Vanderbilt University Press, 2013. ix + 213 pp.
Eirik Saethre’s book, Illness Is A Weapon, is a welcome and crucial addition to the expanding anthropological research on the pervasiveness of chronic illnesses in indigenous communities, particularly in the face of colonization, structural violence, poverty, and constant illness (p. 27). Saethre works with the Warlpiri, a group of Aboriginal people living in Australia’s Northern Territory town of Lajamanu, to weave a narrative of how the Warlpiri produce indigenous social identity through their deliberate defiance of both biomedical practice and the Australian government’s paternalistic attitude towards them, an attitude shaped by widespread perceptions of Aboriginal people as lazy and indifferent to self-care. Saethre places these issues within a historical context that provides a thorough analysis of how one remote Aboriginal community’s struggle with chronic illnesses represents the need for emic, structural changes and greater autonomy over healthcare.
Saethre structures his book into seven chapters and a glossary of Warlpiri words; each chapter illustrates one aspect of the struggle for the maintenance of ethnic identity and individual autonomy and agency in the face of an unyielding government regime. By interlacing narratives of Warlpiri Lajamanu community members and the predominantly non-Warlpiri nurses and physicians, Saethre accentuates the intricate relationship between yapa-kurlangu (Aboriginal) and kardiya-kurlangu (white people) healthcare practices and broader worldviews by highlighting the complexity of Aboriginal life as it incorporates biomedicine into Warlpiri cosmology (pgs. 26-7). For example, the Warlpiri’s reluctant reliance on biomedicine is played out in the Warlpiri unwillingness to take pharmaceuticals even though they consistently access biomedical healthcare facilities. The grudging use of biomedicine represents an example of the Warlpiri taking control of their identity and defying a loss of Aboriginality, despite the biomedical clinical team’s grievances and complaints of Warlpiri noncompliance and irresponsibility.
In particular, Saethre uses food consumption to exemplify the way in which an oppressive government used illness as a weapon to marginalize indigenous communities (pg. 3). Saethre underscores the Australian government’s continuous attempts to assimilate Aboriginal people through a history of food rationing and the effect that that rationing has had on Aboriginal people’s current reliance on welfare. The effect of this forced assimilation is borne out in the stark poverty that many Aboriginal communities face, creating and reinforcing a complex “us/them” dichotomy which leaves Aboriginal people living in separate communities yet relying on the government for support. In doing so, the Australian government places the blame for poverty and illness firmly on the difference between Aboriginal and non-Aboriginal culture (pg. 13), stressing the need for the government to take care of Aboriginal people for their own good. Food is a tool of social control, and as a result, Lajamanu residents consider many chronic illnesses to be white peoples’ diseases. This is particularly true of diabetes, which is prevalent in Lajamanu and is seen as related to changes in diet. This is especially the case, since not all healthy foods are easily available or affordable (pgs. 45-46). Indeed, with diabetes afflicting nearly one in three adults in some Aboriginal communities (Dussart 2010), Saethre’s inclusion of food production, access, and consumption as companions of chronic illness among the Warlpiri is timely. Food is thus not only a signal of health, but also a manner in which the Warlpiri’s social world is embodied (pg. 57): the Warlpiri attempt to maintain hunting as a traditional method of obtaining food in order to offset a fracturing of their social world that comes with the high prevalence of food-related illnesses in Lajamanu.
Saethre further draws on local cosmology to accentuate the power struggles between the Warlpiri and biomedical practitioners. Saethre describes how the Warlpiri will credit sorcerers with successful healing despite having undertaken biomedical procedures (pg. 96). Saethre’s account of gender and age norms highlights the biomedical indifference to Warlpiri cosmology that forms part of the core of the conflict between Lajamanu community members and the predominately female nurses that staff the health center in town. These tensions between what is needed and what is actually done are an acknowledgment of broader structural problems. The nurses’ inability to adapt to Warlpiri cultural norms regarding maintaining one’s masculinity in the face of female nurses stresses the need for cross-cultural training and a break from the entrenched poverty that prevents the Warlpiri from accessing higher education and becoming biomedical practitioners in their own right. The resident doctor position in Lajamanu is oftentimes left unfilled for months at a time, leaving the female nurses in charge of the community’s primary healthcare facility, despite the male Warlpiri’s desire to see male healthcare providers.
However, while Saethre provides numerous examples of failed health interventions, such as the Northern Territory Emergency Response’s efforts to mitigate the number of children suffering from ear infections (pg. 172), he does not provide many suggestions of how to develop potentially successful interventions. Given both the poor state of health among many Lajamanu residents, Saethre’s detailed knowledge of and experience with both yapa-kurlangu and kardiya-kurlangu healthcare cosmologies, and his involvement in Lajamanu, he is in an excellent position to be at the forefront of emic policy creation and implementation to improve health and healthcare provision.
Nonetheless, Saethre offers a critical look at the structural factors that perpetuate chronic illness in indigenous communities and the retention of a unique ethnic identity in the face of attempted assimilation. Poverty, racism, a lack of education, and hostility all trigger the high prevalence rates of chronic illness in Lajamanu and highlight the health consequences of colonization. Saethre’s book is a good general introduction to this topic, and would serve well as both an introductory medical anthropology ethnography and a guidebook for biomedical healthcare practitioners seeking to expand their cross-cultural understandings and efforts to reach out to indigenous communities.
Shir Lerman is a doctoral candidate in medical anthropology and a master’s candidate in public health at the University of Connecticut.
Dussart, Françoise. 2010 “It is Hard to be Sick Now”: Diabetes and the Reconstruction of Indigenous Sociality. Anthropologica 52(1): 77-87.