Ceridwen Spark

Learning From the Locals: Gajdusek, Kuru, and Cross-Cultural Interaction in Papua New Guinea

The everyday practice of making colonies is as 'fractured and erratic' as the various personalities of the colonisers and colonised brought together in the process. Drawing on the journals of Dr Carleton Gajdusek, who worked as a medical researcher on kuru among the Fore people of Papua New Guinea in the 1950s and 1960s, Gajdusek's approach to the Fore peoples' response to sickness is analysed. Providing evidence of an individual western medical practitioner who valued and respected local ways of responding to the sick, it presents a critique of the idea that imperialism as a 'macro-historical' theoretical model provides a sufficient explanation of localised medical practice in the tropics.

In recent years, scholars have begun to critically examine western medicine's status as a 'superior' knowledge and to give increasing attention to the social and political contexts in which it exists and operates. This recent scholarship is important and necessary, not least because it plays a significant role in highlighting the racial politics (and racism) that are often at play in imperialist 'progress' narratives. And yet, there are risks associated with this critique of western medicine, including that 'every western person [is in danger of becoming] automatically identified with the west and complicit in its imperialist crimes.'¹ This is a problem because individuals do not tend to embody and reflect imperialist discourses in unambiguous ways.

This article contends that rather than being rigid and absolute, the everyday practice of making colonies is as 'fractured and erratic'² as the various personalities of the colonisers and colonised brought together in the process. Drawing on the journals of Dr Carleton Gajdusek, who worked as a medical researcher on kuru among the Fore (pronounced Foray) people of Papua New Guinea (PNG) in the 1950s and 1960s, the article provides clear evidence of an individual western medical practioner who valued and respected local ways of responding to the sick, while maintaining a commitment to advancing western science. In this way, it explores the idea that while western medicine might rightly be characterised as an imperialist knowledge, in the actual and less ordered world of the cross-cultural colonial encounter, notions of imperial authority may be less relevant for understanding these interactions than has been assumed.

Re-examining the cross-cultural interaction surrounding kuru, this article explores Gajdusek's deep respect for the Fore peoples' approach and response to sickness as evident in his journals and letters. Highlighting the mutually transforming nature of cross-cultural interaction, it demonstrates that while Gajdusek's encounter with the Fore and his subsequent acquisition of honour and fame might appear to constitute a classic example of imperial conquest, Gajdusek engaged in relationships and processes which cannot be accounted for purely within the conquest narrative of 'empire.' Furthermore, by drawing attention to the ways in which the Fore unsettled—however momentarily—Gajdusek's own belief in the supremacy of western medical science, the article presents an implicit critique of the idea that imperialism can be put forward as a 'macro-historical' explanation of medical practice in the tropics.

Gajdusek and kuru

Kuru, a Fore word meaning 'trembling or fear'³ was 'found' among the Fore people of PNG in the 1950s. Gajdusek's association with the disease began with his arrival in PNG's Eastern Highlands. Having heard about a 'shaking' disease that was killing people in this area, this brilliant and ambitious paediatrician and medical scientist from Yonkers, New York, travelled to the region to see the strange disease for himself. Days later, in March 1957, Gajdusek wrote excitedly to his mentor and early collaborator, Dr. Joe Smadel, at the National Institutes of Health in Washington:

I am in one of the most remote, recently opened regions of New Guinea (in the Eastern Highlands), in the center of tribal groups of cannibals, only contacted in the last ten years and controlled for five years—still spearing each other as of a few days ago, and cooking and feeding the children the body of a kuru case, the disease I am studying.⁴

Over the ensuing months Gajdusek covered 'miles of cliff-faced and precipitous jungle slopes'⁵ in order to track kuru. In doing so he effectively compiled the 'first census of the region,'⁶ thus contributing to a colonialist fund of knowledge about the Fore and surrounding peoples.

Eventually Gajdusek showed kuru to be caused by a transmissible infectious agent. Extracts from brain tissue of kuru victims were injected into chimpanzees, which subsequently manifested symptoms of the disease.⁷ Cannibalism, practised among the Fore people, was identified as the mode of transmission.⁸ Kuru affected mostly women and children and was transmitted through open sores and cuts when affected tissue was handled during the preparation of human flesh for consumption, or during consumption itself.⁹ Fore men were not involved in the preparation of the body, nor did they commonly eat the affected tissues.¹⁰ A 1962 survey conducted in the area identified the profound effect kuru was having on the Fore, establishing that over 30 percent of deaths were caused by the disease, making it the main cause of death, while also determining that '[f]emales accounted for 89.1 percent of deaths from kuru.'¹¹ As Australian anthropologist Shirley Lindenbaum observed, kuru was 'predominantly a disease of adult women,' and with 'high female mortality and low birth rates,' the 'Fore believed their society was coming to an end.'¹² With the numbers of adult women declining, forty- and fifty-year-old men took twelve- and thirteen-year-old girls as wives.¹³

Gajdusek's work on kuru helped to shed light on the understanding of what are now known as prion diseases (transmissible neurodegenerative conditions). In humans, this includes Creutzfeldt Jakob Disease (CJD). Prion diseases have previously been described as 'subacute spongiform encephalopathies, slow virus diseases, and transmissible dementias.'¹⁴ Bovine Spongiform Encephalopothy (BSE), commonly known as 'mad cow' disease is recognised as one of the animal forms of prion disease.

In 1976 Gajdusek won the Nobel Prize for medicine for his discovery concerning 'new mechanisms for the origin and dissemination of infectious diseases.'¹⁵ For the Fore there were also gains; medicines and knowledge brought by the outsiders improved the collective health while, as a result of a policy discouraging cannibalism, forty years on, kuru has almost disappeared. Yet for those one to two people a year who succumb to kuru in the present era, long after the researchers have gone, there remains no cure for the disease.

