Medical Anthropology Studies Research Articles

Traditional remedies and other characteristics among human snakebite survivors in Baringo county, Kenya, 2010-2020: a case series.

Seeking traditional remedies following snakebites leads to avoidable deaths in rural settings in developing countries. In this case series study, we identified and recruited 169 snakebite survivors in Baringo county, a hard-to-reach region in northwestern Kenya, who experienced snakebites from 2010 to 2020 using a snowballing technique. We explored associations between traditional and hospital care in managing snakebites and other characteristics. χ2 tests assessed these categorical differences. Fifty-four (33%) of the survivors used traditional remedies to manage snakebites. The majority (56%) were men and aged >18y (72%); 59% had low education levels and income. They sourced water from rivers or lakes (93%) and used charcoal as an energy source (74%). These survivors (>67%) resided in households practicing free-range and stall-feeding animal husbandry systems and in houses with thatch roofing or an earthen floor structure. Also, >62%reported muscle tremors, fever and chills, while 80% visited health facilities for further treatment. Community sensitization covering the risks of non-effective remedies and escalation of training to traditional healers could improve the speed of referrals in hard-to-reach snakebite hotspots. Medical anthropology studies could explore the enablers of continued use of traditional remedies in snakebite management in rural communities.

The narrative paradox of the BRCA gene: an ethnographic study in the clinical encounters of ovarian cancer patients

In this era of personalisation a patient’s molecular profile plays an increasingly central role in development and delivery of personalised medicine. This paper sets out to explore the sociocultural implications of mainstreaming BRCA genetic testing in the treatment of advanced ovarian cancer patients, who carry a BRCA1 or BRCA2 gene mutation. It draws on ethnographic research conducted by between April-June 2016 in a large tertiary London hospital. Participant observation was conducted across two sites. For the first two weeks participant observation was conducted in the traditional genetic testing setting in two separate clinics. From thereon, participant observation was conducted in the clinical encounters of treating patients in the ovarian cancer clinic. In addition, face-to-face interviews were conducted with medical oncologists who worked in the clinic. Contributing to the fields of cancer genetics, personalised medicine and medical material culture studies in medical anthropology the paper seeks to further discussions about the interactions and relationships unfolding between medical objects and subjects across the landscape of cancer care. It highlights the importance of clinic-based ethnography to examine the complexities of identities and technologies as they intersect with the themes of suffering and hope in new and contradictory ways for BRCA-positive patients with late-stage disease. The paper argues that a BRCA mutation is not only central to the political economy of hope but takes on a more materialist nature as it becomes an embodied practice that moves in and beyond the clinic.

The Culture of Terrorism Da'ashi and its Implications on Iraqi Society Medical Anthropology Study

The main theme of the research is the culture of terrorism and its implications in the Iraqi society-a study of medical anthropology in Tikrit. The most important cultural, social, psychological and health effects of the terrorist organization on the residents of Tikrit during the period of occupation. To reach the most important of these effects, and by staying in the study community for an appropriate period, and to reach important results.

Antropologia Médica Vitalista: uma ampliação ao entendimento do processo de adoecimento humano

Antropologia é a ciência que tem como objetivo estudar o homem em sua pluralidade de modos de vida e de pensamento, incorporando os diversos aspectos da individualidade às suas modalidades de estudo (biológica, social, cultural e filosófica). Por sua vez, a Antropologia Médica estuda os fatores que influenciam o processo saúde-doença, incluindo os aspectos biossocioculturais e os variados sistemas de saúde. Seguindo o objetivo intrínseco de estudar o homem em sua pluralidade, a Antropologia Médica Vitalista fornece subsídios filosóficos para uma ampliação do entendimento do processo de adoecimento, analisando o mecanismo saúde-doença em conformidade com a estrutura ontológica humana. Fundamentando o diagnóstico e o tratamento das doenças em diversas racionalidades médicas não convencionais (Medicina Tradicional Chinesa, Medicina Tradicional Indiana, Medicina Homeopática e Medicina Antroposófica), a concepção vitalista é uma doutrina filosófica que considera a existência de uma força (princípio) vital responsável pela manutenção da saúde e da vida, unida substancialmente ao corpo físico. Além disso, valorizando a interação de outras instâncias superiores da individualidade humana (mente, alma e espírito) no equilíbrio fisiológico-vital, a concepção vitalista inclui a influência dos pensamentos, sentimentos e emoções na etiopatogenia e na evolução das doenças, aspectos difundidos pela dinâmica psicossomática moderna e pelo recente campo de pesquisas que relaciona a saúde à espiritualidade.

