Tracking Traditional Medicine on the Vietnamese Internet: Dang Nguyen to Visit Yale

PhD candidate Dang Nguyen has been awarded a prestigious Fox International Fellowship, which will see her spend the 2019–2020 academic year at Yale University Graduate School. She spoke with Nicole Davis about her work.

What’s your doctoral research about?

I’m interested in how the internet and social media are affording increased visibility of medical knowledge and practices that generally exist on the fringe. In popular discourse, these practices are often referred to using a variety of ambiguous terms – alternative medicine, traditional medicine, unorthodox medicine, unconventional medicine, and so on. In the policy space, the current official term for these modalities is traditional and complementary medicine (T&CM).

I use a slightly technical term to conceptualise these therapeutic modalities. I call them non-biomedical knowledge – a term that covers a range of therapeutic modalities outside of the mainstream, scientific, biomedical practices. This term gives proper recognition of medical practices that persist at the margin of the scientific enterprise as they continue to evolve, while allowing us to have a more complete appreciation of the unique historical significance of biomedicine.

What research will you be conducting at Yale?

My proposed project while at Yale is titled “Miracle Doctors, Miracle Cures, and Invented Traditions: Harnessing Digital Methods for Knowledge-based Policy Building in Vietnam”. This project is a subset of my larger doctoral project. Within the context of the project at Yale, I’ll be investigating ways to include digital methods and digital data into the evidence base for policy making on T&CM in Vietnam.

Why this topic?

Traditional medicine is hugely popular throughout Southeast Asia and other parts of the world, and the advent of the internet and online social networks has seen an even greater proliferation of non-biomedical knowledge and practices via platforms like Facebook. A quick search for 21 keywords on Facebook, such as “disease”, “Southern medicine”, “Northern medicine”, and “Eastern medicine” in Vietnamese alone returns almost 2000 public pages and community groups. Approximately 300 of these groups have over 30 000 active members with an average of over ten posts per day. So we’re talking about a very big scale here, and we’re talking about a phenomenon which can potentially have a huge impact on population health. But it’s also a phenomenon that hasn’t really been studied in very much detail yet.

This is starting to change. The World Health Organization recognised the significance of this issue and has created a Traditional Medicine Strategy 2014–2023, which is a roadmap for how we might harness the potential contribution of traditional & complementary medicine (T&CM). The Strategy outlines, for example, how we might promote therapeutically sound use of T&CM through regulation and national policies, or how we might incorporate T&CM in building people-centred healthcare.

One especially important recommendation in the WHO Strategy has to do with the development of knowledge-based T&CM policies. In order to achieve this aim, we need a comprehensive understanding of the specific nature of local T&CM sectors; we need baseline data before we can design policies regulating the supervision of T&CM practices. And there are a set of explicit questions that need to be answered before a knowledge-based T&CM policy can be developed: why are people using T&CM, when are people using it, what are the benefits, who is delivering it, and what are their qualifications?

These are really fundamental questions, but often developing countries don’t have the resources required to provide adequate answers to these questions. In resource-poor contexts, there are various economic constraints on data collection, monitoring, processing, dissemination, and publication; and these are often worsened by poor institutional conditions and capacities that perpetuate non-standardisation, non-structured information operations, and non-transparency.

At the same time, however, internet access is often heavily subsidised in developing countries, so this means that people are increasingly performing significant parts of their everyday lives online. In the process, they’re generating a large amount of standardised and structured data. These data are highly accessible, and constantly expanding – so they have enormous potential for being transformed and incorporated into the evidence base of regulation and policymaking. So far, however, this potential has remained largely untapped. And my aim is to find out how we might go about harnessing this potential – using digital data and methods to widen the evidence base for policymaking.

So how exactly are people in Vietnam using the internet when it comes to T&CM?

The content and the activities, much of which take place via public Facebook groups and pages, are as diverse as the traditions of non-biomedical therapy themselves. These activities range from sharing family medical recipes; discussing the medicinal properties of indigenous plants, and buying and selling these plants; through to crowdsourcing the diagnosis of disease via photos and videos. People use Facebook to advocate for traditional alternatives to unaffordable biomedicine; in some cases it’s even being used to create cult followings for miracle doctors. We might think of these online social networks are constituting an emerging health ecology; and it’s an ecology reflects the historical continuities of local and regional socio-cultural realities as much as it conditions health experiences of the local population.

Traditional medical knowledge and skills have often been transferred from generation to generation orally. In the past, this made it difficult to identify qualified practitioners; and it was also hard to systematically monitor popular discourses surrounding quality, safety, and efficacy. But the internet has opened up exciting new opportunities here: the large-scale propagation of traditional medical knowledge and practices via the internet means that, to a really unprecedented degree, we have the capacity to expand the global knowledge base about indigenous therapeutic traditions and practices. And this is especially important in the context of resource-poor countries, where there is a continuing lack of robust knowledge databases, frequent national surveys, and national research centres. Here, harnessing digital methods to incorporate big data into health policy determination opens up a whole new venue of evidence for informed policymaking.

About the Yale Fox International Fellowship:

The Fox International Fellowship is a graduate student exchange program between Yale and 20 world-renowned partner universities. One Fox International Fellow is selected from each partner university each year. Doctoral students, graduating masters students, or graduating seniors can apply to this fellowship. The award includes round-trip travel, accommodation in rental housing provided by the Fox Program, visa assistance, health insurance and a US$1,400 per-month stipend in addition to any existing scholarships or funds that the fellow is entitled to.

Fox International Fellows are expected to report on their progress and activities throughout the year and are often asked to present their research. Fellows also produce a Policy in Practice brief that translates their research into a digestible written piece for relevant stakeholders.

About Dang Nguyen:

Dang Nguyen is a second-year PhD candidate in the School of Historical and Philosophical Studies (SHAPS) at the University of Melbourne. She is working under the supervision of Associate Professor Michael Arnold (SHAPS) and Associate Professor Richard Chenhall (MSPGH).

Her PhD project investigates the performance of non-biomedical knowledge on the internet. The aim is to understand how digital technologies influence the propagation of knowledge that exists in the margin of scientific knowledge, and how these technologies are transforming non-biomedical cultures as living practices.

To read more about her work, visit www.dangnguyen.digital

Dang can also be found on Twitter @digitaldang

Feature image: Dang Nguyen, 2019. Photographer: TN