Tangos Therapy: Health Behavior as the Result of Normalizing

Power in Medicating Symptoms of Malaria on the Community of

Sebesi Island

Vera Budi Lestari Sihotang

, Pujo Semedi

and Atik Triratnawati

Department of Anthropology, Faculty of Cultural Sciences, Gadjah Mada University, Indonesia

Keywords: Response to Disease, Recovery, Traditional Medication, Local Knowledge, Tangos Therapy.

Abstract: Tangos is a health therapy by using potion made of some types of medicinal herbs. The study aims to examine

tangos therapy as a health behavior carried out by the community of Sebesi Island to heal malaria symptoms.

This study also purposes to interpret the type of power which results health behavior of tangos. This study is

an important contribution regarding malaria in Indonesia. Also, cross-cultural study on malaria is important

to carry out to document the response of the population to malaria symptoms, as a measure of disease control.

Data collection was done through participation observation, interview, and literature study. To explain health

behavior, data were analyzed by using types of health categories, while the analysis of types of power was

employed to see whose power which results normalizing power. The results show that tangos is a form of

health behavior categorized as response to disease and preventive, protective, and safety behavior. It is

discovered that normalizing power is carried out by the community. This normality is reproduced and

legitimized through tangos therapy. The people’s knowledge about this therapy can be viewed as a control

instrument contributing to individual’s choice in treating symptoms of malaria.

1 INTRODUCTION

In Foucault's view (1980), power is closely related to

knowledge, there is no knowledge without power, and

vice versa there is no power without knowledge. In

terms of the relationship between power and

knowledge, (Foucault, 2003) for example, sees

medical science as developing a set of criteria to

describe what is called normal, healthy, and abnormal

in an individual. The use of this specialized medical

terminology strengthens the position of health

professionals to be at the top. In this study, the form

of power as a result of knowledge is seen in the use

of tangos by the people of Sebesi Island to heal

symptoms of malaria.

Sebesi residents still experience malaria

symptoms. When facing them, the people prefer to

cure it through self-medication, which is tangos.

Tangos is a form of traditional medicine originating

from the original culture of Lampung and has become

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the health behavior chosen by the Sebesi community

for symptoms of malaria.

Sebesi Island is located in Lampung Bay and is an

administrative area of Tejang Village Sebesi Island,

Rajabasa Subdistrict, South Lampung Regency.

According to (Jedrusik, 2011), the characteristics of

the community of an island also can be viewed from

the dominating activities namely relating to water

(fishery, inter-island trade, tourism). Fragility is also

a characteristic of people living in an island (Lewis,

2009). The remoteness, smallness, and its isolated

characteristic are those which are the most noticeable

of an island. This remoteness is also owned by Sebesi

dues to it natural condition. With this characteristic,

the people of this island have developed the

mechanism to survive and adapt to the threats, one of

which is disease, with traditional knowledge. It acts

as a crucial role and they rely on this knowledge,

particularly to decrease the risk of disaster and

diseases.

574

Sihotang, V., Semedi, P. and Triratnawati, A.

Tangos Therapy: Health Behavior as the Result of Normalizing Power in Medicating Symptoms of Malaria on the Community of Sebesi Island.

DOI: 10.5220/0010755500003112

In Proceedings of the 1st International Conference on Emerging Issues in Humanity Studies and Social Sciences (ICE-HUMS 2021), pages 574-583

ISBN: 978-989-758-604-0

Malaria is a life-threatening disease caused by

parasites transmitted to human through mosquito bite,

the infected female Anopheles. In 2019, there were

approximately 229 million malaria case in the world.

The estimation of death rate reached 409,000 in 2019

(World Health Organization, 2021). Malaria can

attack people in all ages. The period between 2020-

2024 is important and it determines the efforts in

reaching Indonesia Bebas Malaria Tahun 2030

(Indonesia is Free of Malaria in 2030) (Bureau of

Communication and Community Service, 2020).

There are about 4 percent or 23 districts / cities and

around 1.1 percent or 2.9 million Indonesians who are

still living in areas with high potential for malaria

infection (Pranita, 2020).