Counting bodies? On future engagements with science studies in medical anthropology

ABSTRACTThirty years ago, Nancy Scheper-Hughes and Margaret Lock outlined a strategy for ‘future work in medical anthropology’ that focused on three bodies. Their article – a zeitgeist for the field – sought to intervene into the Cartesian dualisms characterizing ethnomedical anthropology at the time. Taking a descriptive and diagnostic approach, they defined ‘the mindful body’ as a domain of future anthropological inquiry and mapped three analytic concepts that could be used to study it: the individual/phenomenological body, the social body, and the body politic. Three decades later, this paper returns to the ‘three bodies’. It analyses ethnographic fieldwork on chronic illness, using a rescriptive, practice-oriented approach to bodies developed by science studies scholars that was not part of the initial three bodies framework. It illustrates how embodiment was a technical achievement in some practices, while in others bodies did not figure as relevant. This leads to the suggestion that an anthropology of health need not be organized around numerable bodies. The paper concludes by suggesting that future work in medical anthropology might embrace translational competency, which does not have the goal of better definitions (better health, better bodies, etc.) but the goal of better engaging with exchanges between medical and non-medical practices. That health professionals are themselves moving away from bodies to embrace ‘planetary health’ makes a practice-focused orientation especially crucial for medical anthropology today.

Multidisciplinary Study on Immigrants African and Asian Children’s Health: Socio-Cultural Factors Influencing Breastfeeding

In 2013-2014, NIHMP (the National Institute for Health, Migration and Poverty) carried out a project study in medical anthropology titled “Clinical and social evaluation of medical practices in paediatric treatment of infectious diseases for children belonging to vulnerable populations”. Keywords: Barriers to breastfeeding, migrants, children, healthcare, medical anthropology.

Clinical Practice and Knowledge in Caring: Breastfeeding Ties and the Impact on the Health of Latin-American Minor Migrants.

In the context of the project "Clinical and social evaluation of medical practices in the treatment of infectious diseases in pediatrics for children of vulnerable population" carried out in 2013 by a multidisciplinary team at the National Institute for Health, Migration and Poverty (NIHMP) in Rome, a study in medical anthropology on the incorporation of illnesses that mothers feel they transmit to their children through breastfeeding was conducted. The results of the anthropological study, that targeted 34 children and adolescents from the age of 3 to the age of 17, all immigrants from Latin America residing in Italy, show that some forms of suffering in minors are described by women as being connected to factors such as susto ("fright"), coraje, muina, enojo ("anger") and mal de ojo ("evil eye"), and are in relation to a specific cultural frame. It is clear that barriers that prevent the access to the healthcare system must be removed, barriers that are accentuated by linguistic and cultural incomprehension, through adequate multidisciplinary healthcare settings such as the one we are presenting, composed of a medical doctor, an anthropologist and a cultural mediator.

Deaf capital: an exploration of the relationship between stigma and value in deaf multilevel marketing participation in Urban India.

