Bodies, Politics, and African Healing: The Matter of Maladies in Tanzania

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This subtle and powerful ethnography examines African healing and its relationship to medical science. Stacey A. Langwick investigates the practices of healers in Tanzania who confront the most intractable illnesses in the region, including AIDS and malaria. She reveals how healers generate new therapies and shape the bodies of their patients as they address devils and parasites, anti-witchcraft medicine, and child immunization. Transcending the dualisms between tradition and science, culture and nature, belief and knowledge, Langwick tells a new story about the materiality of healing and postcolonial politics. This important work bridges postcolonial theory, science, public health, and anthropology.

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1 Orientations

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This book is a study of healing practices in southeastern Tanzania and the worlds they render meaningful and concrete. The World Health Organization (2002) estimates that 80 percent of Africans have sought out traditional medicine and states that many depend on herbal remedies as a critical aspect of their primary health care.1 Some African health professionals, including the district nursing officer in Newala, where I conducted the majority of the fieldwork for this book, suggest that the use of traditional medicine is on the rise due to the inadequacy of health care services under the growing economic pressures of neoliberal reform. The incorporation of traditional medicine and healers into health development goals raises the question of how to describe the efficacy of such therapies. This includes how to account for happenings that are salient to many therapeutic experiences but are discounted by biomedicine. Often the entities that healers claim to be treating—mischievous spirits, troublesome devils, disgruntled ancestors, the embodiments of human jealousies and greed—are not recognized by medical science, and the transformations that healers effect cannot be confirmed through biomedical procedures. Yet when Binti Dadi tests the toxicity of a new potential medicine on a rat and when Kalimaga keeps careful records of those who use his medicine in the name of “clinical trials,” these healers refuse to observe the familiar boundaries between science and nonscience.2 Rather they reflect the ways that colonization, missionization, postcolonial state building, international development, and transnational capitalism have shaped the practices known as healing in Newala today.

 

2 Witchcraft, Oracles, and Native Medicine

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In 1999, the district commissioner of Newala—feeling a little guilty, I believe, that the “district archives” to which I had requested access were a heap of termite-eaten, mouse-inhabited papers in a warehouse that was partially open to the elements—invited me to read the current files in his office on traditional medicine. Healers’ appeals to work in the district dominated these files. The Tanzanian government mandates that all healers in the country register with the Ministry of Health and requires that healers declare on the record, in any and every district they intend to work, that their therapies do not involve “witchcraft.” As healers sought permission from the district office to sell medicine in Newala, they declared that their trade was different from divination and from the practice of mass distribution of medicine to identify witches or protect whole communities from witchcraft. A common letter giving healers permission to sell their medicines reads:

The District Commissioner has consented that this comrade mentioned by name above has been given permission to sell traditional medicine here in the town of Newala, and not to divine or to give all people medicine to drink . . . [Period for which permission has been granted is stated] . . . S/he will sell medicine to those who want it, not make it obligatory.1

 

3 Making Tanzanian Traditional Medicine

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In 1968, a research officer in the Tanzanian Ministry of Agriculture and Cooperative Development attended the first Symposium on African Medicinal Plants, which was held in Senegal. Upon his return, he claimed for scientists the role of transforming “the old or indigenous ways of curing diseases” into “new” forms of modern treatment (see first epigraph to Part 1). His argument for transforming “primitive medicaments” through scientific investigation reflected the broader recommendations crafted during this gathering of the Organization of African Unity (OAU) member states (Kasembe 1968). The symposium marked a shift in emphasis from the colonial prohibition against some healing practices to the funding, research, and legalization of traditional medicine in postcolonial Africa.

