1. health and fitness

"IT IS HEALTH WE WANT":
A CONCEPTUAL VIEW OF TRADITIONAL AND NON TRADITIONAL
HEALTH PRACTICES IN TONGA WITH SPECIAL EMPHASIS ON
MATERNAL CHILD HEALTH AND FAMILY PLANNING.
SIOSIANE FANUA BLOOMFIELD
A Thesis submitted to the School of Social Economic
Development at the
U n i v e r s i t y of the South Pacific
i n p a r t i a l f u l f i l m e n t of the requirements f o r the
Degree of Master o f Arts (MA) i n Sociology.
The University of the South Pacific
School of Social Economic Development
Suva, F i j i ,
September, 1986.
DECLARATION OF ORIGINALITY
I hereby declare that t h i s M.A. thesis does not contain
any material that I have previously submitted for a higher degree
of any u n i v e r s i t y .
The thesis contains work undertaken by me
under the supervision of Dr. Michael C. Howard, and to the best
of my knowledge, does not contain any material written by any
other person(s) except where due acknowledgement is made.
Siosiane Fanua Bloomfield
September, 1986.
TABLE OF CONTENTS
CHAPTER
Page
List of Tables
vi
List of Maps
vii
Acknowledgements
I
II
viii
Abstract
x
INTRODUCTION
1
Purpose of the Study
2
Setting
3
History
7
Ministry of Health
11
Maternal Child Health and Family Planning
14
Research
17
Key Concepts
26
TONGAN ETIOLOGY OF ILLNESS AND HEALTH
29
Illness and Disease
30
Illness and Health
31
Tongan Myth Relating to Good Fortune and
Misfortune
•
32
Ancient Religion
34
Examples of Social Relationships which May
Cause Illness if not Maintained according
to Tongan Society's Norms
38
The Concept of Health in the Tongan Context
48
iii
.•r,,.
VIB
VIIA
VIIB
GUIDING QUESTIONS FOR 10-12 YEAR OLDS OF
INTERVIEWED PARENTS IN KALISI (NUKUNUKU
VILLAGE) AND TAFAHI ISLAND - Tongan T r a n s l a t i o n
250
GUIDING QUESTIONS USED FOR SOME OF THE OLD PEOPLE
OVER 69 YEARS IN KALISI (NUKUNUKU VILLAGE)
AND TAFAHI ISLAND - E n g l i s h T r a n s l a t i o n
251
GUIDING QUESTIONS USED FOR SOME OF THE OLD PEOPLE
OVER 69 YEARS IN KALISI (NUKUNUKU VILLAGE)
AND TAFAHI ISLAND - Tongan T r a n s l a t i o n
252
REFERENCES
253
v.
LIST
OF TABLES
TABLE
Page
1
Key Health Services Indicators 1975 and 1980
14
2
Reported Live B i r t h s , Total Deaths and Deaths
of Infants 1 Year Throughout Kingdom of
Tonga 1979 to 1983
15
3
Family Planning Programme:
New Acceptors by
Method Used 1971-1983
16
4
Average Number of Housholds in Tafahi Island
5
Average Number of children in a family in
Tafahi Island
146
147
6
Attendants of Home Deliveries
147
7
Assumed Causes of Death in Children of Couples
i n Sample
148
8
Preference for Intervals between Pregnancies
150
9
Preference for Ante Natal Care
151
10
How Family Planning Programmes first heard of
by Parents in Sample
153
11
Preference of Family Planning Sources of Information 155
12
Utilisation of Family Planning Method by Couples
in Sample
How the Family Planning Programmes were first
heard of in the Sample
Preference of Family Planning Sources of
13
14
Information by Parents in the Sample
176
177
177
15
Ages when Couples were Married
16
Average Number of Children per Couple in the Sample 180
17
Average Number in a Household
180
18
Ideal Spacing for Pregnancies among 40 Mothers
180
19
Preferred Medical Care During Pregnancy
181
20
Preference of Curers when a Member of Family
Falls
III
179
183
21
Vi.
Preferred Sex of Children
184
22
Preference of Curers by Total Sample of Couples
204
LIST OF MAPS
Page
Map
5
1
The Kingdom of Tonga
2
Modern Medical Services: Location of
Hospitals and Health Centres
12
3
Tafahi Island
19
4
Tafahi Village
20
5
Tongatapu Island
22
6
Nukunuku Village
23
Vll
ABSTRACT
Health, illness and cure in Tonga were, and s t i l l are, a t t r i b u t e d
by the majority of the people to sanctions of the supernaturals.
All the interviewed adults in Tafahi island and Nukunuku v i l l a g e ,
Tongatapu, believed that breaking of tapu belonging to persons or
things with mana could generate illness or other misfortunes t o
those concerned.
Likewise curers and cures are viewed as only
vaka (boats) for the healing power of God.
Despite these b e l i e f s ,
people on the whole also believed that there are Tongan diseases
and European diseases which should be treated by Tongan t r a d i t i o n a l
and modern medicines respectively.
Since the Tongan society is homogenous, some 98% of its nearly
100,000 people being indigenous Polynesians, i t is assumed that the
information obtained from Tafahi island and Nukunuku village, where
the research for this study was concentrated, would be very similar
to those in other parts of Tonga.
There are four categories of health care practice currently
functioning in Tonga,
card playing.
They are modern, traditional, religious and
Of these four, the modern and traditional are the
most dominant in the
society.
Modern health care is the o f f i c i a l
category of care in Tonga, as well as that most preferred according
to the majority of people.
I t is however, not uncommon for two
or more of these categories to be administered simultaneously to
a sick person, without any o f f i c i a l prohibition.
The social aspect of health is highly valued in Tonga.
Health is a feeling that all is well with one:
a feeling of
monutonu; a feeling that is relating t o the satisfactory knowing
that one has done his/her duties towards the land, God and fellow
humans.
The perserverance of such a feeling may compel Tongans to
give a l l they have to the church or to put up a big feast for customary
celebrations without thinking of tomorrow.
Tonga is a male dominated society but the women are held in
great respect.
Furthermore, the women's role on mohe ofi; of
teaching the children when very young to know themselves in relation
to others in society, is of paramount importance to the maintenance
of peace within the institution of the family as well as in the
whole society.
Children have always been welcome and accepted as manifestations
that one is looked upon favourably by the supernaturals.
The
concepts of 'ofa (love) and fanau ( a b i l i t y to have children) are closely
related.
The importance of such concepts in Tongan society is
demonstrated in the sharing of children with others who have few or
no children as pusiaki (adopted).
But pusiaki appears also to be
designed as a method of revitalising distant kinship.
is greatly valued in the Tongan society.
i t is alien
And kinship
I t follows then t h a t , because
to the Tongan way of thinking, the concept of family
planning is d i f f i c u l t to accept by the people.
Although there are many traditional medicines available to
encourage f e r t i l i t y , there appears to be very l i t t l e to discourage
fertility.
Likewise, there are numerous traditional medicines to
keep children healthy when compared to those available for
gynaecological problems.
Moreover, women on the whole tend not
to complain of gynaecological conditions.
Religion permeates a l l areas of the Tongan society.
Inevitably i t has always played a great part in curing.
xi.
Although
nearly 100% of the population are supposed to be Christian, there
is no denying that many aspects of the Tongan ancient religion are
still
at large.
The institutions of tapu and mana, for instance,
have embraced a l l aspects of the Tongan culture, and without them
the existing fabric of Tongan society would disintegrate.
xii.
ACKNOWLEDGEMENTS
I t would be impossible to adequately express my g r a t i t u d e t o
a l l the people who were instrumental i n t h e c o l l e c t i n g of data f o r
this thesis.
I warmly remember the people of Nukunuku village, Tongatapu, and
the people of Tafahi island.
Without t h e i r tolerance, patience and
many kindnesses, the research for this thesis would not have been
possible.
I am grateful to a l l traditional and non-traditional curers
interviewed in Tonga, for sharing their ideas and ancestral secrets.
Thanks is also due to the Netherlands Government and the University
of the South Pacific, the joint sponsors of the Post-Graduate
scholarship which financed my programme of study at the University
of the South Pacific.
I would also l i k e to thank DrLaquian of the
UNFPA Office, Suva, F i j i , for his encouragement and for obtaining
funds for research which greatly assisted in the writing of this
thesis.
With humility I thank the Honourable Minister of Health of the
Kingdom of Tonga, Dr Sione Tapa, for his most needed encouragement
and his support in allowing me to have two years leave without pay
from my work in the Ministry of Health to do this study.
I am
grateful to the Tongan Government for the assistance given for this
research.
I would like to thank the Tongan Staff members of the University
of the South Pacific for moral support and encouragement.
In this
regard, to Sitiveni Halapua, Konai Thaman and 'Epeli Hau'ofa in
viii.
particular.
I would like to acknowledge the assistance given by
the Librarians at the University of the South Pacific, particularly
that of Linda Howard.
I know for certain that without the encouragement, personal
interest and assistance of my supervisor, Dr Michael Howard, this
thesis would never have been completed.
To him I owe a great deal
of gratitude.
I would like to acknowledge the assistance given by my mother,
Tupou Posesi Fanua in discussions relating to Tongan customs.
Thanks is due to Kato Reichelmann, Lu'isa Taufatofua, Vasa Tu'iniua,
'Anau Wyler, and to Marica Bolabola of the University of the South
Pacific for typing the i n i t i a l draft of the thesis from very
d i f f i c u l t w r i t i n g . I am also thankful to Judith Finau for the
retyping of this thesis until its completion.
Finally, to my husband Paula Bloomfield, for allowing me to pursue
this study in F i j i while he looked after our family in Tonga, I say,
MALOHO'O'OFA.
IX.
Chapter
I
INTRODUCTION
This thesis is a study of maternal/child health and f a m i l y
planning in Tonga.
I t may seem strange t o treat these two t o p i c s
together, however, i t is f e l t that they are closely i n t e r r e l a t e d i n
t h e i r concern with the well-being of women and t h e i r c h i l d r e n .
In
examining maternal/child health care and family planning in Tonga i t
is especially important to look at the r e l a t i o n s h i p between indigenous
b e l i e f s and practices,and introduced
Western ones.
Notions o f
b i r t h control and mother and c h i l d care were present in indigenous
Tongan society i n the form of elaborate care of mother and c h i l d
before and a f t e r b i r t h ; and the great emphasis placed on v i r g i n i t y among
women before marriage.
Such beliefs and practices often d i f f e r
considerably from those that have been introduced more r e c e n t l y .
Thus, children t r a d i t i o n a l l y are considered monu (blessings) and any
idea of reducing the number of children a woman bears after marriage
runs contrary to t h i s b e l i e f .
But t r a d i t i o n a l and modern b e l i e f s
and practices need not always be seen as contradictory and one o f
the goals of t h i s thesis is to explore the extent to which they do
and can complement one another.
The present chapter is intended mainly to introduce b r i e f l y
the where, what, why, when, and how of the study.
Chapter two
w i l l follow w i t h a short discussion of Tongan etiologies r e l a t i n g to
matters of h e a l t h , sickness and curing.
The curers and cures w i l l be
discussed i n chapters three and four respectively.
Chapter f i v e w i l l
consist of two case studies of Nukunuku v i l l a g e and Tafahi i s l a n d ,
the primary settings of f i e l d research.
1.
The conclusions of t h e
study w i l l be presented in Chapter Six.
PURPOSE OF THE STUDY
This study focuses on the sociological aspects of m a t e r n a l / c h i l d
care and family planning.
This is seen as including values and b e l i e f
systems as they r e l a t e to h e a l t h , sickness and curing.
The existence
of two medical systems i n Tonga, a ' t r a d i t i o n a l ' one and an i n t r o d u c e d ,
Western system, i s of considerable significance.
In this r e g a r d , not
only do I intend to describe these systems (especially the ' t r a d i t i o n a l '
system), but moreover I w i l l analyse how each serves the needs of
Tongan society.
Doing so i s no easy matter.
As Foster and
Anderson (1978: 125) note:
We see f r o m this contrast between the roles of Western and
non-Western medical systems that one measure of efficiency
must be the a b i l i t y to s a t i s f y the expectations of the people
served.
But, since expectations vary so greatly, comparative
ratings of the effectiveness of d i f f e r e n t systems cannot be
achieved i n absolute t e r m s .
I t is a l i t t l e like the problem
of how to add apples and oranges.
Nevertheless, an attempt must be made, for as more and more researchers
around the world have come t o discover, blind acceptance of modern
Western medicine has numerous p i t f a l l s and t r a d i t i o n a l medical systems
often have a great deal to of-fer.
The present study is not meant
t o advocate one medical system against another, nor to deny the
obvious improvements that have been brought about by modern medicine.
I t is intended, however, t o question the almost t o t a l emphasis
being placed on modern medicine to the detriment of the indigenous
system.
In p a r t i c u l a r , i t is f e l t that heavy reliance on modern h e a l t h
practices poses a number o f p o t e n t i a l problems f o r Tonga.
Among
these, are t h a t they:
1)
promote dependency on foreign a i d ,
2)
advocate the use o f drugs that may have dangerous s i d e -
effects ,
2.
3)
can reduce confidence in one's a b i l i t y to deal oneself
with minor illnesses,
4)
are l i k e l y to weaken confidence in indigenous curing practices
that have and are likely to continue for some time to serve
as the backbone of primary health care, and
5)
foster the illusion that modern medicine possesses cures
for all diseases.
The general aim of this study is to improve the welfare of the
people of Tonga by:
1) encouraging self-reliance in matters of health,
particularly in the area of maternal/child health care and family
planning, and 2) appreciating the dynamic nature of culture and the
need for frequent evaluation of health programmes.
The objectives
are therefore aimed at investigating seven key questions.
These
are:
1.
How do the Tongan people view the concepts
'health'
and 'disease'?
2.
How do health and disease etiologies serve as nodes of
social control in Tonga?
3.
What are the attitudes of the Tongans towards present
maternal/child health and family planning programmes?
4.
How can couples be motivated to practice family planning?
5.
What are some of the relevant health practices (other than
modern ones) relating to maternal/child health and
family planning?
6.
What are the attitudes of Tongans towards available cures?
7.
What are the attitudes of Tongans towards available curers?
SETTING
On a world map, Tonga appears as several insignificant dots
on the wide Pacific Ocean.
Although insignificant in size, on
each thumps the beat of l i f e of the descendants of those who survived
hazardous voyages, foreign intervention and the introduction of
many new diseases.
Tonga comprises only 670 square kilometres of land area,
scattered over a sea area of approximately 360,000 square kilometres.
I t is located between latitude 15oS and 23.5oS and longitude 173oW
and 177°W (see Map 1).
Only about 45 of Tonga's 171 islands are
inhabited permanently, although the smaller uninhabited islands are
often used for agricultural purposes by the people who live on
nearby islands.
Tonga is divided into four main island groups:
Tongatapu to the south, where the capital of Nuku'alofa is located;
Ha'apai;
Vava'u;
and Niuas, furthest north and nearest to Tonga's
neighbours, F i j i and Samoa.
In general, while Tonga is blessed with relatively f e r t i l e
s o i l , the land remains under-cultivated.
I t is possible to grow
a wide variety of tropical fruits and vegetables with l i t t l e e f f o r t .
Numerous varieties of cash crops are also grown, usually requiring
l i t t l e f e r t i l i z e r or pesticide.
The climate is subtropical.
The average rainfall is 1.9 metres
and the annual mean temperature is 25.5oC.
Generally, May to
September is cool and dry, and the rest of the year is warm and wet.
From August 1982 to July 1983, however, Tongatapu and Ha'apai received
very l i t t l e rainfall which adversely affected agricultural production
in these two areas.
Hurricanes occur occasionally.
In March 1982
Hurricane Isaac did considerable damage (which is s t i l l in evidence)
on Tongatapu and Ha'apai.
The population of Tonga is in many ways a homogeneous one.
Some 98% of i t s nearly 100,000 people are indigenous Polynesians.
Christianity is practiced by nearly 99% of the population, although
there are denominational divisions.
There are thirteen Christian
denominations with the Free Wesleyan Church (Methodist) claiming
nearly half of the total population.
A common Tongan language is
spoken almost universally, although there are different forms of
speaking according to social rank.
can speak
Also, a large number of Tongans
English.
Literacy is high:
83% of the population can read and write
Tongan and 50% are literate in English.
Education is compulsory
and free at the primary level (age 6-13).
About 91% of the primary
school population attends government primary schools, while the
remaining 8% attends church-run primary schools.
The situation is
almost the reverse at the secondary l e v e l , where church schools (and
one private non-church school) account for 90% of the students;
and
the government schools account for only 10% (Tonga 1981: 310).
Tongan society traditionally was very hierarchical, there being
a structure of ranked nobles and commoners.
This structure
continues to be of considerable importance today and Tongans are
taught from an early age to know their place in society.
The main
social strata of Tongan society consists of the king and his f a m i l y ,
the nobles and chiefs, and the commoners.
aspects of the Tongan ranking system.
Sex and age are important
In particular, a woman is
always of higher rank than her brothers and their children, but of a
lower rank than her eldest sister.
and nobles.
This is true of both commoners
In recent years another level of society has become
increasingly noticeable, comprising educated e l i t e s , local
entrepreneurs and church leaders.
These are fast becoming a class
above the commoners and perhaps equal to the nobles and chiefs.
Thus, for example, the language traditionally reserved to be used
for nobles and chiefs is sometimes used now for members of t h i s
new e l i t e .
Tonga is a constitutional hereditary monarchy under the 1875
Constitution.
This makes i t the only remaining Polynesian kingdom.
The government is divided into three branches under the king:
6.
I.
the Executive, which consists of (a) the King, his
Privy Council (made up of cabinet ministers appointed by
the king), and the Governors of Vava'u and Ha'apai and
(b) the Cabinet, which is headed by the Prime Minister and
consists of all members of the Privy Council except the
king;
II.
the Legislative Assembly, which consists of the members of
the Cabinet, seven nobles representing the 33 noble titles
elected by the nobles themselves, and seven peoples'
representatives (to be increased to nine in the 1984 election)
elected by the people;
III.
the Judiciary, which consists of the Supreme Court, the Land
Court and the Magistrates Court, all having the right of appeal
to the Court of Appeal.
There are no political parties and all new laws are subject to royal
veto.
As estate holders, the main function of the 33 nobles is to
distribute land to male Tongans aged 16 years or over.
Constitutionally,
members of this latter category are each entitled to an 'api 'uta (bush
allotment) of about eight acres and an 'api kolo (town allotment) of
about 2/5 of an acre.
However, mainly because of the growing
population, only about one-third of those entitled to these' allotments
have actually received them (as of 1976).
HISTORY
While this is not the place to present a thorough history of
Tonga, i t should be useful to provide a brief review of Tonga's
history.
According to archaeological findings, Tonga was probably f i r s t
settled about 1200 BC by people from a wide-spread Pacific culture
referred to as the Lapita people by archaeologists.
Furthermore,
unlike people of other societies who have had the same origins, the
people of Tonga today can s t i l l be traced back to the same ancestory
(Poulsen, in Rutherford 1971: 67).
These people brought to Tonga
many items of material culture and social organisation, including an
incipient
aristocracy.
Over the centuries that followed, Tonga
developed more intensive methods of agriculture and a progressively
more hierarchical form of organisation.
The period 950 AD to 1200 AD
was marked by the rise of sacred chiefly power in the office of the
Tui Tonga.
linked
As elsewhere in Polynesia, chiefly power was closely
to the concept of mana. There was a royal sacred lineage that
was divided into a senior and a junior line, the role and status of
the former being essentially religious in nature and the latter
secular.
The period from 1200 AD witnessed the rise of secular
chiefly power.
I t became a period of internal political rivalry
and external m i l i t a r i s t i c expansion in which chiefly power was
increased and concentrated.
Mention should also be made of Tongan myths concerning the
origins of the islands and the people.
Tongan myth has i t that the
f i r s t rocks were made from slime and sea weed.
made from these rocks.
Later, the gods were
Some of the islands were then pulled up from
the sea by the god Maui and the higher islands were thrown down from
the sky by the god Hikule'o.
Afterwards, soil was sent down to
cover the bare rocks and then seed was given.
A broad leafed
creeping plant grew and covered the land.
One of the gods broke
part of this creeper and l e f t i t to rot.
Soon a maggot was produced
from this rotting creeper.
The maggot was divided into two parts by
Maui K i s i k i s i , a god who came down from the sky in the form of a
sea-lark.
Kohai
The two parts of the maggot became the first man
(who) and Koau (me).
Unknown to Maui Kisikisi, a small piece
of the maggot had stuck to his beak and fell off to form a third man,
Momo (morsel, remainder).
Kohai and Koau married two women from
Pulotu, but Momo never married and was said to have remained e t e r n a l l y
young (Farmer 1855: 133).
Pulotu is the place where the s p i r i t s of
the kings and chiefs of Tonga were supposed to go after death.
Some
said that i t was an island lying to the west of Tonga, while others
said i t was a place underneath the land.
The f i r s t Tui Tonga (king of Tonga), 'Aho'eitu, is said to have
been the son of a god but of earthly mother.
According to the
myth, 'Aho'eitu went to v i s i t his father in the sky and was eaten
by his brothers because they were jealous.
Later he was re-created
by his father who commanded his sons to vomit into a kumete (kava
bowl) and to then add his bones.
This assumed divine origin of
the Tongan monarchy may explain in part the mana attributed to the
Tongan rulers which is effectively maintained by the institution
of tapu (taboo).
The f i r s t Europeans to set eyes on Tonga were the navigators
Schouten and Lemmaire in 1616.
They sighted Tafahi and Niuatoputapu.
An attempt at i n i t i a t i n g trade with the islanders ended in a fight
which l e f t two dead.
Tonga'-was l a t e r visited by various explorers
such as Cook in 1773, 1774 and 1777; and Bligh in 1789.
Cook named
the island of Lifuka, in the Ha'apai Group, the Friendly Island.
Later the whole of Tonga came to be known by this name.
During the
early 19th Century Tonga was visited by beachcombers (e.g. Mariner
1806-10), whalers, and Protestant and Catholic missionaries during the
1820s.
The European presence increased during the 19th Century,
playing a role in the establishment of a centralised monarchy and
introducing Tonga to Western culture, commerce and diseases.
9.
Missionary-inspired reforms in 1862 and the 1875 Constitution were
significant developments in the establishment of the Tongan s t a t e .
German influence was strong through the commercial activities of the
copra-trading company Goddefroy und Sohn.
influence was the missionary Shirley Baker.
Also of considerable
Baker, the Goddefroy
company and the Tongan monarch were closely allied and played a
dominant role in the political and economic development of Tonga
during the late 19th century.
Toward the latter part of the
century, British and Australian commercial interests came to replace
German.
In 1900 Tonga became a British protectorate.
British
influence grew in part because of increasing financial d i f f i c u l t i e s
of Tonga.
In particular, the British took over more and more of
the responsibility within the Tongan bureaucracy.
The period between 1918 and 1929 was a relatively prosperous
one for Tonga as its copra exports increased in quantity and value.
Economic growth encouraged the emergence of local capitalist
development (e.g.shopkeepers).
Members of the nobility sent many
of their children to Australia and New Zealand for higher education
and the c i v i l service became largely localised once again.
care was improved.
Health
There was also an increasing amount of urban
drift.
The depression h i t Tonga very hard and all but the e l i t e were
forced to return to subsistence production.
As the economy began to
recover in 1935, Tonga continued to develop as i t had before the
depression.
This pattern of slow economic growth and social change
continued through the Second World War and up to the 1960s.
The
pace of change increased in the early 1960s, with the ascendence of
Tupou IV, who sought to 'bring Tonga into the twentieth century 1 .
The l a s t two decades have witnessed many changes as Tonga's economy
has been d i v e r s i f i e d , many Tongans have migrated or spent time
10.
overseas, education has spread, and outside influences are
increasingly f e l t .
Thus, while Tonga today retains many of i t s
traditions in modified form, i t is in many ways very different than
i t was one or two generations ago.
The interface of
'traditional'
and 'modern' is an important element of all aspects of Tongan l i f e
today, including health care and beliefs.
MINISTRY OF HEALTH
Because this study concerns health matters, this section w i l l
give an outline of the Ministry of Health in Tonga, particularly
i t s activities as they relate to maternal child health and family
planning.
The Ministry of Health is administered by the Director of
Health who is responsible directly to the Minister.
divided into five technical divisions:
Public Health, Dental and Nursing.
It is
Administration, Medical,
I t is further divided for
administrative purposes into ten medical/public health d i s t r i c t s .
There are altogether four hospitals, eleven health centres and
thirty-two maternal child health clinics in Tonga (Tonga 1982:2).
In addition there are three outpatient clinics conducted by the
Roman Catholic Church and two by retired medical officers.
As in many other countries, following the International Primary
Health Care Conference held in Russia in 1978, the Tongan Government
adopted the goal 'Health for all by the year 2000'.
Primary health
care is said to be "the key to attaining this target as part of
development in the s p i r i t of social justice" (Tonga 1980: 299).
To achieve the above goal, the Ministry of Health's objectives
for 1980-1985 are as follows:
11.
increase social and econoniic productivity through improved
health of the population,
improve the quality of family l i f e through education and
family planning to bring the natural growth rate of the
population into balance with socio-economic development.,
increase equity in the health services system by maximal
development of the abilities of Tongan nationals within
the system and a more balanced distribution of services to
all island groups rural areas,
increase the efficiency of health services, and
improve the protection of the population from environmental
hazards.
The role of Tongan traditional curers is recognised as a means
to alleviate health problems in isolated areas.
In particular, the
role of M a ' u l i or Traditional Birth Attendant (TBA), is expected to
increase in promoting health care and improving the quality of service,
The role of the individual and the community in primary health care is
to be developed since 'self-help' is recognised as more costeffective and often the best way to improve health.
The present service f a c i l i t i e s are recognised by the government
to be inadequate.
Also there is a shortage of staff, particularly
trained doctors.
13.
estimates in 1962.
A part-time medical o f f i c e r was appointed i n
1965 and i t was then that the family planning programme became more
active and strongly supported by the government as well as by f o r e i g n
aid donors.
Maternal c h i l d health and family planning are s t i l l high in
government p r i o r i t i e s .
In f a c t , one could surmise from the
continuous emphasis on maternal c h i l d health and family planning t h a t
these two services have indeed become the pampered projects of the
government, international health agencies and donor countries to
the possible detriment of other health needs of the society.
With
these strong backings combined with an increasing orientation and
awareness of health hazards and t h e i r possible prevention, the
mothers' and childrens' health have improved.
The fact that the
sum t o t a l of women i n t h e i r child bearing age (15-44) and pre-school
c h i l d r e n (0-5) make up more than one-third of the t o t a l population
(Tonga's 1976 Census),and the v u l n e r a b i l i t y of these age groups t o
i l l n e s s and disease, probably j u s t i f i e s t h i s a t t e n t i o n .
At present,
however, there is a near absence of tetanus neonatorum, whooping
cough, measles and mumps.
On the other hand the common problems o f
upper r e s p i r a t o r y infections and diarrhoea in children are s t i l l
prevalent.
RESEARCH
Field Work
The f i e l d work f o r t h i s study was carried out in Tonga from
January t o the end of May 1983.
Although kau f a i t o ' o fakatonga
(Tongan t r a d i t i o n a l curers) were interviewed a l l over Tongatapu
I s l a n d , parts of Vava'u, Ha'apai , Niuatoputapu, and Tafahi I s l a n d s ,
the f i e l d work was concentrated on two areas, Nukunuku Village on
17.
Tongatapu Island and Tafahi Island.
The two areas were selected
because of the marked differences in opportunities offered by modern
medical care to these two areas.
Nukunuku,
one of Tonga's more
progressive villages, has a modern medical centre which was opened in
1981.
Furthermore, i t is only about seven miles from Vaiola Hospital
(the main hospital in Tonga), Houma and Kolovai medical centres.
Kolovai is one of Tonga's oldest medical centres, whereas Houma is
one of the newest.
The road is good and public transport is
reasonably reliable to a l l these modern medical f a c i l i t i e s .
Besides,
there are many people in Nukunuku owning private cars which could be
used in emergencies.
Many people in Nukunuku village have been
overseas and most of the houses are b u i l t with timber or bricks.
Tafahi island, on the other hand, is relatively remote and
underdeveloped.
Although i t is only about six miles from i t s
nearest neighbour Niuatoputapu, the sea area in between is often
rough and Tafahi's harbour is not safe.
Two men were lost when
travelling from Niuatoputapu to Tafahi in 1983.
Small open boats
with attached outboard motors are the usual mode of communication
now.
In the past, people were able to row across to Niuatoputapu
in canoes, particularly when water was in short supply on Tafahi.
Tafahi does not have modern f a c i l i t i e s such as shops or maternal
child health c l i n i c s .
Niuatoputapu is the nearest medical centre.
There are no water sealed t o i l e t s on the island.
Most of the
people were born in Tafahi or Niuatoputapu and they have rarely
ventured out beyond Vava'u and Tongatpau.
Method
The principle research strategies used were participant
observation and interviews.
Both scheduled and unscheduled
questionnaires were used as well as informal interviews.
The
questions were mainly open-ended to give f u l l e r opportunities f o r
18.
the respondents to explain their answers.
The questions in the
unscheduled questionnaires were merely guiding questions.
I spent
one month each in Tafahi island and Nukunuku village interviewing
and as a participant observer.
My normal place of residence being
in the next village (about 10 minutes bicycle ride) to Nukunuku
village, i t would have been very strange to shift and stay in Nukunuku.
Therefore during this month I spent most of the time in Nukunuku
village, but slept in my home village.
Because Tafahi is smaller in population than Nukunuku v i l l a g e
(Tafahi 269, Nukunuku 1325), only a section of Nukunuku was chosen
for participant observation.
Nukunuku is divided into four areas
by the Methodist Church (the dominant church in Nukunuku) for
administrative purposes.
These four areas are named, Pilitania
( B r i t a i n ) , 'Amelika (America), Tonga and Kalisi (Greece).
Kalisi
was chosen for my purpose mainly because i t is the closest to my
village (see Map 6).
Apart from informal interviews of government officials, church
leaders, and experts in Tongan culture, five categories of persons
were selected for interviews:
1.
All married couples present in Kalisi (Nukunuku) and
Tafahi island at the time of research.
There were 40 couples in Tafahi and 37 in Kalisi.
To make up
the number of 40 in K a l i s i , one couple was randomly chosen from each
of the three remaining areas of Nukunuku.
both partners were present.
I t was necessary t h a t
Originally, I had hoped to interview
the husband and then the wife (or vice versa) to check any
discrepancies in their replies,
but had to give up the notion when
the couples seemed to enjoy discussing the answers together.
It
was, however, s t i l l possible to detect differences of opinion, i f
Map
5.
TONGATAPU
'EUEIK!
infill
•?
22.
not during the interviews, then afterwards i n participant observation.
The questions were geared to obtain information as to how they
generally care f o r t h e i r children and themselves, p a r t i c u l a r l y when
s i c k , t h e i r attitudes to family planning, and who is really the
decision maker in the home (see Appendix 3a and 3b).
All questions
were i n both English and Tongan except those f o r the modern doctors
which were in English only.
Discussions with the respondents were
mostly i n Tongan.
2.
Some of the old people in Nukunuku and Tafahi aged
70 years and over 9 in Tafahi 5 men and 4 women)
9 in Nukunuku (4 men and 5 women)
The questions were geared to f i n d out how they cared f o r t h e i r
c h i l d r e n , i f any, and how they were cared f o r by t h e i r own parents
when they were c h i l d r e n .
Information on issues such as family
planning, modern and Tongan medicines were sought as well.
people were randomly selected.
These
The main c r i t e r i a were age, and
t h e i r willingness to t a l k .
3.
Children of 10 to 12 years of age belonging to parents
interviewed in Nukunuku and Tafahi.
15 children were interviewed i n Nukunuku (9 girls and
6 boys)
17 children were interviewed in Tafahi (13 girls and
4 boys).
These children were interviewed to f i n d out whether there is
much discrepancy between t h e i r treatment preferences, and those of
t h e i r parents, when they are s i c k ;
t h e i r preferences for the size
of the f a m i l y , and to whom they are likely t o obey more at home,
mother or f a t h e r .
24.
4.
23 modern trained doctors were interviewed.
The only
c r i t e r i a , apart from being qualified doctors, for their selection
was their availability.
Many of these doctors were trained at the
F i j i School of Medicine.
The questions were intended mainly to find out their opinion
of Tongan traditional medicine and whether they can see the
categories of health care systems in Tonga o f f i c i a l l y combined as
one health care system in the future.
Most doctors appear to
subsume a l l non-scientific medical care under 'faith healing'.
5.
86 Tongan traditional curers were interviewed.
I
interviewed 71 of these curers personally and 15 were interviewed
by public health nurses on two of the islands in the Ha'apai group,
namely Ha'ano and
'Uiha.
Most of these curers were selected when
I asked villagers such as shopkeepers, town officers and local
church leaders for information.
Some of these curers were f a i r l y
well known to people in other villages as w e l l .
Of the 86 traditional curers interviewed:
43 were in Tongatapu (11 traditional b i r t h attendants,
26 general curers and 6 paediatricians)
28 were in Ha'apai (2 traditional birth attendants,
23 general curers and 3 paediatricians)
5 were in Vava'u (2 traditional birth attendants,
2 general curers and 1 paediatrician)
4 were in Niuatoputapu (1 traditional birth attendant)
2 general curers and 1 paediatrician)
6 were in Tafahi (1 traditional birth attendant and
5 general curers)
Included in the general category are curers who were professed
gynaecologists, but most women's conditions known to curers are
25
I
often treated by the kau
ma'uli.
Most children's ailments are also
treated by kau ma'ul i , but 13 curers professed to be specialised in
t r e a t i n g children's diseases.
The general curers are those who
professed to treat the ailments of children, as well as those o f
adults.
Information on how t h e i r s k i l l s were obtained, rewards f o r
t h e i r services, and treatment used were obtained.
General information
on how they conducted t h e i r treatment and some of t h e i r successful
and unsuccessful cases were discussed.
The interviewed curers were
those t o whom other people take t h e i r sick p a t i e n t s , and are known
as 'tangata or f e f i n e f a i t o ' o fakatonga' (male or female t r a d i t i o n a l
curer).
But most women in the v i l l a g e s , such as Nukunuku and T a f a h i ,
appear to know some medicines f o r children's ailments.
I also interviewed two r e l i g i o u s (Christian) curers and one
cared playing curer.
I t was necessary, of course, at the preliminary stage of the
research to meet Government o f f i c i a l s , such as the Minister o f
Health, Dr. S. Tapa, church leaders and town o f f i c e r s of Nukunuku
and T a f a h i .
I also met the p o l i c e magistrate at Niuatoputapu and
the d i s t r i c t o f f i c e r f o r the Niuatoputapu area, which included
Tafahi.
KEY CONCEPTS
1.
B i r t h Control "refers to a l l the measures, natural, a r t i f i c i a l ,
and s o c i a l , by which the rate of births can be decreased or
increased"
2.
(Newman 1977: 27-35).
Contraception " i s the avoidance of conception by a r t i f i c i a l
means."
(ibid).
26.
3.
Family Planning "refers to particular voluntary decisions
about birth control made at the level of the family in
society "
(ibid).
4.
Faito'o Faka-Tonga - Tongan traditional medicine.
5.
Fefine Faito'o fakatonga - Tongan female traditional curer.
6.
Health,
7.
Maternal and Child Health Services.
A feeling of well being.
In this study, the concept
is as defined in the Minister of Health Report, Tonga, but i t
is to be noted that the school children's aspect of the definition
is rarely realised in r e a l i t y in Tonga.
Thus as far as this
study is concerned, Maternal and Child Health Service i s :
. . . . the total care and well being of mothers,
maintenance and promotion of health and welfare of
infants and pre-school children . . . . (Tonga 1981: 11).
8. Ma'uli
9.
is a Tongan traditional birth attendant.
Medical System - includingall of the clinical and non-clinical
a c t i v i t i e s , the formal and informal institutions, and any
other activities that, however tangentially, bear on the health
of the group and promote optimum functioning of society
(Foster and Anderson 1978: 36).
10.
Modern or Scientific Medicine - a system of curing based on
"rational" techniques, and " s c i e n t i f i c " concepts of cause
and effect (McKim 1955: 266).
11.
Population Control "consists of governmental policies
intended to stabilise or control numbers of people - that
is birth rates, and migration - and including, besides
voluntary family planning such measures as tax incentives,
27.
health education, and those programmes (defined as public
health and preventative medicine) that relate to reproduction
and longevity "
(ibid).
12.
Tangata Faito'o Fakatonga - Tongan male traditional curer.
13.
Traditional Birth Attendant is a female or male whose function
i s to give women i n the community, pregnancy, birth and postnatal
care.
His/her s k i l l was either handed down through the family
l i n e or has been learnt from somebody else by observation.
14.
Tradition "refers to those aspects of the culture which have
been practised by the ancestors, which may or may not be
maintained at present" (Latukefu 1975:
15.
19).
Traditional curer " . . . a person who is recognised by the
community in which he lives as competent to provide health
care using vegetable, animal and mineral substances and c e r t a i n
other methods based on the s o c i a l , cultural and rule background
as well as on the knowledge, attitudes and beliefs that are
prevalent i n the community regarding physical, mental and
social well-being and the causation of disease and d i s a b i l i t y "
( i n WHO 1976: 9 ) .
16.
Traditional medicine " . . . the sum t o t a l of a l l the knowledge
and practices, whether explicable or not, used in diagnosis,.
prevention and elimination of physical mental or social
imbalance and relying exclusively on practical experience
and observation handed down from generation to generation
whether verbally or in writing" ( i b i d . 8 ) .
20.
CHAPTER
II
TONGAN ETIOLOGY OF ILLNESS AND HEALTH
The Introduction of Christianity. Most illnesses and diseases,
according to the Tongan etiology, are caused by supernaturals.
Even
minor sores and cuts when they do not heal quickly are suspected to
be supernatural sanctions for some wrongs committed by the victim or
a close relative.
When Christianity was brought to Tonga in the early 19th century,
the missionaries condemned the Tongan traditional beliefs regarding
health and illness as evil, particularly as they were interwoven with
the Tongan ancient religious beliefs and values - the very things which
they pledged when leaving their own countries to eradicate and to
rescue the 'heathens' from.
Although the missionaries were not well received at the beginning,
they later became well accepted by chiefs and commoners alike. Some
of the missionaries became very powerful, like the Reverend Shirley
Baker, who became the Premier of Tonga in 1880.
Inevitably, many of the Tongan's traditional health practices
were forbidden and forgotten.
The missionaries introduced their
God and their medicines, intending to replace those of traditional
Tonga.
But albeit such forces, many of the traditional health
practices are still practised today. Likewise, some of the old
traditional religious beliefs are still there, but now many are
mingled with those of the Christian beliefs.
The Tongan traditional health practices which survived are still
practised by many people in Tonga: chiefs and commoners, educated
29.
and uneducated,
rich and poor,
and non-Christians.
old and young, as well as Christians
In short, traditional health practices are
s t i l l very strong strands of the social fabric of which the indigenous
Tongans are made.
