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ABSTRACT
This paper introduces the notion of ‘risky encounters’, referring to the way in which contacts with doctors are commonly perceived by the inhabitants of Bishkek, the capital city of Kyrgyzstan. The author's research conducted between 2011 and 2013 revealed that most people were extremely critical of biomedical personnel, despite positive assessments of healthcare reforms expressed by experts. Owing to the prevailing distrust of doctors, their interventions are often considered risky to one's health, which strongly influences people's health-related strategies in the context of medical diversity. This perception of risk is deeply embedded in feelings of uncertainty and anxiety, which should be viewed from the more general perspective of the political, economic and social uncertainties resulting from the difficulties of the period of post-Soviet transformation. It is evident that medical diversity in Bishkek provides people in need with many non-biomedical treatment options, and a distrust of doctors significantly contributes to the popularity of complementary medicine. Economic constraints and local concepts of health, illness and efficacy are among the many other factors that play a role in therapeutic choices. However, the current paper focuses on risk, uncertainty and trust, as emotions that are central to an understanding of the health-related strategies and tactics used by the inhabitants of present-day Bishkek.
Ethical approval
This research did not require institutional ethical approval either in Poland or in Kyrgyzstan. The author has generally followed the ethical guidelines for good anthropological research of the Association of Social Anthropologists of the UK and Commonwealth. Each interview was conducted with a prior expression of consent.
Acknowledgements
The author wishes to thank all her friends and colleagues from Bishkek, whose assistance and advice was invaluable: anthropologists from the American University of Central Asia, Elena Molchanova, a psychiatrist from the same university, Lubov Skreminskaya from the Department of History and Culturology of the Kyrgyz-Russian Slavic University, Gulnara Aitpaeva, Director, and the staff of the Aigine Cultural Centre. The author is deeply indebted to her interlocutors for their help, kindness and patience. An earlier version of this paper was presented and discussed at the workshop on medical pluralism that the author organised at the Institute of Ethnology and Cultural Anthropology, Adam Mickiewicz University in Poznań, Poland, in April 2013. The author would also like to thank the anonymous reviewers for their helpful comments and suggestions.
Disclosure statement
No potential conflict of interest was reported by the author.
Notes
1. It is significant that the Manas and Manas Taalimi reforms were named after a great hero of the famous Kyrgyz epos who has risen to the rank of a national symbol of the Kyrgyz.
2. A doctor who had participated in the reform regarded such opinions as a heritage of the Soviet times. She claimed that it would change only when people remembering the USSR system had died out.
3. Pseudonyms are used to preserve the anonymity of the interlocutors.
4. According to Parker (2013, 125), ‘encounter’, as opposed to ‘negotiation’, is a relation that ‘presupposes a hierarchy of power in favour of the healer’ and this is exactly the character of relationships between biomedical practitioners and patients in Kyrgyzstan.
5. It needs to be noted, however, that although wages in the health sector increased significantly in 2011, this did not result in a diminishing of informal payments, which shows the complexity of the issue.
6. I use here the terms ‘strategies’ and ‘tactics’ with a different meaning from that introduced by de Certeau, who used the first term in reference to the tools applied by people in power, and the second to describe ‘an art of the weak’. However, similarly to my approach, he also stresses that a tactic, as opposed to a strategy capable of calculating general plans, ‘takes advantage of “opportunities” and depends on them’ (de Certeau Citation1984, 37).
7. This should be seen as a stereotyped view, since I observed, for example, preventive strategies popular among the Kyrgyz men and women, who eagerly undertook, in early summer, a procedure of ‘cleansing’ the organism by drinking saamal – fresh mare's milk.
8. As Waldram (Citation2000, 619) rightly points out, ‘efficacy is shifting and fluid, shared among many role players who do not necessarily exhibit the same views, and whose views may develop or change through time.’ It is noticeable that among the Kyrgyz, healing efficacy involves spiritual transformation.