Leiden: KITLV Press, 2008. xii, 252 pp. (Maps, B&W photos.) US$44.00, paper. ISBN 978-90-6718-278-2.
Restoring the Balance is a welcome addition to the ethnographic literature of Pacific cultures, dealing with the relatively little-known interior of the Bird’s Head of West Papua in eastern Indonesia. The monograph is narrow in scope, focusing on the performance of healing rituals in the village of Ayawasi, in the northwest Ayfat District. Ien Courtens has revised her 2005 anthropology doctoral thesis from the Radboud University Nijmegen, Netherlands. The work is based on field research in 1994-95 supplemented by a brief return visit ten years later.
The heart of the monograph is a single detailed case study of the serious illness of Mama Raja, a woman of high status in the village. The illness extended over a period of several weeks, giving ample opportunity for the family to draw on the full range of healing resources in the community. The author uses the case as a framework for discussing the hierarchy of resort to health care.
Early in her illness, Mama Raja performed private healing rituals, using the extensive knowledge of medicinal plants and spells she had acquired in initiation. When the illness continued, her family called in specialized male healers who performed the traditional rites appropriate to their understanding of the cause of her illness. One healer named a witch; another used a glass of water for divination of the spirits responsible.
Simultaneously, Mama Raja pursued biomedical treatment, getting a laboratory diagnosis of malaria and treatment from the nurses in the outpatient clinic. The clinic was first established in the village in 1963 by Dutch Missionary Sisters (CPS) who were replaced by Indonesian Franciscan sisters and local staff in 1992.
The final healing performances for the desperately ill Mama Raja, after the local priest had already conducted the last sacraments, were the syncretistic rites of the Christian healing society Kelompok Sabda, a peculiarly local integration of Christian and indigenous healing practice.
The term “hierarchy of resort” was introduced by Lola Romanucci-Ross in 1969, describing the search for health in Manus, Admiralty Islands, Papua New Guinea. The concept is well-established in medical anthropology, so it seems odd that Courtens does not credit her or other medical anthropologists who have struggled with the question of the extent to which different modes of treatment are accessed (1) in a firm sequence, (2) simultaneously, or (3) simply as a matter of convenience. In the end, Courtens comes down on the first option, that there is a firm hierarchy, since she knew of no cases in which an indigenous healer was called in after a Christian healer had begun to treat the case.
The use of a single dramatic case study is a common strategy in medical ethnography, this one inviting comparison with several such monographs from neighbouring Papua New Guinea (e.g. Gilbert Lewis, Verena Keck). The strength of the case study approach is that it makes a good read, an engaging narrative with all the tension of a novel, while allowing readers to absorb a good deal of cultural and geographical information. Fieldwork methods are worked in along the way. A particular fieldwork challenge was the requirement of secrecy imposed by the women who taught Courtens the names and uses of 60 or 70 medicinal plants, few of which were botanically identified or could be named in the text.
The weakness of the dominant case study is that by definition it is an atypical case, however repeatedly its generalizability might be asserted. Also, a reader unfamiliar with West Papua is left with a myriad of questions that would not flow in a narrative but might have been answered in a differently organized presentation. This reader had at least one pesky question per page: What were the injections given for malaria? Where did the local priest get a seminary education that helped him confidently develop a contextual theology? What is “malaria tropica”? (For that one, at least, finding an answer was easy: it is better known as falciparum malaria.)
The volume is attractively presented, with numerous photographs, map, glossary and index. The monograph can be recommended for university libraries and anthropology students at any level.
Patricia K. Townsend
University at Buffalo,The State University of New York, USA
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