Here you go buddy, please have a lookJournal of Ethnopharmacology 167 (2015) 97–104Contents lists available at ScienceDirectJournal of Ethnopharmacologyjournal homepage: www.elsevier.com/locate/jepFood or medicine? The food–medicine interface in householdsin SylhetHannah Maria Jennings a, Joy Merrell b, Janice L. Thompson c, Michael Heinrich a,naResearch Cluster Biodiversity and Medicine/Centre for Pharmacognosy and Phytotherapy, UCL School of Pharmacy, University of London, 29-39 BrunswickSquare, London, WC1N 1AX, United KingdombCollege of Human and Health Sciences, Swansea University, Singleton Park, Wales SA2 8PP, United KingdomcUniversity of Birmingham, School of Sport, Exercise & Rehabilitation Sciences, Edgbaston, Birmingham B15 2TT, United Kingdomart ic l e i nf oa b s t r a c tArticle history:Received 24 March 2014Received in revised form15 August 2014Accepted 5 September 2014Available online 18 September 2014Ethnopharmacological relevance: Bangladesh has a rich traditional plant-medicine use, drawing onAyurveda and Unami medicine. How these practices translate into people’s homes and lives vary.Furthermore, the overlap between food and medicine is blurred and context-speciﬁc. This paper exploresthe food–medicine interface as experienced by Bengali women in their homes, in the context oftransnational and generational changes.Aim and objectives: The aim is to explore the overlap of food and medicines in homes of Bengali womenin Sylhet. The objectives are to explore the inﬂuences on medicinal plant practice and to scrutinise howcatagories of food and medicine are decided.Material and methods: The paper draws on in-depth ethnographic research conducted in Sylhet, Northeast Bangladesh as part of a wider project looking at food and medicine use among Bengali women inboth the UK and Bangladesh. Methods included participant observation, unstructured interviews andsemi-structured interviews with a total of thirty women.Results: The study indicates that the use of plants as food and medicine is common among Bengaliwomen in Sylhet. What is consumed as a food and/or a medicine varies between individuals, generationsand families. The use and perceptions of food–medicines is also dependent on multiple factors such asage, education and availability of both plants and biomedicine. Where a plant may fall on the food–medicine spectrum depends on a range of factors including its purpose, consistency and taste.Conclusions: Previous academic research has concentrated on the nutritional and pharmacologicalproperties of culturally constructed food–medicines (Etkin and Ross, 1982; Owen and Johns, 2002,Pieroni and Quave, 2006). However, our ﬁndings indicate a contextualisation of the food-plant spectrumbased on both local beliefs and wider structural factors, and thus not necessarily characteristics intrinsicto the products’ pharmacological or nutritional properties. The implications of this research are of bothacademic relevance and practical importance to informing health services.& 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BYlicense (http://creativecommons.org/licenses/by/3.0/).Keywords:Food–medicineBangladeshEthnographyHealth beliefsHealth practices1. Introduction1.1. Food and medicinesIn the context of wider debates as to what constitutes food(materia dietetica, substances) and what constitutes medicine(materia medica, medicinal substances) this paper investigateshow the food–medicine interface translates into people’s homesthrough lay food–medicine practices. The paper highlights thenCorresponding author. Tel.: þ 44 20 7753 5844.E-mail address: firstname.lastname@example.org (M. Heinrich).localised nature of the food–medicine continuum, which is subjectto multiple familial, societal and transnational inﬂuences.Speciﬁcally, the research presented in the paper explores thefood–medicine practices among women in Sylhet, NortheasternBangladesh. It draws on in-depth qualitative research in the regionconducted as part of the ﬁrst author’s Ph.D. research. The aim ofthe paper is to explore the overlap of food and medicine in thehomes of Bengali women in Sylhet. The ﬁndings indicate apractical but highly contextualised nature to food–medicine categories. Before discussing the methods and ﬁndings of the researchit is important to look at the context of the research, both in termsof the medicinal practices in Sylhet and research examining theoverlap of food and medicine.http://dx.doi.org/10.1016/j.jep.2014.09.0110378-8741/& 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/).98H.M. Jennings et al. / Journal of Ethnopharmacology 167 (2015) 97–1041.2. Medicinal traditions on SylhetBangladesh is rich in medicinal plant-medicine practices thatremain widespread, with estimates of up to 75% of the populationusing alternative and complementary medicines to manage theirhealth care needs (Ghani and Pasha, 2004). However medicalpluralism, which