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Nazra - Power Dynamics of modern medicine 

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Nazra - Power Dynamics of modern medicine 

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Allen's work is quite interesting as he dissects various forms of sickness and healing amongst the Madi people. Given the scarcity of medical supplies and resources, the Madi people were inclined to come up with their own traditional forms of healing. It is interesting how sickness was often associated with "evil ghosts" and considered as a result of another person's jealousy or revenge. What i thought was most interesting however was this notion of western medicine being "elite" or "superior" from the traditional, herbal forms of practice done by the Madi people. The Madi people themselves believe that accessing western medicine is a sign of progress and development however, I would argue that this may actually be a form of colonization? After all, Christian missionaries and activists deliberately eliminated these traditional forms of medicine. Could this act influence the Madi people to believe that their own practices are outdated/barbaric and there is a need to modernize their own medical practices/accessibility? On one hand, traditional herbal medicines are still being used today and they work - but this may be considered by some as "outdated" when compared to modern forms of medicine.
I would argue that western medicine is used as a tool to control and colonize indigenous practices and traditions as is the case with the Madi people.

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I found Marsland’s paper an interesting account of the dichotomy of constructed categories between the ‘traditional’ and ‘biomedical’ illustrated through not just practices but also social representation. Marsland reveals that 'traditional' healers are considered non-knowing and dangerous, having been left out of governmental policies and national debates, such as issues of AIDS. This paper made me think about how the West, in the realm of health and beyond, has constructed and dictated what it means to exercise values of modernity which isolates, opposes and dismisses those thought to be ‘backward’. The waganga challenge the stereotypical constraints associated with the ‘traditional’ healer, aspiring toward modern technological practices and transcending these “imagined categories” (764).

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I am interested in Kamat's article because it show how parents react to their children's disease (degedege) with three case studies. It also shows various way to cure degedege. Moreover, those case studies show that serious problem of Malaria, poverty, limitation of access to good health care in Tanzanian society. There might be same problems in current Covid situation as the Tanzanian government's reaction to Covid shows (buying anti-Covid tea from Madagascar etc.).

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An interesting idea in the Langwick piece is how nurses straddle this line between the traditional and the biomedical. How, within post-colonial societies, the positionally one holds towards traditional medicine showcases the modernity/cosmopolitan nature of their beliefs yet within the health sphere this line continues to be more fluid. Nurses act as this kind of bridge within the hospital setting - gauging a patients prior medical history and extent of their involvement with traditional medicine, supporting a patients or their kins decision to get a second opinion through a traditional healer and so on. They are both bridge and gatekeeper to overcoming the ‘interference’ of traditional medicine and biomedicine in this setting.

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The combination of traditional and modern medicine is e embodied in an informal medical practice that breaks the limits of the institutional framework. The relationship between the informal medical practice developed by the nurses and the official medical regulations is not in conflict, as they together serve a 'Health for All' aim, and the introduction of traditional medicine is indispensable in a background of insufficient labour, and medical resources.
-Zhenyuan Fang

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I felt what Prince was able to map out effectively through the medium of ethnography was to, capture this how a whole city (Kisumu) has been built off the back of HIV/AIDS infrastructure the global 'AIDS economy'. Prince highlights in p.69 how pervasive the 'Aids economy' is, there is almost nothing it doesn't touch and Elias, after securing a job volunteering attempts to recruit he's wife through a similar pathway.Prince highlights the double imperative of two competing truths living side by side. The idea that something can be hidden and almost taboo, but still well known about. "Knowledge about HIV and the pursuit of this knowledge have become central to life for many in Kisumu" (2014:69). As well pursuit of this 'knowledge' is tied to assumptions of who people are, and what they do, and their social status. Acquisition of knowledge seems to inadvertently push stigma away from HIV/AIDs.

What is observable form the piece as well is how the NGO 'international' global health directive shapes the social-scape through intervention in the name of HIV/AIDs, such that interactions with the community almost produce a form of code-switching observable in p.70 "Through this exposure, as much as any formal training he received, he learned particular ways of seeing, speaking and acting upon, and also moving through the city and its hinterlands" perhaps it may not even be code-switching , and it may be a whole new language game (Wittgenstein) created through the AIDs economy, created community.