This article ethnographically examines how some deaf people in urban India have begun to orient themselves toward the future by participating in multilevel marketing businesses. In the absence of other structural possibilities for deaf future-making, deaf Indians have turned to such businesses in search of social, economic, and moral livelihood. This article analyzes participation in one particular business and asks how participating within the business both enables and disables the cultivation of specific ideas of development. Particular attention is devoted to exploring the multiple registers of the concept of "deaf development" and how such development may be cultivated through multilevel marketing businesses. This article aims to make a critical intervention in medical anthropology studies of disability by arguing that disability (or in this case deafness) can function as a source of value, therefore highlighting tensions between stigma and value.

Neurofibromatosis Type 1: Persisting Misidentification of the "Elephant Man" Disease

during informal interviews in the course of an ethnographic study on intergenerational dialogue between individuals with neurofibromatosis and their parents, many members of Canadian neurofibromatosis associations have stated that they continue to be told the condition that afflicts them or their children is "elephant man's disease." Today, even though well-established clinical criteria make it possible to diagnose and differentiate the 2 diseases, the confusion between neurofibromatosis type 1 (NF1) and elephant man's disease persists in both the media's and physicians' representations. this was an ethnographic study in medical anthropology. some reference sources and print and online news media have all contributed to the persistence of the association between NF1 and elephant man's disease. Our observations suggest that confusing NF1 with the Elephant Man's condition harms the interests of those with NF1 and thus increases the burden of the disease. changes of attitude regarding medical teaching and the media could dispel the confusion among physicians and journalists.

Thinking about Dementia: Culture, Loss, and the Anthropology of Senility (review)

Reviewed by: Thinking about Dementia: Culture, Loss, and the Anthropology of Senility Martha Holstein Annette Liebing and Lawrence Cohen, eds. Thinking about Dementia: Culture, Loss, and the Anthropology of Senility. Studies in Medical Anthropology. New Brunswick, N.J.: Rutgers University Press, 2006. vii + 299 pp. $68.00 (cloth, ISBN-10: 0-8135-3802-5, ISBN-13: 978-0-8135-3802-0), $24.95 (paperbound, ISBN-10: 0-8135-3803-3, ISBN-13: 978-0-8135-3803-7). The dementias, especially Alzheimer's disease (AD), elicit anxiety and dread. They are often perceived as the end point of the aging process in a society that seems capable of accepting old age only if the person maintains many features associated [End Page 493] with middle age, that is, be "not old."1 Such cultural values reinforce the visceral fears about aging that resurface each time we forget a colleague's name or search for glasses that were just in our hands. For these and other reasons, I welcome Thinking about Dementia. The essays in this volume open a particular window on Alzheimer's disease that is historically revealing, clinically useful, and intellectually stimulating. In the remainder of this brief review, I can highlight only a few themes, but that is no reflection on the overall quality of the entire work. Historian Jesse Ballenger importantly situates the conversation about Alzheimer's disease in the larger arena of aging. In contrast to other essays in the volume, he argues that AD is still stigmatized and "overshadow[s] the entire experience of aging" (p. 107). The fear, he suggests, that accompanies threats to the self and a coherent identity cannot be easily eliminated by the "facts" of the disease. In contrast, André Smith's subjects—all younger women—found the diagnosis of mental illness more stigmatizing than that of AD. AD was a "real" neurological disease, an acceptable medical problem capable of explaining their symptoms. Is the stigma of dementia so closely linked to the "fallen" state of old age in which one has not aged "successfully" so that it provokes feelings of stigma that do not similarly affect younger women? In their very rich chapter on genomics and Alzheimer's, Lock, Lloyd, and Prest also mention the moral neutrality of Alzheimer's compared to mental illness. This chapter's focus, however, takes the reader in another, perhaps surprising, direction. Given the considerable attention now attributed to genetic links with even late-onset dementia (work on the gene APO4), these investigators found that neither clinicians nor adult children caring for a parent with AD paid much attention to genetics. While not mentioning stigma, one can wonder if Kaufman's study of "Alzheimer's near death" and the troubles families encounter as they face decisions about life-extending treatment might also be linked to the ambiguous nature of AD: is it a disease or not, and, if not, what actions can be justified? This collection's significant attention to personhood is an important effort to recover the strengths and potential of the person with AD. The "personhood" movement emerged in reaction to the almost single-minded focus on cognition and neurological changes in the brain that had so long dominated the dementia "industry." In Leibing's words, the "double gaze" of biomedicine and personhood reveal different people, and treatment as a reaction to one or the other of these perspectives elicits very different responses. Other writers, like Anne Basting and Pia Kontos, explore voice and how some coherence might be achieved through narrative, dramatic production, creative storytelling, and collaborative preservation of memory. For many, AD is the fate worse than death. I recommend this book to health and social service providers and to family members who want to understand the unresolved dilemmas that this condition opens so that they may gain a sense of how we might integrate AD into our concept of what it means to be a person. [End Page 494] History has certainly shown us the mutability of how AD has been understood medically, socially, and culturally. This book suggests that the final story has not yet been told. It also reminds us that, while a cure is not at hand, changes in...