is the simultaneous engagement with multiplemedical practices, is widespread and dynamic in Bangladesh(Ahmed et al., 2013). Ayurvedic, unani, allopathic, faith healing,homoeopathy and kobiraji (traditional healers) are popular andoften overlapping in Bangladesh and speciﬁcally in Sylhet. Theemployment of different medical systems is affected by manyfactors including migration status, class and religion, with manyconsidering ‘folk’ practices as backward (Gardner, 1995, Wilce,2004). However, it does appear that folk healers are widespread,and pluralistic beliefs and practices remain prevalent. Turning toSylhet speciﬁcally, Gardner (1995) found during her ﬁeldwork inSylhet that healers would often employ many systems of healthincluding Ayurveda, homoeopathy and Muslim prayer, with theboundaries of herbal medicine, magic and Islamic healing blurred.In Sylhet, the impact of migration – and particularly migration tothe UK – is palpable. Research conducted by the ﬁrst authorindicates that the exchange of both ideas and medicine has animpact on the food–medicine-scape in the homes in Sylhet(Jennings, 2014). Furthermore the ﬁndings indicate that pluralisticmedical practices are reﬂected in caring practices among Sylhetiwomen in the home (Jennings, 2014). The use of food–medicines,which this paper explores, is particularly prevalent.1.3. Food–medicine interfaceThe blurring of food and medicine is not new; it is a commontheme across multiple contexts and cultures. It was Hippocrateswho famously stated “let your food be your medicine and yourmedicine be your food” (1480-377 BC proclamation, cited inLeonti, 2012: p. 1295). Similarly, Ayurveda has taught the centrality of food to both health and healing (Caldecott, 2011). While theimpact of diet and food continues to be recognised in research,food and medicine have largely been studied academically as twoseparate entities (Prendergast et al., 1998, Frei et al., 1998, Pieroniand Price, 2006). However, several academics from the disciplinesof ethnopharmacology, ethnobotany, anthropology and pharmacyhave begun to address this dichotomy as they explore the food–medicine interface from various perspectives. Notably Etkin andRoss (1982), looking at medicinal plant use among the Hausa inNigeria, found that 63 plants out of 235 were used as food as wellas medicine; they stress the importance of both local contexts andthe pharmacological properties of plants, and highlight the importance of bio-cultural adaptation in relation to what is consumedtherapeutically (as food and medicine). Several other studies haveexplored both the pharmacological aspects of food–medicines aswell as differing populations’ bio-cultural adaptations in a range ofcontexts (Owen and Johns, 2002; Grivetti, 2006; Leonti et al.,2006; Owen, 2006; Pieroni and Quave, 2006).When looking at food–medicine in the context of Bangladesh,there are few relevant studies. Among South Asians in Britainthere have been a few urban ethnobotanical studies, all of whichreveal a signiﬁcant food–medicine overlap with ‘traditional’ food(spices, vegetables) often being utilised therapeutically (Sandhuand Heinrich, 2005; Pieroni et al., 2007, 2010). Vegetables werereported to be frequently used in cooking, and were also viewed asmedicinal (Sandhu and Heinrich, 2005; Pieroni and Torry, 2007;Pieroni et al., 2010). Taste was found to be an important factor indetermining the medicinal nature of food, for example ‘bitter’vegetables were believed to counteract sweetness and thereforecould be used for diabetes (Pieroni et al., 2007, Pieroni and Torry,2007). The study among Bengalis in the north of England (Pieroniet al., 2010) did not delve into much detail regarding the food–medicine interface; however, Asian vegetables in particular werefound to be used medicinally. In Bangladesh, one study wasidentiﬁed, conducted by Rahmatullah et al. (2010) examining‘functional foods’. Looking at different plants used by kobiraji(healers) in three different villages, plants advised to be consumedfor preventative reasons (as opposed to curative purposes) werelabelled ‘functional foods’ by the researchers. These ‘functionalfoods’ were consumed for general nutrition, promotion of thehealth of different parts of the body (hair, eyes, memory, etc.), asblood puriﬁers, as well as for the prevention of respiratory, hepaticand stomach disorders. The research however did not delve intomuch depth as to why or how the practitioner viewed plants asfood or medicine.The research above brings to light the various approaches thathave been taken to researching the food–medicine interface, aswell as the range of contexts and inﬂuences on classiﬁcations asfood and/or medicine. The highly contextual nature of food–medicine, which has been under-researched to date, is exploredin some depth in this paper through looking at the context ofBengali women in Sylhet.2. Aims and objectivesThe overall aim