The virus in Kisumu almost serves to exacerbate the discrepancies in the systems that operate in that society, be it the NGO global health machine, patriarchy, capitalism. it creates a liminality between taboo, and what is brought to the surface" a more subtle shift between different registers of revealing and concealing, visibility and secrecy"

What for me is highlighted in this paper, is a form of social mobility that is created in response to the AIDS economy that feeds off of prevailing notions of education and religion grounded in coloniality that are constant tension and negotiation, with each other.

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What i found interesting about this article of the jump was, "tradition (mila) are frequently singled out as obstacles to maendeleo" (2007:753) this to me was reminiscent of Mao Zedong's doing away with "4 olds: Old Ideas, Old Culture, Old Habits, and Old Customs" during the Chinese cultural revolution. Both Nyerere and Chairman Mao, being strong socialist advocates and China having strong relations with Tanzania.

The foregrounding of this article,  is how biomedics is linked to nation-building, colonial legacies and prevailing global hegemony "status of 'doctor' was hard-won, and partly contingent on conversion to 'European values' (2007:755)

Marsland delicately highlights that there is some reconciliation and reclaiming of historically created myths about long held traditions" his observation that the tablets patients are given at hospital are no more than a convenient version of miti shamba has some truth" (2007: 758).

Then leading on to the insidious nature of the biomedical industry seemingly rooted in wealth accumulation " wagangas... get in the way of their business" (2007:759)

Ultimately the heart of the article was questioning modernity and who fits into these ideas of modernity, as it relates to health and wellness. In many ways it defines modernity not as static nor standard, or purist; but ever-changing in real-time to reflect the times and the community in which one lives

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Langwick, immediately calls to question, the credibility biomedicines' claim sit on, when hospitals are understaffed, underfunded, out of reach to locals, lack medicines and equipment etc "biomedicine's inability to address the very crises that constitute it as a necessity is leading to the formulation of new realities" (2008:429) what arises in the midst of this is what Marsland speaks of in their article. The gap created in the crafting of modernity in health and creation of something that is neither quite 'biomedicine' in the strictest sense nor what we believe to be indigenous practitioneering. It actually works to trouble notions of what we believe to 'biomedicine' and indigenous wellness practices. In reality what I understood through this article is that both categories innovate of each other.

What the article makes clear is the drawbacks associated with neoliberalising health and trying to capitalize of wellness, particularly from the perspective of biomedicine. Like Shebeshe, has written above me, it seems the nurses in this article are straddling two worlds. But as well it makes me question, to what extent is this this the same world ? and not really two worlds ?

In some sense, i want to liken nurses and nurse aides to Heaton's (2013) Black Skin, White Coats, via Franz Fanon's Black Skin White masks "Nurses and nurse aides craft themselves as modern subjects, as cosmopolitan, as legitimate embodiment of the state and exemplary forms of citizenry" not only might they be if they even are straddling two realities of 'indigineity' and 'modern' biomedicine' but themselves as well.

I think hegemony in some ways determines what is considered to be 'modern' and what is not. Who is say that indigenous wellness and health practices are not part of modernity ? this article builds well on Marsland's article and troubles these concepts. In this article Langwick highlights that traditional healers are not always people who are just tucked away in some hut in a village, or in traditional garb regalia as described by Marsland. They are embedded in our communities, operating in the hospitals, they help shape communal and biomedical realities.

Similarly to Prince (2014) and their AIDS study in Kisumu about knowledge production. It is seen as favorable that they are knowledgeable about traditional healing methods, especially as it relates to biomedicine however, it is almost seen as taboo, for them to be as "modern subjects", "embodiments of the state" and "exemplary forms of citizenry" to be actively partaking in it.

Langwick's introduction of the 'body multiple' is a powerful call to expand definitions and realities. It has potential to encompass the fractures in identity and navigation everybody in the therapeutic ecologies experience.

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This piece by *Courtright draws very useful parallels in state practice towards crises, particularly that of health, in Kampala over the last century or so. Although short and blog-ish - therefore omitting various details about the Ugandan capital and its formation such as the tensions capitalised upon by the British between the competing powers of the Buganda and Bunyoro kingdoms, and the becoming of the Uganda Protectorate in 1984 and what that afforded the ruling Bugandan elite in comparison to neighbouring Kenya under full colonial administration - Courtright nimbly demonstrates that violence perpetrated but the ruling class ultimately remain similar in form.

Might Museveni's use of state forces to control the Ugandan capital during Covid-19 also have to do with the elections? Quite possibly as much of Bobi Wine's support was in the urban areas thus curfew forbade meetings, made communication more difficult etc. Therefore, the larger picture Courtright alludes to is the politicisation of health crises and how power moves are exacted under the surface.

