Abstracts

– ABSTRACTS –

Bernhard Hadolt & Monika Lengauer University of Vienna/Austria	Of ovarian stimulation and sperm preparation : An Actor-Network-Perspective of In-Vitro-Fertilization
Tina Otten IFree University of Berlin, Institute for Cultural Anthropology	Indigenous and Biomedical Concepts of Disease among the Desya, India
Viola Hörbst Albrecht-Ludwig-University of Freiburg Institute of Cultural Anthropology	Between Global Claims and Localization: Medical Values among the Cora, Mexico
Maria Delius Technical University Munich	Disturbances in the postpartum period- an unsolves issue for biomedicine
Yvonne Adam Albrecht-Ludwig University of Freiburg, Institute for Cultural Anthropology	Traveling from place to place – the contribution of migrants and cultural anthropology to globalization
Michael Knipper University of Bonn, Institute for the History of Medicine	What is disease? The “ontological term disease” between theoretical disapproval and global usage
Angelika Wolf Free University of Berlin Institute for Cultural Anthropology	Aids and Kanyera in Malawi: Local Answers to a Global Phenomenon
Hansjörg Dilger, Free University of Berlin Institute for Cultural Anthropology	“PositHIV leben” in Tanzania: Globale Dynamik am Beispiel internationaler und lokaler AIDS-Arbeit
Brigit Obrist van Eeuwijk University of Basel/Switzerland Institute for Cultural Anthropology	Appropriate nutrition in Papua Neuguinea: Claim and Reality
Elsbeth Kneuper University of Tübingen	Natural Birth as an achievement of civilization – Ethno-medical implications for the birth scenery at a University Town in Southwest Germany

 

 

Of ovarian stimulation and sperm preparation : An Actor-Network-Perspective of In-Vitro-Fertilization

Bernhard Hadolt & Monika Lengauer
University of Vienna/Austria

In public discourse, the term In-Vitro-Fertilization (IVF) is often used in two ways: on the one hand it is the term for the medico-technical act of “artificial insemination”; on the other hand, IVF is also used to describe a particular area within reproductive medicine in which artificial insemination acts as an organizing principle, yet which also encompasses other techniques and actions such as the transfer of embryos or follicular puncture. In both meanings, IVF appears as clear-cut monolithic entity while other aspects and actors responsible for creating the desired pregnancy remain invisible. Whereas IVF in the first meaning is reduced to the mere technical act, also the second usage cuts off important aspects, techniques and ways of action within the context of IVF.

In contrast, our paper aims at understanding IVF as a complex network of techniques, ideas and interests that cooperate in their mutual necessities and complex relationships in order to achieve the desired result – the pregnancy. Based on ideas of actor-network-theory we thus present techniques that are seldom spoken of but are yet of central importance: the monitoring of ovulation, sperm preparation, hormonal stimulation of the ovaries, egg retrieval and the transfer of embryos as well as various interest groups and ideas as “actors” within their global relations and historical developments, their mutual conditions of existence and their clinical-practical organization. In order to clarify the network-character of IVF, we do not take the artificial insemination in vitro as our starting point, but the so called “ovarian stimulation” – the application of hormones by injection in order to stimulate the ovaries, a procedure that antecedents egg retrieval which is hardly ever talked about in public discourse.

The Desya are a peasant society located in the Eastern Ghats in Orissa, Koraput. The area is known as one of the “most backward areas”, hardly touched by industry and modernization; electricity and infrastructure based on public transport exist only to a small extent. The peasants work on their fields only equipped with their own bodies and animals. Koraput, however, faces changes that are the result of global influences. For about 40 years projects of water reservoirs and an aluminum manufacture exist. Half a year ago, groups of tourists started visiting the region. Since 5 years the region is equipped with a hospital offering “modern medicine” (biomedicine) based on (more or less) Western standards.

My presentation is based on the following questions: how does indigenous medicine represent itself? And, what is indigenous medicine? According to my observations, medicine of the Desya is mainly based on relationships with gods, other entities and human beings; within our terminology it could be called astrological medicine. Treatments within this ‘traditional’ system are quite expensive for the poor, even in Indian standards, and can cost as much as a month’s salary. Treatments within the biomedical system appear to be cheaper. Which relationships have been built between biomedicine and indigenous medicine? How do Desya judge “modern medicine” and how do they integrate it into their local conceptions of disease and health? Is biomedicine within the surroundings of indigenous medicine integrated into the body image of the Desya-medicine? And how do in turn concepts of biomedicine change? In order to answer these questions, I will shed some light to the concept of person within Desya medicine. I will then present some of the indigenous concepts of disease. Global conceptions such as malaria and scabies are discussed according to their indigenous disease conceptions.

