Suspicious Medical Matters
Panel organiser: Ulrika Trovalla, Department of Cultural Anthropology and Ethnology, Forum for Africa Studies, Uppsala University, Sweden.
In many African societies where trust has been eroded by economic harshness or social tensions, questions continuously arise about what is really going on behind the scene. This is especially true in matters of health, disease, and medicine, as they touch people where they are the most vulnerable. In these settings, suspicions multiply, involving neighbors as well as states, foreign countries as well as NGOs and pharmaceutical companies. Since bodies, information and matter have become increasingly mobile across the African continent and beyond, the same is true for medicines, diseases, and the narratives that surround them. Rumors and suspicions about diseases – their origins, victims, healers, and how they can be prevented or cured – travel quickly across nations, or indeed the African continent at large, through text messages and social media.
People’s stress of falling ill is made worse by their sense of suspicion towards institutions, healthcare providers and treatments, whether they are conventional or traditional, stemming from narratives and experiences of poorly run hospitals, incompetent doctors, and expired or counterfeit medicines. Absorbed into the body, medicines are also often suspect of being vehicles of malignant intent beyond mere capitalist greed, such as poisons prepared by enemies. Similarly, suspicion is directed towards the origin and spread of diseases, whom they affect and how they enter the body. These suspicions become real in the way they shape people’s actions – their everyday choices. No matter if it is the state, donors, producers or sellers of medicine, healthcare providers, patients or ordinary citizen they all have to relate to, operate in, and try to maneuver in these medical landscapes of suspicion. This panel invites presentations that focus on the complexes of suspicion, which connect to healthcare institutions, healthcare providers, medicines as well as the movement, and transmission of diseases.
Approved abstracts panel 40
1. Wealth of waters: Diviners at the source of the White Nile in Uganda
Author: Terje Østergaard, The Nordic Africa Institute, Uppsala, Sweden.
The historic source of the White Nile at the outlet of Lake Victoria in Uganda was the Ripon Falls before it was dammed. The next waterfalls are the Bujagali and Itanda, the former being dammed and a dam is planned at the latter. The very forces of the torrential waters in waterfalls are testimonies and physical manifestations of the powers of the river spirits residing in the waterfalls. The most powerful waterfalls are believed to be the homes of the strongest and most superior spirits. And these mighty divinities embody particular healers or diviners they have chosen as their earthly representatives. The very water is not holy, but because it is not holy the role of water in society and religion is more omnipotent and omnipresent than in world religions. The healers are at the very epicentre in this cosmology; both feared and revered. The water is the source of wealth, but also for witchcraft. Moreover, not only is the church condemning many of the practices, but also many believers are horrified by the alleged human sacrifices to the Bujagali Falls. Even among the diviners there are disputes about who the true mediums are and who are charlatans and cheaters. Still, by being the intermediaries between humans and gods, the diviners are believed to be mediums for wealth and prosperity. Thus, this paper will address the suspiciousness surrounding the healers and their practices at the source of the White Nile.
2. Suspecting an epidemic: Burkinabé health workers observing the Ebola outbreak in West Africa
Author: Lise Rosendal Østergaard, University of Copenhagen, Denmark.
During the Ebola outbreak in 2014, the West African region was subject to intense media coverage of the dire consequences of this epidemic. The media published accounts from the directly affected countries of self-sacrificing and heroic health workers but also of outrage, violence and riots directed by the local population against frontline nurses and doctors. Although Burkina Faso did not experience any cases of Ebola, the health workers I interviewed felt directly affected by the outbreak as they were preparing mentally and technically for receiving patients in their poorly equipped health clinics. Health workers’ stress of being exposed to this contagious disease was being made worse by their suspicion of the government’s inability –and possibly unwillingness – to protect its employees against work related hazards and risk. Rumors played a central role in how health workers assessed their own exposure to a potential outbreak.
Based on extensive ethnographic fieldwork among rural health workers in Burkina Faso and taking its point of departure in a situational analysis, this presentation will discuss the role of rumors, suspicions and (lack of) trust between front line health workers and the government. It is a central argument of the presentation that the heightened awareness of Ebola risk fleshed out already existing tensions between health professionals and the government. To develop this argument, I will use empirical observations of health worker practices and of how nurses and doctors carefully manage and reflect upon the practical and technological means that are available to them to sustain a basic level of safety.
3. "The Skulls of Bald Men, Blood Suckers, and Witchcraft": Folklore and Disease in Malawi
This paper offers a critical inquiry into the imaginative role and function of folklore and storytelling in framing discourses of occultism and health in contemporary Malawi. It is an absurd reality to live in a sub-Saharan African country where the leaders promise people immortality and yet do not offer inadequate medical facilities or structures. As a result, the people turn fiction to narrate and makes sense of disease. This is the case in Malawi where beliefs in witchcraft and the supernatural are widespread with the accused belonging to the most vulnerable sections of society: the elderly, disabled, and the mentally ill. Increasingly, practitioners of healthcare have been targeted as practitioners as well.
