Borders and Healers: Brokering Therapeutic Resources in Southeast Africa available in Paperback
Borders and Healers: Brokering Therapeutic Resources in Southeast Africa
- ISBN-10:
- 0253218055
- ISBN-13:
- 9780253218056
- Pub. Date:
- 02/02/2006
- Publisher:
- Indiana University Press
- ISBN-10:
- 0253218055
- ISBN-13:
- 9780253218056
- Pub. Date:
- 02/02/2006
- Publisher:
- Indiana University Press
Borders and Healers: Brokering Therapeutic Resources in Southeast Africa
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Product Details
| ISBN-13: | 9780253218056 |
|---|---|
| Publisher: | Indiana University Press |
| Publication date: | 02/02/2006 |
| Pages: | 240 |
| Product dimensions: | 6.12(w) x 9.25(h) x (d) |
| Age Range: | 18 Years |
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Borders and Healers
Brokering Therapeutic Resources in Southeast Africa
By Tracy J. Luedke, Harry G. West
Indiana University Press
Copyright © 2006 Indiana University PressAll rights reserved.
ISBN: 978-0-253-34663-6
CHAPTER 1
Working the Borders to Beneficial Effect: The Not-So-Indigenous Knowledge of Not-So-Traditional Healers in Northern Mozambique
Harry G. West
When I first decided, after several years conducting anthropological research in Mozambique, to focus my attention during a 1999 research stint explicitly on healers, I paid a visit to the Ministry of Health in Maputo before heading north to my field site on the Mueda plateau in Cabo Delgado Province. I was somewhat surprised by what I heard from one ministry official: "Traditional healers are the stewards of a Mozambican medical cornucopia," she told me. Days later, an officer of the Cabo Delgado Provincial Directorate of Health echoed this perspective: "Traditional healers are Mozambique's doctors and Mozambique's medical textbooks," he averred. When I arrived in Mueda, the district director of health added his own endorsement to these views: "Traditional healers know cures for diseases that Western medicine cannot heal," he told me proudly. "They even know cures for diseases that Western medicine has not yet diagnosed."
The views expressed by these officials reflected a dramatic reversal of the official position on "traditional healing" in Mozambique. In the years following Mozambican independence in 1975, the socialist FRELIMO (Frente de Libertaçao de Mozambique) state had sought to establish a national health system that would provide basic biomedical care to residents of even the remotest villages (Cliff and Walt 1986). The regime cast traditional healers as "obscurantists" whose primitive and superstitious practices undermined the project of "socialist modernization" of the countryside (AMETRAMO 1998; Green, Jurg, and Dgedge 1993, 264; Green, Jurg, and Djedje 1994, 7; Honwana 2002, 169–173). From the late 1970s, however, FRELIMO socialism had met with violent opposition in the form of RENAMO (Resistencia Nacional Moçambicana) insurgents backed by the white settler regimes of Rhodesia and South Africa (Finnegan 1992; Hall 1990; Minter 1989; Morgan 1990; Vines 1991).
By the end of the 1980s, the socialist project — including hundreds of rural health clinics — lay in ruins (Cliff and Noormahomed 1987; Cliff and Noormahomed 1988). As FRELIMO moved toward a negotiated peace with RENAMO — necessitating constitutional reform and the transition to multiparty democracy — the government also came to terms with the International Monetary Fund on a structural adjustment support package (Hanlon 1991). Although it was victorious in the nations first national elections in 1994, FRELIMO possessed neither the resources nor the will to reconstruct socialist-era health programs in a postcivil war era defined by the end of the Cold War, the end of apartheid, and the global ascendance of neoliberalism. The government instead took cues from international donors and nongovernmental organizations which espoused "democratic decentralization" and the "empowerment of local communities" to solve their own problems and meet their own needs. It was within this political and economic climate that government officials such as those with whom I conversed came to speak of traditional healers not as subversive delinquents but instead as low-cost local human resources.
Even in the early 1980s, the Mozambican government had shown some interest in traditional healing. Paradoxically, while the state expressly prohibited the practice of traditional healing, researchers in the Ministry of Healths Department for the Study of Traditional Medicine (Gabinete de Estudos de Medicina Tradicional, GEMT) gathered data on medicinal plants used by healers throughout the country. In the mid-1980s, the ministry published a fourvolume catalogue of Mozambican medicinal plants and their various uses in the practice of traditional healing (Jansen and Mendes 1983–1984). During the heyday of Mozambican socialism, however, a strict boundary was established between medicinal substances, which might be of scientific value, and healers, whose practices were generally deemed incompatible with scientific medicine.
