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? 

For the past couple of years, Van has been carrying a map of northern Vietnam with her, "to find my uncle and bring him back home," she explains. At first, the way she talks about her uncle makes me think that he's still alive. Only as our conversation progresses, I finally understand that he passed away in the "American War", as the Vietnamese call the Vietnam War, and his remains have yet to be found. Running a small silk shop with regional handicrafts, Van is the one in her family who travels the most and while she is looking for local weavers for beautiful fabrics, she also carries out the family search for her uncle's remains.

Thousands of families are searching for their relatives who died in the war and since official information is rare and hard to obtain, they seek help from psychics and spiritual mediums of the exact locations (read more from the BBC). Van's family has attended a session where a psychic channeled her uncle's spirit into her cousin. But the spirit was of the dumb kind and couldn't answer any questions so the family continues to seek help through professional mediums. “We know of the right place, once three mediums have given us the same information, then we can be sure.”

Medium centers from the outside looks like homes or offices but inside the living communicate with the dead – many to seek answers to their decade-long searchers for the remains, but some to just talk with the deceased because they miss them, are concerned of their well-being or need their advice.

When the remains of a family member are home, mediums aren't needed as the ancestor's spirits are readily accessible in prayers and dreams. Every Vietnamese home seems to actively care for the family altar as the ancestors are perceived as extremely important for the physical, emotional and financial well-being of the family. “It's the duty of the living to care for the spirits of the deceased and send them whatever they might need,” Van explains. This is done by burning paper money in all currencies, paper clothes, and even paper motorbikes, airconditions, TVs, cell phones and laptops. The idea is that happy spirits can better protect the family.

“The ancestors give us advice and help us with important decisions. It's common that an ancestor has an opinion and helps us make the right decisions, for example when we buy a house or a family member is sick and requires medical treatment. Then, the ancestors might tell us which hospital to go to, whether to trust that doctor, or when to stop or change a treatment plan.”

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