The point of departure is the work of social scientists who have been adept in identifying the resurgence of witchcraft and supernatural in health as a response to modernity; however, the view is this model is outdated especially in reading the context of Malawi. Therefore we examine the complex system of traditional belief, isolation, and the poverty as it intersects with collective beliefs in madness, the supernatural, and ill health. Fundamentally, rather than rely on the vocabulary supplied by the media which is inclined to the primitive, and the primal; we lean towards allegory, metaphor and the symbolism associated with disease and the forms in which it is narrated and circulated in Malawian communities.
KEYWORDS: Africa, myths, narrative, storytelling, medicine, poverty and systems
4. Medicine and Poison: Movements of Evil in a Nigerian City
Author: Ulrika Trovalla, Uppsala University, Sweden.
With the violence that broke out in the Nigerian city of Jos on Friday, 7 September 2001, and which came to be known as ‘the crisis’, feelings of suspicion, fear, and hate became everyday companions in the urban landscape. While the Other increasingly came to be conjured up in terms of the Evil Other, Christians and Muslims moved away from each other, gates were closed, and no-go areas emerged – an increasingly religious and compartmentalised landscape came into being. Simultaneously as people moved apart to feel safer, there emerged a new fear – a fear that brought a novel anxiety and presence into the urban landscape. As borders between different areas became thicker people stopped crossing them, but there were other malevolent things that with new intensity did. These were matters that were based on a tension between presence and absence. Medicine, water and food – seemingly mundane matters – came to be imbued with the essence of evil. In their capacity to move beyond their makers, they became manifestations of an enemy residing in an elusive elsewhere. In a very real sense, places became haunted by absent others.
5. Mapping suspicion surrounding HIV/AIDS through the analysis of South African fictional literature
Author: Roberta Biasiotto, University of Bologna, Italy.
South Africa is one of the most affected countries by HIV/AIDS worldwide and has been dramatically hit by the HIV/AIDS epidemic. The perception, the impact, and the representation of the disease have been given expression through the literary responses to the epidemic. The present research aims at exploring and mapping the suspicion that the HIV/AIDS epidemic in South Africa has been surrounded with, by analysing selected novels written by South African writers. The novels Welcome to Our Hillbrow by Phaswane Mpe, After Tears by Niq Mhlongo and High Low In-between by Imraan Coovadia - published in 2001, 2007, and 2009, respectively - showed that suspicion was spread and directed towards both the main features of the disease and to all the stages of the epidemic: the origin and the transmission of the disease, the drivers of the epidemic, the treatment and the therapeutic strategies were under scrutiny and became contested territory of rumors, theories and conspiracy. In the novels, suspicion around HIV/AIDS is expressed through gossiping, myth and circulating narratives and is fueled by shame and blame. Suspicion is deeply informed by historical experiences such as the experience of apartheid and the tension between tradition and modernity, and by supposed dichotomic epistemologies and opposing ways of understanding the world. The present anthropological analysis of selected South African novels aims at contributing to get an insight into the complex and multifaceted scenario of the anxieties, expressed as suspicion, evoked by the HIV/AIDS epidemic in South Africa.
6. "From ‘death houses’ to ‘miracle’ hospitals": Transformation of the Zimbabwean Public Health System, 2000-2017
Author: Ivo Mhike, International Studies Group, University of the Free State, South Africa.
This study explores the changes in public health seeking behaviour among Zimbabweans under economic crisis. The post 2000 Zimbabwean economy was characterised by hyperinflation and infrastructural collapse which severely affected social service delivery. Government funded health at every level experienced debilitating budget cuts, shortage of drugs and a haemorrhage of health personnel. By 2007 the parlous state of government medical institutions had spawned a pervasive image of government hospitals as ‘death houses’ forcing the public to find alternative health. The private-public mission health institutions provided alternative health and inspite of some measure of economic stability and government effort to revive its medical institutions (2009-2013), mistrust of government institutions increased. Meanwhile, mission health institutions entered a new dawn as the efficient and cheap public health alternative. Mission hospitals, it was claimed, were also endowed with ‘spiritual’ and ‘miraculous’ powers of healing and health which went beyond the work of physicians and drugs. Through the use of newspapers, interviews and secondary literature, this paper uses the case of public health as a lens into public mistrust of and anxiety about a moribund state whose capacity for social service delivery was failing. It also engages the debate on the role of private-public health players in increasingly failing African economies and the pursuit of the Millennium and Sustainable Development Goals on health.
