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The infancy of Edward Shelonga Part II: The extended case; ethics

an extended case study in medical and religious anthropology from the Zambia Nkoya

Wim van Binsbergen

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to Part 0 (Abstract)
to Part I (Problem and Method; Background)
Part III (Interpretation; Conclusion)
Part IV (References; Postscript on Cognition)

4. The extended case

I shall present the facts of Edward’s [6][1] and his parents’ health experiences in chronological order and with such relevant detail as my data allow. Only after this has been done, shall I, in the subsequent sections, interpret these facts in the light of the central questions posed in this chapter.

Diagram 1 presents a genealogy of the protagonists in this extended case. (click for diagram 1)

     Muchati [7], born in 1946, had left his father’s village Nyamayowe in 1961. He had been called to Lusaka by his kinsman Shipuna [5]. The latter had promised to see Muchati through his primary-school education, which in the village had stranded due to lack of money for school fees. Muchati joined Shipuna’s household, but not until almost a decade later (1969) did he find an opportunity to actually continue his education. Meanwhile Shipuna’s urban following waxed over the years, so that by the late 1960s he found himself the leader of a fenced ward in Lusaka’s Kalingalinga squatter compound. The ward comprised six to eight households of close kinsmen of Shipuna, including Muchati. By that time Muchati had found employment as a cleaner with a nearby educational institution. In his spare time he ran a clandestine bar. He had established a stable relationship with a non-Nkoya townswoman.

1969. Muchati’s kinsmen in Nyamayowe village prearranged a marriage for him with Mary [4], a moderately educated (grade 4) girl living in Jimbando village. Under grave pressure from his father Shelonga [13], Muchati terminated his relationship with his urban concubine. Following his father to the village, he reluctantly married Mary there.

     Muchati did not know that Mary was his distant classificatory sister, and thence a more or less prohibited partner. Both Muchati’s and Mary’s parents, however, were aware of this fact. They did not consider it a real obstacle, as marriage prohibitions in similar cases are believed to be recent innovation among the Nkoya. Muchati’s parents themselves were distant classificatory siblings, and their marriage had lasted for over thirty-five years already. Yet the sibling link between Muchati and Mary was kept a secret until after the wedding, mainly in order to deny Muchati a valid argument against marrying Mary.

     There was yet another reason why, according to Nkoya standards, the marriage was somewhat unusual. Apart from consanguinean relationship between Mary and Muchati (which referred to a common ancestor in the distant past), there was a marital link in actual existence between Nyamayowe and Jimbando village. Kawoma [24], headman of Nyamayowe village, was married with Mary’s cousin Kashimbi [40]. Besides being a headman, Kawoma was employed on Chief Kahare’s royal establishment. He divided his life between Chief Kahare village (where the household of his favorite and senior wife was located), and Nyamayowe where his other two wives lived, including Kashimbi. Nkoya consider it disadvantageous to contract, within one generation, more than one marriage with the same village. By entering into marital ties with as many villages as possible, the village members maximize the social field where new generations can find residential and economic support. At the same time avoidance of multiple marital ties with one village minimizes the probability of chain reactions in the deterioration of inter-village relationships, in the (only too likely) case that one of these marriages breaks down. For divorce is extremely frequent in this society.

     Thus the marriage of Muchati and Mary started out with a number of structural disadvantages. The spouses’ personalities and their life spheres (town versus village) were not yet attuned to each other. Contrary to many contemporary Nkoya marriages the affinal relationships surrounding this marriage lacked the clear-cut juxtaposition between the husband’s and the wife’s immediate kin group. Having been recognized as distant classificatory siblings, both spouses in theory belonged to the far periphery of each other’s kin group — and while this may initially have been regarded as a sign of positive integration, it deprived the parties in this marriage from the advantage of well-defined kinship positions from which future marital conflict might be adequately dealt with in a judicial context.[2] Nyamayowe village had already received a wife from Jimbando village, and the vicissitudes of this earlier marriage could have repercussions on Mary’s and Muchati’s own marriage. The accommodation of Mary’s and Muchati’s initially quite district personalities and interests, as well as the development of affinal tensions inherent in any Nkoya marriage but acerbated by the confusing overlap in affinal relationships and by the multiple inter-village marriages, are to form major specific structural dimensions of Edward’s case.

     Just how exceptional was Muchati’s and Mary’s marriage, involving remote classificatory siblings and multiple inter-village links? While normative pressures exist against both structural features, I estimate that either feature is present in roughly 10% of all marriages. In the Nkoya kinship system, affinal ties produce classificatory sibling relations in the next generations; therefore the two features do not occur independently, and the probability of their combined presence would be something between 1% and 10%. However, this relatively unusual marriage does by no means explain any Edward’s case as non-representative. Beneath the specific details, a more fundamental and universal principle can be detected: the extreme optional nature of group formation in Nkoya society, and hence the incessant competition for followers and associates, with both medico-religious and other means, inside and outside the medico-religious sphere.

     Immediately after the wedding ceremony in the village, Muchati took Mary to Lusaka. Only part of the agreed bride-price had been paid. The rest was to follow in installments over the next few years. The couple settled in Shipuna’s ward. Now that he was married, Muchati no longer depended on Shipuna’s household for the preparation of his food and for other domestic services. He has passed out of the immediate domestic control of Shipuna and the latter’s wife Banduwe [2], and no longer submitted to them a considerable portion of his income. Banduwe greatly resented these developments. Soon after the wedding she started a gossip campaign in order to affect Muchati’s relations with his in-laws. She alleged that Muchati did not feed Mary well, did not give her proper clothes etc. Alarmed, Mary’s mother Malwa [28] came to Lusaka to inspect the situation. She satisfied herself that the accusations were quite unfounded. Meanwhile Muchati lost his job as a cleaner.

August 1970. While Muchati was unemployed, their first son Joseph [3] was born without any complications. He grew up without serious health problems.

November 1970. In Kalingalinga, Mary participated for the first time in a nocturnal session of the Bituma cult of affliction. She had never been diagnosed as suffering from this particular affliction, but when she heard the drums play she could not control herself and started to dance. As she did not remove her clothes from the upper part of the body (as is obligatory in this cult), the cult leader Jilemba accused her of sacrilege and fined her K1.[3] Hoping to incorporate Mary in her cult faction, Jilemba continued for years to harass Mary and Muchati about this offence.

December 1970. Muchati found work again as a domestic servant with an expatriate member of the academic profession.

November 1971. Muchati entered our employment: originally as a domestic servant, but soon devoting an increasing portion of his time to research assistance among the urban Nkoya. With his family, he moved to our premises. Thus a period started of 2 1/2 years of very intimate day-to-day interaction.

