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The infancy of Edward Shelonga Part I

an extended case study in medical and religious anthropology from the Zambia Nkoya: Introduction; Method; Background

Wim van Binsbergen


to Part 0 (Abstract)
Part II (The extended case; Ethics)
Part III (Interpretation; Conclusion)
Part IV (References; Postscript on Cognition)

2. The problem and the method

In modern Zambia, people’s pursuit of health and healing usually takes place on the interface between on the one hand what Loudon (1976:4) has called cosmopolitan clinical medicine (the bureaucratically-organized realm of public health services and certified private practitioners) and on the other hand a variety of alternatives: self-medication, intra-family treatment, and the services of such African specialists as midwives: diviners; herbalists; priest-healers specializing in the alleged effects of ancestral wrath, sorcery, or affliction spirits; and leaders of certain Christian churches specializing in spiritual healing. There are some social-science studies available, both on cosmopolitan medicine in Zambia[2] and on some of the alternatives: herbalists,[3] priest-healers,[4] and African midwives.[5] Whatever the merits of these studies, their major shortcoming is that they rarely deal with the crucial problem of the interaction between cosmopolitan medicine and local alternatives.

     The importance of this problem is certainly acknowledged in the work of Frankenberg and Leeson,[6] but these two authors have so far not published an exhaustive empirical study on this point. Close came Leeson’s short paper on ‘Paths to medical care in Lusaka’ (1970), where she found that ‘nearly two-thirds of all ngangas’ [African healers — WvB] patients had previously consulted ‘‘western’’ medical advisers’ (1970:9). In a preliminary yet thoughtful analysis, Leeson concludes that ‘to consult [the nganga ] does not imply a total rejection of western medicine’ but instead should be considered an attempt to assess why western medicine has failed to be effective, or an attempt to try all available paths to health (1970:11). Extremely stimulating in Leeson’s argument is that, here as elsewhere (1969; cf. Frankenberg and Leeson 1976), she tries to vindicate the African healers, claiming that greater success in public health will not be achieved by needlessly attacking the healers who perform many essential tasks, but by improving the working of the western health agencies. For a member of the cosmopolitan medical profession (Leeson is a physician), this is quite a courageous statement to make.

     Leeson’s research was carried out in Lusaka. Here the Zambian patient is surrounded by easily accessible cosmopolitan health agencies: the University Teaching Hospital, a number of urban clinics, and an abundance of private practitioners. The majority of these (in fact: all except the private practitioners) are non-fee-paying; also drugs are dispensed free of charge. Yet even here, despite the overlap between cosmopolitan and nganga consultation noted above, Leeson found that about 40% of the ngangas’ patients claimed not to have consulted cosmopolitan agencies. And these are not just patients complaining of illnesses that could be considered the ngangas’ special domain: ‘madness’, ‘spirit possession’, etc. A considerable number of Leeson’s informants consulted the nganga, at the exclusion of cosmopolitan agencies, for complaints that (cf. table 1) many Zambians today consider amenable to western treatment: they allow themselves to be hospitalized on the basis of these complaints.

Table 1a. The six most frequent reasons for hospitalization in Zambia (source: Stein 1971; click to access table 1a)

While these data demonstrate the prominence of these diseases in the Zambians’ utilization of cosmopolitan medicine, table 1b indicates that the same diseases constitute important reasons for the consultation of non-cosmopolitan healers:

Table 1b Consultation of ngangas for the six most important diseases in Zambia (sample: patients of Lusaka ngangas; source: Leeson 1970; click to access table 1b)

