a conversation with Caitlin Farley
Caitlin Farley is an anthropologist focused on community and global health, the role of culture in health and the issues of trust between patients and healthworkers. Her graduate studies were based in Indonesia working with traditional healers, ethnopharmacologists and community members and she has also completed field work in Ireland, Singapore and with the immigrant and refugee community in the New England region of the US. She is currently working as an HIV project manager and Community Health Worker at a Community Health Center in Massachusetts, and spends her weekends singing, sailing and working on traditional wooden boats and exploring all the forests and waterways of her home.
In this episode, Caitlin discusses her work as a Community Health Worker, her research on community health abroad and traditional medicine, how she hopes to change the field in her future work, and how she became interested in the concepts of traditional medicine, medical anthropology, and cultural sustainability.
In this episode we touch upon issues of decolonization, bio piracy, and the effect of climate change on medicine, people, and future generations.
K: What inspired you to lean into this work?
Caitlin: “Uhm, so I actually originally started in a very different direction like I think a lot of people our age do. I started in Egyptology and had to drastically change directions because around the time I was looking into graduate school the Tahrir Square situation was going on in Egypt. I started to get really interested, towards the end of my Egyptology work, in a lot of the medicines and things that were put in the tombs in the Egyptian burials. And I sort of had to go backwards and backtrack why I was drawn to Egyptology in the first place and figure out what was possible for me with changing direction. I realized that that had always kind of been on my radar… I looked over at a bookshelf and there were like three shelves of Egyptian medicine and things like that on my shelf and I was like, “hmmm, I’m really into healthcare and culture and where those intersect. And actually, my partner right now, years ago we were just friends and he introduced me to a Cultural Sustainability graduate program at Goucher College and he had just started and gave a really glowing review and throughout my time there, [I] was just able to kind of process all of that and blossom and ended up going more towards global and community health work.
K: Awesome. So, what did your time abroad really teach you the most about community health work?
C: That when we think about patients... there’s this like stereotypical image a lot of people have in their heads that the people who are scared, or “scared”, to access medical, Western or Allopathic, as we call it, medicine and prefer to rely on traditional - which is more preventative medicine... and the way that community of people, like... each individual has their own reasons and also across every culture those reasons are vastly different. And so working in Ireland, working in Singapore, working in Indonesia, and working here in the US in my home region—the way that we sort of work in Community Health is to figure out the way people define health, the way people make decisions about what’s urgent and what isn’t and how to address it. It’s so individual to people and I think that’s something that we’re starting to see more and more as a trend in global and community health. It’s less of a public health numbers focus and more of a medical anthropology focus, which is of course close to my heart - passion.
K: *Sounds of agreement* Great! Well, so I guess my next question is really you know, looking at your time abroad, and I mean you’ve worked with quite a few different populations, but how is that different from being here? Like what are some of the similarities? What have you been able to bring back? What are the challenges and sticking points of all of this cross-culturally?
C: Hmm, I think the thing that stuck out the most to me was the number of people I saw in Indonesia that reached the age of 100 and beyond and were still truckin’—like lugging giant bags of rice uphill every day. And so many of them use plants and their natural environment to prevent, I guess, the degradation of their health. So, just spending all that time outside walking everywhere, maintaining motion, adding plants and medicinal plants to their diet every day. They don’t need to go to their doctor for check-ups every now and then, they don’t need to go to the hospital for as many emergencies, they don’t need have access to ERs as quickly. And so I think about that a lot with the work I do in community health centers here. It’s almost so easy for me to work with the refugee and immigrant communities who have come from places where that is kind of the same for them. It’s actually been harder for me... I guess that reverse culture shock - to take that hat off and work with patients who have never had those as options (walking, medicinal plants). But, in the process of doing that, I’m taking everything I’ve learned from what good health looks like in people that, you know, in (the minds of the) Western world don’t have access to health(care), but yet appear to be so much healthier. And just take those lessons and try to bring them to patients here in the US that have never known that way of life, as a standard way of being healthy.
