Chapter 1
Chapter 1
The Kuna have achieved what very few native peoples have been able to do: adapt to change on their own terms. When I visited Kuna Yala, I saw reminders of this ability all around me: in the way tourism into their territory was regulated, in planning how to confront the effects of global climate change, and in negotiating social change between generations. By and large, young girls choose Western clothes, often wearing shorts or jeans and t-shirts, rather than traditional dress. This image of an older Kuna woman and a young girl reminds me how generational change occurs regardless of our ability to control it. Nonetheless, societies do have the cultural tools to control the rate and extent of how change occurs, and in this control, to maintain a sense of wellbeing. Panama's Kuna are an example for other indigenous peoples adapting to a rapidly changing and modernized world.
Introduction Sign Posts
Introduction Sign Posts
It is sometimes hard to explain what an anthropologist does; it is even harder to explain what medical anthropologists do as we correct assumptions that our work centers on categorizing old bones. Now, our task is more difficult than ever, and a summary descriptor-studying people's experience of sickness and health, care seeking and care-is banal and inaccurate. Medical anthropology helps make sense of suffering as a social experience, but it does much more than this. It carries us into refugee camps, birthing centers, factories, boardrooms, gaols, rehabilitation centers and schools, across countries and between communities. And, as we describe below and throughout this volume, it is also a field of great privilege; medical anthropology takes us into the most intimate aspects of people's lives, and the most intimate expressions of their joy, anxiety, grief and tenderness.
Let us begin by explaining who we are and how we have worked, since this is central to why we have written what we have written. This was a collaborative project, and we brought to our conception of the volume and the task of its construction our experiences as students, researchers and educators in diverse settings.
Lenore was trained in Asian studies and history in Australia, and there, she held positions as a medical anthropologist in public health and medical schools until two thousand thirteen; she now lives and works in South Africa and the United States, working partly on questions on public health in Africa, partly on environment and climate change. Her earliest field research projects, as an historian and anthropologist, were in Malaysia. For most of her career, she has conducted research and trained others there, elsewhere in Southeast and East Asia, and in Australia with Indigenous, immigrant and settler Australians, on questions of infectious and non-communicable diseases, gender and sexuality, diversity and inequality. Her research students have come from and conducted their research in diverse settings throughout Australia, Asia and Africa. Her work with the Special Programme for Research and Training in Tropical Diseases over nearly thirty years has likewise contributed extensively to her understanding of medical anthropology both theoretically and in relation to its practical application in disease control programs and in enhancing people's access to care and improved health.
Liz trained in anthropology in the United States, after initially training and working as a nurse. Her primary work has been in the United States, particularly with Spanish-speaking immigrants,
and in Mexico, Central and South America, working on environmental health, immigration, and social justice-her students too are drawn from these areas. Her work among farmworkers in the US resulted in the creation of 'The Hispanic Health Project' that was located in southeast Idaho for over a decade. Through this work she refined her understanding of the value of high-quality data for community-based participatory research methods and community interventions. She now is employing these insights in her work with rural agricultural communities in the Peruvian Andes. Liz conceived and developed the course on Systematic Video Analysis for the Short Course on Research Methods held under the auspices of the National Science Foundation and the direction of Russell Bernard; this course is currently offered in an online format during summer sessions at the University of Florida, Gainesville. She is a trained videographer and has taught ethnographic filmmaking in the US, Mexico, Australia and Vietnam.
Anita was trained in medical anthropology in the Netherlands, after initially training in medical biology. She has conducted extensive fieldwork in the Philippines and elsewhere in Southeast Asia, with her graduate students drawn primarily from Europe, Asia and Africa. With her colleagues Sjaak van der Geest and Susan Reynolds Whyte, she spearheaded the anthropological study of pharmaceuticals in the late nineteen eighties. Since then she has been engaged in multi-level and multi-sited ethnographies on immunization, new reproductive technologies and AIDS medicines that have generated important ethnographic insights on the appropriation of these technologies in diverse social-cultural settings, their efficacy in everyday life, the role of social movements in their design, and the dynamics of care and policy making in their provision. She makes it a priority to communicate her research findings to patient advocates, policy makers, and public health researchers and practitioners, through and in collaboration with activist organizations.
This combined geographic and intellectual diversity-of where we studied, where we have taught, where we have undertaken field research, and the diverse backgrounds of our students-inspired us as we thought through the structure and potential uses of this volume, identified the case study authors, and wrote the chapters. Our shared vision, while providing a personal review of medical anthropology in the early twenty-first century, was to keep in focus the directions that contemporary medical anthropology was taking across space. These directions-no single pathway-are shaped by the intellectual traditions of our different continents, despite the travel of ideas between them. They are shaped too by inspirations from various other theoretical, epistemological and disciplinary conventions and concerns across the social sciences, and by medical and public health priorities in our different countries.
Current and emerging economic, political, social and environmental challenges, and the priorities of the people with whom we have worked, have further shaped the content and structure of this volume. The photographs that we have included stand alone, invitations to readers to engage and reflect. The fifty-two case studies, from sixty-six authors, add polyphony to this volume, offering rich and diverse ethnographic examples of our dominant themes as they play out across geography, theoretical landscape and the political directions of contemporary medical anthropology. Around these case studies, we have woven our own texts in a shared voice.