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Teaching Medical Anthropology in Nepal: Of Doctors, Journals, and Web Sites

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                                                                         Students trekking near Pokhara. (courtesy Mary Cameron)

For two consecutive years, in 1999 and 2000, undergradu­ate and graduate students from Auburn University in Alabama participated in a study abroad class that I designed entitled “Medical Anthropology in Nepal.” The course is a hybrid of in-class preparatory lectures and seventeen days of intensive study in Nepal. This article is intended to provide a review of the traditional and nontraditional forms of learning used in the course, a summary of the travel planning process, and some guidelines for those interested in planning similar courses with travel components. With most study abroad courses in Nepal being at least one semester, and typically one year long, the med­ical anthropology course is unique as a study abroad course in that it is short by comparison.

Throughout my years of conducting research and living in Nepal, my Nepali colleagues and American students have encour­aged me to involve them in some way in what I do. Thus, with the momentum from my research on Ayurvedic medicine having evolved beyond a preliminary stage, I decided to organize a course on the subject of health care in Nepal with a focus on Ayurvedic medicine. The course goal was to provide students with a cross-cultural learning experience in which they could explore the role of an indigenous form of medicine in a develop­ing country. Through contact with practitioners of Ayurvedic medicine, the students would gain knowledge of the variety of training and professionalization experiences of doctors, ranging from family apprenticed to university educated. The students would also observe the many threats to Nepal’s medicinal plant wealth, and would gain critical perspectives on the Nepali state’s role in shaping health care delivery, and how Ayurvedic medicine is erroneously but typically represented as an “alternative medi­cine” in the United States. Most importantly, the students would gain first-hand experience in the health care challenges facing a poor country.

To briefly summarize Ayurvedic medicine, it is considered one of the world’s best examples of a non-Western medical sci­ence and is widely practiced throughout South Asia. My own interest in Ayurveda came about through years of observing the plant- and humoral-based medical practices of the community of rural farmers I lived with as a Peace Corps volunteer and later as a researcher pursuing my doctorate. The word “Ayurveda” means “knowledge of life.” Classical Ayurvedic medicine, described in ancient medical texts which are over two thousand years old, the­orizes the body as comprising three humors (tridosa: vata/wind, pitta/bile and kapha/phlegm), with qualities in dynamic equili­brium with internal and external substances (food, metals, animals, plants) and phenomena (seasons, planets). Ayurvedic ideas are not confined to the medical and the biological, but inform political, religious, social, sexual and physical domains common to the everyday lives of urban and rural South Asians.

. . . Ayurvedic medicine presents a sharp contrast to the kind of medicine most American students are familiar with; the course encouraged the students to move outside their familiar culture bound frames of understanding the body and its functions, and to consider new paradigms and possibilities of understanding somatic functions.

This indigenous ‘ecology’ and ‘economy’ of the body and person in Ayurvedic thought are in sharp contrast to the biomed­ical model of the body. There the mechanistic and individualized body is vulnerable to attack from discrete pathogens that form equally discrete and classifiable etiologies and nosologies. In its positivist goal of scientific objectivity, modern biomedicine dis­tances the subject and subjective experience; Ayurvedic medicine, in contrast, makes the subject’s daily practices, social relation­ships and environmental surroundings integral to diagnosis and treatment. Indeed, the very word for health is swasthya, which means where one is, or self-place. Clearly, Ayurvedic medicine presents a sharp contrast to the kind of medicine most American students are familiar with; the course encouraged the students to move outside their familiar culture-bound frames of understand­ing the body and its functions, and to consider new paradigms and possibilities of understanding somatic functions.

The course took several months to initially design and orga­nize. The overseas part of the course would take place during 17 days of the spring break, following five predeparture lectures, ice-breaking activities, and sessions intended to address student con­cerns (most of which were about their own personal health). To advertise the course, I created a glossy brochure produced on my home computer that incorporated digitized photographs of Nepal, a brief itinerary, descriptions of the country, and approximate cost ($2,200, not including personal expenses). I presented a one-hour evening summary of the course to the 20–25 students who had contacted me; the final group sizes were 11 the first year and 13 the second year. Much of the Nepal-side planning was done with colleagues who own and operate a travel and trekking business in Kathmandu. They arranged the hotels, meals, 4-day trek, sightsee­ing and in-country transportation. I managed the finances, which began with the well-received news that financial assistance from Auburn University was available to most of the students. Students secured their place with an initial deposit, and a final deposit that covered airfare, lodging and breakfast, trek, speakers’ fees, trans­portation, and incidentals was paid three weeks before leaving. All other meals and expenses were covered out of pocket. Students were responsible for receiving immunizations completing University release forms, and obtaining passports and visas, all of which I checked at intervals during predeparture.