ILLNESS AND DISEASE
The concept illness is used here rather than disease, because i t
is the 'unwell' behaviours of the individual in contrast to what is
considered 'wellbeing' behaviour
of this study.
of society, which is the concern
The difference in the meanings of these two concepts
was aptly described by Howard and McKim (1983: 362) when they state
that:
Disease is a concept referring to a pathological condition
of the body, or of some part of i t , in which its functioning
is disturbed or deranged,
while,
Illness is a cultural concept: a condition marked by
pronounced deviation from what is considered a normal
healthy state.
In this study, the Tongan term mahaki, will be used for disease
and puke for illness.
Mahaki is a general term that may be applied
to plants and so on, while puke is a term that applies mainly for
human beings.
Puke is also the term used for commoners when they
are ill, while the terms tengetange and puluhi are used when referring
to the illness of chiefs and of the monarch, respectively.
The term puke may be used synonymously for when a person is
feeling ill, and when she/he assumes the sick role.
But once an
illness or sickness is diagnosed, the ill person is referred to as
mahaki (the patient), and puke is then the acute unwell feelings
that the person may experience from time to time, manifesting in
signs and symptoms recognised and accepted by society as illness.
ILLNESS AND HEALTH
There were reasons allocated to all happenings in Tonga. When
they were recognised as monu (good fortune, blessed, good luck), i t
was considered that the supernaturals were pleased.
It meant also
that individuals had carried out their expected customary functions
in society, and observed the tapu of those things, or of other things
which have mana. Good health belongs in the category of good fortune.
On the other hand, when happenings were recognised as mala
(misfortune, s i n , bad luck), i t meant that the expected customary
functions had been neglected, and that some tapu had been broken.
Illness belongs in the category of misfortune.
While happenings
associated with good fortune may be seen as rewards or encouragements,
those categorised as misfortune were seen as punishments or warnings
from the supernaturals to individuals to abide within the norms
of society.
Snow (cited by Foster and Anderson 1978: 77)
asserted:
Good health is classed with any kind of good luck:
success,
money, a good job, a peaceful home.
Illness on the other
hand, may be looked upon as just another undesirable event,
along with bad luck, poverty, unemployment, domestic turmoil
and so on.
The attempted maniuplation of events (by
individuals) therefore covers a broad range of practices that
are carried out to attract good, including good health, and to
repel bad, including bad health.
The term supernatural is used in this study to include a l l
those not of this world like gods, s p i r i t s or ghosts:
or beyond this world.
IIlness
those of ope
is supposed to be caused when a person
has gone ope or beyond his physical, mental and social capabilities.
That i s , going beyond profane to the tapu areas.
I t is, in other
words, not knowing oneself.
I t would seem correct to say therefore that the Tongan etiology
of illness and curing, like many non-Western etiologies, is
3 1.
p e r s o n a l i s t i c i n contrast to n a t u r a l i s t i c .
That i s , i t a t t r i b u t e s
e t i o l o g y of i l l n e s s and curing more t o those of the ope and l e s s t o
n a t u r a l i s t i c e t i o l o g y , which a t t r i b u t e s causes of illness to mostly
natural phenonema such as c o l d , hot and so on.
Both p e r s o n a l i s t i c and n a t u r a l i s t i c etiologies are, however,
unable to explain the contagious concept.
Forgiveness is sought when a person i s having misfortunes
i n Tonga.
In the old days, a person would go to a t a u l a ' e i k i
( p r i e s t ) t o determine the reasons f o r misfortunes, whatever they
were.
Kava (pepper methysticum) and food were usually taken as
presentations t o the p r i e s t .
In the case of sickness, Tutu 'unima
(amputation of phalanges of f i n g e r s ) and even human sacrifice
might be necessary,
(Mariner
1817).
p a r t i c u l a r l y i f the sick person was a c h i e f
The priests were u s u a l l y males, thus i n d i c a t i n g
t h a t communication with supernaturals was
perhaps a role mostly
f o r males.
TONGAN MYTH RELATING TO GOOD FORTUNE AND MISFORTUNE
A myth is t o l d (Fanua 1975: 27-28) o f how a beautiful woman
from 'Uiha I s l a n d , Ha'apai, was madly i n love with the sun.
Eventually she became pregnant by the sun from d a i l y bathing i n
the sea and d r y i n g herself naked i n the warmth of the sun.
A
b e a u t i f u l baby boy was born who e v e n t u a l l y grew to be a very
handsome youth.
Because of his unusual beauty, he was selected
personally by t h e king t o marry his daughter.
But he and h i s
mother had no koloa (valuables 'of mats, tapa cloth and so on)
t o o f f e r , b e f i t t i n g a k i n g ' s daughter, a t the wedding ceremony.
I t would not o n l y be embarrassing f o r the mother, but r e c i p r o c i t y ,
an important element of Tongan social i n t e r a c t i o n s , would be badly
32.
neglected.
The whole society would not approve, let alone the
supernatural.
I t would bring misfortune.
The mother, Fataimoeloa, sent the youth, Sisimataela'a ( c a l l i n g
the attraction of the sun) to go and t e l l his father, the Sun, about
his coming wedding.
The young man did this after swimming out at
night to a rock directed by his
mother.
After Sisimataela'a talked
with his father, the sun gave him two parcels for his wedding.
was called monu and the other was called
mala.
One
The young man was
told by his father to open monu on the wedding day, but to leave mala
until after the wedding.
Unfortunately the young man was so curious
that he started to l i f t the wrapper of the mala parcel gently on one
corner.
Immediately, there was lightening, thunder and a great
storm blowing which would have taken the young man's l i f e had not
the sun intervened and saved his son.
On the wedding day, the young man opened the monu parcel as
directed by the sun, and straight away, a l l that was proper f o r such
a chiefly wedding was assembled.
The koloa and food presentations
from the bridegroom's party surpassed those of the bride's party.
But her people knew and accepted that i t had all been done through
supernatural powers.
Sisimataela'a was dressed with fine mats from
the koloa brought by the monu parcel, but his mother put on top a
kietonga (chiefly Tongan finely woven white mat) which she herself
had made.
I t is said that since that occasion, the kietonga has
been worn traditionally on top of Tongan wedding garments.
After the wedding, the mala parcel was then properly opened,
and a great wind came and cleaned a l l the rubbish as well as the
big house brought by monu for the wedding.
In a general sense this myth emphasises the extent to which
obedience to one's parents is valued in Tongan Society.
33.
The mala
or monu of children somehow relates to the children's obedience to
their parents, just like Sisimataela'a to his parents.
On particular relevance here, mala, may also serve a purifying
role in society.
According to the myth, mala has a cleansing
function in society as i t did to a l l the rubbish after the wedding.
Thus, in a case of illness where forgiveness is vital to regain
health, misunderstandings and social grievances between those in
important social relationships should be healed.
But i t is
important that individuals must make an e f f o r t to show that there
is genuine trying, such as the kietonga lovingly made by a mother
for her son.
In the final analysis, monu and mala indicate that
the supernatural sanctions are only temporary, depending on how one
is functioning in relation to others in society and to the supernatural .
Illness is usually considered t o be temporary, but so too,
is good health.
Only the death of the physical body is permanent.
ANCIENT RELIGION
Polytheism was practised in Tonga.
be the annointed of the gods.
Kings were understood to
Although there was no organised church
as in Durkheim's notion of religion (Durkheim 1967), the Tongan idea
of the lotu (religion, prayer) was similar to the definition given by
Yinger (cited by Vrijhof in Brothers 1967):
A system of beliefs and practices by means of which a group
of people struggle with their ultimate problem of human l i f e .
PRIESTS.
earth.
The priests were the representatives of the gods on
They were usually members of the hierarchy.
The Tu'i Tonga
(King of Tonga), for example was the chief priest of Hikule'o who was
supposed to be in charge of Puiotu.
The priests who were not chiefs
had to have a 'chief like' t r a i n i n g .
Although women were eligible
to become the representatives of god, as in Fai'ana's case,
34.
the s i s t e r of Ata (one of Tonga's powerful chiefs when C h r i s t i a n
missionaries commenced t h e i r work in the early 19th century),
priesthood was usually a role for males.
Most powerful chiefs had t h e i r own god and each god u s u a l l y had
a priest.
The priests endorsed the power of the chiefs in s o c i e t y .
These priests and priestesses were u s u a l l y found in special
houses b u i l t f o r the gods.
little
These l i t t l e houses were the same as
the other houses except, i t i s s a i d , that they were better made.
There were also sanctuaries where a f u g i t i v e might escape and f e e l
safe as well as the small houses b u i l t over the great chief's tombs
where people went to worship.
priest.
However, some gods did not have a
In such cases, a matapule acted as a p r i e s t .
Even though the commoners were said t o have no soul,
had t h e i r gods.
Many were t i t u l a r gods only.
they too
According t o an
early missionary, John Thomas ( c i t e d i n Farmer 1855: 125) i t would
have been an easy matter to i d e n t i f y seventy gods in the early
19th century.
But these gods were not a l l objects of worship.
There were also created gods:
the Mauis, who were seen r e a l l y
as super human beings l i v i n g under the e a r t h ;
sky;
Hikule'o of Pulotu.
the Tangaloas o f
the
Of these created gods, only H i k u l e ' o
{who was also regarded as god of harvest) was presented with
o f f e r i n g s by the people.
These o f f e r i n g s were conducted y e a r l y
i n the ceremony of ' i n a s i when poiopolo (offerings of f i r s t
fruits)
was presented to the T u ' i Tonga for his role as the chief p r i e s t of
Hikule'o.
The polopolo is one of the few occasions in which people
were organised on a regular basis f o r the purpose of a r e l i g i o u s
f u n c t i o n that could resemble what is c a l l e d a church,
SORCERY AND WITCHCRAFT.
Sorcery and witchcraft were not common
i n Tonga and were thought to have been brought from F i j i according to
35.
Mariner (1817).
contrary.
However, Collocott (1928) recounted a tale to the
Apparently a Tongan magician went to F i j i taking a branch
of t o t o f i s i (a medicinal plant) with him.
Present in Fiji at this
particular time was a magician who owned a hohoni (coconut shell dipper
for collecting water) that would make i t s way to fetch water as
commanded by i t s master.
The Tongan magician, to show that his
fakalou'akau (black magic or drauni kau in Fijian) was stronger, sent
his branch of t o t o f i s i to intervene, resulting in breaking the Fijian
magician's hohoni.
The story goes on to say that when the Tongan
magician l e f t for Tonga, he l e f t behind his branch of totofisi with
the result that his magical powers were l e f t with the Fijians.
The type of sorcery known to have been used by Tongans was mainly
preventative.
According to many Tongan traditional curers and old
people, medicinal plants like lautoiu'uta (canavalia maritime) and uhi
(evodia hortensis), well known Tongan medicinal plants for the treatments
of s p i r i t
possessed patients, were often planted close to the sleeping
houses to drive away evil s p i r i t s .
One 76 year old Tongan traditional
curer in Nukunuku village said that fue, a type of creeper similar to
lautolu, was cut into pieces and thrown around the house to protect
a patient who was possessed by evil s p i r i t s from further attacks
(the Bible in the house is said to have the same effect today).
Parcels of pulverised medicinal leaves called sausau in the
not too distant past were often seen tied on to f r u i t trees.
These
were to protect the f r u i t s from being taken by just anybody.
The
sausau was supposed to give those who steal the fruits the disease
that the leaves of the sausau would heal.
The idea is again
that both evil and good come from the same source.
An old Tongan
traditional curer aged 70 explained that her grandmother had a
sausau which had the effect of causing the person who eats her f r u i t
trees without permission to pass wind
36.
uncontrollably.
As
passing wind in company is very embarrassing in the Tongan context,
the young people who were tempted never touched her grandmother's
trees.
They knew what would happen.
But there was also sorcery intending to do serious harm to a
person.
The charm of t a t a ' o , for example, which concerned hiding
a portion of an inferior relative's personal belongings in a part of
a deceased superior relative's grave in order to make
the former sick and die, presumably by the s p i r i t of the dead
relative.
Another supposedly minor cause of illness was taiatuki
(curse).
The taiatuki usually was pronounced on the victim by someone of
superior rank for breaking of serious tapu such as making one's
mehekitanga (father's sister) or fahu (one's social chief on earth)
angry or stealing the church's collections.
In addition, some diseases are said to be caused by certain
happenings to the remains of dead relatives.
I interviewed a
middle-aged Tongan woman who was suffering from very bad headaches
supposedly because roots of a tree went through her dead father's
skull.
The woman was in New Zealand when she started to suffer from
these bad headaches.
She was taken to see specialists in New
Zealand and was given numerous medications, but with no avail.
Finally, she returned to T o n g a . S h e . v i s i t e d many Tongan traditional
curers, but s t i l l with no result.
F i n a l l y , she went to see a card
playing curer who diagnosed that some roots had gone through her
dead father's skull and that this was the cause of her misery.
After some customary preparations, the grave was opened and the
s k u l l , as well as the whole skeleton, of her dead father was cleaned
of tree roots, oiled, rewrapped in ngatu (tapa cloth) and reburied.
She said that she could almost feel
the pain removed bit by b i t
from her head on the day her father's grave was opened.
37.
Mariner (1817) described how the c h i e f Finau's daughter was
taken from one priest to another seeking a cure for her i l l n e s s
which was supposed to have been caused by Finau's many sins.
Although Finau presented large amounts of food, kava and other g i f t s
to the priests as he begged f o r f o r g i v e n e s s , the gods were not
appeased and his daughter died.
Finau's beliefs in the ancient god's
powers was said to have been shaken by t h i s incident.
In f a c t ,
it
was the a b i l i t y of the f i r s t missionaries t o cure some illnesses that
helped to draw the Tongan people f i r s t to C h r i s t i a n i t y .
One o f the
e a r l y Methodist Missionaries, John Thomas f o r instance wrote:
I f we could cure the bodies of the people of t h e i r various
diseases, i t would be a great recommendation for us to the
a t t e n t i o n of the people
(Cited by Latukefu, in Rutherford
1977: 119).
The people reasoned, surely the C h r i s t i a n God must be very powerful
i f His
'priests'
can cure diseases and i l l n e s s e s .
The majority of the people i n Tonga today continue to believe
that most illnesses are given as punishment for some wrong doings.
Only now the Christian God is s u b s t i t u t e d f o r the Tongan gods.
Even modern trained doctors often joke about the need for
'peni Jehovah' rather than p e n i c i l l i n when illnesses are hard to
diagnose or to cure.
EXAMPLES OF SOCIAL RELATIONSHIPS WHICH MAY CAUSE ILLNESS IF NOT
MAINTAINED ACCORDING TO TONGAN SOCIETY'S NORMS
MOTHER AND CHILD.
This r e l a t i o n s h i p begins when a c h i l d is
s t i l l i n the mother's womb.
When a woman is pregnant she has to
observe some tapu for the sake of her unborn c h i l d .
These tapu
are s t i l l observed by many Tongan women although they are now
branded as s u p e r s t i t i o u s .
One hundred percent of the mothers
inter-
viewed i n Tafahi and Nukunuku know at l e a s t two of these tapu and have
38.
tried to observe them, particularly the tapu concerning ridiculing
persons with physical defects, and stealing.
It is interesting
however to note that the two tapu mentioned above have Christian
connotations.
Mothers are also encouraged to think 'beautiful' so
that her child would be beautiful physically.
Listed below are some of the pregnant women's tapu and the
alleged consequences if broken:
Tapu for Pregnant Mothers
Consequences if broken
1.
Inu he niu sitake (drinking
from a coconut which is
opened at the bottom,widely)
The baby w i l l have an abnormally
large mouth.
2.
Fesi va'e moa (breaking
chicken's legs)
The child w i l l have t a l i p i e s .
3.
Kai he mohenga 'oe mali
(eat on the husband's bed)
The baby's head w i l l become
soft and swollen.
4.
Kai feke (eat octopus)
Will
5.
Kahoa Takatakai (wind
things around her neck)
The baby might be strangled
by the umbilical cord.
6.
Kakapa (straining to
reach something)
Same as No. 5 .
7.
Kaiha'a (stealing)
Birth marks shaped l i k e the
stolen article may show on the
baby's body particularly on
the face.
8.
The child w i l l be born w i t h
Luma'i ha mele 'oha taha
tautautefito ki he kei mahina
the same abnormality.
1 pe 2 he 'oku kei tohi 'ae
valevale.
(Ridiculing persons
with physical defects particularly
at 1-2 months pregnant when the
baby is s t i l l in the very early
stage)
give baby a red s p o t t e d s k i n ,
Nofo he matatuiutulu 'oe fale
Baby w i l l be suffering from
( s i t t i n g under the edge of the mavaeua (a very common disease
of babies said to be due t o
roof outside)
niche fontanelle).
Mother w i l l have frequent
bowel motions during labour.
10.
Kaitu'u holo 'i tu'a (eating
while walking around outside)
11.
Cause d i f f i c u l t y of labour.
Ta'utu ma'u ta'e fetongitongi
hoto nofo'anga ( s i t t i n g on one
place without changing positions)
39.
Nutrition and exercise also are
mother's care.
the time.
She
important aspects of the pregnant
is encouraged to get up and not to s i t down all
At the same time she is warned not to overstrain herself.
Because octopus often gives allergic reactions to people who eat i t ,
she is warned against i t .
eat properly.
She is supposed to go and sit down and
Eating while standing is extremely bad mannered i n
the Tongan society anyway.
I t appears that the Tongans knew t h a t
the baby's future health depended largely on the mother right f r o m
the early stages of pregnancy.
Tongan children are taught from an early age,by their mothers
or mother figures,to know their place within the family as well as
in the society at large.
out of place.
near);
'loaded'
Mothers are blamed when individuals act
The Tongans say 'koe ta'e mohe o f i ' (not sleeping
that i s , not sleeping near to his/her mother.
with meanings that can easily spark off serious r i f t s
between individuals and families.
For i f the mother was not
sleeping near her children, then where was she?
men?
The saying is
Out with other
Thus implying that she considers her own pleasures to be more
important than her children (which are regarded by society as koloa
mahu'inga [precious valuables]).
Furthermore, her duty to whisper
social norms concerning various social relationships to the children
at night (as in the Fananga stories) has been neglected and her
children have grown up ignorant of society's norms, and thus not
knowing their place in society.
The saying 'ta'e mohe o f i ' is
directed towards such persons who are considered not of the
but 'outside' of society.
Not only may a mother's
'inside'
irresponsible
behaviour be linked to such shortcomings on her childrens' p a r t , but
i t may also lead people to feel that she herself was brought up
poorly, thus involving a wider social c i r c l e in the matter.
40.
The husband does not have to observe any tapu during h.is wife's
pregnancy, although in some cases he suffers 'morning sickness' for
the mother.
He is not blamed for the behaviour of his wife and
children, even though he may in fact have been the cause of t h e i r
problems.
The home and children are seen to be primarily the
mother's responsibility,and for these she must be prepared to
sacrifice i f
necessary.
And i t is in the home that the meaning of
health in the Tongan context begins.
The 'ofa (love) between mother
and child is nurtured during the 'mohe ofi ' period.
grow into all things that is treasured by
This
'ofa
will
Tongan society.
Indeed,
Kavaliku (1961), in his analysis of ' o f a , analysed seven types of
'ofa and concluded that 'ofa is the treasure of Tonga.
Father and
Child.
The father i s the head of the home.
This is
confirmed by the actions of family members towards him at home.
Children would normally know this through the akonaki (teachings) of
their mother during the 'mohe ofi ' period.
Children are not allowed
to eat the left-overs of their father's meals.
Nor is i t proper for
them to touch their father's head or play on his bed.
These types
of familiarity may cause a child to have ihu pe'e (runny nose) or a
swelling on the neck called
fula.
Fula may occur also when i n f e r i o r
persons eat the left-over foods of chiefs or their fahu.
Although women are revered and respected (as in the concept of
fahu), the man is s t i l l the head and decision-maker in the home as
illustrated in the following assertions:
"The Husband is considered the head of the immediate family
(Gifford 1929) and again Mariner (1817) " . . . for even i f his wife be
of superior rank he is nevertheless of higher authority in all
domestic matters and no woman entertains the least idea of rebelling
against authority...."
41.
"
Brothers and Sisters.
Very early in life, brothers and sisters
are made aware of their responsibilities towards each other and also
to their respective families when they are married.
Alongside their
mothers' teachings they also learn from observing the behaviour
of
their father towards their own sisters and close female cousins as
well as those of their mother towards her brothers and close male
cousins.
They have to learn to faka'apa'apa (respect) each other.
In
Tongan custom, once the children have grown to adolescence, the males
are of the 'outside' and the girls are of the 'inside' of the house.
That is 'tu'a' and 'fale' respectively.
Boys usually sleep i n a
different house and go outside the house when their sisters or close
female cousins come into i t . T h e s e customs are s t i l l observed by
many people in Tonga, particularly in chiefly circles and in the
rural areas.
Boys are strongly reprimanded from childhood i f they h i t their
sisters.
Girls are usually seated and served f i r s t at meals.
However, with this 'chief-like' treatment at home, girls are expected
to behave like chiefs in many ways.
They are not allowed to wander
around alone or go out on 'dates' without chaperones because i t is
considered common.
In contrast, boys enjoy much greater freedom.
I t is s t i l l customary today for a brother to take the polopolo
( f i r s t f r u i t s ) of his garden to his s i s t e r at least once a year,
particularly towards the end of the year.
His sister is expected
to reciprocate with a ngatu (tapa cloth) as a blanket to keep her
brother warm for the year.
Thus brothers and sisters are trained to know their place i n
the society, f o r the social relationships between them and their
respective families are vital to maintaining a healthy society.
42.
The matter of incest, which is strongly rejected in Tongan society,
is related to t h i s .
Incest was, however, known in ancient Tonga,
particularly among the chiefly circle.
Brother's Children and His Sister.
The social relationship
between the brother's children (tu'asina) and their aunt (mehekitanga)
is one of the most important relationships in Tonga.
Customarily,
the brother's children are his sister's fa'iteiiha'anga (to do with
as pleases).
She may assert her position, although this is regarded
more as a privilege rather than a duty.
The proper functioning of this social relationship invariably
rests on the social relationship between the wife of the brother
and his sisters.
I t is the wife after a l l who is responsible
primarily for teaching his children proper behaviour toward t h e i r
mehekitanga.
And the mehekitanga should know how to behave towards
her brother's family without demand.
A mehekitanga, i t is believed, can cause her brother's children
illness or death by taiatuki (curse) or even by simply being angry
with her brother and sister-in-law.
justified
I f the cause of her anger is
one of her brother's children may get i l l or even die.
This can occur even i f the mehekitanga does not wish i t on the child.
To cancel such misfortune, the mehekitanga's forgiveness must be
sought by the brother and his nuclear family.
Forgiveness is of .
course a vital element of good health in T o n g a . B y way of a
contemporary example, the death of two children during a dengue
fever epidemic in Tafahi a few years ago was blamed on the bad
social relationships between their mother (brother's wife) with
their mehekitanga (father's sisters).
The people explained, "many
children and adults were sick, but only those two children died."
The tensions in the relationship between the brother's wife and his
43.
two sisters were obvious, and the people were freely gossiping about i t .
Sister's Children and Her Brother.
Contrary to the relationships
between father's sister/s and their brother/s, the children of sisters
('ilamutu) can do what they like with whatever belongs to their mother's
brothers (fa'etanqata).
But the degree to which this sort of
relationship is allowed in reality depends on many factors.
One
important factor is the relationship between the brother's sister/s
and his wife.
Chiefs and People.
Respect for chiefs in the traditional Tongan
context often involved unquestionable obedience.
This sense of
respect started at home with the mother and child 'mohe o f i ' and the
child's relationships to its
father.
The notion that Tonga 'belongs
to the king and chiefs' is also learned very early in life and is
closely linked to one's well being and the land.
It is often said
that the mana of the land will do more for you i f one is prepared to
fuakavenga (carry responsibilities) for the king and chiefs and church.
To do the opposite w i l l have a mala e f f e c t , such as illness or death.
The chiefs also have their responsibilities towards the people.
The monu of their future generations rests on their fairness to people,
particularly in the matter of land.
After a l l , i t is believed by
many, the land was the Christian God's mana, since Tupou I gave i t
to Him to protect.
Many misfortunes in Tonga are attributed to foul
play over land issues.
While for the most part the people of Tonga respect the royal
family and chiefs, there is occasional grumbling.
Any discontent
toward the hierarchy may be subsumed under the notion 'nguiungulu
' a f ei' umu' (grumbles of the 'urnu_ makers), denoting the saying (as in
'ngulungulu'), and doing (as in fei'umu), are two different things.
I t is the making, the doing, of the 'umu that is important.
44.
For as
long as the 'umu are being made, the allegiance of the people to the
chiefs remains assured.
The idea that action is more important than words also manifests
i t s e l f in how Tongans show their 'ofa to people by the trouble they
go t o , for example, in preparing food for them.
Making an e f f o r t
to v i s i t the sick with some foods is a good example of showing one's
'ofa.
At the same time, 'ofa in this fashion also inhibits social
intercourse, since people are shy to go along with empty hands to see
returning relatives, v i s i t o r s , chiefs or sick persons.
They say,
'koe me'a fakavaleanga koe masiva' (poverty inhibits good manners).
But the worst type of poverty
is
not knowing one's self.
I t is also important to give what is appropriate to the status of
the receiver, because g i f t s communicate how the giver feels towards
the receiver of the g i f t s as well as one's knowledge of Tongan
etiquette.
A well-off noble in Tonga, for instance, may approach
the King with a mere basket of f i s h because his ancestors were
traditional fishermen for the royal house of Tonga.
On the other
hand, i t is proper for most people to present a huge pig and kava
when going for a special audience with His Majesty.
however, does not demand t h i s , nor expect
The King,
a huge pig and kava every
time a Tongan person is going to see him.
Since the monarch is not viewed by Tongans generally as a
creation of chance but rather of 'God's ordinance", the status of
his being must be upheld with proper rituals.
Not performing
what is considered right can be seen as disrespect to the hierarchy.
And disrespect to the hierarchy i s seen as breaking an important
social tapu which w i l l bring mala to people concerned.
To t h i s end,
people would go without good food for days and spend much on
customary feasts.
Those who do so argue that i t is much more
45.
important for the Tongan people as a whole to 'feel well' socially
than physically.
The Supernatural and the People.
The Tongan concept of
illness is related to ope, and i t is the ways in which Tongans f u l f i l l
obligations associated with various relationships to obtain the
maximum approval of society that are f e l t also to please the
supernaturals.
past.
There were many gods and ancestors' spirits i n the
Today, they believe only in the Christian God.
However,
it
would be wrong t o assume that a l l aspects of the ancient religion
have been demolished.
medicine.
This is especially true in relation to
Thus, one hundred percent of the people that I came
across in Tafahi and Mukunuku have been involved in some traditional
Tongan curing.
I t would seem reasonable therefore to assume that
this is true of many other Tongans as well.
Furthermore, in the Judeo-Christian tradition, illness is also at
times explained as God's punishment for sins.
Thus i t seems that
while the Tongans changed their gods many of the sentiments they
held for their past gods
were
transferred to the Christian God.
And the fear of supernatural punishment for socially unacceptable
behaviour has remained a cornerstone for maintaining society's moral
order.
In this respect, Tonga is not very much different to other
non-Western societies in which:
Central values are reinforced by the belief that sickness is a
penalty f o r bad conduct. (Howells, cited by Foster and
Anderson 1978: 44)
Family Planning and Society.
Fertile wombs were and are s t i l l
considered to be blessings, not only for mothers but the whole
extended family.
To have fanau '(children) is a monii.
It
shows that
the God is smiling upon the parents and has approved the family's
interpersonal relationships towards each other.
46.
On the other hand,
pa'a is considered mala'ia ( f u l l of misfortunes).
A woman who
cannot produce a child is referred to as pa'a (barren).
The concept
pa'a is associated with attitudes such as not loving, hardness of
s p i r i t , aggressiveness and selfishness.
fanau ( a b i l i t y to bear children).
Pa'a is opposite to
The concept fanau is associated
with attitudes such as love, tenderness, forgiveness and unselfishness.
Pa'a attitudes are not approved of within Tongan society, while fanau
attitudes are.
pa'a!"
The Tongan people would say, "fieiau he koe manava'i
("It is no wonder for her womb is barren!").
The assumption
is that when a woman is ta'e'ofa (unloving), a child in the womb would
bring love and caring to her l i f e .
Because of the assumed lack of 'ofa in those who are pa'a and
also because of the Tongan notion of reciprocity, parents with many
children may reluctantly agree to give away one of their children for
those with no children to pusiaki (adopt).
This usually occurs
among blood relations, for i t is also designed to reinforce kinship.
That i s , to keep the blood relation warm instead of cold.
I t is most important for most Tongans to have at least one child
or pusiaki to pooki (close) ones eyes in death, that is to look after
one when dying.
I t is a poor man or woman indeed who has no one to
perform this very important t a s k . F o r i t could indicate a lack of
sharing while a person was alive.
to me in Tafahi.
This fact was brought home strongly
An 83 year old man with no children or pusiaki was
dying a l o n e . I saw him in a p i t i f u l s t a t e , alone, about two hours
before he died and had never witnessed a lonelier Tongan.
Today, the connotation of family planning is to render barren,
a f e r t i l e womb, and that as quickly as possible.
The choice,
however, is supposed to rest with the c o u p l e . I n the Tongan context,
as explained above, this is in a sense consciously denying love to
grow inside a woman's body, and thus in the society at large.
47.
THE CONCEPT OF HEALTH IN THE TQNGAN CONTEXT
I t is perhaps the use of the words m o ' u i lelei (good l i f e ) to
describe health in Tonga that has led some people (notably Parsons
1981) to assume that the concept health is a Western notion that has
no relevance to Tongan society.
denied in this study.
This assumption is emphatically
I t is hoped that i t is clear by now that the
Tongans are very much concerned with health, but their emphasis is on
the social aspect of health, p a r t i c u l a r l y the spiritual side of social
l i f e . L i f e is threefold, as the Tongans would say, sino, atamai
moe laumalie (body, brain and s p i r i t ) .
What is i n fact the Western notion of health?
I t is probably
true to say that most western countries would agree in principle
with the WHO d e f i n i t i o n of health that i t is "a state of physical ,
mental and social wellbeing . . . "
Health is a relative term and
d i f f i c u l t to define in any general way (Dubos 1965).
There is no
c r i t e r i a as to what aspect of health is more important than another,
nor is there a universal description of what a person should call
'wellbeing'.
I t is the supposition of t h i s study that the Tongan
notion of 'well being' rests more on how s a t i s f a c t o r i l y they are
carrying out the functions of their important social relationships.
And they can only do this with knowledge brought about by mohe ofi ,
and not by ignorance resulting from ta'e mohe ofi (not sleeping near).
Because the term mo'ui l e l e i is ambiguous to say the least, I
suggest that the Tongan term, monitonu, which means 'that all i s
well with one', should be used instead of mo'ui l e l e i .
Good health,
in the Tongan context is related t o the f e e l i n g of 'freedom', of
knowing that one has done a l l the expected duties to one's family,
land and society.
And the term monimonitonu (having everything go
right with one continually) may occur when one is strong in all the
three aspects of l i f e that Tongans value - sino, atamai and laumalie
48.
(body, brain and s p i r i t ) .
When asked how she feels when she is mo'ui lelei an 80 year
old m a ' u l i replied "'Oku ou ongo'i ta'e puke" (I feel not sick),
but when I asked how she feels when she is monitonu her answer
was '"Oku ou ongo'i l e l e i mo nonga"
( I feel good and in peace).
I would argue that the latter answer describes the Tongan concept
health, more than the former.
The importance of the physical and mental aspect of health is
not neglected by Tongans.Most Tongans are very concerned when a
person is t h i n . T o them to be fat is
healthy.
The thin person
in the home is l i k e l y to be given the best food to eat, encouraged
to rest and to take some traditional medicine.
Skills in warfare, sports, boat building, fishing, healing and
oratory were very much admired and encoraged.
learned by observation.
These skills were
Tupou I , known as the maker of modern
Tonga, was not only a great chief in his own r i g h t , but was also very
s k i l f u l l in all the arts that were honoured by Tongans.
his rise to power was both ascribed and achieved.
Thus
The people i n
Tonga now are very keen to educate their children and would
sacrifice a lot of family comforts to educate their children.
To sum i t up, in the Tongan concept of health, stress is
placed on the social aspects of health, which include matters of
the s p i r i t .
Sickness is considered to be caused by breaks in the
social relationships between inferior human beings and superior
human beings or humans and s u p e r n a t u r a l s . T h e misfortune of not
feeling well is brought about by not knowing oneself and going
ope or beyond his/her capabilities.
Tapu of people or things with
manaare l i k e l y to be broken by ignorance caused by not 'mohe o f i ' .
49.
Forgiveness is v i t a l in regaining health in the Tongan context.
I t provides a means for achieving as much freedom as possible,
from the bad feelings which can be harboured by others.
Health in the Tongan context, is f i r s t and foremost thought
to be freedom from bad feelings held by others, and freedom from
holding such feelings towards o t h e r s . ' O t h e r s ' would include those
of the world and those not of the world ( o p e ) . T h e mental and
physical wellbeing would be affected when these social relationships
(va) are not what they should be, through ignorance or blatant
disregard of society's n o r m s . T o this end a Tongan would disregard
physical health, and give all to what is believed to be one's
monu to fua (shoulder, carry).
50.
CHAPTER
III
THE CURERS
From t h e i r traditional role as healers and soothers,
doctors have been transformed into sophisticated
technocrats with arsenals of machinery to analyse,
diagnose and sustain the human body. Advancing
into unchartered water, doctors and medical
scientists have captivated the press and the
public with miraculous new gadgets and techniques
from test-tube conception to promises of a
mechanical heart that w i l l do everything short of
f a l l i n g i n love.
Linda McQuaig (cited in Maclean's, 6.8.82: 34)
Introduction
In a sense the term curer can be used for a l l of those
individuals who strive to relieve human sufferings regardless of
whether i t is a shaman carrying out r i t u a l s among Australian
Aboriginals, or a sophisticated heart surgeon in a modern operating
theatre equipped with the latest medical technology.
It is
common practice to divide curers into categories of modern or
t r a d i t i o n a l , a l l too often with the connotation of backward or
primitive on the one hand and modern or s c i e n t i f i c on the other.
This would appear, however, to be something of an over simplification.
Thus, at a meeting of an international group of experts
convened by WHO on the 'Promotion and Development of Traditional
Medicine' in 1977 i t was held that:
. . . a l l medicine is modern in so far as i t is satisfactorily
directed towards the common goal of providing health care,
despite the setting in time and culture . . . . that the
essential differences among the various systems of medicine
arise not from the differences in the goal of effects, but
rather from the cultures of the peoples who practice the
different systems. (WHO 1978: 9)
51.
In Tonga, people tend to associate s c i e n t i f i c knowledge with
maama ( l i g h t )
and traditional knowledge with fakapo'uli (dark).
But these labels can be misleading because Tongans think of both
l i g h t and dark i n this connection as r e a l . I n fact, i t is the
'dark'
rather than the ' l i g h t ' that many Tongans, i n the writer's opinion,
tend to pin their hopes on in regard to many phenomena, such as
illness and h e a l t h . I n contrast, modern scientists tend to deny
the dark as i f it did not exist.
In this chapter, the categories of curers currently available in
Tonga will be discussed.
There are the Kau toketa (doctors),
kau f a i t o ' o fakatonga (Tongan t r a d i t i o n a l curers), kau faito'o fakalotu
(religious curers), and kau f a i t o ' o faipele (card playing curers).
The l a t t e r two categories will be b r i e f l y d e s c r i b e d . T h i s is because
there are only a few of them when compared with the other two
categories.
Although modern doctors are the legal curers in Tonga, there i s
no actual legislation in Tongan law prohibiting the other categories
of curers mentioned above from practising their curing arts.
I cannot claim to be an expert on either of these four categories
of c u r e r s . M o s t of the data for this chapter are from interviews
and observations during f i e l d work and attention is drawn to how
these curers viewed themselves and viewed other curers and how people
generally tended to view these categories of c u r e r s . I t is important
to note that t h i s is not meant to be an in-depth study of the four
categories of curer.
Categories of Curers in Tonga
1.
Kau Faito'o Faipele (Card Playing Curers)
There are many fortune-predicting card playing individuals i n
52.
Tonga whom people v i s i t to seek solutions for some of their misfortunes,
particularly in regard to lost property or in matters of courtship.
Only a few of these 'card players' venture also into curing.
some of these card playing curers are well
others are ridiculed as ]_oi_ ( l i e ) .
While
thought of by people,
Many humorous stories are told
to demonstrate the ]oj[ aspects of the faipele.
For instance, a story
was related to the writer about a man who went to see one of these
card players about a lost pig.
The card player fetched his deck of
cards, shuffled i t then arranged them upwards one by one in front of
him.
The card player looked at the cards solemnly for a l i t t l e while,
then triumphantly announced "Don't worry, your pig has merely gone
away to have her l i t t e r and will be back soon."
puzzled and said, "but my pig is a boar!"
The man looked
The card player was very
annoyed and started to scold the man, "Man! you should have told
me that your pig is a boar.
But since you said nothing, I assumed
i t was a sow and shuffled the cards in the 'sow fashion'!"
Nevertheless, people s t i l l see these curers frequently, perhaps in much
the same way as people in developed countries consult their psychoanalysts.
There appear to be two main card playing curers in Tonga, both
are in Tongatapu.
But there are also others as well.
In Tafahi,
for example, I was told that one of the prisoners who is often
brought from Niuatoputapu to work on the government's land on
Tafahi was a card playing curer.
He had correctly diagnosed sicknesses
and treated the victims successfully.
One of his patients, a child
of eight, was brought forward as evidence to this man's curing a b i l i t y .
The child's legs were covered with fading scars.
The scars,
according to her mother, were due to sores which refused to be healed
by modern curers or traditional Tongan curers.
Finally, she took
her to this card playing curer who diagnosed the child's disease
53.
1
correctly and further told her of the right herbs to be used f o r the
child's sores.
"In no time", the mother said, "the sores cleared".
The three card playing curers noted above are the three curers of
this category that the writer collected information on.
males.
All are adult
Two are c i v i l servants and one i s , of course, a prisoner.
I was able to interview only one of these three personally.
He i s
forty years old and is a trained primary school teacher who works
f u l l time as a teacher.
He is married and has children, but is
doubtful that any of his children can continue his curing methods
because i t demands so much of a person's time.
a devout Christian,
He said that he is
This man also has a small shop which his wife
runs with his assistance, during the weekends.
He appeared to be
active and very sociable.
Sometimes, he said, he sees more than twenty patients in a day
before he leaves for school and when he returns in the afternoons.
He said that he has many European friends who also come to seek his
help
because of their dissatisfaction with modern medicine.
accepts g i f t s , but does not demand any payment.
He
Most of the people
from Nuku'alofa who consult him give him tofoto'o (to ask for medical
treatment by native method) at the beginning and tukuto'o after the
patient is cured.
Tukuto'o is a g i f t given to the curer after the
patient has recovered, formerly in the belief that this would
prevent the disease from returning to the patient.
His s k i l l was obtained from an English Roman Catholic p r i e s t
who was working in Tonga in the 1960s and from an Indo-Fijian.
He started practise in 1970.
