Hidden Superstitions as a Barrier between Doctor and Patient in an Island Culture

HIDDEN SUPERSTITIONS AS A BARRIER BETWEEN DOCTOR AND PATIENT IN AN ISLAND CULTURE IAN SHINE* Captain James Cook, a Fellow of the Royal Society, was killed and perhaps eaten by the natives of Hawaii in 1779.1 Cook was a talented mathematician, astronomer, explorer, and practitioner of preventive medicine. He charted many hitherto unknown coast lines and discovered many islands including Hawaii. When taking his leave ofthe natives who had regarded him as a god, a misunderstanding arose which rapidly escalated and got out ofhand. It would seem unlikely that such a sympathetic and kindly man as Cook should enter into, and be unable to get out of, a bitter dispute, particularly with Polynesians, who are renowned for their friendliness and hospitality, even to mortals. But, regrettably, it is all too easy to misunderstand another's intentions and to miss the subtle microsigns ofcommunication. This is particularly so when (like Cook in Hawaii) the investigator and subject come from a different culture; but perhaps it isjust as difficult when a common language or a friendly reception beguiles the investigator to believe that other aspects oftheir culture are equally compatible. While practicing medicine and conducting genetical research on the island ofSt. Helena in i960, 1 became aware of some ofthe mistakes thatarise through an insufficientunderstanding ofthe islanders' customs. Perhaps because the islanders are even friendlier than * Department of Community Medicine, University of Kentucky Medical Center, Lexington, Kentucky 40506. 1 A young American,John Ledyard, gave the following eyewitness account: "But we were extremely affected and disgusted when the other Indian produced from a bundle he had under his arm a part ofCook's thigh wrapped in a clean cloth which he said he saw himselfcut from the bone in -the manner we saw it, and when we enquired what had become ofthe remaining part ofhim, he gnashed his teeth and said it was to be eaten that night." 63 the Polynesians, the mistakes did not result in sudden termination ofthe project, but they did interfere sufficiently to stimulate this account ofsome ofthe pitfalls. The St. Helenians speak English and have acquired many English ways and habits, but they also have oriental culture passed on by their indentured Chinese ancestors, and they have African culture passed on by their slave ancestors. The most important ofthese traditions, from my point of view, was their belief in the Evil Eye. Shortly after my arrival at the island, I was invited to attend a dance thatwas to beheld in avillage school. The dancing was lively and uninhibited, and music was provided by a violin, accordion, and guitars. The whole affair was much like any local village dance, buttherewas a curious sequel. When I arrived at the clinic the next morning, the dispenser came to me and said, "I hear you was at the dance last night." Upon my confirmation , he very forcibly advised me not to go to any more dances in that district. I asked why not. "Well," he said, "the islanders are very pleased now to have a good doctor, and we don't want anything to happen to you. "What could possibly happen?" "It's a wicked little bay down there, and we wouldn't want anything to happen to you." I was surprised by his remarks, but I could get no more meaning out of him. This was the first ofmany similar incidents in which an islander would hint that he was afraid ofa particular person or place where no danger was apparent to me. For example, one day I was examining a man with an early pulp space infection ofthe finger, and finally told him that in my opinion there "might be something in it." The man hurriedly thanked me and left before I had time to give him any treatment. Soon after this episode I became very friendly with an old man (Grandpa Jones) who explained about the art of witchcraft. He said that most islanders were reticent about discussing the subject, particularly in front of "overseas people," and hence they had developed several ways ofalluding to witchcraft . They might say, "he was not done right by," or "there's something extra," or "there's something in it." I...