METODOLOGIA Y DESARROLLO DE LA UNIDAD DE CONTROL

Before I discuss Karen patients’ understanding of malaria, I summarize some of the Karen beliefs and health practices that have been studied by other ethnographers. Both in lowland and hills, the Karen have shown that they believe in ancestral spirits and animism

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(Sirisai 1993). The Karen believe in supernatural causes of illnesses and practice treatments using herbal remedies and household materials, such as salt and ashes, or seek consultation from spiritual specialists. A pioneering Karen ethnography written by Harry Marshall (1920) described that the Sgaw Karen in Burma believed in the existence of a supernatural power (“k’sa”) or divinity in the natural beings and environment, and that they would bring

prosperity or cause illness and unexpected events to the people (Marshall 1920: 225). One of the roles of elder family member or of religious specialists is to conduct offering rituals to these supernatural powers. These traditional village leaders are called “he kho” in the Sgaw Karen language. Marshall described that the motivation of the Karen offering was

characterized by fear of the powers (ibid.: 234). Studying the traditional Karen rituals in northern Thailand, Buadaeng claimed that the Karen adapted to changes in their social, political, ecological, and economic environment.

Larcharojna (1983) described that spirituality and customs among the Pwo Karen in remote western Thailand still played an important role in agricultural and annual village ceremonies. The animistic beliefs and customs are well integrated into Buddhism without much conflict among the Karen. Other studies also reported that various Karen groups have adopted beliefs and religious practices of world religions such as Buddhism and Christianity into their spiritual practices more or less easily (Iijima 1971). Conducting extensive

fieldwork in Karen villages in northern Thailand, Hayami (2004) and other scholars have described the au xae ritual as the centrality of Karen spiritual aspects and cosmologies.

Michael Gravers (2001) argued that anthropologists should be cautious about idealized or essentialized images of the Karen. Gravers further points out the complexity among the Karen groups in religious practices, identity politics, and their strategies of

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presenting Karen ethnic identity. If we keep the discussion of the Karen as a peripheral and marginalized people, we will miss their segmented process of integration into modernism and categorize them as static and primordial hill tribes. This static, essentialized perspective has received criticism from ethnic minority groups (Gravers 2001:155).

In this dissertation, my focus was not on the village setting, but the clinical setting. Although I do not go into the discussions of Karen spiritual rituals for health-seeking, I acknowledge that even Karen medical staff who had been practicing medicine at the SMRU clinics told me that people still practiced healing rituals as home remedies for fever,

particularly for children.

One senior medic who diagnosed and prescribed medicines at one of the SMRU clinics explained to me that in remote Karen villages in the mountain, people still believed in spirits and thought that these spirits would live in sacred places in the mountains. Such sacred areas are prohibited to approach without giving offerings. He described a story of some villagers who crossed the prohibited area to go hunting and logging in the mountains returned with high fevers. Thus, villagers suspected that their acts in those sacred places might have angered spirits. According to the medic, malaria was not considered a disease by the villagers back then. Thus, if people developed high fevers as a result of the disease, they most likely consulted religious specialists who made offerings to the spirits in the nature and performed rituals to cease the stress caused by the spirits (Interview with Mr. W, August 12, 2012).

A lab technician who worked at the same SMRU clinic assured me that his parents were still conducting such healing rituals in his home village in Burma. I also heard from a SMRU staff member at the SMRU-Mae La camp that one of the medics at the clinic was often requested by Karen refugees to conduct healing rituals that were not involved with

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biomedicine outside of the SMRU clinic. In his case, he worked within a biomedical framework at the clinic and a framework guided by Karen traditional rituals at his house in the refugee camp. Unfortunately, this medic left the SMRU and Mae La camp to go back to Burma before I could conduct an interview with him; thus, I could not ask him details of his healing practices and how people came to learn that he could conduct such rituals.

The following three episodes of Karen medics and a lab technician at the SMRU show that even in a biomedical setting, Karen traditional beliefs in spirits and rituals were not completely rejected by medical practitioners. Sirisai (1993) claimed that the concepts of time and location of spirits are related to understandings of malaria among the Karen in the Thai- Burma border. In fact, the concepts of time and location become important factors to understand the complexity and fluidity within illness narratives that are associated with malaria among Karen migrant patients. I will explore how the Karen patients’ understandings of malaria and the body have been changed or not changed by the biomedical interventions at SMRU in the next chapter.

2. Illness Narratives and Malaria Suffering among the Undocumented Karen Migrants