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Paper short abstract

Based on ethnographic research in Ethiopia and Japan, this paper examines how medical pluralism is built through different infrastructures of care. It shows how aid programs and medicinal plants reorganize therapeutic pathways, producing uneven regimes of legitimacy, regulation, and intervention.

Paper long abstract

This paper revisits medical pluralism as a set of hybrid and unevenly organized care trajectories through two ethnographic case studies from Ethiopia and Japan. Approaching pluralism from different but related angles, the authors highlight the productive tensions that emerge as diverse medical knowledge practices intersect, overlap, and diverge in practice. The first case draws on ethnographic research in Tigray (Ethiopia), tracing contrasting care trajectories within a single family. Conditions targeted by supranational health aid programs are integrated into regulated biomedical pathways, while other conditions remain excluded and are addressed through informal, locally managed practices. These divergences show how global health priorities actively shape therapeutic legitimacy and hierarchies of care, producing polarized forms of care within the same social unit. The second case examines more-than-human practices of healing in Nara (Western Japan) by following medicinal plants as they mediate care across institutional, medical, and ecological domains in two herbal gardens. In these gardens, therapeutic knowledge is hybridized, agency is redistributed, and medical practices are detached from clinical institutions. By following plants, seeds, and cultivation practices, the case shows how grassroots activism reshapes medical pluralism as a multispecies practice of negotiating disease between systems under conditions of environmental and social uncertainty. Taken together, the two cases show that medical pluralism foregrounds how care is differentially organized, authorized, and sustained across sites. What comes into view is a shifting configuration of practices in which care is continually enacted, adjusted, and coordinated under uneven conditions of intervention.