Medicine and health in Southeast Asia

‘The Real Expedicion de la Vacuna and the Philippines, 1803-1807’ presents the expedition of Francisco Xavier Balmis who intended to spread the smallpox vaccine from Spain to all its colonies (including Philippines). Thomas B Colvin analyzed the archives from different countries (Spain, Mexico, the Philippines, Hong Kong and Macao) to present the unknown documents about the spread of the preventive technique across the Spanish empire, focusing on its reception in Philippine. As Colvin showed, the expedition managed to deliver the vaccine using a new technique – the ‘human chain’ method – which meant transporting a number of healthy young boys who had not been exposed to smallpox and transferring the vaccine from one boy to another until they arrived at the final destination. Contrary to previous presentations of this expeditions, as the new documents showed, the expedition was well received in the Philippines. The colonial administration even provided financial support for the expedition and appointed a Central Vaccination Board to continue Balmis’ work. The chapter showed that, in this specific case, the Spanish interests (to stimulate the economic activities in the colonies by reducing the number of population affected by the smallpox) were in line with those of the colonies (to reduce the population’s vulnerability to smallpox epidemics) and this convergence had granted the success of introducing a new medical technique. Colvin also stressed the fact that at stake here there are two types of mobility: the mobility of the vaccine and of its carriers, on the one hand, and, on the other, the inter-regional and colonial networks through which the expedition had traveled.

The second chapter of the volume (‘The Nguyen Initiative to Acquire Vaccinia, 1820-1821’) presents also the introduction of smallpox vaccine in South Asia, this time in a different location – that is, Vietnam. C. Michele Thompson focused on the Nguyen Dynasty’s project to introduce the cowpox vaccine in Vietnam after the success of the Spanish success in the Philippines. Even the project was a long-term policy, as Thompson showed, it failed in its first phase, due a mistake in choosing the transportation technique: the French colonial administration chose to transport the vaccine via glass vials and, in that way, the live virus couldn’t be preserved alive through the summer heat of the South China Sea. Following this failure, the Nguyen court negotiated with the Spanish to obtain samples of the vaccine from Macao and, after the vaccine was transported safely to Vietnam the project succeeded. The chapter also stressed the regional exchanges, stressing the transnational character of the appropriation of Western medicine in Southeast Asia.

Liew Kai Khiun focused on the activities of the Rockefeller Foundation’s International Health Board in the chapter ‘Wats and Worms: The Activities of the Rockefeller Foundation International Health Board in Southeast Asia (1913-1940)’. The chapter used new archival documents related to the public health campaigns of the International Health Board, showing that those (campaigns) had relied heavily on consultations with local players and their monetary contributions as well as community mobilization. From here, as Liew Kai Khiun stressed, International Health Board of the Rockefeller Foundation can be seen as a public health interventionists, which acted to extend American influence in Southeast Asia. The chapter succeeded to present new perspectives on the activities of the Foundation and its initiative in creating a culture of public health in the region.

Annick Guénel was interested in the analysis of the Conference on Rural Hygiene which took place in Bandung (Java) in 1937. The chapter’s title contains a question at which Guénel searched to find an answer: ‘The 1937 Bandung Conference on Rural Hygiene: Toward a New Vision of Healthcare?’. The author examines the obstacles to regional (south Asiatic) public health collaboration during the 1930s and the emergence of new themes related to health in the recommendations issued at the conference (such as, the accessibility to essential’ healthcare and the recognition and participation of traditional healers and their ‘secular experience’). In Guénel’ s opinion the governments’ involvements and measured were responsible for the success of this emerging health agenda in the region and one can even identify the development of a regional agenda towards improving public health in that period of time. The main problems in implementing those measures were mainly related to the transfer of responsibility from the colonial government to the local groups and charitable foundations. In fact, as the author stressed, the thesis of state’s involvement to grant the right to health to all citizens was supported mainly by a small group of people (for example, elite doctors who advocated the anti-colonial ideas) and faced real obstacles at the grassroots level (such as superstitions and religious beliefs).

In her chapter ‘Science, Sex and Superstition: Midwifery in 19th-Century Philippines’ Raquel A. G. Reyes analyzed the ways in which Spanish and Western-trained physicians presented the indigenous midwives from the Philippines. The central thesis dealt with the relation between science and superstition but the ‘lens’ through this relation is seen are gender-sensitive: midwives were seen as completely uneducated in the context of a struggle of women’s reproductive health and of the ‘biomedicalization of domesticity’ in the 19-th Century in the Philippines. Related to that, Reyes revealed the existence of a paradox: while the Western-trained physicians lead a broad assault on superstition’ and empiricism (with the aim to make clear the distinction between scientific medicine and other practices of healing), the indigenous practitioners’ knowledge of medicinal plants was nonetheless recognized for its practical value in the Philippines. At the more practical level, the severe lack of trained professionals regarding the childbirth allowed the work of indigenous Philippine midwives in the general framework of the Western-oriented medical discourse and practices related to public health.

Liesbeth Hesselink’s chapter – ‘Dokter Djawa and Dukun: Perceptions of Indigenous Western-Trained Doctors about Traditional Healers in the Dutch East Indies around 1900’ – is centered also on the relation between indigenous medical practitioners (this time, the dukun, that is, Indonesian traditional healers) and Western-educated Indonesian doctors (that is, dokter djawa). The author analyzed the articles about dunkuns published in ‘The Journal for Native Doctors’ in the period 1893-1922 and showed the existence of some divergences between the dokter djawas and the colonial medical establishment, a prove that the effects of Western training on Indonesian social relations in the healthcare domain were not linear and simple as it could be supposed at a superficial view, but they were a mix between competition, respect and (even) exchange between various types of medical practitioners. Hesselink stress the existence of interesting forms of exchange between the dunkuns and the dokter djawas and pointed out the fact that the dokter djawas had never been a real and complete medical alternative to the dukuns – especially for local people who had preferred the indigenous traditional healers on the basis of the trust they have in dunkuns.

