The Perception of Illness
What community service in Indonesia taught me
Sometimes, people get sick. It’s a fact of life. But a community service opportunity in a rural village in Bali forced me to question our very understanding of illness. What exactly does ‘being sick’ look like?
It’s frankly impossible to come up with an objective consensus on what sickness is. While the word can be loosely defined as an unhealthy condition of the body and mind, the concept of illness and ailment differs from one individual to another, from one culture to another.
Sometime around July last year, I enrolled myself into a community service program that brought me into the depths of Bali’s spiritual landscape, in a rural village called Karangasem. The month-long program was illustrated by an array of social work, which mostly involved family visits and lending hands out into community healthcare programs.
Because network connection was restricted and technology sparse, days felt unusually long. Some days we really had nothing to do, and while most of the fellow volunteers were busy lounging about in our shared primitive lodging, I channeled my unspent social energy on striking up conversations with the local village inhabitants.
These discussions naturally transitioned into health-related topics, a subject that was particularly of interest. In hindsight, I noticed that I may have subconsciously steered the conversation that way, and in the process discovered that for the locals, financial restraints were the main source of a hindrance towards seeking health attention.
In one interesting conversation I had with a farmer, I learned that ‘illness’ was only appreciated when it was inconvenient enough to warrant absence from the fields. In other words, they considered themselves sick only if the disease had rendered them invalid and powerless.
The occasional flu or sore throat is simply brushed off as a mere matter of inconvenience, and does not fit any category of ‘illness’ by their books. Whatever it is they had — allergies, low back pain — if they could continue working on their rice field, it was no disease to worry about.
The explanation was simple. Leaving the field for a day could mean there was no food on the table for the family. The only way for the household to survive was if they kept working through the hot and the cold, the dry and the wet, the pain and the sorrows, until they simply can’t go on. It’s a sad reality but it is what it is.
Part of the reason alternative and herbal medicine is so popular in the eastern world is the fact that it’s cheaper and is more accessible. Some farmers even grow their own medicinal herbs on their plantation grounds as means of free medication. As a result of the perceived financial downsides, conventional medicine is often regarded as a last resort.
In the more affluent west, this works in almost the complete opposite — loosely reflected through the event of sick leaves. I am acquainted with people who call in sick to work with a runny nose. A tiny rash on their palm warranted a visit to the GP, even though a simple Google search will usually do the trick.
I’m not saying that the health-conscious people of the developed world are bad health practitioners, in fact, I think there are plenty of positive takeaways from it. One way to detect cancers in their earliest stage — where chances of remission are at its peak — is to perform regular medical check-ups, even when you don’t feel ill.
But on the other side of the globe, things look a little grimmer. For the less fortunate inhabitants of the developing world, seeking treatment for basic illnesses can be financially arresting, let alone partake in annual medical check-ups. This, among many other factors, is the reason why ‘primitive’ diseases are so difficult to eradicate in developing countries.
Another factor is the prevalence of strong traditions and cultural influence within traditional communities. Health-associated rituals that have been rooted in community practices for generations are considered sacred to these people, and as far as they’re concerned, it is the only way out of diseases. They lack the capacity to grasp the concepts of modern medicine to fully appreciate the virtues of seeking conventional treatment.
For the extreme, some, conventional medicine is considered fraudulent and harmful to their society, just as many anti-vaccine activists believe that their children are better off without potentially life-saving immunizations.
The perception of illness, it seems, varies not only within cultures, but also individuals. This goes to show that the notion of illness is just a much philosophy as it is science. It’s written all over the placebo effect, in the soothing voice of our family physician, and in the herbal concoction that’s been passed on for generations.
Illness is something that’s both easy to define — as in the clear-cut case of lung cancer — and difficult to illustrate, like in Alzheimer’s disease. But if there’s anything I learned in my 4 years of medical school, bolstered by my brief community service experience, it’s that it’s always the approach that matters. Everything boils down to respectful and intentional communication.
Just as building rapport is vital for any effective communication to transpire, establishing a mutual sense of trust and understanding should be a part of any successful conversation strategy. It is of utmost importance to act in the best interest of the subject. It could be talking them into getting the medical checkup that they so clearly need, providing economic aid for the financially restrained, or giving appropriate attention to those who are in desperate need.