December 1971-January 1972. For several weeks Mary had complained of vague, diffuse ailments.[4] Finally she proclaimed that she wanted to travel to the village in order to submit to treatment within a cult of affliction. Muchati could not detain her, and she took Joseph with her. Relational problems partly explained Mary’s departure. She had been increasingly unhappy in town. She missed her village friends as well as the rural economic tasks in which she has been brought up and which she had learned to regard as inherently meaningful. She found it hart to accept and enjoy her uxorial role in the urban environment. For in town her economic power was very limited. The family lived on the husband’s income. Mary did not find satisfaction in her very limited domestic chores. She declined any suggestion made by her husband that she could try en engage in some useful activity outside the house (marketeering, making a garden). Frequently she would drive Muchati to exasperation with her sulkiness and her taste for very expensive clothes.

     The cults of affliction stipulate actions that the (almost exclusively female) adepts must undertake for the sake of their own physical and spiritual well-being. Usually these actions run counter to the short-term interest of their husbands or male relatives. Cult obligations comprise expensive nocturnal sessions, exceptional and luxury foods and clothing, inconvenient absences from the family home. The expenses of all this are to be borne by men. While the men resent these cultic actions they, too, take the idiom of the cults of affliction seriously, and seldom oppose them. Therefore the women can manipulate their cultic claims as an expression of domestic conflict. Thus the cultic idiom provided a context in which Mary could temporarily retreat to the village without any over display of marital conflict. Another reason why Muchati was unable to hold her back , was that he still owed her kin group the final installment of the bride-price.

     In Jimbando village, Mary participated in a Bituma session, directed by her mother’s sister, Masholi [26]. After a month, Muchati went to collect her and paid the outstanding amount.

Early 1972. In Chief Kahare’s area Muchati’s cousin Kwambashi [18] died. She was one of the leaders of the Bituma cult of affliction. Kwambashi’s sister Nchamulowa [20], a widow of the cults founder, still fostered the latter’s relics and now intended to succeed to the name of Kwambashi. Thus she hoped to effectuate her latent leadership claims in the cult.

May 1972. Mary participated in a Bituma session in Matero suburb, Lusaka, led by her original cult leader, Jilemba. About this time, Mary’s second pregnancy became manifest. On instigation of Muchati, she once or twice visited an antenatal clinic in Lusaka. These visits were frowned upon by the elderly Nkoya women in Lusaka.

August-September 1972. Two nocturnal mourning rituals were held among the Nkoya in Lusaka: one for a recently deceased Nkoya townsman of Shipuna’s ward, another for Muchati’s brother’s child [16] who had died in the village. Being highly pregnant, it was taboo for Mary to attend. For pregnant women, unborn of small children, and chiefs are not to enter into the sphere of death. However, Muchati found herbal medicine for her that was supposed to lift the taboo and protect her, so she could go mourning.

13 September 1972. Mary’s labor had begun in the afternoon, and Muchati went on a quest for herbal medicine which allegedly would ensure a speedy delivery. He sent his younger brother to Kalingalinga, in order to collect a midwife and her assistants from among his Nkoya relatives there. Soon four women arrived, including Banduwe [2] who was to play the women insisted that they would rather first try for themselves, at home. However, the midwife and her assistants appeared to become unnerved by Muchati’s lack of faith in them. He repeatedly point out the availability of allegedly superior alternatives: the hospital, which our car could reach within ten minutes; or, in our main building, my wife, who was however far from eager to interfere. During the delivery, the women in attendance kept Muchati out of doors. Repeatedly he came to request our advice in matters which these women must often have carried out with perfect confidence when on their own, e.g. the tying and cutting of the umbilical cord. Finally, around nine o’clock, an alarmed Muchati urged us to take full control: the child had been born, but the placenta had failed to be produced. Although the women greatly resented Muchati’s interference, we were finally allowed to take Mary to the University Teaching Hospital, were she was admitted She was discharged again early in the morning, i.e. nine hours later, without any follow-up appointment.

     Recent newspaper reports had brought out the shortage of school places in Zambia, and the preference given, in the matter of registration of pupils, to children who could produce a birth certificate. Therefore Muchati decided to formally register the new baby (something he had not done in the case of his first child). Forced to publicly name the newborn child at a moment that this is still immature according to Nkoya custom, he haphazardly gave him the name if Jimbando, his maternal grandfather [30]. ‘Mary’s family will like that name,’ Muchati said. Little could he know what haunting role the child’s name, and the attendant affinal relationship, were yet to play. For domestic use, Muchati decided on the name of Edward [6].

     After a few days, a Nkoya man was called in from Kalingalinga to ritually cleanse the conjugal bed and to provide birth amulets. This action was meant to terminate the puerperal avoidance between father and child. It was all post-natal care the child received. Despite hospital delivery, the parents refrained from visiting the hospital or the nearby under-five clinic. Elderly women in town, including Banduwe [2], insisted that such visits would be to the child’s disadvantage, particularly if taking place before he was three months old. These were the same women, among others, who had assisted in Mary’s confinement. We got the impression that, feeling slighted about their failure or humiliation then, they now aimed to assert their medical authority over Mary and her newborn child.

18 October 1972. Edward developed an alarming lump on his head. Although Muchati urged Mary to take the child to the under-five clinic, she was reluctant in view of the elderly women’s attitude. Muchati was at a loss: he felt he could not force her to go.

20 October 1972. When in addition to the lump on his head, Edward ran a fever, Mary went to the clinic out of her own will. Edward was referred to the University Teaching Hospital. The doctor there urged her to admit that she had dropped the child on the ground, but this she denied strongly. (A Nkoya mother whose infant incurs serious harm is liable to physical punishment by the child’s kin group and by the elders in general. People therefore agreed that Mary could not afford to speak the truth, if in fact she had dropped Edward.) Edward was admitted to hospital on a diagnosis of pneumonia, possible related to Mary’s habit of bathing the baby out-of-doors in cold water. In addition, the baby was said to have developed ‘brain trouble’. Edward was too weak to suck, and was therefore tube-fed. In accordance with general Zambian practice in the case of hospitalized children (cf. Boswell 1965), Mary stayed at the hospital premises, in the relatives’ shelter, where she was daily visited by Muchati. The frustration of having to spend two weeks without any meaningful activity, in the company of equally displaced and frustrated women whom she had not known before, in a crammed and ill-accommodated shelter, added to her worry over the baby and made this a very unhappy episode for Mary.