Malaria is a disease of particular concern in

Rencana Pembangunan Jangka Menengah Nasional

(RPJMN) during 2020-2024, as well as heart disease,

stroke, hypertension, diabetes, cancer, tuberculosis,

malaria, HIV/AIDS, emerging diseases, the diseases

with potential to cause extraordinary events,

neglected tropical diseases (leprosy, filariasis,

schistosomiasis), mental disorders, injuries, vision

problems, and dental and oral diseases.

Indonesia becomes a home for more than twenty

malaria anopheline vectors which transmit the four

species. In Lampung, especially South Lampung

Regency, in 2020, there were seventeen cases caused

by malaria (Statistic Indonesia, 2021).

One of the islands in South Lampung is Sebesi

Island. It is the largest island in this regency (4643

acres), included in Rajabasa Subdistrict. Although

according to a report from the Puskesmas (Health

Service) UPT Rajabasa Subdistrict that malaria cases

have decreased, in fact it still occurs. Moreover,

malaria is a threatening disease, especially for people

living in coastal areas.

Several studies related to malaria have been

carried out. An overview of ethnobotany studies of

the types of plants used to treat malaria by (Willcox

et al., 2004). The book explains the types of medicinal

plants to prevent, treat, and control malaria. Research

on malaria in Indonesia was conducted by (Elyazar et

al., 2011). In this study, malaria and its control in

Indonesia were studied, both by the community and

by malaria experts in the colonial Dutch East Indies

until after 1998 (the period after the fall of Soeharto).

Other research on traditional malaria treatment in

Indonesia has been conducted by (Suswardany et al.,

2017). It was revealed that most people with malaria

symptoms in Indonesia used traditional medicine as

part of the treatment and used free antimalarial drugs.

Taek et al. (2018) conducted research on

traditional medicine in areas of high malaria endemic

in Indonesia, namely in West Timor. The Timor

region has long been attacked by various dangerous

diseases such as malaria and cholera. A total of 96

plant species from 41 families were documented as

medicinal plants for the treatment of malaria by the

indigenous people of Belu and Malacca Districts.

Based on this research, knowledge about traditional

medicine still persists among elderly people, on the

contrary, it is getting lost among youths. In

Pesawaran Regency, Lampung, research on malaria

was carried out by (Ritawaty & Supranelfy, 2018). It

was explained that the habit of going out at night was

related to the incidence of malaria and also discussed

community resistance to malaria drugs; the

distribution of Anopheles spp., mosquitoes, in

Pesawaran Regency; the community has the behavior

toward malaria such as the habit of going out of the

house at night, installing gauze, the density of the

walls of the house, the use of mosquito repellents, and

wearing body coverings.

From studies related to traditional treatment for

malaria that have been carried out, traditional

treatment for symptoms of malaria has never been

seen as a health behavior. In addition, the form of

power in health behavior to treat symptoms of malaria

has not been studied. For this reason, this study aims

to analyze tangos as a health behavior and investigate

the power of health behavior by the community on

Sebesi Island for symptoms of malaria. Also, this

study is another important contribution regarding

malaria in Indonesia, in the form of ethnographical

research.

2 METHODS (AND MATERIALS)

This research is a part of a dissertation research that

took place on Sebesi Island. The initial survey of this

island was carried out on 2

-4

August 2019. The

ethnographic fieldwork method began on 12

October-18

October 2020 then continued from 11

April until 30

May 2021. The purpose of this study

was to analyze the form of power in the use of tangos

by the Sebesi community to treat symptoms of

malaria. This form of power is seen from the

perspective of the theory of power by Michel

Foucault. Furthermore, the analysis of health

behavior will be seen through Gochman's concept of

health behavior.

Data collection techniques were carried out by

unstructured interviews, field observations, and

literature studies. Informants are one of the important

elements in a study, namely data sources that are able

to answer the formulation of the problem. Therefore,

Tangos Therapy: Health Behavior as the Result of Normalizing Power in Medicating Symptoms of Malaria on the Community of Sebesi

Island

575

the researchers chose informants using the purposive

method, namely village officials, traditional healers,

health workers, community leaders, and the general

public.

To get information about village profile and its

history, interviews conducted with Mr. Miftahuddin

(Kepala Desa), Mr. Firdaus (Sekdes), Mr. Andi (Kaur

Pemerintahan), and Mr. Rojali (former Sekdes), Mr.