He uses verses from the Bible to aid him in his diagnosis.
Each
patient is given a verse from the Bible which is revealed through the
cards.
These verses usually suggest strongly what is wrong with the
54.
patient socially and s p i r i t u a l l y .
This is followed by the revelation
of the herbs to be used for the patient's physical complaints.
Strangely enough, he said, the treatments revealed in the cards are not
very much different from those used by Tongan traditional curers for
the same complaints.
But each case is treated individually, in the
sense that each patient must have a card game specifically to determine
her/his Bible verse, as well as to determine the person's disease and
treatment.
He strongly believes that God has given the people in
each environment what is suitable to t h e i r bodies.
Thus we cannot
expect medicines suitable for people in cold climates and who eat
different types of food to be effective f o r the Tongan people in
Tonga where the environment and style of l i f e is quite different.
Since he began practising in 1970 no government official has
ever approached him to stop.
He is confident that his treatments
together with the patient's f a i t h and God's help can cure even cancer
patients.
He claims to have cured cases announced hopeless by
modern doctors.
He is a fortune card player also, but he is well known only
because of his curing functions.
He provided information about
some 'common' medicines for diseases which he had written down in
a book.
But he insisted that treatments can be different f o r
similar conditions, depending on what the cards revealed.
obviously a general curer, but l i k e the other non-scientific
He is
curers,
he could give no definite medicinal herbs for the spacing of
pregnancies.
However, he has medicine to bring about abortion,
although he does not approve of i t being used.
He believes that to
cause" abortion is s i n f u l , not only because a l i f e is taken by force,
but that a g i f t from God, a m o n u , i s rejected.
This curer obviously combined r e l i g i o n , traditional Tongan
medicine and his own n o t i o n s . P e r h a p s the most important revelation
55.
in connection with these relationships
is his claim that his
cards often reveal similar treatment for some diseases as provided
or used by traditional Tongan curers.
2.
Kau Faito'o Fakalotu (Religious Curers)
These curers are usually supposed to be devout Christians to whom
God had chosen to give curing
and ministers of religion.
powers.Very
A few are
often they are males
women.
interviewed during fieldwork were both women.
The two curers
In a d d i t i o n , I
gained information from informal talks with a very well known curer
in this category who died at the beginning of 1980.
His influence
had spread not only in Tonga but to other parts of the world among
Tongan communities.
He was not only a curer, but also a Methodist
ordained minister with considerable charisma.
A f t e r his death,
his followers in Tonga started a new church called Tokaikolo and
also continued to run a school, called
opened shortly before his death.
primary and secondary students.
Lavengamalie,
The school
which had been
now has about 2,000
The reputation of t h i s curer was
particularly strong during the late 1970s when his name became a
household word in T o n g a . H e was married with children and was
probably in his early 60s when he died.
The doctors at the hospital were very c r i t i c a l of this curer
because they said he had kept patients who should have been admitted
to the hospital, with the result that i t was often too late to do
anything when they f i n a l l y decided to go to the h o s p i t a l .
But
people continued to flock to him not only with t h e i r illnesses but
with other misfortunes as w e l l .
our misfortunes
He was convinced that most of
are due to sins and that they are given as warnings
to mend our ways.He was equally convinced t h a t no problem on earth
is too big for God to solve, provided that we repent our sins and
56.
and trust in God.
When I presented the case for 'germ theory'
as cause of diseases to this curer, he said, "If God can control
human beings who were made in His own image, do you think that He
can't do that to mere germs?"
He went on to say that we need t o
work to be cured by fasting and praying.
The present President of the Methodist Church in Tonga,
Rev. Dr. Sione 'Amanaki Havea, stated in a paper presented in a
meeting in Aliscishager, Madang, Papua New Guinea, in 1981, that he
actually saw this curer bring a child back to l i f e who was dead f o r
sometime.He did this by simply holding the child, according t o
Havea, praying to God and asking the people present to have f a i t h
that the child w i l l live again.
Because of health regulations that infectious diseases such as
tuberculosis should be isolated to prevent their spread, I reported
one of his patients to the hospital .
She was a young woman of
t h i r t y - s i x years of age, who was suffering from pulmonary tuberculosis,
She had asked to stay at her home (a small Tongan house of about five
and a half metres long and four metres wide) which she shared with
six adults and her three year old son.
She assured me that t h i s
curer had told her that she would die on the next day in the evening.
She wanted to die among her f a m i l y . H o w e v e r , she was vomiting blood
and appeared to be endangering the health of others in the house.
Soon after being reported to the hospital, she was removed without
her or her family's consent.
the curer told her she would.
She died on the very evening that
Although the modern medical system
prescribed the necessity of her removal to the hospital, no modern
curer was available to see her u n t i l her condition became worse.
Her family came to blame modern medicine (and myself) for the
unfortunate way she d i e d . T h i s is a very good example of the
difference between disease theory systems, and health care systems
57.
When there are a lot of people gathering to see her she w i l l
see as many as she can individually at about 6-10 minutes per patient.
She w i l l then pray for the rest of the people.
Some people claimed
that they were healed without ever meeting her or talking to her
personally.
All they had done was to be with the crowd when she
talked and prayed f o r t h e m . O n e such patient, a university student,
explained:
We were playing basketball in the 1981 Christmas vacation,
and I f e l l and broke my right arm.
My parents took me to
a traditional bone-setter in the v i l l a g e where we live.
After a few days, my arm was s t i l l s t i f f , very painful and
would not bend at the elbow.
I was worried because I might
not be able t o resume my study at the University.
I decided
to go and see this religious healer, whom I have heard much
about.
The place was f u l l and she could not see all of us
individually.
She came over however, and started to talk
and pray with the rest of us.
She did not know why I was
there.
But while I was listening to her, I f e l t very warm
within myself.
I also f e l t so unworthy of the love that she
was talking about.
All of a sudden I was bending my arm.
I t e l l you, i t was a m i r a c l e !
Most people i n Tonga trust this woman and practice praying,
drinking of rainwater and applying a wet towel over painful areas.
According to this religious curer, the towel and water treatment is
to remind those who are i l l of Christ's l a s t supper with his
disciples.
Christ knew that he was going to be betrayed by one
of His dearest f r i e n d s , and f i n a l l y to be crucified.
But He
trusted God completely with His l i f e and desired only God's w i l l .
Moreover, i t was i n the last supper that Christ greatly emphasised
that i t is better to serve than to be served
by washing His own
disciples' feet with water and drying them with a towel.
I t was
a situation where strength can be obtained in the face of personal
sufferings.
Likewise,
in illness and sufferings, i t is well to
remember the source of strength and grace that Christ tapped that
evening long ago.
She thinks t h a t people come to her because they are dissatisfied
with the modern medicine and doctors.
59.
Although some feel a need for
s p i r i t u a l guidance, some go to see her merely because she is easier to
approach and w i l l promptly attend to their needs at any time and under
any circumstances.
She encourages the people to go to the doctors, or other curers
as well because she believes they are also 'vaka kihe ivi fakain'oui
'ae 'Otua' (boats which convey God's healing power).
Since she
started to practise curing in 1979, no government official has ever
approached her to stop practising curing.
and she does i t f u l l time.
She is a general curer,
Sometimes, she said, she does not have time
to eat or sleep, and yet she is amazed at the strength she has to do
her work.
The other female curer in this category received her curing
a b i l i t y through a dream.
She said she dreamt that an aeroplane
arrived and out came seven Methodist ministers who were dead.
gave her leaves and instructed her to use them for healing.
They
She
remembered the leaves when she woke up and now uses them as medicine
for a l l types of illnesses.
She was busy with eighteen patients s t i l l waiting, when I came
to see her.
Among her patients were modern trained nurses.
She massages each patient with the leaves which she has chewed and
gives them a l l the same medicine which she has prepared by b o i l i n g
and
bottling.
She is in her 50s and is married with children.
Every Friday
she rests and meditates to ask God for help in the next week.
She also
does not demand any payment for her services and has never been asked
by government o f f i c i a l s to stop.
In some ways, these curers seem to be taking over the role
played by the ancient Tongan priests, except that the rituals of
tofoto'o and tukuto'o are usually not given.
60.
The faith of the victims
and their relatives in the healer is important. The latter in
particular i f the patients are young children.
The victims or close
relatives of the sick child required assurance that their wrong doings,
whatever they were, are fakamoiemolei, (forgiven).
The curing of
patients by both ancient and modern religious curers hinges greatly
on the element of forgiveness.
The main difference lies between the
identity of the supernaturals and the r i t u a l s required.
As
was
shown before, i t was often necessary to cut the digits of fingers or
sacrifice a human in order to appease the ancient gods' wrath and to
obtain forgiveness and therefore h e a l t h . B u t with the Christian God,
only sincere repenting hearts, and f a i t h is said to be required.
Both
the present and the ancient curers, however, appear to believe
that mala and monu come from the same source:
illnesses.
likewise, cures and
These are given as rewards or punishments respectively,
according to how we conduct ourselves on earth by God (now) and gods
(in ancient Tonga).
3.
Kau Faito'o Fakatonga (Tongan Traditional Curer)
Tongan traditional curers usually have learned their s k i l l s
'in service' from helping one of their parents, grandparents or close
relatives who were c u r e r s . T h e s e s k i l l s have been kept as family
secrets for g e n e r a t i o n s . T o d a y , however, many of those in this
category have taught themselves;by piecing together information from
neighbours, friends or relatives.
Most people in Tonga know some traditional medicines.This
is particularly true of mothers who are usually given tips by their
own mothers and other old women on how to treat their infant's minor
complaints such as wind, teething and t h r u s h . T h e curers interviewed
in this study, however, are those to whom others beside their own family
would go to
seek advice in health matters relating to sickness
and curing.
61.
These curers are called 'tangata f a i t o ' o fakatonga' (Tongan
male traditional curer) or 'fefine f a i t o ' o fakatonqa' (Tongan
female traditional curer), but for the sake of c l a r i t y ,
has been inserted.
'traditional'
This is done so that there w i l l be no confusion
between this category and any of the other three categories of curers
in Tonga.
After a l l , a l l Tongans involved in curing, regardless of
their medical orientation, are curers or healers.
Most of these curers are general practitioners.
treat both males and females, adults or children.
That i s , they
However, society
usually recognises them as particularly useful in treating a
specific disease, which, the curers w i l l t e l l you is their 'family
disease'.
Such a statement implies a family procession of power
over a particular disease.
There are some major sub-categories among these curers.
These
are the ma'uli (traditional b i r t h attendants), kau faito'o fanau i i k i
(paediatricians), kau faito'o fasi (bone setters), kau fotofota
(masseur).
Fotofota is a common treatment which many people attempt
when a person is sick, but the specialist fotofota deals with
the more serious physical ailments.
Collocott (1923: 136-137) wrote
highly of the Tongan fotofota since he benefitted from this type
of treatment several times.
For this study, eighty-six Tongan traditional curers were
interviewed informally in various parts of Tonga.
Seventy-one
of these were interviewed personally by the writer and fifteen
were interviewed by public health nurses on the islands of 'Uiha
and Ha'ano in the Ha'apai
group.
curers, but a few were specialists.
These curers were mainly general
Of those interviewed seventeen
(20%) were ma'uli, thirteen (15%) were paediatricians, f i f t y - f i v e
(64%) were general curers, and one (1%) was a bone setter.
62.
1
Except for nine (10.46%) male curers ( a l l over sixty years of
age), all the remaining seventy-seven were females.
In so f a r
as healing in the past, the priests (who appeared to do a lot of
this because of their said a b i l i t y to contact the gods) were mainly
males. In spite of t h i s , the tamaha fefine (daughter of the Tu'itonga's
daughter) was considered to possess the highest healing power, being
higher in social status than even the Tu'itonga.
The age of the seventy-one curers interviewed by the writer
ranged from twenty to ninety-one years o l d .
Nineteen (26.76%) were
seventy years old or over, thirty-one (43.66%) were f i f t y to sixty-nine
years o l d , seventeen (23.94%) were f o r t y to f i f t y years of age, and
only four (5.63%) were thirty-nine years old or less.
Unfortunately
the ages of the fifteen interviewed by the public health nurses were
not recorded.
None of the curers interviewed had regular employment.
Most
of them worked at home, women doing weaving to sell to the tourists
and men planting food crops.
Those who were seventy years or over,
stayed with relatives and appeared to have been well looked a f t e r .
Although i t is customary to present a tofoto'o (usually kava)
when going to see a Tongan traditional curer for the first time
and a tukuto'o (usually a g i f t of food, tapa, mats etc.) after
the patient is healed, a l l the curers interviewed in this category
said they do not expect payment of any sort for their services.
Such expectancy would render their curing
practices void.
They
would, however, take gifts so as not to hurt the feelings of grateful
patients.
Misuse of curing s k i l l s can cause harm to the curer
concerned.
Below are two stories recounted to the writer by curers
in this category to demonstrate the effects of using one's curing
s k i l l s for gain and misuse of curing s k i l l s .
63.
One of the Tongan traditional healers interviewed was an eighty
year old lady who is a relatively well known curer of children's
diseases.
Both her hands are crippled with what appears to be
a r t h r i t i s . B u t the curers from the surrounding villages have a
different story to t e l l about her conditions.
They say that this
particular old lady was asking rewards for her services.
were always out to get.
Her hands
Her condition is thus seen as a punishment
from God for breaking the accepted norms of these curers.
The other story concerns a curer in her sixty's who is suffering
from 'Au (vaginal bleeding).
The curer in the village next to her's
told me that this curer performed abortions for many young g i r l s .
Her condition is also seen as a punishment for using her s k i l l s for
evil purposes.
Many Tongans today are strongly against fakatotama
(making the baby f a l l , illegal abortion).
I t is not clear, however,
whether this was always the case or i f i t is an influence of Christianity.
Many curers, f o r instance, have medicine to cause abortion but said
they never used i t .
These medicines are usually family secrets, which
could suggest 'private use' and keeping unpleasant scandals within the
family.
Over 50% of the curers interviewed by the writer learned
their curing s k i l l s from one of their parents or grandparents.
Thirty-two (45.07%) learned them from friends, neighbours or from
their own dreams.
Dreams have always been an accepted cultural way
of conveying treatment from the ope.
In the past i t was considered
together with traditional r e l i g i o n .
However, i t has been explained
in relation to the Christian b e l i e f , as one Nukunuku man explained
" i f we believe that only God can f o r e t e l l the future, then we must
accept that i t is God who is t e l l i n g us things in the dream - our
accepted cultural way of communication with those in the ope".
64.
All of the seventy-one curers interviewed personally by the
w r i t e r , except one, were w i l l i n g to reveal at least some of t h e i r
cures.
The curer who was not w i l l i n g stated that "My medicines are
my livelihood, i f I give them away, I w i l l have nothing."
The same
curer (a female) told me at the beginning of the interview t h a t she
gets nothing f o r her services.
I t is not normal to give away family medicinal secrets which
have been kept for generations.
But nowadays, because curers are
often unwilling to go looking for the medicinal herbs for treatment
themselves, they commonly ask the patients' relatives to find them.
But the preparation of the medicine is usually l e f t for the curer.
Modern agriculture destroyed many of the traditional medicinal
herbs and people have failed to cultivate them again.
Many o f
the older Tongans said that because traditional curing practices
were associated with the Tongan t r a d i t i o n a l religion, cultivating of
medical herbs was 'discouraged' after the introduction of Christianity.
The curers who were w i l l i n g to reveal their medicinal secrets
reasoned that the medicines would not be useful anyway i f the writer
were to t r y to use them.
Some would say, "Sai pe he taha teke lava
'e koe 'o nqaue 'aki 'ae f a i t o ' o 'oku 'ikai ke fanofano'i atu" ("Anyway,
you won't be able to use the medicine yourself with the absence of
f a n o f a n o ' i " ) . F a n o f a n o ' i is a r i t u a l whereby a traditional
medicinal practice may be given to another person.
It is a simple
r i t u a l but of great importance, particularly to those whose s k i l l s are
handed down from their ancestors.
person (receiver).
I t involves the curer facing the
The curer's hands hold the hands of the receiver
of the s k i l l s (usually someone within the family or someone who was
successfully treated by the medicine) and says something l i k e t h i s :
"Oku ou 'oatu 'ae f a i t o ' o . . . kia koe keke ngaue 'aki kihe kakai 'e
faingata'a'ia
ai.
'Ofa
ke 'aorga ' i ha'o f a i . "
65.
(I am giving you
the medicine for the treatment of - name of disease - to use f o r
those suffering from i t .
I t is hoped that you w i l l use i t
successfully).
According t o those who have learned their s k i l l s by piecing
information from others and not from relatives, fanofano'i is nonsense.
They pointed out that they have practised what they have learned
successfully without going through the r i t u a l of fanofano'i.
This may indicate that the herbs used are of some physical value i n
curing.
After a l l , they are results of experiments carried out f o r
generations on human beings, and experiment is a valuable s c i e n t i f i c
method of research.
I t may also point to the importance of the
general social and psychological context
of curing.
Most of these curers attended only primary school.
But a
few have spent some years at secondary school level - particularly
traditional b i r t h attendants who were given some modern training
by doctors and nurses from the Ministry of Health.
The traditional birth attendants appear to be the only
sub-category of the Tongan traditional curers that has been recognised
by the modern medical system in any way.
been brought for modern training
to assist them in their work.
For years now,some have
and have been given modern equipment
They are also used for the promotion
of Family Planning and for distributing condoms (particularly by
the National Family Planning Association).
They currently deliver
about one-third of the total births yearly i n Tonga.
Of course,
in many other developing countries, traditional birth attendants
deliver between 60% and 80% of the yearly b i r t h s .
WHO (1980: J-439) has defined a traditional mid-wife or
traditional b i r t h attendant as:
66.
"Ti!
A person (usually a woman) who assists the mother at childbirth
and who i n i t i a l l y acquired her s k i l l s delivering babies by
herself, or by working with other traditional birth attendants.
The above definition of traditional birth attendants is very
limited in as far as the Tongan ma'uli is
concerned.
are often general traditional curers as w e l l ;
children's and women's ailments.
ma'uli
These people
in particular, for
Many women in Tonga prefer the
to a modern physican or nurse.
In my opinion, many more
babies would s t i l l be born outside of hospital, delivered by ma'uli ,
i f the ma'uli themselves did not encourage the mothers (in part
because of their modern training) to go to the hospital.
The
ma'uli
also give the mothers ante-natal and post-natal care, which includes
medicines to ensure normal delivery and after birth to improve
lactation and to get rid of a f t e r b i r t h blood from the uterus.
Mothers
are also taught how to cope with their babies and the appropriate
medicines for minor ailments in infants.
The writer asked t h i r t y ma'uli who were assembled at
the National Family Planning Office i n Nukualofa for a training
workshop, what they considered to be the main reasons for women's
preferences to have their babies at home rather than in the hospital.
They gave several reasons, but the five main answers in order of
p r i o r i t y are l i s t e d below:
1.
Some mothers cannot afford the articles required to take
to hospital for themselves and their babies.
2.
They (kau ma'uli) are available to stay close to the
labouring mother and give comfort until birth is
accomplished.
3.
Some mothers are frightened of the hospital environment.
4.
Some mothers are too embarrassed at the way they are
'over exposed' (usually in lithotomy position - that i s ,
67.
n
f l a t on the back with the legs up on stirrups)
not only to
nurses but male doctors.
5.
Some mothers are frightened of episotomy.
The kau ma'uli
further stated that they encouraged the mothers to
go to hospital (because they are told to do so by nurses and doctors)
and even refuse to deliver
t h e i r babies at home.
mothers call for t h e i r help at the last
minute.
Despite t h i s , some
Thus, they are often
forced to deliver babies at home.
There are several reasons that the kau ma'uli are hesitant to
deliver babies at home now.
I t appears that their 'modern training'
sessions promote the superiority of modern methods.
For instance,
in their tests they may be asked to l i s t reasons why i t is important
not to encourage mothers to have their babies at home, or why i t is
dangerous for women to have babies at home.
Some of the kau ma'uli
have lost their former confidence and are frightened of o f f i c i a l
retaliation.
The most common attitude of Traditional Tongan curers towards
themselves is one of i n f e r i o r i t y .
A l l of those interviewed mentioned,
albeit jokingly, that t h e i r cures are 'fanga k i ' i loi fakatonga pe
'oku fa'a 'aonga' (some l i t t l e Tongan lies that are sometimes useful).
Yet they would also strongly advocate the value of their cures and
boasted about people whom they successfully treated.
When I asked
why they called t h e i r cures l i e s while continuing to use them,
most indicated that t h i s was because people s t i l l demand their services,
although they are not as clever as the modern doctors who have gone
overseas to learn.
They have nothing against the modern doctors,
except that sometimes they prescribed injections and usually some sort
of p e n i c i l l i n which may be dangerous to the patient.
They have
often had to deal with patients who were unsuccessfully treated by
modern doctors.
66.
Of eighty couples interviewed, twenty-two (27.5%) preferred
Tongan traditional curers.
and twelve from Nukunuku.
Ten of these families are from Tafahi
The four most common reasons for this
preference are listed in their order of priority:
1.
The Tongan traditional curers are easier to approach;
2.
They are often closer;
3.
They can be approached at any time;
4.
They would attend to the patient immediately.
On the whole, the children's preferences are the same as those
of their parents.
The old people often yield to the curers
preferred by their children or relatives who look after them.
It is of significance that more parents in Nukunuku village
in comparison to those in Tafahi island
prefer traditional curers,
even when modern medical f a c i l i t i e s are
available.
Most parents
in Tafahi island prefer modern medical f a c i l i t i e s , even though
these are difficult to reach.
Because I am a trained nurse,
biased answers are not overruled.
Nevertheless, we can assume
that there is probably growing disillusionment with modern
medicine's ability to cure all in Nukunuku, while modern doctors
are relatively rare and therefore s t i l l precious on Tafahi.
There is no doubt about the value of traditional Tongan
curers in primary health care, as the four reasons given above
indicate.
Their assistance and the way this is given is approved
by most members of Tongan society.
The fact that most mothers
know medicines for common children's ailments and for acute conditions
such as abdominal pain and headache, indicates a wide use of
traditional methods of curing for the purpose of primary health
care.
69.
On the whole, Tongan traditional curers are declining in
number.
Many of those interviewed said that they have forgotten some
of the herbs used f o r a particular medicine because they did not
write them down before the last f u l l time curer in the family passed
away.
This was certainly the case when I called to interview a
well-known traditional curer in the village of Nakolo, Tongatapu.
The old lady, who was over seventy years o l d , was dying.
None
of her children or close relatives could remember the complete range
of the diseases she used to t r e a t , l e t alone the herbs for their
cure.
Fewer than 60% of the curers interviewed had somebody in the
family
who was interested in learning their techniques of curing.
There are some countervailing tendencies.
Knowledge of some
traditional medicines which used to be held as family secrets, as
noted above, is now more wide spread as a result of curers asking
people to get the ingredients of a particular medicine instead of
them getting the herbs themselves.
Some people are also writing
them down on paper for future reference.
4.
Kau
Toketa (Doctors)
Most of the modern trained doctors in Tonga were trained in the
Fiji School of Medicine, which was established in 1888. The
selection of Tongan students for medical scholarships, beginning in
1928, has been very rigorous.
selected to study medicine.
Until the last decade males only were
Fiji School of Medicine graduates until
recently obtained only diploma in medicine.
The School has been
upgraded in the last couple of years and affiliated to the University
of the South Pacific, so that students can obtain a medical degree
at the end of their training.
In addition, Tongan doctors have been
trained in various universities in countries such as New Zealand,
Australia, the United States, United Kingdom, India, West Germany
70.
and Papua New Guinea.
The status of the medical profession is very high in Tonga,
despite limited monetary prospects.
Nevertheless, many of the doctors
have seen those who lagged behind them academically in school raised
to much higher positions because they started early in the c i v i l
service, while the doctors spent years studying overseas.
Available literature cites different dates for the appointment
of the f i r s t medical officer in Tonga, but i t was somewhere between
1883-1886.
medicine.
Before then missionaries treated people with modern
I t is said that some of the missionaries resisted the
appointment of the f i r s t medical officer because they were making
money out of their medical practice (Puloka, in Finau 1983).
The
f i r s t hospital was opened in 1907.
There were thirty-eight doctors working for the government in
Tonga at the time of research (not counting the Minister of Health,
Director of Health and the Governor of Vava'u who is a retired
medical o f f i c e r ) .
Only t h i r t y - f i v e out of these were at t h e i r posts.
Nineteen (54%) of the t h i r t y - f i v e , and four (57%) of the seven
retired medical officers were interviewed.
Only one of the retired
officers (who has since passed away) was not involved in some health
work because he was i l l .
The terms doctors, modern curers, scientific curer and Western
trained doctors are used here to include those with medical diplomas
or degrees obtained from medical schools and universities recognised
by the Tongan government.
By retired medical officer, I mean those
qualified as defined above, but who are no longer working as c i v i l
servants in the Ministry of Health.
The ages of those interviewed
range from early 20s to late 70s.
71.
1
There is no discrimination now in
for the newly qualified doctors.
the salary scale
Those with diplomas, and those with
degrees, commenced on the same salary scale.
The posts, however, are
arranged in hierarchical order, as in any other modern medical
institution;
from medical o f f i c e r s , to medical officers special grade,
to senior medical officers, and f i n a l l y medical superintendent.
The number of doctors in each grade are twenty-five, five, four
and one, respectively.
The interviews were carried out informally, although there was
a l i s t of open ended questions used as a guide (attached as Appendix 5).
Doctors appeared to be more concerned with 'traditional' medicine versus
modern medicine thus the discussions focussed mainly around these two
categories.
Religious and card playing curers were mentioned, but
in a much lesser degree since i t appears that the doctors usually
subsume all non-Western curers i n Tonga under the label traditional
curers.
Of the twenty-three interviewed, f i f t e e n (65%) were favourable
towards traditional medicines and their practitioners, four (17.39%)
were neutral, and four (17.39%) expressed negative attitudes
towards any alternative type of curing i n Tonga.
were favourable and who were neutral (82.6%
All of those who
of the total) towards
traditional medicines and their practitioners qualified their answers
by saying that the value of t r a d i t i o n a l healing practices are in
their psychological effects only.
Two young doctors in their 20s
who were positive about the value of traditional healing practices
mentioned close relatives who have been successfully treated for
some thronic disease after years of modern treatment.
Interestingly, the only two foreigners in the sample were
favourable towards traditional healing practices.
Both are females,
one was trained in Scotland and the other was trained in F i j i .
72.
They are both married to Tongans working in the Ministry of Health.
The husband of the Scottish doctor, also a doctor, was one of the
four who were negative towards Tongan traditional health practices
(even though his mother is a firm believer in the value of the Tongan
medicines).
useless.
These four doctors
thought that these practices are
Two of these four are surgeons,
and one an obstetrician.
one an ophthalmologist,
One of the surgeons aptly described
their attitude when he remarked:
" I t is a bit s i l l y to go into
the light then decide to go back to the dark."
The four most commonly given reasons for the value of the Tongan
traditional health practices by the doctors are listed below in their
order of p r i o r i t y :
psychologically valuable, particularly in the treatment
of psychiatric
patients,
valuable in terminal cases,
lighten the burden of the hospital,
treat the person as a whole.
All the interviewees, except the two women who were born
outside Tonga, had Tongan medicines given to them by their mothers
as children.
One s t i l l remembers well a bad leg fracture that
was successfully treated by a traditional bone setter.
Another
remembered an ear infection which was successfully treated by a
traditional curer.
All the rest (including the four who are against
traditional health practices) remembered taking vaipaia, a type
of internal cleansing medicine which has an emetic effect.
The head of the dental section was also interviewed.
firm believer in the value of t r a d i t i o n a l health practices.
He is a
He
said that there are many diseases of the mouth and throat that
traditional curers can successfully cure.
73.
Three doctors stated that they would recommend traditional
curers to patients they cannot diagnose in hospital.
One said
that he would support relatives who wanted to try traditional
healing practices in the hospital.
Fourteen stated that they would
definitely recommend traditional cures i f the prognosis is not
favourable according to modern medicine.
Five (including the four
who do not approve of traditional curers) did not think massage
would
be harmful.
Ten of the sample did not think that there are any diseases
peculiar to
Tonga.
However, twelve thought that 'avanga'(type
of s p i r i t posessed disease), one that
loiomai
(a disease associated
with fainting attacks and loss of strength, that mainly affects
middle aged women), and one other that kulokula (associated with
shivering and itching - some people call i t f i l a r i a ) are diseases
that are peculiar to Tonga.
Only nine (39%) of the doctors have made some efforts to find
out more about the Tongan t r a d i t i o n a l methods of curing.
However,
the younger doctors expressed a wish that such topics be included
in their courses - to make them more aware of their availability
and uses.
Despite such positive attitudes towards traditional curers,
twelve {52%) stated that Tongan traditional cures are definitely
inferior to modern medicine.
supportive,
Four (17.39%) thought of it as
two (9%) thought of i t as an alternative medical
health practice and five (22%) thought Tongan traditional curing
practices were superior to modern medicine in as far as psycho-social
problems, but thought organic abnormalities, infections, neoplasm,
diabetes and ulcers should be l e f t entirely to modern doctors.
The value of traditional medicines for psycho-social problems is
74.
also recognised by modern curers in many areas of the Pacific such
as Samoa (Kinlock
1979) and the Cook Islands (Davis and Davis
1955).
Fourteen (61%) of the sample did not think that there is a future
together for t r a d i t i o n a l medicine and modern medicine.
however, thought that there was.
The rest,
Such positive answers can all be
subsumed under the following:
1.
the patients w i l l benefit from such a combination.
2.
the present modern medical knowledge is limited.
3.
t r a d i t i o n a l medicine (and any other in Tonga) is part
of the Tongan culture of which the majority of their
patients are members.
The ideal image of the doctor in Western thought is one of a
person who is psychologically and socially a l i t t l e aloof.
In a
small society l i k e Tonga this is d i f f i c u l t to achieve without
impinging on important social relationships, especially those of
kinship.
I interviewed a 19 year old Tongan female medical student
who is currently studying at the University of the South Pacific.
When asked why she wanted to do medicine, she hesitated and then
said:
"Well I did not really know what I wanted to do.
But my
family thought that i t would be good for me to do medicine since
none of our immediate relations is a doctor.
They said that is the
profession where I would be most useful to my relations."
In some cases doctors f r i g h t e n people with their hurried and
seemingly abrupt manners.
This is particularly true in busy
hospitals, where shortages of s t a f f are frequent.
In such
situations, the doctors become very important, and the patients
whom the doctors are employed to look a f t e r , become less and less
important.
Margaret Stacy and Hillary Homans (1978) have touched
upon this problem when they wrote:
75.
Sometimes the human sufferings is not the center of these
elaborate health centers, but the modern healers themselves
who have become chief priests of science.
While some doctors view the fringe benefits (social and material)
for their services as their r i g h t , other people call i t corruption.
Sometimes, only the elites can be seen by these doctors.
Indeed,
in some developed countries, only the rich can see the fashionable
doctors.
To relieve human suffering is no longer the p r i o r i t y of
modern medicine, but money, as the ladder of specialization rises
higher and higher.
Attitudes Toward Traditional and Modern Curers
An attempt was made in the research to gain a sense of people's
attitudes in general toward traditional and modern curers and t o
see what were the relevant variables influencing differences.
The common wisdom in Tonga is that educated people should
prefer modern medicine, whereas only uneducated people prefer
traditional medicine.
My research indicated that the situation
is much more complicated than t h i s .
In f a c t , i t appears to be
d i f f i c u l t to draw a simple correlation between education and medical
preference.
In the case of Nukuriuku, where the population is
relatively well educated (85% of the parents questioned had some
secondary schooling), questioning revealed that more people have a
decided preference for t r a d i t i o n a l medicine, in comparison with
Tafahi, where the level of education is much lower (less than 25%
of the parents in my sample had any secondary education).
True,
the only people on Tafahi with a Tongan Higher Leaving Certificate,
a couple working as teachers, preferred modern medicine.
But so
too did most of the people, including those with the least education.
76.
Sometimes the human sufferings is not the center of these
elaborate health centers, but the modern healers themselves
who have become chief priests of science.
While some doctors view the fringe benefits (social and material)
for their services as their r i g h t , other people call i t corruption.
Sometimes, only the elites can be seen by these doctors.
Indeed,
in some developed countries, only the rich can see the fashionable
doctors.
To relieve human suffering is no longer the priority of
modern medicine, but money, as the ladder of specialisation rises
higher and higher.
Attitudes Toward Traditional and Modern Curers
An attempt was made in the research to gain a sense of people's
attitudes in general toward traditional and modern curers and to
see what were the relevant variables influencing differences.
The common wisdom in Tonga is that educated people should
prefer modern medicine, whereas only uneducated people prefer
traditional
medicine.
My research indicated that the situation
is much more complicated than t h i s .
In f a c t , i t appears to be
d i f f i c u l t to draw a simple correlation between education and medical
preference.
In the case of Nukunuku, where the population is
relatively well educated (85% of the parents questioned had some
secondary schooling), questioning revealed that more people have a
decided preference for traditional medicine, in comparison with
Tafahi, where the level of education is much lower (less than 25%
of the parents in my sample had any secondary education).
True,
the only people on Tafahi with a Tongan Higher Leaving Certificate,
a couple working as teachers, preferred modern medicine.
But so
too did most of the people, including those with the least education.
76.
The interviewed t r a d i t i o n a l curers on the whole thought i t
would be nice i f they were 'recognised' by the government for the
services they are rendering the
public.
They would not mind f u r t h e r
training but f e l t they would be out of place in the h o s p i t a l .
On
the other hand, some of the t r a d i t i o n a l birth attendants have
already been incorporated into modern medicine.
In Niuatoputapu,
for example, the Traditional Birth Attendant is brought into the
hospital to manage obstetric cases in labour i f both the doctor and
the nurse are busy.
They do not have any wages, although those
who are 'case findings' f o r the National Family Planning Association
are given small wages.
The people on the whole prefer modern medicine, but would, and
do, definitely consult other curers i f necessary.
The modern doctors are more c r i t i c a l of other forms of curing
practices in Tonga.
'open'
On the whole, the younger doctors are more
to learn new ways.
The surgeons are the most 'closed' or
biased of the doctors interviewed towards any alternative during
practices.
I t is possible that the people in Nukunuku are disillusioned
with the modern medicine and that is why more are reverting to
traditional curing practices.
On the other hand, the people of
Tafahi probably do so because modern medicine is a rare commodity,
which is therefore precious.
The people of Nukunuku are better educated and therefore
better informed.
They
appear to appreciate the values of herbs
more than do the people of Tafahi.
On the other hand, the
people of Tafahi are much less informed and probably regard
anything new as good and progressive, and anything old as o l d fashioned and not so good.
77.
The domination of the Roman Catholic Church in Tafahi may have
something to do with this preference in health care practices.
As the Tongan concept of health is very much related to forgiveness,
i t is possible to assume that because these people of Tafahi can
confess their sins to the priests, they would not feel the pinch of
this need to go to traditional curers.
I t is unfortunate that no comparison can be done regarding
the influence of religion in Nukunuku and Tafahi (there were no
Roman Catholics in the Nukunuku sample), but a similar situation
has been reported in a Roman Catholic community in F i j i .
That i s ,
i t seems that Roman Catholic communities practise more modern
medicine.
The people tend to obey priests like they would
traditional hierarchies.
And i t has been known in Tonga that
some priests condemned traditional medicine because of its
connection with traditional r e l i g i o n .
On the whole, the non-modern categories of healers are not as
c r i t i c a l as modern healers towards their health practices.
They
continue to practice because a considerable segment of Tongan
society s t i l l demands their services.
Education and availability
of modern health services do not seem to have much influence on
the people's preferences of
curer.
The modern curers are seen as
better educated and knowing more, but are less approachable.
On the other hand, the non-modern curers are less educated and do
not know much, but are more approachable and compassionate.
iii
HI
ii
78.
CHAPTER
IV
THE CURES
F a i t h i s the correctness of ones own medicinal and health
b e l i e f s probably characterizes a l l people; i t is one of
the most important symbols around which the group organizes
i t s p e r c e p t i o n of i t s ethos, i t s uniqueness, i t s v i t a l essence.
.... Hence, a l l kinds of accommodations are made and a l l
manner o f r a t i o n a l i s a t i o n s appear, t o j u s t i f y continuing
f a i t h i n the old system while simultaneously accepting the
new.
(Foster and Anderson 1978: 251).
INTRODUCTION
The s u b j e c t of curing is very broad and cannot be f u l l y covered
in a s i n g l e chapter.
What t h i s chapter attempts to do is to describe
some of t h e s o c i o l o g i c a l aspects of c u r i n g in Tonga in relation t o the
categories o f curers described i n the previous chapter.
Some o f the
cures w i l l be discussed, i n p a r t i c u l a r those concerning Maternal Child
Health and Family Planning.
They w i l l be categorised according t o
modern medical terminology (such as p a d e i a t r i c s , gynaecology, o b s t e t r i c s
and f a m i l y planning) f o r the sake of c l a r i t y and easier comprehension.
Most o f the remedies which w i l l be recorded i n this study are
n g a a h i f a i t o ' o fakatonga (Tongan t r a d i t i o n a l cures).
The decision
to dwell on these was made not because other types of curing are less
i m p o r t a n t , but i t was f e l t that there is more need to record such
cures s i n c e 'modern' ones are r e l a t i v e l y well known while the
t r a d i t i o n a l ones are poorly recorded.
79.
The r e l i g i o u s cures and the
card playing type of cures are essentially divined, and as such do
not really have a set pattern of treatment for particular illnesses.
Nevertheless the card playing curer did explain that some of the cures
divined through his cards have a similar pattern to those of the
Tongan t r a d i t i o n a l cures.
The Unwell Feeling
The frequency and severity of 'feeling unwell' often depends on
what society defines as i l l n e s s .
But in most societies illness occurs
when a person is no longer able to perform his/her function in society.
The importance of the individual's functions in society, particularly
in relation to one's immediate family, is shown in the degree to
which the functions of the society's institutions are affected as a
direct consequence of a person's 'not feeling w e l l ' .
The majority of the people in Tonga do not worry how the
'feeling unwell' is to be removed, as long as i t is done.
Thus,
except for a two day old baby in Nukunuku, who so far had only been
given Tongan traditional medicine, a l l the parents interviewed and
their households had had more than one type of cure at one time or
another.
Sometimes these cures are taken simultaneously for good
measure.
I t is important to realise, however, that some people
enjoy being sick and may not want to be 'cured'.
Tafahi,
A housewife in
f o r example, was suffering from fakamokomoko (shivering).
When I asked the husband about his wife's condition, the husband
answered looking very concerned:
alanga mahaki tauhi pe ia 'o'ona."
her usual l i t t l e i l l n e s s " ) .
'"Oku
sai pe i a , ko hono k i ' i
("She is all right.
It is
Later the neighbours were saying that
the wife usually got sick when the husband wanted to go to
Niuatoputapu.
As a result, more than l i k e l y , the husband would not
go.
80.
patient would get better.
In so far as church denomination and
i t s relationship to curing is concerned, I believe that in places
where the Roman Catholic church is dominant, people are more apt
to accept modern medicine.
