The Recovery of Healthcare: A case study of Javanese medical practices and related discussions about pluralism in healthcare
DOI:
https://doi.org/10.13135/2384-8677/4561Abstract
The use of 'traditional' medicine is a common phenomenon throughout Indonesia. In today’s Indonesian healthcare system 'traditional' and complementary medicine coexist with globalized biomedicine and even urban, educated households are still more likely to use 'traditional' than biomedical healthcare. This paper explores the fundamental differences between Western and Javanese understandings of health, illness and healing. It highlights first the Javanese relational perspective on healing, which involves resonance with the surrounding whole. It contrasts this with the entanglement of biomedical knowledge and economic interests, which is identified as a major problem of governmental healthcare services, as it enables overshadowing the medical objective of helping health-seeking persons with the objective of generating profit. Relationships with biomedical experts are described as shaped by monetary considerations, while rejecting non-biomedical treatment methods is suspected of being a way of protecting the interests of biomedical businesses. Based on these categorical and structural barriers between different medical traditions, the nationally structured and formally recognized system of healthcare is contrasted with a common informal, socially and culturally rooted way of navigating healing. Therefore, against the formal background of these conceptual differences, the paper highlights health seekers’ sensual experiences, embodied realities, and their common routines of tinkering and combining healthcare practices between conceptual differences. This provides glimpses into everyday informal cooperation between distinct medical traditions, which easily bridge categorical, structural and economic barriers.
Key words: Healthcare Bricolage; Indonesia; Jamu Medicine; Javanese Tradition Medical Degrowth; Medical Pluralism; Primary Healthcare; Traditional Knowledge; Traditional Medicine.
References
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Chilisa, B. (2012). Indigenous Research Methodologies. Thousand Oaks: Sage.
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Eriksson, K. (1997). Understanding the world of the patient, the suffering human being: The new clinical paradigm from nursing to caring. Advanced Practice Nursing Quarterly, 3(1), 8-13.
Eriksson, K., Bondas-Salonen, T., Herberts, S., Lindholm, L., Matilainen, D. (1995). Den mångdimensionella hälsan - verklighet och visioner [Multidimensional health: Reality and visions]. Vasa: Vasa sjukvårdsdistrikt och Institutionen för vårdvetenskap. [The Nursing district of the Federation of Municipalities of Vasa and Department of Caring Science].
Fedoryka, K. (1997). Health as a Normative Concept: Towards a New Conceptual Framework. The Journal of Medicine and Philosophy 22, 143 – 160.
Ferzacca, S. (1996). In this Pocket of the Universe: Healing the Modern in a Central Javanese City. Doctoral Dissertation, Madison: University of Wisconsin.
Ferzacca, S. (2001). Healing the Modern in a Central Javanese City. Durham: Carolina Academic Press.
Geertz, C. (1973). The interpretation of cultures. New York: Basic Books.
Green, L.J.F. (2012). Beyond South Africa’s ‘indigenous knowledge – science’ wars. South African Journal of Science. 2012;108 (7/8), Art. 631.
Green, L.J.F. (2013). Contested Ecologies: Dialogues in the South on Nature and Knowledge. Cape Town: HSRC Press.
Harley, D. (1999). Rhetoric and the Social Construction of Sickness and Healing. Social History of Medicine 12, 407–435.
Hewson, J. (2014, November 24). “Indonesia's ambitious social reforms launched”. Al Jazeera. http://www.aljazeera.com/indepth/features/2014/11/indonesia-ambitious-social-reforms-launched-201411248297500401.html.
Illich, I. (1973). Tools for conviviality. New York: Harper Row.
Illich, I. (1976). Limits to medicine. Medical nemesis: the expropriation of health. London: Marion Boyars.
Jong, H.N. (2017, February 13). “Indonesia to tackle unhealthy practices in health sector”. The Jakarta Post.http://www.thejakartapost.com/news/2017/02/13/indonesia-to-tackle-unhealthy-practices-in-health-sector.html
Kleinman, A. (1973). Medicine's Symbolic Reality: On a Central Problem in the Philosophy of Medicine. Inquiry 16, 206 – 213.