The first course requirement was to attend five 2-hour pre-departure lectures. During these sessions we discussed the course readings, cultural expectations, the history and culture of Nepal, and how to stay healthy; reviewed lists of things to bring; and talked about the students’ fears and expectations of the trip. Stu­dents’ prior international experiences varied, so these sessions also aimed at developing rudimentary cross-cultural communication skills. I maintained daily e-mail contact with the students, plying them with reminders, deadlines, assigned readings, Internet links of interest, and reading, food, and clothing recommendations. All course readings, assignments, syllabus, itinerary, list of things to bring, including medicine and clothing, rules of etiquette and codes of conduct while in Nepal, and important Internet links were put on a University regulated Web site. This allowed students access to the materials even while in Nepal. In addition to their luggage, students were asked to carry one box of books donated by my department colleagues, to be given to the Department of Anthropology and Sociology at Tribhuvan University in Kathmandu.

Once we arrived in Kathmandu and rested after the 25-hour journey, we settled into a regular daily schedule. The hotel’s lounge functioned as the classroom. It was on the ground floor with easy access to the lovely gardens and the hotel restaurant dur­ing breaks. The “classroom” was equipped with a phone and sev­eral electric outlets (for audio and video recording of lectures), and hotel staff were close by to assist with last minute prepara­tions; in a few instances, invited lecturers came with special requests not indicated earlier, and a staff person would run out to the market to obtain the needed good. The lounge-classroom had plenty of natural light and comfortable seats, and was decorated with Tibetan rugs from the owners’ personal family collection.

Lectures took place in the morning and ended at noon. Speak­ers included Ayurvedic and biomedical doctors, anthropologists, an astrologist, and development activists. Ending the classes with a lengthy question and discussion period, we would then break for lunch as a group, and prepare for afternoon excursions into the city. Sightseeing during the afternoon was assisted by a Nepali guide, and included trips to famous temples (Swayambunath, Pashupati­nath, Boudhinath), visits to Ayurvedic clinics and to the Ayurvedic teaching hospital, the Tibetan Refugee Center, and ancient villages. A few afternoons were set aside as free time for students to go shopping, which they did with great energy! We would meet as a group for dinner, when I would guide the class on discussions of their experiences, encouraging them to express not only their awe and fascination, but also the troubling feelings they might be experi­encing. In the evenings, students would continue writing in their journals, and visit me if necessary during my “office hours” (every night from 6–7). The first week of the Nepal part of the course ended with a four-day trek outside of Pokhara, an area famous for its lakes and spectacular views of the Himalayas. We returned to Kathmandu for the final three days of lectures.

Lecture room in Kathmandu hotel. (courtesy Mary Cameron)

Class grades were based on a journal, four ethnographic field projects, and a final project, with attendance counting for a small percentage of the final grade. The four projects were designed to sharpen the students’ skills of observation by mapping a block of the city (which many did from the hotel rooftop), observing a ritual (partially or entirely), observing and describing body lan­guage, and briefly eavesdropping on a conversation. The three rules of journal writing I insisted on were: (1) begin each entry with place, date and time, and other relevant information; (2) pro­vide as much detail as possible; and (3) keep the journals with them at all times, and write in them whenever possible. I provided the students with abstract ideas (such as balance, contradiction, and beauty) and words relevant to everyday life in Nepal (family, farming, environment, body, illness, food, poverty, clothing, streets, sidewalks, graffiti, art), from which they could develop short journal essays. I encouraged them to ask questions of the Nepalis they would meet, and to take notes as they traveled that could be converted into longer passages later. I told them to draw, to collect images, to be creative, and to be absorbed. Details they should pay attention to included their physical surroundings, the appearance of people, smells, sounds, animals, vegetables, air quality, time of day, feelings, what they wore, and what they ate. They were reminded that nothing is too trivial. Techniques for writing included imagining writing to others, writing to a deceased loved one, writing to one’s child, writing to oneself, and writing to a teacher. If they heard an inspirational quote (common in the Hindu and Buddhist culture and art that surrounded them), they were encouraged to explore it in writing. Ideas about religion and spirituality, and concepts common to Buddhism and Hinduism that they were asked to pay attention to and write about in their journals included nonaggression, conditional existence, nondualism, emptiness/formlessness, medi­tation, death, birth, karma, dharma, reincarnation, compassion, generosity, courage, female, and male. I suggested to them that connections between self and other could be explored and experienced in their interactions with Nepalis, the impact of place on self and mind, moments of self-reflexivity, and culturally based negotiations of public and private space. I left them with the challenge to make the strange familiar and the familiar strange.