Perhaps this is because of similar-
i t i e s between the Roman Catholic Church and Tongan society.
The
Pope like the Tuitonga of the past is a representative of God on
earth.
The priests are more l i k e l y to be obeyed unquestionably
than are the ministers of the Protestant church.
The Roman
Catholic people would feel that i t is their duty not to practise
Tongan traditional medicines i f the priest suggests that i t is
connected with the unchristian ancient religions of Tonga.
The
Roman Catholic Church is the only religious institution in Tonga
which is actively promoting modern medicine.
For instance, i t has
health clinics in some of the most populated Catholic areas such as
Ma'ufanga in Tongatapu, where people can go to consult the nuns for
health purposes and to obtain modern medicine.
I t also has a
Family Planning programme where natural methods are promoted,
particularly the ovulation method.
parents were Roman Catholics.
In Tafahi, 65% of the interviewed
More than 53% of the total sample
of parents who prefer modern medicine and modern curers, were from
Tafahi.
Unfortunately, there were no Roman Catholic parents among
those interviewed in Nukunuku for comparison.
Both the couples who
preferred religious cures in Nukunuku are Mormons.
There are no
Mormons in Tafahi.
TYPES OF CURES
Although there are four categories of curers discussed in the
last chapter, the type of cures w i l l be narrowed down into three
main categories.
They are:
and non-scientific cures;
modern medical cures;
and non-scientific cures.
82.
both s c i e n t i f i c
1.
MODERN MEDICAL CURES
This type of medicine is sometimes referred to as Western,
because of i t s source.
And, according to Leeson and Frankenberg
(1977: 217- 233) the appropriate term for orthodox medicine in
Europe and North America is Allopathic medicine. The term modern
is used here however because i t is seen to be better understood
by most people.
cures.
Modern cures are also referred to as scientific
f
I t is the medical system that has monopolised science and
further, i t has been accepted and has been approved of by most of the
world's societies.
According to the latest report of the Minister of Health in
Tonga (1981), outbreaks of influenza and similar illnesses continue
to top the l i s t of notifiable diseases.
Pneumonia and other acute
respiratory infections (which could be caused by virus) are important
causes of hospitalisation.
as:
The three main causes of death were
listed
i l l - d e f i n e d (232), diseases of circulatory system (68), and
malignant neoplasm (41).
These together comprise about 10% of the
total (482) medically c e r t i f i e d causes of in-patient and out-patient
deaths in 1981.
Most of the diseases mentioned above probably would
not warrant the use of a n t i b i o t i c s , but would need, in combination
with whatever chemotherapy given, good personal health care.
Tonga spends just over T$l.5 m i l l i o n f o r health care, which i s
11.3% of the total recurrent budget of 1982-83.
per head is estimated as about T$17.
Gross expenditure
Equipment such as kerosene
operated refrigerators which w i l l probably cost less than T$1,000
were badly needed at Niuatoputapu health centre (where there is no
e l e c t r i c i t y ) but there was no money available for such an item
according to the resident doctor at the centre.
I t appeared that
the old one which was sent to Tongatapu f o r repair, went back to
Niuatoputapu minus some parts and had to be sent back again. The
83.
doctor explains:
" I t is so frustrating.
I cannot give the pregnant
mothers any anti-tetanus injections, nor the diabetic patients any
insulin i f needed, because there is no refrigerator to keep these
medicines."
He continued to explain that one of his diabetic
patients had to be sent to Vaiola Hospital (Tongatapu) where
eventually one of her legs had to be amputated, " . . . perhaps I could
have saved her leg i f only I had insulin here..."
There is no denying that in most developing countries, the problem
is no longer how to get people to u t i l i s e modern medical i n s t i t u t i o n s ,
but how to cope with the growing demands of the people for, and on,
such i n s t i t u t i o n s .
Tonga is no exception in this regard.
For
instance, most of the people on Tafahi island expressed their wish
that a trained modern doctor, i f not a nurse, be stationed in Tafahi.
When I suggested that they throw away the unlabelled bottles of
tablets they showed me, because they could be dangerous, their reply
was that "No one died yet from taking them.
What else can we do i f
we get sick since there is no doctor or nurse here?"
When I
suggested that they could use herbs as their ancestors had done,
they explained, "We use them also, but the tablets are that much
easier.
night
I t is too rocky to go looking for herbs, particularly at
time."
This preference for modern medicine because ' i t is
easier' may be analogous to people preferring bread for breakfast
instead of local foods because the latter may take longer to prepare.
Likewise, bread is considered a status food for breakfast in most
homes in Tonga, just as modern medicines are status health care.
Thus i t is clear that the people strive for status even though they
know that local foods have more food value than bread, and local
medicinal herbs have better healing effects.
Surgery and caring for infectious diseases, are two areas in
which modern medicine surpassed any of the alternative types of cures
in Tonga.
Recommendations for surgery however, are not always
84.
accepted by Tongans,
Young v i r g i n g i r l s in Tonga (and t h e i r parents)
would probably not allow any kind of surgical interference with the
hymen membrane to relieve gynaecological problems such as
dysmenorrhaea.
This is because i n t a c t hymen before marriage is
highly
valued i n the Tongan s o c i e t y . L u m b a r puncture, p a r t i c u l a r l y of small
children is feared by parents.
Many people complained that t h e i r
patients died a f t e r a lumbar puncture is done, apparently not
recognising that the patient would have died anyway since t h i s type of
diagnostic procedure is carried out mostly only with extremely
patients.
ill
A middle aged woman in my v i l l a g e was supposed to have a
mastectomy about f i f t e e n years ago f o r alleged breast malignancy.
Her husband begged the surgeon not to operate when his wife was being
taken to the operating t h e a t r e , because she started to cry and was very
frightened.
The surgeon was very annoyed and told them that i f
they
came back to the hospital he would have nothing to do with her.
(The
woman is s t i l l alive today, having had several Tongan t r a d i t i o n a l
cures).
I s o l a t i o n of infectious patients is a l i e n to Tongans and
when a person is sick people v i s i t them frequently to give support
and encouragement.
V i s i t i n g a sick person is an important part of
the t r a d i t i o n a l patient care system.
The crude b i r t h rate recorded i n 1981 for Tonga was 28.6 and the
death r a t e , 4 . 9 .
I t i s hoped by the year 1985 the b i r t h rate
come down to
25.
Family planning is a major strategy to reduce the
birth rate.
Most of the methods of family planning advocated by
the Ministry of Health are
modern.
In 1981, depo provera was
by about 39% of a l l users of family planning methods.
will
used
Condoms were
next w i t h about 27.1%, the p i l l 15.9%, others 7.1%, IUD ( I n t r a Uterine
Device, better known as the loop) 6.9%, rhythmn 2.8%, and tubal l i g a t i o n
1.2%.
There has been no vasectomy since 1977, according to the r e p o r t .
The f a c t that depo provera i n j e c t i o n is to be given only once i n every
three months, appears t o be the most important appeal of this method.
85.
This method is also advocated by the Ministry of Health.
Like most
people in the Pacific, most of the 606 women receiving depo provera
injections in Tonga are probably not f u l l y aware of the possible side
effects of this family planning method (Griffen 1983).
Certainly,
the few who talked to me who were using depo provera knew very l i t t l e
about the affect of this drug on their bodies apart from 'preventing
pregnancy'.
The fact that the use of condoms has been steadily
increasing for years and is the only male contraceptive in use in
Tonga, contributes to the premise that Tonga is a male dominant society.
The absence of tetanus neonatorum cases since 1977 in Tonga has
been attributed to the early vaccination of pregnant women.
This
may be true, but i t is to be remembered that not all pregnant mothers
are vaccinated.
For example, only about 20% of the pregnant women in
1981 were given tetanus vaccination.
Unlike tetanus neonatorum,
measles, diptheria and polio, mumps have declined in frequency but
without any preventative vaccination.
I t is therefore likely that the
general reduction of communicable diseases in Tonga may be due to
improved social measures such as good sanitation and safe water supply
more than to wonder drugs.
There are twelve health centres (by the end of 1981) in Tonga.
Most of these health centres are run by 'unqualified doctors'.
These
are mainly health officers graduated from the Tonga Health Training
centre after two years of training.
This training centre opened in
the late 1970s, aided by the World Health Organisation.
The services
of these centres are wide, covering most of the services offered by
the four available hospitals, except for major surgery cases in
which*experts and suitable equipment are required.
Apparently the roles of health officers and those of the locally
trained nurses are sometimes in c o n f l i c t .
The nurses who have had
three years of training and years of service in the Ministry of Health
86.
think that they should not have to 'clean up' for the health officers
because they are not proper doctors.
But these health officers are
called toketa (doctor) in the areas they serve.
As 'toketa' the
health officer's status is superior to that of the neesi (nurse).
Indeed, the title doctor is a magical one to many people in Tonga.
It embodies wisdom, skill, wealth, qualification, ability to cure
diseases, and above all, legitimation.
Thus, it is often confusing
when people get the title toketa for other than medical qualifications.
In fact, a newly qualified doctor of philosophy from America a few years
ago was apparently consulted by many people about health problems.
Often, people go to the hospital for a non-medical reason themselves (like taking food to a patient) but would decide to see a doctor
while there, 'just in case' someone in the family gets sick.
These
people pretend that they are seeing the doctor on behalf of some relative
at home.
They know symptoms like fever, coughs, headaches and chest
pain, are very likely to persuade the doctor to write out a prescription
for tablets such as aspirin, panadol and sulphadimidine. Sulphadimidine
tablets are often taken by people in the same manner as aspirin or
panadol.
According to many of the people interviewed, they take two
sulphadimidine tablets before retiring to bed every now and again if
they feel ill. Even relatives who are away in developed countries
write and ask relatives to send them some 'fo'iakau niumonia'
(pneumonia tablets) as sulphadimidine tablets are popularly known
by Tongans.
The Tongans have a lot of faith on these tablets as
'good fixers' of any physical ailment.
The people in Tonga, notably women, are very modest, particularly
in exploring their bodies.
All of the mothers interviewed stated
that they are embarrassed to be examined by doctors, particularly
male doctors.
On the other hand they enjoy going to see a ms'uli
when pregnant.
The kau ma'uli are usually females. It appears
87.
that women with gynaecological problems would rather not go to the
hospital because their bodies would be exposed for several people
to see and examine, while the non-modern curers usually do not find
this necessary.
In f a c t , most Tongan traditional curers would not
insist on seeing the affected part i f told i t is an 'awkward'
position.
Some would apply the treatment on the knee i f the boils
are on the buttocks.
Perhaps this is one reason why the mothers
prefer depo provera injection and p i l l s for family planning instead
of the relatively less complicated loop, because they do not have
to over-expose themselves to undergo vaginal examinationSimilarly, some mothers are frightened
to
go to the hospital
for delivery, not only because they w i l l be exposing themselves
(often in a lithotomy position, that is with two legs up on stirrups)
but also of being cut (episiotomy).
Some of the kau ma'uli
explained that mother's confided in them that they think that their
husband's i n f i d e l i t y may be due to the fact that they are too wide
down below as a result of the episiotomy.
When I explained that
episiotomy is done to save the muscles below from a worse tear or
being over-stretched, one ma'uli retorted:
"only i f you don't know
how to control the baby when i t comes out."
None of the kau
ma'uli
admitted that any of their deliveries ever had tears.
There is no denying that modern medical practices in Tonga
have improved the general health as well as saving lives.
Nevertheless, Tongan people continue to talk of hono 'aho (his/her
day) when a person dies, as i f nothing could have been done to save
a person when the appointed day of death arrives.
The Minister of Health Report for 1981, recorded that about
12%of the 1,501 hospital deliveries were abnormal (36 breach,
70 forceps, 76 Caesarian sections).
I t is possible that many of
these mothers and t h e i r babies would have died without modern medical
88.
1
assistance.
Because Tongan mothers also have a tendency to obesity,
there seems to be a need to check for diabetes and hypertension during
pregnancy.
Nevertheless, some of the kau ma'uli asserted that i f the
mothers have frequent ngaahikete (abdominal
palpitation) and Tongan
medicines to prevent diseases affecting the birth canal, most
deliveries w i l l be normal.
However, they did not have any formula
when a large baby is carried by a woman with a small pelvis (except to
encourage the woman to go for an early morning walk for exercise).
There is a tendency to believe that i f children are kept too clean
and too protected from the normal environment of the community, they
w i l l not be strong enough to prevent prevalent infections and
therefore w i l l
easily contract infections as they get older and
away from the jurisdiction of their parents.
As one mother puts i t
"Tuku ke nau kai ha mei ' u l i ke nau anga k i a i " ("Let them eat a bit
of d i r t so that they are used to i t " ) .
The percentage of mothers attending ante-natal clinics is
declining according to the Minister of Health 1981 report.
But
this decline may be due in part to better informed mothers who
might feel that they could look after themselves.
kau ma'uli have had limited modern medical training.
Some of the
Because the
mothers on the whole feel more at ease consulting kau ma'uli, this
extra training would render them 'qualified' in both modern and
traditional types of maternal care in the eyes of the mothers.
I t is possible that the kau ma'uli
coming to them for ante-natal care.
are now having more mothers
On the whole, however, many
mothers complained of the unreliability of the visits of the
Maternal Child Health nurses to the villages.
Thus i t is
probably the unavailability of the modern staff, as well as
unpredictability of times allocated to c l i n i c s , that are to be
blamed for the decline of attendance mentioned in the health
report.
89.
;\
The work load of the public health nurses are often heavy as
well as u n p r e d i c t a b l e . T h e y are often involved in research
(assisting visiting WHO e x p e r t s , for example) in tabulating information
from the charts of p a t i e n t s .
They also have to attend seminars and
inservice training as well as involving themselves in immunization
programmes and so on.
There are also transport problems.
All of
t h i s has contributed to an unsatisfactory maternal child health/family
planning service.
The fact that over 50% of a l l deliveries in Tonga in 1981
were conducted in hospitals may be due largely to the influence of
the kau ma 'ui i on mothers.
Most of the kau ma'uli interviewed said
that many mothers asked them to deliver t h e i r babies at home but
they urged them to go to h o s p i t a l , as taught by modern medical
personnel.
However, they said, some mothers would leave it too
l a t e to go to the h o s p i t a l , and they are forced to deliver them a t
home.
Some mothers indicated t h a t the main reasons for their
v i s i t i n g the ante-natal c l i n i c was to be given 'protective
and t a b l e t s to strengthen t h e i r bodies.
injections'
But the most important
reason is to have a sort of 'legitimate passport' into the hospital
j u s t in case complications a r i s e .
As one mother explained:
"If
something happens and you have to go to hospital, when the staff
find out t h a t you have not been t o the ante-natal clinic they would
say 'we are not Jesus, t h i s would not happen if you went to the
ante-natal c l i n i c ' . "
If however, a woman did go to the clinic and
the problem was overlooked or not prevented, nothing is said and
the staff are more a t t e n t i v e .
The school dental service which aims at 6-12 year old children
i s functioning well.
According
to a study in 1978, Tongan children
have the lowest enamel flouride content in the Pacific.
expectant mothers also visited the dental c l i n i c s .
90.
2,208
While the majority of people in Tonga prefere modern medicine,
at the same time they are frightened of i t for the various reasons
mentioned e a r l i e r .
I t appears that this is a common feeling i n the
South Pacific according to information gathered from students at
the University of the South Pacific from the various Pacific
territories.
Foster and Anderson have recommended looking at modern medicine
in terms of two distinctive systems.
The two systems are (1) disease
theory system and (2) the health care system.
Although these two
are i n t r i n s i c a l l y related, the former giving logic for the actions
of the l a t t e r , they can be examined separately.
This would a s s i s t
us, among other things in viewing the strengths and weaknesses o f
a total medical system in a better
light.
I t should also render
us more sensitive and appreciative of the feelings of the people who
are the receivers of new medical systems.
Foster and Anderson
(1978: 37) define these two systems as:
A disease theory system embraces beliefs about the nature
of health, the causes of i l l n e s s , and the remedies and
other cure techniques used by doctors.
In contrast, a
health care system is concerned with the ways in which
societies organise to care for the sick and to utilise
disease "knowledge" to aid the patient.
I t appears from what we have said so far that the problems o f
the modern medical system in Tonga (and perhaps in other Pacific
|
Islands) is not so much i t s disease theory system as its health
care system.
Since modern education has been prevalent in Tonga
for sometime (more than a century), i t is possible that children
are taught in school that siemu (germs) cause diseases.
They
are taught where these siemu l i k e to live and where they do not
to l i v e .
like
Simple health practises such as washing of hands before
eating foods, the importance of having enough sleep, rest, fresh
a i r and good n u t r i t i o n , are generally accepted by many, well before
91.
adulthood.
In my own experience, so far I have not come across
anyone who is seriously opposed to germ theory as the cause of
diseases.
What they question is why i t happened at a particular
time and why particular people suffer and not others with similar
backgrounds.
I t is in a sense questioning the 'authority' whom
they believe controls the world.
The notion that doctors are
clever and wiser than the traditional curers is also instilled
early in the minds of the children.
Many children in Tonga are
ambitious to be modern doctors when they grow up, but I have come
across no child who is ambitious to be a Tongan traditional curer.
I f people do not fight with the 'germ theory', then what
is the problem with the modern medical system as a whole in Tonga?
I t is the way the modern health workers conduct or implement modern
health care to the people in their curing or preventative capacity
that often deters people from the institutions of modern medicine.
The superior behaviour displayed in the past by priests in curing
situations were in tune with the Tongan's disease theory of those
times.
The priests were merely supposed to convey the 'replies'
from the gods whose mercies and forgiveness were being sought.
Sometimes these replies were favourable and sometimes they were
not.
Thus the health care system organised by the community for
the sick was i n line with their disease theory.
Although there
were human sacrifices and amputations of the phalanges of the fingers,
the actual care of the patients was conducive to obtain maximum
social, mental, physical, and spiritual comforts.
Illness and
sickness were not an individual concern but the concern of the
whole
community.
The patients were nursed back to l i f e with the
love and concern of not only their immediate family but those of
the whole community.
92.
importance of kinship in Tonga pervades a l l institutions and often
gives j u s t i f i c a t i o n to nepotism.
2.
BOTH SCIENTIFIC AND NON-SCIENTIFIC
Faito'o fakatonga (Tongan Traditional Cures)
Like most non-Western type of cures, Tongan t r a d i t i o n a l cures
may be viewed as
non-scientific.
However, i t is placed in t h i s
category because some of the cures have obviously been proven
empirically for generations, to be of great value in treating
illnesses in Tongan
society.
Furthermore, the present s c i e n t i f i c
methods of testing for the medicinal value of plants are
limited.
Reliance on the dictates of s c i e n t i f i c medicine alone may prove
detrimental to the continuation of the traditional health services
which may be the only health services available in many developing
countries, p a r t i c u l a r l y to the poor.
Already much of the Tongan curing knowledge has been forgotten
and abandoned since European contact, particularly when the
missionaries came i n the early 19th century.
Admittedly some of
the Tongan curing practices, such as human sacrifices and amputation
of phalanges of the f i n g e r s , may be seen as barbaric, but these
treatments were logical in relation to Tongan etiology of diseases
as discussed in Chapter Two.
Nevertheless, many traditional Tongan
cures are s t i l l valued today by the people despite foreign intervention.
But many of the meanings attached to these cures and health practices
have, been forgotten.
New ideas and materials diffused from other
cultures also have been added.
I t is commonly assumed that Christianity dispelled a l l beliefs
of the ancient r e l i g i o n in Tonga.
94.
This study argues that elements
of the ancient religion in Tonga are s t i l l retained.
For example,
people s t i l l believe in the institutions of mana and tapu;
that
punishment would follow breaking of tapu and that disrespect of
chiefs, of mehekitanga, or chiefly burial places and so on would
cause i l l n e s s .
These beliefs serve as invisible threads whereby
the values and beliefs of yesterday are bound with those of today.
Illness in Tonga was categorised by Collocott (1923) into
three main categories:
1.
2.
Illness caused by ghosts of deceased relatives.
Fasi
( l i t e r a l l y translated as broken) include bone
fracture, strained muscles and so on.
3.
Hangatamaki (can be any disease, but commonly means
' b o i l ' ) embraces boils, ulcers, skin diseases, as
well as swellings and tumours.
I t can be said that the f i r s t category embraces two and three
also.
For example, i f a wound or an ulcer refused to heal for a
long time i t may be thought to be caused by ancestral ghosts.
And i f a person f a l l s from a tree and breaks many bones i t may be
considered that he or she was pushed by a ghost, even though facts
such as the tree was slippery, or the climber was careless, may
have been obvious.
The important facts to be considered are
why did the person want to climb under those conditions, why was
he or she not more careful and why did the person want to climb
in the f i r s t place?
I t insinuates that a non-human may have
influenced events to cause harm.
If the tree was all right and
the climber was careful, then i t is possible that the tree probably
belongs to some dead person who does not approve of the climber.
There are endless explanations to j u s t i f y the theory that a
ghost may have been involved in an accident.
95.
I t is also said that
i f ghosts are involved in making a person sick, and they do not
want the person cured i t would be hard to find the right medicinal
plants.
Furthermore, the relatives would consult the wrong curers.
The people sometimes use the term fakavaie'i (made not to know) for
this type of interference from the supernatural.
All in a l l ,
maladies are often considered as punishments or warnings to
individuals or to relatives for something they are doing or not
doing which is not approved by society.
The term fasi i n Tongan means much more than the notions of
fracture and strained muscles.
For example, when a child or for
that matter anyone is badly undernourished i t is called fasi manava.
I t indicates that the person's very source of l i f e is broken (manava
being both breathing and l i f e ) .
womb.
The notion manava can also mean
When a person is emotionally hurt, i t is called fasi e loto
(broken hearted).
fasi e peau.
When the waves break on the reefs, i t is called
Thus when a person's illness is being described as
fasi i t can mean a variety of things in the Tongan context.
The
term fasi is also used by many people in Tonga to explain pulmonary
tuberculosis.
But the use of fasi in this context is probably
to make an unacceptable disease in society more acceptable.
can be localised or f e l t by the whole person.
Fasi
Collocott (1923: 140)
described how he asked a Tongan man "what was broken", and the man
answered " I t ' s just a break".
Collocott wanted him to pinpoint
the broken area, but he could not because his concept of broken is
different from what was understood by Collocott.
The fact that
fasi now usually means fracture could be due to modern medicine's
obsession for precision.
The term hangatamaki can also be used instead of mahaki.
Usually when a Tongan traditional curer diagnoses a disease as the
one he" can t r e a t , h e w i l l say " ' l o ko 'eku hangatamaki (or nahaki)
96.
'eni" (Yes, this is my disease).
A Tongan traditional curer will sound possessive about his
hangatamaki, as if he is the only one that the hangatamaki will
listen to.
This notion is manifest in some of the chants that
are used as part of the treatment.
to as a person.
The hangatamaki is referred
The curer usually begs the hangatamaki to shift
and live in someone else who is rich.
The following chants are
examples:
1.
For a matafa (stye)
Matafa hulupa, 'alu kiha taha
'oku ma'u ha'ane me'a keke kai a i ,
kae sai a (hingoa 'oe taha puke) he'oku
masiva pea 'e ' i k a i ma'u ai ha'o me'a.
Stye hulupa, go to someone
rich and eat there
and leave (name of the p a t i e n t ) because he/she
is poor and cannot give you anything.
2.
For mea (a type of skin rash that could be a l l e r g i e s ) :
Mea f e l e , mea hafe, mea k u l a , mea toka
mea vai, mea maka, mea kulokula,
kapau kokimoutolu, mou
matuku atu a mu'a 'o kumi ha taha
'oku lahi 'ene pa'anga kae
tuku a 'ae taha ni ke f i e m a l i e .
Mea f e l e , mea hafe, mea k u l a , mea toka
mea v a i , mea maka, mea k u l o k u l a ,
i f that is you people, go please
and look for somebody with plenty of money
and leave this person in peace.
The f i r s t two lines of the above chant are the names of
different types of mea.
They are descriptive in nature.
The
second line, for example reads "water mea,stone mea, red mea".
The rash that is inclined to be watery is called 'water r e a ' , the
rash that is inclined to be hardened is called 'stone mea' and the
rash that is inclined to be red is called 'red mea'.
97.
I have not come across or heard of a curer asking the disease
to s h i f t to a chief, even though the chief may be rich.
i t may be assumed
Therefore
that the hangatamaki is probably viewed as
inferior to the chiefs but superior to the curer since the curer
almost has to beg the hangatamaki to leave the victim.
Like
sorcery, the harm is wished on somebody that the curer perhaps
cannot openly confront, but who is envied or disliked.
(See
Evans-Pritchard 1970).
j
I t is assumed that one of the reasons that some Tongan curers
do not want to part with the secrets of their remedies is because
of the 'possessive' attitudes described above.
When their cures
are handled by anybody without proper fanofano'i, i t is often
considered unsafe and useless.
using
I t would be analogous to a person
modern drugs for treatment without knowing much about them.
In the Tongan custom, i f a curer is treating someone, both
the curer and the patient must observe the tapu associated with a
particular remedy.
For instance, i f the patient is not allowed
to eat salty foods or go out in the sun, the curer must do the same.
I f the patient is not keeping the tapu, the curer can get sick and
vice versa.
Some Tongans have suggested that this is one reason why
tofoto'o of kava was routinely observed i n the past when the curer
was f i r s t approached.
I
To accept a patient for treatment is a great
responsibility, but the curer could not refuse a patient who brought
the kava, which is given as indicative of friendship (Bott
1977).
Contrary to Mariner's (1817) assumption that the use of herbs
was not known to the Tongans prior to about 1800, and that the
Tongans learned t h e i r s k i l l and knowledge of medicinal herbs from
other Pacific countries (particularly from F i j i ) , this study proposes
98.
that the use of herbs for treatment in Tonga went further back
than 1817.
One thing to remember is that Mariner's knowledge of
Tonga was mainly through the chiefs.
Since Mariner was staying
with Fi.nau 'Ulukalala who was one of the most important and powerful
chiefs of that era, he was very likely confined to the company of
those in the hierarchy.
Again, because 'Ulukalala was a great
chief i t is possible that his body was tapu for most of the Tongans
who were traditional curers , except the priests who were more divine
in fashion.
However, foreigners who are not included in that tapu were
allowed into the chiefly compound to treat this great chief when
ill.
When Finau wanted to consult a Tongan curer he consulted
the priests, who were not ordinary Tongans. Weiner (1971)
asserted that of the 71 medicinal herbs he collected during his
f i e l d work in Tonga, 68% are indigenous, and about 30% were
introduced to Tonga during the post-contact period.
A l i s t of
fourteen plants (see Appendix 2) shows some of their medicinal uses in
F i j i , Samoa, Tahiti and Tonga.
Though incomplete, i t does show
that their uses are not sufficiently uniform among these islands
to suggest much borrowing.
Some of the names are also very
different.
Once the traditional Tongan medicine is fakaheka (to put on
top of something or a vehicle, like a boat, car, horse and so on,
or that medicine is introduced to the patient for the f i r s t time)
to the patient, some change should occur in the patient's condition
within 24
hours.
One of the important features of Tongan t r a d i t i o n a l
medicine is that the patient should quickly show some change f o r the
better i f the medicine is 'aonga (useful).
In fact some of the
curers interviewed explained that i t is not good to keep the patient
99.
on traditional Tongan medicine after about two days without any change
for the better.
The curer concerned should realise that it is not
his hangatamaki and advise the relatives or the patient to look
elsewhere for an appropriate curer.
When a curer hangs on to a
patient who shows no sign of recovering during this period, it is
called tata'o (to put between two layers; to submerge).
This would
only occur if the curer is tempted with good rewards from the patient
or patient's relatives, or because of desperation.
SOME TONGAN TRADITIONAL REMEDIES
The remedies in this section were selected for the following
reasons:
1.
They appear to represent commonly used Tongan traditional
remedies relating to maternal child health and family planning and
also common general conditions shared by both sexes and age groups.
2.
They are remedies that the majority of those interviewed
proposed to be indigenous to Tonga.
For clarification, the remedies will be divided into four
categories: paediatrics, gynaecology, obstetrics and family planning.
But there will also be a brief section on the general remedies which
the people have found useful for primary health care.
It has not
been an easy task to select from about 300 remedies collected during
the fieldwork, but it is believed that the few selected will
adequately serve the purpose of this study.
One of the main problems encountered in writing of this section
was that of differentiation.
There are diseases which appear to be
the same but with different names (examples: Mavaeua and topa momoko);
there are plants which are different but because they are similar
come curers think they are the same (for example: Malolo and Masioka);
100.
and there appear to be a few plants which are named differently in
different parts of Tonga (example: Masikoka is the same plant named
Mahame in Tafahi).
It would be impossible to cover all the different-
iations of remedies.
What this section hopes to achieve is to give the
reader some insight into the complexity of Tongan traditional cures.
PAEDIATRICS
Right from birth most babies in Tonga are lovingly cared f o r ,
not only by their mothers, but by relatives and friends as well.
The relatives and friends of the mother and father w i l l v i s i t and
ask to hold the new baby.
The baby is usually oiled when i t is born,
and the f i r s t bath is given in about twelve hours after birth i f the
baby is considered normal and well.
This
movements, cry and sucking actions.
whole body is gently massaged with o i l .
is manifested by the baby's
At each bath time, the baby's
His/her legs are straightened,
the nose is stroked from top to bottom in an upward movement so that
i t w i l l not be f l a t .
The whole body i s also gently massaged so that
i t is firm and strong.
At night, a pae (fence) of tapa is put around the new born baby
and some light material covers the top.
This is done so that evil
s p i r i t s do not know where the baby is at night as they may wish to
harm the baby.
Similarly, mothers are warned not to take their
very young babies to grave yards because their dead relatives may
unknowingly harm them with their affections.
The afterbirth (placenta) is buried in a hole which was specially
dug and warmed with f i r e .
This is usually done where people
frequently walk so that the earth on top is kept firm, thus preventing
the baby having hiccoughs or general discomfort.
When this condition
occurs, someone is sent to stamp where the placenta is buried to keep
the earth over i t f i r m .
101.
In the past babies were given namoa to eat in the f i r s t few days
when the mother's lactation is not yet established.
of chewed roasted ripe coconut flesh.
Namoa is made
This is put in several small
pieces of white unprocessed tapa cloth called feta'aki.
parcel is about the size of a medium sized marble.
Each small
When the baby
cries for food one of these parcels is put into his mouth to suck.
The people believed that the namoa helped to clean out all the te'evao
(meconium) from the baby's system.
Currently, the baby is given a
bottle of cooled boiled water or some milk mixture i f hungry when
the mother's lactation is not yet established.
This is part of
the knowledge brought in by the modern health care system.
The cord is kept dry.
Sometimes juice of medicinal plants is
introduced i f the child is considered to be suffering from a disease
called tapitopito, but this w i l l be discussed later.
But many
people in Tonga are now aware that infections could be introduced
through the cord and are not too keen to employ this type of treatment
any more, particularly in the urban areas.
Most mothers and old women in Tonga know the medicines for the
common ailments of children, and administer them to the baby without
calling a traditional curer.
Children are also frequently given
preventative medicines called Vaipala, even when well, to clean out
their 'inside' and keep them well.
Since massage is an important element of Tongan traditional
health care, a word about i t would probably be warranted at t h i s
stage.
There are several Tongan terms which can be subsumed under
the term massage:
*'Amo -
gentle stroking movement with tips of fingers.
This is used when babies are massaged and in
certain treatments of adults, particularly i f
located in the neck or face.
102.
Tolotolo - a type of massage which is done mainly by the
pressing down of the thumb with a downward movement.
This is used a lot in treatment of strained muscles.
Fotofota - a type of massage in which the pad of the hand is
used.
This is used a lot in treatment of abdominal
pain, headaches and in aching limbs.
Massage is usually done with oil made of coconut and sweet smelling
flowers.
Fotofota is the commonest type of Tongan massage.
Common diseases of children and remedies:
1.
TAPITOPITQ
This is considered a common disease of children in Tonga.
The
disease may occur very early in life, even on the first day of birth.
Children over three months old do not usually suffer from tapitopito.
The prefix ta (to hit) gives the notion of something of the profane.
Some curers for example said that there is a disease called ta_ that
is treated with faito'o ta (ta medicine often consists of the
medicinal plants used for treatment of spirit possessed patients).
The word pito means umbilicus, but it can also mean full, when it is
pitopito it can mean full to capacity. Pitopito here appears to
mean that the umbilicus is full of disease which is not entirely
physical.
Signs and Symptoms.
with this illness.
There are many signs and symptoms connected
The following list is in their order of importance;
ie. how often they were mentioned by sixteen individual curers who
professed to know how to cure the disease:
a)
hollowness around umbilical area
b)
crying a lot
c)
the body spasm from time to time
103.
d)
rumblings of abdomen
e)
sleepiness
f)
breasts hardened
g) intermittent fever
h)
discharge from umbilicus
Plants used for treatment.
(See Appendix 2 for s c i e n t i f i c names
of plants).
There were 17 plants mentioned in the remedies given by
the curers.
Of these, the most important appear to be the tono
leaves (used by 12 or 75%). malolo leaves (used by 7 or 43.45%),
kavakava'ulie,
lautolutahi
and nonu leaves (each used by 3 or 18.75%).
The rest included fau leaves, maile leaves, nukanuka leaves,
root, kihikihi
laufale
leaves, masikoka leaves, volovalo leaves, koka leaves,
kuava leaves, bark of tava, fekika and 'ovava and the tiny f r u i t s of
coconuts with no j u i c e .
Remedies usually consist of two or more
plants although i t is possible to have only one plant for a medicine
(although I have come across a medicine with 23 different herbs).
Examples of remedies for Tapitopito.
a)
Six each: lautolutahi,
tono, malolo and kavakava'uiie leaves are pounded and put into a clean
cloth or coconut stipule.
The small parcel is then tied and put into
a clean cup or clean coconut shell with about 60 mils of water.
The
medicine is squeezed into a cup to get the juice out of the medicine
(this is the usual preparation for Tongan traditional oral medicines).
The medicine is taken orally (two teaspoons) twice a day or applied
to the forehead, feet and abdomen of the child.
A tapu associated
with the cure is that the mother must not eat any salty food i f she
is breast feeding the baby.
leaves.
b)
Six each: young fau and heiiaia
The leaves are chewed and put into a clean cloth or coconut
stipule as described before.
The medicine is applied either by
squeezing a b i t of medicine into the baby's mouth twice a day or
rubbed (amo) on the umbilical area.
104.
c)
Tono leaves and Laufala
roots (enough of either for the baby's size).
By enough, the
traditional curers explained, meant that enough leaves from the
required herbs to prepare a medicine parcel that is about one inch
in diameter but i t would depend on the size and age of the baby.
The medicine is prepared by using a clean coconut shell with a l i t t l e
b i t of water, then i t is put on a shimmering f i r e until the infusion
is hot.
When the infusion is cool i t is applied onto the umbilicus
and surrounding area and amo for two to five minutes.
2.
MAVAEUA ( l i t e r a l l y means separate into two parts)
This disease is also a common one during the f i r s t few months
after b i r t h when the fontanelle is said to be too wide at b i r t h .
This disease is apparently the same
'Ulumavaeua (separate head).
as
another disease called
Some of the curers also asserted
that the disease, topamomoko, pihipihii and Molokau Ngaheiehele ma'u
mei m-nava are a l l types of mavaeua.
Topamomoko involves c h i l l s ,
pihipihi is diarrhea, while the last disease with the long name
means a centipede given to the baby in his/her mother's womb.
Although some of the signs and symptoms are the same, none of the
l a t t e r three diseases centre around a wide fontanelle.
However,
samples of remedies w i l l be given in this section for each of the
diseases mentioned.
Mavaeua is also a disease that can be caused
by the mother breaking the pregnancy tapu of s i t t i n g under the edge
of the house outside (see pregnant mothers tapu in Chapter 2).
Signs and Symptoms.
There were eight signs and symptoms
given by twelve traditional curers.
in their order of importance:
a)
wide fontanelle
b)
hardened fontanelle
c)
the baby cries a l o t
105.
The following l i s t are also
d) the body spasm from time to time
e) . noisy breathing
f)
sleepiness
g)
vomiting
h)
diarrhoea
Plants for treatment.
twelve traditional curers.
There were eighteen plants given by
Of these, Laufale and Malolo seem the
most popular (used by three or about 25%), then maile, hehea, tono
and kihikihi (used by two or about 11%).
The rest of the plants,
masikoko, f i s i ' u l i , kavakava'ulie, volovalo, mangele, t u t u ' u l i ,
poiotonga, uhi, fekika, heilaia, i f i , and lautoiu'uta were mentioned
only once.
Examples of remedies for mavaeua. a)
Laufale leaves and
young malolo leaves (enough for a small c h i l d ) .
in the usual way.
Both are prepared
As mentioned before, some of the curers declared
that malolo and masikoka are the same;
but according to some Tongans
they are different although similar in some respects.
In
Tafahi,
these plants are called Mahame which is nearer to the Samoan name
for the plants, Masame.
a day o r a l l y .
Laufale is given by infusion three times
The same is done with the malolo infusion, but some
of i t is also rubbed (amo) on the baby's head.
or f i s i ' u l i leaves.
b)
Six maile
The leaves are prepared in the usual way.
The patient is given two teaspoons of the infusion twice a day and
some of i t is applied (amo to the head.
c)
Six each:
young
Kavakava'ulie, Malolo, Laufale and volovalo leaves, prepared i n the
usual way and applied as in (b).
106.
3.
TOPAMOMOKO
Signs and Symptoms.
These include:
a)
sleepiness
b)
vomiting
c)
restlessness and crying
Examples of remedies for Topamomoko.
(plenty) and four young Tava leaves.
manner and applied as above.
leaves.
b)
a) kihikihi leaves
Prepared in the usual
Six each: Tutu'uli and Fekika
The leaves are divided in the middle and the right side
of the leaves is prepared in the usual way.
The dividing of
leaves and use of the right sides only is not uncommon in
preparation of Tongan traditional medicine.
The right side is
often associated with the male, and if the foetus is lying more
on the right side of the mother's womb it is assumed to be a boy,
and if on the left side it is a girl.
Again two or three teaspoons
of the infusion is applied as necessary.
4.
PIHIPIHI (diarrhoea)
Signs and Symptoms.
These include:
a)
frequent watery motions
b)
lethargy
Example of remedies.
Toa and volovalo bark.
The bark is
prepared as usual and three teaspoons are given orally,as is
necessary.
5. 'MOLOKAU NGAHELEHELE MA'U MEI MANAVA
One of the more famous traditional curers in Tonga who deals
mainly with children's diseases described this disease and treatment.
107.
The disease apparently starts when the baby is s t i l l inside the womb
f
due to the mother's pica (craving for special types of food) during
f
pregnancy.
j
1
i
Signs and Symptoms.
These include:
a)
the baby is born slightly jaundiced
b)
breasts hardened and slightly enlarged
c)
blood shot eyes
d)
tongue hardened and baby cannot suck the breasts
e)
f)
any more
cries a lot
urine is yellow
g) muscular spasms of the whole body
h)
the baby appears to be constipated.
Examples of remedies.
a) Young taya leaves and kuava
leaves (enough for the baby).
