TRANKELL OVESEN & A unique blend of historical anthropology and contemporary ethnography. At face value, this book is about medicine in Cambodia over the last hundred years. At the same time, however, it is an historical and con- temporary anthropology of Cambodia, in that ‘medicine’ (in the sense of ideas, practices and institutions relating to health and illness) is CAMBODIANS AND THEIR DOCTORS used as a prism through which to view the colonial and post-colonial society at large. Rich in ethnographic detail derived from both contemporary anthropological fieldwork and colonial archival material, the study is an account of the simultaneous presence in Cambodia of two medical traditions: the modern, biomedical one first introduced by the French colonial power at the turn of the twentieth century, and the indigenous Khmer health cosmology. In their reliance on one or the other of the two traditions, the Khmer people have continually been concerned to find efficient medical treatment that also adheres to norms about the morality of social relations. CAMBODIANSAND THEIR The authors trace the articulation of these two traditions from the French colonial period via the political upheavals of the 1970s through to the present day. The result is more than a medical anthropology; this is a key text that makes a significant contribution to the anthropological DOCTORS study of Cambodian society and will be an important resource for scholars as well as for development planners and aid workers in medical A Medical Anthropology and related fields. of Colonial and Post-Colonial Cambodia ‘This is a compelling, persuasive study of the “indigenization” of global bio-political knowledge in Cambodia from colonial to modern times. Rigorously researched, balanced in interpretation and cautionary rather than idealistic, scholars and policymakers alike will derive much benefit JAN OVESEN and INGBRITT TRANKELL from this insightful assessment of the human condition in Cambodia today. It is benchmark, interdisciplinary social science for showing us how social order and everyday survival are continually shaped and reshaped by successive models of governance.’ – Laura Summers, University of Hull The authors are associate professors of anthropology at Uppsala University in Sweden. They have been engaged in the study of Cambodian society since 1995. www.niaspress.dk Ovesen-Trankell_pbk-cover.indd 1 16/11/2009 14:47 CAMBODIANS AND THEIR DOCTORS Oves&Trank_Prels.indd 1 16/11/09 11:21:03 nias – NORDIC INSTITUTE OF ASIAN STUDIES Monograph Series 80. Helle Bundgaard: Indian Art Worlds in Contention 81. Niels Brimnes: Constructing the Colonial Encounter 82. Ian Reader: Religious Violence in Contemporary Japan 83. Bat-Ochir Bold: Mongolian Nomadic Society 84. Shaheen Sardar Ali & Javaid Rehman: Indigenous Peoples and Ethnic Minorities of Pakistan 85. Michael D. Barr: Lee Kuan Yew: The Beliefs Behind the Man 86. Tessa Carroll: Language Planning and Language Change in Japan 87. Minna Säävälä: Fertility and Familial Power 88. Mario Rutten: Rural Capitalists in Asia 89. Jörgen Hellman: Performing the Nation 90. Olof G. Lidin: Tanegashima – The Arrival of Europe in Japan 91. Lian H. Sakhong: In Search of Chin Identity 92. Margaret Mehl: Private Academies of Chinese Learning in Meiji Japan 93. Andrew Hardy: Red Hills 94. Susan M. Martin: The UP Saga 95. Anna Lindberg: Modernization and Effeminization in India 96. Heidi Fjeld: Commoners and Nobles 97. Hatla Thelle: Better to Rely on Ourselves 98. Alexandra Kent: Divinity and Diversity 99. Somchai Phatharathananunth: Civil Society and Democratization 100. Nordin Hussin: Trade and Society in the Straits of Melaka 101. Anna-Greta Nilsson Hoadley: Indonesian Literature vs New Order Orthodoxy 102. Wil O. Dijk: 17th-Century Burma and the Dutch East India Company 1634–1680 103. Judith Richell: Disease and Demography in Colonial Burma 104. Dagfinn Gatu: Village China at War 105. Marie Højlund Roesgaard: Japanese Education and the Cram School Business 106. Donald M. Seekins: Burma and Japan Since 1940 107. Vineeta Sinha: A New God in the Diaspora? 108. Mona Lilja: Power, Resistance and Women Politicians in Cambodia 109. Anders Poulsen: Childbirth and Tradition in Northeast Thailand 110. R.A. Cramb: Land and Longhouse 111. Deborah Sutton: Other Landscapes 112. Søren Ivarsson: Creating Laos 113. Johan Fischer: Proper Islamic Consumption 114. Sean Turnell: Fiery Dragons 115. Are Knudsen: Violence and Belonging 116. Noburu Ishikawa: Between Frontiers 117. Jan Ovesen and Ing-Britt Trankell: Cambodians and Their Doctors Oves&Trank_Prels.indd 2 16/11/09 11:21:04 Cambodians and Their Doctors A Medical Anthropology of Colonial and Postcolonial Cambodia Jan Ovesen and Ing-Britt Trankell Oves&Trank_Prels.indd 3 16/11/09 11:21:05 NIAS Monographs, 117 First published in 2010 by NIAS Press NIAS – Nordic Institute of Asian Studies Leifsgade 33, DK-2300 Copenhagen S, Denmark Tel (+45) 3532 9501 - Fax (+45) 3532 9549 Email: [email protected] - Website: www.niaspress.dk © Jan Ovesen and Ing-Britt Trankell 2010 All rights reserved. Jan Ovesen and Ing-Britt Trankell assert their moral right to be identified as the authors of this work. British Library Cataloguing in Publication Data Ovesen, Jan, 1945- Cambodians and their doctors : a medical anthropology of colonial and post-colonial Cambodia. -- (NIAS monographs ; 117) 1. Public health--Anthropological aspects--Cambodia. 