David R. Counts
Dorothy A. Counts
University of Waterloo
Counts, David R. and Dorothy Ayers Counts. 1989. Complementarity in medical treatment in a West New Britain society. Pp. 277-294. In A Continuing Trial of Treatment: Medical Pluralism in Papua New Guinea. Stephen Frankel and Gilbert Lewis, eds. Dordrecht, Holland: Kluwer Academic Publishers.
The Lusi are a Austronesian-speaking, horticultural people living in the Kaliai area of the northwest coast of West New Britain Province in Papua New Guinea. Kaliai was contacted and pacified around the turn of this century by German colonial representatives. Despite the fact that small parcels of land were alienated in the early 1900s for a mission station and for a private plantation, the peoples of the northwest coast of New Britain have remained, until very recently, among the most isolated of coastal dwelling societies anywhere in Papua New Guinea. There is still, in 1984, no government-administered office closer than 100 kilometres by sea from the central part of the Kaliai coast. The land bought by the Roman Catholic Mission was not occupied by a priest or by sisters until after World War II, and while Iboki Plantation has been in nearly continuous operation from German times until today, its effect on the local population has been small except as an occasional source of casual employment, as the location of a trade store, or more rarely as a market for local garden produce.
Access to medical care from professionally trained persons came to the Kaliai region only after 1952 when a clinic staffed by a triple-certificate nursing sister was opened in connection with the Kaliai Roman Catholic Mission. Now known as the Kaliai Health Centre, the clinic has passed into the control of the Health Department of the government of Papua New Guinea, and continues to provide the only professional Western medical care available for at least 80 kilometres in any direction.
In this essay we examine the way in which the people of Kaliai perceive the opportunities for medical therapy that are available to them. Those opportunities clearly include the care offered by the nursing staff of the Kaliai Health Centre, and may occasionally include care from more distant medical centres, such as the one at Cape Gloucester 80 kilometers to the west or the General Hospital located in Kimbe, the provincial capitol, 160 kilometers to the east. The medical treatment available to the Kaliai also includes that offered by indigenous healers or curers who proceed from different assumptions and operate by different methods than do the personnel practicing at aid-post, regional health centre, and hospital.
Because these alternatives are available, when a Lusi experiences injury or illness s/he must make a decision about the level or kind of treatment to seek. This decision is made, as are those that follow through the course of the illness, on the basis of notions about the nature of illness and disease, the causes of such health problems, and the efficacy of the available treatment. Such notions arise from Lusi culture, and it is on that culture, with particular attention to the domain of illness and its treatment, that we focus in this essay.
The research on which this essay is based has taken place during four periods of residence in the Kaliai area, beginning in 1966 when we resided in Kandoka village, the largest of the five coastal villages of Lusi speakers, for a period of eleven months. We returned to Kandoka in 1971, in 1975-76, and in 1981.(1) During our nearly thirty months of residence there, what began as fairly standard graduate field research in anthropology has become a long-term study of a people's accommodation to increasingly rapid change. None of the research projects that took us to live among the Lusi has been directly concerned with their ideas of health and illness, but the general circumstances and particular events of our residence there have made us intensely aware of the problems that threaten their health and of their attempts to deal with illness, injury, and death.
In part, our awareness of Lusi concern with illness and injury arose because we have actively conducted research into the domains of aging and death (D.R. Counts 1976-77; Counts & Counts 1983-84; D.A. Counts 1980, 1983, 1984b). This research has led to considerable discussion with consultants about the nature of the infirmity that comes with age and about the kind of illness and injury that leads to death. The data that we have collected may also be ascribed in part to the fact that among the most dramatic events occurring during our residence in Kaliai have been those occasioned by someone falling victim to serious illness, suffering traumatic injury, or dying. In all these kinds of occurrences we have, because the Lusi spend a lot of their time discussing it, become aware of the cause and course of illnesses as the villagers conceive them to be. Finally, though neither of us has medical training, our friends in the village regularly come to us for first aid, and often seek our help in much more serious cases.
The nature of our training and, therefore, of our data clearly do not let us speak with authority of the clash between Western medical conceptions of illness and those held by the Kaliai. The do, however, permit us to discuss the Lusi's views of illness and what they regard as the respective merits and failures of the systems of therapy available to them.