What then of the wider context of western medicine in this place and time? The Fore area closely corresponds with the Okapa sub-district of the Eastern Highlands Province in PNG's central mountain ranges. The region was 'largely isolated until after the Second World War.'¹⁶ Goroka is the closest large town in the broader area of the Eastern Highlands Province and this is located about ninety kilometers northeast of the small administrative centre of Okapa. Dispelling the idea that scientists arrived suddenly among 'villagers with no previous contact with the outside world,'¹⁷ Pacific historian Hank Nelson argues that by the time Gajdusek arrived among the Fore they were 'at the end of a line connecting them to the rest of the world.'¹⁸ As he details, this 'line' began with goldminers in the 1930s, and by 1947 the first administration patrol visited the area. Native Medical Orderlies were present on this and most subsequent patrols, which were led by 'kiaps' (native law enforcers) appointed from within the Australian administration. By 1957, there was a government school in Okapa. Thus, it is clear that by the time Gajdusek arrived in 1957, the Fore were well and truly 'contacted.'

Long after Gajdusek's arrival, however, the Fore considered kuru to be the manifestation of a powerful and malignant evil, the work of sorcerers.¹⁹ As government anthropologist Charles Julius wrote at the time of Gajdusek's initial investigations, '[until the disease can be successfully treated] it seems improbable that any amount of explanation or propaganda will achieve much in removing what is the main cause of suspicion and insecurity in an otherwise unusually harmonious group.'²⁰ Julius' estimation of the significance of sorcery is supported by Gajdusek who writes: 'We may be able to dispel the magic ("poison") of yaws and leprosy from the native's thinking, but as long as there is death, they can still find its explanation in the maliciousness of those around them.'²¹ The Fore's emphasis on sorcery provides clear evidence that after the introduction of western medicine they continued to utilise traditional medicines and explanations. This is an important key to understanding the context in which Gajdusek was working.

Before embarking on the analysis of Gajdusek's journals and demonstrating how these reveal his respect for the Fore's knowledge about and response to sickness, it is necessary to situate the current discussion in relation to previous work in the history of medicine on kuru.

The history of medicine and kuru

As noted above, recent scholarship in the field of imperialism, science and medicine has helped to contest the notion that western medicine is a purely rational enterprise existing outside the social context in which it is produced. Alison Bashford, for example, has written of the 'deep connection' between tropical medicine and colonialism²² while others have discussed the ways in which tropical medicine was established in order to know, legitimate, and make possible the colonisation of 'other' lands by white races.²³ Arising out of the express desire to increase the profitability of colonialism, western medicine sought first to promote the health of white men in the tropics and subsequently, when the necessity of a strong indigenous labour force became clear, to achieve this in as cheap and expedient a manner as possible. Thus, social and hygiene issues were overlooked 'in favour of research into diseases deemed ... to be tropical in provenance.'²⁴ As several scholars have noted, this exploitative and racist discipline betrayed a 'very close connection between medicine and government.'²⁵ Moreover, because '[t]he logic in the very idea of "tropical" medicine always suggested that western science was investigating something exotic to itself,'²⁶ tropical medicine invoked and perpetuated racist binaries—for example, self and other, primitive and civilised—which both reflected, and were fundamental to, the imperial project and imagination.

In light of this history, it is important to be attuned to the ways in which imperialism, as 'a political and economic event,'²⁷ has created forms of material oppression that continue to produce 'real victims' in the present. It is also worth remembering, however, that day-to-day interactions between the colonisers and colonised involve 'messier' encounters that lie outside this dichotomous framework. As such, they confirm the invalidity of resorting to 'imperialism' as a macro-historical explanation of medical practice in the tropics. The need for complex analysis of the relationship between imperialism and medicine is supported by Gyan Prakash who notes that the history of colonised places involves more than 'a record of submission (or opposition) to trajectories chartered by ... [colonial] mastery.'²⁸ Nancy Rose Hunt's work on the Congo also advocates a more complex approach. Her research focuses on the ways in which local therapeutics differentially translate and reshape the opportunities that colonial medicine offers 'according to pre-existing logic and emerging formulas of authority and prestige.'²⁹ In this way, Hunt has avoided writing what she calls 'an epic of colonial encounter' and instead has provided an account of the way 'local Zairians use and rework colonial elements every day.'³⁰

In the study of kuru this subtlety also is evident in the work of Shirley Lindenbaum. In Kuru Sorcery Lindenbaum observes that while the Fore were never 'mere accepters of intruding power,'³¹ they responded creatively and pragmatically to western medicine, incorporating, adapting or resisting its interventions as they saw fit. Their (at least partial) openness to kuru researchers' attempts to understand the disease makes sense when we consider that many Fore had already experienced the seemingly magical success of basic treatments such as penicillin injections for yaws. At the same time, however, and as Lindenbaum outlines, the Fore developed a lengthening catalogue of sorcery methods to account for the disease that was devastating their population. This adaptation of local beliefs confirms the importance of conceptualising the relationship between western and indigenous medicines in terms of translation and negotiation, rather than opposition.

