the baladi curative system of cairo, egypt

EVELYN A L E E N E EARLY

T H E B A L A D I C U R A T I V E S Y S T E M O F C A I R O , E G Y P T

ABSTRACT. The article explores the symbolic structure of the baladi (traditional) cultural system as revealed in everyday narratives, with a focus on baladi curative action. The everyday illness narrative provides a cultural window to the principles of fluidity and restorative balance of baladi curative practices.

The body is seen as a dynamic organism through which both foreign objects and physiological entities can move. The body should be in balance, as with any humorally- influenced system, and so baladi cures aim to restore normal balance and functioning of the body.

The article examines in detail a narrative on treatment of a sick child, and another on treatment of fertility problems. It traces such cultural oppositions as insider:outsider; authentic :inauthentic; home remedy:cosmopolitan medicine. In the social as well as the medical arena these themes organize social/medical judgements about correct action and explanations of events.

I N T R O D U C T I O N

This ar t ic le on pr inc ip les of a t r ad i t iona l cura t ive sys tem is b a s e d on my

resea rch ~ in a m o t h e r - c h i l d hea l th clinic and the su r round ing a rea of

Bulaq A b u Ala , a t rad i t iona l , o r baladi, qua r t e r on the Ni le R ive r nea r

centra l Cai ro . A f o r m e r por t , Bulaq A b u A l a was one of the first a reas

indus t r i a l i zed by M u h a m m a d Al i in the ear ly n ine teen th cen tu ry and

t o d a y remains c r a m m e d with small w o r k s h o p s for ca rpen t ry , lathing,

p las t ics and welding, and with m a m m o u t h l u m b e r and c rude i ron s torage

yards . Bu laq and o the r t r ad i t iona l a reas in Ca i ro are k n o w n as ba lad i

quar ters . Baladi is a r ecogn izab le life style con t r a s t ed with that of afrangi, l i teral ly foreign, qua r t e r s which are the m o d e r n quar t e r s of c o s m o p o l i t a n

Egypt ians . Ba lad i peop le , a l though t rad i t iona l , a re ne i the r unsoph i s t i ca t ed

nor geograph ica l ly o r t echnolog ica l ly isola ted. They t ravel all ove r C a i r o

with ease and are ski l led at cop ing witl-, u rban bu reauc racy . Ba lad i w o m e n

may ea rn i ncome as pedd le r s , shop owners , service p rov ide r s of sewing o r

b r e a d m a k i n g , and - - a m o n g younge r w o m e n - - as g o v e r n m e n t o r p r iva te

sec to r emp loyees . The i r h u s b a n d s are day labore rs , ar t isans , pedd le r s ,

merchan t s and office workers .

The ba lad i Egyp t i an wor ld is de f ined by a ba lad i : a f rang i oppos i t ion .

At h o m e ba lad i Egyp t i ans use the t rad i t iona l ha rd kanaba (couch) , but on

a visit they d o not feel u n c o m f o r t a b l e sit t ing on an afrangi Louis X V gold

g i lded couch. Balad i Egyp t i ans use ba lad i h o m e r emed ie s but they also

seek afrangi cl inical t r ea tment . T h e i r c o n c e p t i o n s of the s t ruc ture of a

pe r son and o f a cura t ive sys tem reflect the d ivis ion of the wor ld into

Culture, Medicine and Psychiatry 12 (1988) 65--83. © 1988 by D. Reidel Publishing Company.

66 E V E L Y N A L E E N E E A R L Y

baladi : afrangi, an opposition of we : they or included : excluded. The baladi curative system ultimately aims to restore baladi values, the baladi view of the world.

In this article I interpret the traditional Egyptian healing system via illness narratives. After presenting the narratives, I discuss the symbolic structure (value system; social, physiological, personhood structure) of the baladi system revealed in the narratives. Finally, I suggest why the baladi curative system can be seen, not as a pluralistic, multiple system but as a unified single system whose multiple elements all cohere within one structure.

I L L N E S S N A R R A T I V E S

I define "illness narrative" as a commentary on illness progression, curative actions, and surrounding events - - both relevant and irrelevant. It is constituted of incident-specific fragments which are spontaneously rendered and which, with time, are codified into an elaborated version that is referenced and recounted for years to come. Because narrative fragments are interspersed with other conversation, because research conditions in Cairo in 1974--77 dictated against taking notes or tape recording, and because narrative fragments are not easily elicited in interview situations in Egyptian baladi culture, the narratives presented here and in the rest of my data are ones I reconstructed in field notes which I wrote or tape recorded from one-half hour to three hours after the narrative's rendition. I am not sure that even now my baladi women friends could be convinced of the need to record their versions of illness episodes. The narrative, like a ritual performance or ceremony, conveys social intent and endorses a state of affairs - - in this case, the condition of well-being which curative action seeks to engender. A narrative is shared by members of a lay therapy managing group which makes decisions about when and what practitioner to consult and about how to comply with instructions. The narrative, as a kind of spontaneous, everyday cultural performance, provides a window on culture which complements that of more visible, more formal rituals. Increasingly, social scientists (Turner 1982: 12; Manning 1983: 13; Bourdieu 1977: 16) have become interested in informal discourse and in mundane cultural performances. Narratives in general, and illness narratives - - so intimately tied to cultural understandings of personhood and wellbeing -- in particular, are excellent examples of a spontaneous performance, created custom-made to the context in a culturally shaped format.

