Accounting for Children's Illnesses: Epistemics and Social Relations in Mapuche Healing and Chilean Primary Care Medicine
This dissertation examines how indigenous Mapuche children's illnesses are defined in Mapuche ethnomedicine and Chilean primary care medicine. Based on 11 months of fieldwork in the Araucanía Region of Chile, the study documents the illness account genres of pelotun pronouncements and presenting concerns, which drive the respective diagnostic processes of these two medical systems. The study draws on a data corpus that includes videorecordings of 32 pediatric acute care appointments with general practice physicians and 45 consultations with Mapuche healers. It combines ethnographic and discourse analytic methods to explore how indigenous families and the medical practitioners with whom they seek care negotiate the rights and responsibilities that are associated with representing children's illness trajectories for the purposes of diagnosis. The study asks what stands to be gained and what is at stake in the representation of illness experience and the cultural construction of clinical realities. To address this question, the study adopts a linguistic anthropological view of genre that sees generic conventions as flexible and successful performances as social achievements. In light of this perspective, the study identifies the orienting frameworks, role expectations, and normative features of pelotun pronouncements and presenting concerns in the context of their performance. Analytic attention is given to the process of selection of a primary teller to establish what is ailing a patient, the generic regimentation of tellership rights, the evidentiary grounds on which accounts are based, and the ways participants hold each other accountable for the accounts they produce. Illustrative cases of both felicitous and problematic accounts demonstrate the range of semiotic resources that characterize each genre and show how participants orient to, legitimize, enforce, and challenge generic norms. The close analysis of these medical discursive genres is contextualized by discussions concerning the contemporary situation of ethnic discrimination and unequal medical plurality that exists in southern Chile.