In this nuanced vein medical historian Warwick Anderson notes that 'the complex transactions involved in kuru fieldwork ... confirm that explanations framed in terms of dominance and subordination will often (but not always) misconstrue local meanings and global power relations.'³² Anderson also calls for histories of science that 'creatively complicate conventional distinctions between center and periphery, modern and traditional, dominant and subordinate, civilised and primitive, global and local.'³³ In light of this deconstructive trajectory, Anderson's conclusion that Gajdusek 'oversimplified the transactions that had taken place between himself and the Fore ... [and] ... proceeded to rework and exchange "his" kuru goods for recognition in science' bears investigation, not least because it appears to imply that Gajdusek's behaviour among the Fore can ultimately be understood primarily through a framework of imperialist exploitation. In particular, Anderson's claim that this appropriation of 'kuru material' was in some way possible because 'Gajdusek remained a scientist, a member of a different community' appears to belie the lifelong and reciprocal relationships that Gajdusek entered into in this period and which he has since maintained, not least through his adoption and education of many children from the area.³⁴ Given Anderson's apparent resistance to oversimplification when it comes to understanding the relationship between imperialism and medicine, it seems odd that he neglects to consider the ways in which Gajdusek, far from being merely or straightforwardly 'a member of a different community,' became entangled with and obliged to the Fore; and not merely because they provided him with the body parts of their dead, but because he proceeded to create a family from individuals among them.

Annette Beasley's work on kuru also raises questions about the ways in which a focus on the links between western science, medicine, and imperialism can occlude the fractured, idiosyncratic, and personal aspects of cross-colonial scientific encounters.³⁵ Taking a social constructionist approach, Beasley demonstrates that the early kuru investigations, occurring, as they did, in the second half of the twentieth century, took place 'in a period marked by optimism over the potential of science' and in a remote and seemingly 'stone age' place readily identifiable as a 'last frontier.'³⁶ She insightfully notes that this situation and the many challenges of working in the Fore area indicates that many scientists who did so 'were exceptionally motivated professionals, if not adventurers.'³⁷ This certainly seems to have been the case with Gajdusek of whom Smadel observed: 'he is one of the unique individuals in medicine who combines the intelligence of a near genius with the adventurous spirit of a Privateer.'³⁸ Gajdusek's letters, journals and many professional publications also demonstrate that his work on kuru was motivated by his romantic attraction to primitive people and his thirst for adventure as well as scientific imperatives.³⁹ Nevertheless, even adventurous individuals do not reflect and embody imperialist discourses in unambiguous ways. Indeed it needs to be remembered that some have shown considerable 'resourcefulness, scientific acumen, heroism and self-sacrifice'⁴⁰ in bringing western medicine to developing countries.

The cross-cultural relationships that began with Gajdusek's research on kuru seem to embody a double-sidedness and entanglement that make it difficult to construe him merely as 'a scientist, a member of a different community,' and/or as someone who embodies colonialism in any straightforward way. As such, his writings from the early years of the kuru investigation offer an opportunity to point toward the limits of both the 'white saviour' narrative and the more contemporary—though equally reductive—characterisation of white western medical men in the tropics as inherently exploitative and imperialist.

Gajdusek's journals and letters: Evaluating the sources

In the manner of someone with a strong sense of his own significance, the now eighty-two-year-old Gajdusek has kept a journal since the age of fourteen. He is also a prolific letter writer. This extensive collection of material constitutes one of the most significant documentary records in the field of Pacific history. Moreover, and pertinently for this article, Gajdusek's journals also are a particularly fruitful site for investigating the ways in which western medical practioners respected and esteemed indigenous knowledge about sickness and ways of responding to the sick. This is significant when we consider how little we know about the ways in which indigenous health knowledge and ways of caring have impacted on western medical practioners in 'foreign' lands.

One important factor contributing to the paucity of knowledge about the impact of indigenous knowledge on western medicine and its practioners is that white medical practioners have tended to narrate their experiences in the tropics through an exaggeration of cultural differences and a reliance on various racist tropes, including and especially that of the 'white saviour.' These narrativisations have tended to occur in the autobiographical and biographical genres.⁴¹ Discussing this 'participants' history,' Roy MacLeod notes: 'Memoirs of tropical doctors are the journals of medical Caesars confronting microbial Gauls, in lands never more than half won.'⁴² Designed to tantalise readers with exoticising images of 'the other,' such writing contains little thoughtful speculation about more reciprocal forms of cross-cultural interaction.

It is precisely because this writing is premised on the racist assumption that cross-cultural interactions affect the colonised other and not the colonial self that both whiteness and its corollary, western medicine, are 'bracketed off'⁴³ from inquiry. Portraying themselves and their medicine as 'universal' and superior, the white writers in the participants' history genre have little time to note, let alone speculate on, the value and possible benefits of indigenous health knowledge for their own practices. Yet, as Stephen Frankel and Gilbert Lewis reflect,

It may well be that many Papua New Guineans have made a realistic appraisal of the benefits of 'western' medicine from the way they find it practised in their home areas; it is we, the white outsiders, who are being unrealistic or blind in imagining that its benefits must be obvious, except to those with irrational beliefs or closed minds.⁴⁴

Gajdusek's journals also allow some insight into the Fore response to western medicine and the continuation of local health practices. This is important because health practices are historically overlooked in favour of a focus on indigenous ideas and beliefs. Indeed,

the balance of medical anthropology in general has been tipped towards theory, ideas, semantic content, symbolic interpretation, rather than towards practice and behaviour. This is surprising as it should be a particular virtue of medical anthropology to alert us to the social context in which the management of illness is set.⁴⁵