of this research was ‘to explore the overlap offood and medicine in the homes of Bengali women in Sylhet’. Theaim was achieved through two key objectives. The objectives were(1) explore the inﬂuences on medicinal plant practices of Sylhetiwomen, and (2) scrutinise how the categories of food–medicineare decided. The ﬁrst objective provided a background as tomedicinal-plant use in Sylheti homes, illustrating perceptionsregarding health and medicinal plants, the dynamic exchange ofknowledge between generations, differing sources of knowledge,the practical nature of medicinal plant use and the transnationalnature of knowledge. The second objective was achieved throughlooking speciﬁcally at the classiﬁcations and constituents of foodand medicine, highlighting the importance of the purpose of food–medicines, taste and constitution in food–medicine classiﬁcations.3. MethodsThe paper is drawn from ethnographic ﬁeldwork conducted bythe ﬁrst author of the paper as part of her doctoral researchexamining the therapeutic uses of food-plants and the transmission of knowledge among women of Bengali origin in London,Cardiff and Sylhet. This paper reports on the ﬁndings from theresearch conducted in Sylhet. Research in Bangladesh took placeover two six month periods (January–June 2011 and January–June2012). The research focused exclusively on women due to practicalreasons and the nature of the project.1 However, over the course ofthe research it was found that women were primarily responsiblefor the cooking and preparation of food in the house, furtherjustifying the exclusive focus on women in this study.A qualitative ethnographic approach was adopted due to thenature of the research, which aimed to gain an in-depth understanding of the complex dynamics of medicinal and health plantfood knowledge. Such an approach enables one to explore in aﬂexible manner complex, and indeed ﬂuid, interrelationships aslived meaningful experiences (Denscombe, 2010). Within the1The Ph.D. is part of a larger project, (Migration, Nutrition and Aging (MINA)Across the Lifecourse in Bangladeshi Families: A Transnational Perspective, www.projectmina.org), focusing on Bengali women in the UK and Bangladesh.H.M. Jennings et al. / Journal of Ethnopharmacology 167 (2015) 97–104qualitative approach several methods of data collection wereemployed. They included semi-structured interviews, unstructured interviews and participant observation.As the research was in-depth and qualitative, it was concernedwith researching speciﬁc networks as opposed to a large representative sample. Thus women whose families in the UK could also beinterviewed were selected for research when possible, as well asmother and daughter or daughter in-law pairs; therefore it waspossible to examine family dynamics as well as generational andtransnational exchanges. The selection criteria for the intervieweeswere that they were over 16 years of age, had family in London andwere female. ‘Older participants’ were over 45 and the mothers (ormother in-laws) of ‘younger participants’ who were in their 20s and30s. Participants were recruited by snowballing, as this is aneffective means of selecting cases within a network (Neuman,2006). Purposive sampling was used to identify women with highlevels of medicinal plant knowledge. The semi-structured interviews were conducted with six mother and daughter or daughterin-law pairs (twelve interviews in total). The interviews were of anhour’s duration and the questions asked related to food andmedicine practice, health beliefs, links to the UK and generationalchange. The questions were derived from a literature reviews andpreliminary research, and had been piloted. Informal interviewsspeciﬁcally regarding medicinal plants were made with three‘knowledgeable’ women identiﬁed during ﬁeldwork. As part ofparticipant-observation, regular visits were made to ﬁve intergenerational Londoni (people with family in the UK) homes. Inaddition, visits were made and talks conducted with people atvarious nurseries, seed shops and herbal medicine shops in thearea. Informed verbal consent was given by participants and ethicalapproval was gained from the relevant ethic committee. The interviews were audio recorded and transcribed verbatim. During moreinformal interactions, detailed ﬁeld-notes were taken. The ﬁndingswere analysed using a thematic approach and with the assistance ofthe computer software Hyper RESEARCH.Research that is valid means that the instruments of research,the data generated and the subsequent ﬁndings are both accurateand trustworthy (Bernard, 2006). In order to ensure the data wasvalid a number of measures were taken. They included theresearcher reﬂecting on her role as a researcher throughout theresearch process (Bernard, 2006; Denscombe, 2010). When conducting the research she strove to build relationships in order tomake the participants feel comfortable and gain