The completed journals were interesting in their variety and style. Some were stunning in visual content and often surprising in their level of cultural understanding. Others expressed anxiety about friends and family back home, while still others are reposi­tories for found objects depicting the fusion of modern and traditional elements that are the visual forms of Kathmandu con­sumer and tourist culture. All the journals contained extensive descriptions of Ayurvedic theory and practice, including notes from lectures and readings, and visual depictions of the dosa (humors). Reflecting the students’ desire to learn Nepali lan­guage—an effort truly appreciated by the Nepalis they met—most of the journals contained numerous Nepali words and phrases.

The final projects were to be completed before midterm of the following semester at Auburn. Many chose electronic formats, while others elected to write conventional research papers. Of the students who chose to do electronic projects, most had to learn how to construct simple Web pages. I arranged for some students from Auburn’s architecture program to assist the students in the technicalities of Web design. The electronic projects and other photographs from the trip are located at the Auburn Univer­sity Anthropology program’s Web site, www.auburn.edu/ anthropology. Sample projects include the living goddess Kumari, medicinal plants, arts and handicraft, refugees, women’s organizations, monks, Buddhist temple architecture, modernity, environmental challenges, and nutrition.

What made the course successful was the combination of extensive planning and endless attention to details (the logistical side), and the freedom given to the students for self-guided experiential learning (the pedagogical side). Two students went on to formally study Ayurvedic medicine in India and Nepal, and still others have entered graduate school to study medical anthropology and public health.

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For two consecu …

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连续两年,在1999年和2000年,undergradu­吃从阿拉巴马州奥本大学和研究生参加了一个留学类,我设计了《医学人类学在尼泊尔。“课堂预备课的课程是一种混合在尼泊尔和17天的深入研究。本文旨在提供一个审查中使用的传统和非传统形式的学习课程,旅游规划过程的总结和一些指导方针对于那些感兴趣的规划与旅游组件类似课程。与大多数留学课程在尼泊尔被至少一个学期,通常一年长,地中海­ical人类学课程是一项独一无二的留学课程,它是由比较短。

SELECT BIBLIOGRAPHY


Cameron, Mary M. On the Edge of the Auspicious: Gender and Caste in Rural Nepal. Champaign, Illinois: University of Illinois Press, 1998.

Durkin, Maureen. 1988. “Ayurvedic Treatment for Jaundice in Nepal,” Soc. Sci. Med. Vol. 27(5) (1988) 491–5.

Hill, Deborah. Innovative Approaches to Curriculum Design in the Study Abroad Program. Renaissance Publishing, 1987.

Himalayan Ayurveda Research Institute. Project Report: Medicinal Plants and Traditional Medical Practice in Gorkha District. Kathmandu, Nepal: Gorkha Development Project/GTZ, 1996.

Justice, Judith. Policies, Plans and People: Culture and Health Development in Nepal. Berkeley: University of California Press, 1986.

Leslie, Charles and Allan Young (editors). Paths to Asian Medical Knowledge. Berkeley: University of California Press, 1992.

O’Sullivan, Marie. Academic Year Abroad 2001: The Most Complete Guide to Planning Academic Year Study Abroad (Serial). Washington, D.C.: Institute of International Education, 2001.

Stone, Linda. “Concepts of Illness and Curing in a Central Nepal Village,” Contri­butions to Nepalese Studies 3 (Special Issue, 1976), 55–80.

_____ “Primary Health Care for Whom? Village Perspectives from Nepal,” Soc. Sci Med. Vol. 22 (3) (1986) 293–302.

Swinger, Alice. Planning for Study Abroad. Phi Delta Kappa International Inc., 1985.

Zimmermann, Francis. The Jungle and the Aroma of Meats: An Ecological Theme in Hindu Medicine. Berkeley: University of California Press, 1987.

_____ “Gentle Purge: The Flower Power of Ayurveda,” Paths to Asian Medical Knowledge, Eds. Charles Leslie and Allan Young. Berkeley: University of Califor­nia Press (1992), 209–23.

Zysk, Kenneth. Asceticism and Healing in Ancient India: Medicine in the Buddhist Monastery. New York: Cambridge University Press, 1991.