Post-Colonial Medicine and Biopolitical Warfare (2024)

10 years ago my friend’s mum had a blood clot in her leg requiring immediate life saving surgery. Mum, a middle class university educated former state bureaucrat, decided however, not to go back to the hospital. Instead she travelled to a remote village in Ubon Ratchathani province to visit a Maw Moo Baan, a Village Doctor. The term Maw Moo Baan can be translated in many ways, directly it’s Village Doctor, but it can also be interpreted along a huge spectrum ranging from shaman, to homoeopath, to even physical therapist. In mum’s case, it was the latter, who practised a kind of touch therapy passed down over centuries. At the time I pleaded with my friend to make sure her mum also went to the regular hospital just to be safe, my pleas fell on deaf ears. One month later, after the visit to Ubon, she relented and went to the hospital, only to find out that the blood clot had dissipated and no longer required surgery. The trip to the Village Doctor was a success and I was left humbled. A decade later, a severely sprained shoulder later, a botched sinus surgery later, and I’ve enrolled as an apprentice to a Village Doctor in Northern Thailand specialising in touch medicinal therapy.

Mum’s decision, and her validation, are a sign of the rising tide of post-colonial medicine, a medical practice that comes not from the laboratories of the ivy leagues or royal institutes of the colonial west, but a means of healthcare from the villages for the villages. One which has always nascently held on throughout the classic and contemporary colonial era.

The hospital, the institution, the bright white lights, the staleconditioned air, the appointments and referrals, the reception, the fear, the pain, the waiting and waiting and waiting room, being passed around by different staff like a relay batton, a trial to complete before you, the patient, has been processed sufficiently to sit in front of a vacant stare wearing a white coat for 5 minutes of disinterested procedural facetime and a prescription.

Do you feel better? Sometimes.

The whur of the electric fan, the thick oily menthol scent, the open windows, the mismatched furniture, the family photos, maybe a softly spoken voice, maybe a sharp tongue, maybe some banter or maybe just silence. The touch of warm bodies, being held, heavy breathing, being cared for, the strange role reversal wherein the patient asks the doctor, do you feel it? Can you feel my pain?

Do you feel better? Yes, I think so.

Please however, do not misinterpret this as a complete dismissal of Western medicine. If I was in a serious car crash I wouldn’t head straight to an acupuncturist, nor would I run to a homoeopath if I contracted HIV. But this is a false paradigm. I would also rather be born in Switzerland than Cuba. I would rather live in a modern house than a slum. That is not a critique of the slum dweller, the Cuban people or the acupuncturist, rather a recognition of the realities of western medicine, geopolitical power and capital.

Across the globe Western medicine is ubiquitous, it is the gatekeeper of medicine, stamping all that sits outside of its narrow realm as quackery. Despite its self-acknowledged limitations, Western medicine simultaneously sees itself as a hard science, like mathematics, while adhering to a tight epistemological dogma, like religion. Critics are labelled quacks and any alternative practices are considered to do more harm than help. Western medicine is an applied social construct, a complex interplay of social practices, riddled with institutionalised powers, bound by rigid histories and discourses that go beyond mere clinical interventions, rigidities that encompass broader issues of care, morality, power, identity and pain.

Here we find the study of biopolitics which seeks to investigate how political power intersects with medicine, pain, health and biological life. What we seek in this article, and the practice that informed it, is how to apply the findings of that field of study against those issues of power and pain, which brings us to the title, post-colonial medicine, to examine what that means requires an understanding of colonial medicine.

Colonial Medicine and Biopolitics

History is littered with case studies of colonial medicine. To name just a few, the forced sterilisation of Kenyan men by the British empire in the 1950s or the empire’s calculations of minimum caloric intake during the famine they instigated in Bengal. Today two of the biggest pharmaceutical companies in the world owe their foundational contemporary R&D to human experimentation in the Holocaust and Imperial Japanese Manchuria; respectively Bayer AG and foundational companies of the Mitsubishi Tanabe Pharma Corporation. This should come as no surprise when the aforementioned epistemology of western medicine, its conceptual framework of knowledge, relies so heavily on thinkers like Emmanuel Kant and his vile ideas of race and personhood. Of course, this lineage extends in a straight line to today with Thai doctors forcibly sterilising refugee women from Burma.

