Post Colonial Medicine

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Post-colonial health provisions are an admixture of medical practices and perceptions that reflect the colonial experience. These local health care systems continue to include a combination of hospitals, clinics, health posts, pharmacies, nurse paramedical practitioners, and health cadres as well as a multitude of government-sponsored health programs, for example family planning programs, family nutrition improvement programs, village community health development programs, advanced age programs, and programs that train local level health promoters, to name just a few. Mention should also be made of the increasing number of magazines on health, or articles and newspaper columns, television and radio programs, and advertisements that all promote health from the perspective of scientific medicine.

In addition, indigenous medicine, often referred to as traditional medicine, is vibrantly apparent as well. Anthropologist Charles Leslie (1974), in his work on Asian medical systems, noted that in the context of modernization medical revivalisms of traditional medicine constituted a "looking forward-looking backward" for many nations in their quest to become modern developed countries. Particularly in China and India, medical revivalism was a significant "aspect of cultural nationalism in these societies" (Leslie, 1976, p. 319). Indonesia provides an illustration of post-colonial medicine which reproduces colonial categories while at the same time producing something different.

The popularity of pengobatan tradisional, or traditional medicine, in Indonesia indexes a concern with tradition at a time when Indonesian nationalist rhetoric portrayed the nation on the brink of becoming modern. This modernist revival marked a heightened attention toward traditional medicine within a vibrant and powerful national discourse on contemporary life and citizenship in Indonesia. The Indonesian government considers pengobatan tradisional an essential resource in the cause of development (pembangunan) (Ferzacca, 2002). As a consequence, traditional medicine becomes a progressive tradition. The logistical issues inherent in the Indonesian engineering of an Indonesian-flavored modernization have set limits on the ability of the government to provide "modern" scientific medicine to a diverse and dispersed national citizenship. For a developing country such as Indonesia, modernist technologies of health embodied by scientific medicine cannot always be made available to the Indonesian population overall. Nor, given the diversity of ethnic groups and their nearness to or distance from the centers of modernity, is scientific medicine always an appropriate technologic intervention.

Therefore, safe and rationalized forms of traditional medicine and practice are promoted until the time when progress toward an advanced social-cultural-economic stage is reached. For Indonesian governance, standard Western modernization theory that advocates breaking down tradition as an obstacle to development is replaced with one that produces, reproduces, and so re-distributes tradition. Tradition and its authenticity, then, are not just artifacts, images, and activities, but a mark of social relations and identities.

From the perspective of Indonesians traditional medicine includes a wide variety of shaman who practice as curers, sorcerers, and ceremonial specialists. In addition to this varied group of shaman are the roving sellers of health elixirs, entrepreneurs who make and sell elixirs and other medicines out of their homes and in the markets. Practitioners of traditional medicine also include: masseuse; Chinese herbalists and acupuncturists; healers who practice South Asian Ayurvedic and Arab Unani medicine; particularly potent teachers of Islam who have the ability to heal; persons who exhibit a particular talent for healing and other shamanistic practices such as divination; spirit mediums; medical doctors who include traditional medicine in their practices; a wide variety of dentists, optometrists, and surgeons who use traditional medical techniques and medicines; and entrepreneurs who sell manufactured and prepared traditional medicines. Practitioners of traditional medicine are often referred to simply as dukun, even though with more frequency there are those who prefer other terms such as the currently popular paranormal.

While the availability of traditional medicine in Indonesia represents the contingencies of health care provision in a developing country, medicine is also anchored in historically contingent social forms and practices as well as environmental circumstances. Health and medicine also provide "idioms" and forms of agency for which Indonesians can come to say something of the conditions of their lives and the state of things as they see it. The use of traditional medicine engages communities of sense and sentiment that are experienced as re-enactments of an authentic culture situated within the emergent communities of Indonesian modernity. The continued post-colonial use of colonial categories and essential binaries embedded in development ideology and practice reproduces "partial presence" of these practices and structures of thought (Bhabha, 1994, p. 86). Medical pluralism in post-colonial societies such as Indonesia offers a "complex border zone of hybridity and impurity" (Gupta, 1998, p. 6) within which post-colonial identities are produced through the use of medicine.

Post-colonial development promises many benefits for societies embarking on the road toward prosperity and an improved quality of life. Under the gaze of development ideology and technique the health status of a society serves as one indicator of where it stands in the process of developing. The demographic, health, and nutritional profiles measured by the instrumentalities of government bureaucracies and evaluated from enumerated collections by statistical examination are considered the objective realities of individual and social conditions at a particular historical moment for a segment of society or for an entire nation-state. Under the ideological gaze of development these objective measures become moral barometers that mark both the degree and kind of conditions underway in the process of development. Medical anthropology concerned with post-colonial development has operated within the context of development ideology to apply anthropological approaches and knowledge toward problem-solving—problems that appear in development encounters. At the same time medical anthropology of post-colonial development has also been concerned with the structural aspects and cultural politics of development. In this way medical anthropologies of post-colonial development are also subject to and so reflect the complex border zone of hybridity and impurity that is post-coloniality.

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