Disability in Local and Global Worlds (review)

Benedicte Ingstad and Susan Reynolds Whyte, eds. Disability in Local and Global Worlds. Berkeley: University of California Press, 2007. 324 pp. Disability is realized through a complex web of human, structural, and ideational interactions that turn bodies and ailments into subjects, citizens, and/or statuses, at times providing benefits, at other times denying opportunities or preferred futures. The essays in Disability in Local and Global Worlds, edited by Benedicte Ingstad and Susan Reynolds Whyte, convey this complexity. The contributors explore disability in local contexts, at the levels of individual, kin, and community, and at the same time, also consider the ways in which disability experiences are influenced by global forces, institutions, advocacy and rights movements, nonprofits, and governments, to name a few. Building upon themes covered in their 1995 co-edited volume on disability (Disability and Culture), the editors provide a timely and critical look at definitions of abnormal and of normal, ideals about the body, belonging and marginality, the politics, both near and far, of identity formation, and the implications of meanings derived from those identities. Ingstad and Whyte define disability broadly: anthropologists are interested in people's own experiences of what is disabling in their world rather than in some universal definition (11). They intend this collection to be a contribution to both disability studies and anthropology, and stress that policy-makers, healthcare professionals, scholars from various disciplines, NGOs and advocates, and others seeking to understand disability must consider the wide range of cultural contexts in which the disabled person is situated. Without feeling forced or tendentious, the volume has an applied element, as many studies in medical anthropology do. Ingstad and Whyte hope that, ultimately, the descriptions and analyses presented in the volume will prompt scholarship and debate (25). They assert that for the study of disability, there is still a need for work that provides a more radically comparative perspective through the juxtaposition of ethnographies and the questioning of global (9). The volume is divided into two parts, the first, Locating Embodied Entities, includes six chapters, each of which deal with disability or disabling conditions in different contexts, demonstrating that what is disability is often unique to a community's cultural ideals regarding normalcy, completeness, correct functionality, or acceptability of the body. These chapters explore the ways in which some-bodies experience themselves and their world through interacting with other subjects and imagining horizons (Ingstad and Whyte 2). Hilde Haualand, for example, analyzes the Deaf Olympics (Ch. 1) as a ritual gathering, where a dispersed, transnational community comes together in one place to form a brief community, reaffirm their identities and sense of belonging, and in a sense transcend the everyday boundaries of disability. In an essay on the changed meaning of female circumcision to Somali women immigrants to the UK, Aud Talle (Ch. 2) makes a notable contribution to our understanding of the contextualization and interpretation of bodies, and the impact these processes have on marked persons. For Talle, the reterritorialization of a local practice such as female circumcision in the global setting of a human-rights discourse may help us theorize 'disability' one step further (57). In Egypt and India, as Marcia Inhorn and Aditya Bharadwaj explain in Chapter 3, new biomedical technologies available to treat infertility signal a change in opportunities among a socially stigmatized group still living in the context of traditional expectations. Infertility is now experienced in both old and new ways, as sufferers negotiate the socio-cultural implications of fertility treatment options. These first three essays help to broaden notions of what disability is, and how it is experienced, by relocating familiar topics within new or unexplored contexts. …

