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Beyond the anglophone world
Sm. Sri. Med. Vol. 33, No. 6, pp. 741-742, Printed in Great Britain
BEYOND MEDICAL
0277-9536/91 $3.00 + 0.00 Pergamon Press plc
1991
THE ANGLOPHONE
ANTHROPOLOGY
It is only this year that the field of medical anthropology will be recognized in The Netherlands as a specialty via the establishment of a Chair and an official faculty department at the University of Amsterdam. This does not mean, however, that anthropologists conducting research in the field have neglected to form networks and forums for the exchange of experiences and research findings. One of the first activities undertaken was the publication, from December 1983 to December 1986, of the Nieuwsbrief Medisch Antropologie (Medical Anthropology Newsletter) at the University of Amsterdam. The first issue provided an overview of the activities and publications of 64 social scientists who considered themselves medical anthropologists de facto; among those listed were Belgian researchers, a result of the links between Holland and Flemish speaking Belgium which has continued to date. The Newsletter contained articles, announcements and book reviews; special issues were devoted to body symbolism, medicines, general practitioners and nutrition. Follow-up to the Newsletter began in 1989 with publication of the journal Medische Antropologie (Medical Anthropology). The editorial board, divided evenly between social scientists from the Netherlands and Belgium, welcomes contributions from established researchers as well as students who report on field-work. Article topics appearing in the first three issues have been diverse, including anthropological methodology, socio-cultural interpretations of physical disability, patient-doctor interactions in a multicultural context, collaboration between general practitioners and medical anthropologists, and sociocultural factors related to the distribution and use of medicine. Many contributions focus on exploratory and descriptive research, although theoretical questions have occasionally been highlighted (e.g. how should culture be defined in relation to studies concerning migrants, the contribution of psychodynamic theory in explaining the placebo effect, reception theory as background for the assumption that anthropologists do not collect existing data but rather produce them during interactions with respondents). Reports on research also appear regularly in general Dutch anthropological and sociological journals as well as the journal on migrant studies. In recent years, practitioners in the field have collaborated with medical sociologists in conferences and symposia. One group which meets regularly is focusing on a ‘linkages perspective’ in research concerning primary health care (PHC). They devote attention to differences and similarities between PHC-related social organization, cultural values and communication at vertical levels (international,
WORLD
IN THE NETHERLANDS
national, regional, local) as well as horizontally across levels and over time. In 1988 they developed an outline for an international comparative research programme in collaboration with colleagues from India, Indonesia, Peru, the Philippines, Somalia and Zimbabwe [I]. Conferences held in 1989-90 included: ‘Technology and the practice of health care’ and Medicines from an anthropological perspective. The conference on ‘Gender, health and development’ attracted participants from Belgium, France, the Scandinavian countries and the United Kingdom and was organized in collaboration with staff members and students of the Social Sciences Faculty of the University of Leyden and the Medical Faculty of the Free University in Amsterdam. Medical anthropological and sociological perspectives are further promoted in Holland via two special courses which are open to all Dutch university students. At the University of Amsterdam, the course focuses on medical anthropology, while the University of Leyden course treats the topic of medical sociology and health organization in developing countries; yearly, about 80 students attend these courses. At the Royal Tropical Institute in Amsterdam, anthropologists further contribute to the HP Unit’s research and advisory programme, the AIDS Coordination Bureau (which deals specifically with AIDS in developing countries), and courses offered to people working in the health-care sector of developing countries (including the International Course on Health Development, a Master of Public Health programme offered specifically to students from developing countries). Two points are noteworthy in the practice of medical anthropology in the Netherlands. First is the fact that health-related issues in Dutch society are receiving as much attention as the ‘classic’ research themes in developing countries. Nevertheless, with regard to the former field, the studies have to a great extent concentrated on the provision and use of biomedical services to and by (im)migrants. This research has been strongly influenced by demands from the biomedical profession for assistance in overcoming problems encountered in dealings with these patients; it involves on-going debates on the role of ‘cultural’ (e.g. language, religion, family structure, health and illness concepts) versus ‘sociological’ (socio-economic and migrant status) factors in types of illness presented, illness experience and expression, patient-health worker communication and use of services. Attention for patient-health worker interactions and lay concepts concerning specific illnesses and use of medication among Dutch ‘natives* is gaining ground but mainly among medical sociologists. As in other countries, ‘ordinary’ medical insti741
