Journal Club: Sept. 12
Posted by Lance Gravlee on September 10th, 2008 in Journal club | 1 Comment »
As usual, journal club will meet this week at 11:45 a.m. on Friday, September 12, in the Diaspora Room (Turlington 1350). First-year doctoral student Alan Schultz will lead a discussion of:
Thomas, Felicity. 2008. Indigenous Narratives of HIV/AIDS: Morality and Blame in a Time of Change. Medical Anthropology 27 (3): 227-56.
You can access the PDF from the journal club page or directly from the publisher (subscription required).
If you’d like to share your thoughts about the article or raise questions for discussion before we meet, please leave a comment below.
One Response
Women pollute men, men ‘witch’ back.
In this week’s article Felicity Thomas, Ph.D. qualitatively explores illness and HIV/AIDS in a resource-poor context based on data she collected during nine months in three rural settlements in the Caprivi region of Namibia. With an aim of better understanding how affected individuals and communities experience the epidemic she considers the frameworks within which illness and HIV/AIDS are interpreted and responded to by actors in the community. She claims to demonstrate the important role of “alternative” illness narratives among community members when dealing with illness.
The illness narratives are subdivided four ways into: illness and resource use; gender and pollution; religion and morality; witchcraft accusations. The article is further divided into sections on context—including just one paragraph on methods buried in the penultimate paragraph of the this section—four sections covering each of the illness narrative types, treatment seeking in the Caprivi, selection and external factors influencing treatment, and narratives of blame.
The strongest part of this article for me was the last section on narratives of blame that I thought did a great job of distilling the research into very cogent and helpful ideas—lots of power issues. From a start point of exploring the epidemiology of HIV/AIDS in Namibia and the Caprivi, Thomas manages some very keen insight into local context. She (even) almost tells us that witchcraft appears to be sitting in as a proxy indicator of HIV/AIDS and/or opportunistic infections that, but for the awful stigma surrounding HIV/AIDS locally, would be showing up more accurately in health surveys. We would do well to follow these clues to help better ascertain estimates of true disease prevalence. Well, that’s what I wanted to hear at least.
I was disappointed to see a step towards conflating poverty and lack of resources with culture and illness narratives. The author herself struggles with many times including at the top of p.245 where she has just finished explaining the inadequacies of the biomedical options only to begin her next section by declaring how a lack of resources is subordinate as an explanation of treatment seeking to community “beliefs that modern medicine lacks culturally appropriate explanations for illness and that modern health practitioners treat the symptoms not the underlying causes of illness.” And then goes on to quantify the number of traditional healers in that area and how much work they get and money they make compared to most.
The relative importance of illness narratives seems overplayed at least when considering appropriate ways forward structurally for the country and healthcare system. The demonstrative vignettes also read more like descriptions of inadequate care and employee training (and a total lack of local doctors who speak the language and understand the culture) instead of their intended purpose of showing that people prefer traditional healing or at least value it equally. However, as an explanation of the sad cycle of illness, stigma, and impoverishment that accompanies HIV/AIDS in resource-poor settings—and determines its immediate course in individual lives—this article succeeds wonderfully. I still worry that critiques of biomedicine as a treatment method in these contexts only reinforce false dichotomies of traditional healing vs. biomedicine (and help those in power justify the paucity of their aid historically and currently).