Since 1966, Kandoka village has experienced a modest growth in population, and the shape of the village has changed to accommodate the creation of new households and the loss, through death, of others. One small group of kinsmen have moved away to start a new community but, in general, the physical setting of the village has not altered much in nearly two decades. There have, however, been other dramatic changes, for the outside world has literally come closer to Kandoka. Administrative appointment of village headmen (luluai) has been replaced with local self-government by council; political administration by Australia of New Guinea as a United Nations Trust has been replaced by independence for the state of Papua New Guinea; western New Britain was separated from eastern New Britain first as a district and subsequently as a province; finally, the new provincial government has been situated in a town, Kimbe, which came into existence in the 1970s as part of a major development scheme centered on the production and processing of palm oil.
These developments, giving the Lusi increased access to cash and the ready availability of local transport to move people and goods to the town, have combined to reduce the isolation of Kaliai. One aspect of reduced isolation is greater access to Western medical care. Before about 1975, care for serious illnesses or situations requiring surgical treatment was available only from the hospitals located in the extreme eastern part of New Britain, at Rabaul and Kokopo. This was a difficult journey from Kaliai and one that few made because of lack of transport and the time and distance involved. By 1981 hospital care for the seriously ill was no more than a few hours away on a canoe powered by one of the numerous outboard engines to be found in every coastal Kaliai village.
While reduced distance and greater availability of locally controlled transport have improved access to Western medical treatment for the Kaliai during the last fifteen years, the cost of using these facilities has risen marginally by the imposition of small fees for the services offered. These fees, of ten toea(3) for pain-reliever tablets and fifty toea for an injection of penicillin for example, were originally instituted in the early 1970s when what had been a mission and hence supported by contributions from abroad, became a parish and expected to provide its own support. The increased availability of cash from the sale of copra has meant that the fees have not been a serious deterrent to use of the health facilities, but villagers sometimes grumble and delay going to the clinic because each visit requires the outlay of still relatively scarce money.
Kaliai Health Centre is located on the grounds of the Roman Catholic mission station near the village of Taveliai in the central coast of the Kaliai census subdivision of the Gloucester District of West New Britain Province. It is now a government-staffed and supported health centre and the personnel are all nationals of Papua New Guinea. Despite the departure of the last expatriate nursing sister (a nun) about a decade ago, the ties of the Kaliai Health Centre to the Catholic mission remain close. The centre serves the entire area of the Kaliai census subdivision, supplemented by two aid-posts in the interior of the two thousand square kilometers area. The aid-posts, staffed by medical orderlies and offering only extended first aid, are located inland on the Vanu and the Aria rivers, the major drainage systems of the region. Serious cases are referred by the aid-posts to the central health centre where there is a registered nurse in charge. From there, in turn, difficult cases may be referred to the district centre at Gloucester or to the General Hospital at Kimbe. All referrals and patient transfers must be made by sea, as no roads currently link Kaliai to any other part of the province. Kandoka is located on the coast, some ten kilometers east of the Kaliai Health Centre, and it is there that Kandokans routinely go for care when they are injured or ill. The distance separating the coastal villages from the Kaliai Health Centre is not a major problem limiting access except in the worst times of the year during the northwest monsoon season. At such times even poling a shallow draught outrigger canoe may be an arduous and daunting task and may be an occasion for delay in going to the clinic.
Reasonably ready access to Western medical care has not caused the villagers to give up their indigenous system of treatment of serious illness and injury. On the contrary, they often rely on their own system of treatment in addition to, or instead of, the care offered by the Kaliai Health Centre personnel. One aspect of traditional Lusi therapy has, however, fallen into disuse. For first aid treatment of minor wounds and sores, they are now completely dependent on the services of the clinic. Our oldest consultants have identified for us a number of leaves, plant saps, barks, and other sources of potions that were applied as medicines and bandages to cuts, abrasions, and the like. But among the coastal Kaliai few people use these any longer and younger people are only vaguely aware of their existence. What remains of the indigenous treatment of illness and injury is almost entirely restricted to conditions that the Lusi regard as life-threatening.
It is questionable whether the non-Western therapy that the Lusi use can appropriately be called "traditional." It is traditional in the sense that it proceeds from assumptions about the causes of disease and the efficacy of treatment that are part of Lusi culture. This does not necessarily mean that the specifics of treatment that may be applied in a particular case are the same treatments that might have been applied in a similar case fifty or one hundred years ago. Since pacification and the imposition of colonial government, the people of Kaliai, in spite of their isolation, have been exposed to ideas about the etiology and treatment of illness from many sources. From the beginning of this century, they were recruited to work as plantation labourers throughout Papua New Guinea. Today they travel widely, frequently visiting the town of Kimbe, and they have people from other social and linguistic groups living in their villages. Given the assumptions and beliefs about illness that we detail below, each foreigner with whom a Lusi comes into contact is a potential source of illness and of treatment for illness. This situation is unlikely to be a new one, for the people of Kaliai have long been engaged in the overseas trading network that links northwest New Britain to the northeast New Guinea mainland (see Harding 1967). Also, Lusi readily borrow the cultural equipment of others. This is no less true of the methods of curing than it is of the songs, dances, masks and numerous other things that they use as their own but that derive from others. The point is that it would be unwise to infer that there is something exclusively Kaliai in the medical pluralism that they currently use in their treatment of serious illness.