The leaves are prepared as usual
and the patient is given two drops of infusion orally and some of
the medicine is rubbed (amo) on the head.
(plenty).
above.
b) kihikihi leaves
The leaves are prepared as usual and administered as
c) Four young kuava leaves and enough Heilala leaves
for the baby.
The leaves are prepared as usual and administered
as above.
J
6.
;|
KULOKULA
Kulokuia, which translated literally means red, is a type of
disease that is common to all age groups according to all the
traditional curers interviewed.
The disease is often associated
with shivering attacks andappearance of rashes on the skin.
There
are many types of kuiokuia. The types that are described here are
those said to be common among babies:
108.
A.
Kulokula No'osia
Signs and Symptoms.
These include:
a)
dyspnoea
b)
fever
c)
sweating, particularly on the head
d)
noisy breathing
Examples of remedies for Kulokula no'osia.
a)
Four lautolu'uta
and four lautolu tahi leaves prepared in the usual way and given to
the child o r a l l y i n sufficient quantity to encourage vomiting.
(Lautolu'uta is the same as lautolu veil , and lautolu tahi is the
same as Lautolu
hina).
b)
Six laufale leaves and
laufale
roots
(six pieces about two inches each) prepared in the usual fashion and
given in small amounts to the baby orally twice a day.
8.
Kulokula
Patanivai.
(The term patanivai appears to
describe the appearance of the rash as containing fluids inside
the raised spots).
Signs and Symptoms:
a)
raised spots like flea bites
Examples of remedies for kulokula patanivai.
leaves and roots (prepared in the usual manner).
a)
Laufale
The patient is
given two to three teaspoons o r a l l y , 2-3 times a day.
b)
Two
Matolu leaves prepared in the usual fashion and administered as
above.
c)
The inner bark of Lepohina prepared i n the usual
fashion.
Treatment is as above but with some of the medicine
also "applied to the affected parts of the body.
109.
7. NIFO KONA (poison teething, teething problems)
Signs and Symptoms.
These include:
a)
crying and restless
b)
diarrhoea
c)
swelling of gums
d)
loss of appetite
Examples of remedies f o r
leaves prepared as usual.
o r a l l y each day.
b)
Nifo
Kona.
a)
Six koka and tono
About two to three teaspoons are given
Six young hehea leaves and the inner bark
of hehea is prepared as usual and administerd as above.
milo
c) Six
leaves that are turning yellow i n c o l o u r , prepared and
administered as above.
8.
KONA HAMU 'OE VALEVALE
Signs and Symptoms.
a)
not sucking
b)
muscular spasms
c)
lock-jaw
(Tetanus Neonatorum)
These i n c l u d e :
Examples of remedies for tetanus
neonatorum.
Tamatama leaves,
young hehea leaves and malolo leaves (enough for the baby) prepared
as usual. Four teaspoons are administered at a time orally as
necessary.
9.
FEFIE (thrush)
Signs and Symptoms.
These include:
a) smelling, sore and red looking mouth
b)
white furry tongue
c)
dripping of saliva from tongue.
110.
Examples of remedies for
Fefie,
a)
(enough for baby) prepared as usual.
Ango ango tuber
Two to four teaspoons are
administered orally about three to four times a day.
b)
Tuitui
bark is scraped and then is chewed by the curer u n t i l soft.
chewed bark is blown into the baby's mouth.
Telie leaves, prepared as usual.
c)
The
Six young
About two to three teaspoons
are given three times a day.
10. KAHI VEKEVEKA
Kahi is also a common disease in Tonga that appears to a f f e c t
all age groups, but more so adults.
translate kahi as haemorroids.
The modern curers often
In the Tongan context, however,
the meaning of kahi is much wider.
I t relates to blockage or stiffness,
and in the l a t t e r sense i t is almost opposite to f a s i .
Treatment
is often given to clean out the affected part of the body and straighten
whatever is supposed to be hardened inside.
treated with kahi medicine.
Signs and Symptoms.
Backache is also often
Kahi Vekeveka is kahi of small children.
These include:
a)
diarrhoea until blood comes
b)
fever
c)
loss of appetite
d)
restlessness
e)
red buttocks
f)
strained when having bowel motions
Examples of remedies for Kahi vekeveka.
a)
The scraped
inner bark of Ifi and Tava prepared as usual but with hot or warm
water instead of cold.
After i t has cooled, two to four teaspoons
are administered orally when necessary.
b)
The scraped inner
bark of Tava and Lemani prepared as usual , but with warrr. instead of
cold water.
Two to four teaspoons are administered orally twice a
111.
day.
c)
as usual.
The scraped inner bark of Tava moli and Ifi prepared
Two to four teaspoons are given a day.
11. MOFI (fever)
Most Tongans will say that there are two types of fever:
mofi fakatonga (Tongan fever) and m o f i fakapapalangi (European
fever).
The mofi fakatonga is supposed to occur intermittently
and only the head and sole of the feet are hot.
Respiration is
normal and the child can move around and eat normally.
A person
with mofi fakapapalangi, on the other hand, usually has a much
higher
temperature.
The child is hot a l l over and both pulse
and respiration are raised.
The ta 'ae mafu (heart beat, pulse)
is detected by watching or touching the area j u s t above the baby's
ears (temporal pulse).
A child who is suffering from mofi papalangi
should be taken to a modern doctor.
Examples of remedies for mofi fakatonga.
a)
'uta leaves and six heilala leaves prepared as usual.
teaspoons are given orally twice a day.
b)
Six Lautolu
Two to four
Scrape the inner
bark of Tava, Toi, Loupata and Toa, prepared as usual, but using
hot instead of
12.
cold
water.
Treatment is as above.
FASIMANAVA (Undernourished)
Signs and
Symptoms.
Loss of weight (this condition usually
affects pusiaki or adopted children, perhaps because they are not
breast fed).
Examples of remedies.
Voiovalo
bark of Uhi prepared as usual.
leaves and the scraped inner
Two or three teaspoons are given
three times a day.
112.
I
GYNAECOLOGY AND OBSTETRICS
This section deals mainly w i t h o b s t e t r i c s since there are
apparently few gynaecological cases apart from 'au (abnormal
vaginal bleeding), to'oa (threatened abortion) and kahi, which was
already mentioned i n the paediatrics s e c t i o n .
Kahi
is blamed f o r
many conditions such as backache, i n f e r t i l i t y , c o n s t i p a t i o n , abnormal
menstruation, abortion and d i f f i c u l t
labour.
As indicated
earlier,
women on the whole are r e l u c t a n t to seek help f o r gynaecological
problems in the hospitals because they are modest about having t o
expose themselves, p a r t i c u l a r l y to male doctors.
Few
of the e i g h t y
mothers and women i n the other categories who were interviewed admitted
t o having any gynaecological problems.
And i t i s not clear whether
there is d e f i n i t e lack of them i n Tonga or whether women simply take
them f o r granted.
Most women who have had 'au blamed t h e i r
on some family planning method they f o l l o w e d .
Four declared t h e i r
conditions cleared once they stopped taking the p a r t i c u l a r
planning method.
condition
family
However, 'au is not uncommon among women over
f o r t y years old i n Tonga.
1.
'AU
The curers referred to this condition simply as 'au, which
indicated abnormal vaginal bleeding.
But this would embrace any
type of vaginal bleeding that is not normal to the woman concerned.
Thus it could be excessive bleeding during and between menstrual
periods or scanty daily bleeding.
Signs and symptoms.
a)
These include:
excessive uterine bleeding during and between nenstrual
periods.
b)
frequent bleeding
113.
'51
Examples of remedies for 'an.
a} Mangele bark, puopua bark, and
Fao bark cut into small pieces and boiled.
stored in bottles.
When it is cool it is
One mouthful is given as is necessary.
b) Koka
bark, Loupata bark and Moengalo tuber prepared as usual and
administered as above.
c) Scrape inner bark of Ahi, Toi , Loupata
and Manonu prepared as usual and administered as above.
2.
PALAMATAKI LUA
Signs and Symptoms:
Offensive copious vaginal discharge.
Example of remedies for paiamataki
lua,
a)
Six voiovola
leaves and six lautolu'uta leaves prepared as usual .
The patient
is given about two mouthfuls two or three times a day.
b) Loupata
bark prepared as usual and administered as above.
3.
LAM
Signs and symptoms:
Offensive vaginal discharge of old blood.
Example of remedies for Lanvi.
a)
sunrise, take the inner husk and prepare
Pick a green coconut at
with cold water added.
One mouthful is to be taken by the patient while s i t t i n g in front
of the house as necessary.
The curer must put the rest of the
medicine in a specially prepared basket (usually of coconut leaves)
and hang i t in his house away from the f l o o r ,
b)
A large quantity
of fau leaves prepared as usual and given as before.
4.
TO'OA
(threatened abortion)
Signs and Symptoms.
a)
These include:
abdominal pain during pregnancy, p a r t i c u l a r l y in the
lower part of the abdomen.
b)
sometimes vaginal bleeding.
114.
Examples of remedies for
To'oa.
as usual and given as above.
b)
a) Olonga leaves prepared
Unuoi leaves and Fataimelo branches
prepared as usual and administered as above.
abdomen is rubbed (amo) and l i f t e d upwards.
In addition the patient's
She must also have bed
rest.
5. MAHAKI'IA FAKALANGA
(dysmenorrhea or Painful Menstruation)
Signs and symptoms:
Lower abdominal and backpain during menstruation.
Examples of remedies for Mahaki'ia Fakalanga, a)
prepared as usual.
b)
Fiki
leaves
A mouthful is given two to three times a day.
Fiho 'a leaves and young green coconut prepared as usual but
the cold juice from the coconut is added instead of water.
administered as above.
c)
I t is
The scraped bark of the 'Ovava and of
the Volovalo prepared as usual and administerd as above,
d)
The
scraped bark of the Puopua prepared as usual and administered as above.
6.
BREAST DISEASES
A.
Huhu Pala (sores on breast)
Signs and symptoms: breast is dry and itchy and sores
start to appear.
Examples of remedies for Huhu pala:
leaves, Fa - mui'ifa and Enga.
Polotonga leaves, Uhi
After the above ingredients are
pounded they are strained through the coconut bark and enga
(powder made from Zingiber Zerumbet tuber) is added. The
mixture
|
is applied topically twice a day.
B.
Huhu Fefeka (Hardened breast)
Signs and symptoms:
the breast feels hard to touch and
it may be painful.
115.
I
Examples of remedies for Huhu Fefeka,
a)
Eight Kavakava'ul ie
leaves, eight Nonu leaves, eight Heilala leaves, one laufale leaf
and eight Malolo leaves.
The ingredients are pounded together
until soft and applied topically to the breast twice a day.
b)
The scraped inner bark of Kanume prepared as usual.
A mouthful
is given two to three times a day.
7.
KAHI
As mentioned before, kahi is blamed for a number of internal
conditions, particularly in the lower trunk of the body.
woman who blamed kahi for infertility explained:
One
"All women should
have children except when they have kahi inside their bodies or
of that of their husbands without treatment.
They would never have
children."
A.
Kahi Pupunu
Signs and symptoms:
D i f f i c u l t y and painful defecation.
Examples of remedies for kahi pupunu:
a) the scraped inner
bark of Loupata, Tava, Fekika, Manonu and six kavakava'ulie leaves
prepared as usual.
b)
One mouthful is given three times a day.
I f kahi hangs out of the anus (haemorrhoids) chew six leaves
of kavakava'ulie and blow direct.
B.
Kahi M u u ' i f a ' e l e
Signs and symptoms:
backache, s t i f f back, d i f f i c u l t y of
defecation.
Examples of remedies for Kahi Muu'ifa'ele.
remedies which involve many
plants.
can also be given for this condition.
to be practical and easy to obtain:
There are numerous
The remedies f o r kahi pupunu
The one mentioned here appears
Scrape the Loupata root and
prepare as usual giving the patient a mouthful three tines a day.
116.
|
8.
FEFIE LOTO
Signs and symptoms. These include;
a)
frequent miscarriages.
b)
grape l i k e growth inside the womb which would break and
discharge.
c)
milky f l u i d s from the vagina.
d)
pain and itch
on l e f t side of abdomen.
Examples of remedies for Fefie
Loto.
a)
Scraped inner bark
of manonu and six fue'aepuake leaves prepared as usual.
is given a mouthful twice a day.
The patient
b) Scraped inner bark of
and six Ate leaves prepared as usual.
Olonga
Administered as above, and
the medicine is used to massage (amo) the lower abdomen.
OBSTETRICS
In this section, remedies mainly concerning pregnancy, labour
and b i r t h w i l l be l i s t e d .
But f i r s t a b r i e f description of b i r t h
as conducted by the m a ' u l i .
The b i r t h is conducted in a part of the house where i t is private
and not very well l i t .
Delivery
of the baby is ' f e l t ' rather than
'seen' by the m a ' u l i . The mother is either lying on the side or f l a t
on the back.
While the ma'uli is coaching the mother to push, one
other person (usually the woman's mother or close female r e l a t i v e )
is saying soothing things to the mother as well as rubbing where
the pain is f e l t most.
Once the baby is delivered the cord is cut
with a boiled pair of scissors and tied with boiled cotton.
The
baby is then wrapped up warmly and given to one of the people i n the
house.
The mother is asked by the ma'uli to push out in the next
contraction, while she puts her hand on the abdomen and push forwards
and
downwards.
This is to get r i d of the fonua ( l i t e r a l l y translated
land) or placenta.
Afterwards, i f there are no complications the
117.
\
j
]
!
mother is sponged
and i t given food to eat before she rests.
Formerly, the mother was painted from head to toe with enga for
several nights to beautify the skin.
The umbilical cord is often
cut on top of something relating to the family's wish for the baby's
future.
For example, i f i t is a g i r l , the baby's cord may be cut
over a bundle of loa'akau or tutu so that the child grows up to be
a great weaver and tapa maker.
Similarly, a boy's umbilicus may be
cut over gardening equipment so that he w i l l grow up to be a great
farmer.
FEITAMA KOVI (morning sickness or
Signs and symptoms.
hyperemesis)
These include:
a)
vomiting and nausea
b)
lethargy
c)
loss of appetite (particularly during the f i r s t few months
of pregnancy).
Examples of remedies for Feitama
Kovi.
a)
Two p i p i f a i i o l o
f r u i t s , and plenty of Heilala flowers, langakali flowers, mohokoi
flowers, Uhi flowers and plenty of Siale Tonga flowers ( i f not
available, scraped inner bark is used).
These are prepared as usual
and the patient is given one mouthful three times a day.
b)
Toi
hark, fekika bark, Volovalo bark, takafalu bark and Tuitui bark are
pounded together, boiled and stored i n bottles when cool.
is given a mouthful when necessary.
Akataha plant.
Fekika leaves and the whole
Only the right side of feki ka leaves are used and
the mixture i s prepared as usual.
when necessary.
c)
The patient
d)
The patient is given a mouthful
I f there is too much vomiting, plenty of Vi leaves
and Longolongo'uha leaves are prepared as usual and the patient is
given a mouthful three times a day.
2.
T
MEDICINE TO TELL WHETHER A PERSON IS IN TRUE LABOUR.
A.
Ate leaves and scraped Olonga bark prepared as usual.
The patient is given one mouthful and i f the pain stops, i t is not
true labour.
B)
Two or three Mangele leaves are given to the patient to chew.
I f the pain becomes stronger the patient is in true labour.
3.
TALAU (Post Partum Haemorrhage)
I f the mother vomits during labour, there is a strong p o s s i b i l i t y
that she will suffer- post partum haemorrhage.
I t is therefore
considered advisable to prepare a remedy j u s t in case.
There are
several types of post partum haemorrhage identified by the ma'uli .
There is talau maka (stone t a l a u ) , talau vela (hot t a l a u ) , t a l a u vai
(water talau), and talau toka (submerged talau).
Talau maka and talau
toka appear to be what is termed as concealed post partum haemorrhage,
when bleeding occurs mainly inside and w i l l come out in c l o t s .
Talau vela and talau vai appear to be unconcealed post partum
haemorrhage, when the blood flows out of the vagina in spurts.
Some of the remedies are directed to a specific talau, but there are
also remedies f o r a l l types of t a l a u .
A)
Examples of remedies for general talau.
a) Ngatae
leaves, Masikoka leaves, scraped inner bark of Siale Tonga, Moho
leaves, tava leaves, Maito leaves, Fotulona leaves,
and fau leaves.
Pukovili
leaves
The mixture is prepared as usual and the patient
is given a mouthful when necessary.
b)
Ten Lautolu tahi leaves
and ten Heilaia leaves (more than ten leaves can be added, but they
must ye added i n pairs).
The mixture is prepared as usual and the
patient is given a mouthful when necessary.
bark of
Sialetonga.
c)
The scraped inner
The mixture is prepared as usual and the
patient is given a mouthful when necessary.
119.
B)
Talau MaKa
Examples of remedies for Talau Maka. Ngatae fisi bark
prepared as usual and the patient is given a mouthful when necessary.
At the same time, so that the patient will not go to sleep, warm
water is applied to the head and cold water to the pubic area.
C)
Talau Toka
Examples of remedies f o r talau toka.
Tava bark and Maito
bark are prepared as usual and the patient is given one mouthful when
necessary.
D)
Talau Vai and Talau Vela
Examples of remedies f o r Talau vai and Talau vela.
Plenty of Noho leaves prepared as usual.
The p a t i e n t
is
given one mouthful when necessary.
I f i t is difficult to get the plants for the different types of
talau, scraped tava bark can be used while looking for other plants.
4.
TOKA OLA
Signs and symptoms;
Painful abdomen after delivery.
Examples of remedies for toka ola. Scraped inner bark of Ate
prepared as usual.
The patient is given a mouthful three times
a day and the abdomen is rubbed (amo with medicine.
5.
VALE VALE FANAU
Signs and symptoms.
These include:
a)
tired and sleepy after delivery.
b)
no energy.
Examples of remedies for Valevale fanau.
prepared as usual.
Plenty of tono leaves
The patient is given a mouthful when necessary
and is put on a diet of hard biscuits and corned beef to strengthen
her as soon as possible after delivery.
120.
6. FONUA PIKISIA (Retained placenta)
Signs and symptoms:
The placenta remains inside after the
birth of the baby despite attempts to push it out.
Examples of remedies for Fonua Pikisia.
a)
Young Tava
]
leaves and a whole Fataikena plant prepared as u s u a l . T h e patient
is given a mouthful when necessary.
to chew in an emergency.
b) Six young tava leaves
The patient is allowed to swallow the
juice three times and the remains are rubbed (amo) on the abdomen.
FAMILY PLANNING
f
There are few remedies to stop or to prevent pregnancy which
j
i
may indicate the lack of concern of Tongans in this area. On
the other hand, there are many remedies for infertility or to
encourage pregnancy.
While Infanticide was common in some ancient
Polynesian societies such as that of Hawaii (Ellis, 1942), and Tahiti
Levy, 1969), and also used as a means of population control
(Wagley, 1977), it was not common in Tonga except as a means of
curing of high chiefs.
Most of the means employed to prevent
pregnancy are social in nature and have nothing to do with herbs.
1.
TO PREVENT PREGNANCY
A)
After b i r t h , the father or mehekitanga can put one leg
on the mother's abdomen and say:
ke tauhi he'e fefine n i "
"Malo kuo fe'unga ae fanau ko'eni
("Thank you, this is enough children
for this woman to look a f t e r " ) .
There is some confusion as to
whether i t is the husband's father and mehekitanga or those of the
mother who is to say t h i s .
The majority seem to think that i t
must be the mother's since i t is her womb.
121.
They argue that since
she is of lower social status than those of her f a t h e r ' s s i d e ,
p a r t i c u l a r l y her mehekitanga, (see Chapter 2 ) , i t is t h e r e f o r e her
f a t h e r ' s side of the family who are i n charge of her.
One ma'uii i n Nukunuku devised a s i m i l a r method h e r s e l f .
consists of the
ma'uli
It
and the husband p u t t i n g both t h e i r hands on
the abdomen of the mother a f t e r b i r t h and praying for no more
children.
2.
The ma'uli reckoned i t worked and some mothers a g r e e d .
SPACING OF PREGNANCY
A)
worked.
One ma'uli devised a method of her own which she i n s i s t e d
Her method consists of burying the placenta of the
woman's l a s t confinement with a b o t t l e upside down.
I f the
mother l a t e r wants more c h i l d r e n she can take the b o t t l e o u t .
She explained t h a t the upside down b o t t l e prevents pregnancy, but
that once i t i s back t o i t s r i g h t f u l p o s i t i o n the mother w i l l
have c h i l d r e n again:
"The b o t t l e can be f i l l e d again,"
she s a i d ,
"symbolising the f i l l i n g of the womb w i t h a baby."
B)
Clean one's vagina a f t e r intercourse with water.
C)
Go and l i v e with one's own mother p e r i o d i c a l l y .
D)
I t was a common p r a c t i c e i n the past f o r women to go and
stay with t h e i r own parents j u s t before d e l i v e r y .
She would s t a y
there u n t i l she and her baby were both well (sometimes a m a t t e r o f
a whole year) before returning t o assume her w i f e l y d u t i e s .
Breast feeding was also taken f o r granted.
Both of these
practices assisted i n delaying pregnancies i n the past.
3.
FOR FERTILITY PURPOSES
Examples of remedies.
a) The juice of one Lemani fruit,
kihikihi leaves and one teaspoon of sugar prepared as usual. The
122.
patient is given one mouthful twice a day,
leaves, monomono leaves,
prepared as usual.
kihikihi
b)
Heilaia
leaves and lautolu tahi leaves
The patient is given one mouthful.
c)
Heilala
leaves moengalo leaves, mohokoi leaves and lautolu tahi leaves shredded
together into very small pieces and put in a basin.
Water i s
added and the mixture strained through a clean cloth and then stored
in bottles.
The patient is given a mouthful twice a day.
Some of the f e r t i l i t y medicines are taken by both the mother
and father.
Also the mother's abdomen is often rubbed (amo
daily
by the curer.
4.
FAKATOTAMA
(Illegal induced abortion)
Most curers were not keen to relate information on this subject.
However, most of the kau ma'ui i suggested that any plant which i s
strong and could cause diarrhoea or vomiting would also induce
abortion.
Langakali and Loupata roots are examples of such p l a n t s ,
they said.
Examples of remedies to induce abortion,
a)
Scraped inner
bark of loupata and toi roots prepared as usual, but the bundle
of prepared medicine is put into a clean coconut shell and put on
top of hot coals.
I t is then allowed to cool and the patient
drinks the infusion once a day for three days.
b)
Scraped
inner bark of t o i roots and huni leaves prepared and administered
as above.
c)
Scraped inner bark of
and administered as above.
d)
langakali
roots prepared
Unopened new Si leaf applied l o c a l l y
through the vagina to induce abortion.
Tongans generally disapproved of abortion (even legal a b o r t i o n ) .
Women who indulge in such practices are considered mala'ia.
123.
GENERAL ILLNESSES THAT ARE SAID TO BE INDIGENOUS TO TONGA AND.
AFFECT ALL AGE GROUPS OF BOTH SEXES
A few
will
of
the remedies that may prove useful in emergencies
be discussed in this section as well as two diseases thought by
some to be indigenous to Tonga ('Avanga and Lolomai).
1.
A
' VANGA
I t is important to differentiate three terms relating t o
this illness that are sometimes confusing.
t e ' i a and
fakamahaki.
supernaturals .
They are 'avanga,
These terms a l l indicate diseases caused by
'Avanga, however, is an acute spirit-possession
illness in which the patient shouts and talks of dead people.
Sometimes the patient runs to the graves of the people or person
she/he talked about.
adolescent females.
This disease occurs most often among young
No doubt the restrictiveness of society i n
the face of t h e i r growing physical body and emotional needs may have
bearings on t h i s .
Te'ia
interested i n l i f e .
and stares.
is when a person appears no longer to be
The person does not eat, and usually j u s t sits
Fakamahaki, on the other hand, can be applied t o any
disease which did not
heal quickly.
There are six types of plants commonly used for the treatment
of 'avanga, t e ' i a and fakamahaki.
They are:
Lautolu
(tahi and 'uta)
leaves, Uhi leaves, Nonu leaves, Mo'ota leaves, Sialetonga bark,
and Heiiaia leaves.
According to Tongan myth the f i r s t plant to
grow on Tonga was a tree creeper (similar to Lautolu).
explain why i t is used for these types of disease.
This may
In the myth,
men were made from the worm grown on t h i s creeper, but the women
were brought from pulotu (see Chapter 2 ) .
The person who is
suffering from 'avanga is usually fotofota with lautolu leaves a l l
over the body.
Later, when the patient is more s e t t l e d , some
124.
medicine may be made from the leaves and i n s t i l l e d in her eyes and
nose (perhaps t o prevent the s p i r i t s from re-entering these o r i f i c e s )
2.
LOLOMAI
Lolomai is a condition that is associated with shivering
attacks, palpitations of the heart and fainting attacks. The
doctor who is in charge of the psychiatric ward in Tonga thinks
that it is some sort of depression.
It occurs mainly in females
approaching, or who have passed, menopause.
Usual treatment is
fotofota, particularly at the back of the neck.
3.
USEFUL REMEDIES
Many of the herbs that were normal inhabitants of the forests
have now grown scarce because of modern agriculture and growing
of cash crops.
For example, Manonu (Tarenna sanbucina), a p l a n t
whose bark features greatly in infusions for the disease
is now hard t o find on
Tongatapu.
kahi,
Yet, not many years ago, the
old people say Manonu was p l e n t i f u l in areas not so f a r from
Nuku'alofa.
1.
For acute general stomach ache, chew some kuava leaves and
swallow the j u i c e , or drink infusion of Mohokoi bark.
2.
For c u t s :
wash clean and apply j u i c e of tamatama leaves t o
prevent tetanus.
3.
For burns:
apply raw scraped yam straight away.
If i t
is
a large area and i f unable to go to the h o s p i t a l , pound
twelve young hehea leaves, and twelve young ngatae leaves
and mix with plenty of coconut o i l .
This mixture is applied
generously and frequently so that i t remains moist for f i v e
days.
After f i v e days the patient is sent to bathe in
125.
the sea.
4.
For b i t e s :
(eg. centepede bites or poisonous f i s h ) , rub
with j u i c e of 'akau veii or mo'osipo leaves.
5.
For skin sores:
apply juice of hehea leaves after bathing.
6.
For fatigue and sleeplessness, boil plenty of lautolu leaves,
uhi leaves and nonu leaves, allow to cool and then s i t i n
mixture for about fifteen minutes.
Also get someone to
massage the body i f necessary.
7.
For ringworm (or any fungal infections on skin):
apply the
juice of te'eiango leaves.
8.
For threatened abortion, l i e down, get plenty of fau leaves
or kautetonga leaves, prepare an infusion in the usual way
and drink plenty while awaiting the doctor.
9.
For infected wounds, apply the juice of kakamika plant twice
a day.
10.
For b o i l s , heat nonu leaves, rub and apply straight on to
the boils so as to act as a poultice (apply several leaves
so that heat is maintained longer).
11.
For cough, rub neck with coconut o i l and apply a warm material
around the neck to keep warm.
12.
For chest infections, boil water and put in crushed Uhi
leaves.
Inhale steam from mixture twice a day.
The modern concepts such as immunity, addiction, resistance
and s u s c e p t i b i l i t y were not entirely absent from Tongan concepts
of curing.
For example, the term ma'u (to receive, right) may
be used to mean addiction.
We can say, 'kuo ma'u ia ne'e kava'
126.
(the kava has got him).
I t means that he is addicted to kava,
that he cannot do without taking i t daily.
One curer also
explained that lautolu'uta (canavahalia maritina) should always be
used in combination with another plant such as Heilala leaves
(garcinia s e s i l i s ) , otherwise the disease w i l l get used to i t and
become ta'e'aonga (resistent).
In the old days, people in Tonga
were known deliberately to infect young children with yaws, so that
i f they contracted the disease later as adults, i t would be in a
mild form.
I t is of importance to note that although the curers were not
always exact with the amoung of leaves or scraped mark used f o r the
preparation of medicine, the finished medicine parcel is not usually
more than two inches in diameter.
The leaves used in these medicinal
recipes are not considered in number, but in amount.
Some leaves
like the kihi k i h i , for example, are t i n y while as the laufale leaves
are big.
The important thing is that the amount used reflects the
size of the finished parcel.
The usual way to prepare Tongan medicine (the type to be taken
orally) consists of pounding the ingredients to a pulp, putting them
in a clean piece of coconut stipula and tying i t at the top.
A
small amount of water (about two or three ounces) is put in a cup
or coconut shell where the medicine parcel is squeezed several
times to l e t the juice from the ingredients run'out into the water.
The patient then drinks the contents of the cup.
3.
NON-SCIENTIFIC CURES
The non-scientific category of cures in this study include
those of a religious nature ana card playing.
This section w i l l
b r i e f l y describe the main r i t u a l s relating to treatments, p a r t i c u l a r l y
in relation to gynaecology and obstetrics, paediatrics and family
127.
planning.
Information on religious curers will focus mainly on the
interviews with one well known female curer of this type in Tongatapu,
mentioned in the last chapter.
A.
RELIGIOUS CURERS
Regardless of the ailments, i t is of great importance to confess,
and to pray earnestly to God for forgiveness.
Afterwards, the patients
and relatives must wait and trust in God's w i l l .
But there is no
reason (according to the interviewed curer in this category) to stop
anyone from taking any type of medicine which they wish to take.
Although this curer does not go and deliver babies, or preach
family planning, she encourages a l l who come to her with any problem
to t e l l God t h e i r problems.
them encouraging t a l k s .
She also prays with them and gives
She has a r i t u a l which she t e l l s the
patients to do daily or whenever they feel any physical,
social and spiritual problem.
mental,
The r i t u a l is simply to drink a
glass or two of rain water and pray.
With physical ailments she also recommends that the sufferer
put a wet towel on the sore area.
abdomen of pregnant mothers.
This could also apply to the
One pregnant woman i n Tafahi
informed me that she practised this during her last pregnancy and
that she had the best delivery ever.
The f i r s t t h i n g she did
when she f e l t the f i r s t contraction was to put a wet towel on her
abdomen, drink rain water and pray.
An 80 year old woman in
Nukunuku also informed me that she had a very big abdomen for years,
which made her look permanently pregnant.
She went to see doctors
in hospital, she also visited several Tongan t r a d i t i o n a l curers
and took t h e i r remedies but with no effect.
But
the simple r i t u a l
of drinking rain water, praying and applying a wet towel to her
abdomen d a i l y , cured her.
A nursing colleague drinks cold water
128.
and prays whenever she feels upset about her work. She said it
helps tremendously.
One of the Tongan traditional curers
interviewed was taken to see this religious curer because she was
very sick with an abdominal ailment.
too proud of her work as a curer.
She was told that she was
At the time of the interview
she was well again having followed the ritual described above.
All paediatric cases and gynaecological problems are given the
same advice.
With very young children, parents or guardians are
asked to do the praying.
As explained in the last chapter, the ritual of water, praying
and placing the towel is, according to this curer, to remind those
who are sick,of the last act of Christ on earth, which was the
washing of the apostles' feet.
She hopes that the patients will
thereby be reminded not to 'think of themselves' and to think of
others.
In this way, their problems will seem less important
and they will be stronger as individuals.
In Nukunuku also, two of the Mormon parents indicated that
they often call on their church 'elders' when members of their
family are sick.
These 'elders' bring specially blessed oil with
them which they proceed to apply on the patient and pray with the
laying on of hands.
It is well accepted (in fact expected) in Tonga for clergy
or groups of church people to go into the homes of the sick or
hospitals to pray for the patients' recovery.
Many times at
Vaiola Hospital, I witnessed clergy saying a prayer for the
patient.
The other occupants of the room participated as if it
is the most natural thing to do, regardless of differences in
denomination.
129.
B.
CARD PLAYING CURERS
The cures in this section are divined through the playing of
cards, focusing on the problem/s of the persons concerned.
According to the card playing curer interviewed, all ailments
can be cured through the revelations of the cards.
At present,
however only a few people in Tonga can cure in this manner.
And
all of these curers are apparently guarding the secrets of
interpreting the cards - which most of them, it is said, have
learned from foreigners.
The curer interviewed said that he had
recorded some of the remedies revealed through the cards soon after
consultations.
When he later compared them to some of the remedies
used for the same disease by some Tongan traditional curers, he
found that they were surprisingly similar.
"That" he said,
"should confirm my belief that God had put in Tonga, herbs suitable
to treat Tongans when they are sick."
Most of the patients who go to see this curer are chronic
cases.
They have tried the hospital and several traditional cures
to no effect.
step.
Finally, in desperation, they arrived at his door
"I had cured patients even after having been given up as
'hopeless' by other curers", he said.
Many people have said that they
were benefitting from this curer's treatments.
However, I did not
come across any patients who were actually 'incurable' hospital
patients among those cured by this curer.
In comparing the few remedies given by this curer with some of the
Tongan traditional cures for the same diseases, I found that they are
not really similar.
For example, his herbal remedy for the children's
disease tapitopito is quite different from that of others.
remedy is: kuava leaves and koka leaves.
His
The leaves are pounded
and put in a clean white cloth or the stipule of the coconut (to
130.
act as a sieve) and then squeezed with a small amount of water into
a cup (about one tablespoon) and given to the child to drink.
The
amount of leaves and the frequency of the dose w i l l depend on how
sick the child i s .
Likewise, his remedy for the children's disease
topamomoko is quite different from others obtained for the same
disease.
His remedy i s :
Ifi
bark and hehea leaves.
Even the
two remedies he himself got i n i t i a l l y from two Tongan t r a d i t i o n a l
curers in his village are d i f f e r e n t :
six volovalo leaves and six
hehea leaves or about four kuava leaves prepared as described above.
The dosage and frequency of administration o r a l l y , w i l l depend again
on the patient's condition.
I t was noticeable that this curer was not prepared to give
exact information on most remedies.
According to him, i t all would
depend on the patient's condition.
Good food, adequate rest and sleep and personal cleanliness,
are also important parts of his treatment - thus u t i l i s i n g some
s c i e n t i f i c approach in his curing as w e l l .
He is by far the best
educated curer among the non-scientific and s c i e n t i f i c curers
interviewed - and the only one who readily admitted that he would
accept rewards f o r his services.
The fact that his s k i l l in the
cards was said to be obtained from foreigners,but that the diseases
and remedies revealed in his cards are very much Tongan in name
and nature, did not seem to be at a l l strange to him.
I have discussed three categories of cures in Tonga under the
headings:
modern medical, both s c i e n t i f i c and non-scientific, and
non-scientific.
All curers in these categories are viewed as providing
genuine attempts to alleviate pain or to cure the
'unwell
feeling'
of the patient so that he or she w i l l once again assume his or her
function as a member of Tongan society.
131.
Most Tongans value health as they understand i t , and w i l l go
to great lengths to restore i t .
The choice of cures frequently
depends on how they view the cause of an illness.
Although the
majority of thepeople in Tonga tend to prefer modern medical cures,
people on the whole t r a d i t i o n a l l y have been believers in supernatural
sanctions of how people perform their functions in the society.
And
since Tonga became a Christian society in the early 19th century,
the Christian God is assumed by most people as the Supernatural
who gives these sanctions.
Consequently, cures are grequently seen
as only vaka for the healing power of God regardless of their
orientation.
132.
CHAPTER V
CASE STUDIES
In this chapter, case studies relating to the health practices
in Tafahi island, and Nukunuku village (the two areas were research
for this thesis was concentrated) will be discussed.
It was felt
that only through such detailed accounts can we hope to get close to
the attitudes of the people in those communities to health, including
those concerning maternal child health and family planning.
A CASE STUDY OF TAFAHI ISLAND
"I do not know why anyone would like to live there!"
Comment made to the writer by a well educated Government
official after visiting Tafahi-)
"Life may be hard here, but I have the satisfaction of knowing
that my children go to bed with their stomach full", (Extract
from an interview of one of the mothers in Tafahi.)
The purpose of the study was to find out how the people of Tafahi
view health practices, but in particular those relating to maternal
child health and family planning.
It focussed on the sociological
aspects of health and sought to understand the general attitudes of
the community to life in relation to cultural aspects of the past
and the changes brought about by modern education, Christianity,
migration and the monetary economy.
Background Information on Tafahi
Myth has it that Tafahi island was originally an elevated part
of Niuafo'ou (an island further north which was famous for its
'tin can' mail). It is said that some of the Samoan supernaturals
133.
admired this piece of land and plotted to remove it at night to
Samoa when all the people were asleep.
Unfortunately for them,
two superanturals at Niuatoputapu came to hear about the plan and
decided to trick them into thinking that it was daylight when the deed
was in process.
Thus, on the night when the actual removal of the
land occurred, one of the supernatural at Niuatoputapu, Tafakula,
whose anus was supposed to be very red, turned his bottom towards
Niuafo'ou while another supernatural crowed like a rooster. Sure
enough, the Samoan supernaturals (who were already on their way with
the piece of land) thought that it was day, and dropped Tafahi where
it is now and fled.
The origin of the name Tafahi was not known to
any of the people interviewed but the words in Tongan denote a
meaning of strike and split, which may relate to the myth and the way
it was removed.
There are also areas in Tonga called Tafahi.
For example, there are tracks in Ma'ufanga and Lakepa villages, in
Tongatapu and 'Uiha in Ha'apai
called Tafahi (Gifford 1971: 204).
The area from which Tafahi was supposed to have been removed from
in Niuafo'ou is a big lake called 'Vai Lahi' which is about 3840
acres, while as Tafahi is only about 841 acres.
But as one man, who
tried desperately to confirm the myth, said: "Do not forget, the
bottom of Tafahi which is sitting in the sea is much bigger!"
Tafahi is a small volcanic island of approximately 841 acres,
about 500 kilometres to the north of Tongatapu.
Tafahi is one of
Tonga's remotest islands, as well as furthest north.
It is in fact
nearer to Samoa and Fiji than to Tongatapu.
Tafahi and Niuatoputapu were the first islands in Tonga ever
to be seen by Europeans.
these"two islands in 1616.
Dutch voyagers Schouten and Le Kaire saw
The islanders came to the boat on canoes
to trade with the foreigners.
Somehow things got out of hand and guns
were fired resulting in the loss of lives.
134.
The remoteness is further aggravated by transportation
difficulties.
At present the final part of the journey is accomplished
by small open boats with attached outboard motors.
The six mile
channel between Tafahi harbour is also difficult to approach
and
apparently has been a scene for many travel tragedies in the past.
Yet this channel was frequently used by the people of Tafahi
before the days of cement water tanks and boats with outboard motors
to fetch water from Niuatoputapu when there were droughts.
It is the second highest point in Tonga, its 610 meter high
point (called Piu'o Tafahi) being only second to Kao island's 1030
meters.
There is no natural running water.
Its water supply
in the past was mainly from rain water trapped in the hollows of
big rocks near the beaches.
Today, many homes (25) have small
cement tanks to catch rain water, and recently six huge cement
water tanks were built with aid money.
The islanders have not
been out of water since these tanks were constructed about two
years ago.
Tafah's remoteness served the people well when they were saved
from the rage of the 1918 influenza epidemic.
