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Medico-religious extended case study of a Zambian infant

The infancy of Edward Shelonga Part 0

an extended case study in medical and religious anthropology from the Zambia Nkoya: Abstract and links to other parts

Wim van Binsbergen

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First published in: van der Geest, J.D.M., & van der Veen, K.W., 1979, eds., In search of health: Essays in medical anthropology, Amsterdam: Antropologisch Sociologisch Centrum, pp. 19-90

to Part I (Problem and Method; Background)
Part II (The extended case; Ethics)
Part III (Interpretation; Conclusion)
Part IV (References; Postscript on Cognition)

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1. Abstract

In this article I shall present a case history based on the health experiences of a Zambian boy in the first years of his life. The reason for publishing this case is that it sheds some light on one of the crucial medical problems of the Third World: the interplay between cosmopolitan (i.e. western, modern) medicine, and such other forms of medicine as exist locally; the latter forms usually are part and parcel of the local religion. Use is made of the ‘extended-case method’, which sees in the relationships between people within one social field, and in the evolvement of these relationships over time, the major key to structural principles, in casu those governing the interplay between the various forms of medicine.

     In section 2, I introduce the problem, and the method by which I shall approach it. The next section gives some background data (medical, social-structural, cultural) without which the case cannot be understood. In section 4, I present the case history. In the next section I examine the researchers roles in the case, which were so crucial that the story might be considered a research artifact. Having demonstrated that the case is not thus contaminated, I proceed in section 6 to outline the structural principles that can be derived from the case history, as they apply to the specific social setting of Zambian peasants and urban poor belonging to the Nkoya ethnic minority.

     Although displaying a seemingly irrational movement to and fro between cosmopolitan and Nkoya medicine, the health behavior of the people involved in the case will be shown to be rational and understandable in the light of the following principles:

     — Health choices are made not only on the basis of cognitive elements (beliefs, concepts concerning health and disease), but also on the basis of an evolving social process, in which social relationships (including those with health agents) develop and their effects (in the form of positive and negative experiences and expectations) accumulate.

     — Given the indeterminate, ephemeral, extremely flexible nature of Nkoya social groups, the social process among this people revolves around continuous shifts in social relationships, through which individuals try to maximize social, political, ritual and medical support; in this light it is understandable that people pursue both cosmopolitan and Nkoya medicine, but the extent to which they do so depends on the quality of the evolving social relationships through which they get access to either source of health care.

     — Kinship and marriage, and the authority relations defined by these institutions, set the internal constraints for the social process within Nkoya society, and thus largely determine when and why younger people have to submit to the health actions which the elders are continuously imposing upon them.

     — For those Nkoya who participate in the multi-ethnic urban environment, modern-sector employment as well as personal relationships and experiences with agents of cosmopolitan medicine largely determine the extent to which cosmopolitan health care is utilized.

     — Most Nkoya (and many other African urban migrants) are in a peculiar socio-economic position. They participate in urban capitalist structures but their ultimate socio-economic security rests in the village, not primarily because of the so-called ‘force of tradition’, but because the political economic of this part of the world has assigned to the village the task of reproducing cheap labor and accommodating discarded labor. Remaining dependent upon the village, even those Nkoya who are committed supporters of cosmopolitan medicine have to abide by the institutions of their rural society, including the medical role of the elders, through which authority is asserted, the group affiliations of junior members are manipulated, and town-earned money is channeled to the village.

 

Note: This paper is a product of my research into religious change and urban-rural relations in Zambia, in which I have been engaged since 1972. Field-work was undertaken alternatingly in Lusaka and Western province, Zambia, from February 1972 to April 1974, from September to November 1977 and in August 1978. A research grant from the University of Zambia covered initial research expenses in the period February-April 1972. In 1973-74 and 1977-78 I was a Research Affiliate of the University of Zambia's Institute for African Studies, in which capacity I greatly benefitted from the intellectual exchange and research facilities offered. The Netherlands Foundation for the Advancement of Tropical Research (WOTRO) provided a writing-up grant for the period 1974-75, when the first draft of the present paper was prepared for the 11th International Course in Health Development, Royal Tropical Institute, Amsterdam, April 1975. The final version was written under the stimulating conditions of my current appointment as Research Officer at the African Studies Centre, Leiden; this institution also financed my 1977 and 1978 research trips. While registering my indebtedness and gratitude vis-\'e0-vis these various institutions, the Zambian authorities and my informants, I wish to thank in particular the following people: Henny van Rijn, my ex-wife, with whom I shared the traumatic experience of studying the Nkoya medical situation, and to whom consequently this paper is dedicated; Muchati and his wife Mary for reasons which my argument will make sufficiently clear; D.G. Jongmans for offering me the opportunity of presenting my data and views before a medical audience; the students of the International Course in Health Development, to whose passionate and incisive discussion the argument owes a great deal; J. Vosters, sometime medical officer in charge of a hospital in Western Zambia, to whose constant advise and supervision we, as medical laymen, owe much of our clinical experience with the rural medical situation; the District Medical Officer, Kaoma district, who actively encouraged the medical line in our research; J. Kee, sometime medical officer in charge of a hospital in Western Zambia, for adding to our understanding of the area's medical situation and medical history; S. van der Geest, K.W. van der Veen and H.C.F. Zwaal (M.D.) for detailed comments on earlier drafts of this paper; and finally the members of the Leiden Africa Seminar whose discussion of an earlier version of the paper was most helpful.

 

to Part I (Problem and Method; Background)
Part II (The extended case; Ethics)
Part III (Interpretation; Conclusion)
Part IV (References; Postscript on Cognition)

   


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