Lewis has observed that the Gnau draw a major distinction between the illness or injury of a part of a person's body and the illness of a person expressed as a general condition (1975:130-132). This broad division of conditions requiring therapeutic attention works for the Lusi with only a slight modification. By illness we mean any condition that causes general discomfort or pain but that has no clearly perceptible surface manifestations. This condition normally causes a Lusi to use the term rivalinga 'illness', 'sickness', or to say \ngarivali,\ 'I am ill'. Conditions that are clearly localized, or that have an obvious surface manifestation, will almost always be described with reference either to the condition of the affected part, for example ravagu iaiai 'my head hurts', \ahegu aia voto\ 'my leg has a sore', or to the nature of the injury, as in ngaketi limagu 'I've cut my hand'.
These two categories of conditions requiring medical treatment are not clear-cut taxonomic classes, and there is no cover term in the Lusi language to include all of the conditions that are minor, localized, or superficial, and that would stand in opposition to the statement, ngarivali 'I'm sick'. A minor condition may, indeed, become an 'illness' if it does not disappear or heal in the expected time. Despite the lack of elegance of these categories, they are important because of the implications underlying a Lusi's statement that s/he has an 'illness'. A person who says "I'm sick!" is, of course, calling attention to the fact that s/he is suffering from general discomfort that requires treatment. S/he intends that the statement be taken to mean that the condition is so serious that, should the course of the illness not be altered and healing obtained, death may well follow. Finally, the person intends that it should be understood that something serious may be wrong, not only with his body but with his social relationships as well.
When we assert that a Lusi's statement "I am ill!" contains the implication that his social relationships may be unwell, we are stating a corollary of the underlying assumption that most illnesses do not just happen. The causes of illnesses that lead to death are to be found, not in nature, but in society. There are, to be sure, illnesses that may be caused by natural occurrences, and all of the conditions that Lusi consider minor are initially assumed not to have a social cause. However, any minor condition that either fails to respond to treatment or that worsens in spite of treatment, will probably come to be perceived as life-threatening and as having its origin in society rather than in nature. Bad social relations that can give rise to illness are not restricted to those that obtain between living human beings. The social relations that may require repair before the body can be made well may exist between ghosts and their living relatives as well as between living persons.
Illness of the very young is frequently attributed to the activity of ghosts, while the illness and death of the extremely aged is likely to be thought merely the working of the natural order. On the other hand, almost all serious illnesses of mature persons stem from bad relationships existing among the living and may be attributed to the practice of sorcery or to the contamination of the body by sexual fluids, especially menstrual blood.
To a limited degree, it is possible for the Lusi to ascertain the cause of a particular condition from its expression in symptoms. We choose the term 'condition' in the foregoing statement because the Lusi think of some states, that in Western medicine are considered to be illnesses, as being of the same nature as physical deformities. They are unfortunate conditions arising from the actions of particular agents, but they lack the implication for social relationships that inhere in the notion of 'illness'. A good illustration of this is the attitude toward the disfiguring effects of filariasis. Filariasis is common on the northwest coast of New Britain, and the enlargement of the extremities associated with this disease affects a number of people in the villages of Kaliai. Our consultants have offered two explanations for the condition. The first, most commonly expressed view, is that the swelling is the result of the sufferer having violated the territory of a type of masalai 'bush spirit' who has retaliated by causing the disfigurement. A contrary view is offered by those who note that the enlarged extremities are often seen in several members of one particular family, while they are totally absent from another. These consultants argue that the condition is, clearly, an inherited one. The point is that in neither case do people regard the condition as an illness, and no one attempts to relieve it. Filariasis is, from this perspective, not a disease to be avoided or cured; rather, like a deformed limb, it is a condition to be endured.