Colonial medicine was developed to manage and maintain the colonial subject on behalf of the colonial power. This is merely an extension of Deluzes basic point on bio-politics, that the way medicine was developed in the West by the bourgeois class was to manage and maintain their extractive relationship with the proletariat. In this analysis, the body is seen as a machine of labour, while pain is just a warning light, signalling that there may be something wrong with the machine. If the machine is checked by the medical practitioners and found to be dysfunctional it will be repaired to the point of working function. If the machine is checked by the medical practitioners and found to be functional the machine is sent back to work. In both instances, pain plays only a minor initial role in the process.

One of the founders of this journal is a doctor of Western medicine. A few years ago he worked in a hospital near a palm oil processing plant where lost thumbs and fingers are commonplace. In Thai hospitals it is standard practice to reattach a severed finger whenever possible, in this hospital however there is a different policy. Doctors are told not to reattach the fingers, as the patient will likely go back to work within a few days, without the adequate allotted time for recovery and cleaning of the extremity causing greater problems down the line, thus, in the minds of the administrators, saving the workers the effort and discarding the severed finger is the sensible medical decision. The machine, the worker, is sufficiently repaired by the public hospital to go back to the private factory floor. This is the biopolitical hell that we are faced with today.

Village Medicine

Village medicine takes the opposite approach, it is a medical practice which stems from the necessities of treating the medical issues of everyday village life through phronesis– a type of wisdom or intelligence concerned with practical action over the theoretical. In this regard. This was practised by people who, not only lived in, but were engaged in the cycles of village life. There was little to no wall between the practitioner and patient, the village doctor is a villager, not an elite doctor with receptionists and institutional walls to hide behind. As such village medicine is dependent far more on the feeling of the patient than their perceived functionality.

This can lead to village doctors taking on strange forms, joint roles, oftentimes blurring the lines between the physical, psychological and spiritual realm – hence the aforementioned broad translation of what the term actually means, from Shaman to Physical Therapist. There is no textbook or graduate program for village medicine, each practitioner is shaped by the needs and demands of the village, of the community. To this end, what is and isn’t a practitioner can be highly blurred. Perhaps they’re a fulltime village doctor operating from the same space everyday, perhaps they’re a typical villager with a certain touch to be called upon when needed, or perhaps they’re a mother taking care of their child’s ailments, who, in that moment, using the knowledge gained through generations of phronesis, becomes a village doctor.

To western colonial medicine, the village doctor was, of course, perceived as a threat. During the great de-communising of humankind, starting with the rise of the grain state and going into overdrive in the colonial era, any communal elements to the life of the peasant, the worker, the colonial subject, had to be eradicated. To this end, village medicine plays only a small role in the great de-communisation, a topic covered in far greater detail elsewhere. In the colonies, village medicine or traditional medicine was deemed barbaric and a threat to the new capitalist modernity that the imperialists insisted they were ushering in. This process continued unabated into the neo-or post-colonial era, wherein the village doctor was replaced by the modern white coat and the sanctioned state religion.

Pain and Epistemology

It is through examining the roots of these two traditions, western colonial medicine and village medicine that we begin to see how their fundamental conceptual frameworks differ. One example of this, is how, epistemologically, western medicine can not understand a muscle knot, that little ball of pain that forms and hardens in a sore spot causing intense acute pain, indeed some doctors do not even recognise its existence. But I can feel it, you can feel it, we know it’s there, scientifically speaking however, there are doctors that will tell you that it’s not. This is what I was referring to above when I wrote; western medicine simultaneously sees itself as a hard science, like mathematics, while adhering to a tight epistemological dogma, like religion.

From personal experience, I had a mild case of pneumonia a few years ago, after it had passed however, I still had shooting chest pains, so I went to the hospital for a lung x-ray. The doctor told me that my lungs were fine. “It’s probably a muscle problem from the coughing” he said, “What do I do in that case?” I asked. “Just wait, it will probably go away.” he told me. “And what if it doesn’t go away? What should I do?” He shrugged. “I don’t know. It will probably go away.” It didn’t go away, for the next year that is, until I started my apprenticeship with the village doctor who fixed it in around a week through intense muscle and nerve manipulation of the muscle knot that had formed in my pectoral tendon or as he calls it “feeling the pain”. There was no chanting, no ceremony, no magic, just a mat on the floor and the physical application of his body to mine. It was painful, it was intense, but it worked.

There’s a special kind of hopelessness that comes with undiagnosed pain, one interwoven with fear and foreboding. One that grows ever more severe after each unsuccessful hospital visit, x-rays, scans, blood tests, endoscopes, the cold ominous metallic tool kit. The ubiquity of Western medicine leads us to assume that there are no alternatives, few know that the mat on the floor and the Village Doctors hands are even an option.

