Volume 105 1996 > Volume 105, No. 2 > Reviews, p 259-261
MACPHERSON, Cluny and Laavasa: Samoan Medical Belief and Practice. Auckland: University of Auckland Press, 1990, 272 pp.
Malama Meleisea University of Auckland
This book provides an informed description and perceptive analysis of a subject about which a great deal of nonsense is talked nowadays in the context of alternative medicine and “cultural safety”. It provides a discussion and extended case study of the cultural and ideological context of beliefs about illness and healing, pointing out that these are usually systematic; reflecting interconnected ideas about cause and effect, nature and culture, and the individual and society. In Samoan epistemology, the Macphersons argue, most facts within a generalised framework of knowledge are contestable. They cite Milner's contention about the dialectical nature of Samoan culture: “it is rare for information to be given, even from a reputedly sound and authentic source, without it soon being contradicted from another equally reputable and reliable source”. In this analysis the Samoans are bricoleurs (in the anthropological sense that Lévi Strauss used this word), who over time reassemble aspects of their culture through new combinations of indigenous and borrowed ideas and practices. Attempts to understand all aspects of Samoan medicine as a consistent theory of illness and treatment are therefore doomed to failure, since this approach does not recognise the eclectic and experimental aspects of so-called “traditional” Samoan healing practices.
The book provides an historically informed overview of the precontact health status of the Samoans and their medical paradigm. The major endemic diseases of the precontact past were yaws and filariasis, along with a range of bacterial and fungal infectious ailments. This discussion necessarily involves a review of historical accounts of Samoan religious explanations within the pre-Christian framework of ideas. From 1830 onwards this world view accommodated a synthesis of old beliefs and new teachings. Missionaries brought not only a new theology but also their own system of explanation of disease and healing, which in those days were no more scientifically based than the ideas and beliefs of the Samoans. Out of this synthesis, the Macphersons argue, a new medical paradigm arose, shaping that which the Samoans now consider to be their indigenous system of medical explanation and practice.
The Samoans did not abandon their old system of explanation but supplemented it with borrowings from Missionary medicine, Christian theology and the Bible, and introduced herbal remedies and medications borrowed from European settlers, other Pacific Islanders, and Chinese and Melanesian contract workers. This “augmented paradigm” was also stimulated by the spread of introduced diseases; for example, the - 260 Samoans were afflicted by a series of epidemics throughout the nineteenth century — syphilis, whooping cough, mumps, typhus and influenza — and so required new ways of explaining sickness and new techniques for its management. The provision of health services to the Sarnoans under the German administration (1900 - 1914) was sufficiently minimal for it to make little impact on the new Samoan medical paradigm, while under the New Zealand administration there was relatively minor emphasis on Western curative approaches, but instead a largely Samoan-managed programme of disease prevention, emphasising self help and local participation.
Today, as the Macphersons point out, two sets of medical belief and practice exist alongside one another in contemporary Samoa, in which there is little conflict or competition between the two. These co-existing systems, “western” and “traditional” are built on different epistemological foundations, employ different practices within different institutional forms, to which both villagers and the educated élites seek recourse simultaneously or alternatively. One of the ways in which the Samoans organised their ideas about the cause and treatments of disease, in order to decide to which of the two systems they will seek recourse, is to classify illness into categories of indigenous (ma'i Samoa) and foreign illnesses (ma'i Palagi). If an illness is thought to be one peculiar to Samoans, the afflicted person is taken to a Samoan healer (fofo), and if the illness responds to these ministrations (massage, herbal concoctions and various types of supernatural interventions) then its classification is confirmed. The same system of classification and confirmation by results is used for recourse to the foreign medical system. For example nowadays people with severe injuries go straight to the hospital or to a western-trained doctor, since the efficacy of the treatment is widely recognised. However when symptoms are more ambiguous, a sick person is likely to seek recourse to both systems and decide afterwards as to the nature of the illness (Samoan or European) depending on which treatment works best.
The Macphersons illustrate the Samoan hierachy of resort with a number of case studies to demonstrate how Samoan indigenous medicine is organised within society. In this discussion, they draw out the manner in which illness is contextualised within social and particularly family relationships. Where such relationships are severly dislocated, supernatural agents (aitu) are typically identified as the cause of illness. Therefore, the primary role of a healer is to try “to restore balance” in and between the natural, social and supernatural elements of individuals' lives. Healers may be male or female, and earn respect on the basis of accumulative reputation for their medicines (vai) and treatments (fofo or togafiti). Many become known for their skills in dealing with a particular kind of disease manifestation or, in some cases, for their ability to intercede with particular supernatural elements. The book provides a detailed description and analysis of Samoan beliefs about physical processes, human physiology, health and illness. This is related to an analysis of the way in which diagnosis are made, illustrating the system of thought which underlies Samoan beliefs about illness and its treatment.
In their conclusion, the Macphersons speculate on the future of indigenous medicine and raise the question: Why does the distinction between ma'i Samoa and - 261 ma'i Palagi and their associated specialists continue to exist? The short answer is that ma'i Samoa continue to exist in Samoa because introduced illnesses did not displace them. They simply extended the range of illnesses that beset the Samoans. Had the conditions which gave rise to ma'i Samoa and explanations of them changed dramatically they might have “disappeared”, but this has not been the case. The Macphersons conclude that Samoan “traditional” medical beliefs and practices are likely to continue as long as Samoan culture itself remains unique and distinguishable from other cultures. The main challenge to this uniqueness comes from the assimilating Samoan migrant communities of the United States, New Zealand and Australia, whose continuing connection to and interaction with their homeland is providing a major source of ideological transformation.
Readers need not have a particular interest in Samoans or Samoan culture to learn from and to enjoy this book. It should be required reading for members of the health profession in New Zealand and other multi-cultural societies. Importantly, it provides a means to locate much of the current woolly-minded New Zealand discourse on “cultural safety” within a scholarly sociological and historical context. It will interest students of Sociology, Anthropology and Human Geography, and will inform general readers as well, with its accessible style and fascinating content. Although its particular focus is Western Samoa, it provides an instructive case study which will enhance a general understanding of the way that non-Western cultural values and world views shape the systematic explanation of illness and approaches to healing and how they change and adapt to new circumstances.