior,” or “public-private partnerships,” the volume lacks coherence, sound methodologies, and theoretical rigor, thus falling short of significantly advancing the intellectual agenda of medical anthropology in India.
Unhealthy Health Policy: A Critical Anthropological Examination. Arachu Castro and Merrill Singer, eds. Walnut Creek, CA: AltaMira, 2004. 387 pp. J. Bryan Page Department of Anthropology University of Miami When engaged in advocacy, we anthropologists run the risk of overselling the particular. Our strong suit has been the compelling