At the same time, some states that a Western medical practitioner might not regard as similar sorts of illnesses are classified together and accorded similar treatment by the Lusi because their causes are perceived to be the same. For example, extended periods of lassitude and inertia that cause a person to fail to meet his ceremonial obligations or to repay his debts of shell currency are considered to be rivalinga, 'illnesses' because the sudden onset of an inability to meet one's obligations stems from sorcery. A rival has ensorceled the victim. For the Lusi 'human action' is the most important source of health problems that are thought to require medical attention. While this is an accurate assessment of Lusi thinking, the situation is more complex. For example, there is a major distinction to be made between human action that is diffuse in its intent to cause illness or injury and that which is specific in intent. Diffuse human action refers to those acts that may cause injury illness (1) where the particular victim was not chosen by the agent, though the effect was intended for anyone who came into contact with the disease-causing substance or situation, or (2) where the effect of the human action was inadvertent. Where the victim was, in effect, an accidental victim. The first category includes such action as placing magical devices to protect one's property -- gardens, isolated houses, trees, etc. Such devices are marked by a clear sign warning the public at large that the device is in place and that the property should be avoided. Anyone injured as the result of contact with such a device has, in the opinion of most Lusi, only himself to blame. The second category is best illustrated by the use of a protective device by a sorcerer who is afraid of his rivals. A sorcerer who is likely to be in the presence of other sorcerers will prudently protect himself with a device called a kisinga 'protective spell'. He signals the existence of the protective spell by wearing an armband in which special crotons are placed. Although intended to be purely protective, the power of the spell is so formidable that anyone coming near or touching the device may be made ill. For children, who are particularly vulnerable, the effect may be serious illness or death.
By specific human action we have reference to sorcery in which, through the use of magical rituals and spells, the sorcerer intends to harm his victim. All of the human actions that cause illness or injury are united by their use of spells, incantations and/or other magical devices in order to manifest their effects. In figure 2 the category 'sexual contamination,' although caused by the action of a human agent, is thought by Lusi to be more akin to the effect of a chemical poison than to the action of a sorcerer or a magician. Menstrual blood, widely regarded as a contaminant in Papua New Guinea societies, may be given to a man by his wife with the intent of making him fall ill (Frankel 1980; Lindenbaum 1979; Herdt 1981; Brown 1978). However, the careless contamination of her own (or someone else's) food by a menstruating woman is thought to have precisely the same effect. Similarly, semen that can contaminate the milk of a nursing mother and cause colic in her infant, requires no spell to do its work. The baby's consequent illness results in the indictment of the careless mother and not of the man whose semen caused the child to be ill (see D.A. Counts 1984a for further discussion of this point).
Another complexity arises from the fact that there are some conditions for which our consultants give contradictory explanations. We noted one such contradiction above in the case of filariasis. Some others are even more problematic. Our most reliable consultants said that the health problems known by the Kaliai term pura aiaoa 'the mouth of God' or 'white person's mouth', were unknown in northwest New Britain before the coming of the Germans and the Australians. The consultants who make this assertion and who link the appearance of leprosy, malaria, and pneumonia to the arrival of the white skinned foreigners, say that they are reporting the beliefs of their forefathers in denying the appearance of these problems before first contact. At the same time, these informants are able to give us names for these diseases in the Lusi language. The fact that these health problems have Lusi names strikes us as prima facie evidence that they are conditions of some long standing. Furthermore, at least in the case of malaria, a series of recurring attacks of increasing severity will likely lead the sufferer to conclude that the source of his illness is sorcery and to seek a remedy in the repair of social relations rather than from the Kaliai Health Centre.
This extended discussion of health problems and their causes is intended to underscore the lack of consistency and uniformity among Lusi with regard to knowledge of illness. Largely, the explanation that is given for any condition will depend on the pragmatics of the particular case. The most general rule that can be stated with regard to Lusi judgements about illness is that any condition that responds to Western medicine is likely (1) to be just an illness, i.e. not to have its origin in the practice of sorcery, and (2) to be thought a sik bilong ol waitskin 'white person's disease', one brought with the Europeans when they came. The corollary of this rule is that any condition that does not respond to the efforts of practitioners of Western medicine will be asserted to have a local cause and to be susceptible only to traditional types of cures.
In order to illustrate the foregoing observations about Lusi understanding of conditions needing medical attention, we present below a series of vignettes drawn from a combination of field observation and consultant's recollection. Each is a real situation, not a composite, though the names of those involved have been changed.
