re-think some question on public health: to what extend individual’s health-seeking behaviours is driven by logic of ‘reasoning’ and ‘rationality’; can we abandon the framework of ‘rationality’ in thinking about the ways people consider health, and what are the alternative conceptualisations; what is the collective meaning of health?

Nevertheless, as for Marsland that “it is in the interests of biomedicine to work at keeping the ‘traditional’ and the ‘modern’ apart in medical practice” (2007:754). As such, it might be that both traditional healing and biomedical medicine are productive in the making and practice of the other. The making of the ‘modern’ is at the same time the construction of the ‘traditional’. Nevertheless, how other actors, namely state, capitalism, legislature and so on can also be productive in the changing of the ‘traditional’ and the ‘modern’ medical practices? 

 

Following on from Edward’s comments about Development, the nature of these ‘Precarious Projects’ certainly give pause for thought. Prince provides the example of a German-funded project coming to a halt overnight because of allegations of financial mismanagement (p. 78). This brought to mind Allen’s observations about MSF visits to Laropi in the 1980s (Allen and Storm pp. 34-5). For the most part, MSF volunteers failed to engage with the local community on any meaningful level and rumours spread that they were making money from experiments being carried out on patients in a nearby hospital. “By and large, they were thought of not as real people at all but as a resource”. 

 

I found the extent to which the West’s understanding of medicine dictated the legitimacy of the Waganga problematic. The association of modernity and progression with the West led to the Waganga feeling the need to appropriate aspects of Western biomedicine in order to gain credibility, be perceived as ‘legitimate’, and break through the stereotype of ‘backwardness’. 

I find interesting how both biomedicine practitioners and traditional healers are attached to these constructed categories while challenging them. 

The mganga groups together a set of herbalists, practitioners of Islamic medicine, sorcery and witchcraft, midwives and healers who depend on spirits. For patients, who represent one Tanzanian out of 400, waganga are central to medical care. Moreover, waganga challenge the status of ‘traditional’ and ‘backward’ they have been assigned to, by innovating, co-operating and learning from biomedical technology on their own terms. They used mass produce pharmaceuticals with Ngetwa which ‘‘localised the global’’. (752)

On the other hand, the understanding of ‘modern’ biomedicine in Tanzania, is closely related to President Nyerere’s African socialism and more specifically to maendeleo, a development project based modernist values of education and rationality, and expert knowledge. Maendeleo is linked to westernisation and material improvements. For Marsland, it is also a moral project that sees tradition as an obstacle. Although biomedicine is less flexible regarding the two categories of medicine because of its ‘‘claim to medical hegemony’’ (764), biomedicine practisioners are  interested in identifying and testing herbal medicines, and  accept a certain ‘‘division of labour’’ which reserves diseases associated with witchcraft to traditional healers. Wouldn't this be, in a way, an acknowledgment by both categories of their limits?

 

deeply entwined with identities and relationships and invested with hope and anticipation’ p. 79. In consideration, a certificate bears no value but the qualification does. It does not only represent knowledge but it also represents hope for the future and their wider family.

staffing, the conditions of the clinic, and the availability of medicines" (p 430). These harsh realities triggered nurses in hospital T to employ  "traditional

medicine in an effort to address the immediate needs of

their patients" (p 430).