     The hospital staff did not give the slightest attention to the continuation of Mary’s lactation. In combination with the worry over the baby, and the frustrating experience at the relatives’ shelter, this resulted in Mary being unable to breast-feed Edward any more, when after two weeks he was discharged. Raised in a culture where breast-feeding is very strongly emphasized as a mother’s main link with her child,[5] the impairment of this function was a very heavy blow for Mary, and a cause of intense feelings of guilt. Mary and Edward were sent home without anyone on the hospital staff noticing the problem or trying to do anything about it. Alarmed, Muchati and I referred to the hospital. We were anxious to have Mary’s lactation function restored. Although bottle-feeding would not be impossible, it would mean an enormous burden in terms of hygiene, expense and maternal role patterns (cf. Raphael 1976). At the hospital a doctor told us, rightly, that nothing specific could be done to restore lactation. We were advised to try a protein-rich diet for Mary, as this might have some success. Upon our request we were told that there was no powdered milk available for distribution to out-patients: neither did we get the feeding schedule we asked for.

     With his nearly-completed primary school education (recently, through evening classes, he had reached grade 6), and his previous experience with expatriates’ infants including our own daughter, Muchati accepted the absolute necessity of sterilization of bottles etc., and he conveyed this insight to Mary. With all our modern comforts at her disposal (pied water, kitchen dresser, refrigerator, electrical stove, sterilizing tablets, brushes, several glass feeding bottles, teats, containers etc.), and determined to see her child through, Mary quickly absorbed and accurately performed all the necessary routines. Initially she feared making a fatal mistake in these rather complex operations whose rationale she did not understand in detail. Also was she embarrassed about her nurtural inadequacy and her dependence on members of the opposite gender to rectify this condition. But all this gradually gave way to relief and to a measure of pride. In conversations with friends and relatives Mary would often tell how her lactation function had become impaired and how she could yet manage to fee her child. Yet her dealings with Edward seemed somewhat mechanical, formal, and lacked the spontaneous generosity so typical of Central African patterns of breast-feeding. An important factor in this was no doubt the fact that Mary’s bottle-feeding forced her, several times a day, to work in the kitchen of the main house. Here she was doubly an intruder: both vis-à–vis us, who lived there, and vis-à–vis here husband, whose professional domain it was. In relation with Muchati, Mary’s presence may have brought to the fore a typical domestic servants’ role conflict: that between being a wife’s husband, and doing low-status work commonly reserved for women. Mary’s preparation of the bottles would often happen to take place under our joint scrutiny, and would very infrequently give rise to such petty friction as may be inevitable in a confined space where so many parental, domestic and employment roles of two families intersect so confusingly. On a deeper psychological level it would appear as if Mary was subconsciously reproaching Edward for causing her to fail in her nurtural duties. The lessened affection to which this condition may have led, seems also detectable in Mary’s later behavior towards him, which directly relates to the series of health crises he was to go through.

     Edward responded well to be bottle-feeding, and became quite healthy again. Meanwhile, we did put Mary on a protein-rich diet, but (apart from an occasional few drops of milk, which Mary would insist on offering her child)with no other effect than greatly improving her general condition. For the latter reason we yet continued the diet until Edward was about one year old. The costs of this diet and of Edward’s powdered milk amounted to over 20% of Muchati’s wages, which was much more than he cold afford. Therefore we subsidized about 80% of the extra amount needed.

December 1972. Muchati’s mother, Munyonga [11], another leader of the Bituma cult of affliction, visited Lusaka to look into the marital and religious problems of her daughter Jenita [9], Muchati’s full sister. Munyonga staged a Bituma session in Kalingalinga, in which Mary, Edward and Jenita were the main patients. We were not surprised to see Jenita feature as a patient. Jenita lived in Chaisa squatter compound, where she and here infant daughter Lusha [15] were extremely poorly provided for by Jenita’s husband [10]: a shop assistant in a butchery, he would squander his relatively considerable income on beer and girl-friends. Not only had this state of affairs noticeably affected Jenita’s and Lusha’s health. Also had the husband (quite exceptionally) refused to pay the fees for the cult leader Kashikashika, to whose treatment Jenita had subsequently subjected herself and Lusha. A conflict with this cult leader had ensued, and Jenita feared that Kashikashika would punish here by making her illness come back. Treatment by her own mother, Munyonga [11], would greatly reduce that risk, at the lowest possible costs (for no fee would be required). At the much better diet, may have had much to do with this. However, within the idiom of the cults of affliction she, as an adept, was still to be considered a patient. Initiated by her mother’s sister [26] in the village, Mary was still a potential member of that leader’s cult faction. Moreover, there was still a lingering claim on Mary from the side of the leader of her very first session, Jilemba. Munyonga resented Jilemba’s insistence, not only because Mary was Munyonga’s daughter-in-law but also because it had been Munyonga who installed Jilemba as a Bituma cult leader. Jilemba should yield to Munyonga when told to do so. The fact that Mary now joined in the session staged by Munyonga meant that Mary, too, denounced the claims that here previous cult leaders, Masholi and Jilemba, might have over her, and that she joined Munyonga’s cult faction.

     On the extra-religious plane this move is another manifestation of a process that runs as a red thread through this case: Mary’s gradual dissociation from her kin group of orientation, and her increasing incorporation into her husband’s effective kin group.

     Finally Edward’s parents justified his inclusion in the ritual by saying that this initial illness and hospitalization and demonstrated his proneness to illness. Among the Nkoya, such proneness is considered the main sign that one is predestined for a leading career within the cults of affliction. Although Edward’s health was now satisfactory, an occasional cold and slight cough were stressed as demonstrations that all was not well yet.

     Meanwhile, Muchati and Mary had again taken up sexual relations. Mary’s ovulation had resumed and, without having menstruated after Edward’s birth, she conceived again.

March 1973. Mary claimed that she should go to the to assist her sickly parents, and moreover to seek treatment for her own affliction and that of Edward. Mary’s sulkiness had come back, and she was very angry with Muchati for not letting her go immediately. However, an additional reason for going presented itself. Muchati’s kin group began to suspect that Edward’s initial illness and minor later complaints all referred to his deceased aunt Kwambashi [18]. An ancestral ritual at the village shrine of Nyamayowe village might need to be performed, in order to confer Kwambashi’s name upon Edward.

     When told about this, we pointed out that Mary would not be able to keep up her exemplary standard of hygiene and bottle-feeding when on the road or in the village, where there were no modern comforts whatsoever. But this did not deter Mary.

     With a supply of powdered milk and sterilizing tablets she set out for Chief Kahare’s area. In the village it was publicly ascertained that she was pregnant again. Menstruating women must not cook or handle fire: so a woman of childbearing age who continues to perform her domestic work for over four weeks must be pregnant, and she will be questioned about this by the other women in the village. During this visit, Mary participated again in a Bituma session stage by her mother-in-law, Munyonga [11]. No ancestral ritual was performed for Edward, however. Edward’s paternal grandfather, Shelonga [13], had formally welcomed Edward, calling him by the name of Kwambashi [18]. But for a proper name-inheriting ritual Kwambashi’s only surviving sister, Nchamulowa [20], should have been present. Shelonga had written to her in Lusaka, but she had not replied, as she was still hoping to inherit the name herself.