 

 

Between Global Claims and Localization: Medical Values among the Cora, Mexico

Viola Hörbst
Albrecht-Ludwig-University of Freiburg, Institute of Cultural Anthropology

One of the findings of my fieldwork (since 1997) among the Cora in Jesus Maria (Sierra Madre Occidental) has been that biomedical practices of both patients and healers belong to the indigenous repertoire of dealing with sickness. Most of the time these practices are embedded in religious contexts. Individual treatments are thus linked to collective activities of the religious ceremonial community; at the community level so called Cargo Systems play an important role in the health care services of the Cora.

In 1996, a modern hospital was built in Jesus Maria, hosting both an indigenous as well as a biomedical ward. Two rather contradictory translations of global claims are thus linked on the local level: the specialists of the biomedical part represent the global claim of biomedicine to have the better and more effective system of treatment and knowledge. In the indigenous ward a variety of healers of different ethnic groups of the Sierra work together, all of them being members of the Organization of Indigenous Doctors. From the site of the Mexican government the hospital thus attempts to follow the propagation of WHO to integrate “traditional” healing systems into the national health care system.

How do the Cora handle these contradictory claims? What kind of dynamic processes emerge out of these competing systems? In my paper I will argue that it is the Cargo System that plays a central role within the negotiations of medical values at the local level. While contributing to selective integration of biomedical practices it simultaneously supports the superiority of the own medical views.

 

 

Disturbances in the postpartum period – an unsolved issue for biomedicine

Maria Delius
Technical University Munich

There are several clinically accepted psychological disturbances for the postpartum period, among them the so called Baby Blues and the postpartum depression. In our society, percentages of those two disturbances vary between 50% and 10%. So far, biomedicine has not been able to offer a homogenous explanatory model for these postpartum disturbances, rather three models co-exist: the “biological” model points at a hormonal etiology, the “psychological” model looks for the reasons in the individual psyche of women. The third, the “anthropological” model emphasizes the social and cultural context of the postpartum period. In many cultural contexts transitional phases such as pregnancy, birth and the postpartum period are heavily structured and ritually regulated. The current argument is that it is the lack of such “rites de passage” that leads to these psychological disturbances.

On the basis of this anthropological model data of a study with postpartum women of Turkish and Kurdish descent, carried out in Munich, will in the following be presented. I will thereby fall back upon the traditional sequence within the postpartum period in Turkey.

A special focus will be on the information of female doctors, midwives and nurses of Turkish and Kurdish descent on traditional ways of the postpartum period. Following their “biomedical” perspective elements of the traditional concept of postpartum period in Turkey will be integrated into the biomedical model of disease and translated into biomedically existing diseases.

According to this ordering of local concepts into biomedical models I will present an interpretation that illustrates why postpartum disturbances do not gain much attention in the biomedical system despite their high prevalence.

 

 

Traveling from place to place – the contribution of migrants and cultural anthropology to globalization

Yvonne Adam
Albrecht-Ludwig University of Freiburg, Institute for Cultural Anthropology

Objective of this paper is to elaborate on the mobile, processual and traveling of knowledge about pregnancy and birth within globalization. Theoretically, this paper is framed by the article of Gisela Welz “Moving Targets” (1998) and the postulate of George Marcus on “multi-sited ethnography” (1995). Exemplary I will accompany some migrant women with their conceptualizations of pregnancy and birth from their country of origin to Germany. On the other side of the spectrum of this transported knowledge about ‘giving birth’, we find midwifery students who have reflected upon the concept of culture after having been made sensitive for the variety of “birthing cultures” by the referent and her colleague teaching together at the Academy for medical professions at the Teaching Hospital in Freiburg. In its practical application cultural anthropology specialized in intercultural comparison of birthing systems has the task to mediate between the different conceptualizations of pregnancy and birth around the world. It is, however, questionable whether cultural anthropology thereby manages to produce “imagined worlds” (Appadurai). The paper discusses to what extent it might be possible to counteract the biomedical localizing of “natural birth” in foreign countries, to look at birthing systems under the aspect of transition and to finally relocate itself between the ‘own’ and the ‘other’. The focal point in my presentation will be the local meeting of migrant women and the midwifery students.

 

 

What is disease? The “ontological term disease” between theoretical disapproval and global usage

Michael Knipper
University of Bonn, Institute for the History of Medicine

The idea of disease as concrete object, defined and classified as an autonomous entity, corresponds with the “ontological term disease” of past epochs within biomedicine in which the system of medical thought based on the emerging “precise” natural sciences strived for a taxonomy of diseases in the sense of a ‘natural system’, thus following the ideal of botanical taxonomy. While on the level of theoretical reflection, such a taxonomy is meanwhile disapproved of it is still used in practice, both among professions as well as lay people. Moreover, this taxonomy has meanwhile been globally transferred to a variety of local contexts: “diseases”, “indigenous disease terminology” and “local disease phenomena” are thus treated as if they were concrete objects that can be defined, classified and compared with each other. However, in indigenous societies this search for clear definitions often leads to misunderstandings rather than to an adequate perception of local relationships. In this presentation I argue that only the departure from this ontological view of the term disease and the reconstruction of the implicit presuppositions of (kn)own ideas by looking at our own history, will enable us to see and interpret visible phenomena in a less rigid way.