Apparently, a Tafahi
canoe went to Niuatoputapu, but at approaching
a man waved to the
occupants of the canoe to go back, shouting that there was a terrible
disease on the land that had killed many people.
the people on the canoe went back safely to Tafahi
everybody not to leave the island.
With that warning,
and told
After the epidemic, people from
Niuatoputapu went to Tafahi expecing to find most of the people on
the island dead.
Instead, they found all of them well with not
a single death from the influenza.
Since then, the people of Tafahi
have celebrated their being spared from the influenza epidemic in the
first week of December each year with a week of thanksgiving prayers.
135.
Normally the men spend the day either in the bush planting
or out fishing for the family's meal.
Women stay at home and do
the cooking or weaving or go out collecting shell fish to eat.
The women of Tafahi also are well known for the artifacts they make
from pueki, the small conch shaped shells that are unique to Tafahi
in Tonga.
The people are religious.
The notion of 'prevention of
infection' is less important to them than the fact that the man on
the beach at Niuatoputapu who waved and shouted to the canoe to
go back so long ago was inspired by God to do so.
have been God's messenger.
He is seen to
There are two denominations on Tafahi,
Roman Catholic and Methodist.
Twenty-six, or 65% of the couples in the sample, are Roman
Catholics, and the remaining fourteen, or 35% are Methodists.
However, 68.3% of the total population of Tafahi at the time
of research were Roman Catholic and the remainder were Methodists.
Tafahi is perhaps the least developed of all the forty-five
inhabited islands of Tonga, mainly because of its location and the
nature of the land.
There are no shops, no modern health centre,
no type of public entertainment except kava parties and church going
There were about fifty homes on the island, but only about thirty
pit latrines. There are no bicycles on the island let alone a
motor vehicle.
The main transport is by foot.
There are a
few horses on the island, but even they cannot walk on some of the
rocky and difficult tracks.
Another important development in Tafahi, which according to
the people is the best thing that has ever happened to them, was
the construction of 154 steps from the beach to the village level.
They claim that it was extremely difficult to climb up and down
136.
before, but now both humans and horses can use the steps, and it is
making life easier for everyone in Tafahi .
The soil of Tafahi is very fertile and produces bountiful
food crops, which are sometimes sold to the people of Niuatoputapu
when food is scarce there.
Because of a generous rainfall, the
plants may remain a lush green while most of the rest of the country
is suffering from drought.
There are plenty of fruits in Tafahi.
The childrens' breakfast
before school and lunch usually consist of seasonal fruits and pieces
of mature coconuts.
People did not seem to mind when other people
come to pick the fruits at their homes.
plentiful
Custard apples were also
and are often seen rotten on the ground, thus helping
to increase the fly population of the village.
Most adults have
a breakfast of roasted breadfruit dipped into concentrated coconut
cream.
Because of the rocky nature of Tafahi, the village (which is
also called Tafahi) is arranged in levels like a cake with tiers.
The houses are built on the flat part of each level .
homes are fenced by piles of stones.
Many of these
In fact, there seem to be
stones everywhere one walks and everywhere one looks.
On the 269 people enumerated (in a house-to-house survey) on
21 April 1983, all the inhabitants of the island were indigenous
Tongan and born in Tonga.
Unlike the stereotypical large and plump
Tongan, the people of Tafahi are relatively small, lean and muscular.
The fact that they carry incredible loads on their shoulders from
the plantations located up on the mountain to the village below
may explain in part their physical appearance.
137.
Apart from the few horses on the island (which are often fed
with leftovers from the family meals because of the extreme shortage
of grass), the shoulder hoosi (horses) are the peoples' main
assistance in carrying heavy loads on their shoulders.
These are
made of long strong sticks (size and strength depends on the strength
of the owner), but about two meters long and 65 centimeters thick for
an average adult.
Parcels of foods, coconuts, kava and so on, are
secured on to the grooves made near the ends of the stick balancing
from each end.
The weight of the parcels carried by an average
man in Tafahi would probably be enough for two or three average
men on Tongatapu, walking on good flat land.
Most of the houses were made of corrugated iron as shown in
the map.
This is because, the people explained, it lasts longer
and is easier to build.
Houses built of local material would require
too much material to be carted down from the mountain for almost
yearly repairs.
There are few houses made of bricks; they are
extremely hard to build since all the cement, sand and water must
be carried on the rocky paths.
There is
telephone communication between Tafahi and
Niuatoputapu which operates three times a day at 7.00 a.m.,
12 noon, and 6.00 p.m. The most important contribution of this
telephone is perhaps to let the people in Niuatoputapu or Tafahi
know when to expect the arrival of a boat.
In this way, an overdue
boat may be able to get assistance before too long.
According to the people of Tafahi who were interviewed, by
the age of fifty a Tafahi man often has physical health problems,
and by sixty they are better off in a flat place, where it would
be easier for them to walk about:
(battered) from hard work.
their flesh is havehave
Most of the men in their sixties that
138.
I saw spent their time drinking kava and doing light jobs in the home.
In Niuatoputapu, I met a man from Tafahi in his sixties who was
unable to walk without support.
his plight.
He blamed hard work in Tafahi for
On the other hand, the women of the same age group
are still very active fishing, working in the home, and even
carrying bundles of foodstuffs from the hill on their shoulder hoosi.
The lack of grey in womens' hair was also very noticeable.
The children appear healthy.
The boys are frequently seen
helping their fathers carry agricultural products from the mountain,
where the bush allotments are situated.
The girls look after
their younger brothers and sisters, if their mothers are helping
their fathers in the bush or busy weaving.
Stone picking, however,
is a job for everyone.
When it is raining, the stones are washed
down from the mountain.
The people clean the stones from their
yards in much the same way as people in flat parts of Tonga sweep
the leaves to keep their yards clean.
All the adults interviewed said that they can read and write
in Tongan,and some can also write and read a little English.
This
is mainly the result of compulsory free education in Tonga up to
the age of thirteen. Apparently, many of the children in Tafahi
remain in class six for two or three years until they reach thirteen
instead of going on to secondary schools in Niuatoputapu or other
parts of Tonga.
The decision not to go to secondary school appeared
to be that of the parents rather than of the children.
All of the
children interviewed stated that they would like to continue on to
a secondary school.
More than 40% of the parents interviewed did
not want their children to go to secondary school .
They fear mainly
the likelihood that their children would not like to return to Tafahi
after secondary education, thus depriving the parents of much needed
labourforce.
On the other hand, over 58% of the couples interviewed
139.
did want their children to further their education.
At the time of
the research over thirty children from Tafahi were in secondary schools
in other parts of Tonga.
There are also people from Tafahi in the
civil service and inprivate enterprises in Tongatapu.
There is even
a young man from Tafahi in Fiji training for the priesthood at the
Pacific Regional Seminary.
While 269 people were enumerated in my survey of 21 April
about 300 people were recorded in the 1976 census.
1983
Four families
had moved from Tafahi since 1976.
There are also the students who
are away in the secondary schools.
But other people have migrated
to Tafahi, mainly to grow kava, a cash crop for which Tafahi 's soil
appears to be most suitable.
Kava production has become the main livelihood of the people
of Tafahi.
From June 1981 to June 1982, the kava planters of
Tafahi received about T$38,958 from the Produce Board, which is
the 'middle man' in the kava market.
During the same period, only
about T$431 was received for their copra, despite there being plenty
of coconuts. Very few people are interested in making copra,
because of the strenuous work in carting coconuts from the mountain,
while 98% of the men are kava planters.
Financially, the people of Tafahi are better off than many
other communities in Tonga because of their kava.
fairly distributed also.
The wealth is
The storekeeper at Niuatoputapu's Copra
Board store joked that when the people of Tafahi bring their kava
to sell, they would buy most of the goods in the store as soon as
they received their money, leaving very little for the people of
Niuatoputapu.
140,
FINDINGS
The people of Tafahi tend to 'afa' (exaggerate) when talking
about anything.
noticeable
Frequent use of the word tavale was particularly
since this term is rarely heard in ordinary conversation
in Tongatapu.
The word tavale donates a meaning of
such as 'oughly and
anyhow'
'unsure'
(Churchward 1959: 471),
Sometimes
when traditional curers in Tafahi were asked "How many leaves do you
use for this medicine?"
any amount).
The answer would be "'Ai tavale pe" (use
In contrast, other traditional curers interviewed
in other parts of Tonga were more exact with the number of leaves
or they may use the word fakafe'unga (approximate).
An unusual happening occurred in Tafahi that I have not
experienced anywhere else in Tonga.
Two sisters were asked by
their brother to go and 'fakamolemole' (ask forgiveness) of his
wife.
This is something unusual in Tongan custom since sisters are
of higher rank than their brothers (Rodgers
1977).
perhaps another manifestation of the tavale concept.
was the talk of the village.
But
this is
The incident
I f i r s t heard about i t from the
neighbour who sided with the wife.
Later the same evening, one
of the sisters came to me for a talk and she explained their side
of the story.
She said, that since i t was Easter Sunday
i t was
only Christian to beg forgiveness of their sister-in-law, regardless
of her being at fault.
She added that already two of their brother's
children had died because of their mother's attitudes towards her and
her sister, the children's mehekitanga. On the next day, the
brother's wife also came for a talk and described her sisters-in-law
as demons.
She also said that she would rather her children all died
that to give into her sisters-in-law.
Both parties thus confirmed
the belief that diseases and death can be caused by some breach
in
a social relationship, particularly when those concerned are
141.
of different social ranking.
As the brothers' sisters (mehekitanga)
are fahu (earthly chief), they are customarily allowed to do what they
like with their brother's children.
It is only logical therefore
that their anger should be the cause of the childrens' deaths.
Despite the fact that the two children died of dengue fever, most
people in Tafahi believed that they died of supernatural sanctions.
When I explained to people the effects of dengue fever on the body
and the probable reasons for the children's death, most people said,
"But there were many other children with dengue fever, why only those
two children died?"
According to the medical officer in charge, who was stationed at
Niuatoputapu, the people of Tafahi would come to see him, expecting
to be given the medicines that they want and not advice from the
doctor.
The people apparently look down on asprin and often ask for
injections.
healthy.
On the whole, however, the people of Tafahi are fairly
From January to April 1983, only eleven people from Tafahi
were recorded in the outpatient book - although they sometimes consult
the doctor on the road and he had to write prescriptions on the spot
without entering their names in the book.
The health centre in Niuatoputapu also serves Tafahi.
staff consists of a doctor and nurse.
The
It is a very poorly equipped
centre in as far as drugs or equipment.
They were running short
of even antiseptic lotions used for dressing of wounds at the time of
my research.
There was no refrigerator.
Consequently there was no
toxoid to give pregnant mothers for months, although some have been
given a dose or two sporadically (when an officer brought some from
Nuku'alofa by aeroplane).
completed.
But the full course was not usually
As a result pregnant women frequently deliver with local
midwives, both at home or in the health centre.
Luckily there has been
no incident of tetanus neonatorum for some years now.
142.
While I was in Tafahi, three people got very i l l .
One was a
mother of f i f t y years o l d , and the other were two young children of
two and four respectively.
lolomai,
The woman was suffering from the disease
a disease commonly occuring in middle-aged women in Tonga
and characterized by attacks of extreme physical weakness and f a i n t i n g
attacks.
The woman announced that she would die without intravenous
therapy (which was her usual treatment said to be given by the modern
health workers) but Tafahi 's harbour was very rough
go across to Niuatoputapu.
and no boat could
Fortunately, the woman did not die but
survived on oral f r u i t juice and vegetable and chicken soup.
year old sick child appeared to be suffering from pneumonia.
The four
He was
treated with te 'epilo'a maui (geniostoma vitiense} because his abdomen
was distended
and he was not breathing well.
The idea was to expel
flatus or faecal matter from his abdomen, so that his lungs can
expand downwards.
He was also given f l u i d s and a dose of f i k i leaves.
The decision to give f i k i leaves was mainly due to the fact that the
plant was handy and I knew that they are used for many types of
diseases and therefore should not be poisonous.
The two year old
child went to Niuatoputapu where he had a course of p e n i c i l l i n
treatment.
Two days after returning he had a termperature and both
his pulse and respiration were rapid.
He was cold sponged and given
sulphadimidin tablets and he got better.
In a l l these cases, I was
informed after the patients were given some t a b l e t s , said to be
panadol and sulphadimidin.
I was also informed that these patients
were chronic sufferers of the same diseases and that nothing could
cure them, except modern injections.
The treatments given, however,
were simply based on comfort, posture and n u t r i t i o n , but the patients
a l l got better without the injections.
The disease lolomai (which usually occurs among wonen over
forty) has been l i s t e d by a F i j i trained doctor as a disease peculiar
143.
to Tonga.
Some say that i t is a sign of stress, because women in
that age group are beginning to be less attractive and may not have
confidence in the s t a b i l i t y of their marriage.
sick was over 50 years old.
She had grown children and her husband
appeared to be devoted to her.
to the contrary.
The woman who was
None of the people have said anything
Her fainting attacks seemed genuine.
However,
although her pulse was a l i t t l e weak, i t was regular and 1 did not
think that there was a cause for alarm.
But then the woman called
her husband and children in to hear her talatuku ( l a s t words before
death) and about t h i r t y people quickly gathered in the house and
outside.
Three prayer groups came into the house, one after another,
and prayed for the woman's recovery.
There were also several
traditional curers who were present to amo (to stroke gently) the
patient's arms and legs.
When she got better, because I had had
overseas training and was a stranger to the community, the people
attributed her recovery to my soup.
But like the attitudes of most people in Tonga, 100
of the
adult population in Tafahi believe that medicine, regardless of what
type, serves only as vaka (boats) for the healing power of God.
As asserted before, there is a tendency, though j o k i n g l y , to
regard traditional medicine as a ki' i loi (small l i e ) .
When I
questioned the curers more specifically about the ki ' i loi concept
and i t s relation to Tongan medicines, most indicated that i t is the
attitudes of most modern doctors whom they know.
And since these
people are clever and educated in foreign developed countries, they
must be r i g h t .
I t is to be noted that most missionaries have
discouraged the use of Tongan traditional cures by the people because
of the connection to Tonga's ancient r e l i g i o n .
144.
The average number of children per family in Tafahi is 5.48.
The average children for Roman Catholic couples is 5.51 and for
Methodists is
5.48.
But the average number of children per family
for a l l Tonga is six (UNFPA
1982: 17).
Twenty-six of the f o r t y wives, and seventeen of the f o r t y
husbands in the couples sampled were not born in Tafahi.
Eleven,
or 27.5%, of the wives in the sample were over 45 and twenty-seven,
or 72.5%, were under f o r t h - f i v e years old and considered s t i l l capable
of producing children.
Five wives, or 17%, of those under f o r t y - f i v e
years old were supposed to be pregnant at the time of research, according
to information given by these women themselves.
One of these five
died soon after I l e f t , apparently from post partum haemorrhage.
Her relatives t r i e d to take her to the doctor in Niuatoputapu, but
she died on the way.
Seventy-four of the parents have travelled as f a r as Tongatpau
or Vava'u, and three husbands have been to New Zealand to work.
Fifteen of the families interviewed have close relatives (brothers,
sisters and children, grandchildren, f i r s t cousins) overseas who
sometimes send them a l i t t l e money.
However, the oldest mother in
this sample complained that one of her sons had gone to Tongatapu and
is probably now overseas, but has not communicated with them for over
one year.
Thirty-seven, or 92.5%, of the husbands in the sample were active
kava
planters.
The Methodist minister and two teachers, although not
active kava planters, admitted to owning very small kava plantations.
Only one, or 2.5%, of the total sample of f o r t y wives was not weaving
on her own or in a weaving g r o u p . S h e is a teacher and said that
she had no time for anything else.
She is the only one among the
wives with a higher leaving c e r t i f i c a t e and is also married to a
145.
1
teacher.
This couple has been married f o r over one year and has
no children.
Most of the adult community a t t r i b u t e s t h i s to
supernatural sanction.
They say that the couple has paid l i t t l e
attention to r e l i g i o u s matters since being married.
Twenty-nine, or 72.5%, of the husbands attended primary school
f o r three to s i x years.
f o r two to six years.
Eleven, or 27.5%, went to secondary school
Only two, or 5% continued t o the t e r t i a r y
level { t r a i n i n g as teachers i n Nuku'alofa).
Twenty-five,or 62.5%,
of the wives had three to s i x years of primary school and f i f t e e n ,
or 37.5%, had two to six years i n secondary s c h o o l . T h i r t y - s i x
of the couples were married f o r the f i r s t time.
The average number in a household f o r the whole of Tafahi at
the time of research was seven.
The f o r t y families sampled have
t h i s pattern:
Table 4:
Average number of household in Tafahi
Island
Number of f a m i l i e s
Percentage
1-3
7
17.5
4-6
19
47.5
7-9
11
27.5
3
7.5
40
100.0
Number i n household
10 or over
Total
Only three of the families stay with an old
person.
Two of
these were r e l a t i v e s of the wife and one a r e l a t i v e of the husband.
Two of t h e couples have no children but both expressed great
desire to have c h i l d r e n .
All
of the others have children ranging
in number from one to over e i g h t , as shown i n the f o l l o w i n g t a b l e :
146.
Table 7:
Assumed Causes of death in children of couples i n sample
Cause
Number
Lost at Sea
2
Mavaeua
3
Mamsmas
1
Fever
3
Boils
1
Tetanus Neonatorum
2
Dengue Fever
2
Fish Poisoning
1
Fall ing Accident
1
16
In regard to preference for the children's sex, more couples
preferred g i r l s .
Twenty-six, or 65%, of the wives and twenty-four,
or 60%, of the husbands preferred g i r l s .
Eight, or 20%, of the
wives and eleven, or 27.5%, of the husbands preferred boys and the
rest expressed no particular preference so long as the children
were healthy.
The parents who preferred g i r l s a l l stated that the g i r l s are
more 'ofa, helpful, obedient and less problematic.
F i f t y , or 62%,
of the wives and husbands who preferred g i r l s unanimously agreed
that g i r l s would not forget their parents after marriage, while boys
tended to forget about their parents after marriage since their sons'
wives would direct their husbands to care for t h e i r parents.
I t was
f e l t that Tongan men on the whole would be 'weakened' to the directions
of their wives.
A saying in Tonga associated with this notion is
'vai vai klhe m e ' a ' i f i ' (weakened to the whistle).
Those who preferred boys said that Tafahi being a d i f f i c u l t place
to live is on the whole unsuitable for g i r l s . B o y s , on the other
148.
hand, would be of great help to their fathers in going to the bush
and carrying heavy loads.
Also boys can look after themselves, but
the g i r l s had to be well cared for before marriage to protect t h e i r
virginity.
The majority (25, or 62.5%, of the couples of the sample)
thought that a Tongan family should have only four to six children.
Thirteen, or 32.5%, of these couples have children within that number.
Seven, or 17.5%, have already more than six children and the remaining
five couples have less than three children each.
Only three couples
said that i t is better to have all the children that they can have.
Significantly, no one mentioned God's w i l l as far as the number of
children was concerned.
Nine of the seventeen children interviewed in Tafahi wanted
more brothers and sisters.
three Methodists.
Six of those were Roman Catholics and
Five of the nine parents of these children did
not want any more children.
The main reasons given by the children
for wanting more brothers and sisters were:
1.
To play with
2.
To help each other
3.
To keep each other company
Of the seventeen children interviewed, ten would obey their
mother more than their father.
The reasons given were:
1.
Because mother loves the children more
2.
Because mother is at home more than father
3.
Because mother 'born me'
One child would obey mother and father equally, but six would
obey father more.
The reasons given were:
149.
1.
Father is the head of the family
2.
Frightened of father
3.
Father works hard for the family
The three most common reasons that appear to be common to all
the parents in as far as the desired number of children are:
1.
We should only have the number of children that we can
care for
2.
We need children to help us
3.
We need children to care for us when we are old
The majority of the couples thought that two years was a good
interval between pregnancies, but in reality 19, or 47.55, of the
couples have had babies between twelve and eighteen month intervals,
Table 8:
Preference for Intervals between Pregnancies
Intervals
Number of Couples
1 year
2
2 years
25
3 years
6
4 years
3
5 years
4
40
The majority (38,or 95%, of the couples i n the sample) gave
'to give the mother time to r e s t and the c h i l d a chance to l i v e ' as
the main reasons for spacing pregnancies f o r two years or more.
Only two couples thought i t is b e t t e r t o 'get i t over w i t h ' , as i f
there are a set number of c h i l d r e n i n the womb to come out, sooner
or l a t e r .
T h i r t y - s i x , or 90%, of the sample w i t h c h i l d r e n had had normal
pregnancies.
Two had had morning sickness i n a l l t h e i r pregnancies
150.
(one had seven children and the other fifteen).
suffered from hypertension during pregnancy.
One of the mothers
Five of her seven
children were born in hospital and two were delivered at home in
Niuatoputapu by a nurse.
She was frightened to stay in Tafahi for
delivery after the doctor explained the danger of doing so i n her
condition.
Most of the mothers in the sample carried their pregnancies to
term.
Six mothers however had had abortions;
two abortions each.
All have had normal
two of them having had
deliveries.
The main cause
of the abortions was attributed to carrying heavy loads from the bush.
This may be true.
I have seen one of the mothers who had had two
abortions carrying large loads on her shoulder
hoosi.
The loads
were equal to i f nor more than those carried by her husband.
These
were the only couples on the island who were making copra at the time
of research and are very keen to educate their children.
Twenty-eight, or 73.68%, of the mothers in the sample would
consult only modern health workers when pregnant.
They a l l stated
that they wanted to be sure in case of trouble.
Ten, or 26.3%,
consulted only the traditional birth attendant.
Eight of these
ten were Roman Catholics and two Methodists.
Eight of the mothers
would consult the doctor only.
Table 9:
Preference for Ante Natal Care
Preference
Number of Couples
Doctor
8
Doctor/Nurse
19
Doctor/TBA
2
Nurse
1
TBA
10
Other
Nil
Total
40
151.
The three main reasons for the above preferences are listed
below.
A.
Doctor
1.
Want injections and tablets available in the health
centre to strengthen the body.
2.
Doctor knows best.
3.
To guarantee doctors assistance in case of problems.
Most mothers preferred a nurse to be present when examined because
doctors are usually males.
B.
C.
Traditional Birth Attendants,
Ma'uli
1.
The ma 'uli is closer and less trouble to see.
2.
Felt healthy and did not think they need a doctor.
3.
Used to the
ma'uli.
Ma'uli and Doctor
1.
Double checking in case of trouble.
2.
To please relatives.
3.
Like the medicines given by both.
In so far as family planning, one hundred percent of the sample
have heard of the family planning programme.
Most of the couples
had learned about i t from the family planning programmes on the
radio.
152.
Table 10:
How Family Planning Programmes f i r s t heard of by
Parents in Sample
Source
Number of Couples
Radio
20
Nuns
7
Doctor
10
Nurse
1
Relatives
2
Others
40
Total
When asked what they understand to be the main purpose of the
Fakakaukau'i 'oe Famili (Family Planning programme), a l l of them
came out with the answer 'faka vahavahe fanau' (spacing of children).
Although one hundred percent have heard of family planning,
only five couples (4 Methodists and 1 Roman Catholic) have practised
some form of modern family planning methods actively.
The Roman
Catholic couple are practising the ovulation method, but are not
quite clear about i t yet.
years old.
child.
72.5% of the mothers were under f o r t y - f i v e
One had a loop but pulled i t out when she wanted another
One of the husbands was using condoms, but ceased to do so
when his supply was gone.
There is evidence, however, that condoms
were available to more than one couple because some mothers were
joking about the children blowing balloons 'with what the doctor
gave u s ' .
One woman was having Depo injections.
She said that
she ceased to have any more because the baby, whom she was breastfeeding at the time she took the i n j e c t i o n , was sickly.
She
claimed that the baby became a l l right once she ceased to have the
injection.
She herself f e l t f i n e .
Except for the couples who
have no children yet, some of the couples admitted to practising
abstinence and withdrawal ' every now and then' to prevent the
153.
occurence of pregnancy.
All the couples strongly agreed that no wife or husband should
practice any form of family planning method before discussing i t with
their spouse.
1.
The three most common reasons given were:
Husband and wife are partners and each have a right to
know what the other is doing, particularly in matters
concerning sex.
2.
In case of complications to health.
3.
May encourage adultery.
Only one of the couples mentioned that family planning is not
approved by the church.
They were a Roman Catholic couple.
Most of the couples in the sample thought that person-toperson talks with someone of one's own sex is the best way to convey
the message of family planning.
In this way, they argued, the
cultural tapu would not be broken.
They mentioned the sister and
brother tapu (which includes cousins) in particular.
They also said
that it would be clearer, because people would not be too shy to
ask questions and to discuss their various problems, as they would
in public places.
"Even now", one said, "after hearing so much about
family planning programme from various sources, I still do not know
why the big fuss!"
154.
Table 11:
Preference of Family Planning sources of Information
Source
Number of Couples
Person-to-person
Radio
Kava Party
Town's meeting
2
Books
1
Others
1
Total
40
All those who preferred radio talks thought that it would be
the quickest way for the family planning message to reach the people.
The two who preferred the town's meeting gave the same reason as
those who preferred the radio.
The couple who preferred a kava
party thought that it would be nice to talk about something else
rather than 'to kava' (planting kava} and so on.
preferred books are both teachers.
The couple who
One couple reckoned that the
people would do what they want regardless of how well the family
planning message is being conveyed.
Significantly, both parents
agreed, although the wives as a rule talked hesitantly while looking
at their husbands for confirmation.
On the whole, more couples in
the sample wanted to know more about family planning, while eighteen
couples did not.
Those who said no, simply said that they thought
they knew enough about family planning.
Of those who would like
to know more:
10 (7 Roman Catholic and 3 Methodist couples) want to be
clear about the available methods of family planning.
4 specifically want to know more about the natural methods
of family planning (3 Roman Catholic and 1 Methodist
couples).
5 want to know more about child care.
155.
2 want information on how to cope with marital problems.
1 wants to know when pregnant (couple with no children).
Eighty percent
of the couples in the sample thought that family
planning is necessary for Tonga.
These were the most common reasons
given in t h e i r order of p r i o r i t i e s :
1.
Lack of economical resources.
2.
Lack of land.
3.
Cannot cope with family problems.
Those who said no for family planning were four Methodist
couples and four Roman Catholics. The reasons they gave in their
order of priorities are as follows:
1.
They need children to help.
2.
It is nice to have a big family because it is much happier.
3.
For religious reasons.
Altogether thirty or 75% of the couples preferred doctors to
traditional healers (when a member of their family is sick), although
twenty-seven would go to traditional healers if the doctor does not
satisfy them.
On the other hand, ten preferred traditional healers
but six would go to the doctor if the traditional healer would not
satisfy their needs.
Three couples would rely entirely on doctors
while four couples would rely only on traditional healers.
This is
the information obtained during the questionnaire/interview of the
forty couples in the sample.
However, during the time I spent in
Tafahi, 100% of the couples admitted that they would try any type of
medicine to gain health and two mothers said that they were practising
a type of religious treatment for the last couple of years on all
members of their family when sick, with good effect.
treated by a card playing curer.
Some were also
It appeared also, that unknown to
many parents, grandparents give their grandchildren regularly
156.
(particularly during the first year of life) some Tongan cleansing
medicines.
Catholics.
Nearly 60% of those who preferred doctors are Roman
Also 60% of the parents who have had some secondary
education in the Tafahi sample prefer doctors to traditional healers.
47% of children interviewed in Tafahi were in agreement with their
parents preference of curer and the rest were not.
Both the parents and children who preferred modern medicines
gave 'getting better quicker' as their main reason for preferring
doctors, secondly, that 'doctors have superior knowledge in comparison
with traditional healers', and thirdly, that 'the hospital facilities
and nice and clean'.
With those who preferred traditional curers, they claimed that
traditional curers are more approachable than doctors, quicker to
give assistance at any time and anywhere.
Both parents and children
also expressed fear of doctors, and children mentioned in particular
fear of injections.
The nearest modern health clinic to Tafahi is in Niuatoputapu,
which is about six miles, or about two hours boat ride away.
There
are a number of traditional healers at Tafahi that specialised in
treating particular diseases, but 75% of the mothers said they know
medicines for common children's diseases.
Those who preferred
traditional curers would take their patient to an appropriate curer.
One hundred percent of the sample however, admitted that they believe
there are Tongan illnesses which would heal only by Tongan cures
papalangi (European) illnesses which would heal only by European
cures.
The whole of Tafahi population have had both modern and
traditional cures at some time or other.
More than 52% of the couples in the same sample stated that
doctors have failed to cure a family member's sickness.Some of
157.
and
these cases were diagnosed later as mavaeua or pala and were cured
by traditional curers.
This is a typical story from one of the
mothers:
"One of my children had a rash on the neck.
the hospital.
I took her to
I was given ointment to put on it.
The rash
began to be very red after the application of the ointment
eventually the skin pealed off leaving raw areas.
and
I took the
child to a traditional curer whom I heard treat this type of
sores.
The curer confirmed that it was his hangatamaki.
The child was treated locally with the juice from the bark of
the tava tree, and in no time the hangatamaki was healed."
There are also diseases for which penicillin injections would
be very harmful according to most Tongan traditional curers.
Ngalo'afu (bad sore throat, and some say it is diptheria) is one and
another is aching or swellings without inflamation.
One woman told
me:
"One of my relatives nearly died.
He was suffering from
Ngalo'afu and we took him to hospital.
Despite the fact
that we knew about the Tongan belief that penicillin injection
is not good for condition such as ngalo'afu we allowed the
nurse to give him an injection of penicillin which was
prescribed by the doctor.
Soon after at home, his breathing
became more laboured, because there was swelling inside his
throat.
Fortunately, one of the relatives knew somebody who
could treat the disease.
at once.
This curer was brought to the patient
He amo the neck, gave him medicine, and in no time
the patient was more comfortable, and eventually better."
Among the illnesses which are supposed not to be cured by
modern medicine are:
158.
Paralysis
of the right side of face
Diarrhoea
Tongan fever
Teething
Boils
Breast Abscess
Aching limbs without inflammation
The child's tongue appeared shortened and the child is
irritable.
Some of the illnesses mentioned above are symptoms rather than
illnesses.
This is common in the Tongan idea of disease, particularly
in conversations.
The traditional curers, however, often go beyond
this symptomatic explanation and examine the patient and diagnose
according to their findings, which are based on experiences handed
down over the generations.
In most of these cases, there seemed to be underlying
assumptions that it was not the modern medicine which was at fault,
but its practitioners.
People talk about 'waiting and waiting to
see the doctor', of being given the 'wrong treatment', of the doctor
being 'in a hurry to get away' and so on.
When asked whether traditional curers failed to cure a disease
in their household, 50% of the couples said yes, and 50% said no.
One case was supposed to be hela (asthma) which was treated by a
traditional curer who claimed that it was his hangatamaki:
"The child got worse however, and we ended up taking him
to see the doctor at Niuatoputapu.
He was given an
Injection, and the child gradually got better."
Another one was a child with vomiting and diarrhoea, who was
treated by a traditional curer and nearly died had they not
159.
goneto the doctor in time.
Among the illnesses mentioned are:
Headache
Sores
Abdominal pain
Tetanus
Pneumonia
Fever
Sore mouth
Diarrhoea
It appears that some diseases or symptoms can be treated by
one category of medicine at one time or another at another time
and be successful or unsuccessful.
Since the underlying causes of
symptoms like diarrhoea or abdominal pain varies i t is hard to make
any fast rules about these things.
All the adults that I talked to in Tafahi believed
that there are Tongan diseases and European diseases.
Furthermore,
each category of disease would heal only if given the right type of
treatment.
The diseases mentioned as Tongan are:
Mavaeua
Mofi fakatonga
Kulokula
'Avanga
Pala
Makehekehe
Mavaeua is a disease of the infant already mentioned in the
section on paediatrics.
Mofi fakatonga is a type of fever where
the patient appears to be hot only at the palm of the hands and soles
of the f e e t .
This is 'Tongan fever'.
In the European fever,
according to the informants, the patient is hot all over and the pulse
160.
is fast.
Kuiokula
(red) embraces a lot of diseases in Tonga, l i k e
sores, shivering attacks, odd swellings, etc.
Modern medical
personnel often refer to kuiokuia as being synonymous with f i l a r i a .
'Avanga is a s p i r i t possessed disease in which the patient appears
to see and talk to people who are dead.
Sometimes these s p i r i t
possessed patients are very restless and want to go with 'those'
who are coming for him/her.
leaves.
Their treatment must include the lautolu
Paia also embraces a number of diseases, but is commonly
used for sores.
I t is generally used in conversation to mean
'rotten' or gone 'bad', such as in rotten bananas, yam or a rotten
liar.
Perhaps i t is its l a t t e r , wider connotation that is more
useful here.
Sores have to be seen, but many of the internal paia
in Tongan diseases are assumed through symptoms such as restlessness,
bad breath, cough and lack of appetite for food.
Lastly,
makehekehe appears to be anything internal that is wrong within
the abdominal area.
I t is an umbrella-like diagnosis, similar to
the term abdominal diseases, which could be anything wrong with the
l i v e r , stomach, intestines and so on.
The diseases particularly mentioned as European are:
Fever
Sore mouth
Vomiting
Pneumonia
Tuberculosis
82.5% of the sample agreed that fever is a European disease.
Only when I reminded them of what they had said about 'Tongan fever'
did they qualify the 'fever' and call i t European fever.
The stereotypical modern doctor, according to the people of
Tafahi,
is clever, clean and trustworthy, but at the same time hard
161.
•I
to approach, frightening, and hard to find.
On the other hand,
the traditional healer shows more concern and love, is easier to
approach and more r e l i a b l e , but they are slow, not so clean and
do not know much.
Most of the people in Tafahi thought family planning is necessary
for Tonga.
Thirty-two or 80% of the couples in the sample were for
family planning and only eight or 20% were against i t . T h o s e who
said no included four Roman Catholic couples and four Methodist
couples.
Only one husband and one wife among those who did not want
family planning had had some secondary education, but neither of them
had passed t h e higher leaving
certificate.
The mothers in Tafahi recognized that breast milk is best for
babies.
Most mothers associate breast feeding with the c h i l d ' s
love to h i s / h e r mother.
Some mothers, for example, remarked t h a t
the children t h a t they breast fed longer are more loving than those
they fed for a shorter period.
This is a common belief in Tonga.
The old people who were interviewed all agreed that they were
taught more s t r i c t l y by their parents in m a t t e r s of politeness and
respect.
They were often shocked with the way youngsters behaved
towards t h e i r parents now.
But they agreed that the youngsters
today know much more about the world than they did, although t h e i r
knowledge of fishing and weaving are well behind those of previous
generations a t the same age.
More than 90% of the old people's
sample thought t h a t t h e i r childhood was more carefree.
They
reckoned they played a lot and t h a t even work like fishing or planting
were more like playing in those days.
Food in the old days was said to be very t r a d i t i o n a l .
People
ate a lot of lu l o i o ' i (taro leaves cooked with coconut cream), vai
lesi (pawpaw cooked with coconut cream), f i s h , s h e l l f i s h , land crabs
162.
and so on.
enough to
They had to plant food, but they always seemed to have
eat.
There was certainly no real need for money.
Somehow, those questioned f e l t , people were contented;
people managed to stay alive.
somehow,
All the old people love Tafahi and
would only go away i f they were sick and in need of treatment i n the
hospital.
In the past, they relied mainly on traditional medicines,
but now the tablets are good and quicker to take effect.
One old lady had had an eye operation in Vaiola Hospital ,
Nuku'alofa.
She talked warmly of her experience in the h o s p i t a l ,
but said that she was glad to get back to Tafahi.
This old woman
s t i l l weaves although blind in one eye and able to see only
partially from the other.
All the old people sampled stated that they did not understand
family
planning.
means they
not healthy.
But when I explained to them what family planning
thought that i t was only a good idea i f the mother was
One old man, the local chief, stated that he thinks
i t foolish to t r y and keep the numbers of people down since Tonga
needs people f o r protection.
He said, "who else would protect our
King but us i f we are invaded by foreigners?"
Except f o r the absence of tona (yaws), the people of Tafahi were
healthier before, according to the old people sampled.
People knew
how to behave towards each other in order to foster peace in the
I fr!l
; hil
I
community, they f e l t , and this knowledge was the responsibility of
the mother to teach her children very early in l i f e .
The old people
suspected that the parents and their children did not see each other
often enough today once the children go to school.
The parents now
are often too busy with their economic activities such as planting
and tending kava plantations, and the importance of the children
is not where i t should be - f i r s t .
163.
Even mothers now go with their
husbands to work in the bush, some complained, while in the past the
mothers stayed home and looked after the children.
DISCUSSION AND CONCLUSION
There have been enough people from Tafahi who have gone t o
other more developed parts of Tonga and overseas to realise that
l i f e in Tafahi is relatively hard and dull in comparison.
Despite
t h i s , many people have stayed on, for they feel secure in Tafahi.
It is not economic security that the people of Tafahi appreciate
most, but emotional security, a feeling of peace and being carefree
that money cannot buy.
Whether these feelings will stay for long,
now that the production of kava has opened up a viable market o u t s i d e ,
remains to be seen.
Already every home is aiming to buy i t s own
small open boat with attached outboard motor engine, which will
cost approximately T$2,500.
It is l i k e l y therefore that in the
near future economic security will be uppermost in Tafahi.
But for
now i t remains a small homogenous community whose population is
nearly all related to one another, in which gossiping and petty
jealousy are common, but in which peace is generally prevalent.
The people see l i f e with unscientific eyes and tend to live
l i f e in a carefree fashion.
are l u l l e d .
With such attitudes disappointments
Although most said they found the doctor hard to
approach, they would consult him casually on the s t r e e t
and i n s i s t on the type of medicine they thought suitable.
anywhere
The
fact that they do not understand fully the effect of the modern
drugs does not matter to them.
Likewise, with their Tongan
traditional medicine i t is common t o be told to 'ai tavale pe'
(use any amount) of the leaves used.
More babies were delivered by the aa'uli than the modern health
workers.
In addition people admitted that they would take t h e i r
164.
I
patients to any type of curer (including religious and card playing
curers) for the sake of health.
Health is viewed as a combination
of physical , mental and s p i r i t u a l (which also embraces social and
emotional) well being and everyone believed that a l l types
of medicines and curers serve only as vaka(boats) for the healing
power of God.
This i s , of course, a common belief in Tonga.
Despite t h i s seemingly unscientific approach to l i f e , and
health, more people in Tafahi preferred modern
medicine.
There
were more Roman Catholics than Methodists who preferred modern
health care, as did the better educated and younger (below 45 years
old) people i n general.
When the Roman Catholic priest t e l l s his
congregation i n Tafahi not to practice traditional medicine because
i t is connected with Tonga's ancient religion, the people obey.
^l 1
In addition there is the possibility that modern health care is
•a .1
viewed ( p a r t i c u l a r l y by the younger more educated people of Tafahi)
as a scarce commodity and that i t s value is mainly in its scarcity
rather than i t s effects.
The people of Tafahi tended to 'afa (exaggerate).
The people
exaggerate the food they eat, the feasts they have and so on.
Perhaps
the people of Tafahi are unconsciously trying to j u s t i f y to others, by
their 'afa, t h e i r reasons for staying on Tafahi, despite i t s physical
hardness.