Narratives are set off from conversation, not as a tale or myth would be

THE BALADI CURATIVE SYSTEM OF CAIRO, EGYPT 67

set off, but rather as a stylistically recognizable part of everyday explanations. Elsewhere (Early 1985), I have considered how the narrative is a kind of mundane cultural performance in which one presents problems of and solutions to such personal concerns as health. Here, as there, I consider women's narratives. While men also recount events in everyday narratives, women's narratives provide a unique optic on rules and understandings of baladi medical culture.

Baladi women's narratives are set off from ordinary discourse by verbal style and by body placement and gesture. A woman frames narrative portions of a conversation with such characteristic expressions as "You have heard about X, haven't you" (introducing an account whose assump- tions will be familiar both to raconteur and to listener) or "although it was unbelievable" (remarking on the extraodinary nature of the event). She also employs a specific linguistic style of heightened pitch and elongated vowels. 2 Illness narratives are only one of a genre of explanatory narratives which include political, familial, economic and religious narratives. They, together with descriptive statements, make up much of conversation.

Narrative Texts

In the following text, Aniyat tells of her efforts to cure her son Muhammad. This narrative occured in the midst of a conversation about her pregnancy history.

Narrative A At nine m o n t h s M u h a m m a d was very sick (with p n e u m o n i a ) . . . He cried and was fevered. l took him to the Ministry of Heal th clinic, to the nearby lying-in hospital, and to the nun ' s clinic (one run by a Catholic order). His symptoms persisted.

Then I took him to Shaykh Abdu , whose house is behind the woman selling fruit at the end of the street leading to the Ministry clinic. The night before, I tied M u h a m m a d ' s head in a scarf, and he slept with the scarf on; the next morn ing I took the scarf off and tied a shilling ]five piasters] in it and took the scarf to Shaykh Abdu . He divines and exorcizes. He asked me what I saw in my d r eams and I told him that I saw an old woman running after me trying to hit me, and that I felt irritable . . . . He also said that I should take M u h a m m a d to the doctor . . . . He said that to get rid of the woman, I should take a pigeon and sacrifice it and put its blood on two scarves and give it to him to kill and distribute . . . . Then my d reams started getting better and M u h a m m a d improved . . . . I still have a half kilo of sugar we vowed to take to the shaykh if my son recovered . . . . I did not know that M u h a m m a d had that kind of illness (which needs a diviner) or I would have taken him to the shaykh earlier.

Aniyat's illness narrative describes a therapeutic encounter which led to a change in her understanding of her son's illness. With this new perspective, Muhammad's mother Aniyat alters'her diagnosis of Muhammad's problems from pneumonia to fright (khad'a), saying she had not realized it

68 EVELYN A L E E N E E A R L Y

was "the o the r " (i.e. ba lad i ) k ind o f illness. A n i y a t ra t ional izes he r shift in

e t io logical belief , which was i n d e p e n d e n t of change in symptoms , by an

or iginal ly false cogni t ion. She shifts to a t t r ibu te M u h a m m a d ' s s y m p t o m s

(as well as he r i r r i tabi l i ty) to psychic s tress ( the d r eam, fright) r a the r than

to na tura l causes l ike infect ion. This expla ins M u h a m m a d ' s s y m p t o m s '

reca lc i t rance to penicil l in.

Na r ra t i ve B d e m o n s t r a t e s the cent ra l i ty of the p r inc ip les of the ba lad i

cura t ive sys tem for a w o m a n who has g rea te r exper i ences with its afrangi

aspec ts than Aniya t . La i l a de l ive red her first two chi ldren , girls ages 10

and 6, normal ly . She then gave bi r th twice to sons who each d ied within a

few days. La i la had an R H factor , which means the first two ch i ld ren are

usual ly normal , while subsequen t bab ies a re b o r n j a u n d i c e d if the m o t h e r

(as in La i la ' s case) was no t t r ea t ed af ter the or iginal bir ths. La i l a is f rom a

merchan t fami ly u r b a n - b a s e d for severa l genera t ions , and is m a r r i e d to a

school teacher . She a t t e n d e d schoo l th rough the s econd yea r of s e c o n d a r y

school and reads s o m e English. She is we l l - acqua in ted with afrangi

r emed ies and seeks out p r o m i n e n t doc to r s . H e r gynecolog is t is a f o rmer

hospi ta l d i rec to r , and La i la c o n s i d e r e d this admin i s t r a t ive expe r i ence to

make the gynecologis t a s u p e r i o r choice to t rea t he r infert i l i ty (with

vi tamins and ant ib io t ics ) and her bab ies b o r n j aund iced .

A f t e r losing two babies , La i la r e t a ined he r bas ic faith in afrangi

med ic ine and felt the p r o b l e m s t e m m e d f rom p o o r l y d o n e lab tests.

H o w e v e r , in seeking a hea l thy b a b y she left no pa th unexp lo red . H e r

plight was pa r t i cu la r ly ha rd s ince she had no sons. She conf ided that she

would have been con ten t with he r two daughte rs , but he r husba nd was so

eager for a son that he e n c o u r a g e d he r con t inued p regnanc ies desp i t e the

compl ica t ions . La i la c o n s i d e r e d adop t ing a son, but d a r e d no t suggest it to

he r husband . Be low she r ecoun t s the dea th of he r s e c o n d b a b y boy.

Narrative B We went to the same doctor in Babaluk who had examined our baby earlier. He was sad when he heard that our baby had died. He told us the same thing as other doctors -- that the blood transfusion should have been made right away; that the child's A, B, or O (blood types) could be different from ours and needed changing right away . . . . From this doctor, I understood that it was not the "RH factor" that was the problem but the blood type. Here at the clinic the doctor told me that 1 had no responsibility for the death: "It wasn't your fault." The doctor (Dr. Mustafa) told me that 1 should go to have a blood test at a private clinic and not here in the hospital. My husband and 1 both went (we had already been tested at Farouq Hospital) and the results were the same and I brought the paper to Dr. Mustafa and he said that "The baby will live this time."

