Tribhuvan University Faculty of Humanities & Social Sciences OFFICE OF THE DEAN 2020 Master Degree in Anthropology Course Title: Medical Anthropology Code No.: AN 585 Semester: III

 

Group A

Question 1

Question:
“Analyzing the discourse and practice of Traditional Medical Practitioners and Traditional Birth Attendants, Stacy L. Pigg presents that ‘development institutions in Nepal are positioned as authoritative mediators of all local worlds’. How do you see her position? Validate your arguments with appropriate examples.”

Answer:
Stacy L. Pigg’s work on development institutions in Nepal emphasizes how external development agencies, NGOs, and state-run medical programs are positioned as authoritative mediators between local communities and global knowledge. According to Pigg, these institutions do not merely provide services; they frame local health knowledge, practices, and beliefs in a way that positions modern biomedical knowledge as superior. Traditional Medical Practitioners (TMPs) and Traditional Birth Attendants (TBAs) are often seen as peripheral or secondary to these modern development institutions, even though they have historically been the primary healthcare providers for local communities.

Pigg highlights the power dynamics inherent in development discourse: local knowledge is sometimes appropriated, regulated, or transformed to fit the standards of development agencies. TMPs and TBAs are treated as participants in a system rather than as autonomous experts. This positioning reinforces the authority of development institutions while marginalizing local voices.

For example, in rural Nepal, TBAs were initially trained by NGOs to follow biomedical practices for safe deliveries. While this improved maternal health outcomes, it also subtly undermined the community’s traditional birthing knowledge. TMPs who treated illnesses using herbal remedies or spiritual healing were often encouraged to refer patients to biomedical clinics, portraying local healing as incomplete or insufficient.

Pigg’s position reflects a critical understanding of how power operates in healthcare development. By mediating between local worlds and global development agendas, institutions assert authority while simultaneously reshaping local knowledge systems. This aligns with anthropological theories of “development as discourse,” which argue that development projects do more than implement programs—they construct social hierarchies and redefine legitimacy in knowledge.

Key Points:

• Development institutions mediate between local knowledge and global biomedical norms.

• TMPs and TBAs are often marginalized or retrained to fit biomedical frameworks.

• Power and authority are central in development discourse.

• Example: Training TBAs in rural Nepal and regulating TMP practices.

• Emphasizes critical reflection on the social implications of development interventions.

#MedicalAnthropology #TraditionalMedicine #NepalHealth #DevelopmentDiscourse #TBAs #TMPs #HealthcareInequality #PiggStacy

---

Question 2

Question:
“What do you understand by hospital ethnography? Do you agree with the idea of Van der Geest and Finkler on the debate of whether hospitals are ‘mainland’ or ‘island’ of culture? Why?”

Answer:
Hospital ethnography is a specialized area of medical anthropology that studies hospitals not merely as sites for biomedical treatment, but as complex social, cultural, and organizational spaces. Ethnographers examine hospital routines, hierarchies, communication patterns, patient-practitioner interactions, and the cultural meanings attached to illness and care. Hospitals are sites where scientific knowledge intersects with social norms, economic constraints, and personal experiences.

Van der Geest and Finkler introduced the concept of hospitals as either ‘mainland’ or ‘island’ of culture. According to their argument, hospitals can be considered a ‘mainland’ if they are deeply integrated with local cultural practices, beliefs, and everyday life. In contrast, hospitals are ‘islands’ when they operate as isolated spaces with their own rules, values, and hierarchies that differ significantly from the surrounding society.

I agree with their conceptualization because hospitals often act as islands in the sense that biomedical practices are codified and standardized, creating a microcosm that may not reflect broader societal beliefs. For example, in Nepal, a hospital may follow strict biomedical protocols for childbirth, while local communities continue to practice home births with TBAs, demonstrating a cultural disconnect. However, hospitals also interact with society—they cater to local populations, employ community members, and adapt to social expectations—showing characteristics of a mainland.

Hospital ethnography helps us understand how institutional culture, power hierarchies, and patient experiences shape medical outcomes. By analyzing hospitals as both islands and mainland, anthropologists can better understand the tension between standardized biomedical knowledge and local cultural realities.

Key Points:

• Hospital ethnography studies social, cultural, and organizational aspects of hospitals.

• ‘Island’ hospitals: operate with internal rules, separated from local culture.

• ‘Mainland’ hospitals: integrated with local cultural beliefs and practices.

• Practical example: Biomedical childbirth practices vs. traditional home births in Nepal.

• Highlights the interaction between medical institutions and society.

#HospitalEthnography #MedicalAnthropology #HealthcareCulture #NepalHospitals #VanDerGeest #Finkler #MedicalSociology #BiomedicalAnthropology