April 1973. Banduwe [2] went to the village in connection with the prospective marriage between her son [1] and Mary’s aunt [35] in Jimbando’s village. Muchati, who was anxious for Mary’s return, gave Banduwe money towards Mary’s return journey to Lusaka. Although Banduwe’s son was from a previous marriage of hers and thus no consanguinean relative of Shipuna [5], as a long-standing member of Shipuna’s ward in Lusaka he was yet considered a member of the Nyamayowe kin group when interacting with Jimbando’s kin group. Therefore Shelonga [13] accompanied Banduwe to Jimbando village for the marriage negotiations. However, Jimbando rather unexpectedly began to abuse Banduwe and the whole kin group she represented, claiming that ‘These people do not care properly for the women they marry.’ Not aware of any recent friction, the Nyamayowe delegation tried in vain to pacify Jimbando. Only afterwards it became clear that Jimbando’s anger had little to do with the Nyamayowe kin group’s treatment of the women from Jimbando’s village but... with the fact that some time before I had refused to take Jimbando to Lusaka for eye treatment. By that time we had still been strangers to the rural scene, unwilling to commit ourselves to one particular family be bestowing relatively big favors upon them; Muchati, Jimbando’s son-in-law, did not insist when we turned the request down, and we understood that he was not eager to have his sick father-in-law stay in Lusaka, where he would have to look after him. From Jimbando’s reaction it would appear that the latter considered us as members of Muchati’s kin group, at least in so far as confronting his own kin group. Anyway, the marriage negotiations had failed, and Shelonga and Banduwe returned to Nyamayowe village.

     Mary had not approved of her father’s attitude, and very soon after this episode she returned to Lusaka. She brought back a thoroughly weak and emaciated Edward. However, the bottle-feeding routine was resumed in the proper manner, and rapidly Edward got well again. Meanwhile, in Lusaka, Muchati’s cousin Nchamulowa [20] had found a job as a cleaner. In order to have a free hand she sent her children to relatives in a peri-urban area. She claimed to have taken the job in order to save money for the massive and expensive name-inheriting ritual in which she hoped to take Kwambashi’s [18] name. In anticipation, she had my wife make a splendid white robe for her, to wear during the ceremony.

May 1973. Mary’s mother, Malwa [28], visited Lusaka, mainly in connection with the marital problems of another daughter of hers [29]. Malwa refused to visit with Muchati and Mary. They went to see her at Mary’s sister’s place. There Malwa treated them very coolly. Obviously the relation between Malwa and Mary was still very strained, as a result of the recent events in Jimbando’s village.

     Edward had by now recovered from his stay in the village, but whereas he was physically fit, his motoric development seemed somewhat retarded. Edward’s relatives suspected that he was suffering from shikoba, the result of a presumed mystical competition between a young child and his next sibling who is still in their mother’s womb; the younger child is supposed to launch murderous attacks upon his elder sibling. (Physiologically, this idea of competition may the based on the fact that a woman’s body does not easily combine the tasks of breast-feeding an older child and building up a new child in the course of pregnancy; but this does not strictly apply here since Mary was not breast-feeding Edward.) On a less mystical plane, the fact that Edward would not walk by the time his next sibling would be born, distressed the elders; still referring to the none too distant past when slave-raiding was common and people had to hide in the forest at very short notice, Nkoya consider having two children who both cannot walk yet, an impossible, dangerous burden for a mother.

     In this period, fears of Kwambashi became increasingly pronounced. There was the idea that Edward, under attack from his unborn sibling and his deceased aunt, would have little chance of surviving anyway. Moreover the restricted, formalized way of feeding Edward which was so alien to Mary’s socialization into motherhood, continued to estrange her from her child. In combination these factors made that Edward’s mother was still markedly apathetic and unstimulating in dealing with him, and while he received all necessary material care, the relation between mother and child seemed too deficient for proper development.

     Meanwhile we had made two short research trips from Lusaka to Chief Kahare’s area. We prepared to move the site of the research to this area. We discussed whether Mary and her children should accompany us, or should stay in Lusaka. Now another fear of Mary manifested itself. She had not menstruated after the birth of Edward and before the new pregnancy. Therefore the new child would be surrounded with all the gruesome properties locally attributed to menstrual secretion. Allegedly, Mary would not be allowed to stay in the village when giving birth, but instead would have to give birth alone in a hut in the forest. This prospect was most terrifying her. (Fortunately the issue was never raised again; when her time came, she was confined in her parent’s village.)

July 1973. Munyonga [11] visited Lusaka again. She had been feeling very ill, and this time she came not only as a healer but also in order to seek treatment herself, in the context of cults of affliction similar to Bituma. In addition, and despite Munyonga’s very strong opposition, Muchati [7] and Shipuna [5], with our help, took her also to the main urban hospital and to a private physician. Munyonga sought treatment in town because she found the village an unsuitable place for staging the cults session deemed necessary for her recovery. All her surviving children resided in town (except the youngest [17], a mere schoolboy). Moreover her husband, Shelonga, belonged to the Moya cult of affliction which was opposed to all medicines, including those featuring in the cults of affliction. Although the two roles of patient and healer merge and imply each other in the cult of affliction idiom, Munyonga perceived herself primarily as an exceptionally gifted healer, much more than as a patient. Therefore, while seeking treatment from other healers, she felt she had to make up for this painful loss of status (and money!) by organizing a series of extremely successful and massive Bituma sessions in Kalingalinga. At these sessions Mary and Jenita [9], among others, appeared again as major patients/adepts. Thus Munyonga tried to strengthen the urban ritual faction she had begun to develop in December, 1972.

     Meanwhile it became known that Kwambashi’s relatives (by and large Muchati’s kin group) had formally decided that Nchamulowa [20] was not to succeed to Kwambashi’s name. They pointed out that, with other relatives surviving, it would be a shame if someone were to succeed his or her full sibling — as if left alone in the world. But obviously more was involved, for succession of full siblings is by no means exceptional among the Nkoya. Probably the kin group resented Nchamulowa’s independent character and her successful adaptation to urban conditions — having a job where many mature Nkoya men had failed to secure one. This social and financial independence, moreover, largely enabled her to escape from control by her kin group. Yet, without the kin group’s consent and ritual cooperation, Nchamulowa was absolutely unable to succeed to her sister’s name.