7. Suspicions and Deadly Strategies: Challenges in achieving the 90-90-90 target in Ghana
The Joint United Nations Program on HIV and AIDS (UNAIDS) set the 90-90-90 global target for the coverage of anti-retroviral therapy (ART) to be reached by 2020; 90% of all people infected with HIV know their status, 90% of them are on ART, and 90% of them will have full viral load suppression. Data from UNAIDS shows that less than 50% of the persons living with HIV in Ghana know their status, with just about 34% of the persons who know their status on antiretroviral treatment as the end of 2016. This is a major blow towards achieving the third 90% of viral suppression, with less than two years to the target line. Fighting stigmatization has been identified as one peculiarity that must be surmounted for results to be improved.
This paper explores the complex strategies of PLHIV, howbeit deadly, in a setting where HIV prevalence is comparatively low, bringing to the fore their negotiations between resignation to fate and the struggle for survival as they cope with high levels of suspicion; from families, community members, and health workers. The paper argues that these ‘suspicions’ impact both positively and negatively on the lives of the PLHIV, influencing decisions to test, access to treatment services when found to be positive, and taking antiretroviral therapy religiously. Suspicions thus have consequences on achieving the 90-90-90 target.
This paper draws largely form a multi-perspective study that aimed at exploring the barriers (and motivations) to accessing counseling, testing, and treatment services in the Ashanti Region of Ghana. This aspect of the work is an ethnography of which the researchers have followed 49-HIV positive persons and their families since 2007. It combines observations, conversations, and in-depth interviews to elicit data from the respondents.
Keywords: Suspicion; HIV/AIDS; Antiretroviral; Global Target; Strategies; Ethnography
8. Rumours, Suspicion and Changes in Health Care Consumption in Conflict Affected Areas in Nigeria
Author: Victor Adetula, Nordic Africa Institute, Uppsala, Sweden.
Fear and suspicion thrive so well with the help of rumours particularly in conflict zones where parties in conflict are polarized along ethnic and religious lines. In such situations, political use of rumours, suspicion, and fear is well pronounced as parties in conflict regularly deploy various forms of propaganda to create a climate of fear and as well project their opponents as the ‘reason and cause’ of their unpleasant conditions. The activities of insurgents, rebels and terrorists qualify as extreme cases of the political use of rumours and fear against the state. In countries where the state has lost its capacity to provide the necessities of life to most of the population, the activities of rebels and insurgents have thrived. Also, in many Africa countries where conflicts along primordial identities, parties in conflicts have used rumours, suspicion and fears to gain upper edge. In such societies prolonged violent conflicts have weakened state institutions and structures of governance. For instance, the technical, financial, and infrastructural capacities needed to provide health care are lacking. Also, water and sanitation facilities may have been damaged by the fighting. Usually to fill the gaps are plethora of informal networks that linked to governance structures that also relate privately to the economy. Building on the assumption that “in societies where trust has been eroded by economic harshness or social tensions, questions continuously arise about what is really going on behind the scene”, this paper acknowledges changes in the trends and patterns in the health care consumption in the conflicts zones in Nigeria since the return of the country to civil rule in 1999, and thereafter examines the status and roles of rumours and suspicion as the key variables. Understanding of the links have significant implications for peace building and other related benefits to the policy environment.
9. Suspicions around misoprostol. A socio-anthropological study in Burkina Faso
Author: Fatoumata Ouattara-Traoré, Institut de Recherche pour le Développement (IRD), UMR Laboratoire Population et Développement (LPED), Lomé, Togo.
Initially used in the treatment of gastric ulcers, other efficiencies were then proven in the use of misoprostol in obstetric care: treatment of postpartum haemorrhage, acceleration of delivery, post-natal care abortion and the practice of abortion. These varied efficiencies have made misoprostol as a drug that plays a role in reducing maternal mortality in lowincome countries.
Following the recommendations of the World Health Organization for the effectiveness of this drug in reducing maternal mortality in developing countries, each state is led to decline the procedures and standards for its use and availability in public health structures.
The purpose of this paper is to describe and analyze the institutional logics and local professional practices related to misoprostol enrollment in maternity services in Burkina Faso.
The presentation is based on a qualitative approach and socio-anthropological surveys conducted in Ouagadougou for several years (2010 to 2016) with different actors (ministries of health, NGOs and associations).
The official recognition of misoprostol is a process that involves a variety of actors and relationships that crystallize the sensitivity to face the issue of abortion in the public square.
The confrontation of logic is based on the statement of suspicion about the purpose of misoprostol use. The perspective of tackling maternal mortality is thus confronted with local suspicions and fears that misoprostol use for abortion will open the door to empowering women to control their sexuality.
Misoprostol questions the reports of policymakers and carers about the issue of abortion and maternal mortality. The analysis of these logics necessarily involves the perceptions that local actors have of imported products and their uses. Misoprostol questions crossover issues on the fight against maternal mortality on the one hand and the issue of emancipation of the woman / control of her sexuality.