Busri and Mr. Muchtar (both are the community

leaders). To answer the perception of disease and

malaria for the Sebesi community, interviews were

conducted with traditional healers, community leader,

and midwife. Some of these traditional healers are

considered to be 'orang pintar' on Sebesi Island,

namely Mr. Muchtar (as well as community leader),

Mrs. Sati, Mr. Fuad, and Mr. Saleh to obtain

information about traditional medicine on Sebesi

Island.

In addition, an interview was also conducted with

the midwife Mrs. Elis Sari to answer questions about

the malaria case. Interviews were also done with Mr.

Budi at Dinas Kesehatan Provinsi Lampung; Mr.

Budi Riyanto and Mr. Minak Wardan at the UPT

Puskesmas Rajabasa Subdistrict who administered

malaria treatment directly on Sebesi Island to obtain

information about malaria cases that occurred there.

Interviews were also carried out with several people

who had experienced malaria, namely Mr. Agus and

Mr. Akhyar.

To find out and experience tangos at the same

time, we asked Mrs. Rohani for help, who often did

tangos if one of her family members gets sick.

Interviews were also conducted with Mr. Sahrul, Mr.

Hayun, and Mr. Andi as representatives of residents

who often do tangos. Another method used in this

research was literature study. The literature used is

those related to traditional medicine in Lampung,

people's perceptions of malaria, the community's

response to malaria, and the types of herbs used to

cure malaria.

3 RESULTS AND DISCUSSION

3.1 Overview of Sebesi Island

Tejang Village Sebesi Island is located in Lampung

Bay and is part of the administrative area of Raja Basa

Subistrict, South Lampung Regency. Sebesi Island

Tejang Village consists of four dusun (hamlets),

namely Dusun Bangunan, Inpres, Regahan Lada, and

Segenom. Most of the population lives from

gardening, the rest work as fishermen, civil servants,

Figure 1: Sebesi island. Source: Research Center for

Biology-LIPI documentation and reprocessed by

Geospatial Information Agency.

and honorary teachers. The land area is used for

plantation/agriculture, namely 61.47%; around

0.38% of the area is used for rainfed rice fields. The

forest area is around 35.42% on the slopes of Mount

Sebesi, with an altitude of 535 – 845 meters above sea

level. Settlements occupy an area of 2.69%. Sebesi

was damaged by an eruption in 1883, but not as large

as Krakatau.

The lowland vegetation, including some of the

plantations, was badly affected by the ash rains and

the tsunami in 1883 (Thornton et al., 2002).

Figure 2: Mount Sebesi seen from a soccer field in Tejang

Village Sebesi Island.

As discovered in the 15

century Banten had

begun to establish cooperative relationships and

expand its economic activities to the Lampung area.

Sebesi Island by the Sultanate of Banten was

established with its owner, called Prince Cecobain

(coba-coba). The title of prince is given by the

Sultanate of Banten as a reward for giving pepper

ICE-HUMS 2021 - International Conference on Emerging Issues in Humanity Studies and Social Sciences

576

products. After Prince Cecobain died, the ownership

of Sebesi Island was under Prince Singabrata.

On 23

August 1624, the VOC decided to occupy

Sebesi Island and build a house there. However, due

to chaos and disease, the island was abandoned in

1625 (Historical and Cultural Center, 1997). It was

once a rest area for British ships docked before

entering Banten, precisely in the 17

century. At that

time, there was legal and illegal trade between the

kingdom and the sultanate. Sebesi Island also became

one of the islands where Danish and British ships rode.

The island had facilities for finding inns, lodging,

where people could unload goods, and also had fresh

water facilities, and all of them took place

consistently (Ali, 2021)

After Prince Singabrata died from the eruption of

Krakatau, Sebesi and Sebuku Islands fell to his

nephew, Prince Minak Putra. Then, he was

overwhelmed because he also owned a large island,

but with a lack of financial capacity, where finally it

was sold to Haji Djamaludin (who at that time both

served as village head, Prince Minak Putra was the

head of the Rajabasa village, while H. Djamaluddin

is the head of Kalianda village) in 1896 (Hasanuddin,

2021).