Ethnographic study of factors influencing compliance to intermittent preventive treatment of malaria during pregnancy among Yao women in rural Malawi

In Africa today one of the main strategies to reduce malaria infection during pregnancy is the promotion of intermittent preventive treatment (IPT). To date only a few studies have investigated the factors affecting compliance to IPT. This medical anthropology study aims to describe these factors from the perspective of pregnant women in rural Malawi. We examine women's knowledge and perceptions about the use of medication in pregnancy and the timing and motivation concerning use of antenatal clinic (ANC) services. In addition, the circumstances and interaction at the ANC and the IPT implementation process are described. The data were collected by applying an ethnographic approach, including focus group discussions (n=8), in-depth interviews (n=34), drug identification exercises, participant observation and a 'knowledge, attitudes and practices' survey (n=248). This study discovered several factors affecting IPT. These were: unclear messages about IPT with sulfadoxine-pyrimethamine (SP) from nurses; timing of SP-1; periodic shortages of SP; women's limited understanding of IPT-SP; tendency for late enrolment; and nurses' underperformance. The results of this study show that understanding of the multiple contexts affecting malaria prevention is important, and that ethnographic research is useful for discovering and solving problems beyond the scope of many other research approaches.

O medicamento, um objeto de futuro na antropologia da saúde

O medicamento-produto farmacêutico industrial-tornou-se um objeto central de estudo em antropologia médica no decurso dos dez últimos anos. O artigo passa em revista as condições históricas que conduziram os antropólogos, até então interessados pelos "remédios" provenientes dos saberes autóctones, a considerar os medicamentos. Depois de uma apresentação das abordagens teóricas, que são autoridade nesse assunto, discute-se a relação entre medicamento e cultura. São apresentados os estudos recentes referentes a cinco eixos temáticos: a polissemia e a "cadeia" dos medicamentos; as multi terapias anti retrovirais, pedido dos médicos e significações para os pacientes; os estudos em antropologia política e crítica dos sistemas terapêuticos, a dimensão "iatrogênica" dos medicamentos; a emergência dos medicamentos neo tradicionais. São discutidas as perspectivas de pesquisa referentes, principalmente, ao domínio da produção científica e industrial dos medicamentos.

Donner un sens à la maladie : de l'anthropologie médicale à l'épidémiologie culturelle

Every illness raises questions concerning its causes and even more its meaning. Why me? Why him? Why now? These questions call for an interpretation which goes beyond a simple application to the individual body and the medical diagnosis. This search for meaning is by no means an archaic attitude and does not only concern the cryptic fields of medicine as several studies in medical anthropology and transcultural psychiatry have shown. A review of literature in anthropology points out the basic concepts of "health care system", "explanatory models", "etiological theories", and "causality of illness". The contribution of these studies to epidemiology and public health of infectious and tropical diseases is discussed through the development of so called cultural epidemiology based on the methodology of the Explanatory Model Interview Catalogue.

What is a disease?

