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Proquest Dissertations Healing herbs and dangerous doctors: Local models and response to fevers in northeast Thailand Item Type text; Dissertation-Reproduction (electronic) Authors Pylypa, Jennifer Jean Publisher The University of Arizona. Rights Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. Download date 03/10/2021 21:13:09 Link to Item http://hdl.handle.net/10150/290045 HEALING HERBS AND DANGEROUS DOCTORS: LOCAL MODELS AND RESPONSE TO FEVERS IN NORTHEAST THAILAND by Jennifer Jean Pylypa A Dissertation Submitted to the Faculty of the DEPARTMENT OF ANTHROPOLOGY In Partial Fulfillment of the Requirements For the Degree of DOCTOR OF PHILOSOPHY In the Graduate College THE UNIVERSITY OF ARIZONA 2004 UMI Number: 3131631 INFORMATION TO USERS The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleed-through, substandard margins, and improper alignment can adversely affect reproduction. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. UMI UMI Microform 3131631 Copyright 2004 by ProQuest Information and Learning Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. ProQuest Information and Learning Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor, Ml 48106-1346 THE UNIVERSITY OF ARIZONA a- GRADUATE COLLEGE As members of the Final Examination Committee, we certify that we have Jennifer Jean Pylypa read the dissertation prepared by entitled Healing Herbs and Dangerous Doctors: Local Models and Response to Fevers in Northeast Thailand and recommend that it be accepted as fulfilling the dissertation requirement for the Degree of Doctor of Philosophy Date J. ^teph^i Lansing Date c 1 zA /rc-n i Ana Teresa Ortiz Date 0 , Nancy Fai^zo Da /hj i'h i-P • o? • O V Mimi Nichter Date Final approval and acceptance of this dissertation is contingent upon the candidate's submission of the final copy of the dissertation to the Graduate College. I hereby certify that I have read this dissertation prepared under my direction and recomm.end that it be accepted as fulfilling the dissertation requirement. Dissertation Director Mark Nichter Date 3 STATEMENT BY AUTHOR This dissertation has been submitted in partial fulfillment of requirements for an advanced degree at The University of Arizona and is deposited in the University Library to be made available to borrowers under rules of the Library. Brief quotations from this dissertation are allowable without special permission, provided that accurate acknowledgment of source is made. Requests for permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the head of the major department or the Dean of the Graduate College when in his or her judgment the proposed use of the material is in the interests of scholarship. In all other instances, however, permission must be obtained from the author. SIGNED: 4 ACKNOWLEDGEMENTS This dissertation was made possible through the encouragement, kindness, cooperation, and support of many people. First and foremost, my heartfelt thanks go out to the many people in northeast Thailand who welcomed me with characteristic Isan hospitality, and willingly gave their time to answer my endless stream of questions. Weeraform Phuangtum, Terdsak Phuangtum, and Prakit Phromsakha in particular provided me with extensive assistance in learning about and exploring the area. Tanida Tiengtham and Ratsamee Nitthisong provided both great friendship, and invaluable support in conducting the research. I also owe many thanks to Manop Kanato of Srinakarin Hospital for sponsoring this project, and to Daravone Kittiphanh of Vientiane, Laos for her excellent instruction in both the Lao language and culture as well as her friendship. At home in the United States, Carolyn Smith-Morris deserves my gratitude for her continuous, long-distance support and encouragement via email during my fieldwork. I would also like to thank committee members J. Stephen Lansing, Ana Teresa Ortiz, Nancy Parezo, and Mimi Nichter for their feedback and encouragement throughout my graduate career. Finally, my undying gratitude goes to Mark Nichter, an outstanding mentor, teacher, and friend, whose commitment to my education and training has been beyond measure. This research was also made possible by grants from the Social Sciences and Humanities Research Council of Canada (Award No. 752-97-0631), the National Science Foundation (Grant No. 9816972), the Wenner-Gren Foundation for Anthropological Research (Grant No. 453230), and the Department of Anthropology (Riecker Grant) at the University of Arizona. 