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Adding to the wonderful observations and points made above, what this article emphasised for me was the apparent inadequacy of global economic theories/strategies/ideologies that are enforced by IFIs on developing countries that neglect the very fabric of not just the nation but even the regions within them and varying contexts. In this case the SAPs in Tanzania during the 1980s didn't consider the complexity of the health systems in place - or perhaps purposefully ignored them - and that, broadly, blanket measures and interventions attend to different realities to on the ground so to speak. These same 'one size fits all' procedures happen in 'post-conflict' areas and are used for peace-building etc. Here, this region of Tanzania has managed to negotiate its own relationship to health and well-being beyond institutional policy.

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I found the author’s explanation of Middleton’s distinction between witchcraft and sorcery in the first half of this paper particularly interesting. The conclusion that, although bad, witchcraft is ultimately a result of ‘normal masculine ambitions’ (e.g. an elder losing authority) is striking, especially considering that sorcery was regarded as being a deviance, one that could also be practiced by women.

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This paper presents waganga (used in this context to refer to practitioners of indigenous forms of medicine) as challenging the dichotomy between ‘modern’ (biomedicine) and ‘traditional’ (indigenous) forms of healing. Marsland presents several examples in which waganga are seen to be modernising traditional medicine, one of which is their interest in learning how to modernise their medicines, to help counter the lengthy process of preparing herbal medicine. I found it interesting that in contrast to waganga’s push for innovation, the field of biomedicine is presented as being much more resistant to change, perhaps hindering any hope of ‘hybridity’. Marsland states that while waganga will refer people to hospitals if treatment isn’t working, biomedical practitioners will not refer patients to waganga. She also explains that waganga are aware that there may be incompatibilities between their medicines and biomedicines, and so may leave a few days for any effects of biomedicine to wear off before using their own medicine. They see the solution to this as being in clearing the lines of communication between themselves and the hospital, thus demonstrating another way in which they are willing innovate, and where biomedical practitioners may not.

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From the first sentence of this article, Langwick argues a different point to Marsland. While Marsland dedicates much of her paper to discussing the unwillingness of biomedical practitioners to recognise the importance of ‘traditional’ medicine (or at least their willingness to keep ‘modern’ and ‘traditional’ healing methods separate), Langwick immediately states that members of the international medical community have recognised the importance of traditional medicine and healers since the 1970s. Langwick also calls for renewed attention to the ways in which biomedicine is also evolving because of traditional medicines, given that the modernisation of traditional medicine has received much academic attention.

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I found the comparison of "mzungu" and "corona" particularly striking. In bringing these two words together, the authors links the threat of European colonialism with the threat of coronavirus (imported from Europe): 'their touch and breath can be lethal'.

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It becomes clear from Langwick’s reading that the point of intersection between modern and traditional medicine not only creates ‘new realities and new bodies’ (429), but also a new dimension of communication between the medical staff; a communication that has developed in order to facilitate the taboo presence of traditional medicines within the clinic. Langwick refers to the ‘veiled references, euphemisms, and silences’ (430) that were employed to enable the discussion of traditional medicine between the nurses and patients. Initially this might not seem significant - everyone disguises difficult topics with softer language amongst certain company. But in the case of Hospital T, disguised language does not seem necessary, given that the doctors did not speak Kiswahili or the local languages, and those who are discussing the traditional medicine (the nurses and the patients) are fully aware that it is being used and need no disguises from each other. I think this points towards the power of a contentious topic, in this case the use of traditional medicine, to puncture normal social behaviour and create new ways of communicating, even when it is not needed – it is so pervasive that it forces people to restrict and regulate their own behaviour out of fear (perhaps?) of traditional medicines enigmatic fatal potential.

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Very often , parents are described as passive, ignorant, victims of their own incompetence and so on, without truly understanding what brings them to take certain decisions. Kamat in his article perfectly describes the overwhelming feeling of these parents when dealing with the unstable and risky health of their children, and what clearly emerges is that due to  structural inequalities, people aren't able to seek and receive adequate healthcare. Moreover traditional healer are flexible in terms of payment, and this means a lot to a parent that maybe in that precise moment, isn't able to pay the healer.