At first sight, the answer to “What is a disease?” is straightforward. Most of us feel we have an intuitive grasp of the idea, reaching mentally to images or memories of colds, cancer or tuberculosis. But a look through any medical dictionary soon shows that articulating a satisfactory definition of disease is surprisingly difficult. And it is not much help defining disease as the opposite of health, given that definitions of health are equally tricky. The World Health Organization's claim that health is “a state of complete physical, mental and social well‐being, not merely the absence of disease or infirmity” (WHO, 1946) has been praised for embracing a holistic viewpoint, and equally strongly condemned for being wildly utopian: the historian Robert Hughes remarked that it was “more realistic for a bovine than a human state of existence” (Hudson, 1993) It might not be easy to articulate what a disease is, but we like to think we would at least all know when we saw one. Unfortunately, this is problematic as well. Notions of health are highly context‐dependent, as human diseases only exist in relation to people, and people live in varied cultural contexts. Studies in medical anthropology and sociology have shown that whether people believe themselves to be ill varies with class, gender, ethnic group and less obvious factors such as proximity to support from family members. What counts as a disease also changes over historical time, partly as a result of increasing expectations of health, partly due to changes in diagnostic ability, but mostly for a mixture of social and economic reasons. One example is osteoporosis, which after being officially recognized as a disease by the WHO in 1994 switched from being an unavoidable part of normal ageing to a pathology (WHO, 1994). This has consequences for sufferers‘ …

Human activities and American trypanosomiasis. Review of the literature

Trypanosoma cruzi, the causative agent of American trypanosomiasis (Chagas disease) is a parasite of wild mammals of Americas. It has been further transmitted to man through an insect vector belonging to the Reduviidae family. In the context of an ecoepidemiological study of this vector borne anthropozoonosis, a medical anthropological overview tries, by using data from literature, to clarify the different ways human activities play on the disease epidemiological cycle. The everyday human activities support domiciliation of triatomine bugs. But, the human intervention in the natural environment disturbs strongly the ecology of the vectors or hosts and leads to a new structuring of the natural foci of the disease with its displacement toward the human environment. The way society or individuals manage the disease plays also an important role. Some human activities, as building dwelling structures, have been well studied, but some others, such as the real impact of the human modes of production, are less known. A medical anthropology study of the role of human activities on the foci of Chagas disease is still needed.

Sociocultural impact of Alzheimer disease in a group of families. A case study in medical anthropology

Sociocultural impact of Alzheimer disease in a group of families. A case study in medical anthropology

Cultural Meaning, Explanations of Illness, and the Development of Comparative Frameworks

Starting with the cultural domain of illness and considering the issue of cross-cultural comparisons at the level of meaning, this article discusses the cognitive anthropological approach taken in my research, specifically examining the use of structured interview methods and the collection of illness case histories for cross-cultural comparative endeavors. I situate my own work in relation to several past attempts to construct conceptual schemes for comparing theories of illness causation across cultures. Based on my analysis, I suggest that the tension between existing comparative schemes and efforts to understand how illness is culturally constituted in specific locations can be productively used to construct a comparative framework that remains open to ethnographic possibilities (cf. Hallowell 1960:359). (Cross-cultural comparisons, theories of illness, Ojibway, Tarascan) Illness and suffering are universal human experiences which come to be endowed with cultural meaning. As such, the domain of explanatory frameworks for illness is an appropriate one for cross-cultural comparative research. How illness is understood and dealt with in diverse cultural settings is addressed by a large number of medical anthropology studies. In addition, several general schemes for categorizing theories of illness causation across cultures exist. Three of the better-known proposals (Murdock 1980; Young 1976; Foster 1976) are reviewed here. Although these schemes have been around for some time, their continued relevance is attested to by recent medical anthropology textbooks that organize discussions of cross-cultural variability in etiological understandings with reference to one or more of these schemes (e.g., Anderson 1996:82-86; Loustanau and Sobo 1997:91-103; Brown 1998:15, 110). The ethnographic material considered here is drawn from two field studies.(1) One site is Pichataro, a town in the highlands of the west-central Mexican state of Michoacan, where both Pur6pecha (Tarascan) and Spanish are spoken. (Most of this work was carried out in conjunction with James C. Young.) The other site is an Ojibwa community in Manitoba, Canada. This choice was influenced by A. Irving Hallowell's insightful writings (e.g., Hallowell 1942, 1955, 1976), which led to an appreciation that the Ojibwa might be an illuminating contrast with Pichataro. (Rather than Ojibwa, the terms Anishinaabe, or its plural Anishinaabeg, will be used, as this is how people refer to themselves.) Research in the Anishinaabe community was explicitly designed to be comparative with my earlier work in Pichataro. Adopting a cognitive anthropological approach, the intent was to make comparisons at the level of cultural meaning. In both sites, the focus was on discovering the nature of cultural knowledge brought to the occurrence of illness, how this knowledge is applied in evaluating illness, and what considerations are brought to bear in making treatment decisions; i.e., how illness forms part of these meaningful worlds. Cultural understandings are resources which may be variably drawn upon to help make sense of one's own or another's experiences (Garro 2000). Thus, cultural understandings do not function in a top-down deterministic manner but rather are better seen as tools (which both enable and constrain interpretive possibilities) available to navigate the ambiguity surrounding illness and other troubling experiences. COMPARATIVE FRAMEWORKS FOR THEORIES ABOUT ILLNESS Murdock (1980) coded the ethnographic literature from 139 societies to examine the cross-cultural distribution of twelve illness theories. These theories are of two main types; natural causation and supernatural causation. Theories of natural causation he defined as any theory, scientific or popular, which accounts for the impairment of health as a physiological consequence of some experience of the victim in a manner that would appear reasonable to modern medical science (Murdock 1980:9). …

