Healing herbs and dangerous doctors: Local models and response to fevers in northeast Thailand

Abstract

Many acute infectious diseases found in tropical countries share a set of non-specific symptoms in common, making distinctions between them difficult and diagnosis in clinical settings complex. The high prevalence of comorbidity in developing nations further adds to the difficulty of clinical diagnosis. For families living in rural communities, evaluating symptoms in the home prior to choosing a course of treatment action is even more difficult. Not only are families faced with ambiguities in symptom presentations, their decisions about how to interpret a particular illness episode are influenced by a complex combination of public health messages and ethnomedical models of illness. Furthermore, since cultural illness classifications do not necessarily correspond in a one-to-one relationship with biomedical disease categories, concerns and behaviors associated with a particular cultural illness category may have implications for many different diseases. From a health communication, education, and prevention perspective, it is therefore important to consider different diseases and illness categories not only as individual, separable entities, but also in terms of how they are interpreted and acted upon in relation to each other. In this dissertation, I provide an overview of major, acute infectious diseases found in northeast Thailand, including diarrheal diseases, acute respiratory infections, malaria, and dengue fever. I then examine cultural models and responses to these diseases in detail. I subsequently discuss a cultural illness category prominent in northeast Thailand known as khai makmai ('fruit fever'). I demonstrate how the classification of diverse illness episodes (resulting from a variety of biomedical diseases) as khai makmai, combined with cultural concerns about health practitioners' mismanagement of khai makmai, has important implications for both the treatment and prevention of various infectious diseases. I conclude by arguing for the need for more integrated, ethnomedical approaches to health education and interventions that take into account the impact of cultural models and responses for multiple infectious disease problems simultaneously.