August 1973. We gave up our urban residence and in several trips moved our two households to Chief Kahare’s area. In the evening when we reached Chief Kahare’s village after the last trip, Mary’s niece [43] die din nearby Jimbando village. She was a daughter of Kashimbi [40], who in a later marriage had become the wife of the headman of Nyamayowe village [24]. Her death appeared to be due to extreme dehydration resulting from untreated gastro-enteritis. A young widow, she had only a few days previously settled in Jimbando’s village, having moved from the distant village where her husband [44] had recently died under similar conditions. Malwa [28] and Jimbando [30] had hoped that Muchati and Mary would settle in their village for the duration of the research But now this was out of the question. In view of this ominous death and the lingering conflict with her parents, Mary absolutely refused to live in Jimbando village. In Chief Kahare village, at barely hundred meters distance, we had to arrange accommodation for Muchati and Mary, next to our own house. Joseph [3] was sent to his paternal grandmother Munyonga in Mushindi valley, while Edward [6] for the time being stayed with his parents. Some weeks before, he had been weaned. Therefore his feeding was not likely to cause particular problems in the village, despite the absence of modern comforts.

     From our new rural base the research continued as before.

19 September 1973. Mary’s labor began in the morning. Muchati went to inform Malwa and Munyonga, who were working in the riverside gardens at considerable distance. The confinement was kept a secret from women in the surrounding villages, for fear of sorcery attacks on the mother or the child.

     Malwa, Mary’s mother, acted as midwife. Rather against her will, Mary had been taken into her parent’s house, where until now she had refused to stay. Munyonga arrived only after Mary had given birth. That was however several hours later, as Mary’s labor was to be very protracted. A trusted kinswoman living in a nearby village had given her herbal medicine to speed up the delivery, but without success. Also Muchati’s own medicine, allegedly successful when Edward was born, failed this time. Labor took exceptionally long, probably partly as a result of the baby being oversize due to Mary’s exceptionally good diet during pregnancy. The relatives began to suspect a supernatural influence. Mary’s sister-in-law, Emeliya [25], married with Mary’s brother [27], was asked to divine. Divination took place in the same room where Mary was lying. Emeliya used the standard method of the axe handle: moving an axe handle to and from on the ground, names are recited of people who may be responsible for the evil influence, and when the correct name is found, the movements of the handle are supposed to halt. Begin a member of the family, Emeliya knew all the relevant names. She first recited those of the living, then those of the dead. Kwambashi was found to be responsible. Next the diviner found that Kwambashi, though very irate, was prepared to be approached by Muchati, for whom she had had a special liking when alive.

     Muchati was called and was told to enter the delivery room (which under normal circumstances a man is never allowed to do). He performed the water ritual of ablution and libation without which the supernatural cannot be approached; the he implored Kwambashi to take mercy upon her living relatives, and release the baby Mary heard her husband pray. Five minutes later the child [8] was born.

     When they tried to interpret the outcome of the divination, the members of Muchati’s kin group arrived at the following view. Kwambashi died between the time of Edward’s conception and his birth. Thus Edward had acquired Kwambashi’s ‘shade’ in the most direct way: ‘from his father’s hands into his mother’s womb’. Kwambashi would be his name, no matter what other names might be given to him. This name of Kwambashi had still to be publicly confirmed in a naming ritual; however, that step had until then been postponed. Even had Kwambashi’s relatives (except Shelonga [13] failed to ceremonially welcome Edward as Kwambashi when he had visited their village recently.

     Kwambashi had sufficient reason to feel slighted, and tried to take revenge on the next baby.

     Nkoya individuals have several names. The Kwambashi who died in 1972 had inherited that name when her mother [19] died — her ‘own’ name had been Kafungu. The name of Kwambashi would be reserved for Edward [6]. Munyonga [11] however, the boy’s grandmother, had dreamed of a new name for Edward, the day after Kafungu’s birth. She claimed that the Kwambashi name did not seem to fit Edward. His illnesses and retarded development were cited to substantiate this. She therefore proposed the name ‘Heva’ she had heard in her dream — a biblical name which (contrary to many other biblical names) is hardly used among the Nkoya. Being an illiterate non-Christian, Munyonga may have picked up this name in her dealings with the syncretistic prophet Ngondayenda.

     Although Mary and Kafungu were by this time staying in Jimbando village, Mary’s parents had hardly any part in this discussion. Everything revolved around Muchati’s kin group. Yet it was a diviner from Mary’s kin group who had identified the influence of Kwambashi and thus had laid the ‘blame’ for the difficult delivery on Muchati’s kin group.

     Next morning, when Muchati, his father Shelonga, and a niece arrived to ceremonially thank their affines for the birth of another child, relations were markedly strained. Under the pretext that all work had been done within the family, and no costs had been incurred, Mary’s mother refused to accept the ceremonial payment that the mother’s family is to receive on such occasions. Muchati had no choice but to leave the money on the ground in the middle of Jimbando village, for anyone to take it.

     Many present were aware that a similar situation had occurred thirty-five years before, in Munyonga’s [11] home village, when Shelonga had tried to pay bridewealth for his wife. His prospective affines had then refused to accept the money, pointing out that Munyonga was his classificatory sister; driven to exasperation, he had left the money on the ground, and left.

     One of the implications of this refusal of ceremonial payments is the following. By offering money, Muchati and his kin group tried to offset themselves as a distinct social unit against Jimbando’s kin group, in a bid to secure disproportionally greater rights over the newborn child. They had already made the proper payments in connection with the child’s mother, Mary. The mother’s group, on the other hand, in refusing the birth payment, declined such juxtaposition, claiming that in actual fact Muchati’s kin group and their own kin group were one, and thus refused to accept the other kin group’s exclusive rights over the newborn child.[6]

     As the tensions between these two kin groups became increasingly pronounced, Mary had several quarrels with her mother and prematurely left Jimbando village to join Muchati in Chief Kahare’s village. So rushed was her departure that no medicine had yet been prepared to ritually cleanse Muchati’s and Mary’s conjugal bed.

     Since Mary could not mind two infants, Edward was sent to Munyonga in Nyamayowe village, to join his brother Joseph. Under the circumstances it was unthinkable that he should be sent to his maternal grandmother Malwa, in nearby Jimbando village. Mary stayed behind in Chief Kahare’s village with Kafungu, a pathetically plump and healthy baby whom she had not the slightest difficulty to breast-feed. We got the strong impression that, indulging in the delights of this new and splendid baby, Mary tried to forget Edward and the troubles she had had with him.

     With Edward’s departure, and with Kafungu to replace him, a burden fell off Mary’s mind and she entered a period of euphoria. A remarkable change came over her. In town we had always known her as shy and awkward, giving the impression of being lost and uprooted. However, having returned to the village we found that she commanded considerable prestige on the basis of her four years of urban experience. In Mary’s case, her urban features could be displayed all the more freely as she lived as a young matron in the village of the chief (her classificatory elder brother), under the relaxed control of her husband Muchati but (contrary to most young women) outside the direct control of her senior consanguinean of affinal kin. The greatest threat in this respect came from her parents in nearby Jimbando village. But by refusing to stay with them, by quarreling and ostentatiously siding with her husband’s kin group against her father, Mary ensured that she retained her independence vis-à-vis her parents. In town Mary had always refused to engage in business, but now, in Chief Kahare’s village, she began to augment her household budget by selling beer and tobacco, attracting and entertaining male customers with her urban ways, and (with the aid of a record player) occasionally turning our corner of the village into a bar!

