<div><br></div><div>Sasaks, a people of the Indonesian archipelago, cope with one of the country's worst health records by employing various medical traditions, including their own secret ethnomedical knowledge. But anxiety, in the presence and absence of illness, profoundly shapes the ways Sasaks use healing and knowledge. Hay addresses complex questions regarding cultural models, agency, and other relationships to conclude that the ethnomedical knowledge they use to cope with their illnesses ironically inhibits improvements in their health care.<br></div><div>M. Cameron Hay is a NSF Advance Fellow and an Assistant Adjunct Professor at the UCLA Center for Culture and Health. <br></div>

Remembering to Live: Illness at the Intersection of Anxiety and Knowledge in Rural Indonesia

By M. Cameron Hay

University of Michigan Press

Copyright © 2001 M. Cameron Hay
All right reserved.
ISBN: 0472097857
1 - Written on the Body

It was late afternoon on my third day in the field. I was sitting on a mat just inside the doorway, a glass of too-sweet coffee in my hands. Two men, Amaq Mol and a neighbor, were drilling my limited Sasak vocabulary. Inaq Mol and her daughter were shelling beans and laughing at my errors.

A man I did not recognize crept silently into the house and sat leaning against the open door. The others apparently took no notice of him. The language lesson continued for perhaps 10 minutes. Then the conversation shifted to include the quiet stranger. Their conversation, like all conversations within the hamlet, was in a local dialect of Sasak. Only with non-Sasaks or government officials do they speak Indonesian, and then clumsily at best. At this point I understood only Indonesian, so all their conversations, including this one, were incomprehensible. Then the quiet man said sakit, a word meaning sick or hurt in Indonesian as well as Sasak. Inaq Mol got up and, weaving her way around our legs, her upper body bent down looking at the oor, she went out of the house. Their conversation continued. A few minutes later she came back with a cracked saucer holding about a tablespoon of cooking oil. She knelt behind the quiet man. He took off a shirt that was more holes than fabric. Inaq Mol blew her breath on his back, moving her lips as she did so. Evidently the light was too dim, and they repositioned themselves so that the mans back was turned toward the open doorway and in my line of vision.

Then it was obvious to me what was sakit, sick. There was an angry red welt, the size of an egg, at the base of the back of the visitors neck.

I initially thought it was perhaps an ulcer of some kind or the result of an injury not yet healed. Inaq Mol began giving him a back massage, dipping her hands in the oil so that they would work the muscles rather than tug at the skin. Of course, I thought, it is just an enormous knot in his neck muscles. And I waited for Inaq Mol to begin massaging it, to begin smoothing out the muscles of the knot. But she never did. She completely ignored the spot. Stopping the massage, she chewed a quid of betel, spat its red juice all over the mans back, and asked if he wanted a cup of coffee.

Her response to the word sakit, the massage, was over, with nothing done to resolve that enormous welt. I was baffled. But over the next few days, I noticed that the mans welt was not unique. In fact, every man beyond puberty in the entire hamlet had such a welt! In retrospect the massage had probably been for sore back muscles from working in the elds too hard that day. The welt was not sakit. It was an enormous callous developed over years of carrying produce and wood balanced on a beam over the shoulders and the back of the neck.

Whereas women beson, carry things on their heads, men mikul, carry things on their shoulders. Everything that must be moved either rides on womens heads or on mens shoulders. Heads can carry as much as 20 kilograms, but shoulders can easily double that. Thus it is primarily mens shoulders that carry crops home from the fields, wood down from the forest, and houses from one compound to another. To carry most loads, men tie them to wooden poles, perhaps one and a half meters in length and eight centimeters in diameter. The poles are worn glossy and dark with years of rubbing on sweating skin. The poles and their loads are balanced over the back of the neck and steadied by the mans hand holding it in front. Boys will begin by carrying light loads on narrow poles. Gradually, as they become stronger, their loads become heavier, and the calluses rubbed onto the back of the base of their necks grow larger. In towns, people rent horse carts to move heavy objects. Even if there were horse carts as far north as Pelocok, they couldnt make it along the narrow dikes of the paddy fields or up the steep paths to the forest. In Pelocok, a mans ability to move things on his shoulder is essential to his livelihood. The resulting welt is a mark of peasantry.

This ethnography is about bodies. These bodies are blemished and scarred, scratched and broken, quick and dead. Bodies are written on by life, but how does that writing take place? Following the signatures on the body, we trace the loops of who or what does the writing, how and why.

I will argue that the writings are the results of dialectic and dialogic processes, uncountable and contingent, through which people reshape their worlds and, along with them, their bodies. In essence, dialectic processes are direct interactions between two objectsin this case the body and the environmentthat mutually react to and affect one another. Blisters and calluses form in direct response to the rubbing of the carrying pole. They are physical manifestations resulting from actions Sasak people take to make a living in the environs of Pelocok. Over time a callus develops into a welt making a man capable of carrying much heavier loads, thereby enabling him to transcend his earlier limitations and act with greater effect on the land. Most physical manifestations on the body are the result of similar dialectic processes. On the other hand, dialogic processes are the mutual, sequential relations of interpretation among communicating subjects (Bakhtin 1986, 117). If one takes the abstract structured relationships of dialectics and adds motivated, personal voices intent on understanding, judging, and communicating with other people, one gets dialogic processes (147). It is in dialogue that people perceive and make sense of the physical manifestations on and pains in their bodies. Illness is dened in terms of individual and cultural constructions of physical, physiological, and psychological states. I will argue that it is through dialogue that people construct illness. But we cannot lose sight of the physical manifestations on the body that stimulate those dialogues. Thus we begin by examining bodies. The goal of this chapter is to let the reader see the normal writings on rural Sasak bodies, understand the direct interactions between their bodies and their environment, and touch the surface of the interpretations those writings stimulate.

