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? 

While in Traditional Chinese Medicine there are five elements, everyone I know and have shared health experiences with here in China just refers to two different states: hot (“shang huo”) and cold (“zhao han” or “han liang”). Xiao Zhang*, a college graduate in Kunming, tells me “whenever I get a cold, I first feel for the symptoms to determine whether it's a cold cold or a hot cold. Actually, I always listens to my body to feel what's missing, to stay balanced. If I feel “shang huo”, I eat “cooling” foods to regain my balance.”

Eating in China is all about maintaining balance. For example, fatty foods and most meats lead to an “overheating” of the body with symptoms such as zits and cold sores. Eating bitter tasting greens and roots can have a “cooling” effect and bring your body back into its balance.

This mindset stretches way beyond the freshly prepared foods, into the heart of the supermarket snacking aisle. Lay's has cleverly identified this underlying mental model for their sales of chips. Chips being greasy automatically classify as hot foods, leading many people to hesitate before purchasing this snack. Who wants to break out in zits or even get a cold? Lay's came up with rather unconventional flavors that claim to counteract the heating effect of chips: cherry tomatoes and green cucumber flavors to be cool and refreshing. I wonder what the impact has been on their sales numbers.
The Chinese supermarket snacking aisle also has numerous other cures for overheated bodies, for examples Gui Ling Gao herbal jello and Wang Lao Ji herbal tea. For the first time, I came across apple vinegar drinks. Before I'd only heard about them in the US (thanks to Helena and Rebecca) and now they have them in China, too. Unfortunately nobody could tell me whether this would help with excessive heat or cold.
Curious about other conditions, I ask Xiao Zhang whether the flue is hot or cold. “The flue is a very complex condition. One has to be very careful,” she concludes.

*Name has been changed to protect anonymity of the patient.

(download)

Click here to download:

Binary_Health.zip (5.59 MB)