The ontological implications of the colonial separation of belief and knowledge, spirit and substance, and harming and healing have structured the postcolonial search for the scientific truth of traditional medicine. The newly independent Tanzanian government focused its attention on the commodification of plant, animal, and mineral products that might enable Africa to better position itself in a variety of global relationships. The idea that science might convert plant, animal, and mineral products into desperately needed pharmaceuticals found purchase in the highest levels of the first post-independence administration, led by Julius Nyerere. Stocking the new network of clinics and dispensaries that comprised the fledgling national health care service with pharmaceutical drugs ate up a significant proportion of the nation’s hard currency reserves. Tanzanian leaders hoped that scientific research into medicinal plants would offer a solution to the economic challenges cash-strapped African countries faced. By recasting plant material as a resource for an indigenous pharmaceutical industry, traditional medicine held out the promise of greater economic independence.

 

4 Healers and Their Intimate Becomings

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In 2003, forty-six African countries marked the promise of traditional medicine by declaring the 31st of August to be African Traditional Medicine Day, an annual day of celebration. In Tanzania, this governmental recognition prompted the editorial page of the Tanzanian Business Times to issue the daring call to “bring on the traditional medicine men and women—and their midwives.” Who are these traditional medicine men and women? How do they conceive of their own healing practices? How do they imagine their relationship with the different substances involved in their treatments? In what ways do these traditional medicine men and women distinguish themselves from one another (and from biomedical doctors and “witches”)? Through which processes do they gain expertise and maintain credibility? What categories of knowledge and practice are meaningful to them? This chapter and the next turn to the therapeutic practitioners who have come to be called traditional.

References to tradition in English gloss three different Kiswahili terms: asili, jadi, and keinyeji. Any connotations of a timeless tradition that represent groups of people as frozen in an exotic past that might linger with the English term begin to dissolve as Kiswahili pluralizes the nature of tradition.1 The frictions of translation suggest different, more subtle meanings and open up new questions.2 Asili carries with it a sense of that from which things derive, an origin. It is invoked to describe a base or a foundational element. In another context, asili is used to refer to a denominator in mathematics. The phrase kwa asili (“for the reason”), preempts an explanation for something. In contrast, jadi evokes a sense of ancestry, genealogy, descent, and lineage. Jadi has some resonance with mila, or custom. It speaks most eloquently to the multifarious hybridity of any object as it moves through generations. The third term glossed in English as “traditional” is the place-oriented word kienyeji. It implies locality—tradition in the sense of that which has come to distinguish and define an area. Sometimes when kienyeji is used in reference to healers or medicine it sits a little sourly in the speaker’s mouth. Tone or context can tinge it with the flavor of primitiveness or backwardness. Yet to others, this place-based characterization and the density of connections that it captures is not a problem but a strength. None of these terms (necessarily) define an unchanging past; rather, they evoke transformation over time.3

 

5 Traditional Birth Attendants as Institutional Evocations

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In the 1980s and 1990s, many developing countries, including Tanzania, trained traditional birth attendants (TBAs) as part of their efforts to meet health development goals.1 The integration of lay midwives into the national health care service was one response to the challenges of providing “health for all” in countries that did not have enough professionally trained biomedical staff. TBAs extend the reach of the clinic by going to pregnant women in their homes. As part of the outreach and referral services of state-supported medicine, TBAs trouble any easy opposition between biomedical practitioners and traditional practitioners. They embody the complexities of different modes of ordering bodies, times, spaces, and actions.

The Tanzanian Ministry of Health frames the training of TBAs as a process of transferring knowledge from biomedical staff to lay midwives. TBA training workshops raise the awareness of trainees (or what the national health service calls “unskilled hands”) by sensitizing them to different threats, dangers, procedures, and responsibilities. Development efforts to “transfer knowledge” to those who assist women birthing at home have a distinct agenda. National and international support for lay midwifery seeks to stabilize a biomedical vision of the of the body of the pregnant woman, the fetus, and those things that threaten them during home births. Training TBAs turns out to be about establishing intimate links between the trainee and biomedically salient objects of knowledge; expertise turns out to be about the relationships trainees successfully establish with these objects. By initiating new forms of therapeutic organization, social relations, ethical commitments, and links with scientific networks, TBA training programs (attempt to) shift both the subjects and objects of “traditional” healing.