(Did you ask anyone about the death of the first boy who became jaundiced?). No, the last time we took him to a hospital, and we decided that we'd never do that

again, but that we would go to a specialist this time. Last time we took him to Abu Reich Hospital; either the clinic or the Farouq (local hospital) referred us -- I don't remember since 1 was at home. My mother-in-law and my husband took the baby to the doctor; my

THE B A L A D I C U R A T I V E SYSTEM OF CAIRO, EGYPT 69

mother-in-law cried more than I did this time; I was too tired to cry . . . . That time (the first baby's death) we took him on the third day; he had a fever of 40 degrees centigrade when he got there in the morning so they waited for the fever to subside before making the blood transfusion. "You cannot mix fever and transfusion." He had no veins in his arms as a young thing, and they gave him the transfusion in his forehead. By the time they'd finished the transfusion he had died.

(Didn't you wonder why this first baby died?) We had all the tests after that to check our blood and our Wasserman. The tests were

all normal. But this time I wanted to find out what was the cause of the death; and I have discovered that it was not the RH factor, but something else -- the A, B, O factor. So the next time I will deliver the baby in a hospital so we can have the transfusion right away. The doctor in Babaluk also works at Abu Reich hospital and said we could contact him for the transfusion. But we will find even better contacts than this doctor. My husband now teaches at Cairo University (before he taught in high school) so he will talk to some people in the medical school.

T h e above nar ra t ive was r e c o r d e d in D e c e m b e r 1984. T h e next

S e p t e m b e r I found Lai la four months pregnant . She had taken medica t ions

to p reven t miscarr iage and was current ly on tonics and vitamins. She had

switched f rom Dr. Mustafa at the Minis t ry of Hea l th M C H clinic to a

gynecologis t abou t w h o m her sister- in-law had told her. T h e gynecologis t

was the f o r m e r d i r ec to r of F a r o u q hospi tal - - and thus several no tches

above Dr. Mus ta fa in status. It was R a m a d a n and she was fasting so that

" G o d will let me have this baby." W h e n I asked how she was prepar ing for

the p red ic tab le dangers of this birth, she said she p lanned to de l iver this

baby in the hospital . H e r nar ra t ive account follows:

They (relatives) told me that when I am in my seventh month of pregnancy that I should wear a white gellabeya or house dress . . , and slaughter a pigeon and puts its blood on the house dress and on a small gellabeya in which I will dress the new born . . . . Then I should sleep alone in a room with a candle burning, having bought different kinds of beans, with the small gellabeya under my head. In the morning I bring children and feed them the beans and candies and the pigeon meat.

(Why?) So that the children will enjoy themselves . . . . I do not do this for myself but so that my

brother "under the ground" will be satisfied. (You mean your qarin ?) Yes.

SYMBOLIC S T R U C T U R E OF THE BALADI SYSTEM

Under s t and ing illness narra t ives such as these requires analysis o f the

symbol ic o rganiza t ion of baladi medica l culture, as well as an unders tand-

ing of the pragmat ic d imens ions o f nar ra t ive accounts . First, we will

cons ider the value system implici t in the baladi identi ty and then baladi

e thnophys io logy and the s t ructure of the person.

70 EVELYN ALEENE EARLY

The Values of Baladi Culture

Baladi is an important Egyptian cultural concept whose meaning is based on a series of baladi:afrangi oppositions which order the baladi social world. 3 A baladi person is seen as authentic, honorable, religious, nation- alistic, simple, personal and hospitable. An afrangi person is seen as spoiled, dishonorable, non-religious, Francophilistic, materialistic, imper- sonal and stingy (E1-Messiri 1978). There is the sense that baladi is the included, authentic and that afrangi is the excluded, inauthentic; for example, the afrangi person in seen as excluded from the Egyptian cultural heritage and as yearning for the artificial and the imported (often literally as with Parisian dresses, synthetic fabrics or Scandanavian furniture).

The essence of being baladi is being an authentic, trustworthy and resourceful person. Historically, the term ibna' al-balad referred to local inhabitants who with their "native" ingenuity opposed the occupation of outsider, dishonourable, irreligious Turks and French. Afrangi Egyptians today occupy the structural position of the nineteenth century occupiers and as such are thought of as inauthentic, dishonest, spoiled by luxury, and lacking in practical know how. For example, a baladi woman sees an afrangi woman who works in an office as a woman who is "bound to her desk and hence lacks experience and is unaware of the world about her" (EI-Messiri 1978: 532). Savy is explicit in baladi role types like the mu'alimma, a woman who works in the market and is seen as being as tough as men; she may smoke a water pipe or cigarette, talk roughly, curse with vivid sexual referents, and reprimand anyone insulting her or her area's mores. Her propriety is never in question. A baladi man sees an afrangi man, such as a contractor, as a materialist and as unable to interpret his baladi workers strategies such as "making work" and using tasks to strengthen social bonds.

With its high population density and marginal economy necessitating daily purchases, a baladi quarter's streets throb with activity in contrast to those of afrangi quarters. Baladi housing is rooms in crumbling buildings flush on streets; afrangi is villas and high rise condominiums. In the streets, in addition to the customary coffee house crowd, young boys play with yarn and rubber balls, wheels on sticks and scooter boards; clumps of girls engage in hopscotch, bottletop tossing and chalk drawing. In between them weave women on the way to market, horse cars with produce or used furniture, vendors of scrap iron or bricks and an occasional motorcycle or security jeep. Private lives spill into the streets, not in- discriminately but as prescribed by social norms of decorum. In the lane, barbers shave men and women force feed ducks with soaked bread.