Despite the availability of cosmopolitan medicine, why do contemporary Zambians continue to pursue forms of non-cosmopolitan medicine? Phrased thus, this central question of the present paper may sound ethnocentric, even smack of cultural imperialism. Cosmopolitan medicine is just one particular socio-cultural subsystem, peculiar to a type of industrial society that since the nineteenth century has spread over many parts of the world. Wherever cosmopolitan medicine has penetrated, it has encountered local forms of medicine, often of great complexity and antiquity. Rarely is local medicine abandoned overnight, in favor of cosmopolitan medicine. Moreover, despite its achievements and power, cosmopolitan medicine itself is increasingly criticised within the very societies it sprang from; Illich’s recent Limits to Medicine, Medical Nemesis: The Expropriation of Health (1977) is an eloquent and convincing example of this tendency. Yet, in a country like Zambia great national and personal efforts and dedication go into the propagation of cosmopolitan health care. The latter does possess reliable therapies or preventive routines for certain endemic diseases (e.g. malaria, gastro-enteritis, measles) which cause great suffering and for which local, non-cosmopolitan medicine has no adequate cure. For these reasons I feel that my question is a legitimate one — particularly if the answers we shall find will not lead to a Pyrrhus victory of cosmopolitan medicine, but to a better understanding and appreciation of the contributions various medical traditions, including cosmopolitan medicine, can make towards the well-being of the people involved.

     As regards Zambia, Leeson’s answers were not meant to be exhaustive. Moreover they were based on a possibly biased sample survey: her respondents were found in the ngangas’ consulting rooms and might not be entirely representative for the Lusaka population as a whole. The only other author who has explicitly raised the same question in the Zambian context, is Victor Turner. At the end of a general ethnographic inventory of Ndembu Lunda medicine, he quotes (1967a: 356f) a variety of reasons for the persistence of local medicine. Local medicine is said to rest on the same premises as the total world view of the local society; many illnesses heal themselves, irrespective of the real or alleged effect of therapy; the healing cults have an important psychological effect; and illness is so prevalent that the local culture has no choice but to actively confront it. These reasons overlap with those mentioned by Leeson and throughout the literature on the subject (cf. Lieban 1973: 1056f). Le Nobel’s clinical experience in the field of maternity care at the rural district level in Zambia suggested that access to the outlets of cosmopolitan medicine also plays a major part. When a mobile maternity service greatly increased accessibility, utilization increased threefold (1969: 85f); yet even so it could not be prevented that ‘only 20% of the regular antenatal attendants reported within a few weeks after the delivery’ for post-natal and under-five consultation. Evidently besides accessibility there were other factors at work, one of which Le Nobel suggests to be health education — another point emphasized in a vast body of literature on the subject.

     An increasing number of publications in now becoming available on the interaction between cosmopolitan medicine and its local alternatives. Like the few Zambian examples quoted, much of this literature uses generalized descriptive data, often of a quantitative nature, to arrive at general but as yet rather preliminary conclusions. Studies based on two types of data are overrepresented: those relying mainly on medical records relating to people already pursuing cosmopolitan medicine (e.g. Le Nobel 1969), and those based on speech reactions: on what people say they feel, did, do, or may do in future.[7] It should be noted that both types of data are artificially restricted to the individual, about whom certain facts (often artefacts) are recorded without taking into account the social relationships in which that individual is involved, and the development of those relationships over time.

     In the present paper I shall approach the problem from a different angel: the extended-case method, to whose development Turner himself and his sometime Manchester colleagues (foremost Van Velsen) have so greatly contributed;[8] moreover the presentation of my data and analysis has been modelled, somewhat, after Epstein’s paper on urban networks (1969). In the extended-case method, the fundamental structural features of a social field are identified not primarily on the basis of the participants’ statements concerning such enduring cognitive elements as collective beliefs, rule and norms; nor on the basis of other generalized data such as quantitative surveys; but on the basis of a carefully studied sequence of social events involving the same interacting protagonists. Applied to the medico-anthropological perspective (cf. Janzen 1975), I shall contend that cosmopolitan medicine and its various local alternatives constitute dominant spheres in the social field within which people, through a complex social process, are engaged in the pursuit of health. What form the relations between those two spheres take, and why, shall be tentatively analysed by reference to one extended case, describing in detail the health experiences of Edward, a Nkoya infant. Edward’s experiences largely depend on those of his parents Muchati and Mary; therefore, the latter will also play leading in the account that follows.