On the other hand, their 'afa may be due to lack of
comparison, as i n the Tongan proverb "Lau pe he'e lokua koe moana
hoono
taputa".
The lokua are very small fish often found in small
ponds of trapped sea water near the beach.
The proverb insinuates
that these small fish think that their b i t of sea is the deep blue
ocean; because they do not know any better.
Likewise, when the
Tafahi people exaggerate things, i t is probably not really
exaggeration, but r e a l i t y to them because of their relative i s o l a t i o n .
165.
I.
When people are sick they tend to exaggerate the seriousness of the
illness by saying that only the medicines which are scarce or
unobtainable (at the time of i l l n e s s ) , l i k e p e n i c i l l i n injections,
can cure the sick person.
This was the case with the three sick
people I encountered in Tafahi.
The concept of 'ofa (love) is associated more with females than
with males.
The majority of the parents in the sample preferred
g i r l s because they are said to be more loving and less problematic.
The children obey their mothers more than their fathers at home, so
i t is believed, because they love them more.
Breast fed children
are said t o be more loving and continue to care for their parents
after they are married.
The males apparently do not.
Nevertheless, males are very much needed in Tafahi to work the land.
But the preference for 'loving' g i r l s to 'necessary' boys in Tafahi
seems to further confirm that the people of Tafahi value emotional
security more than physical security at present.
The man is undoubtedly recognised as the head of the family.
However, a woman is credited with continuity and endurance.
Thus,
in the matter of family planning, i t would be v i t a l to obtain the
man's approval f i r s t .
Apart from few old people, a l l the adult population of Tafahi
have heard of family planning,
Furthermore, an overwhelming 80%
of the couples in the sample agreed that family planning is necessary
in Tonga.
methods.
Yet only 12.5% have ever used any modern family planning
But then a v a i l a b i l i t y of the family planning methods to
Tafahi leaves much to be desired.
Few people understand the concept
family planning except to space pregnancies.
They would prefer
person-to-person talks with an o f f i c i a l of their own sex, because sex
is a tapu subject in public and i t would be less embarrassing to
166.
discuss family planning with a person of one's own sex.
On the whole the Tafahi community is a relatively healthy one.
There were no women in Tafahi who complained of any physical
gynaecological problems.
But they are very modest and perhaps
would not discuss such problems freely, even with a stranger of the
same sex.
Although there is no modern health c l i n i c on the island of
Tafahi with staff to conduct frequent maternal and child care as
well as family planning programmes, the doctor and nurse from
Niuatoputapu Health Centre v i s i t Tafahi every now and then.
These
v i s i t s often are limited to sanitary inspection and health education
in relation primarily to communicable diseases.
Sometimes pregnant
mothers and children are seen for routine medical examination.
The
pregnant mothers on the whole are pleased with opportunities to be
seen and examined by the doctor or the nurse at either Tafahi or
Niuatoputapu and to be given 'protecting' tablets or injections.
The m a j o r i t y of the deliveries to date, however, are conducted by the
ma'uli on the island who was also frequently consulted by mothers
for purposes of their own health during pregnancy and that of
young children.
But
their
when anybody is actually i l l they are taken to
the doctor in Niuatoputapu to be treated with modern medicines..
On the whole family Planning is not f u l l y understood by the
people and, l i k e most Tongans, they do not feel free to discuss i t .
Nevertheless, I feel that parents on the whole appreciate the
d i f f i c u l t i e s that a large family may incur and that many would
purchase modern methods of family Planning i f they had confidence,
frequent supervision and encouragement from a trained person who is
sensitive to the people's cultural values.
167.
A CASE STUDY OF NUKUNUKU VILLAGE
"Thank God I s t i l l have a breeze i n f r o n t of my nose t o teach
the c h i l d r e n how to behave and live a poor l i f e .
You know
what men are!
Before the s o i l is put on t h e i r w i f e ' s grave
they are already looking f o r another
woman!
"
(Extract from an interview of one of the mothers in Nukunuku)
" I want to have as many c h i l d r e n as possible.
The more
c h i l d r e n I have, the harder I work to feed, clothe and
educate them...
This house can stay unfinished
The c h i l d r e n are more important.
When the children grow
up, I ' l l j u s t l i e back and rest while they do a l l the work."
BACKGROUND INFORMATION
Situated on the west side of Tongatapu about six miles from
Nuku'alofa,
Nukunuku i s one of Tonga's bigger v i l l a g e s .
The town
area is about 100 acres and i t s population was 1,325 according t o the
1976 census.
The v i l l a g e is a hereditary estate of the noble Tu'ivakano.
The Tu'ivakano (King of Vakan5) t i t l e has t i e s with F i j i .
It
is
said that one of the chiefs of a v i l l a g e called Vakano i n F i j i came
to Tonga to d e l i v e r a canoe t o one of the k i n g s . T h i s chief enjoyed
his stay i n Tonga so much t h a t he wanted to remain.
The rest of h i s
party went back to F i j i . ' The Tu'ikanokupolu, for whom the canoe was
brought, granted a favour to the F i j i a n chief to select a piece of
land f o r himself.
The c h i e f chose the land which i s Nukunuku t o d a y .
The f i r s t Tu'ivakano i s said to have been a Tongan Chief adopted by
t h i s F i j i a n Chief.
The boy was named Tu'ivakano or King of Vakano
a f t e r the c h i e f ' s v i l l a g e i n F i j i .
168.
According to Gifford (1923: 204), the name Nukunuku means "the
land within land".
love".
This may be true since Nuku'alofa means "land of
I t is unlikely that Nukunuku came from the Fijian word nuku
(as one authority in Tongan culture has claimed), since nuku i n
Fijian means sand.
land.
Nuku
Nu'u is apparently the proper Tongan word f o r
is said to be a recent version of nu'u.
Gifford also
noted that there is a tract near Fua'amotu village in Tongatapu
which is also called Nukunuku.
Nukunuku was one of the villages whose people rebelled against
the introduction of Christianity in early 19th century.
The people
expelled the Tu'ivakano of the day because he joined the new r e l i g i o n
(Christianity).
A new Tu'ivakano was installed and a strong f o r t ,
called Hule, was b u i l t .
This f o r t was later to succumb to Taufa'ahau
(who later became King of the whole of Tonga) and his warriors from
whom the deposed Tu'ivakano had asked assistance.
Because of the
people's mutinous nature in the past, Nukunuku is s t i l l known today
as one of Tonga's kolo kovi (bad v i l l a g e s ) .
have t r i e d to live up to their name.
Some of its citizens
As a result, Nukunuku was
one of the f i r s t villages to have a police station and now also
has a magistrate's court which serves the surrounding villages as w e l l .
The Methodist is the dominant church in Nukunuku.
forty couples in the sample were Methodists.
62.5% of the
There are also factions
of the Methodist Church, namely the Tonga Tau'ataina church and the
Tonga Hou'eiki Church.
The Mormons also have a church in Nukunuku.
There are people in Nukunuku who belong to the Seventh Day Adventist,
Roman Catholic, Assembly of God, and Tokaikolo (the newest church
founded by a Methodist Minister about six years ago), but they are
not large in number.
The members of these churches either meet i n
private homes or go to their nearest church.
169.
There are two secondary schools and two primary schools in
Nukunuku.
All schools are run by the Methodist church or by the
Mormon church.
There was a move by some of the villagers to
request that a government primary school be build in Nukunuku, but
the Methodist supporters soon blocked this.
Like the rest of Tongatapu, Nukunuku village is quite flat and
the soil is fertile.
There is no real problem for transport to
bush allotments where the people do most of their food gardening.
Not all the Tongan males who have reached sixteen years of age
get 'api kolo (town allotment) and 'api 'uta (bush allotment) as
prescribed by the Constitution of Tonga.
This is mainly due to the
shortage of land resulting from the growing population of Tonga.
Nukunuku village is modern by Tongan standards.
Most houses
are built with bricks and cement or wood, with corrugated iron roofs.
Some of these houses have modern conveniences such as flush toilets,
kerosene stoves, telephones, electricity and motor cars.
198 households in 1976.
There were
Thirty of these households had flush toilets,
128 manual flush toilets and 34 pit toilets.
Furthermore, 87 households
had kerosene cooking facilities, 62 had electricity and 146 homes had
a radio (Census of Population and Housing, Tonga 1976: 36-39).
houses have piped well water.
Most
Overseas remittances from relatives
working in developed countries like the United States and Australia
have assisted in the constant physical change of the village.
There are two buildings in Nukunuku where pictures and dances
are frequently held.
One is a big banana shed and the other is a
new Methodist youth hall.
Some people, however, would 50 to
Nukualofa for their entertainment.
for the kava drinkers.
There are also kava parties
But these are usually for fund raising.
There is also the pub at Kalisi section where people can have drinks
of liquor.
170.
Like the rest of Tonga, the people of Nukunuku are
That i s , the people are Tongan Polynesian.
have travelled overseas.
homogeneous.
Quite a number of them
For instance, 47.5% of the couples in the
sample for this study have been to either New Zealand, Australia, the
United States, F i j i or Samoa.
Most of these people went on working
holidays, but some had gone only to v i s i t relatives, for r e l i g i o u s
purpose or to exchange goods such as mats and tapa cloth f o r modern
household equipment and so on.
Nukunuku has a modern health centre that was opened in 1982.
At the time of research i t was staffed with an American Peace Corps
medical assistant o f f i c e r , a Tongan Assistant Medical Officer (one
of the f i r s t graduates of the two year medical course conducted i n
Tonga and assisted by the WHO) and a staff nurse.
"Very sick patients
are referred to the main hospital, but we can cope very well with most
things" said the Americal Peace Corps medical assistant o f f i c e r .
Unfortunately, during part of the period of research, a seminar was
conducted i n Nuku'alofa which the staff from the centre attended
I was unable to see more of the work they do.
and
This health centre
also caters for the surrounding villages.
There are twelve health centres now available in Tonga. Two
of these health centres, Kolovai and Houma, are only about f i v e
miles from Nukunuku.
The main hospital, Vaiola, which is situated
at the capital Nuku'alofa, is only about six miles from Nukunuku.
The roads are good to these modern health centres.
Public transport
is satisfactory and there is also private transport that can be used
in emergencies.
Traditional health care is s t i l l prevalent.
All of the people
that I talked to at Nukunuku have used some form of traditional medicine,
Some have consulted religious and card playing curers as w e l l .
171.
Traditional cures include a wide area of general, gynaecological ,
obstetric, paediatric care and family planning.
Thus, one of the
curers (a male) claimed to have a treatment for impotence in males
or f r i g i d i t y in females.
The t r a d i t i o n a l curers thought that modern doctors are clever,
but some diseases should not be treated by them.
Traditional curers
talked about patients who were not able to be cured by the modern
doctors
and were brought to them in a 'bad' state.
Modern Health
workers, for t h e i r part, thought that the traditional curers are
annoying because they would treat patients at home for sometime before
the patients were brought to the health c l i n i c , often in a c r i t i c a l
state.
Like the rest of Tonga, many of the people in Nukunuku believed
that illness is a type of supernatural sanction for breaking a tapu
or for doing something wrong.
Likewise, many believed that
cures and curers are only vaka boats for the healing power of God.
Education is valued. 95% of the couples in the sample went to
secondary schools, although only about 10% gained Higher Leaving
certificates.
The rest attended primary schools until reaching the
f i n a l school year compulsory by law (13 years old).
Most of the
people who l e f t school at primary l e v e l , according to informants,
did so because of financial reasons.
The people on the whole looked healthy, although many are on
the si no (plump) side.
However, i t should be noted that to be plump
is considered better than to be thin in the Tongan context.
Fo'i sino
(plumpness) is associated with beauty, good health and chiefly status.
The people eat a l o t of mutton flaps imported from New Zealand
as their ki ki (protein to eat with their vegetables).
172.
Mutton flaps
is the cheapest meat in Tonga.
Mutton flaps undoubtedly contribute
to the obesity of the people which in turn may cause the r i s i n g in
frequency of diseases such as diabetes and high blood pressure in
Tonga.
Occasionally, however, when people have the time off from
their weaving, tapa-making for the tourists and gardening, they go to
the sea to f i s h and to gather shell f i s h , crabs, sea slugs and so
on for k i k i .
These sea foods are usually a welcome change from
mutton flaps f o r many of the Nukunuku families.
Although Nukunuku is a progressive village and many of i t s
people have been to developed countries, the people s t i l l value
many of the traditional norms.
For instance, even though they
could varely afford a big feast before the new year in 1983, the
people gave a big feast to celebrate the 90th birthday of their chief.
There was enough food in the feast to feed a thousand or more, and
koloa (mats and tapa) were also p l e n t i f u l .
Some people complained,
but most appeared to feel good that they had done what was right i n
the eyes of the Tongan society.
RESEARCH - KALISi
Nukunuku village was too large to be observed during the short
time of t h i s study.
Thus, the north east section of Nukunuku v i l l a g e
was selected as the focus of research.
This section is called Kalisi
(Greece) by the Methodist population for administrative purposes.
other three areas are called P i l i t a n i a (Britain), Amelika (America),
and Tonga
Kalisi was sleeted mainly because i t is the nearest
section of Nukunuku to the village where I lived.
Nukunuku were included whenever possible;
Other parts of
hence, Nukunuku v i l l a g e
has been used instead of Kalisi section, in the main t i t l e of the
study.
173.
The
In addition to a month of constant participant
observation,
I also visited Nukunuku from time to time during May 1983.
There
were 54 households (people lived together and ate their meals together)
in Kalisi at the time of research.
Only 37 (68.5%) of these
households had both mother and father present.
Seven of these
parents, from seven households, had gone overseas to work, four were
widows, and six had shifted to other parts of Tonga.
I interviewed
forty couples (37 in Kalisi, and three couples were randomly picked
from the other sections).
Most of the unparcelled land in the Kalisi area five years ago
has since been divided up into sections and inhabited by the growing
population of Nukunuku, as well as people from other parts of Tonga.
The heir to the Tu'ivakano title recently had built a house in Kalisi.
There is also a new Methodist church as well as a pub (built with
remittances from overseas).
Kalisi will probably become the most
modern part of Nukunuku in the future, although it was the most
backward a few years ago.
The total population of Kalisi at the time of the research was
329.
About 48% of the parents in the sample had been overseas.
Thirteen persons in Nukunuku village were recorded as foreign born,
but none of those interviewed in Kalisi appeared to be of foreign
birth.
The Nukunuku community derived most of its income from agriculture
and selling artifacts to tourists.
Thus, 25 of the husbands in the
sample were farmers. That is, they grow food crops for their own use
as well as selling the surplus at the Talamahu Market, Nuku'alofa,
or to overseas markets.: The remaining husbands included eleven civil
servants, two shop owners and two church ministers.
Thirty-six of the
wives in the sample were housewives who were also weavers and makers
of artifacts to sell to tourists.
174.
Some of them do very well.
One
woman, for example, said that it is possible to sell over $100 worth of
artifacts in a few hours when a tourist ship arrives.
Sometimes
three tourist ships would arrive within one month, whereas none at
all might arrive for weeks.
Most of the families in Nukunuku have
relatives living overseas who frequently send money to pay for school
fees, church misinale (donations) and so on.
FINDINGS
The average number of children of the couples in the sample was
6.8:
s l i g h t l y more in the Mormon families (7,25)
and slightly
less in the case of Methodists and related factions (6.5) and Seventh
Day Adventists (5.33).
There were t h i r t y mothers in the sample who were s t i l l in their
child bearing age (under 45).
A total number of 172 children
belonged to these t h i r t y , making i t about 5.73 children per family
on average.
Although 100% of the adult population in Kalisi have heard of
family planning, only twenty-nine of the couples in the sample have
practised family planning.
One mother claimed that she had not
had any more babies since the ma'uli and her husband had terminated
further pregnancies by the ma'uli 's own method.
When asked how
this r i t u a l was performed, this mother explained that the ma'u1i
called her husband to come soon after the baby had been delivered.
Both the ma'uli and her husband then put both hands on her abdomen
and prayed to God that there were now enough children and asked God
not to send any more to the couple.
The m a ' u l i , when interviewed,
stated that she had been practising this form of r i t u a l when both the
mother and husband f e l t they had enough children.
she had been successful so f a r .
According to her,
Apart from two others who have
175.
been using a natural form of family planning method, twenty-six
have practiced modern methods of family planning as indicated
BELOW
Table 12:
Utilisation of Family Planninq Method by Couples i n sample
Method of Family Planning
Number of Couples
Ma'uli's method
1
Natural
2
t
Ligation
4
[
Pills
4
Loops
6
Depo Provera
i
10
1
Condom
\
1
Foam Tablets
•
Non-users
11
40
Total
Of those (26) who have used modern methods of family planning,
eight have discontinued.
Four discontinued
taking pills. The
reasons given were:
1.
Weakness of the body.
2.
Loss of weight.
3.
Dizzyness.
4.
Laziness to take the p i l l s as prescribed.
Two women discontinued having depo-provera injections mainly
because of abnormal vaginal bleedings.
One took the loop off
because of lower abdominal pains and one stopped using the foam
tablets because i t was messy.
A number of mothers have tried
several family planning methods.
For instance, one thirty-seven
year old mother had been on p i l l s , the loop and had depo-provera
injections in a bid to find one method which would s u i t her.
176.
1
How the Family Planning Programmes were first heard
of by Parents in the Sample
Table 13:
Sources
Number of Parents
Radio
30
Nurse
24
Doctors
18
Relatives
8
Others
0
80
Total
Table 14:
Preference; of Family Planni ng Sources of Information
by Parents i n the Sample
Source of Information
Number of Couples
Person -to -Person
29
Radio
5
Film
2
Public Ta lks
1
Any
3
Others
0
Total
40
The majority of the parents preferred person-to-person
communication.
They
maintained that family planning is a highly
personal matter and i t should be discussed privately so that questions
would be asked i f the information was not clear. 100% agreed t h a t
tapu (meaning brother and s i s t e r or couples of opposite sex) i s the
most important single factor that would stop people from attending a
mixed group watching films or l i s t e n i n g to a public talk on f a m i l y
planning.
However, when groups of women or men are concerned i t was
not too bad, but even then f o r a woman to listen together with her
brother's wife to a family planning programme is considered i n bad
taste.
Those who preferred films thought that i t would be much
clearer i f talks could be i l l u s t r a t e d by a f i l m .
177.
And those who
preferred radio and public talks thought that a bigger audience would
benefit.
Six parents thought that it would not make any difference
how family planning was communicated to people, for people would
practise it only if they wanted to.
The majority (90%) of the couples in the sample strongly
disagreed that the use of family planning methods should be a
matter to be decided by one partner only.
These couples further
agreed that matters relating to sex should be highly sacred between
wife and husband.
These matters are not to be taken lightly, as it
would lead to marital disharmony and suspicions between husband and
wife.
However, 7.5% thought it is a matter for mothers only to
decide, since she is the one who is going to have the baby.
One
couple (Methodist) was undecided.
Only twenty-two of the couples in the sample wanted to know more
about family planning.
The three aspects of family planning which
they wanted to know more about, mentioned most, are listed below in
their order of priority:
1.
The effects of modern family planning methods on the health
of mother and child.
2.
New available methods of family planning.
3.
Ways to get the desired sex of baby.
Those (45%) who did not want further knowledge of family planning,
claimed that they knew enough.
Most of these were couples over forty-
four years old who thought that they were no longer fertile.
Thirty-six of the couples in the total sample thought family
planning is a good thing for Tonga.
Their given reasons are listed
below in their order of priority:
1.
Not all our boys would be able to have 'api 'uta (bush
allotment) or 'api kolo (town allotment).
2.
There is a lack in economic resources.
178.
3.
The population of Tonga is growing f a s t .
4.
A large family has many problems.
5.
There is lack of employment.
Of the few (10%) who viewed family planning unfavourably, two couples
gave religious reasons (both Mormons), one couple claimed that having
many children would serve as an incentive to work harder, and one
couple was undecided.
Like most rural areas in Tonga, K a l i s i ' s mothers have had more
deliveries at home than in the hospitals.
Out of the 40 mothers,
eleven have had a l l their babies at home, and f i f t e e n had a l l of
t h e i r ' s in hospital.
The remaining mothers (14) have gone to the
hospital for some of their confinements, but most of t h e i r babies
were born at home.
Thus, 60.8% of all babies born to these women
were delivered at home.
by the m a ' u l i .
91.4% of these home deliveries were conducted
Only 8.6% were delivered by modern health workers.
The majority of the couples within the sample were married
before they reached the age of 30.
of age.
Only 15% married after 30 years
Thirty-seven of the f o r t y couples were married for the f i r s t
time.
Table 15:
Ages When Couples were Married
Age
0-20
Couples
30
21-30
38
31-40
10:
Women tended to marry younger than men.
41-50
Total
2
80
For instance, all of
the 30 parents who were married before they were 21 years old were
females.
Twenty-eight of the mothers who were s t i l l under 45 years
had f i v e or more children.
Three of the mothers had more than nine
children, while six had babies after f o r t y years of age.
179.
Table 16:
Average Number of Children per Couple in the Sample
Couples
%_
Number of Children
4
10.0
1-3
17
42.5
4-6
13
32.5
7-9
6
15.0
10 and over
The average number in a household was about 7.22 at the time
of research.
The average f o r Tonga was about 7 in the 1976 census.
Most o f the couples (80%) thought t h a t the ideal number of
children was 4 - 6 .
children.
However, f i v e couples wanted more than s i x
In r e a l i t y 42.5% of the couples i n the sample have had
4-6 c h i l d r e n , but most were s t i l l
in t h e i r productive age group and
47.5% had more than six children each.
Table 17:
Average Number i n a Household
Couples
%
Household
3
7.5
1-3
12
30.0
4-6
17
42.5
7-9
8
20.0
10 and over
According to mothers i n the sample, two years is the most
favourable i n t e r v a l between pregnancies.
But, of course, parents
i n the sample have had babies i n less than two year i n t e r v a l s .
Table 18:
Ideal Spacing f o r Pregnancies among 40 Mothers
Interval
Couples
1 yr
2 yrs
3 yrs
4 yrs
5 yrs
16
10
4
5
Total
40
Except f o r four mothers in the sample, a l l claimed normal
pregnancies.
A l l the four who had had some sickness during
pregnancies said t h a t they had suffered from morning sickness, but
180.
that they
were a l l right after the f i r s t few months of pregnancy.
One of these four was supposed to suffer morning sickness only when
she was expecting a baby g i r l .
All of the children born to 34 of the couples in the sample were
s t i l l alive.
Of the children who died, two were supposed to have died
of pneumonia when they were both about two years old.
six, died before they were one year old:
died within fourteen days after b i r t h .
And the rest,
two died at birth and four
Of the four who died within
fourteen days, three died of general malaise and one of bleeding from
the umbilical cord.
All children who died before they were one year
were delivered by the traditional birth attendants.
Table 19:
Mothers
Preferred Medical Care During Pregnancy
Modern
Traditional
Traditional/Modern
Doctor Doctor/Nurse
TBA
TBA & Doctor
8
9
18
According to the above table, only four of the mothers preferred
being cared for during the ante-natal period by the ma'uli (TBA), yet
more than 50% of all deliveries were conducted by the ma
'uli.
It
is possible that this preference may have been influenced by the fact
that those interviewed knew that I was a nurse.
Modern ante-natal
care appears to be an aspect of modern health care where those
concerned (pregnant mothers) are almost 'forced' to go to a modern
health worker for examination.
Even some of the ma 'uli have been
taught to encourage mothers to go for frequent ante-natal checks at the
hospital, health centres or maternal child health
clinics.
On the
other hand, perhaps this is one example where the health care system
and disease theory system (Forster and Anderson 1978: 37-38) shows
their differences in relation to people's preferences.
Although
pregnancy cannot be regarded as an illness i t is often referred to as
181.
such in Tonga.
Thus, when a person is pregnant ( i l l ) she appears
to trust the knowledge and s k i l l of doctors.
But when i t comes to
delivery, where much loving care is needed by the mother in labour,
the traditional type of care is preferred.
Those who preferred modern
ante-natal care gave the following reasons:
1.
The hospital workers have learnt about the whole body,
and therefore, they should know better how to care for
pregnant mothers.
2.
To get protective injections and tablets.
3.
I t w i l l be easier for the staff of the hospital to
accept me for delivery at the hospital i f I have antenatal records.
4.
The hospital is cleaner.
Those who preferred the ma'uli gave the following reasons i n
their order of p r i o r i t y :
1.
The hospital and their staff are sometimes frightening
and strange
and i t is embarrassing to be examined by
a male doctor.
2.
3.
4.
Because the ma'uli is closer
and would come and stay
for the whole time of labour
i f necessary.
Ma'uli
are loving and uncerstanding.
The medicines she gives during pregnancy are useful to
keep the mother healthy.
Those who preferred both doctors and ma'uli do so because they:
1.
Want to be sure that a l l is well with their babies.
2.
Wish to learn both modern and traditional ways on how
best to look after oneself during pregnancy.
3.
Would find i t easier to go to either the hospital or
ma'uli for delivery.
182.
Table 20:
Preference of Curers when a Member of Family
Traditional
Curers
Modern
Curers
Religious
Curers
10
28
2
Couples
Falls ILL
Card
Curers
Reasons for preferring doctors:
1.
The doctor knows best.
2.
The doctor is more modern and more civilized.
3.
The doctor was educated overseas.
Reasons f o r Preferring Traditional Curer (taha faito'ofakatonga)
1.
Because the traditional curer is closer to give assistance.
2.
The traditional curer is kinder and less fightening.
3.
I t usually does not cost anything to go and see a
traditional curer.
Reasons for Preferring Religious Curers
1.
I t is a religious belief (both are Mormons)
2.
Because the religious curer can cope with all diseases.
Despite the specific preference for curers, a l l agreed that
they would t r y others i f their f i r s t preference should f a i l .
After
a l l , the healing power of God can use any type of curers or cures
for a vaka.
Most of the people of Kalisi are less than a kilometre from the
medical centre.
possession.
Many of the villagers have some tablets in their
10% practised some curing themselves, particularly
giving medicines to children.
Others are only a few doors away
from someone (usually a relative) who would know the herbs to be used
for particular diseases.
primary health care.
However, all these are in a form of
When a person does not get better with the
given medicine, the patient may be taken to a doctor or to a
better known traditional curer who is specialized in treating that
183.
particular ailment.
Some of the villagers would rather go to Vaiola
Hospital than to the health centres.
When asked why, the following
reasons were given:
1.
Because there are better qualified doctors at Vaiola
Hospital.
2.
Sometimes i t is a waste of time going to the health c l i n i c
as the workers won't be there or not
'on
duty'.
But in
Vaiola Hospital, one could usually find a doctor there.
3.
In cases of emergency, i t is better to go straight to
Vaiola, where modern equipments are likely to be
available.
Table 21:
Preferred Sex of Children
Girls
Couples
Boys
20
1
Both Sexes
Total
19
40
All the interviewed couples appeared to have the same
preference in so far as the sex of their children.
It was
noticeable in many cases, however, that it was the father who would
make the first comment.
The reasons given for these preferences are
as follows:
A.
Forgirls (50%)
1.
The girls are more loving toward their parents even after
they left home for jobs or marriage.
B.
2.
The girls are less troublesome than the boys.
3.
The girls usually stay home and help their mothers.
Both girls and boys (47.5%)
1.
We ought to be thankful to God for what ever children
we are given.
2.
The children of different sex would be able to help each
other when they grow up.
184.
•
:
\
C.
Boys only (2.5%)
1.
Boys are not hard to look a f t e r , while as girls have to
be guarded a l l the time before marriage.
2.
They are easy to clothe.
The couple who preferred boys only have both passed their Higher
Leaving C e r t i f i c a t e .
The husband is a policeman and the wife is a
teacher.
Most mothers remembered their children's birthdays, but the
fathers found i t d i f f i c u l t to do
so.
The f i r s t birthday of a
child is usually celebrated with special foods and prayers since they
say the f i r s t year of l i f e is the hardest to keep a child a l i v e .
Once that hurdle is reached, the child usually survives to adulthood.
The mothers also admitted that bottle fed babies are often
sickly.
Because milk powder is expensive to buy, the babies are
sometimes given other diluted milk mixtures.
Furthermore, they
would not throw away left-overs in bottles, but leave them for the
next feed.
milk.
In most cases, there are no refrigerators to store the
The mothers know that the breast fed babies have beautiful
skin and rarely get sick.
When asked why they think breast fed
babies are l i k e t h i s , they said i t is because breast milk is what
God meant to give to the babies.
All the adult population interviewed in Nukunuku reckoned that
there are mahaki papaiangi (European diseases) and mahaki fakatonga
(Tongan diseases).
Each type of disease would not be cured i f
given the wrong treatment:
or
Tongan medicine for papalangi diseases
modern medicine for Tongan
diseases.
They cited quite a few
examples of mistreated cases which ended disastrously.
185.
As i
Illnesses which are said to be Tongan:
'Avanga:
Spirits possessed disease.
Ngalo'afu:
Bad sore throat (said to be diptheria).
Makehekehe:
Abdominal diseases,
Kulokula:
A disease associated with shivering attacks and
redness of the skin (said to be filaria).
Mavaeua:
Widening of the fontanela.
Mofi Tonga:
Tongan fever, usually intermittent in nature.
The patient is apparently only hot on the soles
of the feet and palms of the hands.
Tapitopito:
Infant illness which appears to centre around
a slow healing umbilicus.
Fakamahaki:
Any illness which is slow to heal, is assumed
to be caused by evil spirits.
Illnesses that are said to be European:
Include:
1.
Tuberculosis
2.
Pneumonia
3.
Diabetes
4. Asthma
5.
Heart diseases
6.
Boils
7.
Mofi Papalangi (European fever)
8.
Diarrhoea and vomiting
The diseases which are claimed to be Tongan have Tongan names
which are d i f f i c u l t to translate into English.
Diseases l i k e
kulokula and ngalo'afu, however, are said by modern healers to be
f i l a r i a and diptheria respectively.
But f i l a r i a and diptheria are
specific diseases whereas kulokula and ngalo'afu
For example, there are many types of kulokula.
106.
are more general .
Similarly, ngalo'afu
is a term that may be applied to any type of sore throat.
European
diseases tended to have names which may simply be the Tonganised
version of the European names.
and tuberculosis (T.B.) is
For example, pneumonia is niumonia
tipi.
Some names are more descriptive.
For example, diabetes is suka (sugar) and asthma is heia (tiredness a tiredness relating to breathlessness or panting after physical
exhaustion.)
The women in Nukunuku recognised common infant illnesses (such
as mavaeua and Tapitopito) which are best treated by traditional
curers, because they are claimed to be Tongan diseases.
However, the
parents usually take their children to the doctor when they have high
fever, vomiting or diarrhoea.
All
the mothers thought that
immunising of children against infectious diseases, such as p o l i o ,
measles, diptheria, tetanus and tuberculosis is very good for future
protection.
Except f o r abnormal vaginal bleeding (which was usually blamed
on modern family planning methods), very few gynaecological diseases
were evident or admitted.
There was one case of breast cancer, in
which the sufferer was discharged from hospital because her prognosis
was hopeless.
Few Tongan women would go to the hospital to be
examined f o r diseases in the birth canal, particularly since examinations
are usually conducted by male doctors.
Ki' i
loi,
is a term often used by the traditional curers
themselves, as well as the people, for traditional types of
curing practices.
According to many people this is a hangover
from the brainwashing given by the missionaries to the people i n
the old days.
However, this brainwashing is s t i l l continuing,
not only by some church leaders (because of i t s ancient Tongan r e l i g i o n
connotation) but also by some of the modern healers who do not bother
to learn what the treatments are a l l about.
187.
But there is also the
faka'aki'aki mui concept in the Tongan context which frowns on
boasting but values belittling oneself.
All of the adults interviewed in Nukunuku claimed that religious
and card playing types of curing are very important categories of
curing practices in Tonga, particularly in cases where both
traditional and modern medicines have not been effective.
More
than 60% of the adults interviewed volunteered information on cures
which were revealed through dreams.
These cures are particularly
valued in the community because they are revealed from the ope
(beyond) specifically for a particular patient.
However, some of
these treatments have been known to be useful to patients with
similar ailments.
Sometimes
traditional health cures.
these dreams are connected with the
I have not heard of any dream where modern
treatments had been advocated.
This following account is a typical
case of illness and treatment revealed through a dream:
"I have had problems with my skin for three weeks.
All my
body was itching, and when scratched, a red elevation on the
skin would appear which later began to fill with fluid,
like burns.
When these skin elevations break, they left raw
areas all over my body.
I was both miserable and worried,
since I have tried modern and traditional cures without effect.
I decided to go on a little fasting and pray.
In fact, while
I was on this fasting and praying, I dreamt at night that I
was talking to an old aunty of mine.
I showed her my arms
which were full of sores, and asked her if she knows something
which could cure them.
In my dream, I saw a bunch of bananas
close by where my aunty and I were talking.
My aunty pulled
up this bunch of bananas and said 'see the little white things
at the top of each banana, go and gather some of these and make
yourself some medicine in the usual way most Tongans make
medicines and drink it'.
I told my wife what was revealed to
188.
me on the night before.
She went and gathered the s t u f f from
bananas and made the medicine.
I drank i t
Look (and
he showed me his arms) you can hardly see any marks on my s k i n . "
In some cases the person i n the dream (who is usually a dead or
live
r e l a t i v e ) may instruct the person to go to a particular curer.
More than 60% of the couples in the sample have known patients
healed by modern medicine a f t e r a long treatment of traditional
medicine or vice v e r s a . B u t as many pointed out, i t is not an easy
matter t o judge which was the medicine that actually cured the p a t i e n t ,
When a patient is sick, invariably he or she w i l l be given some
t r a d i t i o n a l medicine or tablets (as a type of primary health care)
before she or he is taken to a doctor or to a better known t r a d i t i o n a l
curer.
More than l i k e l y , the patient w i l l be on two or three
d i f f e r e n t categories of cures simultaneously for good measure.
Some of the diseases which the doctors were supposed to f a i l to
cure include those in the previous l i s t of Tongan diseases, plus ear
aches, absesses, b o i l s , sores and engaenga (jaundice).
Diseases which f a i l e d to be cured by t r a d i t i o n a l curers
include those in the previous l i s t of European diseases, plus
toothache, palangakau (peptic u l c e r s ) , abnormal vaginal bleeding and
conditions which need surgery.
P e n i c i l l i n injections are considered dangerous to be given
f o r some Tongan diseases.
These diseases include ngalo'afu, and
non-inflammatory aching swellings.
The main advantages of modern
medicines is t h e i r f a s t action and easiness to obtain (tablets and
injections).
On the other hand, the main advantages of traditional
medicines is that those who are practising i t (kau f a i t o ' o fakatonga)
are usually close and prepared to assist those who are i l l at any
time.
189.
The stereotypical modern doctor, according to the Nukunuku
sample, is clever, clean, confident but busy and arrogant.
they agreed that there are exceptions.
But
The stereotypical traditional
curer is kind, amusing, confident, but slow and not very clean.
All the interviewed children like school and hope to continue
to secondary school.
The parents were also keen that their children
should be educated as far as possible.
To this end, many families
go without good food and other necessities.
Eight traditional curers were interviewed in Nukunuku:
ma'uli and six general curers.
two
Both ma'uli are females and two of
the six general curers are males.
Of the fifteen children who were interviewed, nine preferred
t r a d i t i o n a l medicine to modern medicine, and six preferred modern
medicines.
Of those who preferred traditional medicines, three
d i f f e r e d with the preference of their parents.
Their parents
preferred modern medicines.
The children who preferred traditional health practices did
so because traditional curers are supposed to be less frightening
than the doctors.
Although traditional medicines may taste awful,
they are supposed to be far better and less painful than the injections
of the doctors according to the nine children who preferred Tongan
t r a d i t i o n a l health practices.
Those who preferred the doctors, did
so because their parents know or are related to a doctor.
liked
They
going to the hospital to see the doctors at work and they
reckoned that the medicines they gave were often sweetened and a
pleasure to take.
The nine old people did not have much choice in this matter
because their children or relatives usually decided what was good
190.
for them when they are not well.
Only two of the old people i n t e r -
viewed in Nukunuku stayed with relatives, the rest (seven) were staying
in their own homes.
to help them.
But someone usually stayed with these old
people
One old woman was looked after by a niece and her
husband, and one old man was looked after by his son and his w i f e .
Two of the old people are a couple i n their mid-seventies.
This couple have had twelve children.
Many of them are overseas
and frequently send their parents money.
crop grower in Nukunuku.
One son is a big cash
The children, according to the couple,
were treated equally when being brought up.
aspect of t h e i r family l i f e .
Religion was an important
For instance, family prayers had
to be attended by all the family in the evenings.
children were breast fed.
All the
This breast feeding helped to foster
more lovewithin the children according to the mother.
Most of the old people agreed that people in the past ate more
vegetables, fish and s h e l l f i s h , but less meat.
On the whole, the old people were healthy.
One old lady t o l d
me that she was never sick until she took the kulokula tablets t h a t
she was given to take in a campaign against f i l a r i a in the late 1970s.
She reckoned that she nearly died.
She threw away the rest of the
tablets and she got better.
All the interviewed old people were s t i l l active.
man of 82 was s t i l l going to his plantation in the bush.
reckoned that the secret of long l i f e was 'hard work'.
One old
He
An old
lady (about 75) who was staying with a niece and her husband often
baby sat f o r the couple.
All these old people were s t i l l able to
do their own cooking and generally looked after themselves.
One of the ma'uli was over 80 years old,
She admitted that
she was beginning to feel her age, as now she can barely control the
191.
baby as i t comes out of the birth canal.
The main reason she
continued, according to her, was because mothers s t i l l pester her to
deliver t h e i r babies when i t is too late to send them to the hospital
or to call a younger m a ' u l i . Many of the mothers interviewed
voiced their trust in the old ma'uli and said that they would rather
have her deliver their babies than anyone else.
(who died in 1951) was a ma'uli.
Her late husband
I went to see this old
ma'uli
four times and each time two or three pregnant mothers were there.
One time there was a woman going in with premature labour.
The
young woman's abdomen was palpated and l i f t e d 'upward', with the r i g h t
hand of the ma'uli just above the pubic area while her l e f t hand
applied a gentle pressure on top of the fundus.
out for about ten minutes.
This was carried
Traditional medicines made of olonga
bark and six ate leaves, was given and then she was told to rest
before t r y i n g to go home.
The young woman was already having vaginal
bleeding and uterine contractions, but the contractions stopped a f t e r
the treatment and the young woman was able to sleep for a couple of
hours before boarding the bus to go home.
hopeful that the foetus would be saved.
had a miscarriage that night.
The ma'uli was not
I t was not.
The young woman
At the time I wondered about s i m i l a r
cases who would have probably done well i f f a c i l i t i e s were available
in the ma'uli 's place for mothers in similar conditions to rest f o r a
much longer period as in a hospital.
to the ma'uli one day for teething.
A young baby was also brought
The ma'uli operated on the child
by using the sharp edge of to'o shell to incise the swelling gums of
the child.
She explained that the 'bad blood' must be got r i d of so
that the child is more comfortable and for the new teeth to come
up easily.
