LOCAL KNOWLEDGE, DISEASE AND HEALING IN A PAPUA COMMUNITY Doctoral Thesis to ...

320 Pages·2017·5.2 MB·English

by  Philip Saunders

LOCAL KNOWLEDGE, DISEASE AND HEALING
IN A PAPUA COMMUNITY

Doctoral Thesis
to achieve the Doctoral Degree
of the Faculty of Social Sciences
of Georg-August University of Göttingen

put forward by

Marlina Flassy

born in Teminabuan, West Papua (Indonesia)

Göttingen 2018
Thesis Committee

Supervisor in charge Prof. Dr. Brigitta Hauser-Schäublin
Supervisors Prof. Dr. Michael Mühlenberg
Further member of the Examination Committee Prof. Dr. Elfriede Hermann

Date of the oral examination: August 10th, 2015
Dedication

With gratitude and humility, I dedicate this manuscript to:

1. My parents, brothers and sisters and all the nieces, nephews and grandchildren.
2. Cenderawasih University in Jayapura, Papua, my first Alma Mater, and the
institution where I have worked.
3. Gadjah Mada University Yogyakarta, my second Alma Mater.
4. Georg-August University of Göttingen where I was able to follow the PhD
education in accordance with an international standard.
5. Papuan communities, especially the Tehit people who have provided the data for
this dissertation.

