CHILDREN'S HEALTH AND WELL-BEING:
AN ETHNOGRAPHY
OF AN UPPER EGYPTIAN VILLAGE
by
HANIA MOHAMED SHOLKAMY
A thesis submitted in partial fulfilment
of the requirements for the degree
of Ph.D in Anthropology
The London School
of Economics and Political science
The University of London
Abstract
This thesis is about children's health and well-being as constructed and maintained by villagers in Upper Egypt. It is based on primary data collected during eighteen months of fieldwork in a small village in the district of Abnube in the east of Assiut Governorate in the south of Egypt. The thesis also relies on secondary statistical and qualitative sources.
This work makes three proposi tions concerning children's health. The first proposition is that children's heal th is a distinct part of the tradi tional medical cultures of Egypt and one that should be integral to the analysis of medical culture, pluralism, and services. More over, the focus on child health and ill-health provides a critical commentary to on-going debates about health and healing in Egypt.
The second proposition is that the study of child health and ill-health is an essential and missing component of the ethnography of rural Egyptians. An awareness of the relevance of children, and of the efforts of families to keep them healthy, to the cultural, social, political, and economic construction of family and village can significantly add to anthropological understanding of the Egyptian peasant and village.
The third proposition is that the study of health as a socially and historically constructed category is as important, if not more so, than the study of ill-health. This work looks at processes whereby health is conceptualized and their relevance to the ensuing constructions of ill-health. The work also tries to establish the relationship between village discourses on health and the discourse dominant in the language, services, and structures of modern biomedicine in Egypt. In this thesis, health is viewed as an arena where cultural, historical, social, as well as economic relationships and structures come to shape family practices and choices.
TABLE OF CONTENTS
List of Plates and Maps ••••••••••••••••••••• 8
List of Tables •••••••••••••••••••••••••••••• 9
Acknowledgements •••••••••••••••••••••••••••• 10
CHAPTER ONE: INTRODUCTION
A. INTRODUCTION ••••••••••••••••••••••••••••• 12
B. THEORY IN MEDICAL ANTHROPOLOGy •••••••••••• 16
B.1 Theoretical Paradigms, 17
B. 1.1 An Empiricist Approach
B. 1.2 Explanatory Models
B. 1.3 Political Economy
B. 1.4 Phenomenology
B.2 Medical pluralism, 26
B.3 The Definition of Health, 29
C. THE STUDY OF CHILDHOOD •••••••••••••••••••• 29
C.1 Anthropology and Childhood
C.2 The Study of Children's Health, 36
C.3 Theoretical Challenges Posed by
Children's Health, 38
D. THE STUDY OF CHILD HEALTH IN RURAL EGyPT •••• 41
0.1 Theoretical and Methodological Approach
D.2 Being in the Field, 42
0.3 Data Collection, 44
D.4 Organization of Chapters, 47
CHAPTER TWO: LOCATIONS
A. INTRODUCTION ••••••••••••••••••••••••••••••• 53
B. UPPER EGYPT AND ASSIUT ••••••••••••••••••••• 56
B.l The Governorate of Assiut
B.2 The Population, 57
B.3 The Land, 58
B.4 Health, 60
B.5 Once An Upper Egyptian •• I I, 61
C. THE VILLAGE OF RIHAH ••••••••••••••••••••••• 64
C.1 The Socio Economic Context,
C.2 The History of the Village, 66
C.3 The Physical Village, 75
C.4 The Village Survey, 78
D. LAND, LABOUR AND ECONOMy ••••••••••••••••••••• 82
0.1 Agriculture
D.2 Household Income and Expenditure, 88
D.3 The Migrants, 93
4
D.4 Other Economic Activities, 95
E. CONCLUSION .•.......•.......••.••.....••. 96
CHAPTER THREE: THE BOUNDARIES OF THE FAMILY
A. INTRODUCTION ••••••••••••••••••••••••••••• 105
B. DESCENT AND MARRIAGE IN RIHAN •••••••••••• 107
B.1 The Significance of Marriage
B.2 Notes from a Wedding, 111
B.3 Being a Bride, 117
B.4 Marriage as Security, 121
C. RECREATING THE FAMILy ••••••••••••••••••••• 128
C.1 Childbearing
C.2 The birth of a Girl, 134
C.3 The Significance of Sons, 136
D. CONCLUSION •••••••••••••••••••••••••••••••• 137
CHAPTER FOUR: CHILDREN IN THE FAMILY
A. INTRODUCTION •••••••••••••••••••••••••••••• 140
A.1 Who are Children?