In 1990, the European Union provided funding for a consultant — American medical anthropologist Edward Green — to advise the Mozambican Ministry of Health on policy formation and legislative reform in relation to traditional healers (Green 1994, 121). Green questioned the GEMT focus on materia medica and challenged the GEMT notion that traditional healers were inherently "unscientific." Green counseled it to distinguish not between healers and the potentially valuable substances they used but between magic and the often valuable distinctive forms of local knowledge that traditional healers preserved and deployed in their practices. He argued that researchers and health practitioners alike had long overemphasized the magical components of African notions of health and healing (Green 1999). He wrote: "[I]ndigenous and biomedical etiological models are, in fact, not very different in fundamental and important ways" (12). Seemingly exotic cultural expressions, he argued, worked as symbols (or as metaphors); once decoded, he asserted, these expressions were altogether compatible with biomedical categories and concepts of disease and its treatment (16,18,90). For example, African concepts of pollution constituted an "indigenous contagion theory," Green suggested; and the "invisible snake" (which many southern African peoples suggest resides in the body of a healthy person) constituted an "indigenous theory of resistance" to disease (1997, 1999).
Building upon the "traditional medicine" paradigm elaborated by the World Health Organization from the mid-1970s onward (Bannerman, Burton, and Wen-Chieh 1983; World Health Organization 1978; World Health Organization 1995), Green argued that the "indigenous knowledge" possessed by Mozambican traditional healers made their participation in collaborative research and health care an invaluable national resource. "A society's creativity and genius is embodied in its IKS [Indigenous Knowledge Systems]," Green wrote. "An understanding of health-related indigenous knowledge is ... essential for health planners and implementers, if plans and programs are to be culturally appropriate and therefore effective" (1994, 21).
To that end, Green proposed that the government adopt the World Health Organization definition of "traditional medical practitioners," that it allow these practitioners to form associations, and that it recognize the members of legally constituted associations (1994, 124–125). In 1991, with Greens assistance, the GEMT "proposed a three-year program to begin public health collaboration between the National Health Service and the indigenous health practitioners of Mozambique" (Green, Jurg, and Djedje 1994, 8). The U.S. Agency for International Development (USAID) subsequently funded field studies undertaken by Green and a team of researchers working in the GEMT to examine existent and potential contributions of traditional healing to the prevention and treatment of sexually transmitted diseases and infant diarrhea (Gaspar and Djedje 1994; Green, Jurg, and Dgedge 1993; Green, Marrato, and Wilsonne 1995).
In 1992, the Mozambican Traditional Medicine Association (Associação da Medicina Tradicional de Mozambique, AMETRAMO) was formed with the approval of the Mozambican state. In subsequent years, state administrators and health officials throughout the country nominally recognized members of the association. However, the collaboration envisioned by Green and other advocates of traditional healers was not forthcoming. When I visited with the president of AMETRAMO for Cabo Delgado Province in 1999, he informed me that he sometimes received visitors — foreign and Mozambican — who asked permission to gather materia medica from association members, but he lamented that these visitors abruptly disappeared without sharing the findings of their research or the profits he was certain they garnered. Beyond this, he told me, there was no collaboration between AMETRAMO and the official health care system. When we asked the assistant president of AMETRAMO for Mueda District about forms of cooperation between the associations healers and the district hospital, she bemoaned the fact that while healers sometimes referred clients to the hospital, the hospital never sent patients to healers. Notwithstanding the pronouncements of health officials from Maputo to Pemba to Mueda who now spoke of traditional healers and their knowledge as a national heritage, these officials continued to look upon traditional healing and traditional healers with deep suspicion and/or contempt.
A closer look at the indigenous knowledge paradigm suggests why this should be so. As Arun Agrawal has pointed out, indigenous knowledge exists as such only in the moment of being validated by scientific means and absorbed into the purportedly universal corpus of scientific knowledge (1995,430; 2002,290). The validation of indigenous knowledge, Agrawal further suggests, is a process fraught with power — one in which the bearers of indigenous knowledge are perpetually subordinated to the stewards of science, made to act as eyes and ears to a scientific brain (Howes and Chambers 1980, 327). Despite attempts to shift the boundary of science to encompass traditional medicine within its domain, then, this maneuver entails the construction and maintenance of other boundaries between scientific knowledge and its dubious others — boundaries that traditional healers, by definition, fail to recognize but must nonetheless be made to respect. Because scientific knowledge and its categorical others must be held separate even while the borders that define science allow the passage of indigenous knowledge from one side to the other, the exterior space of tradition must be constantly "sanitized" (Stirrat 1998,242) as a site of "purified" production. Bearers of indigenous knowledge in its raw form must be quarantined in this space — kept well away from the border where they and their knowledge might be "polluted" and/or where they might act as gatekeepers, usurping the borderland brokerage of indigenous knowledge over which stewards of science claim exclusive dominion.
Hence, while policymakers and health officials in postwar Mozambique have been prepared to celebrate the indigenous knowledge of traditional healers and to draw upon it as a resource in the neoliberal climate of state decentralization and economic austerity, they have not been prepared to conceive of traditional healers fully as colleagues, whether in the realm of medical research or health care. To do so would be to undermine their status as the authoritative guardians of vital therapeutic knowledge and resources. Indeed, to do so would be to jeopardize their very claim to modernity — a claim that even after the demise of FRELIMO's project to bring about socialist modernization in Mozambique necessitates a traditional other and a boundary with which to sustain the divide.