     Limitations and possibilities of the extended-case method in medical anthropology will became apparent as my argument proceeds. The health activities of the protagonists, within and outside cosmopolitan medicine and extending over several years, no longer appear as disconnected items but are shown to be parts of a sustained social process. The significant health aspects of this social process will be shown to be intimately related to crucial social, economic and political aspects. But what is thus gained in depth and width, goes at the expense of representativity. We shall therefore have to discuss to what extent the protagonists’ situation is unique. Moreover data of sufficient depth and detail to be amenable to extended-case analysis, can only be collected through intimate and prolonged association between the researcher and the protagonists. In the context of health activities, at the borderline between cosmopolitan medicine and other forms of medicine, is it permissible to use such intimacy primarily for the gathering of scientific data? Or should such influence as the researcher builds up through participation, be used to drag off the patients to cosmopolitan health agencies, thus releasing them from the clutches of non-cosmopolitan healers? When discussing our own role in Edward’s case (section 5), I shall briefly consider this ethical question.

     This paper is an anthropologist’s contribution, and makes no claim to medical competence. When the course of our field-work forced us to diagnose and treat our informants’ illnesses, we did so as amateurs, albeit that my wife’s long-standing experience with medical research as a biophysicist greatly facilitated our access to medical literature and to medical practitioners. The plausibility of such diagnoses as my argument contains has been confirmed in later, detailed discussions with doctors, including three physicians practising in the area itself.

However, as in nearly all cases such tentative confirmation was reached in absence of the patient involved, no medical authority attaches to our diagnoses. In view of the centrality of these diagnoses in my argument this may appear a major weakness, yet it was unavoidable in a rural area where no cosmopolitan doctor is available within 80 km, there a two-hours drive.


3. Background

The protagonists in this case belong to the Nkoya people, a small ethnic group which has its home area in the eastern part of Zambia’s Western Province (formerly Barotseland), and surrounding areas.[9] My medico-anthropological data mainly derive from the Nkoya of Chief Kahare,[10] a small group of peasant cultivators and hunters.

     Chief Kahare’s is not a healthy area.[11]Situated on the central western Zambia plateau, at the Kafue/Zambezi watershed, the area contains swampy streams and fishing ponds conducive to malaria and bilharzia. Respiratory tuberculosis and gastro-enteritis are likewise common. In addition to malaria almost universal hookworm infestation further contributes to the anaemic condition (cf. King 1966: section 24: 64-66) that greatly reduces the resistance of children (measles is a major killer disease here), and of young women in pregnancy and childbirth. Hypovitaminosis is a common condition. With the virtual absence of motor traffic, the major causes of trauma are wild animals, defective bicycles, and human violence. Leprosy and blindness are infrequent but accepted features at the village scene. A massive eradication campaign in the 1950s reduced the rate of venereal disease which before that time was very high.[12] Infant mortality is high. Moreover, fertility is exceptionally low.[13] This may be related to such social factors as high marital instability, polygyny, and labor migration (cf. De Jonge 1974); and to local practices relating to sex and childbirth.[14]

     Being located at the periphery of the province and even of the district they belong to, Chief Kahare’s Nkoya have only recently seen the establishment of a permanent outlet of cosmopolitan medicine in their own area: a Rural Health Centre dating from the late 1960s, at about 30 km from Chief Kahare’s capital village. However, at distances of 80 km and more, dispensaries, and even (just beyond the district’s western border) a mission hospital have existed since the 1930s (Northern Rhodesia, 1930). From the early 1940s, teachers at the few mission schools in the villages kept some elementary medicaments supplied by the mission. Minor village sanitation requirements as enforced by the district administrative staff on their annual tours; tsetse fly control at the borders of the Kafue Park; very rare inoculation campaigns, and the habitual medical check-ups when one registered as a labor migrant at the distant provincial capital: this sums up at about all there was of cosmopolitan medicine, and its derivations, during most of the colonial period.[15] Of the three hospitals now found in the district, one was established in the late 1950s and the other two around the time Zambia became independent (1964). None of these present-day hospitals is within 80 km from Chief Kahare’s village.[16] Although the number of outlets of cosmopolitan medicine compares favorably with other districts in Zambia,[17] it is mainly the people living in that part of the district where the three hospitals are concentrated (each within only 50 km from the others!), who more than sporadically benefit from them.

     For an understanding of the extended case, a minimal introduction to Nkoya social structure is necessary. Throughout my presentation of the case I shall refer to the principles outlines here. I shall take them up explicitly in my interpretation of the case, in section 6.[18]

     In terms of social structure, the contemporary Nkoya situation must be analyzed at two levels. First we have to look at the relations between this society and the wider social, political and economic structures within which it is incorporated; and secondly we need to study the internal structure of this (part-)society. The two levels will turn out to complement each other.

