Kaizen

been recently developed by Hannerz (1992). The

principles underpinning Hannerz's idea are rather

simple : 1) there are diverse cultures (he views

cultures as networks of meanings) in the world; 2) these cultures are, however, no longer confined within particular groups of people but travel widely between individuals and between groups; 3) interaction between different cultures and perspectives is conducive to the production of new cultures and perspectives; 4) however, the cultural repertoires of members of even the same societies are never the same and make the coherence of the shared culture unlikely. Hannerz examines the distribution and production of cultures

in terms of four frameworks (the state, market,

movement and form of life), two modes of flow

(symmetrical and asymmetrical) and various constraints on flow (ideology, secrecy, identity, credence and

expertise). In his view, the continuous process of

cultural flow and human interaction generates the créolisation of cultures and thus never leads to the homogenisation of cultures in the contemporary world.

The idea of cultural flow has an advantage in the analysis of complex medical cultures in that it does not view cultures as segregated between groups nor entirely homogenous in societies. Thus, some medical knowledge and practices are evenly distributed among the members of a society, while others are unevenly distributed to particular individuals. The combination of different kinds of medical knowledge and practices that each member possesses may overlap among them but is never the same. While certain medical knowledge and

practices are reproduced time and again in societies, individuals also encounter and learn new knowledge and practices. The learning of new medical knowledge,

however, necessarily involves the process of

interpretation of the new knowledge on the basis of the existing knowledge that individuals possess.

Thus, it is possible that some medical knowledge and practices can be more or less exclusively distributed to certain groups of people. Undoubtedly, this is the case of medical knowledge and practices of biomedical practitioners and possibly that of certain religious groups. Among lay people, however, it is likely that some medical knowledge and practices are fairly evenly distributed in many societies. The similarity of therapeutic management among people in societies, as indicated in ethnographies, is partially

attributable to such general knowledge. It is

important to note that the use of medical knowledge does not only enable actors to understand illness and manage their therapies but at the same time constrains

their action. Structure is both enabling and

constraining, a characteristic Giddens (1979) calls

the "duality of structure". Phenomenological

approaches tend to focus on the enabling factor of structure alone.

In this regard, the structural articulation of biomedical culture and indigenous medical culture noted in ethnographies would be a case where the

understanding and interpretation of biomedical

practices on the basis of indigenous medical knowledge are not only widely shared but reproduced time and again by people in relatively culturally homogenous

societies. In the case of innovative action by

healers, the synthesis of various kinds of knowledge

and practices is consciously sought for their

particular goals. On the other hand, the situations of the almost chaotic medical cultures depicted by Beals

and Last would be cases where cultural flow is marked by uneveness and fragmentation. It is also possible that these medical cultures are in a state of flux where health seekers encounter diverse new medical knowledge and practices during the course of their therapy management.

Where medical cultures are in a state of flux, actors may have to interpret a multitude of new ideas and practices on the basis of their existing ideas. Such a task may sound complex and contradictory. However, in reality, this may not be the case. Actors may interpret diverse ideas and practices according to

relatively simple conceptual frameworks without

looking into the complexity and detail of the new ideas. In other words, it is conceivable that in such an extremely pluralistic situation, the primary act of

interpretation is to simplify medical ideas. It

appears to me that Last (1981) makes such a point when he remarks on the "significance of not knowing". Obviously, Last is not arguing that people do not know anything about medicine and illness, but that while encountering and having bits and pieces of ideas about

illness and medicine, they do not work out

interconnections between all of these. For example, on the one hand, actors may learn from various people that fever is caused by mosquitos; that fever is

caused by witchcraft; that fever is cured by

chloroquine; that fever is cured by a sacrificial ritual. On the other hand, actors may not consider nor care about how these contradictory ideas fit together. Yet, it appears to me that actors should have at least some basic ideas to make sense of their encounters. For instance, the general concepts of causes and medicine (both mosquitos and witchcraft are 'causes';

both chloroquine and a sacrificial ritual are

'medicine'). This point leads us to another

2) Forms of Knowledge: It appears to me that