This study documents medical and social responses which emerge when a peasant community is brought swiftly into a global economy through tourism. It shows that both the nature of development and pre-existing cultural priorities of indigenous communities configure social responses. The author sees medical systems as cultural systems and shows that they are both derivative and generative of contextual socio-economic forms. She uses "structure-in-process" methods of Giddens, Sahlins and others to analyze change and continuity in the plural medical system of two populations of Khumbu Sherpas of Nepal, one rural and one recently urban. The dissertation traces the underpinnings of medical behaviors to shifts and continuities in the production practices of Sherpas as they increasingly participate in trekking industries.
The thesis is that Sherpas produce themselves as independent individuals who exist in a socially dependent aggregate. Sherpa ideals of independence within interdependence are expressed medically both in therapy use patterns and in conceptions of ill health and its causes. These ideals are also expressed in Sherpa labor practices based on both wage labor and reciprocity. Three principal forms of healing are available to Sherpas: shamanism, Lamaist Buddhism/Amchi medicine, and biomedicine; each promotes its own discourse about the ideal human condition as being either alone or bonded to others, and this is expressed through health messages, clinical episodes, lay and professional interpretations. No medicine promotes one discourse solely, but the former tend to encourage collectivism and the latter, social atomism. As Sherpas participate in trekking, they use traditional labor strategies based on wage labor and reciprocity and kinship found in agro-pastoralism. Social interdependence is thus maintained at a time when tendencies toward social atomism from wage labor demands are increasing. Sherpa production in trekking is presented as reliant upon "social" labor. Rather than the industry subordinating indigenous social bonds to those based on the cash nexus, Sherpas are reproducing traditional labor patterns in order to reproduce their own identity--building the cash nexus around their social bonds. As one consequence of the structural continuity they bring to their new economy, Sherpas adhere to their traditional healers although this is by no means their only reason for doing so.