accurate information (Smith, 2005). Detailed ﬁeld notes were maintained andmultiple research methods employed enabling the crossveriﬁcation of data (Denscombe, 2010). Finally, when recordingthe information, direct quotes and raw data were used as much aspossible (James (2001)).4. Results and discussion4.1. Medicinal beliefs and practice in Sylheti homesThe health practices of the Londoni participants were to anextent pluralistic, varying according to a complex interaction ofbeliefs, perceptions, familial and social inﬂuences. Furthermore,the inﬂuence of different health systems (for example biomedicine, Ayurveda, Islamic) was apparent. During interviews theparticipants were asked about beliefs as well as where they wouldseek health care for both minor and more serious illnesses.The participants viewed eating well and a balanced diet asimportant to optimising health. While views varied as to whatconstitutes ‘good food’, there was a general agreement on the needfor ‘balance’ and plenty of vegetables. Furthermore, the constitution of food (soft versus hard), and the medicinal properties of99certain foods were highlighted; this will be discussed in greaterdetail later in the paper. According to some of the participants,maintaining a balance in one’s diet should extend to regularity inone’s daily activities in order to maintain a healthy body; forexample in one’s daily activities such as sleeping and eating,where one should sleep ‘enough’ (and not too much). The conceptof balance is related to Ayurvedic concepts. Having a cleanenvironment with fresh air was stressed by several participants;related to this, it was expressed that one should keep oneself cleanand that not doing so may create ill health. Along with thesephysical aspects of maintaining health, participants reported thatworries and ‘tension’ too could cause physical ill health; there wasno clear mind-body dichotomy in this regard. Several participantsdismissed spiritual causes of poor health as superstition, and evendangerous. However, spiritual causes were mentioned by others.Three of the participants particularly discussed how jinn, bhut(spirit, ghost), nazoor (evil eye) and other people putting jadu(magic) on one could cause poor health. Interestingly, these threeparticipants (BM5, BM6, BD6) all had spent signiﬁcant time in thevillage, where perhaps beliefs in the supernatural are more widespread and/or more acceptable. Previous research ﬁnds that beliefin the spiritual realm is complex and widespread in Bengali Islam(Karim, 1988; Thomas, 2006).Turning to health-seeking behaviours among Londonis, prior toseeking help from outside of the home (be that from a doctor,pharmacist or a kobiraj/healer), most participants reported ﬁrsttreating themselves or being treated by family members withinthe home. Examples of managing sickness include taking pills(such as paracetamol), taking a homoeopathic remedy or amedicinal plant, or practices such as cooling down someone witha fever through applying cool water to their head. If an illness wasdeemed more serious, outside help would normally be sought.Outside of the home there is an array of treatment centres andpractitioners available in Sylhet: biomedical, Ayurveda, Unani andhomoeopathic pharmacies, private doctors, individual kobiraj,NGO clinics, government hospitals, private hospitals and a homoeopathic hospital.Regarding perceptions of medicinal plants, they were generallyviewed as ‘safe’ but slower-acting than allopathic medicine,though this varied according to the participant and family. Incontrast, the doctori oshud (doctor’s medication) was perceived asmore powerful and ‘strong’ by several participants. Consequently,they were likely to have side effects. Despite being wary of sideeffects, most participants reported using pills as well as medicinalplants at home, depending on the problem. A ‘small’ problem suchas a cough or a cold may be treated with medicinal plants.However, if someone had a severe headache they would prefer a‘strong’ and ‘quick’ cure from a pill. There were of course exceptions as to the extent of medicinal plant use among the participants. This varied across families and generations and was verymuch inﬂuenced by place (discussed in greater detail below).Looking at food–medicines speciﬁcally, they were viewed as notstrong, in line with perceptions of medicinal plants and werefrequently consumed as part of the diet, and like other medicinalplants their use varied across generations, life-course and place.4.2. Generational and transnational exchange and changeWhen looking at the medicinal plant-scape in Sylheti homes,particularly among participants in this research, the role ofgenerational and transnational change and exchange is crucial.While both the ‘elders’ and the ‘past’ were held as the keepers ofmedicinal plant-use and there was a general assumption (p…
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