Cristiana Bastos

Healing holidays? Itinerant patients, therapeutic locales and the quest for health

This special issue on medical ‘tourism’ draws upon the panel ‘Healing Holidays’ held at the Society for Medical Anthropology’s 50th anniversary conference in 2009. The issue brings together anthropologists and historians whose work addresses the historical evolution and contemporary transformation of the traditional spa built around the iconic image of ‘taking the waters’, and the more recent phenomenon of medical ‘tourism’, with its super-speciality hospitals and clinics that repair and replace organs and body parts, or assist infertile people in their quest for conception. The final article addresses medical travel websites that serve as mediators between patients and their destinations in their itinerant quest for health. The articles as a whole problematise whether holidays can be healing and whether healing can be a holiday, exemplified by the often-raised question of whether the spa is medicine or vacation. Using different perspectives and ethnographic contexts, the first five articles address the spa – which in the contemporary imagination is associated with a pleasurable vacation with some health thrown in, best described by the currently popular word ‘wellness’. Partly fashioned by literary and cinematic conventions, this picture of the spa is often used as a form of social commentary on the contemporary middle class. In earlier eras, it was used in much the same way to comment on the aristocracy and the rising bourgeoisie. Or, as is the case in the opening article, spas could be used in the mid-nineteenth century America to craft a distinctly southern ideology of race identity. This function has its counterparts in the spas of the colonial tropics (Jennings 2006) and continental Europe. While this vein of using the spa as a form of social commentary runs through all the articles in this issue, these papers also, and in fundamental ways, point to the fact that until recently in the Euro-American world, the spa lay within the provenance of conventional medicine. This is still the case on the European continent, where the traditional training in medical hydrology, balneology, and climatology available in formal curricula evolved into the specialty of spa medicine. Although not everyone in the medical profession in Europe endorse its ‘scientificity’, spa medicine (or ‘thermalism’) is a legitimate practice in the continent.

Medical Hybridisms and Social Boundaries: Aspects of Portuguese Colonialism in Africa and India in the Nineteenth Century

This article addresses different modes of interaction between medical systems, beliefs and practices under Portuguese colonialism in Asia and Africa. I will argue that there were mutual borrowings for practical healing purposes until at least the 1880s. Prior to that, biomedicine in the Portuguese colonies was incipient, and attempts to promote its expansion had a very limited impact. That is also valid for Goa, India, in spite of the existence of a western-style Medical School since the 1840s. While its students were formally exposed to biomedicine alone, they interacted and were familiar with other systems of understanding illness and healing. Some of the Medical School graduates served in the African colonies in paradoxical circumstances. They had little support as agents of the imperial administration, with poor training, low wages, and secondary roles. And yet they had assigned themselves a role in the imperial project on the side of the colonisers, something they emphasised in several ways, including creating a distance from Africans and rejecting any bridge or interaction with indigenous healing systems. Towards the end of the nineteenth century, with the push towards empire-building in Africa, Portuguese authorities became less tolerant regarding indigenous practices and more vigilant regarding the colonial health services. The standards of the Medical School of Goa, which had been left alone for decades, were criticised and revised. As for the native practices, they were repressed or described as exotic curiosities. Yet, at the turn of the century, the project of biomedicine as a tool of empire was hardly a success. Africans kept fearing and fleeing European-style hospitals and colonial medical care. Noting what little impact they had amongst local populations, some Portuguese colonial physicians argued in the 1920s that a viable strategy to reach the natives should adopt some of their customs – or, in other words, hybridise for success. Their suggestions did not become mainstream, as the later theorists of lusotropicalism might welcome; but they can be seen as evidence of the fragility of biomedical power in that context. The other side of that fragility corresponds to the pervasiveness of other systems of healing, whether underground, unacknowledged or acknowledged by the authorities.

Race, medicine and the late Portuguese Empire: the role of Goan colonial physicians

This article discusses the production and diffusion of racialist theories within the Portuguese Empire by focusing on a particular group of colonial subjects: the Indo-Portuguese physicians trained at the Medical School of Goa. Not fitting into the colonizers/colonized duality, those physicians held important roles in the health services of the Portuguese colonies but were excluded from leadership. Their contribution to the production and reproduction of the racialized views of the world that were needed to run the empire adds complexity and substance to the arguments against the lusotropicalist ideas about race relations in the Portuguese Empire.