Recording aspects of the daily treatment of and response to sickness, whether serious or otherwise, Gajdusek's journals enable some insight into the perhaps more ordinary—but no less significant—indices of a culture in transition. Also, because of Gajdusek's own unusually developed sense of his own cultural situatedness, his journals and letters also allow us to reflect on the value of some specific PNG health practices without romanticising or appropriating these. Presenting an implicit challenge to the idea that indigenous health knowledge is inferior to, and has nothing to offer, western medicine and its practioners, the journals suggest ways in which various groups of people from the PNG highlands provoked Gajdusek to reflect on the limits of the medicine he was importing. In doing so, they demonstrate that cross-cultural interactions are capable of affecting individuals from both 'sides' of the colonial divide.⁴⁶

'How little we have progressed': Gajdusek's reflections on medicine among the Fore

From the outset of his investigations, Gajdusek was impressed by the Fore peoples' capacity to diagnose kuru. In a letter to Smadel, he remarks: 'Native diagnosis of kuru is as reliable as any modern medical appraisal would be. They know what they are talking about.'⁴⁷ Elsewhere, Gajdusek confirms this diagnostic capacity, writing: '[R]ecall of kuru seems to be fairly stable in the minds of the villagers. ... They point to our classical patients and say "the very same thing" in describing past cases.'⁴⁸ In his first published paper on the subject, Gajdusek is unequivocal, declaring that '[t]he earliest sign of the disease is the slight ataxia often noted by the patient or his villagers before we are able to convince ourselves of its existence.'⁴⁹ Where the western model of diagnosis relies on both the presence of a qualified expert and a diagnostic moment—for example, Gajdusek talks of examining suspected kuru patients and getting them to perform certain tasks, such as the 'nose to finger' test and standing on one leg—local diagnostic practices involved daily observation by various, if not all, community members, as they worked and lived alongside the sick. Because 'care of the sick was part of family and local obligation,' rather than 'a specialized department of social life,'⁵⁰ locals were probably more adept at diagnosing some diseases than their equivalent counterparts in western communities, who, since the nineteenth century, had come, increasingly, to rely on trained specialists. Thus, among the Fore of the 1950s and 1960s diagnosis was a fundamentally social practice, informed by various community members and not dependent upon the presence of an individual or 'recruited' 'expert.'

In fact, the Fore frequently recognised kuru before white medical experts, including Gajdusek, who writes in 1962:

As we were dressing sores, wounds, ulcers, etc., which have accumulated here at Agakamatasa in my near-month of absence, I noticed a boy who looked almost fourteen years of age and who was still the image of a much smaller boy of eleven or twelve I have had with me in previous years, but had not yet realized that he was missing here: This was Kageinaro! I greeted him but was a bit surprised by his lack of vocal response, by his unusually dirty appearance, his shredded loin cloth, and his rather restrained stance and lack of usual boyish response. I attributed it to his embarrassment at first seeing me—Wanevi occasionally behaves this way. When I turned to Wanevi to ask where he had been, and why I had not seen Kageinaro, earlier while I was here, and Wanevi embarrassedly diverted his eyes and said "Mi tink I gat sik" [I think he got sick]. And as though electrocuted, I suddenly realized that another of my boys had kuru.⁵¹

All these years later, we cannot claim to know why Wanevi was embarrassed to have to inform Gajdusek that Kageinaro was sick. As historian Inga Clendinnen notes it is 'easy to become over-ingenious in interpreting the intentions lurking in other minds.'⁵² Nevertheless, history involves educated conjecture and it seems possible that Wanevi's slightly qualified declaration of the boy's sickness—i.e., "Mi tink I gat sik"—reflects an unwillingness to make a confident diagnosis of kuru in the face of his 'masta's'—and the expert white doctor's—obvious ignorance in this moment. If this is the case then it suggests that Wanevi, who patrolled with Gajdusek, fulfilling the role of medical assistant, may have recognised and begun to reproduce the western model's construction of illness as something which was managed by individual experts from outside the community. This model implies, as studies of other colonised populations have concluded, that the 'local population ... became the more or less passive recipients and observers' of health care 'rather than controllers and active participants.'⁵³ On the other hand, however, Wanevi's very knowledge and capacity to diagnose kuru before Gajdusek, supports the argument that a whole other local system of diagnosing illness was still in operation. In stark contrast to the western medical framework, for the Fore, the ability to diagnose kuru was inseparable from the ability to dissect social relationships. That is, because kuru was thought to be the result of malicious individuals working vengeance against those who had wronged them or someone with whom they were aligned, the analysis of social attachments and disputes was crucial to the understanding and explanation of the disease.

Recognising value in such an approach, anthropologist Andrew Strathern comments that 'the [Papua New Guinean] idea of stating grievances or confessing to wrongdoing ... is a valuable lynch-pin of the traditional system.'⁵⁴ Noting that '[t]his can be a psychological aid to healing as well as to repairing damaged social relationships,' he suggests that 'modern medical practioners should be educated in these aspects of [local] thought.'⁵⁵

Though Gajdusek does not specifically discuss the native emphasis on social relations in relation to sickness, he is eminently respectful of the locals' manner of relating to one another, writing in 1960:

It is only when one lives closely to these ethical, very moral, and emotionally sensitive people, who have a great respect for person and property, a rigorous yet "enlightened" sexual code, a keen and proud individuality coupled with a strong sense of family responsibility and community solidarity, that one realizes how little we have progressed in five millennia. One can instead easily see only their uncured yaws, their violence and their warfare.⁵⁶

Reversing the usual construction of 'primitive' and 'civilised' peoples, this passage highlights the relative backwardness of the supposedly 'civilised' world. In particular, Papua New Guinean societies are constructed as socially more evolved than their western counterparts. In contrast to western explanations of illness, local diagnoses reflect profound sensitivity to the social and moral worlds. With diseases such as depression and anxiety on the rise in today's affluent west, Strathern's suggestion that western medical practioners might learn something from this attunement is sound indeed.