The garden cleared by Michael and Melissa was not bearing well because it was shaded by a large tree that was occupied by a masalai 'bush spirit', and Michael was afraid to cut the tree and anger the spirit. He was, therefore, especially interested when the Catholic priest sprinkled holy water on a similarly occupied piece of land, rendering it safe for clearing and gardening. When the people who used this exorcized land suffered no ill effects, Michael decided that he could safely cut the 'bush spirit's' tree and open up his garden to the full sunlight. A few months after Michael cut the tree, Melissa gave birth to a son who was deformed: one leg ended at the knee with a vestigial foot; the other foot was webbed at the toes. The angry 'bush spirit' had entered Melissa's womb and had cut the leg of her child in revenge for Michael's cutting its tree. Melissa quickly buried the child alive, but he was found by other villagers who took him to the mission. The priest returned the infant to his parents with the exhortation that they must care for him as they would any other child. When we first met Oneleg in 1966 he was a boy of about twelve years who ran with the aid of a stick and who participated in games with the other children. In 1981 he gardened with his parents, played soccer with the other young men, worked along side his cohorts, and was expected eventually to marry. No special provisions were made by the villagers for Oneleg as he grew up, but neither was there any opprobrium attached to his condition. His nickname, Oneleg, is an observation of fact, not ridicule, and he answers to it with good humour. Villagers agree that Michael and Melissa should have been more respectful of the 'bush spirit' and maintain that Oneleg's condition reaffirms the potency of the spirits of the forest.
CHRISTY AND THE KISINGA
Christy is a woman in her late twenties. When we first arrived in Kandoka village in 1966 she was a child of about six or seven years. She appeared to be, and was regarded by the villagers as being, profoundly retarded. Though she could walk and her physical development appeared normal for a child of her age, she could not speak intelligibly and could not be trusted by her parents to wear clothing, behaviour that is expected of all village children older than about five or six years. Christy was frequently the butt of jokes played by other children and often cried as though she were a much younger child for things that were denied her. When we inquired about her condition, the nursing sister at the mission said that Christy had been a victim of cerebral meningitis at about age two. This illness had left her in her severely retarded condition. The account of the illness given by the villagers is initially consistent with the nurse's report. According to them, Christy accompanied her parents to a ceremony where she fell ill and remained in a coma for three days and nights. Here the two explanations diverge, for the villagers say that the ceremony was also attended by Bou, a well-known sorcerer. Fearing other sorcerers who would also likely be present, Bou wore a protective spell, a kisinga. Bou's \kisinga\ was prepared with a small hole in the wrapped leaves of his armband so that any sorcery directed at him would be caught in the hole and rendered harmless. Unfortunately, Christy's parents carelessly allowed her to come too close to Bou and her spirit was caught in the kisinga. Some time elapsed before her parents realized what had made the child ill, and by the time they had appealed to Bou to open his kisinga and release her spirit, the damage had been done. Our consultants suggest that had her spirit been released earlier, Christy would not have been damaged, and had her parents not appealed to Bou to open his device she would shortly have died.
In late 1966 Paul and his wife were returning from the mission by canoe when they were caught by a sudden storm. Going ashore, they sought shelter under a small house isolated near the pig-pens of a fellow villager. When the storm passed they resumed their journey. Soon Paul caught a fish and, while landing it, was finned in his left thumb.
Paul thought little of the injury until it began to become swollen and painful a few days after the incident. At that point he came to us for first aid treatment and we cleaned and bandaged the wound. The infection continued, though, and became severely painful, so Paul went to the mission clinic where the puncture was cleaned and newly bandaged and he was administered a penicillin injection by the nurse. Nothing seemed to bring any relief, and the swelling and pain worsened. Paul could not get to a higher level of Western medicine because it was the rainy season and there was no transport moving from the northwest coast to either Talasea or Rabaul where the nearest hospitals were located. He soon concluded that he was a victim, not merely of an infection that would have responded to the penicillin, but of the action of a protective magic spell placed to warn off intruders from the house under which he and his wife had sheltered from the storm. He was aware of the charm placed there, he said, but skeptical of its power to harm him and, besides, he was not breaking into the house but only seeking cover from the rain. Nevertheless, Paul and the villagers with whom he discussed the problem now agreed that the iha aimata 'fish eye' magical lock was the only viable explanation for the severe infection that was spreading to affect his entire arm.
