Siu I Moana: Navigating Female Cancer Experience in the Kingdom of Tonga

Abstract

Drawing upon the intersections of gender, health and culture, this dissertation focuses on the growing cancer health disparities in the Pacific through the lens of female cancer experience in the Kingdom of Tonga. Due to the late presentation of the disease and lack of comprehensive cancer health care resources, breast cancer mortality rates in Tonga are disproportionately high. This dissertation approaches this problem on two levels, 1) from an indigenous meaning-centered analysis of health and illness in relation to fonua (land and people), and 2) from a political economic critique that examines the inequalities and structural power dynamics affecting the allocation of resources and health seeking behavior. Through the collection of cancer illness narratives, I critically examine how women, who have limited access to resources, navigate multiple healing pathways, including both local biomedical care and faito’o fakatonga (Tongan medicine). I argue that cancer narratives give voice to issues and experiences that are often silenced by shame and stigma; thus the re-telling of these stories can be a powerful tool in redefining personal subjectivity and confronting structural asymmetries locally and globally. Through ethnographic research at the Ministry of Health, Vaiola Hospital, and the Tongan Breast Cancer Society, I detail the ways Tongan women negotiate tensions between individual agency and the structural conditions that remain a part of everyday life and describe how current conditions of modernity and globalization are transforming the meaning and the management of health and disease. The complex ways that women from various social class standings manage specific aspects of cancer reflects the embodiment of social inequality. I argue that the development of effective interventions for female cancers in Tonga will require a multidisciplinary, holistic, and engaged approach foregrounding indigenous conceptualizations and articulations of health and disease in relation to sociocultural, political and economic inequalities.