(1996; 157 pages)
Injection use is a striking example of the culture-generating ability of technology in general, and medical technology in particular. In societies where injections, and the biomedical thinking behind them, are thought to be 'strange' they appear to engender a high degree of trust and are highly sought after. Both impressionistic observations and directed research make apparent that injection use leaves its mark on both how people perceive illness and what steps they take to effect a cure. Injection use appears, moreover, to shape social relations entered into by individuals in the pursuit of their concern for maintaining or regaining an optimal state of health.
While injection use may indeed influence perceptions of illness, this does not mean that it will necessarily bring about a radical change in thinking. The hope that injection use would serve to promote the biomedical vision and thus influence traditional thinking on illness and health has been little realized. The influence which injection use exerts upon indigenous culture appears to vary somewhat. Surprisingly perhaps, injection use can actually be integrated into traditional notions on illness and, indeed, reinforce them. Injection use confirms existing ideas not only on the central role played by blood in illness and health but also on humoral etiologies, theories on maintaining a balance between 'hot' and 'cold', and on personalistic interpretations of therapy. This culture retaining characteristic of injections can be utilized in combination with ideas which emphasize the alien origin of injections ('foreign is beautiful') to become a formidable source of power.
The ubiquity of injections in medical practices is a logical consequence of cultural reinterpretation. It is not only a question of injections being a passive element of medical practice, but also one of injections, due to their culture-generating capacity, forcing themselves upon health workers. As only the best is good enough where matters of health are concerned, injections become a 'must'. Not only does this occur in formal health care but it is also found in the informal sector, including self-care.
The role of injections in nurturing human relations is both an ambivalent and a contradictory one. On the one hand, they are a means by which social distance and inequality are created and maintained and, at the same time, make patients dependent upon health workers. On the other, they may reflect the financial or social bargaining power of patients vis-à-vis various types of providers. They also serve as a means of communication which both expresses and fosters involvement and empathy between the helper and the helped. Injection use has then the ambiguous ability to both increase and stifle the use of public health institutions.
Many countries have begun information campaigns designed to discourage the use of injections. Because of the important cultural meanings attached to injection use, however, any improvement in the present use of injections in medical practices will probably not be easily achieved. Thorough, comparative research into the preferences for this mode of treatment seems therefore urgently needed.