Kleinman, A. (1988). The illness narratives. New York: Basic Books.
Landri, P., Neuman, E. (2014). Introduction: mobile sociologies of education. European Educational Research Journal, 13 (1), 1–8.
Latouche, S. (2007). Petit traité de la décroissance sereine. Paris: Mille et une nuits.
Lévi-Strauss, C. (1962). La Pensée sauvage. Paris: Plon. [English translation The Savage Mind, first published 1966]. Amsterdam: Het Spinhuis.
Liebich, E. (2003). Scharlatanerie? Weit gefehlt! Jamu: Ein Beispiel traditioneller Medizin. Südostasien, 19(3), 57-58.
Lindsey, T., Mann, T. (2020, April 9). “Indonesia was in denial over coronavirus. Now it may be facing a looming disaster”. The Jakarta Post. https://www.thejakartapost.com/academia/2020/04/09/indonesia-was-in-denial-over-coronavirus-now-it-may-be-facing-a-looming-disaster.html.
Lock, M. (2001a). Containing the elusive body. The Hedgehof Review, 3(2), 65 – 78.
Lock, M. (2001b). The Tempering of Medical Anthropology: Troubling Natural Categories. Medical Anthropology Quarterly 15, 478-492.
Lucchese, M., Pianta, M. (2020). The Coming Coronavirus Crisis: What Can We Learn? Intereconomics 55, 98–104.
Lyon, M.L. (2005). Technologies of feeling and being: medicines in contemporary Indonesia. International Institute for Asian Studies Newsletter 37, 14.
Lyon, M.L. (2009). Epistemology, medical science and problem-based learning: Introducing an epistemological dimension into the medical-school curriculum. In: Brosnan, C., Taylor, B.S. (Eds.). Handbook of the Sociology of Medical Education. London: Routledge, 207-224.
Maldonado-Torres, N. (2011). Thinking through the Decolonial Turn: post-continental interventions in theory, philosophy, and critique—an introduction. In: Transmodernity: Journal of Peripheral Cultural Production of the Luso-Hispanic World, 1 (2), 1–15.
Mignolo, W. (2012). Local Histories / Global Designs: Coloniality, Subaltern Knowledges and Border Thinking. Princeton: Princeton University Press.
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Nicholls, R. (2009). Research and indigenous participation: Critical reflexive methods. International Journal of Social Research Methodology, 12(2), 117-126.
Noerdin, E. (2014). Transport, health services and budget allocation to address maternal mortality in rural Indonesia. Transport and Communications Bulletin for Asia and the Pacific 84(1).
Nordenfelt, L. (2007). The concepts of health and illness revisited. Medicine, Health Care and Philosophy, 10(1), 5-10.
Nurhayati, N., Widowati, L. (2017). The use of traditional health care among Indonesian Family. Health Science Journal of Indonesia, July 2017, 30-35.
Nygren, A. (1999). Local Knowledge in the Environment–Development Discourse: From dichotomies to situated knowledges. Critique of Anthropology 19(3), 267 – 288.
Pfleiderer, B., Bibeau, G. (1991). Anthropologies of medicine: A colloquium on West European and North American perspectives. Braunschweig: Vieweg.
Prasidya, Y. (2020). Glimmer of hope: Indonesians optimistic, likely to spend more. The Jakarta Post. https://www.thejakartapost.com/news/2020/04/23/glimmer-of-hope-indonesians-optimistic-likely-to-spend-more.html.
Prince, R.J. (2020, April 20). Utopian aspirations in a dystopian world: “health for all” and the Universal Health Coverage agenda – an Introduction. Somatosphere. http://somatosphere.net/2020/universal-health-coverage.html/.
Samerski, S. (2016). Tools for degrowth? Ivan Illich's critique of technology revisited. Journal of cleaner production, 197, 1637-1646.
Sciortino, R. (1995). Caretakers of Cure: An Anthropological Study of Health Centre Nurses in Rural Central Java. Yogyakarta: Gadjah Mada University Press.