All the old people agreed that the children in their
young
days were better behaved. This they attributed mainly to the mohe o f i
192.
concept, which means that the mother teaches her children from an
early age how to behave in relation to different members of society.
They f e l t parents of today seemed to spend more and more time away
from their children and the children are l e f t to fend for themselves
as much as possible.
I t is no wonder, according to them, children
are disappointing to their parents.
At the time of research, three people were sick at their homes
in
Nukunuku.
Two came out of the hospital as 'hopeless' cases
(according to relations) and one old woman refused to have anything
to do with modern medicines for her particular ailment.
these three was a case of cancer of the breast.
One of
The young woman was
only in her early 30s, a school teacher, married with three children.
I t was obvious to me that the young woman was unlikely to get better,
but there were many traditional curers who called and tried their
cures.
Although she was very i l l , she was not in pain and was much
more comfortable than when she was in hospital, according to her
relatives.
She died six months afterwards.
There was also another
young woman with a large unsightly swelling on the left side of her
face.
She was in hospital for some weeks but the doctors did not
know how to handle her condition.
The family then asked to take the
patient home and they were allowed to do so.
The American Peace
Corps medical assistant officer at the Nukunuku health centre gave
the patient a course of p e n i c i l l i n , but at the same time the young
woman was also having
ulifi
as
cancer).
ulifi
(many traditional curers identified
Eventually, the swelling burst just below the
ear and a large quantity of discharge came out.
The American Peace
Corps gave the traditional curer (who happened to be a young woman of
only 23) cotton wool, but left the entire dressing responsibility to
the traditional healer.
This healer did the dressings twice daily.
First she made a lotion of tamatama leaves (tamatama or ACHYRANTHES
ASPERA leaves are said to be excellent for the treatment of tetanus)
193.
t o wash the area before l o c a l l y applying a mixture of f i n e l y pounded
hehea, nonii and p o l o f i f i s i leaves.
The area was gently amo
and cotton wool dressing was then applied.
The patient was also given
a mixture of tono leaves to drink twice d a i l y .
quite normal now.
A gauze
This young woman is
The last case was one of an old woman who refused
t o be given modern medicine (although she appeared to be i n agony)
because the t r a d i t i o n a l curer had told her that modern medicine was
tapu.
She had a swelling on the r i g h t side of her back which had
kept her i n bed for two weeks.
I eventually persuaded her to take a
couple of panadol 'for the pain o n l y ' .
I returned from Tafahi i s l a n d .
She was quite well when
He treatment also consisted of
local applications and oral Tongan medicines.
Most (66.66%) of the children sampled obey t h e i r mothers more
than t h e i r fathers at home.
They stated that this was because
they loved t h e i r mothers more since they had given them b i r t h and looked
a f t e r them from day to day.
The rest of this sample obeyed t h e i r
fathers more because they were the heads of their families.
DISCUSSION AND CONCLUSION
On the whole, the people of Nukuniku, l i k e those in ancient
Tonga, believe that i l l n e s s is a sanction for breaking of tapu or
sin.
Thus, values r e l a t i n g to proper social realtionships, such as
respecting of monarch, chiefs and religious leaders are taught early
by the mothers at mohe o f i .
At the same time the people believe
t h a t there are Tongan diseases and European diseases.
diseases must be given the r i g h t treatments.
These
That i s , modern health
care f o r European diseases and Tongan health care f o r Tongan diseases.
The f i r s t choice of 25% of the couples i n the sample , when a
member of t h e i r household is s i c k , were t r a d i t i o n a l cures, while 32.5%
preferred modern medicine.
At the same time, 37.5% would go to
194.
either , depending on the type of disease.
health care - they are Mormons.
5% preferred religious
All admitted, however, that they
would try any type of treatment to gain health, including card playing
cures.
It is interesting to note that 66.6% of the children's
sample preferred traditional medicines, although it appeared more
as a protest against 'injections' rather than liking traditional
cures.
But cures are one thing, curers are another.
On the whole,
the people of Nukunuku preferred modern medicines but traditional
curers.
That is, the people appreciated the fast acting effect of
modern medicines in many instances, but disliked the arrogant attitudes
of the doctors.
Nukunuku is a village which is fortunate in so far as the
availability of modern health care facilities in Tonga.
In
addition, the adult population have all had primary education and 95%
have been to secondary schools.
The fact that many of the people
still prefer traditional health care points to two premises:
1.
That the people are beginning to be more appreciative
of the effectiveness of traditional health practices.
2.
That the people are dissillusioned with the modern
health cares.
If we consider the matter in the light of Foster and Anderson's
(1978: 37-38) divisions of disease theory system and health care
system, it would appear that the people of Nukunuku do not so much
deny modern disease theory, as they dislike the way care is being
directed by the priests of the modern medical system.
The people on the whole recognized the advantages of breast
feeding.
They associate the loving nature of children to breast
feeding.
That is, those who have been breast fed are much more
195.
> i
loving towards the parents than those who were not.
The old couple
with twelve grown children attributed breast feeding and religious
upbringing to the loving regards of a l l their children toward them.
Although 100% of the adult population of Nukunuku had heard of
family planning, only 45% of the couples in the sample had practised
any method of family planning. 89.65% of those who practised family
planning u t i l i s e d modern methods.
30.7% of these had already
stopped due to side effects of family plannign methods.
Because of the social tapu connecting with the discussion of
sex matters i n front of brothers and sisters (or close relatives
of the opposite sex) as well as for c l a r i t y ' s sake, 72.5" of the
couples in the sample thought that person-to-person discussion (and
i f necessary with person of own sex)
planning information.
was the best way to give family
90% of this sample strongly agreed that
family planning must be discussed by both partners before any form
of family planning methods is used.
Failure to do this might lead
to marital disharmony and suspicion between partners.
Only 55% of
the couples i n the sample wanted to know more about family planning.
Although only 10% of the mothers in the sample preferred the
t r a d i t i o n a l ante-natal care as against 45% who preferred modern
ante-natal care, over 50% of the sample's children were delivered
by the m a ' u l i . The rest of the mothers (45%) would have both
modern and traditional health care.
Gynaecological maladies did not seem to be a major health
problem.
Except for the young woman who was dying of breast
cancer at the time of research, none of the women complained of
any.
There are traditional medicines available for abnormal
vaginal bleedings, breast diseases, kahi, etc.
One male
t r a d i t i o n a l curer has a medicine which he claimed could cure both
196.
ill
impotency in males and f r i g i d i t y in women.
This is the only instance
of this that I have come across in Tonga.
There are, however, plenty of traditional medicines for children
which many of the mothers know and administer to their own children.
but the authorities in traditional paediatrics appeard to be two
ma'uli.
The influence of religion in the l i f e of the people in Nukunuku
is emphatic.
Regardless of education and age, most people
believe that cures and curers are only vaka for the healing power
of God.
Similarly they believe that each of us has a day on which
God w i l l call us.
On that day no vaka on earth will convey us back
to this world.
Although modern curers have been trying to discourage nonmodern medical health preactices, the existence of these forms of
health practices serve to lighten their work loads.
Each time I
visited the health centre, people were waiting to see the Assistant
Medical Officer.
In Vaiola hospital, sometimes the people would
wait for hours to see the d o c t o r . I t should be noted, however,
that none of the people interviewed in Nukunuku had been o f f i c i a l l y
inhibited from practising non-modern medical health care.
197.
CHAPTER
VI
CONCLUSION
The best decisions w i l l be based on the judgements of mature
n o n - e l e c t r i c brains possessed by men who have looked s t e a d i l y
and calmly at the s i t u a t i o n and see i t whole.
(Schumacher 1973: 224).
Technologies change, d i r e c t i o n s change, p o l i c i e s change, but
i t i s t h e s p i r i t of man - his s p i r i t of endeavour, his s p i r i t
of concern and sympathy f o r the unfortunate and the most needy,
and h i s s p i r i t o f cooperation - which w i l l u l t i m a t e l y take
him t o reach his goals.
(Tapa 1977)
In t h i s thesis I have sought t o analyse the a t t i t u d e s of the
people of Tonga towards health practices i n r e l a t i o n to the Tongan
e t i o l o g y o f h e a l t h , i l l n e s s and c u r i n g , and p a r t i c u l a r l y i n r e l a t i o n
t o maternal c h i l d health and f a m i l y
planning.
The ultimate aim has
been t o f i n d s u i t a b l e approaches which could a s s i s t i n designing
p o l i c i e s t o improve the welfare of Tongan society as a whole and t o
promote greater self-sufficiency.
Tonga's development has relied heavily upon foreign aid.
For instance, i t has been estimated that during Tonga's development
period 1975-1980, about 82% of the total capital expenditure of the
Ministry of Health came from foreign aid sources.
Exploring the use
of Tongan traditional health care and promoting i t should not only
result in greater self-sufficiency in matters of health, but would
inevitably decrease heavy reliance on foreign aid.
•"Health for all by the year 2000 has been adopted by the Tongan
Government as a health goal since the International Primary Health
Care conference in the Soviet Union in 1978.
198.
Primary health care
is assumed to be the "key to attaining this target as part of
development in the s p i r i t of social justice" in Tonga's current
development plan (Tonga 1980:
298).
Furthermore, i t is recognised
that assistance by traditional curers like the ma'uli (particularly
in the rural areas) in promoting health and improving the quality
of service is important.
For example, in the section on
'Development Strategy for Primary Health Care' i t is written:
The role of traditional birth attendants w i l l be increased
in promoting health and to improve the quality of service.
More emphasis w i l l be given to coordination with traditional
healers.
(Tonga 1980: 303).
In addition 'self'help' is perceived as more cost-effective and
generally the best way to improve health.
This sudden flashing of the 'green l i g h t ' for traditional
health practices came as a surprise since they had been suppressed
by most modern health workers.
Nearly 88% of the doctors interviewed
in Tonga thought traditional health practices were definitely
inferior to modern medicine and about 60% said there is no future f o r
combining modern and traditional health care.
I t is no wonder that
even traditional curers talked of their cures as 'fanga ki ' i
fakatonga'
loi
(small Tongan lies). They have been brainwashed by
missionaries, doctors and modern education for decades.
But
perhaps i t is also f a i r to say that their view also reflects the
concept of faka'aki'akimui ( b e l i t t l i n g one's self) which is valued
in
Tongan society.
Personally, however, I do not think that
the low opinion attributed to Tongan traditional health care is
related to the concept
faka'aki'akimui.
Although the value of Tongan traditional health care has been
degraded for years, all the adults interviewed had had traditional
medicines and many believed in their effectiveness.
Unfortunately,
many of the traditional cures have been forgotten and not many
199.
people are willing to follow their ancestors' footsteps.
traditional curer was dying in a village in Tongatapu,
An old
When I asked
her children about their mother's medicines, no one knew much. They
a l l said how much they regretted not writing down their mother's
cures.
But this is a common regret among children of Tongan
traditional curers who have passed away.
Having low opinions of traditional health practices is apparently
widespread, yet about 80% of the Third World population's only hope
is traditional medicine when feeling unwell.
It
is
also increasingly apprent by the present activities to promote
traditional health practices.
This is obvious from remarks such
as those by Professor Udupa that modern medicine has been unable to
care adequately for many of the people in the poorer countries:
Since all the countries in the world have now accepted the
goal of Health for All by the Year 2000, there is no
alternative but to take the fullest advantage of the age-old
experience of traditional medical practitioners.
(Udupa in WHO 1982: 22).
In this study, traditional health practices are viewed as
different or alternative to other categories of health practices in
Tonga, but certainly not second rate or inferior.
All categories
of health practice are seen as aiming at reducing the suffering and
pain of illness and disease and promoting health.
All have their
quacks and faithfuls; all have killed and performed miracles.
I t would be a fallacy to proclaim that all aspects of
Tongan ancient religion have been wiped out of Tonga and that the
nearly 100% proclamation of Christianity in Tonga is a proof.
There are s t i l l many areas of Tongan culture today in which important
aspects of the Tongan ancient religion are s t i l l very much in evidence,
The institutions of mana and tapu, for instance, are s t i l l prominent
features of the etiology of health, illness and curing today.
200.
The monarch and his fale (house, family) and belongings are still
perceived by Tongans as surrounded by mana. It may be easy for a
non-Tongan to have an audience with King Taufa'ahau Tupou IV, but
it is not so with ordinary Tongans without experiencing the momofi
(feverishness) of his mana - a feeling that is simultaneously of
great fear and great honour.
Tongans can cause illness.
The tapu of his mana when broken by
A similar situation prevails with the
breaking of lesser mana such as those belonging to one's
mehekitanga and fahu (father's sister) or church leaders. Specific
diseases such as fula (swelling in the neck) is said to be the
result of eating left over foods of chiefs or mehekitanga. The
fula can be treated by asking the person concerned to amo the
affected neck - an assurance that one is forgiven, forgiveness being
a very important aspect of healing in the Tongan context.
Hence
the importance also of religious types of treatment when one is sick
and is guilty of having committed a sin.
Mana and tapu also serve
as means of social control.
Many of the illnesses (and other happenings) in Tonga are still
attributed to supernatural sanctions and are treated accordingly.
God is somehow seen as the source of both illness and cure
But
there are also evil spirits who would cause diseases, such as 'avanga
and fakamahaki.
The treatment of these diseases involves the
'forceful removal' of the assumed agents by using appropriate
traditional
medicines.
To insist that all these are simply lies
is to say that the universe is an open book and that there are no
mysteries to solve; that there is no point in continuing with
scientific research.
These views are often ethnocentric, made by
people from other cultures with values and beliefs totally alien
to the culture concerned.
201.
I t has been argued in this thesis that social health is the
most important aspect of health to the Tongans.
For health is more
a feeling of being blessed and being at peace with one's God and
members of one's society than a feeling of physical well-being.
Monitonu (having everything go right with one) has been suggested
as a more appropriate term to describe the concept health rather than
mo'ui leiei (good l i f e ) .
There are four categories of curers in Tonga:
t r a d i t i o n a l , religious and card-playing.
curers are the modern doctors.
(Christian) curers u t i l i s e
modern,
The o f f i c i a l l y recognised
Both the card playing and religious
some traditional and modern cures.
There are also treatments which are revealed through dreams, but
these are often viewed as part of the traditional or religious health
cares.
The traditional birth attendants or traditional midwives are the
backbone of primary health care in many developing countries.
In
some areas more than 90% of births have been conducted by these
traditional birth attendants as well as giving health care to mothers
and children.
In Tonga, despite the accent on hospital deliveries
and the a v a i l a b i l i t y of modern health o f f i c e r s , about 30 of a l l
deliveries in 1981 were conducted by the kau
ma'uii.
In Tafahi
island and Nukunuku v i l l a g e , two areas where the research for this
study was concentrated, over 66% and 50% respectively of the
deliveries in the sample were conducted by the ma'uli.
The
kau m a ' u l i are also used in the f i e l d of family planning, generally
as motivators and sometimes as distributors of condoms to c l i e n t s .
'Traditional medicine is synonymous with primary health care
in most developing countries.
countries.
This is the case in most Pacific
Primary health care is viewed as a new label for
something that has been going on naturally for
generations.
The
202.
nil
present emphasis of primary health care as a new concept may have
adverse social effects.
While illness and sickness are seen
in most Pacific islands as a community's concern rather than just
the individual's, the appearance of primary health officers on
the scene may remove this community spirit and leave things entirely
in the hands of the primary health worker and the patient.
There are some illnesses that are categorised by Tongans as
European and some that are categorised as Tongan.
All the adults
interviewed in Tafahi and Nukunuku, and even over 58% of the
doctors sampled, were of the same opinion.
diseases were identified as Tongan.
Many of the infants'
'Avanga, lolomai and kulokuia
are among those illnesses said to be peculiar to Tonga.
Because
'Avanga is often said to affect young adolescent g i r l s , i t is
suggested that i t may be a cultural reaction to stress occurring
because the young girl is not able to express the growing social,
physical and emotional needs of that stage of her development and
in particular to norms concerning relations with males and the
importance of maintaining v i r g i n i t y .
Lolomai appears to be an
illness of females also, but at an older age.
I t is again suggested
that this may also be a reaction to the stress of physical changes
which render the body physically less attractive to partners.
I t may once again reveal the restricted nature of female activities
within
Tongan society/
Modern health care also involves large international drug
companies and increasingly expensive medical technologies that only
rich developed countries can afford.
seems-to be no way of curbing i t .
It is big business and there
For instance, CT scanners alone
cost $1 million to buy, $200,000 to install and $80,000 a year to
maintain in Canada.
Doctors apparently use the scanners to diagnose
patients with symptoms such as headaches.
203.
This
increasing use of
expensive medical devices prompted Or William Dorsett (Maclean's,
September 6, 1982:
32) to ask:
What benefit is i t to the patient to be able to get even
more precise information about his disease without being able
to do anything about i t ?
The a b i l i t y of the modern medicine to diagnose is far ahead of
i t s a b i l i t y to cure.
At the same time medicines such as a n t i -
tetanus toxoid and i n s u l i n are not available in some areas (as was
the case i n the Niuatoputapu Health Centre) because there is no
fund to buy a kerosene r e f r i g e r a t o r , which would probably cost less
than $1,000.
Modern Health care is preferred o f f i c i a l l y and is the preference
of most of those sampled in the research.
Modern medicine is seen
as f a s t a c t i n g , clean and often easier to obtain and to keep. The
doctors are seen as clean and clever.
Their s k i l l s were learned
from the developed countries where most good things for development
are assumed t o come from.
On the negative side, modern doctors are
seen as unapproachable and lacking compassion in comparison with
the t r a d i t i o n a l , card-playing and religious curers.
Table 22:
Preference of Curers by Total Sample of Couples
Modern
%
Traditional
%
Religious
%
Others
Nukunuku
26
32.5
12
15.0
2
2.5
0
Tafahi
30
37.5
10
12.5
0
0
0
Total
56
70.0
22
27.5
2
2.5
The parents in Tafahi preferred modern cures and curers more
than those in Nukunuku and the preferences of their 10-12 year old
children were similar to those of their parents.
Although the old
people were more familiar with traditional medicine, they would
abide with the decisions of those who w i l l care for them when
feeling unwell .
204.
The main reason for selecting
Tafahi as one of the major
areas for research was because it was assumed that since it is
a small remote island, the people were likely to practise more
traditional medicine in comparison with the more urban Nukunuku
village where the people are close to three other health centres,
not counting their own.
The nearest modern health centre to Tafahi
is at Niuatoputapu which is a distance of about six miles of often
rough sea.
Yet, the opposite proved to be the case.
Three premises
are proposed for this situation:
1.
Because the people of Tafahi are predominantly Roman Catholics.
The forgiveness which is often part of all categories of curing
except modern can be substituted for by confession to the priest.
2.
The priests are the representatives of the Pope who is in
turn the representative of God on earth, according to the Catholics.
This hierarchical set up is similar to that of ancient Tonga where
the Tu'itonga was looked upon as divine and the priest's functions
made sure that people remained faithful to that idea.
It was a
sin to disobey the priests and likewise it is a sin in the eyes of
the Catholics to go against the teachings of the priest.
Traditional
medicine was apparently discouraged by the priest, not because of its
'lie'connotation, but because of its relation to the ancient religion.
The Roman Catholic Church is also the only religious denomination
in Tonga which is running modern general health clinics as well as
a family planning unit where the natural methods of family planning
are taught.
3.
The value of the modern health care system to the people of
Tafahi may be due to its scarcity value as well.
In contrast,
it may be surmised that the people of Nukunuku village in Tongatapu,
where they are less than one kilometre to a modern health centre, are
205.
perhaps disillusioned with the modern type of health care.
Despite different preferences for curers and cures, all the
adults interviewed in Tafahi and Nukunuku viewed curers and cures as
vaka (boat) for the healing power of God.
Furthermore, they admitted
that they would not hesitate to take their patients to other curers
failing their first preference. There is also a wide belief that
there is a set day for each one to die and that when that day comes
it is futile to try to prolong life.
Yet, on the other hand, the
people emphasised that Tongan treatment must be given to Tongan
diseases, and that modern medicines must be given to European
diseases.
Religion is an important part of Tongan society.
all aspects of life.
It permeates
Thus, all categories of health care have
religious connotations in Tonga.
Even modern Tongan doctors
reluctantly admitted to the importance of
religion in people's
lives. The church leaders are welcomed in the hospital wards to
pray for the patients.
Frequently the doctors joked of a need for
'peni-Jehovah' instead of penicillin when a patient's illness was
difficult to diagnose or to heal.
Tongan diseases have Tongan indigenous names as well as
treatments.
Even the diseases which are recognised as European
diseases are subsumed under a Tongan general disease term and treated
accordingly.
For example, Pulmonary tuberculosis and various
gynaecological problems are treated as fasi and kahi respectively.
The notion that herbal treatments did not come to Tonga until about
1800 is viewed as highly unlikely.
It is to be remembered also
that this view was based mainly on Mariner's information (Martin 1827),
a young foreigner who was staying with Finau 'Ulukalala, Finau's
body, since he was a chief was tapu to most Tongans. Only the priests
206.
would have been consulted and failing that only foreigners like
Fijians, Tahitians and others would have been allowed to treat him.
Mariner's opinions may have been formed because he did not see any
Tongans, but only foreigners treating the chiefs.
68% of the
Tongan medicinal plants tested by Weiner (1973) were indigenous.
Certainly (see Appendix 4) it appears that most of the plants used
for medicines in Tonga have different names in other Pacific islands
and their medicinal uses vary from country to country.
Besides,
Tonga had contact with neighbouring islands like Fiji and Samoa
long before 1800.
So even if it is true that they learned their
skills of herbal treatments from them, they are likely to have done
so much earlier than 1800.
A Tongan expert in traditional matters,
Ve'ehala, emphatically denies that Tongan people did not use herbal
treatments until about 1800.
Although modern drugs are seen by the majority of those
interviewed as fast acting (particularly injections), there is no
denying that many of the modern drugs are dangerous when the
prescribed dosage is not adhered to.
In some cases severe allergic
reactions may occur which may kill the patient and addiction to drugs
has been known to occur even with the best intentions. In addition there
is the question of whether all these drugs and treatments are necessary?
According to Dudley (1979: 744), 80% of patients stop taking tablets
prior to the time on the prescription. 30-70% of any group of
persons tested are likely to experience some relief and about 30%
to experience relief from a particular disease when given a placebo.
Furthermore, 20% of those with chronic diseases are likely to get
well no matter what treatment is given.
This suggests that the
psychological value of medicines may outweigh some of the assumed
physical values.
Two people in Tafahi, for example, got better with
simple treatments despite the belief that they would die without modern
injections.
Moreover, fast acting drugs may only delay sickness until
207.
J
another time while slower and more natural types of healing may give
the whole person time to heal.
It is important to understand also
that the priorities of people to regain health varies, so that the
best physical treatment may not be appropriate.
The longer type
of treatment may be the necessary treatment.
It had been noted that tetanus, measles, whooping cough,
diptheria, tuberculosis, typhoid and poliomyelitis have now certainly
decreased in frequency in Tonga largely as a result of numerous
immunisation programmes.
Other infectious diseases such as mumps and
german measles are also decreasing, due mainly to improved hygenic
measures such as good housing and safe water supply and good sanitation.
Improved hygene can, in fact, often do more to prevent diseases than
modern drugs.
As there was no refrigerator in Niuatoputapu to
keep anti-tetanus toxoid, pregnant mothers, children and patients with
deep cuts did not have the benefit of toxoid vaccination for some time.
Yet no tetanus neonatorum or any tetanus cases were reported during
the five year period like other parts of Tonga where opportunities
for such injections were available.
Children have always been important to the people of Tonga.
They are regarded as gifts of God as monu and koioa.
A woman that
is pa'a (barren) is considered mala'a, while the woman who is fanau,
is considered monu'ia. Pa'a is associated with meanness, unloving
and hardness, while the concept of fanau is associated with kindness,
love and compassion.
The child in the woman's womb is supposed to
stir and increase the feeling of love in a woman.
also seen as the parents' keepers in their old age.
Children are
With the
absence of any official alternative arrangements for old people
(the civil servants and church leaders get pensions), this seems to
be the logical arrangement.
Most mothers in the sample preferred about four children, but
208.
some have more than that.
Parents or individuals without children
often pusiaki (adopt) a child.
The child is usually a kin for it is
also designed to keep the blood of the kin relationship warm.
There are many traditional medicines for children's diseases
which the curers and mother proclaimed often to be successful.
However, in reality, evidence indicates that many children died
young in the past.
In the archaeological excavation at 'Atele
(Poulsen 1977: 13), many of the bones found were of young children.
Tongans frequently celebrated the first birthday because it was not
often reached in the past.
Infant mortality, however, has definitely
declined and Tonga's rate is about the lowest in the Pacific (see
Table 2 ) .
Tongan women on the whole appear to have few gynaecological
problems.
But this may be due to the fact that women are very
modest about having to show their 'private parts' for examination,
especially when the examiner is a male doctor.
Many women expressed
their despair in having to be strapped with legs wide apart
(lithotomy position) in the hospital for delivery.
Some of the
ma'uii informed me that many others expressed their alarm also
when given an episotomy in hospital.
Some mothers apparently have
blamed an episotomy for the infidelity of their husbands.
They
say that the episotomy has made their vagina too wide for sexual
enjoyment.
There were women who said that they had suffered from
symptoms such as abnormal vaginal bleedings and lower abdominal pain
when they were on modern family planning methods such as depo provera
injections, but once use ceased the symptom subsided.
In the 1981 report of the Minister of Health, out of 482
medically certificated causes of death, only two died of malignant
neoplasm of the cervex and seven died of malignant neoplasm of the
female breast. Five of these cases died at home.
209.
Many modern doctors
have praised the value of Tongan traditional medical care for such
terminal cases.
There are Tongan traditional medicines for 'au, but there
appears to be no differentiation between types of vaginal bleedings,
except in post partum haemorrhage.
types of breast diseases
There are medicines for various
and numerous medicines to cause f e r t i l i t y ,
but none for spacing of pregnancies or to cause i n f e r t i l i t y .
Medicines to cause abortion were not openly discussed and are considered
sinful to give to anyone.
One curer was suffering from 'au which
was said to be the result of supernatural sanction for giving abortive
medicines to many young g i r l s .
The fact that many curers knew some
abortive medicines may suggest that their lack of use may have been due
to the influence of Christianity.
Women in the past normally went home for confinement and stayed
sometimes for two years with their parents.
Breast feeding was
encouraged as not only the best food for the baby, but also i t was
seen as a means of conveying love to the baby.
These
helped in the past to keep the population controlled.
practices
Some of the
ma'uli have devised their own methods of spacing or terminating further
pregnancies, but they are of the mystic types.
The fact that there are
no medicines to space or to terminate further pregnancies is attributed
to the fact that in general children were welcomed in Tongan society.
Whereas infanticide was commonly accepted in some Polynesian societies
such as those of Tahiti (Levy 1973) and Hawaii (Ellis 1842) and used
as a form of population control in other societies (Wagley 1977),
i t was never well accepted in Tonga except rarely in child strangling
as a sacrifice to the gods for the purpose of curing sore ailing
great chief.
The man is seen as the head of the family according to all of the
wives in the sample.
Writers on Tongan society such as Gifford (1929)
210.
and Martin (1817) confirm this notion also, and there are many
aspects of the Tongan culture which indicate male dominance.
For
example, one of the tapu during pregnancy is for the wife to eat on the
sleeping mats of the husband.
The children are not allowed to eat
their father's food nor to touch his head as it would cause them to
have a runny nose. Maleness is associated with the right, while the
left is associated with females.
It is interesting to note that in
Tongan medicines, the right side of some leaves are often used for
special mixtures, while the left side is discarded.
Similarly,
the right side of the sea shells are used in preparation of some
medicines.
In the Tongan myth of creation, women were brought from Pulotu,
where the spirits of the chiefs go after death, to marry the first men
who were made out of the worm from the first creeper.
marriage of the sacred and the profane.
more curers being female than male.
traditional curers were female.
It was the
Perhaps this accounts for
Nearly 90% of the interviewed
Another interesting thing is that
the leaves that are mainly used for the treatments of 'avanga_ are
usually from the creeper that is often found near the beach, like
the first plant, the creeper where the first men were supposed to
originate.
It could be said that the use of leaves to chase the
spirits away, those of the ope,also symbolises the dominance of
the males over those from beyond, the women.
Despite the dominance of the male in Tongan society, women are
treated with considerable respect, unlike in many neighbouring
islands.
In a sense, women in Tonga were and are put on a pedestal.
The highest social status in ancient Tonga was the Tamaha fefine,
daughter of the Tu'itonga's daughter.
Her grandfather and mother
both moemoe to her (pay their respects by kissing her feet).
was also assumed to have healing powers.
211.
She
The father's sister,
the mehekitanga, is usually the fahu or 'can do as she pleases' with
the brother's children.
Although Tongans obtain their livelihood mainly from agriculture
(65% of the husbands in the sample were farmers), and farming of the
land s t i l l depends on human labour, 55% of the parents preferred
g i r l s as against only 10% who preferred boys.
worry as long as their children are
healthy.
The rest did not
Girls are said to be
more loving and helpful at home and more obedient.
According to the
parents who preferred g i r l s , g i r l s on the whole continue to care for
their parents even after marriage, while boys do not.
The majority
of children interviewed would obey their mothers at home more than
their fathers because their mothers were said to love them more.
The notions of male dominance and female perserverance in
Tongan society are important facts to remember in family planning
projects.
The male must approve f i r s t but the women are those that
must perservere with the implementation.
Unfortunately, the only
study of "Knowledge, Attitude and Practice (KAP)' of contraception
in Tonga was carried out on women alone (Wolffe and Desanna 1970).
This neglect of sensitivity to cultural values could have negative
effects on health programmes (Mamdami 1972).
I t is interesting to postulate the path that family planning
projects would have taken in Tonga had men been involved right from
the beginning instead of women alone since many wives will not
practice family planning because their husband will not allow i t .
All the couples in the sample in Tafahi and Nukunuku had heard
of family planning.
The majority had heard of i t through the radio,
but would have preferred a person-to-person discussion (with a
person of own sex i f possible) because of the nature of the subject.
Discussion of sex subjects is tapu in mixed company particularly
212.
when close relatives (sister and brother or cousins) of the opposite
sex are present.
More than 87% of the total couples in the samples in Tafahi and
Nukunuku approved of family planning, although only about 44% had ever
practised family planning.
The majority of those who approved of
family planning (67.5%) gave a shortage of land as their main reason.
Many Tongan males who have reached 16 years of age have not been given
a bush or town allotment as directed by the 1875 Constitution.
During
the period 1966-76, only 35% of those eligible for allotments were
actually given one.
This percentage is expected to decrease with the
growing population.
One of the government's major population policies
for the 1980-85 Development Plan is to reduce the birth rate to 25 per
thousand by 1985.
This was expected to be achieved through family
planning services.
Inevitably, religion plays a big part in family planning.
While a l l the other denominations (including the Roman Catholic)
approve some method of family planning, the Mormon Church does not
according to the Mormon couples interviewed.
I am therefore inclined
to postulate that given the present attitude of the Mormon Church to
family planning the Mormon population may continue to increase and in
the future Tonga will be predomonantly Mormon.
The Roman Catholic
Church advocates only natural methods of family planning; particularly
ovulation and 'safe period'.
I t appears from the changing patterns of family planning practices
in Tonga there there is a 'latest best' attitude to family planning
methods.
For instance, since depo-provera injections appeared on
the scene in the early 1970s, i t has continued to gain in popularity,
while the use of other methods has decreased - with one exception
perhaps, the condom, which appears to remain popular.
213.
Although the
condom is not considered a very safe type of family planning method
in comparison to depo-provera, the IUD (Intra Uterine Device) and
the pill , it is obvious that it has great potential as a family
planning method in Tonga.
The condom has been used successfully in
Japan which is another male dominated society.
The main advantage of
the condom is the fact that it has no side effects, unlike the so-called
'safe methods' of family planning like
depo-provera and pills.
In America, where depo provera is manufactured by Upjohn, it is
prohibited to be used by the Food and Drug Administration.
Yet the
company is allowed to continue to manufacture it and trusted
international organisations like WHO and UNFPA let women of the
developing countries use it.
The Upjohn company no doubt is making
a huge profit while the lives of women who use it are at risk in
developing countries.
Tonga, like its neighbouring Pacific island territory, is
moving towards modernisation.
Modern medicines are preferred by
many of those sampled mainly for their fast acting effects. People
seem to want to get better qu
modernisation.
on the body.
in order to start running towards
There is no thought of the effects of these drugs
The body is treated as a working horse for one's
aspirations for more and bigger things.
There seems to be no time to
pause once climbing the ladder of modernisation begins.
In the
past, Tongans had time to pause and evaluate themselves against the
accepted norms of society.
Today, the tendency is not to pause,
because the model of progress is no longer in Tonga, it is away in
the developed countries and one must climb high to see it.
Many
mothers no longer have time to breast feed their babies, to give them
love, to chew food for their babies, lovingly sharing the meals.
The institution of mohe ofi where once the child learned about customs
and the ways to obtain the feeling of monitonu, the feeling of health,
214.
is disintegrating in many parts of Tonga.
Mothers are too busy during
the day pursuing modernity and too tired at night to lie and talk with
their children.
There is no claim made hereof either completeness or of f i n a l i t y .
I am aware of the limitations of this thesis, but i t is hoped that i t
w i l l serve as a stepping stone for future research;
in particular,
research that w i l l help to bring about a more self-sufficient health
care system for Tonga.
Perhaps the planners and the policy makers in Tonga are fortunate.
They are planning for a homogenous society with nearly 98% of its
nearly 100,000 population indigenous.
Similarly,nearly 100% of i t s
population are of one major religious belief, that of Christianity.
Furthermore, the majority of the people are l i t e r a t e , having 83% of its
total population able to read and write Tongan and 50% also in
English.
The people are used to respecting hierarchy, so they appear
to l i s t e n to the o f f i c i a l s of the government.
On the other hand,
such homogeneity makes i t d i f f i c u l t to change or to implement projects
that go against the grain of social norms.
The slowness of projects
to catch the imagination of the population should be an indication
of the need for careful re-evaluation of the programmes of implementation.
Because culture is dynamic, change is inevitable, particularly with
modern modes of communication.
But in the process of change
let us
remember that the less alien are the methods of change the healthier
the people of the society w i l l be.
In short, we should not subject
the people to culture shock in their own country.
Although there are definitely differences in the availability of
modern f a c i l i t i e s in Tafahi island and Nukunuku village, I could
not really detect much difference between the two areas.
The people
are a l l well fed, although the people of Tafahi eat more traditional
215.
food and definitely favour mutton flaps than the people of Nukunuku.
Both communities appear to be healthy, but the people of Tafahi are
l e s s fat and appear to be more active physically and mentally.
The people of Tafahi seem to cope with their lack of social
entertainment by gossiping and drinking kava.
However, like in
Nukunuku, the drinking of liquor seems to be catching up with the
young men (which further confirmed the preference of the parents for
girl
children).
The need for modern medical f a c i l i t i e s appears to
be an indulgent luxury.
In Nukunuku village, where the community
has b e t t e r access to modern medical f a c i l i t i e s , they utilised more
t r a d i t i o n a l health practices than the people of Tafahi Island.
Most of what the Tafahi people imagined would occur without the modern
medical f a c i l i t i e s are untested assumptions, although i t is appreciated
t h a t in medical c r i s e s , modern medicine would be invaluable.
But
the problem with these outlying modern medical care centres is that
they are not at all equipped for medical emergencies.
Perhaps what
the people of Tafahi island and Nukunuku village exhibit are
commonsense actions when i l l n e s s occurs.
This combines a knowledge
of traditional and non-traditional medical s k i l l s implemented with
one thought uppermost, achieving the best health possible.
216.
31.
Do you think Family Planning is a good thing f o r Tonga?
Yes
No
Give reasons for your answer.
238.
APPENDIX IVA
GUIDING QUESTIONS USED FOR TONGAN TRADITIONAL,
RELIGIOUS AND CARD PLAYING CURERS
1.
Category of Curer
2.
Name
3.
Address
4. Sex
5.
Marital Status
6.
When commenced to be a curer.
7.
From whom did you learn the skills.
8.
Is it a full time job?
9.
If not what other job are you doing?
10.
Do you get any rewards for your services as a curer such
as tofoto'o or tukuto'o?
11.
What are your specialities.
12.
Type of care given to mothers before and after birth.
13.
Type of care given to new born babies.
14. Have you ever been approached by any government officials
to cease practising your curing functions?
If so, why?
15.
Do you know any women's d.iseases?
16.
Do you have treatments for these diseases or to prevent
or space pregnancies, induce pregnancy, prevent abortion,
induce abortion?
17.
How can you tell the differences between the Tongan diseases
and European diseases?
18.
Do you know any children's diseases that are peculiar to Tonga?
19.
What are the children's diseases that you can treat?
20.
What are the treatments?
21.
How do you treat a sick person with your medicine?
244.
22.
Can you tell me names of some patients that you have treated
successfully?
23.
Can you tell me names of some patients that you failed to
treat successfully.
24.
How do you dispose of used or remaining medicines?
25.
How do you get on with people in this community?
26.
Are you training someone to take over your work as a curer?
245.
APPENDIX
V
GUIDING QUESTIONS USED FOR MODERN CURERS
1.
What is your a t t i t u d e towards t r a d i t i o n a l healing practices?
2.
What value do you place on t r a d i t i o n a l health practices?
3.
Have you ever been treated by a t r a d i t i o n a l
healer?
I f so, in what circumstance?
4.
Do you ever recommend any of your patients t o v i s i t
healers?
Do you think there are diseases peculiar t o Tonga?
how can you t e l l ?
traditional
If
so,
Have you ever taken any i n t e r e s t i n learning about t r a d i t i o n a l
types of healing?
Give reasons f o r your answer.
How do you grade t r a d i t i o n a l healing p r a c t i c e s i n comparison
t o modern healing practices?
Do you think there is a f u t u r e together f o r modern and
Tongan t r a d i t i o n a l health practices?
248.
APPENDIX
VIA
GUIDING QUESTIONS FOR 10-12 YEAR OLDS OF INTERVIEWED
PARENTS IN KALISI (NUKUNUKU VILLAGE) AND TAFAHI ISLAND
1.
How old are you?
2.
Do you 1ike school?
3.
Do you take more notice of your father or mother at home?
Why?
4.
Would you prefer to have more children in your family?
Why?
5.
What type of medical care do you prefer when you are ill?
Why?
6.
What treatment are you given at home when sick?
249.
APPENDIX
VIIA
GUIDING QUESTIONS USED FOR SOME OF THE OLD PEOPLE OVER 69 YEARS
IN KALISI (NUKUNUKU VILLAGE) AND TAFAHI ISLAND
1.
How old are you?
2.
Date of Birth?
3.
Earliest event in the Tongan history that can be recalled.
4.
Can you remember how you were looked after as a child?
5.
Do you think that type of care was better than at present?
6.
Which type of medical care would you prefer when you fall
ill?
7.
Have you ever been in hospital?
8,
If yes, why, and how did you feel about it?
9.
Do you know any Tongan traditional medicine for women's
diseases?
10.
Do you know any Tongan beliefs regarding fertility or
infertility of women?
11.
Do you know any Tongan beliefs regarding children's diseases,
particularly from birth to five years old?
251.