142
Beyond the Anglophone World
tutions and health practices in their own society still seem to constitute a largely ‘foreign’ territory for medical anthropologists in the Netherlands. The second point of note is a strong ‘action-oriented’ component in Dutch medical anthropology. This is partly because few positions are available at universities, so that financing for research to a great extent comes from third parties who wish to have specific ‘practical’ topics investigated. On the other hand, the medical anthropologists themselves often show a strong orientation towards making concrete contributions to the improvement of health-care services. In organized form, this finds its expression, for example, in the Medical Development Cooperation Working Group (WEMOS), whose research bureau was instituted by critical medical students. WEMOS staff members and volunteers (often anthropologists who work for the group on a temporary basis while trying to find employment) study socio-economic factors affecting the health of people in developing countries and the role of the Dutch Government and organizations in relation to this. Critiques of Dutch development assistance in the medical field are
brought forward in an effort to intluence the policymaking of governmental and other bodies, such as the pharmaceutical industry. Individual researchers, too, often show an action-research bias; at many universities, students are also strongly urged to make their research findings available in the local language to authorities and organizations in the countries where they worked. Unfortunately, this practical orientation is not yet reflected in the employment figures for medical anthropologists in Holland; few are offered positions in development assistance projects, the health-care sector or university medical schools. MARIADE
P. L. Takstraat 268 1073 KL Amsterdam The Netherlad
BRum
REFERENCE
1. van der Geest S. et al. Primary health care in a multi-level perspective: towards a research agenda. Sot. Sci. Med. 30, 1025-1034, 1990.
BEYOND MEDICAL
0277-9536/91 $3.00 + 0.00 Pergamon Press plc
1991
THE ANGLOPHONE
ANTHROPOLOGY
It is only this year that the field of medical anthropology will be recognized in The Netherlands as a specialty via the establishment of a Chair and an official faculty department at the University of Amsterdam. This does not mean, however, that anthropologists conducting research in the field have neglected to form networks and forums for the exchange of experiences and research findings. One of the first activities undertaken was the publication, from December 1983 to December 1986, of the Nieuwsbrief Medisch Antropologie (Medical Anthropology Newsletter) at the University of Amsterdam. The first issue provided an overview of the activities and publications of 64 social scientists who considered themselves medical anthropologists de facto; among those listed were Belgian researchers, a result of the links between Holland and Flemish speaking Belgium which has continued to date. The Newsletter contained articles, announcements and book reviews; special issues were devoted to body symbolism, medicines, general practitioners and nutrition. Follow-up to the Newsletter began in 1989 with publication of the journal Medische Antropologie (Medical Anthropology). The editorial board, divided evenly between social scientists from the Netherlands and Belgium, welcomes contributions from established researchers as well as students who report on field-work. Article topics appearing in the first three issues have been diverse, including anthropological methodology, socio-cultural interpretations of physical disability, patient-doctor interactions in a multicultural context, collaboration between general practitioners and medical anthropologists, and sociocultural factors related to the distribution and use of medicine. Many contributions focus on exploratory and descriptive research, although theoretical questions have occasionally been highlighted (e.g. how should culture be defined in relation to studies concerning migrants, the contribution of psychodynamic theory in explaining the placebo effect, reception theory as background for the assumption that anthropologists do not collect existing data but rather produce them during interactions with respondents). Reports on research also appear regularly in general Dutch anthropological and sociological journals as well as the journal on migrant studies. In recent years, practitioners in the field have collaborated with medical sociologists in conferences and symposia. One group which meets regularly is focusing on a ‘linkages perspective’ in research concerning primary health care (PHC). They devote attention to differences and similarities between PHC-related social organization, cultural values and communication at vertical levels (international,