Notwithstanding the indigenous knowledge paradigm animating health policy reform in post-socialist Mozambique, however, my findings suggest that the knowledge, and the power, of so-called traditional healers is inextricably bound up with their transgressions of boundaries between categories such as "indigenous" and "scientific," "traditional" and "modern." The healers with whom I worked in Mueda situated themselves at borders between the traditional and the modern, between the indigenous and the scientific, between the familiar and the foreign, between the local and the global, between this world and a dimly perceived other world, and even between good and evil, (redrawing these borders in the act of managing flows across them. Like their "colleagues" of official standing in the national health service, these healers acted as brokers of the therapeutic resources within their grasp. Indeed, even as traditional healers' advocates sought to vouchsafe the value and integrity of their indigenous knowledge, these so-called traditional healers worked assiduously to transcend the bounds of locality, of indigeneity, and of tradition with which these sympathetic reformers circumscribed them. Their legitimacy as traditional healers, in fact, generally depended upon such border work.
Terezinha "Mbegweka" António
My research collaborators and I spent considerable time in 1999 with the healer Mbegweka, who also served as assistant president of AMETRAMO for Mueda District. On the night of August 1, our work with Mbegweka culminated in our passing the night in her compound in Mueda town as she presided over a healing ceremony for a woman having difficulties nursing her newborn child. The woman s breasts were greatly engorged — each one was nearly as large as her head. When her child suckled, she had reported to Mbegweka, her breasts did not let down milk. She had lost her previous child because she was unable to nurse it; she feared that she would lose this one as well.
On the preceding day, Mbegweka had asked Marcos Mandumbwe and I to take her nephew with us as we traveled outside of Mueda town to conduct interviews in a nearby village. According to her instructions, we had dropped the youngster along the way in the village of Mpeme and fetched him on the return trip. By that time, he had organized a small troupe. They carried several drums, which they would play for Mbegweka s healing rite. When we arrived in her compound late the following afternoon, we found the place transformed. From a pole driven into the ground in the center of the yard flew a flag adorned with a red crescent and star above Arabic script. Two fires burned at the edge of the yard around which the young men we had brought the day before heated drum skins.
Once darkness settled, the drumming began. The ritual more closely resembled the healing practices of ngoma (Janzen 1992; van Dijk, Reis, and Spierenburg 2000a) or zar (Boddy 1989, 125–165) healers than the methods of other Makonde healers we had witnessed — healers who generally worked with mitela (medicinal substances) and the occasional incantation but not with drumming and dancing. Mbegweka led the patient out of the small closed pavilion in which she kept her mitela and seated her at the base of the flagpole. She then came to greet us, explaining that they would dance tonight to help the woman receive the spirit that afflicted her. Once the woman learned how to host her jini, Mbegweka told us, she would be able to nurse her child.
When Mbegweka stepped away, Marcos leaned close to me and said, simply, "majini" (pi.). Like me, he was struck by Mbegweka's use of the term — prevalent among Swahili populations on the Tanzanian coast, but foreign, and unfamiliar, to most Mozambican Makonde. Mbegweka, we knew from previous conversations, had never been to Tanzania. Born in Palma (Cabo Delgado, Mozambique) in 1949, her parents had baptized her Terezinha Antonio when she was born. "I was never given a Makonde name," she told us, "but the name I use in my healing practice is Mbegweka" — a name we later learned meant "I am alone." Mbegweka's parents both died while she was young — of what, she did not tell us. She passed the years of the Mozambican war for independence (1964–1974) in a zone controlled by FRELIMO in the Imbuho lowlands east of the Mueda plateau. Rather than returning after the war to the Palma region, where she "had no one," she moved to Mueda town. Around this time, she told us, she fell ill. She was taken to an nkulaula (healer) who attempted to cure her, but her illness persisted. Eventually she was told that she was possessed by a spirit. She explained to us:
In the past, this kind of affliction — being possessed by spirits — was called mangonde. But in my case it was something special. I went to see my fathers elder brother [a man named Libata], who was also an nkulaula. He told me that the spirit possessing me was my mother's father, Ndonagwamba Shing'oma, who had been a powerful diviner. These kinds of spirits — the spirits of ancestors — are called vanungu. In the past, when a person was possessed by this kind of spirit, she would get fevers and begin to tremble. Then the ancestor would ask her to perform a ceremony. Once she did this, it was finished. Nowadays, it's different. These spirits stay with you. They return again and again. Ndonagwamba left no successor when he died, so he was calling me to follow him. I started treating patients around 1978 or 1979, learned my mitela from my uncle.
(Continues...)
Excerpted from Borders and Healers by Tracy J. Luedke, Harry G. West. Copyright © 2006 Indiana University Press. Excerpted by permission of Indiana University Press.
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