African Medical Pluralism

By William C. Olsen; Carolyn Sargent | Go to book overview

Afterword

Arthur Kleinman

SINCE THE POST–WORLD WAR II era, anthropologists have studied medical pluralism, and the subject remains salient today as this fine collection of essays demonstrates for Africa. Indeed, that pluralism has become even more complex and influential in Africa as globalization has brought Chinese financial investment, the migration of several million Chinese workers, and the introduction and dissemination of traditional Chinese medicine in virtually every major African urban space and many rural ones. That reality can be encompassed within the overview of salient issues canvassed so effectively in the Introduction.

I seek here to raise additional issues that connect the study of medical pluralism in Africa with the current condition of global health. One longstanding issue that I first ventured to address in my 1980 monograph, Patients and Healers in the Context of Culture, but have developed further more recently, is the question of caregiving. Many ethnographic and historical studies reveal the embodied and contextually-embedded processes of caring for others and oneself. There are large cultural differences but also a limited number of existential ways by which people go about addressing the sick and attempting to be of help. In my view, not enough attention has been paid to the actual physical practices of care, including such things as protecting, assisting, feeding, carrying, washing—the hands-on work of ritual and of the most practical acts of accompanying, acknowledging, affirming, and loving.

As anthropologists we (including I) have rightly studied the communicative, explanatory, symbolic, and more broadly moral and political aspects of treatment. We need to complement these crucial aspects with the equally crucial and deeply human acts that represent the bodily work of families, networks, individuals, and culture in order to better document what caregiving is and what is most at stake in it for local communities and individuals. African studies of therapy management teams have long established the key role of families and networks, yet even here more detail is required to really gain an understanding of local differences and translocal similarities and how these relate to global patterns.

Once caregiving acts per se are the focus, the unavoidable question is one of quality. Here there has been a tendency to patronize traditional forms of healing

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