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

这项研究调查了南非本土医学的现状和实践者，调查了历史和殖民叙事如何形成医学的法律图景，以及如何在政策和实践中调动真正医学的复兴代表。在殖民时期的南非，土著和生物医学之间的关系变得紧张，因为殖民官员管制土著人民如何行医。土著治疗师被限制只能使用当地的天然产品，如草药，只有白人医生才能合法地使用欧洲的药物和治疗方法；非洲禁止使用这种工具，并在“土著”、“自然”和“生物医学”实践之间形成了法律上的区分。今天，辩论艾滋病治疗的南非官员同样主张使用甜菜根和大蒜等“传统”天然材料来治疗疾病，这提出了殖民时代的人出人意料地熟悉的问题。这项研究问：随着艾滋病毒/艾滋病等新疾病和治疗方法的出现，殖民观念在当前的表现和围绕医学的斗争中表现出了多大程度？具体地说，南非关于艾滋病毒/艾滋病药物的政策中的叙述如何创造、复制或改变殖民医疗政策中的叙述？从业者对药物的使用与对土著医学的叙述有何不同或反映？使用档案数据揭示殖民话语，再加上对当代临床医生、当地从业者和决策者的采访，以了解当代辩论，随后将进行叙述性政策分析，以检查当前的政策结构。这项研究试图确定当前的辩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疾病的阐述。了解生物医学和本土医学之间的斗争在今天的南非具有重要意义，在那里，人们围绕当代的艾滋病毒/艾滋病健康危机展开辩论，估计有29%的成年人口感染艾滋病毒/艾滋病。通过了解“本土”疗法、“自然”疗法和“生物医学”疗法的使用和管理中蕴含的社会假设，我们可以更好地预测和调解南非目前在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论述及其历史根源，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艾滋病毒/艾滋病治疗的临床和教育方案。此外，了解殖民叙事如何在当前的政策和实践中重申自己，有助于消除这样一种有害的想法，即那些在生物医学规范之外行医的人这样做仅仅是因为忽视了现代生物医学的好处。相反，土著医学可能被视为传统医学和现代医学的复杂组合，两者合在一起可能对患病的人有用，使人们能够更客观地分析其对公共卫生的局限性和益处。该项目由地理与区域科学计划和国际科学与工程办公室共同支持。

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.