PseudoScience

To read the English language Wikipedia pages of village medicine practices such as Gua sha and even acupuncture is to see how patronising and belittling modern colonial attitudes are to such practices.

To read from the Gua Sha Wikipedia page:

There is not good clinical evidence supporting the efficacy of Gua sha. In use, it nearly always damages the skin. Negative side effects of gua sha range from minor ones – including dermatitis, burns and blood in the urine – to rare major ones including bleeding in the brain and severe injuries requiring skin grafts.

In contrast, Gua sha is a practice that has been continuously used for over a millennium and is still considered an effective form of treatment by something like ¼ of the world’s population today, regardless of the neo-colonial medical consensus. If it were as ineffective and dangerous as they claim, one would imagine that it would no longer be used.

Indeed on Chinese medicine in general the intro to the Wikipedia page reads:

A large share of its claims are pseudoscientific, with the majority of treatments having no robust evidence of effectiveness or logical mechanism of action.

The term PseudoScience is one which could be explored endlessly, but within the limitations of this article, it seems essential to point out just how much of the history of western medicine is now considered PseudoScience or bad science. Just one example is the colonial race science which characterised western medicine until the past half century and still colours it today. Again, what western medicine can not understand, like the muscle knot, something that it epistemologically can not recognise is deemed pseudoscience. My Village Doctor however, has the epistemological capability, the material capability, to not only see and feel that muscle knot, but to make it disappear.

Agronomy and Pushback

The practice of pseudoscience or bad science by western scientists extends throughout the biosciences and is now beginning to be pushed back on. This can be best seen in the field of agronomy, the science of agriculture. Again, throughout the colonial era to today, there has been a near hegemonic western consensus on epistemological approach to the field, exemplified in the so-called Green Revolution, which had its prominence from the 1950s to 1980s. This was a period where the bioscience behind agronomy was upheaved again supposedly leading to tremendous advances in understanding and improvements to quality of life, and again forcing further decommunisation and severance from aeons of traditional village practices. The bioscience of The Green Revolution saw the ubiquitination of synthetic fertilisers, lab-based crop breeding, pest and herbicides, etc, in short, modern science-based farming.

In the past few decades however, the science behind western Agronomy and particularly The Green Revolution has been increasingly exposed as bad or pseudoscience, showing it to produce less crop yields over an extended period of time, greater disenfranchisement of farmers and leading to a far lower quality of produce and quality of life compared to previously existing indigenous methods of cultivation. This is best detailed in the works of The Violence of Green Revolution by Vandana Shiva and The Great Agrarian Conquest by Neeladri Bhattacharya.

This re-examining of what was once considered Good Science in Agronomy has led to a noticeable shift in farming practices which is gaining momentum in both the Global South and even the Western imperial core, most notably on a communal level. With agronomists, real agronomists, that is to say farmers, rejecting the dogma of Western Science whenever possible, rejecting the synthetic fertilisers, herbicides and mutant crop varieties in favour of indigenous cultivation methods. Such a shift away from the Green Revolution modes of practice is so seismic that it has even been recognised and encouraged by the United Nations.

As the failings and bad science of the western biosciences are increasingly exposed in the field of agronomy, it necessitates a re-examination and a challenge to the bio-science of Western Medicine, and indeed, this is something we are slowly beginning to see such as with the anecdote about mum’s blood clot in the intro to this piece.

An Epistemological Shift

Again, this is not to dismiss the incredible achievements and capabilities of Western Medicine. Even my Village Doctor has a pacemaker and encourages patients to take Diclofenac (a western pharmaceutical) after physical therapy sessions. What I, and many others, are calling for, knowingly or otherwise, is an epistemological shift in our understanding of medicine and its practice. The sheer hours of labour and volume of capital poured into Western Medicine over the past two centuries, alongside the denigration of village medicine, means that the village doctor has become the last port of call for those in need.

However, rather than further diminish and degrade it, Western Medicine must adapt and learn from the conceptual framework of village medicine, one that focuses on care, feeling and curing actual pain. Meanwhile, village medicine must be further developed and progressed to a point where it can challenge the anti-communalist ubiquity of Western Medicine, taking the pacemaker and pre-exposure prophylaxis (PREP) and combining it with the epistemological core of care and communal responsibility.