Like diagnosis, care of the sick was a community event and obligation among the Fore, as among PNG societies generally. As noted above, Gajdusek's observations about care are particularly valuable for the insight they provide into practice, as opposed to ideas—the conventional focus of anthropological literature on sickness and health. A main point to note, especially in relation to terminally ill patients—as all kuru victims were—is the emphasis on dying at home, rather than in a hospital. This is probably related to a number of factors, including the belief in place-based belonging and the idea that the sick are more vulnerable to sorcery when separated from their loved ones. In the case of kuru, the latter included the need to protect and honour the bodies of the dead. Writing to Smadel, Gajdusek discusses the difficulty of getting post-mortems:

[N]aturally, everyone would like to get their hands on kuru brains; we were lucky to get two and may get further ones, but our ex-cannibals (and not "ex") do not like the idea of opening the head, although other dismemberment doesn't seem to perturb them ... death, however, away from their remote villages does!⁵⁷

The Fore desire to die at home is confirmed in another extract from Gajdusek's letters:

New cases are always turning up. There have been other deaths, but we could not get posts. I have my hands on a few others and will try my best to get posts, but these are not people you can push. They are proud and have their own ideas, which are most intelligent, and although they have conceded that I can cure their meningitis and pneumonia, they have decided that this magic is too strong for me and that my prolonging life by treating and controlling decubitus ulcers is no blessing at all. They want to die at home, and once fully incapacitated, they want to die as quickly as possible.⁵⁸

The above passage, further, raises another aspect of Fore care, referring to their resistance to prolonging life—perhaps even suggesting it to have been one of the ideas that Gajdusek considered 'most intelligent.' This is further supported elsewhere. A number of passages illustrate, beyond this, the Fore notion of the assisting of death once the sufferer was beyond experiencing what western medical practioners would refer to as a 'quality of life.' For example:

[T]he native practice of neglect and avoidance once the disease has reached incapacitating stages [is one] which, in the long run, may be the most humane, for [it ensures] a rapid exodus once incapacitation is such that there is no further possibility of entering into any part of normal native social life.⁵⁹

And this, written by Gajdusek on 4 June 1957, some three months after arriving among the Fore:

Local Forei [sic] resistance to hospitalisation is increasing; they know damn well that we do nothing for the disease, but prolong its misery by supportive measures, and they are anxious to return to their technique of starvation and neglect in darkness, which ends in a speedy exodus once the illness is truly incapacitating.⁶⁰

From a western perspective, 'starvation and neglect' may seem harsh as a mode of care. Yet, when one contrasts the 'speedy exodus' this allows with the slow and lonely deaths of many ill and rarely visited older people in western societies, questions of cruelty and humanity in medicine become less certain.

Indicating Gajdusek's difference from many of his 1950s peers, Gajdusek's acknowledgement that 'they know damn well we do nothing for the disease' stands in marked contrast to the arrogant assumption that Papua New Guineans would wholeheartedly accept western medicine because of its supposedly 'inherent' superiority. Indeed, far from assuming that the Fore cooperated with him because of their belief in the power of his medicine, Gajdusek interpreted it, more accurately, as an indication of their own generosity and humanity. This is amply clear in the following passage:

They want to die at home, and ... [w]ith such apparently hopeless neurological disease, you cannot blame them. Since we have done lumbar punctures on over fifty—repeatedly on some—and taken 30 ml blood specimens, collected urine and blood for CBC's, and sedimentation rates frequently, and loaded them with painful shots (everything from crude liver and cortisone to parenteral antibiotics) without any effect—and they know it—I have only more respect for their "hands off" attitude. But, to humor me and repay my many miles of mountain climbing to track them down, they haul the litters over miles of cliff-faced and precipitous jungle slopes to bring the patients in for another shot at our therapeutic trials and experimental poking ... I admire and respect them thoroughly.⁶¹

Similarly, perceiving the limited openness that the Fore demonstrate towards his interventions as evidence of their rationality, rather than the rationality of the medicine he was importing, Gajdusek writes:

The natives very intelligently told me that they knew we had no kuru medicines that worked, that they knew that those patients examined, studied and "treated" at Kainantu did not recover and that therefore they preferred not to send I'ya'o to our hospital. I could only second their shrewd observation and had recourse only to the same humanitarian "research" explanations and approach that we must use with malignancy already metastatic, and other fatal conditions at our teaching clinics. It is to me not surprising that these people are as understanding and receptive of the "research" needs, demands and possibilities as are our own citizens and their resistance can be overcome by intelligent discussion and explanation.⁶²

Western medicine has tended to categorise the worlds' people in ways which reflect 'a broader, western humanism which [places] European Man as the centre of history and [assigns] him ... responsibility for the welfare of "humanity."'⁶³ Contrastingly, the idea that medicine would or should benefit humanity as a whole is anathema to Papua New Guineans whose care for kin and affines reflects local, rather than global social relations. Indeed, for Papua New Guineans, 'the idea of having basic ethical duties towards other people simply because they are human beings ... was not strong.'⁶⁴ Despite this significant difference between western and indigenous Papua New Guinean medicine, in the above passage Gajdusek constructs the locals as rational, challenging both the conventional representations of so-called primitive peoples and the idea that the Fore could be seen as the objects and beneficiaries of western medicine's universal 'benevolence.' Thus, whatever complex array of factors produced the Fore's (partial) complicity with Gajdusek's investigations, one cannot conclude that western medicine—rational, scientific, and universalistic—simply displaced the 'presumed irrationality and superstition of indigenous medicine.'⁶⁵ Rather, and as Gajdusek was well aware, the Fore continued to practise their own 'medicine' and sustain their distinctive view of health and sickness long after the introduction of western medicine.

