Introduction

After being trained in medicine I worked as a doctor in hospital medicine and general practice in the UK. Since 1990 I have both worked in Nepal as a medical practitioner and researched into the practices of medicine and public health as an anthropologist. I have been responsible for recording patient data onto notes, their storage in remote clinics, and their transfer as part of trials of tuberculosis (TB) treatments and their outcomes in remote parts of Nepal. I have talked to patients and their relatives about their medical diagnoses in situations where health is frequently understood in quite different ways than the UK. I have carried out ethnographic studies in clinics and hospital spaces, interacting with patients and health workers, and interviewing policy makers and members of the community. In this chapter I draw on these diverse empirical experiences to reflect on the idea of ‘confidentiality’ both from an interdisciplinary perspective and in the non-Western context of Nepal. I pose questions about whether Western notions of privacy and confidentiality are ethnocentric, and the extent to which they can be applied elsewhere.

When we think of confidentiality there seems to be a lacuna in the literature, namely questions of cultural difference. I provide these examples of my experience as a tentative introduction of cultural difference into the debate. Despite there being wide differences in context, particularly in legal provision, consumer rights and the capacity of the state, I hope that these reflections on cultural difference, ethical relativism and the question of multidisciplinarity in Nepal's health field may also be of use for debate in multicultural Britain.

Medical treatment in Nepal: private space and public Knowledge

Adjusting to Nepal for the first time can be difficult. One of the first things that anyone visiting has to get used to is the apparent lack of privacy. The notions of individual private space that we appreciate in the UK are challenged. This invasion of private space can be experienced as quite profound culture shock. The squeeze of the crowds; the kids staring in through the windows of your flat; the way that others can listen in to what we think of as personal conversations are a few of the numerous examples. That invisible social shield around us, experienced as an extension of our being and developed from our experiences at home, can feel threatened and violated.