Children play, eat and defecate. All social interaction is permissible in the public lane -- vehement quarrels which onlookers may arbitrate, house- wives' banter with merchants, young people's amorous flirtation, and noncommunication with averted eyes signifying a break of relations. There, everything is legitimate because it is seen.

To walk through a baladi lane, keeping an observant eye peeled, is to read a local newspaper. Quranic recitation over loud-speakers signals a funeral. A horse-drawn cart blocking a lane indicates a household on the move. A nearby peddler or a scrawled note tacked up may tell the family crisis absenting a shopkeeper. To walk through a baladi lane is to be prepared to respond to another's predicament or to queries about one's own presence. To walk through an afrangi quarter does not demand the same involvement. Small wonder baladi people feel that afrangi quarters are sterile and confusing with their grid streets and signs, and afrangi people feel that baladi quarters are mysterious labyrinths of winding lanes continually mobbed!

There is no land-use zoning in Bulaq or other baladi quarters. Lathe- shops, horse stables, groceries, bakeries, and doctor's clinics are niched amidst dwelling units. Scrap iron may be melted down next to a house. Since work is done in the lane, the blaze can be virtually on one's doorstep. The cross-section of technology is striking. Several hundred meters from a printing concern with computerizedtype-setting sits a woman dabbing her finger into a glue pot to fashion sacks out of scrap paper. Rooms lighted by kerosene lamps abut ones whose dazzling neon tubes spew garish light over the threshold. While afrangi quarters are not immune from wandering food vendors or goat herds, their residential streets usually sport little more than groceries, pharmacies and presses.

Baladi Treatments

As with the social arena, so the baladi : afrangi opposition defines physical and somatic principles and the structure of the person. The opposition is repeated in baladi etiology within both natural and supernatural categories. Basically, symptoms are either a result of somatic (natural) imbalance or malfunction, or of non-somatic (supernatural) influence. In both natural and supernatural systems baladi, the authentic and good, is essential and natural, while afrangi, the inauthentic and bad, stands outside. This sense of good:bad is a logical extension of baladi social action. The baladi essence is goodness -- known in Islam as hilal (permitted) acts, the opposite of haram (forbidden) acts. A worthy person is ibn al-hilal, an unsavory person (as well as an illegitmate child) ibn al-haram. Baladi


people are confident that the poor person who is generous, honest and religious will go to paradise, while the rich obsessed with worldly things may not. This sense of justice mediates the chaos and despair of extreme poverty. In the baladi world view, goodness and health both result from a restoration of the right and natural order, the included, the baladi.

With natural causes and cures, the opposition baladi:afrangi distin- guishes household remedies (wasfat baladiyya) from cosmopolitan (afrangi) medicine. Wasfat baladiyya are part of a local humoral-based system which emphasize moderation and treatment by restoral of internal balance, although the humoral system itself is not explicit. Diseases requiring the afrangi treatment of cosmopolitan medicine are the result of calamities of the outside world; these diseases are caused by microbs infiltrating the body or by communicable diseases originating outside of the person's body.

Baladi remedies for natural diseases (wasfat baladiyya) utilize natural substances like an infusion of boiled ginger for a sore throat or an onion for a festering sore. Afrangi remedies, in contrast, provide potent antidotes like antibiotics and attempt to reverse a disease's progression rather than allowing natural processes to proceed. Wasfat baladiyya are available from the herbal pharmacist ('atar), and from home stocks. The 'atar consults texts of Galenic medicine, based on the humoral system and its precepts, such as balance of the four humors or treating hot diseases by eating cold food. Cosmopolitan medicine is procured from the cosmopolitan pharamacist (saedali) or the clinic.

In the case of supernatural causes and cures the distinction is between baladi asyad and afrangi afarit -- that is, good and evil spirits. Evil in baladi cosmology is not confined to personalistic influence, and thus a natural-personalistic dichotomy (Foster 1976) does not hold. Evil can be explained as an arbitrary outside force and as specific or generalized malice. When generalized, evil is understood in much the same way as is envy which stands for diffuse malice (Early 1980). Good (baladi) spirits -- the asyad -- are one's alter ego (inside) and an element of one's personality. They are akin to the qarina (double). A woman has a male double (qarin), and a man a female double (qarina). When one's qarina is upset with ego, divination may be required to set things right, but the situation is one of internal imbalance, not of external malice. Evil (afrangi) spirits, on the other hand, originate outside. Possession occurs in a dan- gerous situation -- e.g., filling one's water jug at night when afarit (afrangi spirits) emerge from the water and enter one, or being possessed by black magic willed by an outside, hostile agent.


Principles of Baladi Physiology

The baladi view of physiological process must be considered to under- stand baladi therapeutic action. One basic maxim of baladi healing is that the body should be allowed to function "naturally" (tabi'iyyi), and nature to take its course. Any irregularity - - either in physiological sequences or human events - - is referenced in illness narratives and may even assume etiological significance. Here we consider the principles of fluidity and restorative balance in baladi physiology.

Fluidity

The body is seen as a dynamic organism whose parts are integrally related and through which foreign objects can move following courses other than standard circulatory or alimentary ones. In or thodox physiology organs are distinct although they may have conduits between them, as in the gastro-intestinal system. Baladi women are acquainted with basic physiology; womb, liver, stomach, colon, and tonsils are part of everyday parlance. They do not, however, think of these units as discrete, but rather as overlapping much like the conjunction of sets in mathematics. It follows that one may catch a cold in various parts of the body, most commonly in the head and stomach, and it may then migrate to other areas such as the intestines. Easy circulation means parts adjacent to a diseased organ are vulnerable. This notion of fluidity is consonant with the humoral system and is also not totally alien to modern medicine.