Sciortino, R. (1996). The multifariousness of nursing in the Netherlands Indies. In: Boomgaard, P., Sciortino, R. Smyth, I. (Eds.). Health care in Java: Past and present. Leiden: KITLV Press.
Shohat, E. (1992). Notes on the Post-Colonial. Social Text 31-32, 99–113.
Silitoe, P. (2002). Globalizing Indigenous Knowledge. In: Silitoe, P., Bicker, A. Pottier, J. (Eds.) Participating In Development. London: Routledge. 108 -138.
Silitoe, P. (2007). Local Science vs. Global Science: Approaches to Indigenous Knowledge in International Development. New York: Berghahn Books.
Susanty, F. (2020, April 29). Market reports paint a bright, post-pandemic future for Indonesian ‘jamu’. The Jakarta Post. https://www.thejakartapost.com/news/2020/04/29/market-reports-paint-a-bright-post-pandemic-future-for-indonesian-jamu.html.
Triratnawati, A. (2005). Masuk Angin: Patologi Humoral Jawa. In Ahimsa-Putra (Ed.). Masalah Kesehatan dalam Kajian Sosial Budaya. Yogyakarta: BU-Kepel Press.
Triratnawati, A. (2011). Masuk Angin dalam Konteks Kosmologi Jawa. Humaniora 23, 326 – 335.
Van den Daele, W. (2004). Traditionial Knowledge in Modern Society. In Stehr, N. (Ed.). The Governance of Knowledge. New Brunswick: Transaction Publishers. 27-39
Weydmann, N., Großmann, K., Tijaja, N., Erb, M. (2020, September 8). Healing in context - Traditional medicine has an important role to play in Indonesia’s fight against the coronavirus. Focaal Blog. https://www.focaalblog.com/category/blog/.
Weydmann, N. (2019). Healing is not just dealing with your body: a reflexive grounded theory study exploring women's concepts and approaches underlying the use of traditional and complementary medicine in Indonesia. Berlin: Regiospectra Verlag.
Whittal, J. (2020). COVID-19. What the health pandemic can teach us about universal healthcare. Medicins Sans Frontieres. https://www.msf.org.uk/article/covid-19-what-coronavirus-pandemic-can-teach-us-about-universal-healthcare.
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Yuval-Davis, N. (2010). Theorizing identity: beyond the ‘us’ and ‘them’ dichotomy. Patterns of Prejudice, 44(3), 261-280.
Asdal, K., Brenner, B., Moser, I. (2007). Technoscience: The Politics of Intervention. Oslo: Oslo Academic Press.
Bagga-Gupta, S. (2013). The Boundary-Turn: relocating language, identity and culture through the epistemological lenses of time, space and social interactions. In: Hasnain, I., Bagga-Gupta, S., Mohan, S. (Eds.). Alternative Voices: (Re)searching Language, Culture and Identity. Newcastle-upon-Tyne: Cambridge. 28–49.
Bagga-Gupta, S., Surian, A. (2014). Center-staging global north-south research in the glocal-virtual age: challenges in researching and theorizing learning, communication and diversity. Paper at EARLI. Padova, Italy.
Bal, M. (1991). The Politics of Citation. In: Diacritics 2, 25–45.
Beers, S. (2001). Jamu - The Ancient Indonesian Art of Herbal Healing. Singapore: Periplus.
Bloomberg, P. (2020). “Indonesia President Joko stokes speculation herbs can fight coronavirus”. The Straits Times. https://www.straitstimes.com/asia/se-asia/indonesia-president-joko-stokes-speculation-herbs-can-fight-coronavirus
Borowy, I., Aillon, J.L. (2017). Sustainable health and degrowth: Health, health care and society beyond the growth paradigm. Social Theory Health 15(14), 346-368.
Breuer, F. (2009). Reflexive Grounded Theory: Eine Einführung für die Forschungspraxis. Wiesbaden: Verlag für Sozialwissenschaften.
Butler, J. (1993). Bodies that Matter. New York: Routledge.