Paul went to Loa, the elderly woman who had placed the spell on her property, and requested a luanga 'cure' so that the infection could heal. Agreeing that the charm she had placed was the 'fish eye', Loa tried a curing spell. Shortly thereafter, Paul went to Cape Gloucester for his installation as the first Local Government Councillor from the ward that included Kandoka. When Paul reached Cape Gloucester, his still swollen and now foul-smelling left hand was diagnosed as gangrenous by the medical assistant and he was sent by air to Rabaul hospital where his thumb was amputated. Throughout the course of this incident, no culpability attached to Loa. Though there was unanimity of opinion on the part of the villagers that her 'lock' had caused the infection, Loa had left a clear warning that her property was protected by a 'fish eye' magical spell, and she had done what she could to undo the damage. Instead, Paul was the object of considerable ridicule for having ignored the power of the 'lock' in the first place, and for having delayed in seeking Loa's cure in the second.
Early one morning in 1971 a neighbour came to tell us that Nathan was dying and wished to tell us goodbye. We hurried to find him lying under a canvas shelter just outside his sister's cooking house (a sure sign that he expected death to be imminent), surrounded by his grieving relatives. The day before the left side of his face had begun to swell painfully. He had gone to the Kaliai Health Centre where the nurse had given him a penicillin shot. The medication had not helped, and he was running a temperature, his face was badly swollen, and he was in considerable pain. He and his kin were convinced that he had been ensorceled and that he was dying. We urged him to return to the clinic but he refused, reasoning that because the illness had not responded to earlier therapy it was due to sorcery and not susceptible to Western medical treatment. Finally, after a few minutes of discussion, Dorothy got our Merck Manual and read to Nathan and his assembled relatives the section on peritonsillar abscess, arguing that if a description of the illness were found in an American medical book it was a sickness known to whites and not one caused by sorcery. Nathan had not slept during the night, so we gave him two codeine tablets and a tetracycline. He was to sleep for an hour or so and, when he awoke, we would take him to the clinic for treatment. While he rested, the abscess ruptured spontaneously and began to drain. We, and our pills, were credited with predicting the time of his recovery and with his cure. There was no further discussion of sorcery.
Bertha was an old woman of about eighty years who was dying of tuberculous in 1981. Years earlier her husband, Lawrence, had died of the same disease that he had contracted, according to his sons, as a result of mali, 'menstrual blood poisoning'. When he was in early middle-age, Lawrence had an adulterous affair with a young woman from another village. The woman wanted to marry Lawrence, and even though he paid compensation to her family, her desire turned to rage and she somehow managed to contaminate something he ingested -- food, water, tobacco, or a bit of betel mixture -- with her menstrual blood. During his long illness, Bertha cared for Lawrence, wiping his mouth, bringing him food and water, and eating and drinking from the same containers he used. Shortly after his death, she also began suffering the symptoms of tuberculosis. Her sons denied that she was sick as a result of her carelessness with her own menstrual effluvia, although this is usually considered to be the source or respiratory disease in women. Instead, they argued that she had contracted the illness as a result of her close association with her husband. Her sickness seemed to be a matter of quiet pride for her sons who considered it to be evidence of her loving concern for Lawrence and absolute proof that she was in no way responsible, either through malice or hygienic negligence, for his death.
TINA AND THE GHOSTS
When we arrived in Kandoka in 1981, Tina was an infant of about six months, healthy and developing well. Conversations with Mary, her mother, about her apparent health in contrast to other colicky babies led to insight into the possibility of the contamination of mother's milk by semen, and the dangers that such contamination entail for the children (see D.A. Counts 1984a for discussion of this point). Tina's mother, concerned about the well-being of her baby, never permitted anyone else to serve as wet-nurse, even though carrying the infant to the gardens was often inconvenient. A month or so after our arrival, Tina fell ill with a high fever and became listless and unresponsive. Her sickness was a matter of great concern to her parents but, because of bad weather, they did not take her to the Kaliai Health Centre. Rather, they brought her to us to see if we could help. We thought Tina's high fever was probably symptomatic of malaria, so we gave Mary sufficient infant camoquin and acetaminophen to reduce the fever, and urged her to take Tina to the clinic as quickly as possible. The next day the fever continued unabated and Mary, convinced that because our medicine did no good something else must be at issue, went to Cookie for help. Cookie is an elderly woman with a long-standing reputation for traditional medical knowledge. She prepared ginger and passed it around Tina's body and then gave it to Leo, a man in a neighbouring village who was known to be on good terms with the spirit of ginger. Leo's dream while he slept on the ginger provided both the explanation and the treatment for Tina's illness. Once, when Mary had left the baby unattended in the house while a fire was burning, her dead maternal grandfather had seen Tina and had been sorry for the child left in the smoky house. A small child's spirit is only weakly attached to its body, and Tina's grandfather had taken hers so that she would not suffer in the smoke. While Tina's spirit was with her grandfather, her father's brother, only recently dead and very lonely, had decided that Tina should stay with him and had refused to let the grandfather send her spirit back to her body. Tina's body, therefore, had begun to sicken and, should her parents not be able to convince Tina's father's brother to release her spirit or somehow draw it back to her, she would surely die. When Cookie received this message she knew how to proceed. She prepared the baby, singing over her while brushing downward along her body with the leaves of the molmolo croton. The ritual pulled Tina's spirit away from her uncle and back to her body. She soon recovered.