For instance, in baladi physiology infection is thought to result from a general circulation of rnicrobs and, unlike the cosmopolitan conceptions of contagion, not to have any specific vehicle such as the blood. Microb is a catchall term -- much like germ in English -- to define the etiology of afrangi disease. Microbs are free agents which can "bombard" a patient much as black magic can. As black magic can be neutralized by a more powerful agent such as a priest exorciser, so microbs can be banished by strong antidotes such as shots or antibiotics. This popular conception is reinforced by the Egyptian medical profession's routine prescription of massive doses of penicillin and antibotics.

Baladi etiology often short-circuits a complex explanation with the simple statment that one fell prey to microbs. One c a n suffer from bombardment or from proximity. As baladi etiology warns against the microbs of unboiled baby bottles or air in a room with closed windows (where one breathes air with other peoples' microbs), so cosmopolitan medicine has its theories of contagion.

74 EVELYN A L E E N E EARLY

Fore ign objects in the b o d y are subject to the fluidity principle; they can circulate. A w o m a n exper iencing d i scomfor t f rom an I U D may say it "rose to her heart ." She does not mean that the I U D literally pe r fo ra ted her uterus and ascended to her heart . But given physiological fluidity, a

foreign object like the I U D can " m o v e a round" symptomat ica l ly if not literally. T h e I U D is afrangi medic ine par excellance; it t ransgresses internal boundar ies not to res tore balance, but to subver t it. Also, the hear t is the symbol ic center o f the b o d y and so one natural ly speaks of foreign objects as well as less mater ia l "pain" or "joy" as gravitat ing towards it. Body parts o r processes of ten have social or cultural meanings as well as physiological ones. O the r researchers (B. G o o d 1977, M. G o o d 1980) have no ted how central physiological concep ts such as hear t and b lood descr ibe emot iona l and social categories.

Medicine, a foreign entity, circulates th roughout the body. O n e mothe r ' s account reveals a nurse order ly ' s fluid in terpre ta t ion of the chi ldren 's allergic rash react ion.

When the children's breath is bad or when their stools have a bad smell, it is time to give them the oil (laxative) 1 get at the pharmacy. I have them drink that and drink large quantities of liquids to wash their bowels out. But I don't let them drink tea because it causes constipation. I recently bought a fifteen-piaster jar and gave one teaspoon to the girl, one-half teaspoon to the baby, three teaspoons to the small boy, a half bottle for myself and the rest to my older son. We all got rashes all over us, especially our faces, and I . . . went to the clinic with my children and they said it was a sensitivity (allergy). The nurse orderly there told me that the oil came out of the stomach and spotted the skin and that I was lucky that that was all that it did.

T h e nurse order ly descr ibes the oil 's m o v e m e n t f rom the s tomach, through the boy, to his skin; the o rder ly suggests that it might have migra ted e lsewhere with m o r e harmful results.

The above two examples can be literally or in terpreta t ively r ende red as: (1) a r epor t o f an I U D ' s m o v e m e n t f rom the uterus to the heart , o r an explanat ion of dysphor ia by references to the heart , (2) a r epor t of the oil 's m o v e m e n t f rom the s tomach to the skin, o r explanat ion of a rash by allusion to internal processes . Medical anthropologis ts eliciting physiological categories and principles must reconci le literal and express ive translat ion to de t e rmine actual intent. A cul ture 's express ive style conveys e thnophysiologica l models . In Egypt ian baladi conversa t ion , n u m e r o u s references suggest f low ra ther than hesi tancy or disjunction. O n e speaks of a b a b y "born with great ease - - sl ipping out like turrnice (lupine) out o f its shell," or of social resolut ions where "peop le ga thered spon taneous ly and took care of it." Stages of predel ivery labor or of arbi t ra t ion are glossed over. Such an express ive style may be used in descr ip t ions of the trans-


mission of moral, psychic and somatic qualities which are based on a fluid physiological model. Like foreign objects, psychic disposition flows through the body to affect it. To claim that fluidity is a common baladi expressive style and to claim that fluidity is an important concept in baladi culture in general and baladi ethnophysiology in particular is to make two separate -- not necessarily jointly true -- statements. In this instance I make both claims. Striking evidence of concomitant expressive and cultural/ethnophysiological incidence of fluidity is provided by physiological conceptions like nursing and sleeping which support overall cultural conceptions of morality and anger. Baladi people state that during breastfeeding, spiritual qualities are transferred from mother to child in the milk. An angry woman should not breastfeed lest her anger be transmitted through the milk to the child. Children suckled by the same woman are considered siblings and cannot marry. Some women mention that nursing transfers immunities to the child (a belief corrobarated by cosmopolitan medicine). Milk serves as a multivocal symbol of morality, disposition, genetic relation and physical strength -- all of which it trans- mits. As with moral, so emotional or psychic states can flow into or impinge upon somatic conditions. Eating while angry causes indigestion, and sleeping while angry alienates one's qarina -- bringing spiritual troubles.

Restorative Balance

This principle complements that of fluidity. Both are based on the dynamic interrelation of body parts. Baladi physiological models generalize a symptom, or a recovery, to the body as a whole. Thus, a headache may mean a body so weakened that even walking is difficult. One speaks of aching muscles (as in influenza) in terms like "my body is broken" (gismi mukassir), and of illness by references to one's tired or ill body. Localized symptoms deplete the entire body. The body expends power (quwa') to right imbalance or weakness wrought by disease o r foreign (afrangi) agents. Body energy is depleted both by an internal systemic balance or by outside forces.