Sebesi Island was forest (and inhabited) before

1883 (Hasanuddin, 2021). After being affected by the

Krakatau eruption, Sebesi was increasingly

developed for agriculture, forestry, and urbanization

(Thornton et al., 2002). With further opening and

planting, coconut plantations have expanded to the

highlands, where coffee is also grown. During H.

Djamaluddin's tenure, people outside the island were

prohibited from entering, except for the excerpts from

H. Djamaluddin who were brought from Banjarmasin

and Banten. After he died, the management of Sebesi

Island was under Saleh Ali (son of H. Djamaluddin)

where the management began to change, allowing

outsiders to plant using a profit-sharing system (1938).

The wave of people coming to Sebesi Island can

be said to have gone through several stages.

According to Mr. Busri (a community leader in

Dusun Segenom), Mr. Busri's grandfather, H.

Abdullah, started to enter Sebesi Island around the

1920s to plant coconuts and oversee the northern area

of Sebesi. The owner of Sebesi brought workers to the

island in 1920s for the temporary settle. This is in line

with the story of Mr. Rojali (one of the officers at the

Tejang Village office), Mr. Rojali's grandfather,

Tubagus Nawawi, who started clearing land on

Sebesi Island in 1932. The entry of people to Sebesi

Island is suspected for two reasons, namely being

taken as temporary coconut pickers and people who

asked for land using a profit-sharing system. Since

then, population development there has started to

flourish.

The composition of the population is dominated

by Banten, (Serang Java, Sundanese Java), Lampung

on Kalianda coast, Bugis (one or two people), Batak,

Padang. The Javanese culture of Serang (Banten) and

Lampung are the cultures used on the island. The

latest data for 2021 shows Sebesi Island is inhabited

by 2,795 people, 787 families.

Most jobs are plantation farmers, fishermen as

much as 150 families, 6 people of state servants

(PNS), teachers, midwives, honorary teachers. Most

of the people also have additional businesses, namely

stalls, traveling trades, and goods collectors. In 2019

in Sebesi, electricity has been on for 24 hours. The

educational facilities in Tejang Village are Early

Childhood Education (PAUD), Elementary School

(SD), Junior High School (SMP), and Senior High

School (SMA). PAUD is located in three dusun,

namely Inpres, Regahan Lada, and Bangunan, while

the Elementary School is located in two dusun,

namely Dusun Inpres and Dusun Segenom. The

facilities for worshipping in Tejang Village have

three mosques and four prayer rooms, as well as

sports facilities, there are three soccer fields, three

volleyball fields, and one badminton court.

In terms of health facilities, there is a Puskesmas

Pembantu/Pustu (supporting health service) which

has been established since 1997 and two midwives.

This pustu serves nearly 3,000 people from Sebesi

Island, most of whom handle minor illnesses. When

experiencing serious illness, the community will be

referred outside the island to the hospital in Kalianda,

Rajabasa Subdistrict, South Lampung.

3.2 Malaria and Its Handling Program

on Sebesi Island

Malaria is a disease caused by the bite of the female

Anopheles mosquito, which can transmit the

Plasmodium parasite. The symptoms that appear are

having a body temperature of more than 38⁰ C, chills

after a fever, sweating like after exercising, especially

at night. Patients with falciparum malaria experience

fever every other day, while vivax malaria has a fever

every 3 days. Malaria sufferers who have frequently

been exposed to malaria already have immunity, so

that the usual symptoms do not resurface, what

appears is aches and headaches. After getting these

symptoms, the patient is required to undergo

laboratory tests to determine whether there is

plasmodium in the red blood cells.

The government is targeting by 2024 as many as

405 regencies/cities to achieve elimination of malaria.

Tangos Therapy: Health Behavior as the Result of Normalizing Power in Medicating Symptoms of Malaria on the Community of Sebesi

Island

577

In this case, in Lampung, there are 11 malaria-free

areas, 3 low endemic areas, 1 moderate endemic area.

Elimination means that 1/1000 population in one year,

the four districts that have not been eliminated are

South Lampung, Pesawaran, Pesisir Barat, Bandar

Lampung City. For areas that are still confirmed as

malaria endemic areas, the Ministry of Health has

carried out a strict surveillance program, in this case

through the Directorate of Prevention and Control of

Vector-borne and Zoonotic Diseases under the

Directorate General of Disease Prevention and

Control.

