The first cases of Covid-19 were recorded in Vientiane on March 24th; until then, Laos had been the last country in Southeast Asia to be officially ‘Covid-19 free’, a source of national pride, even if many had doubts. A landlocked country, surrounded by more populated and economically powerful nations, Laos has long felt vulnerable to its neighbours, whilst simultaneously looking to them for assistance. With a long, porous border with Thailand, where cases of Covid-19 are rapidly rising, the large number of young people from every province who migrate for work in low-paid jobs have been returning in droves as the authorities close the last remaining crossing points. Whilst many returnees have been picked up by the military and packed into now-closed schools for quarantine, others have already returned to their home villages.
Last week, the government announced the closure of most private healthcare facilities; a realistic acknowledgement that the majority are run by state-employed doctors to supplement their minimal income, whose presence is now needed in public hospitals. The Thai healthcare system has been the route by which aspirations for better care are enacted – but with cross-border movements now halted, rich and poor alike in Laos must contend with the realities of a national healthcare system which has suffered from decades of fragmented development.
Aid from China, which is viewed by many with suspicion due to its association with expansionist politics, was ceremoniously welcomed as a team of medical professionals arrived to advise on containment efforts soon after the first cases were announced. The World Bank has announced $18 million USD emergency financing to “strengthen health system and response capacity” in Laos, although it is not clear how this is expected to happen within the time-frame of a pandemic.
On the day the first cases were announced, stocking up my kitchen in order to prepare for the coming lockdown, I stopped to buy some fruit from an elderly seller at the side of the road. She affectionately patted me on the arm and, seeing that my motorbike basket was already overloaded with shopping, rummaged around for a piece of string to tie the bag of bananas on for me. A younger man came to see what was happening. “Bo yaan bo, meitao?” (are you not afraid, grandmother?) he asked. I attempted to joke that I was afraid too – we were all afraid!
During the course of my fieldwork in the rural south of Laos, being asked if I was yaan was an ongoing source of humour – sometimes, I felt that I should be afraid of everything, even an evening stroll through the village. In rural Laos, to live in awareness of risks is nothing new. There is the constant possibility of infectious disease – a sudden death from an acute fever episode or lingering malaise due to viral hepatitis are normalised. Drink-driving and lax road safety leads to traffic accidents; raw meat and fish consumption is popular even when people know of the danger of parasites. The very landscape in which people live is sown with spiritual threats, including attack by malicious spirits or harmful sorcery. The most vulnerable state is to be poudio, alone, without the protective influence of others. This is bo muan (not fun), and indeed a preference for being alone is often described as a pathological sign; eating alone is bo seeb (not delicious). A favourite tease involves the ‘bedroom ghost’ who appears if one sleeps alone; other spirits would possess those who ventured too far alone into the forest.
Now that Covid-19 is officially here, the government is acting quickly and has announced a nationwide lockdown after just a few cases, along with regular updates about tracing and testing. Facebook is the medium by which both official government information, and anxious speculation, quickly spreads, with the threat of harsh penalties for those peddling fake news. With the typical good humour and ‘team spirit’ I have often experienced here, Lao social media is full of stories about community groups making masks for health workers and institutions given over to the production of hand sanitiser. However, there is little expectation among the population that the state healthcare or welfare system will provide many resources. People look for their own methods of protection. Pharmacies are packed with residents stocking up on medications of all kinds. The herbal remedy popular against fever, lasabi (Andrographis paniculata) is in demand. Last month, a story of a talking baby, possibly linked with an older myth, prompted a temporary sell-out of eggs in the capital, said to be the cure for the virus.
In the past weeks in northern Laos, taleo, protective talisman made from bamboo have started appearing at the gates of houses. Traditionally used to guard against spiritual threats, they are now in some cases repurposed to mark the confinement of families. Their use may also be linked to predictions by ritual specialists of an especially close connection with the spirit world during this month, or an old story of an angry ghost who re-surfaces every 100 years to cause illness. Human-like effigies have been placed at village gates to warn travellers, and there are reports of roadblocks set up and other actions by village authorities to restrict movement, even pre-empting the government’s orders. To take measures to protect oneself against dangerous or polluting influences which may transgress boundaries is a well-understood path. Methods of isolating those who are accused of spirit possession are now perhaps being applied to those who have returned from abroad, with stories of people sleeping in rice huts far from the village centres.