Carney, M. A. (2014). The biopolitics of 'food insecurity': towards a critical political ecology of the body in studies of women's transnational migration. Journal of Political Ecology, 21(1), 1-18.
Charmaz, K. (2000). Grounded Theory: Objectivist and Constructivist Methods. In Denzin, N. K., Lincoln, Y. S. (Eds.). Handbook of Qualitative Research. Thousand Oaks: Sage. 509-535.
Charmaz, K. (2006). Constructing Grounded theory. A Practical Guide through Qualitative Analysis. London: Sage.
Chilisa, B. (2012). Indigenous Research Methodologies. Thousand Oaks: Sage.
Connolly, C. (2017)."Bird cages and boiling pots for potential diseases": contested ecologies of urban 'Swiftletfarming' in George Town, Malaysia. Journal of Political Ecology 24: 24-43
Connolly, C., Kotsila, P., D'Alisa, G. (2017). Tracing narratives and perceptions in the political ecologies of health and disease. Journal of Political Ecology, 24(1), 1-10.
Coronavirus: Indonesia's panic buying of herbs, medicinal plants takes toll on 'jamu' vendors. (2020, March 4). The Straits Times. https://www.straitstimes.com/asia/se-asia/coronavirus-indonesias-panic-buying-of-herbs-medicinal-plants-takes-toll-on-jamu
D'Alisa, G., Germani, A. R., Falcone, P. M., Morone, P. (2017). Political ecology of health in the Land of Fires: a hotspot of environmental crimes in the south of Italy. Journal of Political Ecology, 24(1), 59-86.
DeVito, S. (2000). On the Value-Neutrality of the Concepts of Health and Disease: Unto the Breach Again. Journal of Medicine and Philosophy 25, 539 – 567.
Duden, B. (1994). Der Frauenleib als öffentlicher Ort. Vom Missbrauch des Begriffs Leben. München: dtv.
Eriksson, K. (1994). Den lidande människan [The suffering human being]. Stockholm, Sweden: Liber Utbildning.
Eriksson, K. (1997). Understanding the world of the patient, the suffering human being: The new clinical paradigm from nursing to caring. Advanced Practice Nursing Quarterly, 3(1), 8-13.
Eriksson, K., Bondas-Salonen, T., Herberts, S., Lindholm, L., Matilainen, D. (1995). Den mångdimensionella hälsan - verklighet och visioner [Multidimensional health: Reality and visions]. Vasa: Vasa sjukvårdsdistrikt och Institutionen för vårdvetenskap. [The Nursing district of the Federation of Municipalities of Vasa and Department of Caring Science].
Fedoryka, K. (1997). Health as a Normative Concept: Towards a New Conceptual Framework. The Journal of Medicine and Philosophy 22, 143 – 160.
Ferzacca, S. (1996). In this Pocket of the Universe: Healing the Modern in a Central Javanese City. Doctoral Dissertation, Madison: University of Wisconsin.
Ferzacca, S. (2001). Healing the Modern in a Central Javanese City. Durham: Carolina Academic Press.
Geertz, C. (1973). The interpretation of cultures. New York: Basic Books.
Green, L.J.F. (2012). Beyond South Africa’s ‘indigenous knowledge – science’ wars. South African Journal of Science. 2012;108 (7/8), Art. 631.
Green, L.J.F. (2013). Contested Ecologies: Dialogues in the South on Nature and Knowledge. Cape Town: HSRC Press.
Harley, D. (1999). Rhetoric and the Social Construction of Sickness and Healing. Social History of Medicine 12, 407–435.
Hewson, J. (2014, November 24). “Indonesia's ambitious social reforms launched”. Al Jazeera. http://www.aljazeera.com/indepth/features/2014/11/indonesia-ambitious-social-reforms-launched-201411248297500401.html.
Illich, I. (1973). Tools for conviviality. New York: Harper Row.
Illich, I. (1976). Limits to medicine. Medical nemesis: the expropriation of health. London: Marion Boyars.