THE DEATH OF BRUNO
In 1967, while returning from a canoe trip to Kilenge with his father, twelve-year-old Bruno became lethargic and complained of a sore throat. The next day we were called to look at the boy and found him lying on a mat, the inside of his mouth and throat covered with running, ulcerated sores. His back was arched, his head was thrown back, and he appeared to have a high temperature and to be in great pain. We thought we could do nothing for the boy, so his parents took him to Kaliai Health Centre about four o'clock in the afternoon. He was dead at dawn the next morning.
The people who accompanied Bruno to the clinic were critical of the nurse's diagnosis and treatment. She reportedly told Bruno's father that the child was ill with malaria -- a diagnosis that no one was willing to accept -- and she bathed him in cool water in an attempt to lower his temperature which had reached 106 degrees. Because the nurse's diagnosis violated local knowledge of the symptoms of malaria, and because her treatment seemed to be both bizarre and ineffective, the villagers concluded that Bruno had been a victim of sorcery. For the next two weeks the identity of the sorcerer was a primary topic of conversation. The question finally culminated in a ritual of divination in which the ghost of the dead child was asked to identify the person who had brought him his poison (For details of the ritual see Counts and Counts 1974:135-141. Similar rituals are reported by Valentine 1965:174 and by Mitchell 1978:153-155).
During the course of the divination, the ghost suggested that Bruno had somehow been ensorceled by his father -- a suggestion that was generally rejected -- and the divination did not satisfactorily resolve the question of the sorcerer's identity. In 1981 the attitude of our consultants towards Bruno's father had changed. Now the man is suspected of practicing sorcery and, people explained, in 1967 Bruno's ghost had accurately pointed to his father as being the source of the poison that killed him. People thought that during the canoe trip the child had touched, or perhaps consumed, some ensorceled item in his father's handbasket and, even though the poison was not intended for him, being a vulnerable child he succumbed to the power in his father's magic paraphernalia. This possibility that Bruno died of some Western illness has never been seriously considered. Instead, it is now generally believed, Bruno was his father's first victim.
In the foregoing vignettes we have tried to present a variety of cases that permit us to illustrate and examine the relationship between Western medicine and traditional Lusi practice. First, we will state briefly what we think are the propositions that can be derived from this examination and, second, we will discuss the reasons why we believe each of these propositions to have validity in today's Lusi society.
(1) There are two complementary medical systems available to the Lusi. The term 'medical system' includes norms accounting for the recognition, etiology, significance, and treatment of illness and injury.
(2) Both of the available medical systems are complete, and each is capable of yielding satisfactory results.
(3) The Lusi choose which system to use, decide when to change systems, or perhaps choose to activate neither system according to the perceived etiology of the problem in each particular case. While such decisions may take symptomatic complaints into account, symptoms often are only a minor factor in the choice.
(4) In the event that the causes of a condition are not immediately apparent, Lusi will seek treatment from Western medicine first.
Traditional medicine and Western medicine are neither in conflict nor in competition with one another, and the use of one system does not preclude the subsequent use of the other. Rather, the Lusi view these two systems as being in complementary distribution. Inasmuch as a set of symptoms may be appropriately explained by either system, the decision as to which is the correct assignment can be known only on the basis of the efficacy of treatment. Therefore, in the case of Nathan, when relief was obtained as a result of finding a description of the illness and the prescribed medication in a book of Western medicine, everyone agreed that Nathan had been suffering from a 'white person's disease'. The discussion of sorcery that had preceded his cure was dropped, Nathan lost his conviction that he was dying, and he made a full recovery. In a reverse instance, the inability of Western medicine to alter the course of Bruno's illness and avert his death led his survivors to reject the explanation given by the nurse and to assume that his illness was caused by sorcery. Although it was too late to treat Bruno, they could try to ascertain the identity of the responsible party and attempt to make sure that he did not kill again
A further point to be noted here is that the two medical systems consistently ask different questions concerning illnesses. Lusi understand and accept that Western medicine asks which disease is making a person ill and proceeds to treatment through the examination of the illness itself. Traditional practice, in contrast, asks who or what is causing this person to be ill and proceeds by identifying the culpable party and trying to alter his/its behaviour.