2. Medicine--Cambodia--French influences. 3. Traditional medicine--Cambodia. 4. Medical care--Cambodia--History-- 20th century. 5. Cambodia--Social conditions--20th I. Title II. Series III. Trankell, Ing-Britt. IV. Nordic Institute of Asian Studies. 362.1’09596-dc22 ISBN 987-87-7694-057-7 (hbk) ISBN 987-87-7694-058-4 (pbk) Publication of this book has been financially supported by the Swedish Research Council. Typeset by NIAS Press Printed in Singapore by Mainland Press Oves&Trank_Prels.indd 4 16/11/09 11:21:05 Contents Preface vii Glossary xi 1. Introduction 1 2. Colonialism and Medicine in Indochina 18 3. French Medicine in Cambodia 43 4. The Khmer Rouge Medical Regime and Socialist Health 84 5. Indigenous Practitioners: Healers, Spirit Mediums and Magic Monks 129 6. Midwives and the Medicalization of Motherhood 169 7. Leprosy: Symbol and Social Suffering 203 8. Contemporary Healthcare Resources 233 9. Conclusion 270 Appendix 275 References 277 Index 297 v Oves&Trank_Prels.indd 5 16/11/09 11:21:05 Cambodians and Their Doctors FIGURES Cover: Surgery at a provincial hospital; Performance of a spirit medium 0.1. Map of Cambodia xv 2.1. Adhémard Leclère 36 2.2. François Baudoin 36 3.1. Ang Duong Hospital 48 3.2. Hospital inauguration 79 4.1. The staff of Calmette Hospital 104 4.2. DK pharmaceutical laboratory 106 4.3. The main DK hospital on the Thai border 111 5.1. Indigenous healer 137 5.2. Spirit medium 154 5.3. Monk performing exorcism ceremony 162 6.1. Indigenous midwife 187 6.2. New mother resting over the fire 189 6.3. Maternity ward (nurse) 196 6.4. Maternity ward (parturient woman) 197 7.1. Inhabitant of the leprosy village 222 7.2. Statue of the Leper King 223 8.1. Pharmacy, a family business 242 8.2. Large private clinic 254 8.3. Patient at a private clinic 255 8.4. Elderly patient at home 262 TABLES 2.1. Population and area of French Indochina, 1913 21 2.2. Population of Cambodia in 1911 and 1921 37 3.1. Number of consultations at the Mixed Hospital in Phnom Penh, 1908 47 3.2. Number of patients at the municipal clinics in Phnom Penh, 1911 49 3.3. Number of consultations at municipal clinics in Phnom Penh, 1911 50 3.4. Number of consultations at the clinic in Takeo Province, 1913 76 vi Oves&Trank_Prels.indd 6 16/11/09 11:21:05 Preface This book is about medicine in Cambodia over the last hundred years. It is at the same time an effort to provide a historical and contemporary anthropology of the nation of Cambodia. We use ‘medicine’ – in the sense of ideas, practices and institutions relating to health and illness – as a prism through which we view Cambodian society more generally. Our anthropological involvement with Cambodia goes back to 1995 when we were asked by the Swedish International Development Cooperation Agency (Sida) to do a study of social organization and power structures in rural Cambodia, as part of the agency’s planning of a country strategy for Swedish development assistance. Despite the very limited time allotted for the study (one month in Cambodia and a couple of weeks to read up on existing social science and development literature), we found the assignment attractive for several reasons. It was only very recently that anthropological field research had again become possible, for the first time since the 1960s. Even by then, studies of the daily life of ordinary people in Cambodia were rare. After the devastations that Cambodian society had suffered in the 1970s and 80s there seemed to be a pressing need for basic anthropological and other social science research. At the time, the prevailing atmosphere among both social scientists and development actors was one of optimism. Thanks to the mission of the United Nations Transitional Authority in Cambodia (UNTAC) that culminated in the parliamentary elections in 1993, it was felt that Cambodia was now about to ‘emerge from the past’ as it was pushed onto the world stage and expected to find its place among the world’s budding democracies. The Cambodian population was seen as no longer just unfortunate victims of past political disasters, but as empowered with agency to actively shape their society in conformity with the international aid organizations’ goals of liberal peace and socio-economic development. In our report to Sida (Ovesen, Trankell and Öjendal 1996) we vii Oves&Trank_Prels.indd 7 16/11/09 11:21:05 Cambodians and Their Doctors cautiously questioned the social science basis for the prevailing development optimism.