K: And have you found that to be possible with the current work that you’re doing? Bringing those traditional medicinal practices here? Have you found applications in your daily work?
C: It’s less the traditional medicine and more the way of thinking about health. So, I guess the people who utilize those practices think and define health and being healthy in a different way. It’s far more about prevention and there has been a push here in the U.S. to get more funding—I was actually just at the State House in Boston recently to advocate for further funding for a grant called The Prevention and Wellness Trust Fund, which is all preventative programs for preventing diabetes, preventing hypertension, preventing asthma (episodes)… And so there is sort of a movement for that, but I find very often that there’s a lot of pushback both in the government for funding, but also in the everyday person. Because that’s one of those things that it’s like... we talk so much about self-care now, it’s a real trending thing, which I think is great, but people don’t have time. They always say, “I don’t have time to do that. I don’t have time to walk to work.” Nor do they often have sidewalks or safe places to walk. “I don’t have time to do these things, to stand up and take breaks. I don’t get to walk around outside, I don’t get to do these things”. And in other places, they HAVE to do it. It is a lot harder to translate here and it’s viewed here as a recreation whereas in other places it’s a necessity and that’s a huge difference.
K: Right. So what did your fieldwork look like when you were doing that?
C: So, it was different in each place. I actually was just supposed to just do work in Indonesia, and as many people in the field learn very quickly, you have to roll with the punches… so I ended up adding other countries to my work on the fly and it worked out. But, my work was supposed to be just in Indonesia and it started with reaching out to colleges in the area, Universities in the area, and trying to make partnerships and see what research was already being done and get a feel for government programs, any cultural programs. Like we think here, coming from an Anthropology or Folklore background, “oh, there’s a state folklore program in every city, every state and they support this” but you know, in another country do they have that? So identifying those things, what was being put up as something of value and what was thought of as something to get rid of from the “old times”. So after forming that picture I did research in which places there had been anthropological work done previously, just because I didn’t really have the time to go find things on my own for the first time and went to the island of Sulawesi, which most people don’t know about. Everybody thinks of Java, Komodo Dragons, Bali. Sulawesi is the sort of octopus-sy shaped one and it has a largely diverse group- just largely diverse cultures there. It’s a huge island and it has a lot of mountains, a lot of rainforests, so the people were very cut-off from each other for a long time, so there’s just a ton of cultures on that island alone. And I found a few, that there were words in the language for like five different kinds of healers, which automatically tipped me off that there was a really rich healing culture there. And I started looking for where hospitals were in the area and how many. So I picked some of the larger (for that area) towns and started there. I wanted to figure out what their approach was to that hospital, what their thoughts about it were, and just sort of go once I was in the field—which is kind of what you have to do if you don’t have anything immediate. I got crazy lucky. I stayed in a homestay (which is when a family opens their home to you) with a gentleman who was a retired village chief and traditional healer.
K: Wow, that’s just really, what’s the word? Fortuitous.
C: It was. Both for my research and I got sick at one poin and he took care of me, so....
K: OH WOW!
C: His whole yard was traditional medicinal plants. So I stayed with him and with an interpreter—we had a lot of conversations about the elders in that village and how they offer traditional medicine and they would sort of…it seemed like they had a sort of system of determining…they knew when something was Cancer somehow and they would go to the hospital for that. They would try to prevent it and keep it in check and they had their own observational system to determine, “this is out of our hands, we need to go to the hospital” and they would. So that was all incredibly interesting to learn about. He took me to some other villages and introduced me to more people- I went to some areas that had been heavily influenced by Dutch missionaries who had converted the areas to Christianity. To learn about what of the culture had remained from before and what had been converted was really interesting - how it was enmeshed. They still use traditional medicine there, even the children. I talked to some 6 or 7-year olds, and one of words for healers is dukun, and when I asked them if they had ever been to see a dukun, they started laughing and made like a spooky wizard gesture with their hands, I pulled out a translation book and clarified specifically a plant-based dukun (because there are types of dukun that are like “Dark Wizard” kind of spirituality, the ones you don’t want to mess with) and that’s clearly the only thing the kids had immediately thought of and when I clarified the plant doctors they went, “oh yeah, yeah they’re in there” like pointing and telling, like going off on this whole story—I didn’t have an interpreter (at the moment) so I don’t know, but it seemed like they were telling me where one was and so even in those places where you think “I have no idea what I’m gonna do” stuff just kind of works out and that’s sort of what happened for me with my fieldwork.