Baladi cures aim to restore normal balance. Although a humoral system is not highly articulated, hot diseases are counteracted with cold foods and vice versa, and humoral principles are implicit in the notions of body energy expenditure to accomodate or overcome alien elements, and of moderation in eating to avoid illness. This moderation entails avoidance of mixing food types and of indulging. A cure should occur as normally as possible. Baladi household remedies (wasfat baladiyya) utilize natural


substances for cures. Since it is abnormal to ail, the body's natural restorative tendency should be allowed to assert itself and aggressive intervention should be avoided. Baladi women often say, "his body got better all by itself" (gismu khafliwahdu).

Afrangi cures, potent medicine which "attacks" disease, are seen as differing degrees of such intervention which rather than allowing the body to cure itself may actually further unbalance its natural state in the course of treatment. Some aggressive interventions such as massive injections or abortions are not entirely avoided. Injections are viewed as modern magic which infuses the body in much the same way that an exorcist's spiritual forces counteract black magic. Self-abortion is a t ime-honored escape from a worse situation -- the lack of physical and/or material resources to support another child. Small children, delicate and vulnerable, are protected from massive medication which it is felt may exacerbate a sick child's suffering. Surgery, however, is resisted. Abdominal surgery, termed "opening the stomach," and its exposure of internal organs is viewed with anxiety. One woman confided that she had been hospitalized with post- partum complications, and had expected the usual D and C. When she awoke to find "mounds of cotton" on her stomach, she was dismayed. "I would not have gone to the hospital if I had known they would open my stomach," she said.

Illness is indicated by threatening symptoms as well as socially disjunc- tive contexts. Illness is an alteration of a normality which the body's power may restore. It may arise from outside, weakening agents, which in baladi etiology include birth control pills and antibiotics. It is believed that both should be supplemented with vitamin pills. This view is reinforced by cosmopolitan medicine's hormonal vitamin therapy to counteract miscarriage and infertility. Illness may be due to abnormal internally generated physical debilitation such as that exhibited in persistem exhaustion; this condition may be used to explain such phenomena as infertility or a physical disability.

As symptoms -- either externally or internally generated -- are etio- logically salient, so also are environmental anomalies, writ small as coincidence or large as calamity, taken into account in baladi explanations of health problems. Illness narratives employ a proximate, specific logic which details an episode to point out irregular somatic and social patterns - - obstructions to natural processes. One mother related two infant deaths and two abortion attempts as follows:

1 had a daughter who was very pretty ("as the moon") but the second day after she was born she turned as black as my black dress. A neighbor took my baby to a pharmacist to try to get some medicine, but the pharmacist must have known the baby was dying because


he told my neighbor to take the girl home. Shortly thereafter she died. People told me that God took this baby away because 1 tried to abort myself with an astara (a long tube inserted in the cervix in home abortions). Now I don't know what to do to avoid pregnancy; pills will dry up my milk for my youngest and I fear the IUD will rise to my heart. 1 certainly will never use the astara again; my oldest girl died when I was trying to abort Omar, my oldest son whom you now see healthy at seven years, with an astara. She caught a cold and died.

The mother relates the first death to an abortion at tempted on the child while it was a fetus, and the second death to an abort ion at tempted on a fetus (not the child who died) at the time the dead child was sick. The mother was attempting to halt a natural process (conception and birth) and thus flew in the face of principles of natural restoration. An aggressive abortion at tempt such as the above is baladi medicine's equivalent of a massive dose of afrangi medication; both are abnormal and should be

avoided. I now return to narratives A and B of the first part of this paper to

examine how they use a blend of baladi and afrangi medicine as multiple elements of a single, unified system.

EXPLICATION OF NARRATIVES: THE RESTORATION OF ORDER IN THE BALADI WORLD

In Narrative A above, we see a fragment of the ongoing problem of keeping a young child healthy. This problem occupies a central position in both afrangi and baladi elements of a baladi woman's holistic system; in the first, it is responded to with clinic visits, innoculations, and medicines, while in the baladi system it is managed with basic remedies, resolution of tensions, and preservation of resources.

Aniyat is worried about her only male son, who is highly valued and subject to envy, and his health; that and other pressures make her irritable. Her only option is to make the rounds of the local clinics and curers. Pneumonia, worry and fright are not her only problems. She cannot afford to visit a private physician's clinic. As a low status baladi woman her reception at the government clinic is unpredictable. Shaykh Abdu is certainly a more inexpensive and familiar option than a psychiatrist. Frustrated, Aniyat turns f rom clinics to Shaykh Abdu and changes her diagnosis f rom the afrangi disease pneumonia to the baladi disease k h a d ' a

(anxiety). Each form of her son's syndrome can be thought of as operating within

each type system. The afrangi disease of pneumonia in an afrangi system is clinically diagnosed and treated. Within a baladi system which seeks restoration of balance, this afrangi disease' causes the mother to worry. As


wife and mother, she bears ultimate responsibility for producing a family and keeping them healthy and is considered deficient in her role if she flags at producing healthy children. Aniyat, frustrated at the persistence of her son's symptoms, dreams that an old woman is chasing her. The baladi disease of khad'a within the afrangi system would doubtless be classified as anxiety by an afrangi practitioner, although it is doubtful that a woman like Aniyat who differentiates two diseases would present the symptoms of khad'a in an afrangi clinic. Within the baladi system, khad'a is seen as the result of disquieting events; ideally once equilibrium (whether adjustment to a shocking death or recovery from a frightening encounter) is restored, health returns.

