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Abstract
This article, based on ethnographic fieldwork carried out with practitioners of traditional Chinese medicine in Switzerland, gives an account of competition between Swiss therapists and Chinese doctors, two groups with radically different training but both of which hope to benefit from the same market. This is all happening in a context that is laissez-faire and yet in which the Swiss government favours its own nationals. The stakes in this contest crystallize around two very different forms of cultural legitimacy, each of which is considered to be a given and not up for dispute. For our interviewees, then, the underlying question is which group of practitioners, Chinese or Western, is more competent.
Acknowledgements
This article draws on the results of a research project, ‘Chinese migrations in Switzerland: network structures and dynamics’, supported by the Swiss National Foundation for Scientific Research (Fonds national suisse de la recherche scientifique, FNS), and directed by Professor Ellen Hertz of the Anthropology Institute of the University of Neuchatel. I would like to thank Florence Lévy and Zhao Yuwen, who carried out some of the interviews, along with me, as well as Janine Dahinden, Ellen Hertz, Mihaela Nedelcu and Ionela Vlase for their attentive readings and helpful suggestions. The article was translated from the French by Marie Deer.
Notes
1. Practitioners A, B, C, D, E, F, G, H, I; secretary-interpreters A, B, C, D; business owners A, B.
2. Practitioners J, K, L, M, N, O.
3. Administrators A, B, C.
4. July 2009.
5. This law replaced LAMA, which dated from 1911. For more information on these laws, see the online Swiss dictionary of social policy (http://www.socialinfo.ch/cgi-bin/dicoposso/show.cfm?id=68).
6. From 1999 to 2005, LAMal allowed for reimbursement for five kinds of complementary medicine, including traditional Chinese medicine, but, since these kinds of medicine did not ‘satisfy the criteria of efficiency’, they were excluded from the reimbursement policies at the end of this period.
7. Registry of Empirical Medicine (Registre de médecine empirique, RME) (http://www.rme.ch/rme-public/index.las) and Foundation for the Recognition and Development of Alternative and Complementary Therapies (Fondation pour la reconnaissance et le développement des thérapies alternatives et complémentaires, ASCA) (www.asca.ch).
8. See the organizational chart at http://www.emr.ch/le-rme/team.las.
9. November 2009.
10. In the rest of this article, I will use the emic category ‘Chinese doctor’ to refer to people who were trained and educated in the long Chinese course of study and who are themselves usually Chinese. I will use the term ‘therapists’ or ‘practitioners’ of traditional Chinese medicine when I am referring to people, whether Swiss or Chinese, who received professional training in the form of weekend workshops or seminars at private institutions in Europe.
11. An analysis of the listings in Meindex, the online directory of empirical medicine, shows that four-fifths of the practitioners of traditional Chinese medicine are Swiss or at least Western, with a disproportionate number of women (approximately two-thirds): http://www.emindex.ch/index_f.las (accessed 5 May 2010).
12. There are also some Chinese individuals who did not complete the university-level course of study, but who received professional training in the form of weekend workshops or seminars after their arrival in Switzerland. One could say that they have taken their migrant identity and refashioned it into a professional identity. On the other hand, one of our interviewees was a Swiss woman who had followed the complete course of study in traditional medicine at a university in China.
13. ‘Chinese doctors’ who have obtained Swiss citizenship and who have their own offices in Switzerland are rare. There are, however, a certain number of Chinese women who are married to Swiss men, trained in traditional Chinese medicine after coming to Switzerland and have opened their own offices (see previous note).
14. The salaries paid to these doctors are indeed relatively low compared to what is paid in other health-care professions, usually around 5000 or 6000 Swiss francs. The Chinese doctors who were sent over by their hospitals in China then also have to send a portion of their pay back to the sending institution. This salary is still above what Swiss labour unions would consider indecently low. However, the Chinese doctors employed in these centres generally discover, after they arrive in Switzerland, that a salary that looked very generous when it was converted into Chinese renminbi is really not that much when it has to cover the high cost of living in Switzerland.
15. Some of the interpreters who were interviewed decried their employers’ unscrupulous insistence on continuing treatments that were known to be ineffective for desperate patients (Interpreter A, October 2009; Interpreter B, September 2009).
16. Practitioner O, November 2009; Practitioner M, October 2009.
17. Practitioner C, July 2009. This point of view is shared by the only Western practitioner among our interviewees to have completed the full course of university study in China: ‘The situation is still catastrophic’ (Practitioner L, September 2009).
18. Practitioner A, January 2009.
19. Although none of our Western interviewees spoke Mandarin, all of them had a large number of anecdotes to tell about China and about their perceptions of Chinese culture.
20. However, Elisabeth Hsu's research shows that only one of the traditional Chinese medicine students at the Yunnan Academy in the 1980s came from a medical family background. Most of them were the children of local leaders or of the university intelligentsia (Hsu 2007).
21. Practitioner K, July 2009.
22. Practitioner J, July 2009.
23. One can see that these explanations often deal in stereotypes, akin to using the image of an anthill to talk about Chinese society.
24. Practitioner J, July 2009.
25. Practitioner K, July 2009.
26. Practitioner O, November 2009.
27. Administrator B, November 2009.
28. In the same interview, this interviewee admitted that she did not actually know any Chinese doctors in Switzerland.
29. See note 15. It becomes clear from the interviews that it is not in fact easy for these people to get used to their new lifestyle, because they are usually new arrivals in Switzerland, do not speak the language well and feel relatively isolated. Their salaries do not give them very much latitude and so they have to manage very carefully.
30. This rhetoric is typical of the boundary work between Western medicine and complementary and alternative medicine (Clark-Grill Citation2010).
31. Looked at this way, traditional Chinese medicine takes on a psychological or even mystical dimension, as described by this practitioner, upset by what she sees as the derailment of the tradition: ‘There is always a Swiss or Chinese therapist ready to respond to the demands of people who are looking for orientalism, romanticism, and that eco mixture of “peace and love”’ (Practitioner L, September 2009).