K: So, and you might not have the answer, but based on the story I just got curious, between the different villages that you went to in Indonesia did you notice (and I don’t know if they really keep track of this) different health trends between communities who weren’t converted by Dutch missionaries and who were? I’m just wondering if that cultural influence has affected their medicine in a big enough way to kind of make it so that there’s not as much focus on preventative medicine as it is in this other village that they are cut off from but who kind of solely still utilizes that practice? Does that make sense?
C: Yeah, absolutely. I totally get what you’re saying. So the particular region where I was working, each of those areas were equally distanced from clinics and hospitals. I think that if that hadn’t been the case, if the missionaries had also built a hospital or clinics, that maybe there would have been a bigger change. But I think because they still didn’t have that easy, short-distance access, they still relied on the same medicines. And because there were the different forms of dukun, a healer that works with plants and doesn’t necessarily have anything to do with religion (from the missionaries perspective)…their religion, historically, is Animist (Animism), so based in Nature. I have found in my own experience that missionaries often have less success with converting that way because it’s not like a person-to person...like there’s not a god to god exchange, so they do tend to enmesh a little more. So there wasn’t really anything for them to replace something with, if that makes sense.
K: Yeah, it does. That’s really interesting. I mean obviously I don’t know, but your logic there seems really sound—that’s fascinating. So, I also wonder, did you have any conversations with the healer you stayed with about traditional ways of healing and plant medicine and the effects of climate change? Is that impacting the plants that are available to them? And did you experience any of that in your fieldwork? Were they kind of talking about that?
C: So this is actually something I pay attention to a lot. I’ve seen it in my own research as well as in the fieldwork. It’s one of the first things people will mention of their own accord without being asked. The concept of global climate change is not always the way they’re thinking about it….
K: But they know something is different.
C: It’s often they can tell the soil isn’t as healthy so there’s less of a plant or it’s smaller or the medicine and the plant is not as strong—they have to use more of it and it’s harder to find enough of it to make it strong. Or they’ll tell me when plants have disappeared completely, although that’s sometimes biopiracy, not necessarily climate change, and they won’t know which one it is.
K: Can you explain a little bit about biopiracy? I’ve never heard of that before.
C: So bio-prospecting is when pharmaceutical or other people trying to find new plant medicine will go into communities and identify a plant and then take it to a lab and synthesize a chemical version so they don’t need more of the plant (with permission of communities via the Nagoya Protocol). Bio-piracy is when it is taken. Often intellectual property is violated, it’s taking traditional knowledge from communities and trying to patent it. There are often attempts by a company to patent a plant in its raw form, which is not legal. Or there have been cases of maybe all of the root, all of the roots of a plant being ripped up or all the bark being taken off every plant findable and a plant going extinct…So if a plant, if they can’t find more of it because it’s all been pulled up or it looks like its all withering and dying because the bark was taken off in the night by a local who was paid a lot of money, they don’t always know what the cause was which is hard. I’ve watched documentaries about it—like there’s a really amazing documentary about medicinal honey in Nepal called “The Last Honey Hunter” by Renan Ozturk and it’s a documentary everyone should totally check out because it’s a really good example of all this…They flat out say…. like there are these really isolated mountain villages in Nepal and they are just now getting their first paved road and yet they straight up say in the documentary “climate change is killing all the bees. There’s no honey left.” Direct identification of it.
K: I mean this is difficult work, you know? Abroad, here in the US. What kind of experiences led you to be willing to go against the grain in this way and in this field? Because I know it’s difficult to really get into the kind of work that you’re really passionate about, what decided that this is it for you? I feel like it’s brave, you know, it’s a big deal.