Rajabasa subdistrict, where Sebesi Island is

located, had a malaria explosion coinciding with the

entry of the hatchery in 1994. The hatcheries came

from Cilacap, Pati, and Eretan, Indramayu. They

carried transmission of infection to the Rajabasa area

which already has malaria endemic status (dos Reis et

al., 2015) argue that fish ponds function as important

and productive breeding grounds for malaria vectors.

For malaria cases, in Rajabasa in 2016 there were 105

cases, in 2017 there were 89 cases, 2018 there were

35 cases, 2019 there were 18 cases, and in 2020 there

were 17 cases.

In Sebesi itself, in 2007-2008 there were quite

high malaria cases and in 2010-2014 there were still

malaria cases on the island. It is in line with the report

from Mrs. Sari, the midwife, that during nine years of

carrying out duty in Sebesi (2011-2020), there were

three malaria cases that she handled and being

transferred to Puskesmas Rajabasa (Sari, 2021). In

2018, malaria cases no longer occurred on Sebesi

Island (Riyanto, 2021) but Sebesi people still feel the

symptoms of malaria. Malaria cases in Sebesi Island

can be occur due to sanitation, housing, namely the

absence of toilets, the indiscriminate behavior of

defecating on the beach, and poor drainage.

Some of the handling programs carried out by the

UPT Puskesmas Rajabasa are periodic larva

monitoring, socialization of the use of mosquito

repellent lotions every night, and the provision of free

mosquito nets, encouraging the breeding of fish that

like to eat all mosquito larvae, making visits to

villages in Rajabasa Subdistrict. Village malaria posts

(Posmaldes) were also opened to handle malaria cases

more quickly. This Posmaldes was opened in

endemic villages in Rajabasa Subdistrict, South

Lampung Regency.

3.3 Perceptions of Malaria for the

People of Sebesi Island

The Sebesi people are dominated by the Javanese

culture of Serang (Jaseng) and Lampung. The Jaseng

culture considers illness to be mystical and medical

causes. They think that serious and frightening illness

is a disease caused by witchcraft, because they do not

know what to face, which results in a thin body, while

minor illnesses are headaches and chills. The people

of Lampung divide diseases into two categories,

namely serious illness (bahaban) and mild illness

(common illness) or makhing. Severe and minor

illness can be caused by germs and witchcraft, this

type of disease can be contagious and not contagious.

The difference is that serious illness is generally

dangerous, while minor illness is generally not

dangerous. There are dangerous diseases that can be

treated by yourself and others, namely 'orang pintar'.

In the understanding of Lampung people, infectious

diseases are common, non-communicable, harmless,

and can be treated on their own (Sirat et al., 1990).

Malaria is deemed as a mild disease commonly

experienced by the Sebesi community. It is also often

called 'tolaut' or ‘hantu laut’, where a sudden feeling

of dizziness, malaria that comes from the sea consists

of cold ‘hantu laut’ and hot ‘hantu laut’. Another

perception about malaria states that there are two

types of malaria, which can be seen from the

symptoms. The first type is having high fever, other

types have symptoms of chills, and if it is very severe

it will trigger vomiting. The next perception is that

malaria has almost the same symptoms as typhus. The

symptoms that appear are heartburn, unwellness, high

fever, bitter mouth, and headaches. These attacks can

occur suddenly, usually due to wrong eating or

drinking. Another perception states that apart from

chills, malaria also has symptoms of yellow eyes and

a yellow body.

The old endemic disease itself gave rise to

empirical experiences from the Sebesi people

themselves, especially with very limited health

facilities, of course, with traditional methods used,

the people believe that to treat symptoms of malaria

is by using traditional medicine with herbs that have

a bitter taste. Based on their knowledge, malaria is a

disease caused by mosquito bites. For this reason,

people often treat with bitter tasting leaves to treat

symptoms of malaria and avoid mosquito bites.

Based on these perceptions about malaria, the

people of Sebesi chose tangos as a health behavior to

treat malaria. Based on the experience that has been

faced over the years, malaria is no longer considered

a threatening and frightening disease. With the

symptoms of malaria that are felt, namely fever,

headache, the people of Sebesi do tangos therapy.