“Those who sow with tears will reap with songs of joy.” Psalm 126: 5
Summary
In my dissertation entitled “Local Knowledge, Disease and Healing in a Papua
Community”, I describe and analyse the concepts, knowledge and practices concerning the
health and disease of the Tehit people in the South Sorong Regency, West Papua
(Indonesia). In the Introduction, I firstly explain the theoretical approach I have chosen,
which is based on the concepts developed by the medical anthropologists Cecil G. Helman
and Arthur Kleinman. The Introduction then continues with the explanation of the research
methods I applied during fieldwork (between 2009 and 2012) and an outline of the living
conditions of the Tehit and their social and cultural organisation.
I then turn to the Tehits’ perspective and the way they conceive the body, well-
being, illness and disease. The Tehits’ concepts show that they do not perceive the body as
a physical entity. Instead, the body and its condition, oscillating between well-being and
sickness, are understood as being deeply interlinked with social and religious dimensions
of their being in the world and the cosmos. I then describe the medication and treatment
procedures the Tehit practice by applying Kleinman and Helman’s methodological and
theoretical approach. Accordingly, I identify three ways of treating the sick: (1) the popular
sector, (2) the folk sector and (3) the professional (biomedical) sector. In the popular
sector, medication proceduresare carried out by the sick person him/herself or by family
members, friends and neighbours. In the folk sector, traditional healing specialists (called
woun, si’qnda or mimit in the Tehit language) are consulted. These specialists possess a
vast knowledge of medical plants, soils and animal substances. This knowledge is passed
from one generation to the next, mostly during long periods of teaching novices in
seclusion. This knowledge and its transmission are indanger of being lost due to cultural
change.
The professional sector is run by the state. In contrast to the other two sectors,
biomedical cures focus on the body as a mainly physical entity. The Tehit choose between
these three sectors; they even sometimes combine the treatment practices offered. The way
and the reason why people decide for or against one (or a combination) of these different
treatment methods depends, as the analysis of interviews shows, on many different factors,
such as the character and the anticipated social or supernatural origin of the illness and the
estimated ‘right way’ of dealing with it. Moreover, since biomedical care is available only
in urban areas and is part of the modern money economy, people in rural areas have only
limited access to it, even in cases where they themselves suppose that a medical doctor
could cure them.
I then conclude that the local knowledge of the Tehit people regarding disease and
medication procedures can be considered as local wisdom that is important and valuable
for the local communities, the way people live together and the individual member’s
health. Therefore, I recommend that traditional institutions, religious leaders, traditional
leaders and the government of South Sorong Regency safeguard the traditional knowledge
of the Tehit communities. Moreover, the diversity of medicinal plants that can be found in
the South Sorong region should be preserved through setting up a botanical garden where
these plants could be cultivated; otherwise this knowledge and the plants will disappear.
Zusammenfassung
In meiner Dissertation „Local Knowledge, Disease and Healing in a Papua