One of the main ways in which the Fore maintained their society's response to health and illness was in their refusal to be morose about impending death. This is probably partly because the mortality rate from sickness was (and remains) higher in PNG than in wealthier countries. Yet, this recognition ought not to detract from the supportive, but highly pragmatic ways in which the Fore responded to sick community members, including those with kuru. Gajdusek discusses the Fore's matter-of-fact response numerous times in his journals and letters, making clear that he was profoundly affected by it. For instance, in his first 'definitive' scientific paper on kuru, he writes:

A remarkable aspect of kuru as it is met in the native communities is the extraordinary good spirited fatalism with which the patient and, in general, his relatives accept the disease. Patients know they are to die; they have observed the terminal incapacitating stages of the disease in others, and, yet, discuss the matter of their advancing illness freely and without apparent anxiety. They will laugh at their own stumbling gait and falls, their clumsiness, inability to get food into their mouths, and their exaggerated involuntary movements, and their kinsmen will join them. The family members live with the dying patient; siblings sleep closely huddled to their brother or sister in decubitus; parents sleep with their kuru-incapacitated child cuddled to them, and a husband will patiently lie beside his terminal uncommunicative, foul-smelling spouse. They may abandon at an early stage such supportive measures as feeding and washing and bringing the patient out into the sunlight, but they never cease to give strong emotional support and security to the patient who, as have they, has accepted the inevitable fact of impending death from the onset of the illness with equanimity. Thus, the emotionalism and euphoria of kuru is supplemented by a security engendered from certain knowledge that one is accepted by his villagers as an unfortunate victim of kuru sorcery, whom they will not desert before death claims him. The vengeful search for the offending sorcerer, which is often the primary concern of the patient's kinsmen, is a source of further emotional support.⁶⁶

Rather than dismissing the search for the sorcerer as an irrational and problematic response to kuru deaths, Gajdusek recognised it as a way of declaring solidarity with the patient. This contrasts considerably with many other medical practioners of the time and since.⁶⁷ Of course this does not mean that Gajdusek accepted sorcery as an explanation of kuru, but it does suggest that he understood and appreciated the Fore perspective and was prepared to learn from their detailed knowledge about aspects of the disease. This is a counterpoint to the idea that Gajdusek, 'fostered by colonialism,' saw his medicine as culturally superior in some absolute or dismissive way.⁶⁸

Gajdusek's respect for the Fore's matter-of-fact response to sickness is also evident in other passages. Speaking of a carrier boy who had contracted kuru, Gajdusek wrote in his 1960 journal:

I took him across the river with a peculiar feeling of respect and admiration for a lad who lives his last year—probably months—so intensely and with such disregard for his fate. Such is the cultural setting of kuru ... and if nothing else on this patrol turns out successful or of value, it will at least have been a supreme demonstration of what the "kuru situation" is for a doomed youth. I have not overheard a word about kuru or his sickness on the trip.⁶⁹

The boy's courage might be construed as a form of patient denial were it not for the fact that the well members of the community also seem to assume that life ought to continue as usual, despite the young man's sickness. The Fore emphasis on the continuation of everyday life in the face of illness is evident in the following extract in which Gajdusek discusses his carrier boys' response to one of their peer's meningitis:

The other boys ... pay little attention to Anua's illness, but are solicitous of his needs. Though they do not take much notice of him, lying by their cook-house fire critically ill, yet they will help him out to urinate, feed him and inform me of any change in his condition. However, their games, their ribald and lewd humour, their singsings do not cease a moment in deference to his illness.⁷⁰

Far from seeing it as uncaring, this no-nonsense approach so appeals to Gajdusek that he declares PNG the place he would choose to be if he were sick. In 1962, approximately five years after first arriving among the Fore, his journal recalls the afternoon spent making scones with a group of carrier boys. Ivuti, another boy with kuru was among them:

Ivuti took it all in, fell over in his laughter a few times, and was propped up again rather passively and as a matter of course by the bystanders more interested in the baking than in whether he rolled over into the fire. But, just in this callous lack of concern—if that is what it is—and nonchalance lies total absence of any sense of tragedy or catastrophe in his current plight, either by him or those about him...and it is this that makes kuru so tolerable for everyone. Here is where I want to be if I ever get it!⁷¹

As with so many other passages from Gajdusek's journal, this lively excerpt provides rare insight into the ways in which western medical practioners have been affected by indigenous health practices and treatment of the sick. Presenting an implicit challenge to the idea that indigenous health knowledge is inferior to, and has nothing to offer, western medicine, Gajdusek's records suggest the inappropriateness of assuming that individual western medical practioners in foreign lands have acted in straightforwardly imperialistic ways.

The following extract, taken from one of Gajdusek's scientific papers on kuru, also supports the idea that the exchange of knowledge was not as one-way as is usually assumed. Specifically, as the extract shows, the Fore taught Gajdusek and his colleagues something significant about caring for those with kuru:

The tremors can be considerably minimized or even occasionally abolished by supporting the trembling patient with firm and extensive anti-gravity support. Thus, one small boy with kuru who trembled violently when trying to sit or stand alone, had discovered a means of almost completely controlling his involuntary movements by remaining inactive in a flexed, fetal posture, cuddled closely into his mother's lap. His responsive mother held him thus completely supported throughout the day. His kuru tremors would only appear when he was removed from this extensive maternal anti-gravity support. By cuddling young, violently trembling patients tightly in our arms and restraining their heads and extremities against our body, we can succeed in almost totally abolishing their tremors.⁷²

This affecting description of a Fore mother's response to her kuru-affected child provides clear evidence that some white western medical practioners, rather than merely imposing knowledge, have learned from their local hosts. As such, the passage directly challenges the idea that health and well-being are contingent upon the provisions of western medicine, rather than something for which local PNG communities are responsible. In addition, and alongside the other excerpts from Gajdusek's journals and letters, it indicates that Gajdusek may have gained more than a Nobel Prize from his investigation of the Fore and their peculiar disease; it seems the Fore also taught him important lessons about caring for the sick and living with sickness and death.