20 October 1973. Soon after our settling in Chief Kahare’s village the people’s insistent demands for medical attention had forced us to establish an improvised bush clinic. So Mary called on us when she was worried over Kafungu’s slight cough at night. Along with some of the more serious patients calling at our clinic, we took the child to the distant Rural Health Center.[7] There we learned that the staff could do previously little, as they had run out of all essential supplies. (That situation was not to be mended soon. A few weeks later, for a boy with a fractured thigh-bone, no plaster of Paris was available, and we had to drive the patient all the way to a district hospital, another 60 km).

23 October 1973. From Nyamayowe, Edward was brought to our bush clinic. His breathing at night was reported to be difficult and noisy; he was weak and apathetic, and had a mild conjunctivitis. After our earlier experience with the Rural Health Center, we decided to apply our own medicines. We urged Edward’s relative to bring him along daily for eye treatment: we were so short of Terramycin eye ointment that we could not afford to give each patient a package to take home. However, we did not see Edward back before three days later, and again four days later.

Early November 1973. In Nyamayowe village, Edward’s health deteriorated steadily. As soon as Muchati had left to accompany us for a week’s work in Lusaka, Edward was immediately declared critically ill by his kin group. Shelonga sent a letter to Muchati urging him to come back. From Nyamayowe village the Rural Health Center is only at a distance of 20 km, i.e. only two hours of cycling along the bush paths. And there were bicycles available in the village. Moreover, Muchati had left some money to cope with eventualities like this. Yet for two reasons Edward was not taken to the Centre. First, recent experience had shown that, however useful at other times (cf. note XXX above [was 14]), the absence of supplies made it now useless to go there. And secondly, after the events surrounding Kafungu’s birth it was so overwhelmingly obvious to his kin group that the determinants of Edward’s illness were not primarily somatic but supernatural, that it was considered a waste of precious time to refer to the outlets of cosmopolitan medicine. Instead, Edward’s kin group decided to invoke the help of a Nkoya healer who happened to visit a neighboring village. This healer lived far away and was, in Chief Kahare’s area, primarily perceived as a member of Jimbando’s [30] kin group. Muchati’s kin group felt that this was advantageous as it meant that the responsibility for Edward’s well-being in this critical situation was not exclusively carried by themselves but shared with Edward’s maternal kin.

     At the same time, in another village, a cousin [45] of Muchati’s reported dreams in which she was harassed by Kwambashi crying ‘My relatives do not respect me. Even if my name comes to Muchati’s child they do not accept it.’ Therefore, despite Nchamulowa’s [20] absence, the Nkoya healer staged the long-awaited naming ritual for Edward. In addition he gave him herbal medicine to cure the concrete, somatic manifestations of the affliction. Mary came to attend the ritual. As the rains had started, she proceeded to make a garden on the land of Nyamayowe village. Later she returned to Chief Kahare’s village, leaving Edward in the care of his grandmother, Munyonga [11]. By that time we had returned from Lusaka.

 

22 November 1973. From Nyamayowe, Edward was again brought to our bush clinic. He ran a slight fever, had diarrhea, and showed initial signs of dehydration. We sent him back to Nyamayowe, with a supply of powdered milk and with drugs to cure his suspected gastro-enteritis.

15 December 1973. Still in the care of his grandmother at Nyamayowe, Edward gradually developed unmistakable symptoms of malnutrition. His worried relatives declared him ill once more, and had the illness diagnosed by a diviner. However, this time the diviner, Loshiya [23], through marriage and subsequent incorporation belonged to their own kin group. She was the wife of Muchati’s cousin [22]. The outcome of this divination carried out by Edward’s paternal kin was strikingly different from the divination his maternal kin had carried out at Kafungu’s birth. This time it was again a deceased relative who was declared responsible for Edward’s illness, but now not a member of Edward’s patrilateral kin, but of his matrilateral kin! Jimbando [30] was generally known to seriously neglect Enesi [32], the young daughter of his deceased brother [31]. Enesi had settled in Jimbando village after a divorce, and there had been treated as mad and as an outcast.[8] None of her fellow-villagers had bothered to improve her ramshackle house of to build a kitchen for her. On a recent occasion the headman of a neighboring village had been allowed to beat her after she had allegedly insulted him. (Instead, the headman should have sued her before the neighborhood court of the local Court; cf. Van Binsbergen 1976b: 51f). Now the diviner Loshiya alleged that Enesi’s deceased mother [33] had made Edward ill, in order to revenge the suffering of her own child, Enesi, at the hands of Enesi’s patrilateral kin, who were at the same time Edward’s matrilateral kin. Edward was now again subjected to an ancestral ritual, this time directed at Enesi’s mother (Edward’s classificatory grandmother). People claimed however that this ritual could only lead to an improvement of Edward’s condition if at the same time Jimbando would actually put an end to Enesi’s suffering. For Mary, who accepted the pronouncements of this diviner, new fuel was added to her conflict with her parents. She was furious that her father’s shortcomings should cause harm to her son Edward. It is not possible, though, that Mary accepted this interpretation of Edward’s misfortune, and eagerly joined in the general indignation vis-à-vis Jimbando, because in doing so she would not have to admit that she herself had been neglecting Edward since Kafungu’s birth.

     The subsequent events must be placed against the background of a high incidence of sudden deaths among adults and children in Chief Kahare’s area during the second half of 1973. Mortality always soars high in this area after the onset of the rainy season, when food is scarce and resistance low. Most of the children involved in this mortality crisis died in the course of a measles epidemic which ran through the district. Although measles immunization was propagated at the district’s under-five clinics, in this remote area virtually no children had been vaccinated. Our bush clinic (where such preventive measures were beyond our means and skills) was frequented by mothers who wanted treatment for the secondary infections their children had contracted while having measles. I have no reliable comparative data to indicate that in this period a truly exceptional number of adults died. At any rate, the population had become virtually paralyzed with fear. Coupled to the prevailing interpretation of death as being invariably caused by sorcery, this rate of mortality had a downright paranoiac affect. For several weeks parents refused to send their children to the village school for fear of the alleged presence of murderers hiding in the forest. A massively attended public sorcery trial was staged at which Chief Kahare and members of his royal establishment were accused of having caused the recent deaths, so as to procure powerful chiefly medicine. The Mema and Mushindi valleys were in the grip of unsettling rumors, a state of dramatic insecurity which was also related to the national general elections which took place on 5 December, 1973.