     In the modern Central African context, ‘Nkoya society’ forms a social-organizational subsystem: the local results of incorporation into the colonial and post-colonial state, and into the world-wide capitalist economy. The members of this subsystem are based partly in the Nkoya homeland and partly in the towns of Central and Southern Africa. The people in these two segments are geographically separated, exist in very different residential environments with varying degrees of multi-ethnic involvement, and specialize in different modes of production. Capitalism dominates urban economic relations, while in the village many pre-capitalist forms still survive, although with difficulty (Van Binsbergen 1978b). Yet the two segments are linked by very frequent interaction, making for a constant stream of people, information, letters, money, food, manufactured articles, between the urban and rural segments. Despite the differences in economy and social-structural environment, in both urban and rural segments of the Nkoya ethnic group the same patterns of kinship, marriage, ritual, medicine obtain, and almost every Nkoya individual is involved in social processes in which both urban and rural kinsmen and tribesmen actively take part. In this sense it is meaningful to speak of Nkoya society, even though many of its members live outside the Nkoya rural area.

     The political economy of the contemporary Nkoya situation can be described with Meillassoux’s phrase (1975: 137f) ‘the mode of reproduction of cheap labor’ (cf. Gerold-Scheepers & Van Binsbergen, 1978: 25f).

     Capitalism brought not only processes of material expropriation and extraction within the Nkoya homeland (e.g. hut tax, partial closure of the forest area for hunting and collecting); it particularly caused, since the 1910s, a drain of locally reproduced labor force from the Nkoya homeland to the places of capitalist employment in Central and Southern Africa. With low average standards of formal education, and as a small ethnic minority in towns the labor market and the informal sector are dominated by other ethnic groups, the Nkoya have rarely been able to become stabilized townsmen who rely entirely on their capitalist employment. Instead, the insecurity of urban employment has necessitated a continued orientation towards the village, and a continued involvement in kinship-dominated social processes focusing on the village. As the village is the place where children are born and raised and where the old and disabled retire, the urban capitalist sector benefits from a labor force while relegating the costs of its reproduction to rural society. The latter becomes economically exploited, in fact impoverishes, and its social organization is eroded since its original economic base has been greatly affected by capitalist relations of production (Van Binsbergen 1978b). Yet the survival of this rural society is obviously of primary importance within the overall political economy of this part of the world. Only if rural society remains essentially intact, can it perform its subservient role vis-à-vis the urban capitalist sector. Thus contemporary Nkoya village society reproduces cheap labor, and at the same time provides a niche of economic, social and psychological security outside the capitalist sector, for the many Nkoya who despite their past, present or future involvement in that sector have not been allowed to become anything but peripheral to it.

     While in town, Nkoya migrants in great majority engage in mutual hospitality and kin assistance. They participate in Nkoya cults and puberty ceremonies, and send remittances to rural kin. thus they demonstrate they still identify as Nkoya. Only in this way can they ensure their stake in the village, in preparation of their ultimate retirement there. While they live in towns and while the majority of the men at least are employed in modern formal organizations, in their free time most urban Nkoya pursue a social, cultural, ritual and medical life that is largely that of their rural relatives. The Nkoya therefore, are an example of the fact that economic and political incorporation need to lead to complete destruction of pre-existing social and symbolic structures. These structures may survive as ‘neo-traditional’ (i.e. deprived of their original base in pre-capitalist relations of production), provided that the incorporated subsystem which they underpin, has been assigned a function within the new, wider system. Under the penetration of capitalism, the Nkoya kinship system has been modified but not destroyed, because Nkoya rural society has been made subservient to capitalist structures.

     I shall demonstrate that Nkoya medicine is an essential part of the Nkoya kinship system, and that the continued partial adherence to the former, depends on the continued reliance on the latter.

     Let us now move on to the internal structure of Nkoya society. The formal principles governing personal intra-ethnic social relationship in the urban segments (i.e. outside the domain of participation in formal organizations) largely derive from the rural situation. It is therefore sufficient for our present purpose to describe the latter.