This therapy is carried out on the basis of the

knowledge of the Sebesi community that has been

owned and learned.

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3.4 Tangos Therapy

In Sebesi Island, Jaseng and Lampung cultures

influence each other, especially in terms of traditional

medication. In the Lampung language, tangos means

‘bergarang’, to evaporate the body. The majority of

people in Dusun Segenom are Lampung people, who

regularly practice tangos. It is a form of native

medicine from Lampung which has been used in

Sebesi Island until now. It consists of 3 types, namely

medicinal tangos, marriage tangos, and rukiyah

tangos. For treatment, tangos (iting bayu) is a therapy

for removing ‘keringat basi’ by using boiled water

from a type of medicinal plant leaves. It is called ‘basi’

because the sweat does not taste salty. In addition,

tangos is also useful for neutralizing the body.

For wedding tangos, the ingredients used are

cempedak flower (Artocarpus integer (Thunb.)

Merr.) pandanus flower (Pandanus sp.), then they are

boiled. The method is the same as the treatment

tangos, where the difference is the leaves and the

mats used. The mats should preferably be those made

of pandan leaves because they smell good and absorb

in the pores. After it is done, scrub the body with

turmeric. Wedding tangos are conducted so that the

make-up on the bride's face does not fade with sweat.

For rukiyah tangos, the types of leaves used are

those attached to wood, coconut leaves (Cocos

nucifera L.), cananga leaves (Cananga odorata

(Lam.) Hook.f. & Thomson), paku tanduk rusa,

seleser, mahar stalks, tali arus (seaweed), its use is

the same as the other tangos, accompanied by verses

of rukiyah and white incense. This is to treat people

who are 'possessed', to drive away spirits.

The knowledge about tangos is mostly obtained

from elderly people, except for Mrs. Rohani from

Dusun Segenom who deliberately studied tangos

directly from the traditional healer with the aim of

treating a sick family. When she lived in Kalianda,

tangos therapy was also widely used. Mrs. Sati, one of

the traditional healers on Sebesi Island also performs

treatment with tangos. Similar with other traditional

healers such as Mr. Fuad and Mr. Saleh who performed

tangos for themselves through their children. Mr.

Wardan, who had experienced 'recurrent' malaria, also

carried out tangos as a prevention and protection

against symptoms of malaria and other diseases.

Tangos does not always use leaf ingredients. This is

based on the experience of Mr. Sahrul in Dusun

Regahan Lada who replaced the ingredients with a can

that had been burned with kerosene.

To treat malaria, tangos is applied after the body

feels cold, not hot. It is to treat symptoms of chills that

malaria has. Tangos preferably use bitter leaves. The

types of core leaves used are ginger (

Zingiber

officinale Roscoe), alang-alang root (Imperata

cylindrica (L.) Raeusch), lemongrass (Cymbopogon

citratus (DC.) Stapf), sembung (Blumea balsamifera

(L.) DC.), turmeric (Curcuma longa L.), and papaya

(Carica papaya L.). Additional leaves that are also

often included are lagun leaves, dringo (Acorus

calamus L.), sekala (honje), bangle (Zingiber

montanum (J.Koenig) Link ex A.Dietr.), and kelaras

leaves (dried banana leaves) (Musa sp.). Bangle

leaves are used to prevent other creatures from

sticking to the leaves or the term rejecting bad luck.

The first stage of tangos therapy is to clean the pot

that will be used, then prepare the leaves needed, each

leaf is taken as needed, the leaves are then boiled.

Figure 2: The leaves to be used in tangos (from left to right)

are starfruit leaves, sembung, ginger leaves, lemongrass

leaves, galangal leaves, and turmeric leaves.

Figure 3: Tangos herb leaves ready to be boiled.

Tangos Therapy: Health Behavior as the Result of Normalizing Power in Medicating Symptoms of Malaria on the Community of Sebesi

Island

579

The method of inserting leaves is also different,

some include the leaves first before water, but some

are the opposite. While waiting for the water to boil,

prepare other ingredients, namely a mat or tarpaulin,

sarong, dingklik or small stool.