WORLD
IN THE NETHERLANDS
national, regional, local) as well as horizontally across levels and over time. In 1988 they developed an outline for an international comparative research programme in collaboration with colleagues from India, Indonesia, Peru, the Philippines, Somalia and Zimbabwe [I]. Conferences held in 1989-90 included: ‘Technology and the practice of health care’ and Medicines from an anthropological perspective. The conference on ‘Gender, health and development’ attracted participants from Belgium, France, the Scandinavian countries and the United Kingdom and was organized in collaboration with staff members and students of the Social Sciences Faculty of the University of Leyden and the Medical Faculty of the Free University in Amsterdam. Medical anthropological and sociological perspectives are further promoted in Holland via two special courses which are open to all Dutch university students. At the University of Amsterdam, the course focuses on medical anthropology, while the University of Leyden course treats the topic of medical sociology and health organization in developing countries; yearly, about 80 students attend these courses. At the Royal Tropical Institute in Amsterdam, anthropologists further contribute to the HP Unit’s research and advisory programme, the AIDS Coordination Bureau (which deals specifically with AIDS in developing countries), and courses offered to people working in the health-care sector of developing countries (including the International Course on Health Development, a Master of Public Health programme offered specifically to students from developing countries). Two points are noteworthy in the practice of medical anthropology in the Netherlands. First is the fact that health-related issues in Dutch society are receiving as much attention as the ‘classic’ research themes in developing countries. Nevertheless, with regard to the former field, the studies have to a great extent concentrated on the provision and use of biomedical services to and by (im)migrants. This research has been strongly influenced by demands from the biomedical profession for assistance in overcoming problems encountered in dealings with these patients; it involves on-going debates on the role of ‘cultural’ (e.g. language, religion, family structure, health and illness concepts) versus ‘sociological’ (socio-economic and migrant status) factors in types of illness presented, illness experience and expression, patient-health worker communication and use of services. Attention for patient-health worker interactions and lay concepts concerning specific illnesses and use of medication among Dutch ‘natives* is gaining ground but mainly among medical sociologists. As in other countries, ‘ordinary’ medical insti741
142
Beyond the Anglophone World
tutions and health practices in their own society still seem to constitute a largely ‘foreign’ territory for medical anthropologists in the Netherlands. The second point of note is a strong ‘action-oriented’ component in Dutch medical anthropology. This is partly because few positions are available at universities, so that financing for research to a great extent comes from third parties who wish to have specific ‘practical’ topics investigated. On the other hand, the medical anthropologists themselves often show a strong orientation towards making concrete contributions to the improvement of health-care services. In organized form, this finds its expression, for example, in the Medical Development Cooperation Working Group (WEMOS), whose research bureau was instituted by critical medical students. WEMOS staff members and volunteers (often anthropologists who work for the group on a temporary basis while trying to find employment) study socio-economic factors affecting the health of people in developing countries and the role of the Dutch Government and organizations in relation to this. Critiques of Dutch development assistance in the medical field are
brought forward in an effort to intluence the policymaking of governmental and other bodies, such as the pharmaceutical industry. Individual researchers, too, often show an action-research bias; at many universities, students are also strongly urged to make their research findings available in the local language to authorities and organizations in the countries where they worked. Unfortunately, this practical orientation is not yet reflected in the employment figures for medical anthropologists in Holland; few are offered positions in development assistance projects, the health-care sector or university medical schools. MARIADE
P. L. Takstraat 268 1073 KL Amsterdam The Netherlad
BRum
REFERENCE
1. van der Geest S. et al. Primary health care in a multi-level perspective: towards a research agenda. Sot. Sci. Med. 30, 1025-1034, 1990.