Later, I reflected on the fruit seller’s generous gesture, which, although risky for both of us in the current context, was reminiscent of the warmth and affection between generations I have observed, often expressed through touch and physical closeness. Stories of the elderly dying alone in Europe are incomprehensible to Lao families. My friend’s father, his health slowly deteriorating, lay for months in the bed of his family home before passing away. He was surrounded by his wife, children and grandchildren, carrying on their daily lives around him. At the home of the traditional healer I studied with, chronically ill people would stay for weeks at a time, with a rotating shift of family members carefully tending to them, cooking, fetching water, preparing their medicines, massaging their feet, bringing grandchildren to lift their spirits.
The extended family represents the safety net for many. Remedies for establishing health are intrinsically social. Being together, experiencing care from others, creates kamlang jai, a powerful heart. The soul-calling or string-tying ceremony (su khuan, baci), performed when there is ill-health or during transitionary periods, is perhaps the most tangible representation of how and what it is to be well. During the ritual, which stabilises the soul-essence in the body, the participants are literally bound together with threads. Simply the act of tying a string onto another’s wrist and wishing them yu di mi heng, good health, is a routine way of enacting and ensuring care for others. To ‘bind the arm’ (phuk khen) is a way of strengthening the boundaries of the self.
Whilst techniques of guarding against dangerous outside influence are well-defined, the concept of “social distance”, especially with the elderly, is quite at odds with Lao sensibilities. Today’s announcement from the Ministry of Health said, “If you love yourself, love your family, and love our country, you must maintain a distance from others at this time”. Although benefiting from a relatively low population density and still nascent moves towards urbanisation, people live closely together from preference as much as necessity. How will they manage to negotiate the prospect of a disease which challenges the very notion of one’s connections with others? How will they negate the risk that their physical proximity poses to their relatives? How will they manage to create eunjai, to have warmth in the heart?
As we move towards the hottest time of year, with temperatures soon set to reach 40 degrees, this is a time of relative rest and plenty for rural people, as vegetables and fruits ripen, until the work of preparing the fields to plant rice begins. Today is the first day of Pi Mai, the Lao new year, but rituals are officially cancelled, and gatherings banned. Even alcohol sales have been prohibited, a perhaps unprecedented step to restrict festivities. As the loudspeaker announcements from the traffic police I hear outside my apartment say, “Go and relax at home!” For those who have already returned home, it will be a time of increased sociality, perhaps a nice distraction but also creating increased opportunities for virus transmission. How long will this current threat last? The rainy season, due to start in 2 months’ time, is a time of food insecurity for many – which may be worsened, if, like last year, the rain arrives late. At this time, Laos is even more dependent on food imports, especially from Thailand. If food prices increase, and with decreased income from children working abroad, what will this mean for people’s wellbeing?
From my small apartment in Vientiane where I am self-isolating with the privileged comfort of a fully-stocked fridge and a swimming pool, I have the ‘safety’ of being alone, although I’m sure my friends in the countryside would disagree. For a medical anthropologist in Laos writing about the everyday realities of negotiating care, it’s an interesting exercise to realise that, with no medical evacuation available, I may well experience this myself. However I am grateful to be in a place where to be jai di, kind-hearted, is such a valued quality – and hope that this may help people negotiate the challenging times ahead.
ABOUT THE AUTHOR:
Elizabeth Elliott is a PhD candidate in the Anthropology department at UCL, currently writing-up her thesis on traditional medicine in Laos, which includes approaches from Medical Anthropology and Ethnopharmacology. She has a background in Asian medicine, and also works on applied global health research projects based in southeast Asia.
Taleo photography by the Traditional Arts and Ethnology centre
All other photos by the author.
 Source: Traditional Arts and Ethnology Centre, Luang Prabang
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