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We see in both Langwick and Marsland’s studies how the boundary between modern and traditional ‘medicine’ is a social construction and that constant work is required on the part of the actors to keep this highly porous boundary in place. Langwick’s ethnography also provides insight into the deeply embedded nature of traditional understandings of health and illness in this community: biomedicine is not an alternative to traditional methods. This contrast somewhat with Kamat’s observations  in a community close to the capital - still poor, but presumably better resourced -  where decisions about whether to attend a traditional healer or a ‘biomedical’ facility appear to be more pragmatic (but possibly this is specific to degedege?). Kamat also makes an important point about the impact of under-resourcing of health care: “In Tanzania it is the failure of access to affordable and efficacious medicine and public health facilities that encourages people to take interest in “alternative” providers.”

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I found this article quite interesting to read. Covid-19 in Europe and the US has caused a literal flip in history of the way that Africa and it's diseases has been portrayed for so long by the West.

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This article helped me to see the Wagana in a different light, as people who not set in their own ways but also looking to develop and grow through knowledge and skills. "The Waganga already knew where their expertise lay, but still wished to learn new skills. The waganga seem to have an open view of knowledge, are interested in innovation, and are not overly concerned about protecting their ‘cultural purity’."

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The pluralistic nature of Allens findings within therapy make the most since to me. It is impossible to eradicate cultural remedies that existed far longer than biomedicine and it is also impossible to ignore the positive implications of biomedicine in cases like malaria and HIV. I would like to explore further the correlations between violence against women and mental health. From what I've read it seems as though women play a huge role in healing and in illness but the consequences of both of those do not seem equal.

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'so called traditional treatments and practitioners must be conceived of as resources for (and therefore distinct from) their biomedical counterparts. What seems clear to me is that the distinction between the two approaches is often blurred and that the embrace of one approach to health and healing does not connote a rejection of the other as can be seen from the examples that Langwick cites of nurses (gatekeepers of biomedicine if you like) themselves accessing traditional treatments.

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My thoughts were similar to Yukie’s, particularly in current times, dealing with COVID, as Tanzania’s response has for the most part been to pretend as though the virus does not exist and life has gone on as usual. I have heard from a few people whom I know that even wearing a mask is frowned upon and seen as taboo. Life seems to have gone on as usual despite COVID continuing to affect people and cause a significant number of deaths.

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I found it interesting how this article drew parallels between Uganda and government’s violent responses to outbreaks of diseases, and how the colonial state conducted similar violence to public health threats. The European colonial solution to this surge in disease, which was instigated by their arrival, was to enforce a strict and violent racial segregation of urban areas the legacy of which can still be seen in Kampala to this day and affects the poorest of the urban population who have been restricted from reaching parts of the city for work due to the lockdown imposed by Musevni, with the police being authorised to keep control by any means. This article reminds us to explore the historical context in which public health responses have been built upon and influenced by.

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Frontline: Primary Healthcare and Covid-19 in Kenya 

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Frontline: Primary Healthcare and Covid-19 in Kenya 

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The insouciant and disdainful manner in which the  Community Health Volunteers (CHVs) are treated by the Kenyan authorities, is for me, the most striking feature of this article. Despite their hard work and commitment to providing 'frontline' healthcare for vulnerable members of the community, this is by no means mirrored in their status (Geissler and Prince observe that CHVs are 'de jure volunteers, without terms of service, or contracts'), or the availability of proper equipment to facilitate the recording of their findings in the community.
The CHVs are not adequately shielded from possible Covid-19 infection, as the county's referral units (hospitals) are not provided with sufficient surgical masks and gloves to safeguard the workers; more poignantly, they are offered no protection against police violence (in the form of identification badges, or similar forms of identification) in the event that they inadvertently breach a night-time curfew.
With the odds stacked so highly against these essential, yet woefully disenfranchised 'frontline' workers, it would seem that the fight against this latest threat to the Kenyan people's health, is likely to be a protracted one.
Laura A

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This article made an important point with regard to decision-making of parents when their child is critically ill. In the three case studies presented, all children eventually died. Kamat makes the important point of structural obstacles - some of the parents did not have the money to pay for transport costs to go to the hospital, and to pay for the costs of treatment. Knowing this from the start, they went to the traditional healers as an affordable option. Moreover, one father had made negative experiences in a biomedical clinic, having been humiliated by staff previously, due to his belief in degedege as an illness rather than malaria. These case studies highlight how structural inequalities prevent people from being able to seek adequate healthcare.