In Aniyat's narrative, Shaykh Abdu, a baladi practitioner, operates in both systems. Recognizing Muhammad's symptoms as serious, he recommends Aniyat take him to an (afrangi) doctor; at the same time he recommends a pigeon sacrifice to get rid of the woman in Aniyat's dreams. Aniyat vowed to take sugar to Shaykh Abdu if her son recovered. Shaykh Abdu leaves room to deal with afrangi pneumonia clinically (in his suggestion that Aniyat take her son to a doctor) and experimentally (in his recognition of Aniyat's worries). He then moves to center his attention on the baladi disease (khad'a) within the baladi system. Sensing that the double of the mother or the child has been afflicted, he prescribes a baladi ritual sacrifice of a pigeon to appease Aniyat's troubled double and supports a vow on behalf of Muhammad's double. Now Aniyat reports that Muhammad is better and she sleeps better; to ask which came first is to ask an afrangi question of a baladi woman. She simply feels that all is better now (after all, if she does sleep better and her double is content that should have a reciprocal effect on her son, within the baladi holistic system).

In Narrative B, Laila, who is literate and from a comparatively well-off family, separates herself from local customs and social life. Baladi identity is consonant with her family's status as urban merchants, but she avoids certain aspects of that identity. This is probably due to a combination of her personality, educational level and status as a school' teacher's wife. She never dons the traditional melaya laf and wears a modern mid-calf skirt and buttoned overblouseojacket when she goes out. At home she wears the pajamas usually worn by young girls, rather than the customary gellabeya (house dress). When she wanted to pay condolences at a traditional ceremony, Laila had to borrow the requisite black gellabeya from a neighbor. Laila disassociates herself from her neighbors, saying that interaction only leads to idle chatter and malice, and that it is better to


keep to oneself. She also shuns common local baladi customs such as spending the day at the cemetery on feast day and visiting saints' tombs. These activities are popular with her neighbor women. Often women like Laila who seem to pride themselves on their lack of involvement with neighbors also tend to abstain from participation in ritual social activities like cemetery and shrine visitation.

Despite Laila's propensity to avoid shaykh and local baladi practices, they still were part of her curative repertoire and when pressed she resorted to them. The baladi definition of Laila's problem is as a problem of fertility. Fertility problems are critical in the baladi system. One prominent syndrome is mushahara, infertility or insufficient lactation induced by careless actions of potent people (such as those recently circumcized, women who have recently given birth, etc.) Another is inexplicable infant death. Laila became interested in a ritual performed during the seventh month of pregnancy to counter this phenomenon and insure the well-being of the soon-to-be-born child. In this, one procures pigeons, takes them to the shaykh to be blessed, sacrifices them, and sprinkles the blood on a white gellabeya which the mother wears to bed, and on a child's gellabeya which the mother sleeps with under the pillow. After the sacrifice, the pregnant woman spends an evening alone in bed. The pigeons and other food are fed to children of the lane who symbolize the living youth and the hope for the newly born to grow up like them.

Laila felt that afrangi medicine would "deliver" if she ran enough lab tests. Frustrated, she turns to baladi cures which, despite her usual reluctance, provide a familiar support to alleviate her anxiety. Laila has absorbed a fair amount of information on afrangi medicine, but her experiences are basically that of a baladi person. Her baladi healing system includes both baladi and afrangi elements and she turns to them in a manner which can only be understood in light of her life experiences -- here, her medical history, her disappointed hope in afrangi medicine, and her core identify as baladi.

Within the afrangi structure, the afrangi related Rh-factor has a set treatment in the initial two births; if this is not given, transfusions in subsequent births are indicated. Within the baladi structure, afrangi treatments and lab tests assume miraculous powers similar to those attributed to injections and penicillin by baladi clients and sometimes by afrangi practitioners, who frequently prescribe vitamin injections and penicillin prescriptions. In Laila's case, she believed that if the correct procedures were discovered and followed, all measures of malady could be righted. It was a question to her, then, of seeking out the right doctor,


one with high status who would know the correct treatment. She and her husband, therefore, looked for a new doctor. They repeatedly took the Wasserman test (for syphillis) and blood profile tests.

Laila became pregnant after a regimen of antibiotics and hormonal stabilizers. She planned to deliver her baby at a clinic next to that of a pediatrician on the assumption that she could shift from specialist to specialist so that the pediatrician could assume responsibility directly after the baby's birth. To Laila, the specialists of modem medicine were the answer to her problem. Laila fussed about when a complete blood transfusion should be done, and planned to discuss this with the pediatrician. She arranged for powerful mediating forces; a relative arranged a bed at the famous Qasr el Aini hospital. This hospital -- which has a special aura because of the medical school attached to it -- attracts people from all over Egypt.

The Management of Everyday Life

The baladi curative system copes with illness and disaster by restoring a natural balance. The afrangi system provides powerful antidotes. The two systems are synthesized into one coherent therapeutic system by baladi Egyptians who attempt to make the most of a marginal economic exis- tence in urban quarters where disease and infant mortality rates remain high. A baladi Egyptian woman handles a health problem holistically, responding to all relevant factors. Her action is consonant with her appraisal of the problem, the appropriate treatment, which may involve both natural and supernatural techniques, the most feasible solution and the most justifiable course of action. She acts according to her model for "problem solving," which is highly responsive to the daily pace of life and its exigencies within the larger socio-economic and cultural context. A woman constantly balances ideal treatment wiih actual possibilities. Disease perception evolves in tandem with everyday life developments.