Conclusion

Analysis of Gajdusek's journals demonstrates that even the most self-certain and eminent western medical practioners are capable of recognising the value of traditional modes of responding to and caring for the sick. Thus, even as he became a central and starring player in the broader, triumphant history of western medicine, Gajdusek demonstrates an openness to critiques of the rationality and efficacy of his craft. This example serves as a reminder that in the quest to understand the relationship between western medical science and imperialism, it is important to dispel the idea 'that the motives and expectations of medicine can be understood only in relation to over-arching imperial interests.'⁷³ Indeed, in light of Gajdusek's journals and letters, this seems as reductive a perspective on the cross-cultural encounters that arise as a consequence of sickness in the tropics as do previous ideas about the 'inherent' superiority of western medicine.

In contrast to this reductionism, this article has sought to provide a complex and nuanced account of how one 'waitskin' medical practioner was himself challenged and changed by cross-cultural encounter. This focus presents an implicit challenge to the culturally imperialist view that it is only the 'other' who is affected by cross-cultural interaction. In doing so, it makes clear that both whiteness and western medicine are socially constructed phenomena, thereby helping to debunk the notion that white western identity is the unexamined 'norm' against which all difference is measured. This approach usefully contrasts with previous discussions of kuru which have tended to occur either within a scientific 'progress' narrative or, more recently, within the important but sometimes overly dismissive province of 'imperialism and medicine.'

Monash University

Notes

^1. Inez Baranay, "Fraught Territory," Meanjin 62, no. 3 (2003): 223–9.

^2. Jane Jacobs, Edge of Empire: Postcolonialism and the City (London and New York: Routledge, 1996), 19.

^3. Shirley Lindenbaum, Kuru Sorcery: Disease and Danger in the New Guinea Highlands (New York: Mayfield Publishing Company, 1978), 9.

^4. Daniel Carleton Gajdusek, ed., Correspondence on the Discovery and Original Investigations on Kuru, Smadel-Gajdusek Correspondence 1955–1958 (Maryland: National Institutes of Health, 1976), 50.

^5. Ibid., 92.

^6. Warwick Anderson, "The Possession of Kuru: Medical Science and Biocolonial Exchange," Comparative Studies in Society and History 42, no. 4 (2000): 713–44, 723.

^7. Daniel Carleton Gajdusek, Michael P. Alpers, and C.J. Gibbs Jr., "Kuru: Epidemiological and Virological Studies of Unique New Guinean Disease with Wide Significance to General Medicine," in Essays on Kuru, Monograph Series 3, edited by R.W. Hornabrook (Oxford: EW Classey Ltd, 1976), 125–45, 126–7; Lindenbaum, 25.

^8. Lindenbaum, 9, 19–22.

^9. Ibid., 19–22, 27. See also John Collinge, "Prion Disease of Humans and Animals: Their Causes and Molecular Basis," Annual Review of Neuroscience 24 (2001): 519–50. I am grateful to one of the anonymous reviewers of this essay for pointing me toward Collinge's article.

^10. Lindenbaum, 19–22, 24–5. This is supported by Collinge, who writes: 'Women and children predominantly participated in the feasts and ate the brain and internal organs, which is thought to explain the differential age and sex incidence. The epidemic is thought to have originated when a case of sporadic CJD, known to occur at random in all populations, occurred in a member of this population and was, as were most deceased individuals, eaten' (Collinge, 523).

^11. R.M. Glasse and Shirley Lindenbaum, "Kuru at Wanitabe," in Essays on Kuru, Monograph Series 3, edited by R.W. Hornabrook (Oxford: E.W. Classey, 1976), 38–52, 46.

^12. Lindenbaum, 6.

^13. [Name withheld], interview with author, Melbourne, 16 September 2001.

^14. Collinge, 519.

^15. Karolinska Institutet, "Press Release: The 1976 Nobel Prize in Physiology or Medicine," Nobelprize.org. Available at http://nobelprize.org/medicine/laureates/1976/press.html (accessed 1 May 2006).

^16. J.F. Bouchard, "A Short Introduction to the Kuru Region," in Essays on Kuru, Monograph Series 3, edited by R.W. Hornabrook (Oxford, England: E.W. Classey, 1976), 1–5, 1.

^17. Hank Nelson, "Kuru: The Pursuit of the Prize and the Cure," Journal of Pacific History 31, no. 2 (1996): 178–201, 187.

^18. Ibid., 187.

^19. Lindenbaum, 61.

^20. Gajdusek, Correspondence, 161–3.

^21. Daniel Carleton Gajdusek, New Guinea Journal, October 2, 1961 to August 4, Part 1 1962 (Maryland: National Institutes of Health, 1968), 158.

^22. Alison Bashford, "Is White Australia possible? Race, Colonialism and Tropical Medicine," Ethnic and Racial Studies 23, no. 2 (2000): 248–71, 250.

^23. Andrew Cunningham and Bridie Andrews, Western Medicine as Contested Knowledge (Manchester and New York: Manchester University Press, 1997), 1.

