Rationality and cultural reasoning in self-madication among the chronically ill poor elderly in a congested community in Bangkok

Abstract

This ethnographic study seeks to understand cultural reasoning in self-medicationand and its rationality among the chronically ill poor people in a congested community in Bangkok. Participatory observation was the chief method for collecting data during 6 months (November 2005-April 2006) in the community. The biographical accounts of chronically ill patients and their neighbors reveal how socio-economic constraints in different life situations, including the quality and complexity of hospital service utilizing and poor quality drug dispensing, shape decision-making of treatment choices in everyday illness experience of the poor, elder prople. I argue that lay cultural reasoning with regard to self-medication was greatly influenced by their own three concerns: the need to maintain social relationship within the family and community; occupational security; and keeping good status in asymmetrical power relation with networks of social support or working party. In addition, reasoning based on these consideratons is the means to achieve two aims: (1) to fulfill responsibilities in one's capacity and role for the well-being of other family members and (2) to invest for long-term advantages which would be useful in the future as when one faces crises in life. These ends could be considered rational since they are appropriate and legitimate and are of great value to the poor people. Therefore, before assessing or interpreting the rationality of different actions, one needs to find out the inner logic, which could differ from that held by the assessor. This study also proposes a cultural model of everyday reasoning on self-medication.