As wife and mother, a woman bears ultimate responsibility for producing a family and keeping them healthy; she is considered deficient in her role if she flags at producing healthy children. Children need a protector. "The child is innocent," one frequently hears. "Why should he have to suffer?" The mother notices children's symptoms and takes them to nearby clinics or practitioners. She consults her husband about major expenditures and trips to distant specialty clinics. A mother is continually preoccupied with conceiving or preventing conception, miscarriage and abortion, retaining her health during pregnancy and lactation, and protect- ing her infant from colds and diarrhea.


Baladi women are comfortable using both baladi and afrangi treatment. There is no sense that they are two, conflicting systems; rather, they form a coherent whole. Choosing one or the other is a matter of accuracy in diagnosing the true nature of the disease. Given the ambiguity of somatic symptoms, this is never completely ascertainable. Baladi categories of disease are consonant with baladi culture's baladi:afrangi opposition. Likewise they are consonant with its pragmatism of everyday life. A baladi woman continually integrates her actions with her situation its constraints by contextualizing illness events. I treat this "making sense" of life via the praxis of illness narratives elsewhere (Early 1982). In short, narrative accounts of an illness express baladi Egyptian perceptions of physiology, body process, disease progression, and correct curative action, these accounts detailing an illness episode within the patient's life situation. Specific detail may justify a shift in diagnosis either when an initial diagnosis proves unfruitful or when there is a rapid turn about in symptoms. An illness may be seen in a new light when someone remem- bers a striking comment made to the patient or a quarrelsome neighbor.

Baladi illness narratives also provide a medium for the affirmation that proper therapeutic effort -- given everyday life constructs - - has been expended. As such, they encode the logic of baladi women's efforts to cure within an economically marginal situation.

There are compelling reasons for utilizing folk (here baladi) cures as a first line of defense, reasons having little to do with superstitions or "curse anxiety." Baladi cures are readily available, inexpensive, and known to work. Baladi practitioners will not insult or ignore one, as government health practitioners and middle class physicians are known to do. Utiliza- tion of folk practitioners is not just a matter of taste or ignorance. It is often a matter of economy. Baladi women may choose cheaper household remedies when cases are not severe. They calibrate their use of baladi and afrangi remedies by cost, severity of symptoms, options available through their therapy managing group, and other elements of the therapeutic situation. For instance, some women attend the maternal and child health clinic to obtain free medicine; others, to obtain another set of opinions from a doctor. At government and benevolent society clinics, they tailor their visits, interaction with staff, and rendition of symptoms according to specific goals. Baladi women's curative action is pluralistic not only in its utilization of both baladi and afrangi cures as appropriate, but also in its appreciation of the spectrum of benefits obtainable from government bureaucracy. One takes what one can find to further well being. For example, a woman may judge that free flour at a clinic is important one day, and "contacts" with staff for referral to a government hospital or

EVELYN A L E E N E EARLY

specialist is m o r e impor tant another day. E a c h bureaucrat ic encounte r

provides leads to further healing or fur ther medicine and commodit ies , and the baladi woman picks and chooses what she needs when. Thus,

baladi illness narratives reflect the logic of the management o f everyday life, as they do concepts o f physiology and p e r s o n h o o d and the underlying

values of baladi life.

CONCLUSION

Throughou t this article I have discussed baladi and afrangi curative

practices as parts o f a holistic system whose alternatives are used as they are found helpful. There is little sense among baladi w o m e n of moving

f rom one system to another ; elements of either or both may be applied simultaneously. As the baladi curative system reflects the baladi world

view, so baladi curative action reflects principles o f baladi social action: a careful utilization o f all resources available to carve out a bet ter life in an

economical ly marginal world.

EVELYN A L E E N E EARLY Department of Anthropology/Honors Program University of Houston -- University Park

NOTES

J This article is based on fieldwork conducted in Egypt from May 1974 through January 1977 under grants from Fulbright-Hays, the Social Science Research Council, and the National Institute of Mental Health. I am grateful to Jean Comaroff, Mary-Jo Del- Vecchio Good, Michael Fischer, Byron Good, Wafiq Ashraf Hassouna, and Mari Lyn Salvador for their comments on various drafts of the paper.

2 Females in traditional Cairo tend to use more elongated vowels than males. EI-Messiri (1976) notes that females frame accounts of calamity with elongated vowels and stereo- typic terms such as ya dahwiti (my disaster).

3 EI-Messiri (1978) offers a comprehensive look at the historical meaning of baladi. Other authors (Attiya 1982; Rugh 1984; Wikan 1980) have written social and cultural analyses of contemporary baladi society.

R E F E R E N C E S

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1977 Outline of a Theory of Practice. Cambridge: Cambridge University Press. Early, Evelyn A.

1980 Baladi Women of Cairo, Egypt: Sociability and Therapeutic Action. Ph.D. Dissertation, University of Chicago.

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1982 The Logic of Well-Being: Therapeutic Narratives in Cairo, Egypt. Social Science and Medicine 16: 1491--1497.

1985 Catharsis and Creation: The Everyday Narratives of Baladi Women of Cairo. Anthropological Quarterly 58:172-- 181.

Foster, George M. 1976 Disease Etiologies in Nonwestern Medical Systems. American Anthropologist

78: 773--782. Good, Byron

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Ohio: Bowling Green Univ. Press. ei-Messiri, Nawal

1975 The Relationships between the Sexes in a Harah of Cairo. Ph.D., Univ. of Indiana.

eI-Messiri, Sawsan 1978 Ibn al-Balad: A Concept of Egptian Identity. Leiden: E. J. Brill.

Rugh, Andrea B. 1984 Family in Contemporary Egypt. Syracruse: Syracruse Univ. Press.

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the baladi curative system of cairo, egypt

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