Academic journal article Africa

Diabetes, Medicine and Modernity in Cameroon

Academic journal article Africa

Diabetes, Medicine and Modernity in Cameroon

Article excerpt

ABSTRACT

This article examines popular understandings of diabetes, and conflicts and ambiguities in the management of diabetes care, in two areas of Cameroon. Conducted over a two-year period, comparative ethnography in Yaounde and Bafut started in four diabetes clinics (two in each place). From there it extended outwards, first to the homes of patients with diabetes, and then on to a number of indigenous healers consulted by patients or their families. We explore here the tension between clinic-based demands for patients' 'compliance' with treatment guidelines, including repeated strictures against resorting to 'traditional' medicine, and patients' own willingness to alternate between biomedicine and indigenous practitioners, a process in which they subject the claims of both to a kind of pragmatic evaluation. The continuing importance of indigenous healing practices, and explanations for diabetes in terms of ancestral intervention or witchcraft, are considered in the light of recent anthropological debate about the 'modernity of witchcraft' in Africa.

RESUME

Cet article examine les interpretations populaires du diabete, ainsi que les conflits et les ambiguites dans la gestion du traitement du diabete dans deux regions du Cameroun. L'ethnographie comparative menee sur une periode de deux ans a Yaounde et Bafut a commence dans quatre cliniques du diabete (deux dans chaque ville). L'etude s'est ensuite elargie au domicile des patients diabetiques, puis a un certain nombre de guerisseurs indigenes consultes par les patients ou leur famille. L'article explore les tensions entre d'une part les exigences des cliniques en matiere d'observance de traitement par les patients (y compris des critiques severes repetees contre le recours a la medecine << traditionnelle >>) et, d'autre part, la volonte des patients d'alterner entre praticiens de la biomedecine et praticiens indigenes, un processus dans lequel ils soumettent les pretentions des uns et des autres a une sorte d'evaluation pragmatique. L'importance persistante des pratiques de guerison indigenes, et les explications du diabete en termes d'intervention ancestrale ou de sorcellerie, som etudiees a la lumiere du debat anthropologique recent sur la << modernite de la sorcellerie >> en Afrique.

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The scene is a small rural hospital in north-west Cameroon. A few night staff remain on duty after their more senior colleagues have left. During the evening an indigenous healer arrives, invited by members of the family of a very ill diabetic patient. Nursing staff allow him in, and he proceeds to perform a ritual to diagnose the 'true' causes of this particular case of diabetes. The purpose of this intervention is not conceived of as calculated subversion of the hospital's treatment, by either the family of the patient or indeed the healer. Instead, it is envisaged as a way to supplement hospital care with something more powerful and effective before it is too late for the fast-weakening patient. Afterwards, the healer is ushered out discreetly, and nobody present will allude to the incident in the days following. All concerned know that this is a consultation seriously breaching hospital codes of conduct, which is why it takes place surreptitiously, after the departure of those more senior staff who would forbid it. Yet equally, all concerned see themselves not as colluding in some kind of shameful wrongdoing, but simply as sharing the same widespread assumptions about illness, diagnosis and therapeutic possibilities. Their thinking and behaviour is 'common sense', pursued in some desperation because of the urgency of the patient's deteriorating condition, yet driven 'out of sight' by the codes of conduct associated with the practice of biomedicine. (1)

We start with this example from fieldwork in Bafut, in the Grassfields of north-west Cameroon, because it highlights vividly several key themes--just as apparent in urban as in rural areas--which we discuss in this analysis of conflicts and ambiguities in the management of diabetes. …

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