In addition to being complementary with one another, each medical system is valid and complete. As far as the Lusi are concerned, both systems work as they should and provide satisfactory results if people diagnose the problem correctly and follow through on the proper course of action. Neither failure or success in any particular case causes either system's validity to be called into question. In general, people respond to failure by assuming that the wrong system has been applied. If there is time, then the alternate system will be activated. It appears, however, that if both systems have been tried and the patient dies then Lusi will always revert to the traditional system to explain the death.
The response to success is generally simple: if a treatment works, then the Lusi look no further for an explanation. However, a success or even a series of successes by one system will not cause the alternative system to be questioned. For instance, should another person fall ill as Nathan did, the same process of system trial would likely be followed again. The cure of Nathan's illness by Western medicine did not place that kind of illness firmly in the category of 'new' illness or white person's disease. Rather, it established that Nathan's particular problem was a white person's illness. The possibility that a sorcerer could cause a victim to suffer in the same way has not been called into question.
Finally, we think it is important to elaborate on the way in which Lusi proceed when they recognize a condition that requires treatment. We noted above that they may not regard as an illness a condition that is so defined by Western medical practitioners, and if the condition -- filariasis for example -- is not an illness, then it has no cure although there may be prescribed ways of attempting to prevent its recurrence. One should avoid the swamps where 'bush spirits' that cause the disfigurement are known to reside. Similarly, since the birth of Oneleg, no one has been foolish enough to cut down the tree of a 'bush spirit' in order to remove shade from a garden plot.
For those conditions that are illnesses and can, therefore, be cured by the appropriate treatment, Lusi will usually choose to go to the Kaliai Health Centre first. They do not seek Western medicine because of a general feeling that such treatment is more efficacious although, as we noted in the early sections of this essay, first aid has virtually replaced traditional cures for non-problematic conditions such as simple sores, minor wounds, and seasonal eye infections. For more serious conditions, though, people seek Western medical care first. Their choice is, we think, based on the fact that Western medical care is considered to be accessible, fast, and inexpensive. Accessibility refers, not to the proximity of a village to a clinic or aid-post, but to the fact that the persons who are capable of practicing Western medicine are clearly and unambiguously designated. Note that nearly anyone who is perceived of as having a white person's living standard and who has medications available falls into this category: a plantation manager, a nurse, a priest, or a visiting anthropologist.
The fact that Lusi consider Western medicine to be fast in curing illness is less a vote of confidence in the system than a problem for it. It is a problem because, in those circumstances when a clinical treatment does not produce relatively dramatic and immediate effects that convince the victim that s/he has chosen correctly by coming to the clinic, the person may terminate the Western treatment in favor of a traditional one. It is clearly a logical choice for a Lusi given the premises from which s/he operates, but it has been for decades a source of frustration for the agents of Western medicine practicing in the area. Dramatic remission of illness is not required of the traditional system, as everyone is, in a sense, 'well-educated' in it and understands that just as it takes a long time for a sorcerer to perform his work it may take a long while for it to be undone.
As to the low price of Western medical care, when compared to the potential cost of acquiring the services of a traditional curer, the treatment offered by a Western medical practitioner is both inexpensive and simple to obtain. If one pays the Kaliai Health Centre a small fee and obtains a cure, then that is the end of it. If the Kaliai Health Centre treatment fails, and a person must seek out the sorcerer who has been hired by his enemies, then all bets are off. The sorcerer will delay agreeing to try his luanga 'cure' in order to throw suspicion away from himself; his first several attempts will fail because he has, after all, been paid to make the victim suffer; he will charge for each attempt, and the more difficult and complicated his cure the higher his fee will rise. A person will, therefore, first seek Western medical treatment in the hope that it will work because the alternative is expensive, slow-acting, difficult, and complicated. It is complicated because any illness that is caused by a sorcerer suggests that both the victim's body and his social relationships are in trouble. Anything that will respond to Western medicine is merely a sickness of the body. Conditions that do not respond are much more dangerous and complex. Illnesses of the body, those that respond to Western medicine, do not kill. In Kaliai people may die benignly, but they do so of old age. The death of active people is not a matter of illness that will submit to the ministrations of a nurse or doctor. Small wonder, then, that Lusi hope that Western medicine will work for only then can a person who is ill cease to worry that he is being killed.
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3. One hundred toea make a kina. One kina was equivalent to one Australian dollar in 1975.
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