Don’t Make a Hole in My Body, Doctor: An Anthropological Perspective on Liver Disease in An Amis Village in Eastern Taiwan

Liver disease is a serious infectious disease in aboriginal communities of Taiwan. Field research conducted in one Amis village of Hualien County in eastern Taiwan explored the explanatory models (EMs) of liver disease, which are the embodiments of the epistemologies of illness in different sectors of the local health care system, through scrutinizing illness narratives told by aboriginal people as well as Western-style and Chinese-style doctors. Discrepant EMs of liver disease between sick persons and specialists represent distinct points of views about the identities, causes, and therapeutic implications of liver diseases in different medical realities of the local health care system. Rather than using a single explanation, the Amis manipulate a hybrid form of illness representation which embraces the notions of adada, biomedicine, and Chinese medicine to conceptualize the causes and healings of liver disease. Comparing the illness representation of the Amis with that of Western-style doctors' and Chinese-style doctors' EMs of liver disease provides insight into the conflicts and harmonies of medical encounters between the Amis and practitioners in the local health care system. Western-style doctors simplify liver disease as a pathophysiological phenomenon while the Amis perceive liver disease as an unwanted condition that prematurely disrupts the normal life style. The neglect of sociocultural factors in biomedical treatment led many Amis patients to terminate treatments. In addition to biomedicine, the Amis also prefer to take either botanical medicine or Chinese medicine (or take both at the same time) to treat liver disease. In terms of the notion of hot/cold, the medicines chosen by the Amis and Chinese-style doctors are "cold" remedies opposite to the characteristic of liver disease that is considered as a "hot" disease by sick persons and Chinese-Style doctors. As such, the occurrences and treatments of disease are culturally and biologically constructed. Consequently, seeking a comprehensive understanding of EMs between aboriginal people and practitioners can explicitly elucidate the conflicts and harmonies in the local health care system and, in turn, apply to the development of biocultural strategies to cope with the health problems of aboriginal people in Taiwan.