     Chief Kahare’s area consists of a number of river valleys, separated by extensive light forests where much hunting takes place. Each valley derives a separate identity from rain ritual, an unofficial neighborhood court of law, and concentration of rights to riverside gardens and fishing grounds mainly in the hands of the valley’s inhabitants. Each valley contains about a score of tiny villages, whose sizes range from one to twenty households, a minority of which are polygynous. Each village is headed by a headman, whose title and office is ritually inherited at the village shrine. After the death of a headman, a successor is chosen from among a large pool of patrilateral, matrilateral, and sometimes affinal kinsmen of all previous incumbents of the office; very often, senior men are attracted from a distant village or called back from town to take up the vacant headmanship of a village. Names and titles of persons other than headman are inherited in a similar fashion. Usually inhabitants of a village are real or putative kinsmen of the headman. However, the Nkoya reckon descent bilaterally; moreover, intra-village marriages have become exceptional and are now frowned upon; and consequently an individual’s maternal kin and paternal kin (either of which he may opt to reside with) tend to be spread over a number of different villages; and in addition to real and putative genealogical links, joking relations between pairs of clans[19] may lead to close personal relationships that in effect contain the same claims and rights as actual kinship.

     For all these reasons each junior Nkoya has potential claims to residence and assistance with regard to a large and geographically very extensive set of senior tribesmen, who all compete for a following of juniors in order to establish themselves as village headman (or to remain successful in that office). In addition to urban-rural migration, intra-rural geographical mobility is therefore very high. All individuals except the aged continually try to improve their kinship-political position by moving from village to village.

     In this extremely flexible, competitive and conflict-ridden set up, the village is the main conspicuous unit of the kinship-political process. Yet the village is not a monolithic whole. As inhabitants come and go, they are rarely bound by the fact that they have grown up together or have interacted with each other for many years at a stretch. Usually the village headman spends much of his time and energy to keep together a village consisting, with some exaggeration, of virtual strangers whom only opportunity and calculation have brought together. Bilateral kinship enmeshes and confuses consanguinean and affinal ties to such an extent as to preclude the emergence of stable kin groups above the village level. Clans are now too dispersed and too devoid of corporate interests (apart from matters of chiefly succession) to form enduring social groups. In the course of kinship-political processes of coalition and opposition, vaguely-defined clusters of kinsmen tend to emerge beyond the scope of one individual village. Such clusters manifest themselves through the members’ repeated association, over a few years, for the purpose of marriage negotiations, court cases, ritual, and inheritance to prestigeous titles connected with headmanship and chieftainship. Although these clusters have to fixed boundaries nor ascriptitious recruitment of members (i.e. their shifting composition cannot be predicted just from a genealogy or a village map), they are not completely ad hoc structures. In each cluster, one or two clans tend to prevail, and often a cluster is primarily (but never exclusively) associated with one particular village, including those of its members who temporarily reside in town. Such a village may even loosely lend its name to the cluster. The definition of such clusters of temporarily solidary individuals is largely situational (Van Velsen 1964, 1967), in that the present state of any one cluster’s composition and internal structure can only be determined when, for one specific social event (particularly conflict), the cluster sets itself off against one or more rival clusters. In the next event, confronting some different cluster over some different problem, the cluster’s composition may be different except for a small but firm core membership.

     Much of the social process among the Nkoya revolves around the definition, mobilization and confrontation between such blurred, shifting and ephemeral clusters. It is them I have in mind when in the following account I shall speak of the protagonists’ ‘kin group’. Specifically, Muchati’s kin group in so far as mobilized in Edward’s case, focussed on Nyamayowe village, which is located in the Mushindi valley. The kin group of Mary, his wife, focuses on Jimbando village, located in the Mema valley within 100 m from Chief Kahare’s capital. Over the road the distance between Nyamayowe village and Jimbando village is about 10 km.