 

6 Alternative Materialities

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Beginnings are especially dangerous. Both traditional and biomedical practitioners consider the first years of life to be particularly vulnerable. Mashetani love to play with young children. Wachawi, those who wish misfortune, favor attacks on infants who promise to extend the lineage and bring wealth. High infant mortality statistics justify this special attention and biomedical care in the first years of life. People in southern Tanzania engage in a wide range of activities to protect the lives and ensure the strength of their children.1 Kin rally medicine of the bush and medicine of the book around newborns to protect them from harm. Regular checkups and hospital treatment are free in government hospitals for children under five. How do these efforts distinguish forms of care, types of expertise, and kinds of threats? At what point do vulnerabilities come to be seen as dangerous, and by whom? How do practices of prevention and protection shape what is being threatened as well as what threatens?

 

7 Interferences and Inclusions

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In southern Tanzania, degedege and malaria are considered two of the most common threats to the well-being of pregnant women and young children. Responding to international and national concerns that malaria contributes significantly to poverty and to high rates of maternal and child mortality in Africa, the Tanzanian Ministry of Health has implemented programs to motivate stricter adherence to malaria prevention and treatment protocols. These programs include local public health education initiatives that aim to impress upon people the importance of recognizing certain physical symptoms as malarial and the urgency of the need to go to the health clinic at the first sign of these symptoms. In these efforts, the “traditional” malady known in Kiswahili as degedege has come to be translated as the “modern” malady of malaria. By tracing the processes involved in treating degedege and the processes involved in treating malaria, this chapter examines what is at stake in assertions that degedege is malaria.

 

8 Shifting Existences, or Being and Not-Being

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The struggle of therapeutic practitioners—both biomedical and traditional—to articulate objects of knowledge that will travel between the hospital and the healer’s home has, to this point, drawn our attention to moments of interference and encounter. Translation, however, requires some combination of political will, social desire, technological need, and ethical demand. What of times when there is no will to translate? Or when there is an active refusal to entertain the possibility of translation? This chapter is about maladies and objects of therapeutic care that remain inaccessible to biomedical practitioners and unintelligible to scientific medicine. It is about the spaces where there is absence, denial, and silence, at least from the perspective of medical science. To the healer, the unseemly growths, dirty breast milk, and oversized heads discussed below are telling clues about which actors are catalyzing the maladies in question, but to the doctor, these symptoms are insignificant and lifeless. For Binti Dadi each of these symptoms provides a glimpse into the unfolding of a person, body, devil, ancestor, and world. In the Newala District Hospital, however, they are neither cause nor symptom but rather non-events, even impossibilities. While at times healers resist the absences and silences forged by biomedicine, at other times they protect them, claiming them as their own, even reveling in them. For the spaces where scientific translation falters turn out to be exactly where the matters of maladies refuse to be subdued or domesticated.

 

Conclusion: Postcolonial Ontological Politics

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If post-colonialism is the time after colonialism, and colonialism is defined in terms of the binary division between the colonizers and the colonized, why is post-colonial time also a time of “difference”? What sort of “difference” is this and what are its implications for the forms of politics and for subject formation in this late-modern moment?

—Stuart Hall, When Was the Postcolonial?

Traditional medicine is a highly politicized and deeply intimate battle over who and what has the right to exist. As a modern category of knowledge and practice—forged through encounters between traditional healers, scientists (from Tanzania, Britain, China and elsewhere), biomedical practitioners, government bureaucrats, and international development organizations among others—it embodies the frictions central to postcoloniality. It grounds arguments for a history that is not bound by colonial categories of knowledge, in the intimate care of loved ones and the bodies of kin. Close attention to struggles for control over the right to determine what objects are central to life and the relations that sustain them reveals a new story of colonization, post-independence socialism, and its collapse in the face of economic liberalization. Postcolonial healing tells this history as a series of struggles over rights to existence and over the particular forms of materiality that support different claims to existence. In other words, postcolonial healing reveals contemporary struggles not only over material and conceptual resources but also over who gets to determine what is material and what is immaterial, or “merely” conceptual.

 

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