The chapter ‘Torn between Economics, Public Health and Chinese Nationalism: The Anti-Opium Campaign of Colonial Malaya, c. 1890s-1941’ presents the anti-opium movement and the effects it had on the Chinese communities in British Malaya. As Ooi Keat Gin showed, the history of the relations between the anti-opium movement in China and the diasporic Chinese communities on Southeast Asia at the end of the 19th century remained a rather unknown topic. The author presents the actions in this field of three prominent Western-educated Chinese doctors (Yin Suat Chuan, Lim Boon Keng and Lien-The) and stressed the difficulties they encountered in dealing with the issue when they confronted the local institutions (e.g. the British colonial government) and local powerful groups (such as the owners of opium monopolies and Chinese local syndicates with transnational connections). One important means of this political movement was the frame of anti-opium campaign in nationalist terms, trying to capitalize on the nationalist sentiment to win support among Chinese immigrants in British Malaya.

‘Hanoi in the Time of Cholera: Epidemic, Disease and Racial Power in the Colonial City’ explores the French administration’s response to three cholera epidemics in the colonial capital of Indochina, Hanoi (e.g. the epidemics from 1910, 1927 and 1937). As Michael G. Vann showed, although the aims of the measures taken to fight the disease were impressive they had as result the deepening of social differences between the whites and non-whites residents of Hanoi and, from here, the enforcement of anti-colonial feelings and actions of the local people. As Michael G. Vann stressed, in the history of French colonial intervention in the public health during that period of time (1910-1037) one could also record a series of failures for the colonial government, among which very important were forced inoculations, the examination of the dead and the criminalization of the sick among the Vietnamese. The author discussed also the issue of forced colonialist projects and its limitations in the specific case of Vietnam.

The chapter of Yu-Ling Huang (‘HIV/AIDS Epidemic and the Politics of Access to Medicines in Thailand: A Study of the Health Impact of Globalization’) examines the recent politics of access to treatment for HIV/AIDS in Thailand and discuss also some earlier efforts to face the disease. The author present the ways in which various agencies and organizations addressed the issue of AIDS/HIV in Thailand during twenty years (1980-2000) and showed the shift of the response of the Thai government in the public policies, from prevention to treatment, by putting a stress on the access of the affected population to antiretroviral drugs. Also, as Yu-Ling Huang pointed out, the problems of HIV/AIDS treatment are not only of a local concern and had to be contextualized in relation to the global political economy, of the trade pressures exercised by USA via the US Trade Representative and the formation of a global patent regime regarding the new-generation antiretroviral drugs. The chapter revealed the impact of globalization on the local health conditions in present day and draws attention to the complexities of non-medical factors which influence health public policies both at the national and transnational levels.

Ayo Wahlberg’ s chapter (‘A Revolutionary Movement to Bring Traditional Medicine Back to the Grassroots Level: On the Biopoliticization of Herbal Medicine in Vietnam’) presents the new history of indigenous Vietnamese medicine after 1955 which has to be understood in relation of the national history and to the successes of nationalism movement in Vietnam. Although Wahlberg showed that the revival of Vietnamese traditional medicine is not as well-known as that of the Traditional medicine from the People’s Republic of China its re-birth was stimulated by the desire to improve national public health system in this country and to overcome the inferiority complex which was the result of the colonial rule. The program of revitalizing Vietnamese medicine initiated in 1955 by President Ho Chi-Min has to be assessed as an attempt to spread a set of better health practices among Vietnamese people. This movement had, in fact, modernized traditional Vietnamese medicine, through the promotion of scientific research, the settlement of modern institutions and the impetus of innovative collaboration in the field.

Chatichai Muksong and Komatra Chuengsatiansup dealt in their common chapter (‘Medicine and Public Health in Thai Historiography: From an Elitist View to Counter-Hegemonic Discourse’) with the narratives and interpretations of medical history in Thailand since the 19th century. As the authors pointed out, before the colonial period, the Buddhism was the main source of inspiration for the majority of text dealing with health issues; while during the Western colonization of Thailand the local elite only ‘import’ the Western medical practitioners but not their narratives. Instead, as Chatichai Muksong and Komatra Chuengsatiansup demonstrated, Thai elites from the royal court had set themselves as legitimate owners of medical knowledge, their aims being to enforce the power of the state in the process of nation-building. The authors argued that the changing narratives in the medical history of Thailand are, in fact, powerful political tools which served as the basis of expressing local authority.

Overall, the volume offers very rich empirical data about the transformations and changes recorded within the history of medicine in Southeast Asia starting with the 19th century until now in different countries (Vietnam, Thailand, the Philippines, Indonesia, and Malaysia). The diversity of perspectives and of the approaches constitutes a major strength of the volume, together with the novelty of the information presented. At the same time, the eccletism and punctual character of the studies gathered together in the collection constituted the main shortage of the same volume. From a critical perspective, the main element which is missing in this volume is the trans-national (Southeast Asiatic) approach and explanation of all (and not of some) issues presented in the collection. Despite this somehow inherent internal fallacy the volume represents an important contribution to the Academic literature in the history of medicine.

Valentina Marinescu, University of Bucharest (valentina.marinescu@yahoo.com)