     Finally, the Nkoya have a richly developed ritual culture, much of which is reminiscent of that of the Ndembu, so eminently described and analysed by Turner (1957, 1961, 1962, 1967a, 1967c, 1968). Most Nkoya rituals have strong medical connotations: they are meant to cure people from illnesses considered to be caused by ancestors, sorcery, the spirits of the wild, etc. Since the early twentieth century, cults of affliction have emerged as the dominant ritual complex throughout Western Zambia, including the Nkoya area. The historical conditions under which this happened I have indicated elsewhere (Van Binsbergen 1976a, 1977a). Building upon previous authors (foremost Turner), I defined such cults of affliction as

‘characterised by two elements: (a) the cultural interpretation of misfortune (bodily disorders, bad luck) in terms of exceptionally strong domination by a specific non-human agent; (b) the attempt to remove the misfortune by having the afflicted join the cult venerating that specific agent. The major ritual forms of this class of cults consist of divinatory ritual in order to identify the agent, and initiation ritual through which the agent’s domination of the afflicted is emphatically recognized before an audience. In the standard local interpretation, the invisible agent inflicts misfortune as a manifest sign of his hitherto hidden relationship with the afflicted. The purpose of the ritual is to acknowledge the agent’s presence and to pay him formal respects (by such conventional means as drumming, singing, clapping of hands, offering of beer, beads, white cloth and money). After this the misfortune is supposed to cease. The afflicted lives on as a member of that agent’s specific cult; he participates in cult sessions to reinforce his good relations with the agent and to assist others, similarly afflicted, to be initiated into the same cult.’ (Van Binsbergen 1977a: 142)

This basic pattern is found in all the many individual cults of affliction of contemporary Western Zambia, including those featuring in the present paper. Most cults of affliction occurring in the Nkoya area have, moreover, in common that their adepts are organized in small factions headed by an accomplished cult leader. Ties of kinship and co-residence are used to reinforce the relationship between leader and adepts; and just like village headmen, cult leaders compete with one another for the allegiance of followers.

     The expansion of these modern cults of afflictions seems to be not unrelated to the introduction of cosmopolitan medicine, at the periphery of Nkoya life. It is remarkable that whenever informants remember these cults’ original founder-prophets (cf. Van Binsbergen 1977a: 155f), the latter are depicted as having tried, at some state, cosmopolitan medicine before founding their own healing cult. Oral traditions concerning one such prophet, Ngondayenda, invariably stress the lack of clinics and hospitals in the district in the 1930s, when severe human and cattle epidemics occurred.

     More historical research is needed on this point. But it can be safely stated that, from its first entrance in the Nkoya area, until the present-day fervent competition for the allocation of Rural Health Centres over the various administrative wards of the district (Kaoma Rural Council n.d.), cosmopolitan medicine has been recognized by the local people as highly valuable and desirable. Yet throughout this period it has been forcibly confronted by Nkoya medical alternatives. This paper tries to understand why this should be so.

[2]Jayaraman 1970; Shattock n.d.; Frankenberg and Leeson 1974; Nur et al. 1976.

[3]Apthorpe 1968; Turner 1967; Gilges 1964; Symon 1958; Frankenberg and Leeson 1976; Leeson and Frankenberg 1977.

[4]Reynolds 1963; Turner 1967b; Colson 1969; Van Binsbergen 1977a.

[5]Le Noble 1969: 31f; Spring Hansen 1971; Munday 1945; Barnes 1949; Stefaniszyn 1964:74f.

[6]1974, 1976; cf. Frankenberg 1969; Leeson and Frankenberg 1977; and Leeson 1967, 1970.

[7]E.g. Ademuwagun 1974; Leeson 1970; Imperator 1974; Maclean 1971.

[8]Turner 1957; Van Velsen 1967, 1964: xxiiif and passim.

[9]Cf. Van Binsbergen 1975; 1976a, 1976b, 1977a, 1978b, and n.d. (b); McCulloch 1951; Clay 1946.

10People’s personal names and titles have been altered in this paper, as have those of localities in Western Zambia.

