Tag: Doctors Without Borders

Review of Healing and Curing: Issues in the Social History and Anthropology of Medicine in Africa
by: Megan Vaughan

Everyone everywhere gets sick whether it is a common cold, a serious disease, or even a life-threatening virus. Likewise, communities across the world work to heal these illnesses and afflictions. Megan Vaughan reminds us that illness and healing are everywhere; there are unwell bodies everywhere and always attempts to heal those bodies. Illness and healing are regular, even normal, features in our lives. However, as Vaughan notes, illness and healing have different definitions and meanings in different areas of the world and within different cultures. How then can we unite the rhetoric into one common topic for academics to discuss?

One of my first thoughts goes to the international organization, Medecines Sans Frontiers (MSF, Doctors Without Borders), and their work across the globe conducting medical missions. How are they able to work towards comprehensive fighting of illness and healing when there are so varied ideas of illness and healing? Do they have anthropological training? Are they equipped with a cultural guide?

Vaughan notes that in Feierman’s article he cited Gilbert Lewis’ work in Papua New Guinea.

Lewis had defined the universe of misfortune by determining who was and who was not ill according to scientific criteria, and then observed how illness was diagnosed and treated within the community. As Feierman pointed out, this was a radically different anthropological approach to that taken by Victor Turner in The Drums of Afflication, a study in which illness appeared to have little independent biological reality, but was described as an important stage in a social drama. (284-5)

Lewis’ work was both innovative and radical in that he worked to apply his Western scientific knowledge well at the same time watching and learning how local communities treated illnesses.
I’d have to say this idea is no longer so radical and more likely than not has become the norm for those working in organizations like MSF.

Among ordinary people in cases of illness caused by sorcery, or in other words by one person’s aggression against another, the course of treatment developed into a contest of power between the medicine men working for and against the sick person. The patient could not recover unless his supporting healer proved fully dominant, and therefore capable of ending the contest of strength. (286)

An issue often arises between separating metaphor and symbol from biological reality in discussions of illness and healing. This is an especially important context in Africa where illness and sickness can refer to actual disease as well as spiritual imbalances or curses. Recognizing the overlaps of science and culture within medical practice is key to effective healing. If culture is ignored in scientific medical realities there can be terrible consequences. But, where is the boundary of biological science in medicine?

More often we have to choose between approaches, since we simply do not have the textured evidence which might allow us to trade both the extent of biologically defined illness and the cultural experiences and constructions of that illness. I would like to argue, then, that we might want to learn something from the new well-documented pluralism of African healing systems. (287)

Something that I have studied and seen is this pluralism of African healing systems. Most notably in Ghana the traditional healers and birth attendants are integrated into the formal health care system. They are provided training and certification and often work alongside those practicing Western orthodox medicine.

[…] we neither have to be totally biologically ‘blinkered,’ focusing exclusively on the disease vector, nor do we have to go so far down the road of social constructionism as to render ‘biology’ totally passive. (287)

Beyond various relative understandings of illness and healing it is important to break into the realm of colonial medicine in order to understand certain inadequacies in response to illness and failures of healing. Vaughan notes that the study of colonial medicine has been one of the areas that has illuminated most clearly the limits of colonial power (288). In Africa, she writes how, “colonial medics were simply too thin on the ground and their instruments too blunt to be viewed either as agents of oppression or as liberators from disease, and studies of African demography confirm this view.” (288)

Although colonial medicine may have been more an inadequate colonial department, it is important to look further and apply the past to the present. The impacts of Western diseases brought by colonial powers ravaged Africa. Because of perceptions of Africans and lacking colonial medical systems, these new diseases were not addressed. A history of disease patterns doesn’t reflect on colonial medicine, but the responses to disease patterns in Africa does. Colonial responses to illness reflected problematic representations of Africa and Africans and so the historical medical accounts are filled with issue.

[…] of course there are many important differences between theories and practices of twentieth century biomedicine, and those of African healers, but in order for us to understand these differences the practice of scientific medicine in its various forms needs to be specified with the same attention to detail as are those of its African counterparts. (291)

To conclude, I applaud Vaughan’s call for medical practice to reflect the pluralism found in Africa health care systems. She writes a compelling piece and hopefully her ideas are heeded at least in medical work conducted in Africa.