     I have pointed out how beyond a small core the composition of kin groups is extremely flexible. This enables people anxious to detect a meaningful pattern behind common misfortune, to rearrange recently deceased members of the local community in such a way that many of them appear as close relatives — even although they would rather be reckoned as members of rival kin group when still alive. Thus it becomes possible to interpret many sad events as a direct attack from some other kin group (which then has to be identified upon one’s own. Now with the spate of sudden deaths, this mechanism was particularly manifest among the members of the kin group focusing on Nyamayowe village. As indicated in diagram 1, this kin group, after substantial losses already in the years 1972-73, literally within a few weeks saw itself deprived of seven of its members. In addition, the third wife [37] of Nyamayowe’s headman, Kawoma [24], was confined of a stillborn child in mid-December 1973. Diagram 1 shows that, though scattered over various villages, the people who died in the last quarter of 1973 were actually rather closely related to our protagonists. The resulting paranoia, therefore, was not merely due to an optical illusion. The surviving members of Muchati’s kin group felt deeply and personally threatened and continually feared for their own lives. Proceedings were set in motion to divine the identity of the rival kin group that would have caused the deaths.

26 December 1973. For over a week, Patrick [41] had suffered from measles. He was a four year old boy in Jimbando village, a grandchild of the second wife of Kawoma [40]. His condition had not prevented him from taking active part in the Christmas celebrations, which form a major social event in the area. On the morning of Boxing Day Patrick was very sick, probably because of the food he had eaten on Christmas. However, against the background of recent losses, his relatives were convinced that Patrick was dying; they panicked, and as a result he did die. Only immediate injection, people claimed, might save Patrick’s life. They did not refer to us, for several reasons. Although people had very often asked us for injections (which here as elsewhere are considered the most powerful technique in cosmopolitan medicine), we had never given any. Moreover, only a few days previously we had returned from one of the district’s hospitals, where my wife and I had been found to be so seriously ill that we had been referred to the Lusaka hospital; we had mainly stopped at the village to collect some personal effects, and were not in a condition to see patients. So we were not told about Patrick’s condition until it was too late.

     The headman of a nearby village possessed an old syringe, which in the past he had wielded with sad results. At least two people were known to have died under his hands in recent years. Yet Patrick’s relatives were prepared to take the risk once more. The boy’s grandfather, Kawoma, was absent, but in his locked suitcase inside his house he was keeping a box containing vials of chloroquinphosphate, bought at the black market during a visit to Lusaka. Kawoma had recently quarrelled with his senior wife, Munjilo [38] (i.e. the co-wife of Patrick’s grandmother [40]). Eager to help and thus in ingratiate herself with her husband, Munjilo now broke open the suitcase and took the medicine to the headman-healer, who injected vials (a manifold overdose).[9] The boy went into a coma, and the healer fled. Patrick was already considered dead, many people had streamed to Jimbando village and had started mourning, when Muchati told me what had happened. He had finally called on me because he was puzzled by the fact that the ‘dead’ boy still had a pulse and felt warm. In vain I tried to revive Patrick from his coma, and he died in my arms. His mother wailed: ‘The witches have waited to kill him until after the injections, so that now everyone will say that he died because of the injections, but I know it is not true...’

     This was the second sudden death in Jimbando’s village within a few months. The rumor started that the senior members of the village, Jimbando and Malwa, were sorcerers intent on killing off younger inhabitants. Moreover, these deaths involved the stepchild and stepchild’s child of Kawoma, i.e. potential members of Muchati’s kin group, which had already suffered so many losses recently. It was now no longer possible even to pretend friendly affinal relationships between the two kin groups associated with respectively Nyamayowe and Jimbando village. Realizing this, and fearing an outbreak of violence, Malwa urged her daughter Mary to leave neighboring Chief Kahare’s village and fly to Nyamayowe village, in order to bring herself and Kafungu into safety. Thus Mary rejoined her sons Edward and Joseph. this move dramatically completed the process, extended over four years, in which Mary gradually dissociated herself from her parents’ village and became more and more closely incorporated into her husband’s kin group.

January 1974. Edward’s condition worsened again, and again a healer from elsewhere was consulted, a woman this time. She staged a divining ritual and began pointing out the responsible person — who, she insisted, was not a deceased relative but a living sorcerer. When she claimed that this sorcerer lived in the neighborhood and was a full sibling of Edward’s paternal grandfather Shelonga, the latter told her that she could stop, collect her fee, and go: his last surviving siblings had died a few months previously (cf. diagram 1).

February 1974. Edward’s condition seemed critical and his parents, themselves now suffering from Malaria, took him to one of the district’s hospitals. There Edward was found to suffer from pneumonia and malnutrition. After initial treatment, and instructions as to diet, Edward returned to Nyamayowe. Muchati was now caught in a role conflict as a father and a research assistant. Although he saw that Edward needed to return to town, he did not want to abandon the field while my wife and I were very ill in Lusaka. However, when hearing of the situation we wrote a letter urging him to collect his family, return to Lusaka and take Edward to hospital there. This he finally did.

March 1974. After the usual hours of queuing, referral, queuing again, completing forms, etc., Edward was admitted to the University Teaching Hospital in Lusaka. The two medical officers (one European, one Indian) who successively examined Edward prior to admission, were reluctant to hospitalize him. One said: ‘What is the use of trying to fix up this child, as with these people he will be the same within a few months?’ The other doctor tore at Edward’s hair and squeezed his limp cheeks and leg muscles, shouting at Muchati with histrionic indignation: ‘Look what you have done, you stupid man. Is this the way you people raise children?’ Utterly shocked by this humiliating confrontation with the health agency whose excellency he had always advocated among his people, and to which he was now applying as a last resort, Muchati rushed out of the ward, to the parking lot where I was waiting. For the first time in all the years that we had worked together, he cried out my first name, without the usual titles of address. Finally he was an equal who in his distress appealed to his friend. He told me to explain to the doctor Edward’s complex medical history, including his earlier hospitalization in the same hospital and its disastrous effects on his mother’s lactation, the trouble and expense of bottle-feeding, the health hazards of village life, etc. This I did, throwing in such weight as my racial and academic status happened to carry in Zambia at that time. Obviously my intervention did much to improve the doctor’s attitude towards the case. Edward was well looked after in the ward, and we received regular reports on his progress.

     Once again Mary stayed at the hospital’s relatives’ shelter, in order to help with the feeding of Edward. As she was still breast-feeding Kafungu, she had to bring the latter as well. Muchati asked a related girl in Lusaka to come and assist Mary, since the hospital staff did not offer her any assistance. However, this girl could not be spared from home, for she had to attend to her sick mother who claimed to be suffering from Bituma.

