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Traditional Health Beliefs and Practices of Postnatal Women in Trinidad

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Traditional Health Beliefs and Practices of Postnatal Women in Trinidad TRADITIONAL HEALTH BELIEFS AND PRACTICES OF POSTNATAL WOMEN IN TRINIDAD By KUMAR MAHABIR A DISSERTATION PRESENTED TO THE GRADUATE OF THE SCHOOT N R TY OF FLORIDA IN PARTIAL FULFILMENT OFU THETT |L REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 1997 For Professor Syam Roopnarinesingh mitted ’ Mt ' ^ ^ H°Pe Women s Hospital to conduct my ^search for Sister Salisha Mohammed-Ragoo who nursed me during6 my7 incubation period at the postnatal ward, and for all the grandmothers, mothers and masseuses who nurtured the birth of a research idea that I had conceived with my wife. [Do] you think if a doctor can't cure you, he will tell you? He will eat all you' money. He would never send you by me. He would say, "Them old woman eh [don't] know nothing." — 70- year-old traditional masseuse in Trinidad, 1995. ACKNOWLEDGMENTS No one can genuinely complete a work of this magnitude without the assistance of others. I am happy to acknowledge the assistance of many people who helped me, in one way or the other, to complete this dissertation. I am especially grateful to have as my mentor Dr. Brian du Toit who is the Chairman of my supervisory committee. I am also indebted to my other committee members: Dr. Allan Burns, Dr. Gerald Murray, Dr. Sharleen Simpson, and Dr. Vasudha Narayanan who offered advice, criticism and direction throughout various stages of the research. I also wish to recognize Drs. Paul Doughty and Irma McClaurin for sharing their experience of doing cross-cultural research with me. Dr. Helen Safa schooled me into adopting a gender perspective in my studies. To my wife, Mera, I owe my gratitude for her encouragement to pursue a doctorate in the first place, and her unfailing support during the five years of doctoral work. Former high-school teacher Kathleen Kassiram read the manuscript for clarity and the expression of good English, and offered some valuable suggestions for its improvement. I would also like to express my gratitude to Samaroo Siewah, Gransham Bagaloo, Harrikisoon Seegobin, Geeta Panday and Drs. Harry Ramnath, Ingrid Poon King, and Pooran Ramlal-all of them from Trinidad. Dr. Rasheed Rahaman and Professor Syam Roopnarinesingh gave me permission to make initial contact with postnatal women at Mt. Hope IV Women's Hospital, and to access their medical records. The clerical and medical staff at the hospital also allowed me to watch them work. Additionally, I would like to thank my female informants who accommodated me into their homes, and graciously shared their time, experiences and knowledge with me. My doctoral studies was funded by a number of agencies. An award from Florida Caribbean Institute enabled me to pay in-state tuition. An A. Curtis Wilgus Fellowship paid my travel expenses to conduct pre-dissertation fieldwork in 1994. And an Organization of American States (OAS) Fellowship in 1996-97 helped me to write the dissertation at the University of Florida. v TABLE OF CONTENTS ACKNOWLEDGMENTS ABSTRACT CHAPTERS 1 INTRODUCTION Problem and Rational Medical Pluralism The Informal Health Care Sector Literature Review Summary Ig Notes jo 2 BACKGROUND Country Profile .21 Ethnicity .25 Formal Health Care Services .27 The Regional to Approach Health .31 The Research Site .34 Summary .38 Notes .39 3 THEORY AND METHODOLOGY Overview of Theories .41 A Critical Medical Approach .44 Preparation for Fieldwork .46 In the Field 51 On Being a Native Anthropologist. .56 Data Analysis 60 Summary .62 Notes .63 4 POSTNATAL WOMEN 64 The Postnatal Ward The Nursing Staff 57 Episiotomies and C-sections 73 Perinatal Mortality 79 Fertility Rates and Teenage Mothers 83 Postnatal Women in the Family 88 Help /Health-Seeking Behavior of Postnatal Women 95 Summary 103 Notes 104 5 TRADITIONAL MASSEUSES 107 Profile of Traditional Masseuses 107 Training of Masseuses 112 Activity Levels of Masseuses 118 Payment for Treatment 121 Relationship with Others 125 Types of Disorders Treated 130 Summary I45 Notes 6 CARE OF THE NEW MOTHER 148 Seclusion and Pollution 149 Special Foods 153 "Setting" the Womb Back in Place 153 Herbal Baths 159 The Chatti Ceremony 155 Summary I73 Notes 7 CARE OF THE NEWBORN 176 Breastmilk 177 Neonatal Jaundice 189 Dew and Evil Elements 192 Thrush and Heat Rash 200 Infant Massage 213 vii Notes 213 8 DISCUSSION AND CONCLUSION 216 The Promotion of Industrialized Medicine 216 The Biomedical Use of Traditional Medicine in the Caribbean 220 Clinical Studies of Traditional Perinatal Practices 224 The Project's Recommendations 228 Summary 232 Notes ..".."".233 APPENDICES A LETTER OF PERMISSION FROM HOSPITAL 235 B HOSPITAL OBSTETRICAL CASE SUMMARY FORM 236 C ETHNO-BOTANICAL DATA 239 D HALWA RECIPE 241 E CELEBRATORY CHILDBIRTH SONG 243 REFERENCES 244 BIOGRAPHICAL SKETCH 278 viii Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy TRADITIONAL HEALTH BELIEFS AND PRACTICES OF POSTNATAL WOMEN IN TRINIDAD By Kumar Mahabir December, 1997 Chairman: Dr. Brian M. du Toit Major Department: Anthropology