[11]The unfavourable conditions summarized here contrast remarkably with the picture emerging from the undp Nutrition Status Survey (National Food and Nutrition Programme, 1974). Based on a national sample including a large number of rural villages, that study carefully maps out the distribution of such somatic conditions as either indicate, or are considered to cause, malnutrition. For the purposes of the survey, the Zambian territory was divided into a number of ecozones. The twelfth ecozones, to which Chief Kahare’s area belongs, compares rather favorably with most other ecozones, in terms of: children’s weight against age; arm circumference; most of many serum, haemoglobin etc. levels that were measured (except packed well volume and ascorbid acid, with regard to which this ecozones scored low); and particularly malaria, where children in this ecozones were found to be least affected among the whole national sample. (Malaria incidence in adult males, however, was average, and in cult females even very high). The report did not attempt a systematic interpretation of these patterns, except for seasonal variation in diet. The main explanation for the difference between this moderately positive picture and the situation in Chief Kahare’s area, becomes clear when we trace the origin of the data in this ecozones (Schültz 1976: figure 30). They derive from four villages in the central part of the ecozones, where not only different ecological conditions obtain (particularly a different hydrography and much greater human encroachment upon the forest), but which is also the region’s centre of gravity in terms of medical facilities, cooperatives, communications, exposure to mission and school education, etc. (cf. Van Binsbergen: 171f; incidentally, this bias also affects Schültz’s own analysis of the area’s ecosystem (1976: 103f).) For an early yet thorough examination of the health situation in a area adjacent to Chief Kahare’s, cf. Newson 1932. Sadly, present-day health conditions in Chief Kahare’s area are still rather similar to what Newson described.

[12]Northern Rhodesia 1956: 95,100; Northern Rhodesia 1955: 110; cf. Evans 1955, who deals with the Nkoya’s eastern neighbors, the Ila.

[13]Cf. Ohadike & Tesfaghiorghis 1975; Central Statistical Office 1975: 6 and passim; Van Binsbergen n.d. b.

[14]On the causal significance of such practices, cf. Central Statistical Office 1975: 21; in the Nkoya case they include: intra-vaginal medicine used to ensure a dry milieu for intercourse (the harmful nature of this substance is indicated by the hemorrhages it frequently causes); and infanticide on various occasions, e.g. when the mother is a girl who has not gone through puberty ceremonies.

[15]In addition, migrants returning to the village had often gained considerable experience with cosmopolitan medicine at their places of employment.

[16]The 1968 returns of one of these hospitals corroborate the disease patterns summarized below (table 2):

Table 2. The seven most frequent reasons for hospitalization and hospital deaths in a rural hospital near Chief Kahare’s area, 1968.

Source: Republic of Zambia 1972; in order to avoid easy identification in the printed source, I imposed upon the original data a random scatter with mean = 0% and standard deviation = 10% (cf. Van Binsbergen 1978a; click to access table 2).

A further brief summary of the local health situation is to be found in: Republic of Zambia, 1976: 191f; Imasiku 1976.

[17]Cf. Republic of Zambia 1967, 1968, 1976; Blankhart 1966: 6f.

[18]A peculiar methodological problem arises here. An extended case is normally used to bring out more general structural principles that presumably have a rather wide application in the society in question. These principles concern, in the present argument, the relationship between cosmopolitan and non-cosmopolitan medicine. However, in order to make the case study amenable to such interpretation, other structural principles must be invoked; these other structural principles, relating to the internal social structure of Nkoya society and its incorporation in the wider world system, can be seen to work in the present case study, but they derive primarily from a much wider set of data, as presented in my other publications on the Nkoya and on Central Africa in general.

[19]Nkoya clan affiliation is ambilineally inherited. Every Nkoya belongs in principle to two clans: his father’s and his mother’s. The paternal clan affiliation tends to be submerged, and a Nkoya usually identifies with his maternal clan. In the case of close kin relations, membership of the same clan is often regarded as prohibitive for marriage. Certain chiefly titles are owned by specific clans. Finally inter-clan joking often forms a starting point for individuals to engage in prolonged dyadic contracts. Today, the membership of the various Nkoya clans is scattered all over the Nkoya homeland. Before the expansion of political and economic scale, around 1800 (which radically altered chieftainship and boosted interregional relationships), Nkoya clans are claimed to have been much more localized, exclusively matrilineal, and with a clan chief discharging major ritual and redistributive functions within the clan area.

to Part 0 (Abstract)
Part II (The extended case; Ethics)
Part III (Interpretation; Conclusion)
Part IV (References; Postscript on Cognition)


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