Dr. Cameron Hay is a premier cultural anthropologist in the study of health, medical systems, and medical knowledge, her major project being ethnography and comparison of the Sasak people of Lambok, Indonesia and their medical practice to American people. She cites her father as her strongest intellectual influence for his empathy and critical eye. Jon Andelson and Ron Kurtz sparked her interest in anthropology at Grinnell College. At Emory University, Dr. Hays earned her MA and Ph.D. in anthropology with a biocultural focus. Earning a NSF Advanced Fellows award helped her continue her postdoctoral studies at UCLA, where she currently holds her secondary position as an associate research anthropologist. She published her her first major paper in 1999 in the Medical Anthropology journal under the title “Dying Mothers: Maternal Mortality in Rural Indonesia.” Since then she has published 18 other papers and a book, Remembering to Live: Illness at the Intersection of Anxiety and Knowledge in Rural Indonesia.
Challenging Understanding of Medical Learning
Hay hopes to demonstrate three things about medical practice in particular and the effect of culture on the neurology of learning as a whole. The cultural context of medical learning affects how important different types of knowledge appear, in turn changing what and how we recall information. What information we tend to recall and how we recall it over time affects the tradition and practice of medicine.This process of ‘co-creation’ between medical knowledge and medical practice extends to “anytime learning takes place” (142). The process of learning then is generalized, not compartmentalized as academia would make it seem. Knowledge affects how we learn and is both culturally contextual and holistic.
Sasak Medical Tradition
Sasak tradition practiced in impoverished, rural community that continues to deal with the consequences of “domination, exploitation, and extraction.” Their history contributes to malnutrition, low wealth, low literacy, and life expectancy being around 50 years. Nevertheless, they have a self-sufficient medical practice, one not dependent on outside aid, in the form of jampi, “inherently potent sequences of words.” These words are memorized and used sparingly so as not to diminish their efficacy.
Although the Sasak medical tradition is vastly different from American medical practice and the communities American practice thrives in, Hay maintains that they can both be understood in terms of medical terminology, organization, and retrieval co-evolving to suit the needs of the community.
The Sasak regard biomedical care as speeding recovery but not healing like jampi. Jampi act as memorized responses to illness and are precious in part because they are not written down. Giving and receiving jampi requires isolation. To limit degredation of memory, Sasak employ “multiple constraints:” consistent form, limited words around the limit of human memory capacity, the association of jampi with great importance leading to heightened arousal and thus encoding, self-concept of healers reinforcing already strong recall, and the intentional encoding based on future need. Because of the importance of memorization, Sasak tradition relies on the hippocampus, medial temporal lobes, and prefrontal cortex.
American Medical Tradition
American practice relies on several assumptions. Skilled practice is supposedly scientifically sound, with medical education valuing semantic knowledge over episodic. By being consistent, American practice hopes to avoid individual variation, especially through guidlines, even though American students are not good at memorization. American practice also assumes that it can be wrong, and thus can always be improved. Physicians tend to become more skeptical the more experience they have reading journals and practicing. Finally, American practice does not transfer knowledge of how medicine works in practice, but expects students to gain a holistic view over time.
Embodied cognition offers a way to understand why practical experience and episodic memory serve physicians better than semantic memory. Cognitive action can stimulate motor action, generating procedural memories. Procedural memory and episodic memory combine to make schemas, maps of one’s knowledge and appropriate response; the process of memory consolidation is closely tied to the hippocampus and neocortex, which takes over the cognitive burden. Over time and with enough reinforcement schemas become hippocampal independent and automatic, employing the basal ganglia and caudate.
Diagnosis and Motivation
Illness not recognized immediately push both Sasak and American healers toward more effortful recall. In Sasak communities, when few people gather, there are fewer jampi and low anxiety, but larger groups talk more often about illness, increasing anxiety and the stress response. Stress leads to release norepinephrine, activating the amygdala and thalamus, increasing attentiveness and potentially leading to activation of the hippocampus, facilitating recall. Since American healers tend not to rely on recall as much, stress pushes physicians to external resources, which might then be reintegrated by the stimulated hippocampus into their schema of treatment. Each of these strategies have a use: the Sasak reliance on memorization and connection to specific individuals helps when someone does not have personal experience treating an illness, whereas the American dependence on schemas and skepticism is suited to developing procedures for and diagnosis of new diseases.