5 TABLE OF CONTENTS LIST OF ILLUSTRATIONS 9 LIST OF TABLES 10 ABSTRACT 11 PREFACE 13 L INTRODUCTION 18 Symptom Ambiguity and Comorbidity 21 Malaria 24 Dengue and dengue hemorrhagic fever 27 Acute respiratory infections 30 Diarrheal diseases 33 Cultural and Social Factors in Illness Evaluation 34 Cultural illness classifications 36 Diagnostic flexibility: beyond taxonomic illness categorization 39 Subjunctive thinking and provisional diagnoses 42 Situational factors influencing illness evaluation 44 Strategic dimensions of illness labeling 48 Implications of Illness Interrelationships for Disease Prevention and Prevalence 52 The Research Context: Local Concerns about Febrile Illness in Northeast Thailand 54 The Dissertation: Outline of Chapters 59 11. SETTING AND METHODS 62 The Region: Northeast Thailand 64 Economic and Health Status of Isan 69 The Research Setting: Life and Health Along the Border 74 Village Life 78 6 TABLE OF CONTENTS - Continued Economics, Subsistence, and Migration 83 Family Structure, Gender Relations, and Child Care Patterns 92 The Three Study Villages: Na Di, San Huat, and Nong Tao 99 Methods 105 Summary: Research in the Northeast Thai Context 115 III. TREATMENT RESOURCES: FROM VILLAGE TO HOSPITAL 117 Formal Health Providers 118 Village health volunteers 122 Government health posts 124 Hospitals 126 Malaria clinics 127 Private clinics 129 Informal Sources of Pharmaceuticals 133 Self-medication 134 Mo theuan: informal providers 138 Traditional Practitioners 139 Mo yapheunban: herbalists 141 Mo pao: blowing experts 143 Mo phi/mo tham: spirit experts 144 Community vs. Formal Health Provider Knowledge and Authority 147 IV. MODELS AND MANAGEMENT OF EARLY CHILDHOOD ILLNESSES: DIARRHEAL DISEASES AND ACUTE RESPIRATORY INFECTIONS 151 Part 1. Cultural Models of Fever 152 Part II. Diarrheal Disease 159 7 TABLE OF CONTENTS - Continued Prevalence and transmission in the Thai context 159 Diarrhea as 'illness': local categories and characteristics 166 Cultural conceptions of cause and prevention for diarrheal illness 168 Treatment practices and the use of oral rehydration solution 175 Thai su: diarrhea as infant development 182 Models vs. practice: situational diagnosis and management of thai su 187 Implications of cultural models of diarrhea 193 Part III. Acute Respiratory Infections 195 Prevalence and risk factors 196 Local categories of ARI 198 Cultural models of pneumonia and abnormal breathing 200 Perceived causes of ARI 205 Mothers' management and treatment of ARI 207 Key issues in the ethnography of ARI 211 Childhood Illnesses in Sociocultural Context 213 V. COMMUNITY MODELS, PREVENTION, AND TREATMENT OF VECTOR- BORNE DISEASES: MALARIA AND DENGUE FEVER 218 Part I. Malaria 220 Overview: malaria in Thailand 220 Malaria and malaria control in Lin Mai District 224 Local models of malaria epidemiology and prevention 228 Symptom evaluation, home diagnosis, and treatment 238 Implications of local models of malaria 245 Part II. Dengue and Dengue Hemorrhagic Fever 248 Dengue in global and Thai perspective 248 Approaches to dengue prevention and control 253 Dengue and dengue control in Lin Mai District 260 Local models of dengue epidemiology and prevention 267 Models and management of dengue illness 278 Community participation in prevention: implications of local models of dengue 288 Making Sense of Infectious Disease: Hybrid Models and Diagnostic Complexity 292 8 TABLE OF CONTENTS - Continued VL HEALING HERBS AND DANGEROUS DOCTORS: THE FOLK ILLNESS KHAI MAKMAI 297 Prevalence and Characteristics of Khai Makmai 298 Illness Taxonomies 302 Incompatibility with Foods and Medicines 310 Health Providers and the Mistreatment of Khai Makmai 314 Deaths from Mismanagement of Khai Makmai 318 Treatment Strategies 322 Ambiguous, Provisional, and Situational Diagnoses 329 Illness Interrelationships: Khai Makmai and Diarrhea, ARI, and Malaria.... 335 Khai Makmai and Dengue Fever 340 Discourses of Blame, Responsibility, and Competency 345 Implications of Khai Makmai for the Treatment of Infectious Diseases 351 Vn. CONCLUSIONS 356 Lessons for Health Services Provision and Health Education 356 Lessons for Medical Anthropology 365 APPENDIX A: TRANSLITERATION OF ISAN TERMS 369 APPENDIX B: GLOSSARY OF ISAN TERMS 374 NOTES 381 REFERENCES 401 LIST OF ILLUSTRATIONS FIGURE 1: Map of three primary study villages, Lin Mai Town, and associated health services 101 FIGURE 2: Aedes mosquito breeding sites:
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