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? 

In China, riding on busses with chain smokers and in polluted cities, our mouth masks have become our best friends.

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mouth-mask-a-multi-purpose-tool-oykrgJyuIwkvAzjxfvpq.zip (2.47 MB)

In Vietnam, the mouth mask is part of the motorbike outfit together with the helmet and gloves during chilly weather.

It also protects you from 'cold winds' entering through the mouth and nose which are commonly believed to be causing sickness. In China, it's utilized to protect others from one's own sickness.

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mouth-mask-a-multi-purpose-tool-xqhpIDlBcGeruDEwoero.zip (3.65 MB)

But there is more to the mouth mask than health. Mouth masks are also utilized in the quest for white skin. What a tan is in the West, white skin is in Asia. And probably even a little more desired, as white skin speaks of higher social class, especially for women. So for this social engineering purpose, women of lower social standing do everything to protect their skin from the sun. 

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mouth-mask-a-multi-purpose-tool-ydxItBhmFaGyBAlqGCID.zip (3.33 MB)

For those of dark pigmentation, there are a range of products to whiten your skin (Pakse, Laos). Alas, it's impossible to find a skin moisturizer that doesn't offer to whiten your skin. And just to be on the safe side, this Nivea deodorant also does the job under your armpits (Bangkok, Thailand).

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mouth-mask-a-multi-purpose-tool-DBCbroDoqFkHiFnawdtu.zip (5.89 MB)

When Chinese travel, their souvenirs include the usual knickknacks as well as local produce such as fruit, honey, meats and also natural medicinal products. Unfortunately, the US and many other countries disagree with such practices and many Chinese travelers have to give up their often pricy purchases. Next time you are at an international airport and a flight from China arrives, watch how the customs activities increase and the dogs sniff around to detect any last bits and pieces of produce.

In Vietnam and Laos, it also seems to be a common practice to purchase medicinal souvenirs. Shops selling local natural remedies are right next to the touristy souvenir stores. In Sapa, Vietnam, close to the Chinese boarder, many natural medicinal products are sold as imports from China. Our Vietnamese friend Yen tells us how her brother bought some of these maggots soaked in alcohol and is crazy about this medicine. Whenever he feels under the weather, it's his first choice to get better.

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This one below are herbs crushed to make a powder for medicinal baths. The Red Dzao tribe use these herbal baths to stay healthy and energetic in the mountains. More on their herbal baths here.

In Laos at a famous waterfall sightseeing spot, local natural medicinal products are sold next to souvenirs: dried roots, dried frogs on sticks and palm sugar wrapped in bamboo fibre.

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Where the river Mekong flows from Laos into Cambodia, the mighty river widens and thousands of islands appear. Some are so small that only a single small bush grows on it, others are much larger and populated. On one of these island villages we met a man in his early thirties who runs a guesthouse with his family. One morning at breakfast, his aunt approaches us with a picture of a rather large Thai monk who has many necklaces hanging down his chest. She had just returned from an all-night prayer at the local temple where she received some pieces of strings to protect from ghosts and evil spirits. These strings are tied around the wrist for protection. Sometimes certain colors refer to specific organs or body parts that needs extra protection.

Spirits live in trees and when you cut down a tree the spirits get angry at you and will cause you to have an accident. We've seen many offerings of incense, food and flowers to big Banyan trees all over SE Asia.

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angry-spirit-causes-accident-czyJBxpCysEAsyhxgsyd.zip (3.22 MB)

I wonder about conversations at the ER when the admission doctor takes down the Health and Physical and is told about the involvement of spirits. Or, are spirits not talked about at the hospital and only 'dealt' with at the temple?

The guesthouse owner doesn't want to talk further about his aunt but explains to us that ghosts are everywhere and come out especially at night. He asks us whether we believe in ghosts, and it gets a little awkward as we try to say what we really think without stepping on his toes. His answer is: “50% - you never know so better play safe.”

More on the Laotian Baci Ceremony here.