 

 

Aids and Kanyera in Malawi: Local Answers to a Global Phenomenon

Angelika Wolf
Free University of Berlin, Institute for Cultural Anthropology

IIn Southern Africa, mdulo, an indigenous disease complex, is often associated with sexual misbehaviour. The individual diseases however presenting a variety of symptoms, all draw back on a common etiology; they all emerge through direct or indirect sexual pollution, through a contact between hot and cold bodily states.

In my presentation I describe the meaning of a local disease category in the context of Aids. Healers in the utmost district of the main city Lilongwe associate Aids with kanyera. Kanyera is part of mdulo, thus I pose the question why an originally minor aspect of this complex suddenly attracts such attention.

Aids and kanyera do show some parallels. However, more important seems to be the regret for the “loss of culture” and the “decline of customs” connecting this disease with a broader discourse about societal morale. The moral discourse about proper and improper social behavior is related to reproduction and social continuity within a matrilinear society. Within this discourse kanyera gains meaning, while at the same time healers actively participate in the production of medical and moral knowledge. The new meaning of kanyera is interpreted in the context of local reactions to global influences.

 

 

‘Living PositHIVely in Tanzania’: the global dynamics of disease with regard to international and local AIDS work

Hansjörg Dilger,
Free University of Berlin, Institute for Cultural Anthropology

Having spread to all countries of the globe in the last 20 years, AIDS is, in the international community, discussed as a global epidemic. However, this term does not only apply to the epidemiology of the disease but also to international AIDS work: concepts for the prevention of the disease were mostly developed in European or North-American settings and were then transferred to countries throughout the world. This is the case with models as ‘safer sex’, as well as with working models that were developed for living with HIV/AIDS.

In this paper I will examine more closely the concept ‘Living Positively’ which stands for a self-determined life with HIV/AIDS and which has today become part of AIDS programmes world-wide. I will show that there are specific structural and ideological implications which the concept entails (for instance, making one’s sero-status public; access to AIDS-specific medications) and whose realisation is, in the Tanzanian case, closely connected to the (non-)presence of non-governmental organisations (NGOs) and to the immediate social environment of people with HIV/AIDS. In the conclusion, I will describe what difficulties concepts that claim to have universal validity experience in the local contexts; finally, I will make suggestions how local (religious) concepts of disease and healing can be better integrated into future work for and with people with HIV/AIDS.

 

 

Appropriate nutrition in Papua Neuguinea: Claim and Reality

Brigit Obrist van Eeuwijk
University of Basel/Switzerland, Institute for Cultural Anthropology
Once a month, a team of the mother-and-child-healthcare service came to the village to weigh children under 5, to give nutrition advice and to treat sick children. After such a visit one of the village women complained: “Why do they teach us how to care for our children? Haven’t we learned this from our mothers and grandmothers?” This event happened 20 years ago and led me to my PhD research about the embedddness of local concepts of child nutrition in cultural, social and economic contexts among the Kwanga in the Eastern Sepik Province of Papua Neuguinea. My research demonstrated that women in this local context distinguish, order and attach very different meanings to a particular constellation of symptoms of which biomedicine usually abstracts the concept of malnutrition. The present paper aims at answering the question whether this and similar research within the past decade has influenced the interdisciplinary discourse on “proper nutrition’ in Papua Neuguinea. It shows that the emphasis on economic aspects within the debates on globalization of nutrition of the 1990s has superseded critical reflection of both cultural and ideological aspects.

 

 

Natural Birth as an achievement of civilization – Ethno-medical implications for the birth scenery at a University Town in Southwest Germany

Elsbeth Kneuper
University of Tuebingen

This paper is based on accounts of twenty women on their pregnancies, deliveries and first postpartum experiences. In the context of the conference’s topic I pose the following questions: do local contexts affect how women shape and experience the process of pregnancy, delivery and the postpartum period? And, can we in turn designate something that has to be called a consequence of the process of globalization?

Even though women are different, their pregnancies are similarly structured by the medical system. Whereas medicalized birth is assigned with the >here<, natural birth is localized in >the somewhere else<. Surprisingly enough though, this ‘somewhere else’ is neither found in the own cultural tradition nor in “other” locations of one’s own biography but at the classical location of cultural anthropology, as represented by ethnomedicine. Natural birth “takes place”, but in locations that are not reachable for pregnant women.

At the same time, natural birth is an ideal many women strive for. However, if “natural birt”’ is >somewhere else<, then that what we base ourselves upon, presupposes that human beings >somewhere else< are of the same kind as we, that they are in principal biologically determined: the tertium comparationis is the biomedical body. It is, thus, the universalizing discourse of biomedicine practiced in the ‘Western world’ which provides the ultimate condition for the recourse to ‘natural birth’ at those very >other spaces< of cultural anthropology.