Therapeutic practices in everyday life: Illness and health seeking in a rural community in Sri Lanka
Therapeutic practices are enacted by people, around the world, as a means of improving or restoring health. While the ubiquity of therapeutic practices is well documented, there is surprisingly little research into the concrete practicalities of their enactment in everyday life. Further, the contemporary social scientific literature on medication use and care practices is largely concentrated on Western societies and/or the Global North, with a pronounced lack of contemporary studies into small rural communities which straddle the old/new worlds of biomedical and traditional therapeutics.
The present study was designed as a focused/ short-term ethnography on a rural resource-poor community in Sri Lanka. It was shaped around questions on people’s understanding(s) of diverse therapeutic practices, their enaction in participant homes, the flow of medications to and from the homes, and therapeutic practices as implicated in the everyday life of the households and the community. I, a Sri Lankan researcher, carried out the fieldwork in one village over a period of nearly three months. The principal method of data generation was household interviews: 20 interviews which included 47 participants (15 men, 25 women and seven children). To gain greater insights into therapeutic practices in the households, photography (of medications) and participant observation (of treatment seeking activities) were used. Additionally, four popular local healers were interviewed in order to better understand the practices involving traditional therapeutics.
Prior to analysis, the household interviews (carried out in Sinhala language) were transcribed and translated to English. Interview data, photographs and fieldnotes were thematically analysed through an iterative analytical process of coding, identifying themes, and drawing out key concepts. The conceptual framework was built primarily on the theoretical work of Veena Das and Annemarie Mol, to explore therapeutic practices as situated and arising within ordinary life.
The findings of the study point to the complexities of a diversified postcolonial therapeutic landscape as played out in resource-poor households. On the whole, household therapeutic practices were identifiable in relation to one or more of the following therapeutic modalities: ‘English medicine’ (biomedicine), ‘Sinhala medicine’ (traditional herbal medicine), supernatural therapeutics, and Buddhism-inspired religious healing. As such, therapeutic practices appeared as hybrid practices that seep into and merge different therapeutic modalities; however, the therapeutic potential of these enactions remains situated and relational. Further, medications are entangled in relations of risk, responsibility and trust, as implied through their spatiality in the homes. They are also variously implicated in time, such as in terms of temporal organisations of treatment and generational transmission of therapeutics.
In addition, it was found that people access a range of healthcare providers, from public hospitals providing fully subsidised healthcare (which, however, often involve other costs) to fee-levying biomedical/traditional practitioners and community pharmacies. Cost-effectiveness of treatment is often prioritised, given the overriding economic concerns of households. Once treatment is received, it is variously adapted, modified or even discontinued within the home. Be it in navigating healthcare settings where they get marginalised as poor and less educated, or in adapting therapeutics to suit their needs and circumstances, what becomes clear is the ingenuity, perseverance and care with which people engage in health seeking and therapeutic practices. I draw on Annemarie Mol and colleagues’ notion of ‘tinkering’ in care practices, and propose a complementary metaphor of ‘wrangling’ to capture the complexities and contingencies of health seeking in a resource-poor community.
As such, the present study aims to contribute new empirical knowledge on therapeutic realities in a postcolonial/non-Western setting, as well as useful insights to inform public health and policy development in the country. In terms of theoretical contribution, the study seeks to problematise the productivity of Western theoretical notions when adapted to make sense of lived experiences elsewhere. The potential of a situated ethnography in furthering a decolonial research approach towards postcolonial/indigenous/non-Western societies is also examined.