Doctors for the empire: The medical school of Goa and its narratives

This paper studies the establishment of medical teaching in Portuguese colonial settings as a means to understand the ways of empire building. The rules and regulations regarding surgeons and doctors in the African and Asian colonies evidence a structure of subalternities within the empire. Goa, in India, emerges as the second to the metropolis within that hierarchy, and the Medical School of Goa becomes the ultimate producer of doctors for the empire. We will bring to the analysis the narratives and representations of Goan doctors about their Medical School and its role in empire building. The analysis raises a number of issues that deserve further discussion: the ideologies of colonialism and the colonial condition, the formation of hierarchies within imperial structures, the tensions between social groups defined by the empire, the interaction between different bodies of knowledge and medical practices in the context of colonization, and the ambiguous position of creóle elites within a colonial system.

The Northeastern Algarve and the Southern Iberia Family Pattern

In the northeastern Algarve, Portugal, semi-dispersed settlements and property fragmentation evidently had coexisted with a predominantly nuclear family household pattern since the midnineteenth century, suggesting that a small holding pattern of land tenure need not always lead to a stem-family household as is so often true in other areas of Iberia. Other comparisons, drawn between the Algarve and the adjacent region of Alentejo, suggest that regional variation is strong on all measures and poses an interesting challenge to social scientific explanation.

Borrowing, Adapting, and Learning the Practices of Smallpox: Notes from Colonial Goa

In this article I will address colonial state policies toward smallpox in nineteenth-century Goa. The picture that emerges from the analysis of health services documents suggests a broad variety of coexisting practices. While the actions of some of the Portuguese head physicians epitomized the conflict between state-sponsored vaccination policies and local preferences for smallpox inoculation, others showed sympathy for and developed arguments in favor of inoculation as practiced by indigenous experts. Still others observed the existence among the population of hybrid practices combining elements of vaccination and inoculation. The diversity of Goan combinations along the violence/collaboration continuum should be interpreted within the context of current trends in the analysis of smallpox in British India—which replace the paradigm of vaccination: variolation :: state violence: native resistance with a more nuanced understanding of a variety of combinations throughout the subcontinent in the nineteenth century.

Displayed Wounds, Encrypted Messages: Hyper-Realism and Imagination in Medical Moulages

ABSTRACT Moulages are three-dimensional colorful replicas of body parts with particular expressions of ailments. Historically, by operating a transition between illness and disease, moulages were a powerful tool in the consolidation of the medical specialty of dermatovenereology. Yet, moulages are not solely an objectification of biological processes suitable for medical teaching; they also activate non-medical cognitions and emotions about life, death, behavior, and morality that are rooted in the history of the art of wax modeling. Furthermore, they provide a window into a dense history of urban health and illness, sex, law enforcement, assistance, gender, class, and politics. Video abstract Read the transcript Watch the video on Vimeo

From Global to Local and Back to Global: The Articulation of Politics, Knowledge and Assistance in Brazilian Responses to AIDS

Brazil is regarded worldwide as an example of a successful and articulated response to the AIDS epidemic. Investing in prevention and assistance, civil society and government are engaged together in efforts towards reducing the number of new infections and the death rate. In the year 2000 the number of people infected with HIV in Brazil was estimated at 600 000 — about a half the 1200 000 earlier projected by the World Bank for the country.2 The number of people receiving antiretroviral therapies keeps increasing; by September 2005 about 170 000 people were receiving treatment, with an overall 75 per cent adherence.3 Brazilian expertise on AIDS is now exported to different world settings, including Asia, Africa, Eastern Europe.

Migrants, inequalities and social research in the 1920s: The story of Two Portuguese Communities in New England

ABSTRACT In this article, I analyse the production and reception of a 1923 social monograph on migrant communities in New England and in doing so: (1) outline an archaeology of the social sciences in the U.S., by analysing aspects of their development, dynamics, institutional politics and research agendas; (2) discuss the tensions between social, racial and cultural interpretations of inequalities in the political economy of the 1920s; (3) analyse the pervasiveness of racialist thinking in science, society and politics, its impact in the hierarchization of groups for purposes of border control, and how the targeted groups responded to it.

Moving to Lisbon: Labour, Lust, and Leisure

Periods of intense cosmopolitanism and global prominence have occasionally emerged in Lisbon’s long, mukilayered, and inward-turned history. The most famous of them was in the early modern age, when the city became a hub of global flows of trade, peoples, riches, and ambitions related to the European overseas expansion, in which the Portuguese played an important role (Godinho 1982–1983, Couto 2003, Pinheiro 2011). With the influx of people, things and experiences from around the world, Lisbon might have become a diverse, multicultural, and global city, but its cosmopolitan moment was a short one. The alliance of the absolutist monarchy and the Roman Catholic Church, supported by the Inquisition, efficiently neutralized whomever they considered opponents. Diversity was not welcome during the Portuguese ancien regime.