Jong, H.N. (2017, February 13). “Indonesia to tackle unhealthy practices in health sector”. The Jakarta Post.http://www.thejakartapost.com/news/2017/02/13/indonesia-to-tackle-unhealthy-practices-in-health-sector.html
Kleinman, A. (1973). Medicine's Symbolic Reality: On a Central Problem in the Philosophy of Medicine. Inquiry 16, 206 – 213.
Kleinman, A. (1988). The illness narratives. New York: Basic Books.
Landri, P., Neuman, E. (2014). Introduction: mobile sociologies of education. European Educational Research Journal, 13 (1), 1–8.
Latouche, S. (2007). Petit traité de la décroissance sereine. Paris: Mille et une nuits.
Lévi-Strauss, C. (1962). La Pensée sauvage. Paris: Plon. [English translation The Savage Mind, first published 1966]. Amsterdam: Het Spinhuis.
Liebich, E. (2003). Scharlatanerie? Weit gefehlt! Jamu: Ein Beispiel traditioneller Medizin. Südostasien, 19(3), 57-58.
Lindsey, T., Mann, T. (2020, April 9). “Indonesia was in denial over coronavirus. Now it may be facing a looming disaster”. The Jakarta Post. https://www.thejakartapost.com/academia/2020/04/09/indonesia-was-in-denial-over-coronavirus-now-it-may-be-facing-a-looming-disaster.html.
Lock, M. (2001a). Containing the elusive body. The Hedgehof Review, 3(2), 65 – 78.
Lock, M. (2001b). The Tempering of Medical Anthropology: Troubling Natural Categories. Medical Anthropology Quarterly 15, 478-492.
Lucchese, M., Pianta, M. (2020). The Coming Coronavirus Crisis: What Can We Learn? Intereconomics 55, 98–104.
Lyon, M.L. (2005). Technologies of feeling and being: medicines in contemporary Indonesia. International Institute for Asian Studies Newsletter 37, 14.
Lyon, M.L. (2009). Epistemology, medical science and problem-based learning: Introducing an epistemological dimension into the medical-school curriculum. In: Brosnan, C., Taylor, B.S. (Eds.). Handbook of the Sociology of Medical Education. London: Routledge, 207-224.
Maldonado-Torres, N. (2011). Thinking through the Decolonial Turn: post-continental interventions in theory, philosophy, and critique—an introduction. In: Transmodernity: Journal of Peripheral Cultural Production of the Luso-Hispanic World, 1 (2), 1–15.
Mignolo, W. (2012). Local Histories / Global Designs: Coloniality, Subaltern Knowledges and Border Thinking. Princeton: Princeton University Press.
Missoni, E. (2015). Degrowth and health: local action should be linked to global policies and governance for health. Sustainability Science, 10(3), 439-450.
Mol, A. (2002). The Body Multiple: Ontology in Medical Practice. Durham: Duke University Press.
Mol, A. (2014). A reader’s guide to the 'ontological turn' – Part 4. Somatosphere. http://somatosphere.net/2014/03/a-readers-guide-to-the-ontological-turn-part-4.html.
Nicholls, R. (2009). Research and indigenous participation: Critical reflexive methods. International Journal of Social Research Methodology, 12(2), 117-126.
Noerdin, E. (2014). Transport, health services and budget allocation to address maternal mortality in rural Indonesia. Transport and Communications Bulletin for Asia and the Pacific 84(1).
Nordenfelt, L. (2007). The concepts of health and illness revisited. Medicine, Health Care and Philosophy, 10(1), 5-10.
Nurhayati, N., Widowati, L. (2017). The use of traditional health care among Indonesian Family. Health Science Journal of Indonesia, July 2017, 30-35.
Nygren, A. (1999). Local Knowledge in the Environment–Development Discourse: From dichotomies to situated knowledges. Critique of Anthropology 19(3), 267 – 288.
Pfleiderer, B., Bibeau, G. (1991). Anthropologies of medicine: A colloquium on West European and North American perspectives. Braunschweig: Vieweg.
Prasidya, Y. (2020). Glimmer of hope: Indonesians optimistic, likely to spend more. The Jakarta Post. https://www.thejakartapost.com/news/2020/04/23/glimmer-of-hope-indonesians-optimistic-likely-to-spend-more.html.