After being boiled, put the stew in the pot into the

mat, then the person who is going to be given tangos

also enters the mat. People who will be given tangos

should not wear anything, only wear a sarong as a

cover, so that the heat directly touches the pores. To

get rid of the stale sweat earlier, the person in the chair

sat while stirring the potion in front of them while

praying. The duration is 15 minutes. The potion can

be used twice. The feeling after that is that the body

feels light and fragrant. After that, the person would

fart quite often. Tangos should not be done too often;

the recommended time is once every 3 months.

Figure 4: Mrs. Rohani was doing tangos to researcher.

3.5 Tangos as Sebesi Community

Health Behavior against Symptoms

of Malaria

A distinctive component of health behavior in

developing countries is the importance of individual,

household, and community activities associated with

tropical diseases. Although not the main cause of

adult mortality, tropical diseases such as malaria,

yellow fever, filariasis, schistosomiasis, dengue fever,

dracunculiasis (guinea worm), onchocerciasis, and

trachoma are significant causes of morbidity and

mortality in developing areas (Coreil, 1997).

Furthermore, knowledge and perceptions of disease

influence treatment-seeking behavior, which is an

important component of disease control. In this study,

the factors that drive the treatment chosen by the

Sebesi community to cure malaria will be explained

through the theory of health behavior.

According to (Gochman, 1998) health behavior

does not embrace clinical improvement or

physiological recovery but it includes analysis of

specific behaviors that have an impact on

improvement or recovery. Behavior denotes

something that people do or do not do, even if it is not

always consciously or voluntarily, not something that

is done to them. Gochman views that health behavior

is also distributed into a population which can be

determined by several factors, namely risk behaviors;

responses to illness; care seeking; lifestyle;

preventive, protective, and safety behaviors

(Gochman, 1997a)

The health behavior of the Sebesi community to

perform tangos is a form of response to symptoms of

malaria. This response is based on their perception of

malaria. According to (Foster & Anderson, 2006),

each community group defines disease in different

ways. Symptoms of chills are a symptom of malaria

that is accepted by them. The World Health

Organization (WHO) stated that malaria is a life-

threatening disease, in fact the people of Sebesi Island

consider malaria a very common mild disease. On the

basis of this understanding, their response to malaria

prevention is to treat the symptoms that appear, one

of which is by doing tangos therapy. Before going to

a midwife, the Sebesi community first performed

tangos therapy to prevent, treat, and restore the

condition of the body.

Tangos therapy is a form of health behavior in the

preventive, protective, and safety category.

"Preventive, protective and safety behaviour" refers

to specific actions to reduce the risk of disease,

condition or disease hazard (Gochman, 1997b). There

are some determinants in this category, namely

personal determinants, family determinants, social

determinants, institutional determinants, cultural

determinants, and health provider determinants.

Tangos therapy is the result of several determinants.

Based on the research conducted, the tangos carried

out by the Sebesi community is driven by several

determinants, namely family determinants, cultural

determinants, and health provider determinants.

According to the family determinant, the treatment of

malaria symptoms using tangos is related to the

frequent use of tangos by the family. In terms of

cultural determinants, it can be said that the use of

tangos is mostly done by the indigenous people of

Lampung who live in Sebesi, because tangos is the

native medicine of Lampung. Tangos therapy is also

a form of health behavior in the preventive, protective,

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580

and safety categories with the determinants of health

provider (Gochman, 1997a). Based on this

determinant, the Sebesi people choose tangos based

on the accessibility, availability, and affordability of

health services. The health facilities on Sebesi Island

are two midwives who work at the Pustu who have to

serve nearly 3000 Sebesi residents. Midwives are not

always on the spot, because they have to fulfill the

call or other administrative work that demands to

leave the island. For this reason, self-medication with

tangos therapy is also the choice of the community.

3.6 Normalizing Power in Tangos as

against Malaria Symptoms

Foucault notes the novelty of reflection on power in

terms outside the realm of power, two antitheses of

the conception of power that conjunction and

disjunction determine the basic rules of most modern

political thought. On the one hand, the benign model

of sociological power as an agent of social cohesion

and normality, serves to ensure the conditions for the

existence and survival of society (normalizing power).

When defining the effect of power as repression,

power must be identified with the law that says no to

power alone, and contains the power to prohibit

(Foucault, 1980).

