| The liver disease caused by hepatitis B virus (HBV), hepatitis C virus (HCV), and excessive alcohol consumption has become a serious problem for indigenous health in Taiwan over the past several decades. This dissertation examines social forces and processes, indigenous culture, and human behaviors related to the epidemiology of liver disease for the Truku people. This study focused on Shioulin, an indigenous township in eastern Taiwan where Truku people represent 90% of the local population, and where I conducted fieldwork between June 2006 and June 2007. In-depth and informal interviews and participant observation were undertaken in the field to study the notions about liver disease and its treatment that were employed by all those engaged in the clinical process, and to investigate Truku people's health-seeking behaviors. Archival research was conducted in the National Central Library where I consulted archives, newspapers, and research reports to explore the Japanese colonial and Chinese nation-state's indigenous policies and the (re)presentation of indigenous people in the media.;Biocultural approaches that integrate the ecological and biological approaches with the ethnomedical and critical approaches of medical anthropology inform the analytic framework of this study. By carefully examining the ethnographic and archival data, this study finds that cultural, social, and biological factors weave the web of causation of liver disease. The dual introduction of Western medical technology and commercial alcoholic beverages during the Japanese colonial period might have contributed to the initiation of an epidemic of liver disease in Truku society. The development of the nation-state after World War II created social inequalities between the Truku and the dominant social class that increased the prevalence and incidence of liver disease. Truku people's health-seeking behaviors are determined by their notions about liver disease, the severity of their illness, and the primary and side effects of the remedies. The discrepant notions about liver disease between the Truku and the doctors, the long subclinical phase of liver disease, and the side effects of anti-viral drugs have had negative impacts for the consequences of disease management. Exploring these factors will provide a direction to develop a holistic strategy for maintaining indigenous health. |