Prince, R.J. (2020, April 20). Utopian aspirations in a dystopian world: “health for all” and the Universal Health Coverage agenda – an Introduction. Somatosphere. http://somatosphere.net/2020/universal-health-coverage.html/.
Samerski, S. (2016). Tools for degrowth? Ivan Illich's critique of technology revisited. Journal of cleaner production, 197, 1637-1646.
Sciortino, R. (1995). Caretakers of Cure: An Anthropological Study of Health Centre Nurses in Rural Central Java. Yogyakarta: Gadjah Mada University Press.
Sciortino, R. (1996). The multifariousness of nursing in the Netherlands Indies. In: Boomgaard, P., Sciortino, R. Smyth, I. (Eds.). Health care in Java: Past and present. Leiden: KITLV Press.
Shohat, E. (1992). Notes on the Post-Colonial. Social Text 31-32, 99–113.
Silitoe, P. (2002). Globalizing Indigenous Knowledge. In: Silitoe, P., Bicker, A. Pottier, J. (Eds.) Participating In Development. London: Routledge. 108 -138.
Silitoe, P. (2007). Local Science vs. Global Science: Approaches to Indigenous Knowledge in International Development. New York: Berghahn Books.
Susanty, F. (2020, April 29). Market reports paint a bright, post-pandemic future for Indonesian ‘jamu’. The Jakarta Post. https://www.thejakartapost.com/news/2020/04/29/market-reports-paint-a-bright-post-pandemic-future-for-indonesian-jamu.html.
Triratnawati, A. (2005). Masuk Angin: Patologi Humoral Jawa. In Ahimsa-Putra (Ed.). Masalah Kesehatan dalam Kajian Sosial Budaya. Yogyakarta: BU-Kepel Press.
Triratnawati, A. (2011). Masuk Angin dalam Konteks Kosmologi Jawa. Humaniora 23, 326 – 335.
Van den Daele, W. (2004). Traditionial Knowledge in Modern Society. In Stehr, N. (Ed.). The Governance of Knowledge. New Brunswick: Transaction Publishers. 27-39
Weydmann, N., Großmann, K., Tijaja, N., Erb, M. (2020, September 8). Healing in context - Traditional medicine has an important role to play in Indonesia’s fight against the coronavirus. Focaal Blog. https://www.focaalblog.com/category/blog/.
Weydmann, N. (2019). Healing is not just dealing with your body: a reflexive grounded theory study exploring women's concepts and approaches underlying the use of traditional and complementary medicine in Indonesia. Berlin: Regiospectra Verlag.
Whittal, J. (2020). COVID-19. What the health pandemic can teach us about universal healthcare. Medicins Sans Frontieres. https://www.msf.org.uk/article/covid-19-what-coronavirus-pandemic-can-teach-us-about-universal-healthcare.
WHO (1978). Declaration of Alma Ata. https://www.who.int/publications/almaata_declaration_en.pdf.
WHO (2020a). Coronavirus disease (COVID-19) advice for the public. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public.
WHO (2020b). Global Health Observatory (GHO) data. https://www.who.int/gho/health_workforce/physicians_density/en/.
World Bank (2008). Investing in Indonesia’s Health: Challenges and Opportunities for Future Public Spending. Health Public Expenditure Review 2008. World Bank: Jakarta.
Wuragil, Z. (2020). Virus Corona Masuk Indonesia, Bisa Ditangkal dengan Minum Jamu? Tempo. https://tekno.tempo.co/read/1314444/virus-corona-masuk-indonesia-bisa-ditangkal-dengan-minum-jamu.
Yates, R. (2020). Let’s emerge from COVID-19 with stronger health systems. Chatham House. https://www.chathamhouse.org/expert/comment/lets-emerge-covid-19-stronger-health-systems.
Yuval-Davis, N. (2010). Theorizing identity: beyond the ‘us’ and ‘them’ dichotomy. Patterns of Prejudice, 44(3), 261-280.
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2021-03-19
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