Manderson (1998)

Manderson, Leonore. 1998. Applying medical anthropology in the control of infectious disease. Tropical Medicine and International Health 3(12): 1020-27.

Anthropological interest in issues on health, illness, death and dying has been part of the main core of the discipline since its early colonial conceptions. But, according to Manderson, issues related with infectious disease control/intervention have been only recently analyzed. So now some focus has moved to analyzing particular illnesses with the specific questions that each illness would bring. Thus understanding not only how human behaviour and social structure work in the spread of infectious diseases, but also how interventions for preventing and treating those diseases could be implemented too. There is a tension between considering on the one hand biomedical knowledge (linked with science, right and truth) and on the other hand laypeople beliefs (indigenous, wrong, magic and myth). Another source of tensions is the field in which medical anthropologists work, many are employed in multinational organisms that tend to de-contextualize the causes that produce illness while they privilege their knowledge over the subjects awareness of their own situation. The problem for medical anthropologists is that they are in middle and they have a “considerable unease in documenting behaviour and beliefs assumed to contribute to disease and ill health, in isolation from the social, economic and politic contexts” (1998: 1021). For Manderson anthropologists should have a “pragmatic position” with a dedication to ease suffering but more as cultural broker (see Scheper-Hughes [1990] critique) helping the access of populations to “effective interventions” (antibiotics, multidrug therapy, early diagnosis and appropriate treatment). She considers that although “local remedies” (she does not mention “medical systems”) could be effective in preventing infections or reducing suffering they are not as effective as biomedicine. And she goes saying that as Wall (1995) argues, “shamans’ songs cannot treat obstructed labour; neither, in the context of this paper, do they prevent pneumonia, malaria or dengue fever” (1998: 1021). The problem I see here is how Manderson defines “context”. She said before that political, economic and social contexts are important but when dealing with infectious diseases they do not count and only biomedicine. She proposes a “rapid anthropological assessment” as a tool to develop when anthropologists work as consultants. Usually anthropologists working for big organizations are under contractual and logistic constraints and because of this they need to rapidly assess the cultural and biological needs people have in relation with ill conditions. One key issue with this approach is to be aware of not over-simplifying people’s behaviour and beliefs due to the loss of contextual information. Another important thing to consider is the need to have an early diagnosis and treatment of diseases such as TB or malaria, and for doing that Manderson proposes to: recognize how people manage to diagnosis illness and/or slight disorders from life threatening disease; and the conditions that preclude or permit the use of biomedical services (if they have access to) and compliance to treatment. The aim for Manderson is to diagnose and treat people in early stages so she presents the case of how laypeople understand cough in relation to pneumonia, and she observes that folk categories may delay biomedical treatment. For her “circumstantial factors” such as “cash” and lack of transportation may complicate and delay the seek for care and would explain why “women with sick children present to clinics relatively late” (1998: 1022). The key action to take is to prevent infection disease and change (ill-oriented) people’s behaviour. Of course, these interventions require financial and infrastructure investment in order to change the social and environmental conditioning of illness, the social conditions of poverty and inequality, and the access to remedies and biomedical services. The problem for Manderson is how people adhere and observe treatments, but when people do not adhere or observe them is not only because of misunderstanding or structural barriers, it is more complex.