Community“ beschreibe und analysiere ich die Konzepte, das Wissen und die Praxen der
Tehit in der Süd-Sorong Regency der Provinz West-Papua (Indonesien), welche
Gesundheit und Krankheit betreffen. In der Einleitung erläutere ich zuerst den gewählten
Zugang zum Thema, der sich auf die Theorien der Medizinethnologen Cecil G. Helman
und Arthur Kleinmann bezieht. Im Weiteren beschreibe ich die Forschungsmethoden, die
ich während meiner Feldforschung (zwischen 2009 und 2012) anwandte und skizziere die
gesellschaftliche und kulturelle Organisation der Tehit.
Danach wende ich mich der Sichtweise der Tehit zu und damit der Art und Weise,
wie sie den Körper, Wohlbefinden, Kranksein und Krankheit wahrnehmen. Die Tehit
verstehen den Körper nicht als bloße physische Größe. Vielmehr ist für sie der Körper und
seine Zustände zwischen Wohlbefinden und sich krank fühlen eingebettet in soziale und
religiöse Gesamtzusammenhänge des Lebens und des Kosmos. In Anwendung des
methodischen Ansatzes von Kleinmann und Helman unterscheide ich drei Bereiche in den
Heilpraktiken der Tehit: 1) den populären Sektor, 2) den Volkssektor und 3) den
professionalisierten (bio-medizinischen) Sektor. Im populären Sektor wenden die kranken
Menschen selbst – und/oder ihre Familie und Nachbarn – Mittel an, die sie heilen sollen.
Im Volkssektor agieren Spezialisten (in der Tehit-Spracbe woun, si’gnda oder mimit
genannt). Diese Spezialisten besitzen ein breites medizinisches Wissen über die Wirkung
und Anwendung von Pflanzen, Erden und tierischen Stoffen. Es handelt sich um
traditionelles Wissen, das seit Jahrhunderten über Generationen hinweg an ausgewählte
Novizen innerhalb einer langen Unterrichtungsperiode abseits vom Alltagsleben
weitergegeben wurde. Dieses Wissen und seine Weitergabe sind vom kulturellen Wandel
bedroht. Auch Pastoren, Evangelisten und Prediger sind mit Gebeten für die Kranken als
Heiler tätig.

Der professionelle Sektor besteht aus Einrichtungen und medizinischen
Fachkräften, die im Auftrag des indonesischen Staates tätig sind. Im Unterschied zu den
beiden anderen Sektoren steht der Körper als physische Einheit im Zentrum der
Behandlungen. Die Tehit wählen zwischen diesen Sektoren und den dort angebotenen
Heilpraktiken aus und kombinieren sie gelegentlich miteinander. Die Gründe für die Wahl
sind unterschiedlich, je nachdem, wie die Ursache des Krankseins eingeschätzt wird. Wie
Interviews mit Betroffenen zeigen, werden in manchen Fällen soziale oder religiöse
Verstöße als Auslöser für eine Krankheit vermutet, was einen entsprechenden
Heilungsprozess erfordert. Biomedizinische Behandlungen werden vor allem in städtischen
Verhältnissen angeboten, wobei die Behandlung und der Aufenthalt in einer Klinik mit
Geld bezahlt werden muss, was bei den Spezialisten des Volkssektors nicht der Fall ist.
Die ländliche Bevölkerung hat deshalb nur beschränkt Zugang zu diesen urban-
professionalisierten Angeboten.
Im Schlusskapitel betone ich, dass es sich bei dem lokalen Wissen der Tehit über
Krankheiten und Heilungspraxen um traditionelles Wissen handelt, das für die
Gemeinschaften und ihr Zusammenleben, aber auch für die einzelnen Kranken wichtig ist.
Die Vielfalt medizinisch wirksamer Pflanzen ist in der Süd-Sorong Regency groß und
sollte erhalten werden, beispielsweise indem sie in einem noch zu errichtenden
Botanischen Garten gezüchtet werden. Die traditionellen und religiösen Führer sowie die
Regionalregierung der Süd-Sorong Regency sollten sich dafür einsetzen, dass das
traditionelle Wissen der Tehit und anderer Papua Gruppen gefördert und gepflegt wird.
Beides, lokales Wissen und die Medizinalpflanzen, werden sonst verschwinden.
Preface

