Doctoral Dissertation Research: The Nature of Medicine: Colonial Regulation, Nature, and Medicine in South Africa

本研究考察了南非本土医学的现状和那些实践它的人，调查了历史和殖民叙事如何形成医学的法律景观，以及在政策和实践中，真实医学的复兴代表在当前被动员起来的方式。在殖民时期的南非，由于殖民官员对土著人民如何行医进行管制，土著和生物医学之间的关系变得紧张。土著医生只能使用当地的天然产品，如草药进行治疗，只有白人医生才能合法地使用欧洲药物和治疗方法；非洲人禁止使用这类工具，并在“土著”、“自然”和“生物医学”做法之间形成了法律上的区分。今天，南非官员在讨论艾滋病的治疗方法时，同样主张使用“传统的”天然材料，如甜菜根和大蒜来治疗疾病，这令人惊讶地引发了与殖民时代相似的问题。这项研究提出的问题是：随着艾滋病毒/艾滋病等新疾病和治疗方法的出现，殖民观念在多大程度上体现在当前的医学表现和斗争中？具体来说，南非关于艾滋病毒/艾滋病药物政策的叙述如何创造、复制或改变殖民医疗政策中的叙述？从业人员对药物的使用与对土著医学的叙述有何不同或反映？利用档案数据来揭示殖民话语，再加上对当今临床医生、当地从业者和决策者的采访，以了解当代的辩论，接下来是叙事政策分析，以检查当前的政策结构。这项研究试图确定当前的争论是否以及如何不仅仅是关于艾滋病毒/艾滋病和南非的治疗政策，而且在一定程度上是对社会历史中出现的一系列结构性条件的阐述。了解生物医学和土著医学之间的斗争对今天的南非具有重要意义，南非围绕艾滋病毒/艾滋病的当代健康危机进行辩论，估计感染了29%的成年人口。通过了解“本土”治疗、“自然”治疗和“生物医学”的使用和监管中隐含的社会假设，我们可以更好地预测和调解目前在南非理解和治疗艾滋病毒方面的冲突。更清楚地了解医疗政策和话语及其历史根源，可以用来揭示对有效治疗（无论是当地的还是“西方的”生物医学）的偏见，这种知识可以用来设计更有效的临床和教育方案来治疗艾滋病毒/艾滋病。此外，了解殖民叙事如何在当前的政策和实践中重新确立自己的地位，可以帮助消除一种有害的想法，即那些在生物医学规范之外行医的人这样做仅仅是因为对现代生物医学的好处一无所知。相反，土著医学可以被视为传统和现代医学的复杂组合，它们合在一起可能对那些患有疾病的人有用，从而可以更客观地分析其局限性和对公共卫生的益处。该项目由地理与区域科学计划和国际科学与工程办公室联合支持。

This study examines the status of indigenous medicine in South Africa and those who practice it, investigating how historical and colonial narratives form the legal landscape of medicine and the ways that resurgent representations of authentic medicine are mobilized in the present, in both policy and practice. In colonial South Africa the relationship between indigenous and biomedicine was strained as colonial officials regulated how indigenous people could practice medicine. Indigenous healers were limited to using only local natural products, such as herbs, to heal and only white medical doctors could legally use European medicines and treatments; the African use of such tools was banned, and legal divisions developed between "indigenous", "natural", and "biomedical" practice. Today South African officials debating treatments for HIV similarly argue for the use of "traditional" natural materials such as beetroot and garlic to cure illness, raising issues surprisingly familiar to those from the colonial era. This research asks: to what degree do colonial conceptions manifest themselves within current representations and struggles around medicine with the advent of new diseases and treatments such as HIV/AIDS? Specifically, how do the narratives found in South African policy around HIV/AIDS medicines create, reproduce or alter the narratives found in colonial medical policy? How does the use of medicines by practitioners vary from or reflect narratives about indigenous medicine? Using archival data to uncover colonial discourses, plus interviews with current day clinicians, local practitioners, and decision-makers to understand contemporary debates, is to be followed by narrative policy analysis to examine the current policy structure. This research seeks to determine whether and how the current debate is not just about HIV/AIDS and South Africa's treatment policies, but is in part an articulation of set of structured conditions emerging from social history. Understanding the struggles between biomedicine and indigenous medicine has important implications in South Africa today, where the debate surround the contemporary health crisis of HIV/AIDS, which infects an estimated 29 percent of the adult population. By understanding the social assumptions embedded in the use and regulation of "indigenous" treatments, "natural" cures, and "biomedicine", we can better anticipate and mediate current conflicts in understanding and treating HIV in South Africa. A clearer understanding of medical policies and discourses, and their historical roots, can be used to uncover biases against effective treatments (whether local or "western" biomedical) and this knowledge can be used to devise more effective clinical and education programs for the treatment of HIV/AIDS. In addition, understanding how colonial narratives reassert themselves in current policy and practice can help undo the pernicious idea that those practicing medicine outside of the biomedical norm are doing so merely out of ignorance of modern biomedicine's benefits. Indigenous medicine might instead be viewed as a complex configuration of the traditional as well as the modern, which together may be useful to those suffering from illness, allowing more objective analysis of its limitations and benefits for public health. This project is jointly supported by the Geography and Regional Science Program and the Office of International Science and Engineering.