C: I appreciate that. I think everybody has something that they can’t stop reading about no matter how angry it makes them. And it’s…You find that thing that you just keep researching and you just keep learning about and you find yourself doing it on your free time and you find yourself staying up accidentally until 3:00 in the morning, or you’re on your lunch break and you’re reading about it and you’re talking about it all the time…and I think everybody has something like that. And it might not be an advocacy thing, maybe it’s art, maybe it’s space, maybe it’s robots, you know? But I think if you have the opportunity and you find yourself consumed by something you kind of just gotta try to go after it…and not everybody has that opportunity. I mean, I started out in robototics in high school and maybe if I had done that, I’d be making a billion dollars, but you know global health and advocacy in any way is certainly not always a super comfortable field to be in, but I just can’t... really... stop. And any time I start to feel myself get pulled a little bit off the path by somebody’s suggestion, maybe it’s an amazing career opportunity, or a project, or even sending me something to read—I’ve gotten to the point where I’m just like, I recognize how it’s a little related and I am aware that everything is connected and I definitely web out and go down different side paths to expand my knowledge of how interconnected everything is—but I still have this focus of, “no that’s not quite it, I need to put my time into this thing” and it’s been more and more about health and listening to people. Giving people a voice to talk about what they want to be healthy, and not telling them what healthy is—and then working to make that (personal) view of health possible for everyone.
K: Yeah, that’s incredible. So what kind of advice would you have for people of all ages (elders, future generations, young people) who are looking to be advocates in this line of work?
C: Start on the front lines. If you want to be a Doctor, start out as a Community Health Worker. Because being in it, really in it, and hearing all the stories and seeing the complexity and really getting it, instead of just saying “I think I understand” and then steamrolling over the reality of what people are living and putting your own proposed fixes that aren’t based in reality…it’s just so important to really be a part of the community and really hear them. And even if you do move up and away, which is often the only way to make a sustainable income - is to distance yourself from people. You have to move up - and that’s unfortunate and I fight with that a lot because its not really what I want. But taking that knowledge of what the reality is and then applying it is so vital for any policies, any change - to actually make change. And remembering and continuing to keep your finger on the reality and touch base with it every now and then, dive back into it, go volunteer again for a little bit, and remind yourself and like... see how things have changed. And just keep doing that and you’ll actually be able to take whatever privilege, or gifts, or connections/networking you’ve been given to do something with that knowledge. You actually can take all these things and apply them in a real and important way.
K: So what do you see for yourself as your aspirations moving forward?
C: I would absolutely love to work for Doctors Without Borders and, again, I know I’ll start in the field which is what I want. But I would love to change any relief group, when they go into a community that is not their own, to have more initial steps be based around listening to the community and getting to know that community and not applying a cookie-cutter relief effort because that exact problem is why the Ebola outbreak is so bad right now.
K: Right. I’m just nodding my head so vigorously at everything you are saying right now.
C: It’s like my dream is to change the policy across the board that it is standard to have like 500 community health workers and like elders and traditional healers on a board advising implementation.
K: Yes, that’s incredible! Absolutely, and it’s needed. It’s very clear that you only get so much out of a textbook and then you kind of drop people into a community and it’s just not, you know, it’s not as effective. There’s not this pre-learning work. And on the one hand I recognize that they’re being put in these situations that are extremely urgent, but at the same time, in order to work on the prevention side of things you need this pre-work and community listening.
C: Absolutely. There’s something you said earlier that you were explaining about that doctor, the professor, there’s a huge movement I think in almost every field and I’ve seen it myself in conservation and in health and it’s decolonized global health, decolonized conservation.
K: Yes, absolutely.
C: It’s exactly what we’re talking about there-- don’t implement what you think is right because it’s not based in reality.
C: And I mean if anybody ever ends up stuck in a hospital or a clinic or anything and you feel scared and overwhelmed, ask someone on staff if there’s a Community Health Worker there. And everyone I’ve met is—they’ll pull you out, they’ll help you.
Full interview audio: