March, 2011:

We are on the plane leaving Asia for Europe. The past three months have been an incredible experience rich in stories and anecdotes, pictures of artifacts and personal health experiences. While there are still so many stories to be written down and shared with you, here are a couple of themes that have bubbled up and sit at a higher level. It's probably not quite accurate to lump China and Indochina together, as there are major differences between each country and region, but given the similarities, I'll attempt it anyways.

1) Maintain the health balance through daily action
One thing that strikes me as major difference between Asian and Western notions of health, is the perception of the default state of health. Growing up in Germany and the UK, I get the sense that being healthy is perceived as normal. If you become ill, something is wrong with you. In China, and it also seems to be the case in Vietnam and Thailand, health is a matter of balance. Everyone seems to be taking something for one ailment or the other. While it is normal to constantly do something for one's health by eating the right foods and taking natural medicine, I wonder how people perceive sickness.

A while ago, I came across an academic paper published by a medical anthropologist that examined how people felt about the common cold versus the flu in Europe. There seems to be an intriguing difference: while people felt that coming down with a cold was their fault, for example they hadn't dried their hair properly after a shower (a Celtic belief) or didn't wear a scarf in cold weather (also a Celtic belief), the flu was perceived as something beyond their control.

Do people feel guilty when they get out of balance, i.e. sick, because they haven't done the right things to prevent it?

2) Fine-tune well-being
Western medicine is known and admired for it is fast acting and solves a big problem quickly. It excels at fixing life threatening emergencies. However, its strength isn't to create sustained well-being . Traditional Chinese Medicine (TCM), herbs and other remedies take longer but enhance one's well-being as they bring the body back into a balanced state. In China, severe and chronic conditions, such as diabetes or hypertension, are not only treated with Western medicine, but also with TCM. In Vietnam and Thailand, it seems that people also complement their treatments with additional herbal medicine from pharmacies that cater both, Western and herbal medicines.

3) Strengthen cultural health identity by practicing local health rituals
Strong presence of Western development organizations seem to push local practices of healing to the periphery, it seems. Cambodia and Laos, the two least developed countries in the region, seemed to have the highest numbers of development organizations, and a correlation with lowest number of herbal pharmacy shops visible and accessible from the street. Are there any development organizations that includes local health practices?

So, when people are poor and cannot afford western medicine, they perceive their local health practices as poor man's solution. It's cheaper and more accessible than western medicine. Health organizations often lump local practices together with superstitions and so practices get pushed to the periphery. Until they are stopped being practiced, maybe.

On the flip side, as people become more well-off, when is Western medicine THE cure versus A cure? What difference does it make for people in their journeys from sickness to wellbeing when local health practices are included by the western medicine healthcare provider vs sought out by themselves? In China, it seems that cultural health practices bring a cultural pride and identity to people. What happens, when people loose this notion of cultural health-self?

Story:
Southern Medicine - Vietnam's medical identity?

4) Including the spiritual world for a complete health stakeholder map
Accidents, disease or disability are commonly linked to people's superstitions and beliefs in ghosts and spirits of the ancestors. While in the West, scientific explanations are sought, it seems that the Asian approach looks into both worlds: the spiritual and the scientific. It's easy to claim that the more educated and developed people are, the more they focus on the scientific explanations. The stories that I've come across suggest something else: both worlds exist in parallel – just to play safe? Or, are there important socio-cultural needs that aren't addressed by the rational scientific approach? The spiritual aspects deal both with the emotions of the individual as well as the family and larger community.

Stories:
Laos - Angry spirit causes accident
Vietnam - Ancestor's spirits top doctor's orders

5) ...?

This is by no means a complete list, and I am curious to hear from you. What patterns have you observed? What is missing? 

At a bookstore in Phnom Penh, we find out some interesting Cambodian cultural titbits: avoid closing business deals on Wednesdays as it brings bad luck; when a cat gives birth people dry and keep the cat placenta in their house for good luck; and it's common for Cambodians to seek the help of a shaman when they are unwell. The latter of course interests me the most. These shamans are called kru in Khmer, derived from the Sanskrit word for teacher 'guru'. The guide book continues “... don't be disturbed if the kru spits on and rubs saliva over your face.” Sounds like an intriguing story for WellAroundTheWorld, so we set out on our mission to find a kru.

In Siem Reap we hire a tuk-tuk driver for multiple days to visit Angkor Wat, Banteay Srei and the other breathtaking sites of the ancient Khmer empire. As we get to know our driver Mr L, we stir the conversation towards health and eventually ask him whether he knows a kru. He is surprised about this request but agrees to take us to one.

A little bit of background: Mr L is 32 years old and a farmer. He is married and has four daughters. His wife takes care of the farm and he contributes to the family income operating a tuk-tuk mostly for tourists. He's been a tuk-tuk driver for seven years and local English classes have helped him to become fluent for his day-to-day business. His fashionable glasses and fluent English let him appear more educated and worldly than he actually is. Mr L took his first pill at age 18. He's only had one experience with needles, that was one year ago when he was given infusions for malaria.

Mr L tells us about the options for treating a health problem for local Cambodians: “When you have money, you go to the hospital. When you don't have money, you go and see a kru. Children are different, we can take them to the local Children's hospital. That is free of charge, but a farmer like me can only afford the kru.”

As we are sitting in the tuk-tuk full of anticipation, James and I envision dark alley ways, a place tucked away from the hustle and bustle of the touristy streets of Siem Reap, pots full of herbal medicine boiling over wood fires, strange smells, and a chanting kru performing the spitting ritual.

When Mr L pulls off to the curbside, we stand in front of what looks like a normal pharmacy. Maybe it's got a second room inside where the 'magic' takes place?

Nothing.

It's a normal pharmacy selling Western medicine. The most exotic thing we find is chicken essence soup cubes. What's has happened? Did he misunderstand our request?

Mr L tells us: “This kru is really good. I explain to him what I have and he gives me medicine. Last time I came here I had an upset stomach. I got a tablet and felt better within a couple of days. He is number one kru. I used to go to a different one, but he wasn't any good. This kru is the best.

To Mr L, there is no difference between a pharmacist trained in western medicine and a kru who administers herbal medicines and other rituals. To him, a kru is simply someone who gives you advice and helps you get better. Kind of makes sense, but we can't help being disappointed that we missed out on the kru experience that we had imagined.

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As Peace Corps Volunteer, James taught Maths and basic computer skills at Mzumbe secondary school. In his final year, he set up computer labs across the region.

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When we visited in June, 2011, we heard the following story from one of the teachers:

One night in the rainy season, some students claim to have seen a creature with a bushy tail pass through the school campus. In the Kiuluguru language, this is called a zombwe. After the sighting, the students noticed a rash appearing on their bodies, especially on their faces and necks, and connected this with the sighting of the zombwe.

They called the disease Mzumbeitis Zombwesis, until their teachers heard about it and laughed at the students: “These are just normal insect bites! The students study late in the night and insects swarm around their desk lights.While the students are studying hard, all heads down, they get bitten by insects! That's the real cause for Mzumbeitis Zombwesis.”

Superstitious beliefs even among the top students are common and teachers feel that it's their responsibility to clarify the scientific causes.

The traces on the skin of the fabulous creature zombwe makes the better story, though.

In his last year as Peace Corps volunteer, James had set up computer labs across multiple schools in the Morogoro regions. One of the schools is run by missionaries: fathers from Kerala, India. We spent some time with the fathers at their retreat outside of Dar, where seven brothers from Zambia, Uganda, Mozambique and Kenya come together for an intensive year of praying as part of their preparation for priesthood. In the spirit of self-sufficiency, they keep cows and ducks, have fruit orchards and a vegetable garden.

Father John* shows us around and we get to admire the curry leave tree and all sorts of other trees which produce leaves and fruits that are used in South Indian cooking. The green fruit hanging from the tree is custard apple, and the yellow round one in the hand is a passion fruit.

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Behind the house, we notice some flowers that are left out in the sun to dry.

These are hibiscus flowers and when dried are added to shampoo to die gray hair black. I was surprised to see such indulgence in vanity at a missionary retreat. Father John and the others giggle about Father Paul* and his habit, but don't seem to interfere and leave him his grooming treatment. He hand picks the flowers and leaves them to sun dry.

It seems that pampering themselves is one of the things the fathers don't abstain from. Staying in their dorms, we are given a towel and soap, and are surprised of their choice: Ayu soap, exclusive fragrance soap, with natural lotus oil. “with a special conditioner made for delicate skin keeps your skin soft and moisturized.”

What can be unpacked about this choice of soaps?

One possible explanation might be the following: since they've all decided to live a celibate life, their grooming of course isn't for courtship. But there seems to be a strong connection between maintaining one's appearance as well as displaying cleanliness and spiritual purity. Another aspect: while these vegetarian-raised South Indian fathers have given up many things in their lives for joining the seminary, they seem to have gained something else:eating meat and carving out the luxury to groom themselves.

Or maybe, Ayu is just the cheapest soap out there - the fathers are good at managing a tight budget.

*names as always changed to protect people's privacy

Years ago, a guy friend told me about an additional use scenario for tampons in the Norwegian military: when female soldiers crawl through the mud and wade through mirky waters, they can catch vaginal infections. So, they use tampons for protection.

This was the first time I had heard of the usage of a tampon to prevent things from going in, instead of protecting things from coming out and causing much embarrassing blood stains.

What a great opportunity space to rethink the tampon to not only offer 'leakage protection' but also preventing contamination. Apart from claiming greater comfort and supposedly easier insertion, nothing much has happened in this industry for a while - until I came across these products at my favorite drugstore dm* in Germany in June, 2011.

Extra protection
This kind of tampon is specially designed for women to enable them to go swimming and do exercise in water during their periods.

Health enhancer
This brand pushes the boundaries even further: their tampons not only protect but even promote vaginal health. The brand understands that women who frequently experience vaginal thrush infections are more cautious to use tampons. So they repositioned their brand as vaginal health enhancers. Treated with pro-biotic 'goodness' they claim to add good bacteria to fight off thrush infections caused by bad bacteria. This way, it allows them to tap into the market of non-tampon using women offering them the comfort of using tampons and at the same time fighting off future thrush infections. Does it really work, though?

Bonus: they are made of fibers that have not been bleached and are all natural - reassuring every worry of their customers.

*dm is a drugstore chain in Germany and Austria, currently expanding into Eastern Europe. Beyond great products, dm is known for their employee-friendly management and their sustainability programs. Their founder Goetz Werner bases his approaches on Rudolph Steiner's Anthroposophy. More on his business approaches and focus on the human being here.