The purpose of this ethnographic study is to describe and analyze traditional health beliefs and practices of postnatal women in a multi-ethnic urban setting in the economically developing country of Trinidad (and Tobago). Not much is known about the existence of traditional health care services which continue to be utilized even when modern sources of medical aid are available. Postnatal women in Trinidad seek health care from biomedical practitioners, older family members, and masseuses in the community. This study examines areas of consonance and dissonance (i.e. symptomology, etiology, treatment, diagnosis and prevention) between biomedical and traditional systems of medicine. The two systems are presented in the context of larger racial, ethnic, class, and gender relationships in which issues of power, control and dependency arise. The study is located in the political-economic context of the Third World which has a history of IX dependency on foreign goods and services rooted in the plantation economy. The implications of this study for primary health care is also discussed. Quantitative and qualitative data for this research were collected through a wide range of methodologies including participant observation, photographic recording, semi-structured interviewing, and the chronicling of personal life- histories. CHAPTER 1 INTRODUCTION The Structural Adjustment Policies (SAPs) implemented by developing countries like Trinidad (and Tobago) 1 in the 1980s have severely affected those at, and below, the poverty line, especially the vulnerable groups of women, children and elderly people (PAHO/WHO 1994; Safa and Antrobus 1992). These policies, prescribed by the World Bank and the International Fund (IMF) for addressing balance of payments problems, brought about alarming increases in health care costs with the result that biomedical health care services are now outside the reach of large sections of the population (Phillips 1994). In a study (READ 1989) undertaken in Trinidad on diabetes, it was shown that traditional or home remedies were used along with cosmopolitan medicine, even though diabetics reported that they were warned against the use of home remedies by health professionals. The study predicts that shortages of medication, increasing prices, and diminishing household incomes are likely to cause more women than men to resort to use of traditional remedies. In developing countries, women are the main providers of health care in their households, in biomedical facilities (as nursing and support personnel) (Mariesknd 1980), and in traditional health care systems (as traditional birth attendants) (Turshen 1991). Graham (1985:25-26) states quite appropriately that informal health care has remained part of the domestic economy, molded by the relations which govern everyday 1 2 life in the family and community. In particular, it is seen to be shaped by two convergent sets of social relations: first, by a sexual division of labor in which men make money and women keep the family going, and second, by a spatial division of labor whereby the community becomes the setting for routine care and maintenance and the institutions of medicine are the location for the acquisition and application of specialist skills. These two dimensions have been closely related historically, with the process of male domination converging with the process of professionalization to define the health work of women. Women invariably act simultaneously as primary providers, negotiators, and mediators of health within the home (Antrobus 1993; Graham 1985). In their time-consuming multiple roles as producers and reproducers, women are given the additional burden of making a decision on which type of health care resource to utilize. The dearth of literature on the health-seeking behavior of Caribbean women, and the sources of informal health care which they provide, have contributed to their muteness and invisibility in formal discourse. Compilers of health data have consistently limited their concerns to biomedical practitioners and the facilities in which they operate. There is the need, therefore, to study all health care systems in developing countries to determine how low-income women cope with their own illnesses, and those of family members, in communities that are, or are becoming, increasingly "modernized" (see Mesa-Lago 1992). Problem and Rationale In the 1980s, Caribbean Governments implemented SAPs as a result of balance of payments problems in their developing economies. These policies had negative effects on national employment, income levels, food prices. 3 social infrastructure, education and housing. Additionally, there were specific reductions in public expenditures for health care and the subsequent increase in the privatization of health care services. The implementation of these policies caused alarming increases in health care costs. As a result, the responsibility for health care was shifted from the state to the household which further increased the burden on women "who have always assumed a primary role in household survival strategies" (Safa and Antrobus 1992:50; see also Phillips 1994).
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