Lombok has 4,738.7 square kilometers of land to host its population of 2.5 million. The island is economically poor with an optimistic domestic product of 194,853 rupiah (approx. $100) per capita and is, as I was frequently told by other Indonesians and some Sasaks as well, totally lacking in culture (Indon., kebudayaan). Perhaps for this latter reason, Lombok has not drawn many anthropologists. Of the hundreds of anthropologists who have worked in Indonesia, only six have written ethnographies on Sasaks, discussing cultural change (Krulfeld 1974), marriage customs (Ecklund 1977), religion and politics (Polak 1978; Cederroth 1981), poverty (Judd 1980), and a history of Lomboks colonial era (van der Kraan 1980). There are also a handful of anthropological writings on Sasak customs (Hidajat 1972), music (Toth 1978, 1979), poverty (Williamson 1984), and maternal health (Grace 1996; Hay 1999; Hunter 1996). Works on the Balinese people of Lombok (Harnish 1985; Gerdin 1982) and travel journals and colonial accounts round out the literature. Of varying quality, these texts succeeded in putting Lombok on the anthropological map although they did not ignite the anthropological imagination.

To sketch the portrait that emerges out of these ethnographies: Sasaks prefer to hide behind the swords of others rather than fight themselves; their customs are symbolically interesting but not elaborate in comparison to their Balinese neighbors; their poor are skillful manipulators of social hierarchies and ideologies; they accept economic development and accompanying social changes with little fuss; and there remains a bitter and political tension between two Islamic groups on the island, the traditional Wetu Telu and the orthodox Wetu Lima. If anything, it is this last that kindles the imagination, but not enough to attract more than the passing tourist. Indeed, those tourists are generally disappointed, for the mythic Wetu Telu are always said to be living in the next village over. In short, Lombok has failed to ignite imaginations and is considered an unimportant island that one passes through going east to Komodo and Sumba or west to Bali and Java.

Geographically too, Lombok is a transitional island, straddling Wallaces line that divides the western, lush islands of Indonesia from the dryer, eastern ones. In its western half Lombok receives much the same precipitation as Bali, but as one travels east, Lombok increasingly resembles its more arid eastern neighbor, Sumbawa. The northern half of the island is dominated by mountains topped off by the volcano Rinjani, rising 3,775 meters, the third highest in the archipelago. Rinjani is active; during the summer of 1994 it burst forth with rains of volcanic ash, killing much of the vegetation throughout the entire mountainous region in the east.

Between the arid south and the mountains lies a belt approximately 10 kilometers wide, where most of Lomboks people live and most of its produce is raised. The main road on the island cuts west-east across this belt, connecting the tri-city urban area of Mataram, Ampenon, and Cakranegara with Masbagik (an hours ride away) and extending east to the coast. Masbagik is a dusty, crowded town, attracting people from all around for its market. Twenty minutes by bemo (minivan) to the southeast of Masbagik is the town of Selong boasting a hospital. A distance to the north of Masbagik is the place I call Pelocok.

Going to Pelocok

There are no minivans going up to Pelocok. Depending on road conditions, the time of day, and ones nancial situation, one must walk, ride the back of a motorcycle-taxi (ojek), or climb onto the open bed of a large truck. The walk is uphill taking about an hour and a half and is pleasant if it is not raining. Riding the ojek, if one has 1,500 Rp ($0.75) to spare, is the quickest mode of transport, but it only works if one is not carrying much baggage, and one still must walk through the muddy spots and up the steeper hills. I, like most people in Pelocok, usually rode in the back of the trucks. The trucks are inexpensive at 400 Rp ($0.20), and run every couple of hours in the morning, carrying people and their produce to and from the marketplace.

If one is lucky, the truck waiting to go up the road is already fairly full before one climbs on. Otherwise one could have a long wait sitting in the heat on the dirty truck bed and talking to the women there. While men will go to market to sell off entire crops or to buy their own clothing, it is the women who usually go to market, selling a basket of produce and buying food and goods unavailable in the gawa (forest), which is what people on the plains call the upland region bordering the foothills of the volcano. Tired from their morning of bartering, these women quietly discuss prices and gossip while waiting on the truck. A truck will not leave before it is jammed with people standing sardine-style along the perimeter of the truck bed with baskets of goods stacked waist-high in the middle. After it is full, if one is lucky, the truck will actually start when it is cranked, and off it goes, with riders ducking to avoid hitting branches of trees along the road.

As one travels up the winding road to Pelocok one can feel the winds change. In Masbagik and everywhere on Lomboks plains, the air is stiflingly humid and warm, usually hovering around 32C (90F). As the truck turns off the paved road north of Masbagik, the landscape changes from the brownish cream of towns to the emerald green of elds and forest. The winds blowing against ones face become cooler and crisper, no longer carrying the dust and noise of the towns. Every few moments, the trucks money collector will let out a piercing whistle, the sign that the driver should stop, and a few women and men will climb down from the truck, suddenly urging another on the truck to come in for a visit before continuing home. This invitation is invariably rejected with not now, later (bareh wah), and, carrying baskets on their heads or plastic bags swung over their shoulders, those few will go off down a path or into a compound of brown houses. The lighter truck continues its journey northward and upward. About an hour after leaving the market town, the road bends and suddenly there is a breathtaking view. Brilliant emerald terraced paddy fields stretch from the road to distant rolling hills and above them in purple splendor rises Rinjani, the sacred volcano. The air is cooler here, ranging between 18C (65F) at night and only about 24C (75F) at zuhurr, the time of the midday prayer. The road bends and the view is again that of a tunnel cut out of green trees and brown compounds. Here, almost at the end of the road, one climbs off the now nearly empty truck and enters the life of Pelocok.



Continues...

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