Margaret Clark's Enduring Contribution to Latino Studies in Medical Anthropology

argaret Clark's stature in Latino studies in medical anthropology stems in large part from the publication of her 1959 monograph, Health in the Mexican American Culture. The book helped to move the emerging field of medical anthropology beyond the narrow gaze that characterized most earlier ethnomedical research (cf. Humphrey 1945; Saunders 1954; van derEerden 1948). Earlier work in medical anthropology tended to focus on the exotica of health beliefs and practices, with little regard to their contexts or social significance. In contrast, Clark's work helped to demonstrate that ethnomedical phenomena could be profitably analyzed as both reflecting and perpetuating broader sociocultural processes. Alongside works by such noted medical anthropologists as Richard Adams, George Foster, Octavio Romano, Arthur Rubel, Benjamin Paul, Lyle Saunders, and Ozzie Simmons, Clark's richly textured analyses added to the enduring impact ethnomedical research with Latinos has had on medical anthropology as a field. Clark's research on sociocultural aspects of health and illness in the economically disadvantaged Mexican American barrio of Sal si Puedes, San Jose, California, helped to establish the legitimacy of ethnographic research with non-Native American populations in the United States while drawing early attention to key issues that continue to interest medical anthropologists to this day. The work focused on informal sector health care, particularly as it was managed within households and by extrahousehold relatives, neighbors, and friends. This perspective helped to set Clark's research apart. Until then, anthropologists had been more interested in the dramatic, colorful, and often supernaturally inspired healing specialists, such as spirit-mediums, diviners, and priests or specialists such as bone-setters and herbalists who controlled well-defined bodies of expert knowledge (e.g., Edgerton 1971; Hallowell 1942; Handelman 1967) And they, like the ethnographers who studied them, were generally men.

The Possessed and the Dispossessed: Spirits, Identity and Power in a Madagascar Migrant Town

This finely drawn portrait of a complex, polycultural urban community in Madagascar emphasizes the role of spirit medium healers, a group heretofore seen as having little power. These women, Leslie Sharp argues, are far from powerless among the peasants and migrant laborers who work the land in this plantation economy. In fact, Sharp's wide-ranging analysis shows that tromba, or spirit possession, is central to understanding the complex identities of insiders and outsiders in this community, which draws people from all over the island and abroad. Sharp's study also reveals the contradictions between indigenous healing and Western-derived Protestant healing and psychiatry. Particular attention to the significance of migrant women's and children's experiences in a context of seeking relief from personal and social ills gives Sharp's investigation importance for gender studies as well as for studies in medical anthropology, Africa and Madagascar, the politics of culture, and religion and ritual.