Praise to God who has given me wisdom and knowledge and strength, so that I can
finish this dissertation with time and of God’s plan. As the author, I realised that in writing
this dissertation, of course, there are flaws in it, so I readily accept all criticisms and
constructive suggestions from various parties to repair this thesis so that it better meets
scientific writing.
On this occasion, I would like to say that this dissertation could only be realised
through the moral and material support from various parties. Firstly, I want to thank Prof.
Dr. Brigitta Hauser-Schäublin as the first supervisor and Prof. Dr. Michael Mühlenberg, as
the second supervisor, who have both given time and energy to guide and direct the author
to finish this dissertation. I would like also like to thank Prof. Dr. Elfriede Hermann very
much to for the motivation and support she has provided as well as time for discussion of
the writing of this dissertation. In addition, I also thank Prof. Dr. Brigitta Hauser-
Schäublin, Prof. Dr. Michael Mühlenberg and Prof. Dr. Elfriede Hermann in their roles as
the thesis committee who read and provided an assessment of this dissertation
I could study at the University of Göttingen because of the financial support
provided by the Government of Indonesia. I would like to take this opportunity to give my
thanks to the Ministry of Education of Indonesia, especially the Directorate General of
Higher Education (DIKTI). I also thank the head of Georg-August University of
Göttingen,and especially Prof. Dr. Brigitta Hauser-Schäublin, who helped me with this
project so that I could get money to continue to live in Gottingen and finish my study. I
express my gratitude to the leadership of the University of Cenderawasih who gave me the
opportunity to continue my studies, in particular to Samuel J. Renyaan, M.Sc and Dr.
Margaretha Z. Pangau for all their help, so that I could continue my studies in Göttingen.
Through this wonderful opportunity, I also express thanks to the Government of
Papua Province, the Government of West Papua Province and the Government of South
Sorong regency, especially the Government of the Teminabuan District and the District of
Sawiat for all the support that has been given to the author for study and research. The
same acknowledgements are also presented to the leadership of Sawiat Health Centre,
Teminabuan Health Centre and the Director and all the staff of Scholoo hospital who
provided data to me.
I also thank the heads and all the people living in the villages of Sawiat, Sadrofoyo,
Wenslolo, Klaogin, Meriba, Seribau and Kikiso who have taken part in my study as
informants. Furthermore, I am very grateful to the key informants who patiently provided
me with all the data that I needed for the writing of this dissertation. Furthermore, I would
like to give my thanks and appreciation to the Mr.Wilhemus/Woun Kalilie (deceased),
Woun Mbolhoq, Wonfi Kollonggia (deceased), Lince Segetmena(deceased), Mr. Woun
Mbolhoq, Woun Wafotolo, Mr. Nico Krenak, Mr. Elly Sesa, Mrs. Waelaruno and Mrs.
Subae.
In addition, I would like to thank Dr. J. R. Mansoben, Dr.Steptinus Saa, M.Si
(Dean of Fisip UNCEN) and the late Dean of Fisip UNCEN Naffi Sanggenafa,MA. who
supported me both financially and mentally during my study in Germany. Similarly, my
gratitude goes to the late Drs. Barkis Suraadmadja, was a colleague in the Anthropology
Department of Cenderawasih University. Healways motivated me to continue and finish
my studies. Thank you so much to the late Mecky Wasfle, M.Pd. who always supported
and motivated me to continue my study. I also express my gratitude to the family of Agus
Momoth who invited me to stay in their home during the early research in Teminabuan. I
would like to thank my friends Wigaty Dyiah Prasasti, I Wayan Suyadnya, Serena Müller,
Miriam Sanmukri, Meike Rieger, Anna Grumblies, Sophie Strauss, Oliver Lueb, Aditya
Eggert, Anne Splettstößer, Arnika Peselmann , Reni, Eileen, Christin, and all other friends
in Göttingen who helped me with all the support, both materially and morally. Anna
Grumblies, Meike Rieger, Miriam Sanmukri and Serena Müller acted as my tutors over
the years and I am grateful for their support and commitment. I am very grateful to my
friend Dr. Dianne van Oosterhout who took the time and energy to give thought to my
dissertation, discuss it with me and improve my English writing before I submitted the
entire dissertation to the university. I also thank Victor Simbiak, herbalist, at Papuan
University in Manokwari, for help identifying the Latin names of plants presented in this
dissertation.
Finally, thank you to Femi, Afie, Yuli,Yosias Gandi and family, Rose, Adel,
Lani,Uli and all my friends and all priests in our church who prayed together with me,
Last but not least, I want to express my deepest gratitude to my family: to my brothers
Don, Daan, Wolas, Yusak and Ruland, and my sisters, Jull, Bitha, Sri, Nelly, Ketty, Lince,
Jubelina, Juli, Frida, Elis and Sance and my nephews Rio Flassy, Samuel, Toror, Steven,
LammyJemmy, and also my nieces Olga, Martha, Rosa, Hilda, Yokbet and Betty. Thank
you for all your prayers and financial support you gave me to complete the study.
Hopefully this dissertation can provide benefits for public health development in
Papua and those who need to study medical anthropology.
TABLE OF CONTENTS

PART 1
INTRODUCTION 1
1. State of medical anthropology research in Papua1
2. Research questions 5
3. Theoretical approach 5
4. Methodology of research 11
5. Structure of the thesis 12

GENERAL DESCRIPTION OF THE RESEARCH 14
1. Research location 14
2. Demography, settlement patterns and languages 16
3. Education system 20
4. The socio-political and economic situation 22
4.1. Kinship, social organisation and marriage systems 22
4.2. Land ownership and economy 28
4.3. Political life 39
5. Religion 40

CONCEPTS OF THE BODY, PAIN AND DISEASE 43
1. Introduction 43
2. The Person and the organisation of the body and its three major parts 48
2.1. The head part of the body, sa 48
2.2. The middle part of the body, qendi 56
2.3. The lower part of the body, olo 60
3. The outside and inside of the body 62
3.1. Falaq ´skin´, sa’gien´hair´, qan‘gen ´body hair´and qindi ´nails´ 62
3.2.Concepts of qan ´flesh´, honi ´bones´, hen´blood´ and se ´water/liquid´ 64
3.3.The Concept of wua, qol/qa’so and sa’ndwan ´soul´and ´mind´ 70
4. Pain and disease “Ni qanyi” 72
5. Conclusion 80

PART 2
ILLNESS, DISEASE AND HEALING IN THE POPULAR SECTOR 82
1. Overview of the popular sector and its main categories of actors 82
2. Symptoms of illnesses and diseases 84
3. Types of illnesses and diseases 87
4. Causes and treatment of the illnesses and diseases 88
4.1. General causes and treatment 89
4.2. Treating of illnesses by differentactors 119
4.2.1. Treating of illnesses by the person him/herself 119
4.2.2. Treating of illnesses by family members 121
4.2.3. Treating of illnesses by friends or neighbours 122
4.2.4. Treating of illnesses by church members 123
5. Conclusion 126
PART 3
DISEASES AND HEALING IN THE FOLK SECTOR 127
1. Overview of the folk sector and its main actors 127
2. Classification of healers 131
2.1. Wuon as an institution 131
2.2. Wuon based on traditional education 135
2.2.1. Requirements for becoming a woun 135
2.2.2.The Leaders of the education and the contrucsion
of the wuon house 136
2.2.3. The education process 139
2.2.4. Reaching the status of wuon: the consecration ceremony, sakein 143
2.3.Si’qnda and mi’mit: Healers based on knowledge inherited from parents
or otherclan members 147
3. Causes of diseases 148
3.1. Diseases caused byNa Agow ´God´ 149
3.2. Diseases caused by qlembet yrafen ´spirits of the dead ´ 150
3.3.Diseases caused by nifralas ´evil spirits ´ 152
3.4. Diseases caused by erneity-yswin-fe´taboo food´ 153
3.5.Diseases caused by naydik lengget and naydikli’lin,‘poisons’ 157
3.5.1. Diseases caused by naydik lengget ´ 157
3.5.2. Diseases caused by naydikli’lin 158
3.6. Diseases caused by lait or suanggi(BI]) 161
4. Healing of diseases 168
4.1.Substances used by healers 168
4.1.1. Se or qla ‘water’ 168
4.1.2. Mbeet,’soil’ 169
4.1.3. Qmbi’aq ‘ash’ 170
4.1.4. Fralaas,‘plant leaves’ 170
4.1.5. Animals 178
4.2. The process of disease treatment 179
4.2.1. Healing of disease by wuon, si’qnda and mi’mit 179
4.2.2. Healing of disease by priests/evangelists 190
4.2.3. Healing of disease by preachers: layman who received
their talent from God 193
5. Combining different forms of disease treatment 199
6. Conclusion 201

PART 4
THE PROFESSIONAL SECTOR 202
1. Overview of the health care system in Indonesia in general,
and in Papua 202
2. The professional sector and formal medical formation in Indonesia 206
3. The organisation of the health caresystem in West Papua Province
and South Sorong Regency: institutions, funding, organisation and
functioning 208
3.1.Rumah Sakit(hospital) 214
3.1.1. Rumah Sakit Pemerintah ‘government hospital’ 214
3.1.2. Rumah Sakit Swasta ‘private hospital’ 225
3.2. Religious health institutions 226
3.3. Pusat Kesehatan Masyarakat ‘health centres’ 227
3.3.1. Puskesmas Teminabuan ‘Teminabuan health centre’ 227
3.3.2. Puskesmas Sawiat ‘Sawiat health centre’ 233
3.4. Pusat Kesehatan Masyarakat Pembantu ‘Communityhealth centre’ 240
3.5. Pusat Kesehatan Masyarakat Keliling ‘travelling health centres’ 242
3.6. Pusat Pelayanan Kesehatan Terpadu ‘integrated health post’ 242
3.7. Pondok Bersalin Desa ‘village maternity lodge’ 244
4. HIV/AIDS and the ‘culture of shame’ in Papua 246
5. Experiencing the professional sector 252
5.1. Prerequisites of being treated by an institution in the professional
sector 252
5.2. Decision to choose the professional sector 255
5.3. The patient: from admittance to hospital discharge 257
6. Factors determining the patient’s choice between the professional
sector and the folk sector 259
7. Conclusion 262

CONCLUSION OF ALL THE CHAPTERS 264
1. Medical pluralism and the way the Tehit make use of it 264
2. Recommendation 272

BIBLIOGRAPHY 278
APPENDIX 286
Appendix 1. The Medical Plants 286
Appendix 2. Glossary 287
Appendix 3. Schema kinship group of Tehit society 304

Curriculum Vitae 306