^24. Donald Denoon, "The Idea of Tropical Medicine and Its Influence on Papua New Guinea," in Health and Healing in Tropical Australia and Papua New Guinea, edited by Roy Macleod and Donald Denoon (North Queensland: James Cook University Press, 1991), 12–22, 14.

^25. Bashford, 255.

^26. Bashford, 267.

^27. Jacobs, 2.

^28. Gyan Prakash, Another Reason: Science and the Imagination of Modern India (Princeton and New Jersey: Princeton University Press, 1999), 19.

^29. Nancy Rose Hunt, A Colonial Lexicon of Birth Ritual, Medicalization and Mobility in the Congo (Durham and London: Duke University Press, 1999), 8–9.

^30. Ibid., 8–9 (emphasis in original).

^31. Bill Gammage, The Sky Travellers: Journeys in New Guinea 1938–1939 (Melbourne: The Miegunyah Press, 1998), 221.

^32. Anderson, 715.

^33. Ibid., 736.

^34. See Ceridwen Spark, "White Out? Historicising the Relationship Between Australia and Papua New Guinea" Journal of Pacific History 40, no. 2 (2005): 213–9.

^35. Annette Beasley, "Frontier Science: The Early Investigation of Kuru in Papua and New Guinea," in Challenging Science: Issues for New Zealand Society in the 21^st Century, edited by Kevin Dew and Ruth Fitzgerald (Palmerston North: Dunmore Press, 2004), 146–66.

^36. Ibid., 148, 154.

^37. Ibid., 157.

^38. Gajdusek, Correspondence, 383.

^39. In particular, there are several scientific papers in which Gajdusek demonstrates a desire to learn more about human development and neurology from his studies of cultures which he depicts as 'vanishing or doomed to distinction.' (See Daniel Carleton Gajdusek, "Ethnopediatrics as a Study of Cybernetics in Human Development," American Journal of Diseases of Children 105, no. 6 (1963): 554–9).

^40. Roy Macleod and Donald Denoon, eds, Health and Healing in Tropical Australia and Papua New Guinea (North Queensland: James Cook University Press, 1991), 1.

^41. See for example S.M. Lambert, A Doctor in Paradise (London: J.M Dent and Sons, 1942); Elizabeth Burchill, New Guinea Nurse (Adelaide: Rigby, 1967); Robert Klitzman, The Trembling Mountain: A Personal Account of Kuru, Cannibals and Mad Cow Disease (New York: Plenum Press, 1998).

^42. Roy Macleod, introduction to Disease, Medicine and Empire; Perspectives on Western Medicine and the Experience of European Expansion, edited by Roy Macleod and Milton Lewis (London and New York: Routledge, 1988), 1.

^43. Ruth Frankenburg, White Women, Race Matters: The Social Construction of Whiteness (Minneapolis: Routledge and University of Minnesota Press, 1993).

^44. Stephen Frankel and Gilbert Lewis, "Patterns of Continuity and Change," in A Continuing Trial of Treatment: Medical Pluralism in Papua New Guinea, edited by Stephen Frankel and Gilbert Lewis (Dortrecht: Kluwer Academic Publishers, 1989), 23.

^45. Ibid., 5.

^46. Obviously because this article relies on Gajdusek's writing, there are limits to its claims to be examining the Fore response to western medicine. Further investigation of the kind being pursued by Warwick Anderson and, separately, Annette Beasley, will hopefully help to redress the relative mutedness of Fore voices that currently characterises this and other accounts of kuru.

^47. Gajdusek, Correspondence, 52.

^48. Ibid., 57.

^49. Ibid., 356.

^50. Frankel and Lewis, 3.

^51. Gajdusek, New Guinea Journal, 268.

^52. Inga Clendinnen, Dancing with Strangers (Melbourne: Text Publishing, 2003), 126.

^53. Frankel and Lewis, 27.

^54. Andrew Strathern, "Health Care and Medical Pluralism: Cases From Mount Hagen," in A Continuing Trial of Treatment: Medical Pluralism in Papua New Guinea, edited by Stephen Frankel and Gilbert Lewis (Dortrecht: Kluwer Academic Publishers, 1989), 152.

^55. Ibid., 153.

^56. Daniel Carleton Gajdusek, Solomon Islands, New Britain and East New Guinea Journal, January 7, 1960 to May 6, 1960 (Maryland: National Institutes of Health, 1964), 133.

^57. Gajdusek, Correspondence, 94.

^58. Ibid., 92.

^59. Ibid., 142.

^60. Ibid., 111–12.

^61. Ibid., 92.

^62. Ibid., 51–2.

^63. Jacobs, 17.

^64. Frankel and Lewis, 22.

^65. David Arnold, ed., Imperial Medicine and Indigenous Societies (Manchester: Manchester University Press, 1988), 18.

^66. Gajdusek, Correspondence, 355.

^67. For example, Gajdusek can be compared with Burton-Bradley who wrote in 1990 that '[m]odernisation and scientific medicine are ... the goals of all reasonable Papua New Guinea people who say they want to go forward, not backwards' (Burton G. Burton-Bradley, ed., A History of Medicine in Papua New Guinea (Kingsgrove, NSW: Australasian Medical Publishing Company, 1990), 13.

^68. Compare with Beasley, 159.

^69. Gajdusek, New Guinea Journal, 76–7.

^70. Daniel Carleton Gajdusek, Journal and Field Notes, Australia, Papua and Trust Territories of New Guinea, October 1955 to December 31, 1957 (Maryland: National Institutes of Health, 1996), 5.

^71. Gajdusek, New Guinea Journal, 340–1.

^72. Gajdusek, Correspondence, 356.

^73. Macleod and Denoon, 1–2.

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