For Foucault, it is the formation of subjectivity

that is the rationale for all disciplines and techniques

of punishment. The emphasis is on how people

participate in their own subjectivity and then

recognize themselves, assess and monitor themselves

and others in an attempt to conform to society's norms.

Treatment of malaria’s symptoms using tangos

therapy is produced by normalizing power carried out

by the Sebesi community. In this case, normalizing

power is carried out, this power is received without

coercion, without being ordered. People look for

alternatives and use traditional knowledge in the form

of tangos for malaria as a reference for curing

symptoms of malaria.

In Discipline and Punish (Foucault, 1977) shows

that the 'power of normalization', the standard of

normality, is not practiced by prisons alone, but is

also established in schools, hospitals, through human

science. Such normality is reproduced and

legitimized through claims and practices of

knowledge, for example nurses, teachers, doctors,

judges, and social workers (Foucault, 1977). The

subsequent development and ownership of objective

knowledge and truth has resulted in the emergence of

'expert' groups such as psychiatrists, social workers,

and doctors in the health care system (Cheek & Rudge,

1993).

In normalizing power or discipline, each

individual is his/her own supervisor. In this research

on malaria in Sebesi Island, the Sebesi people control

and discipline themselves by agreeing to their claim

of knowledge and medical practice, namely the

knowledge to cure symptoms of malaria with tangos

therapy. This knowledge generates power which

ultimately results in normalizing power. This

normality is produced and legitimized through claims

and practices of tangos therapy that can cure

symptoms of malaria. That is, when the symptoms of

malaria, namely when chills come, they do tangos.

Furthermore, despite the normality of power, in

the context of the future power relations of patients

and healthcare workers, (Haug, 1988) argues that

more and more people are learning to manage their

chronic conditions, monitoring their health condition

day by day. This manifests itself in the form of

personal health care, from attention to diet and

exercise to self-medication of symptoms without the

attention of health workers.

4 CONCLUSIONS

Based on the results of the study, it can be seen that

tangos is a health behavior chosen by the people of

Sebesi Island. The health behavior of the Sebesi

community to perform tangos is a form of response

to symptoms of malaria. Tangos therapy is also a

form of health behavior in the preventive, protective,

and safety categories.

In this study, the relationship between power and

knowledge is seen in the use of tangos by the people

of Sebesi Island to heal symptoms of malaria. People

do not choose to treat symptoms of malaria first to a

doctor. That is, the people here as ordinary people in

medical science are considered to have an equal role

with health workers. This is very different in modern

medicine, where in modern medicine the power

relations formed between the two are very contrasting.

Doctors with all the knowledge of the modern

medical world can determine whether a patient is sick

or healthy.

It can be seen that the use of tangos to treat

malaria symptoms begins with the Sebesi

community's perception of malaria. In other words,

the definition of disease is determined by culture. In

addition, it can be viewed from this study that

knowledge is related to power, when people have

knowledge about malaria symptoms treatment,

namely by tangos therapy, this is what results in

normality power. Public knowledge of tangos therapy

can be viewed as a control tool that contributes to

Tangos Therapy: Health Behavior as the Result of Normalizing Power in Medicating Symptoms of Malaria on the Community of Sebesi

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individual choices in treating malaria symptoms.

Although modern medicine can be said to be quite

dominant on this island, in fact traditional medicine is

not just marginalized. Furthermore, public

knowledge about tangos therapy to cure symptoms of

malaria limits the knowledge of health workers. This

also leads to neglect of the health sciences owned by

midwives or further examination through the

laboratory.

ACKNOWLEDGEMENTS

We would like to thank the Science and Technology

Scholarship-National Research and Innovation

Agency Republic of Indonesia (SAINTEK-BRIN).

Without the financial support of this scholarship, this

research could not be conducted. We would also like

to express our deepest gratitude to Department of

Anthropology-Gadjah Mada University and Research

Center for Biology-LIPI. Gratitude is also given to Mr.

Budi Santoso at Dinas Kesehatan Lampung Province,

Mr. Budi Riyanto and Mr. Minak Wardan at UPT

Puskesmas Rajabasa. The last but not least, we would

like to express our deepest gratitude to the village

government of Tejang Village Sebesi Island,

especially to community leaders and local

communities who have shared their information.

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