A.2 Working With Children, 141
B. THE ARRIVAL OF A NEWBORN •••••••••••••••••• 145
C. THE DAILY LIFE OF CHILDREN •••••••••••••••• 147
C.1 Children at Home
C.1 Children at Work, 158
C.3 Children At School, 163
C.4 Children at Play, 167
D. GROWING UP •••••••••••••••••••••••••••••••• 172
D.1 Rites and Experiences of Passage
D.2 Ambitions for the Future, 179
CHAPTER FIVE: HEALTH NARRATIVES
A. THEORY AND METHOD ••••••••••••••••••••••••• 188
A.1 Introduction
A.2 Medical Pluralism in Egypt, 189
A.3 Health Narratives, 190
B. THE DEFINITION OF ILL-HEALTH •••••••••••••• 192
B.1 Being Sickly
B.2 Risk as a Vicious Cycle, 198
B.3 The sick Body, 200
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C. THE DEFINITION OF HEALTH ••••••••••••••••• 201
C.1 The Description of Health
C.2 The Sturdiness of Girls, 202
C.3 Food and Health, 204
D. HEALTH AND HISTORY:
A DISCOURSE OF CONTRADICTIONS ••••••••••••• 208
E. UNTIDY NARRATIVES •••••••••••••••••••••••• 215
F. CONCLUSION ••••••••••••••••••••••••••••••• 224
CHAPTER SIX: IMMUNIZATION AND PREVENTION
A. INTRODUCTION ••••••••••••••••••••••••••••• 226
B. BIOMEDICAL RISK:
THE EXAMPLE OF IMMUNIZATION •••••••••••• 227
B.1 Sources
B.2 Reading the Biomedical data
on prevention, 230
c. THE VIEW FROM THE VILLAGE •••••••••••••••• 235
C.1 Experiences of Immunization in Rihan
C.2 Birth Registration, 241
C.3 street Survey, 242
D. ALTERNATIVE PROTECTION ••••••••••••••••••••• 244
E. CONCLUSION ••••••••••••••••••••••••••••••••• 246
CHAPTER SEVEN: RlHAN AS A MEDICAL SYSTEM
RESOURCES, SERVICES, AND HEALTH PROVIDERS
A. INTRODUCTION •••••••••••••••••••••••••••••• 247
B. PHYSICIANS AND PATIENTS IN THE CONTEXT OF RlHAN
B.1 The Patients, 249
B.2 The Physicians, 252
B.3 Another Physician, 260
B.4 The Physician Working Privately, 264
C. SPIRITUAL DIVINATION AND MEDICINE •••••••••• 269
C.1 The Male Sheikh, 270
C.2 The Female Sheikh, 274
D. Conclusion •••••••••••••••••••••••••••••••• 279
CHAPTER EIGHT: THE MANAGEMENT OF ILL-HEALTH
A. INTRODUCTION •••••••••••••••••••••••••••• 284
B. SALIENT MEDICAL PROBLEMS •••••••••••• 286
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B.1 The First Week of Life
B.2 'Ala batha biyerda', 294
B.3 Maftoum , 308
B.4 Biye'hbi & Biyemshi, 310
B.5 Toddlers and Pre-Schoolers, 312
B.6 Fevers and Meningitis, 314
C. THE COST OF MANAGEMENT •••••••••••••• 316
D. NUTRITION FOR AN UNWELL CHILD ••••••• 320
E. CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . 323
CHAPTER NINE: CONCLUSION
A. RECAPITULATING THE ARGUMENT •••••••••••••• 331
B. CHILD HEALTH AND MEDICAL ANTHROPOLOGY ••• 331
B.1 Health
B.2 Ill-Health, 333
B.3 Medical Pluralism, 334
C. THE MEDICAL ANTHROPOLOGY OF EGYPT ••••••••• 335
D. THE LOGIC OF PROTECTION •••••••••••••••••• 341
E. THE ETHNOGRAPHY OF UPPER EGYPT •••••••••••• 344
APPENDICES ••••••••••••••••••••••••••••••••••••• 352
1. My Past Work in Rihan, 352
2. Survey Questions, 358
3. Peasants, Parents & Politics, 359
4. Mushahra, 368
5. Family Profiles, 378
6. Immunization Survey, 383
7. A History of Biomedicine in Egypt, 387
8. Charms, Writing and Jinn, 402
9. In the House of Sheikh Eid, 409
10. Milestones and Age, 416
11. A Taxonomy of Diarrhoeal Diseases, 420
BIBLIOGRA.PHY •••••••••••••••••••••••••••••••••• 430
PLATES & MAPS
PLATES
1. A Three Years Old in the Field, 50
2. Rooftop View of the Village, 98
3. Old House still Inhabited, 99
4. Old House still Inhabited, 100
5. Inside Courtyard and Kitchen, 101
6. New House Decorated for Owners Pilgrimage, 102
7. Animals and Child in Inner Courtyard, 103
8. A Village in the desert, Rihan from a Distance, 104
9. New baby Girl, 139
10. Baby Girl and Uncle, 181
11. Bathing Siblings, 182
12. The young Carry the Young, 183
13. Feeding Animals, 184
14. The Onion Harvest, 185
15. Playing Outside, 186
16. Playing Inside, 187
17. At the Healers Waiting room, 283
18. Kohl and covering for a new Baby, 325
19. to 23 Tamrees (Massage for Diarrhoea), 326-330
MAPS
1. Egypt, 51
2. Assiut, 52
3. Rihan, jacket Pocket
TABLES
2.1 Health indicators for upper rural and urban
governorates, 60
2.2 Village Survey, 80
2.3 The Structure of Landholding in Rihan, 86
2.4 Estimated Agricultural Yield/Feddan 1992, 87
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2.5 Estimated Annual Cash Expenditure for a Family of 6
persons, 92
4.1 Key Informants, 143
4.2 Time/Activity for Children in Rihan, 150
4.3 School Enrolment in Rihan, 163
6.1 Vaccination Coverage by Antigen in Rural Egypt, 233
7.1 Cases in Paediatric Unit, 255
8.1 Neonatal Death Amongst Some Women in Rihan, 291
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