     Children other than patients were not allowed in the children’s ward. Therefore those mothers who had both a child patient in the ward, and a suckling baby on their backs (a very common situation), were required to leave the baby outside in the porch on the ground. Here, at the ward’s entrance, no accommodation was provided (yet hardly any mother would have a perambulator to leave her baby in), nor any supervision. So within a short while Kafungu caught pneumonia and could be admitted too. It was a time of agony for Mary.

     After a few weeks the two children were discharged and the family joined Muchati in his Kalingalinga house. Over one and a half years old now, Edward still showed no signs of beginning to walk or to speak. But at least he showed more motoric activity than ever before, and had started to crawl.

     When she had both children safely at home again in her Kalingalinga house, Mary vowed that never again would she go and live in the rural areas. ‘Now I know that I can only keep them healthy in town. The village is no place fit for children,’ she said.

This complex and detailed account of Edward’s infancy, while pertinent to the medico-anthropological questions I raised in the introduction, at the same time offers a picture of the wider social dynamics that set the framework within which Edward’s health experiences must be understood. Edward’s case brings out recurrent themes that dominate the health situation of contemporary Nkoya society, in both its rural and urban effects.

     But before analysing the data presented here, let us first consider those aspects of the case that render it not only unique, but also, to some extent, non-representative. And by this I mean our own involvement, as expatriate and temporary members of the Zambian elite, in the lives of Edward and his family.

 

5. Edward’s case: An artifact?

Contrary to current ethnographic conventions, I have refrained from making ourselves (my wife and me) invisible in the preceding account — not (I hope) out of undue self-indulgence, but because we were major actors. Repeatedly we offered alternatives that helped to shape the course of event.

     An example of this is our intervention at the birth of Edward: but then our role was not different from that of most elite employers of domestic labor in Africa. By subsequently providing the means to put Edward onto bottle-feeding we contributed to his vulnerable nutritional status and indirectly to the inhibitions that surrounding Mary’s relationship with him. But short of letting the child starve to death there was no real alternative.

     The next major intervention was the move of Muchati’s and our own household from Lusaka to the village. Many urban Nkoya families occasionally return to the village for longer or shorter periods. This is especially the case after the husband has lost his urban job. However it also occurs while urban employment lasts. In the latter case not directly economic reasons prevail, but reasons such as local leave, family visits, healing, attendance of life-crisis ceremonies. Especially since the completion of the tar road into Western Province (1972), movement between Lusaka and Chief Kahare’s area is frequent and relatively cheap: there are several daily bus services. Before our moving to the village, Mary had twice gone there on her own initiative, both times taking an infant with her. Therefore Edward’s prolonged stay in the rural area (September 1973 — March 1974), even if ultimately instigated by our research, was not really a-typical. What was a-typical was that, due to Muchati’s position as a research assistant, he and Mary should be living in Chief Kahare’s capital, i.e. outside direct day-to-day scrutiny of and control by their senior kin. However, in Chief Kahare’s village Mary lived within earshot from her parental home, where after Kafungu’s birth Edward might have been looked after, had it not been for the increasing friction between Mary and her parents. Edward’s dismissal to distant Nyamayowe, and the dramatic decline of his condition there, had very little to do with our presence in the area.

     Finally, our operating a bush clinic in Chief Kahare’s village introduced an additional health agency in Chief Kahare’s area. The characteristics of our clinic included its proximity, novelty, availability of simple but essential medicines, our informality, use of the local language, attention for social and relational aspects of the patients’ complaints, and considerable success in the treatment of the most frequent complaints. For these reasons our activities amounted to unintended competition with other health agencies, particularly herbalists in the surrounding villages, and the more distant Rural Health Centre. Soon we were seeing about forty patients a day. Naturally, however, we frequently referred people to the district’s hospitals and (until this proved useless) to the Rural Health Centre. Often we would take the patients there in our care, which was for most of the time the only serviceable motor vehicle within a radius of over twenty km. Just as our medical activities did not prevent Edward’s kinsmen from consulting local healers, they did not really block the way to the distant, more formal cosmopolitan health agencies. Therefore, although we were major actors in Edward’s case, I do not think that our intervention was such as to wholly distort the picture of the health situation among the Nkoya peasants and urban poor. I would rather describe our influence as catalytic, or perhaps as a not too well controlled social-science experiment.

     Obviously, our personal involvement and commitment did not stop short at the limits suggested in some handbooks on participant observation. This raises the question of ethical responsibility, which always pervades social research in the domain of illness and death; as it does clinical medical research. Let me try to make our position clear. It was not as if we cynically allowed Edward’s health to decline in order to study his parents’ and kinsmen’s reactions in relation to various Nkoya and cosmopolitan health agencies. But could we not have done more to prevent the near-fatal outcome? Throughout our association with Muchati and his family we had advocated the use of cosmopolitan health agencies including under-five clinics. We warned against the use of black-market drugs and we emphasized that in serious cases, consultation of Nkoya healers should always be accompanied by visits to cosmopolitan health agencies. Yet by continually discussing Nkoya medicine; by making cults of affliction a pivotal element in our research; by helping to organize cult sessions and participating in them — by all this we conveyed the impression that we took Nkoya medicine seriously, considered it eminently valuable, and did not want to see it wiped out entirely by cosmopolitan medicine. In view of strategies of participatory research, it was of course absolutely necessary to give that impression. But it was not merely a façade. From our first confrontation with them, we could not help taking Nkoya cults seriously, both as amazing psycho-therapeutic achievements, and as powerful and creative symbolic configurations, betraying great musical and dramatic virtuosity, and expressing suffering and remedy in a very moving way.[10] Did our admiration encourage Edward’s relatives to look to these cults for a solution of their health problems? I hardly think they needed any encouragement on this point. Might a more negative attitude of ours, particularly if militantly propounded in conversations and advice, have helped to keep them on the straight path to cosmopolitan medical care? I very much doubt it. More likely, such an attitude (which would moreover be contrary to our own awareness of the limitations of cosmopolitan medicine) would have estranged us from Edward’s relatives, would have deprived us of such limited means as we had of intervening in his health situation, and would have made us utterly impossible as participant researchers.

     At the time we did not consciously develop this attitude and weigh it against alternatives. Frankly, we felt as if we had no choice in the matter. Our main guidance lay in a professionally cultivated sense of trans-cultural humility which (being the main stock-in-trade of anthropologists in the humanist tradition) may well be the greatest contribution anthropology could make to cosmopolitan medicine in Third-World settings. Ours was not a research project in applied anthropology. We tried to gain understanding of the nature of Nkoya contemporary society. In the process, we were confronted head-on with its economic and medical misery. We did not allow the temptation of easy answers and solutions to wedge in between ourselves and our Nkoya friends. For better and worse, we were not prepared to extend our intervention in their lives beyond the limits that had implicitly been agreed, and gradually extended, in our interaction with them. That yet we set up an improvised local outlet of cosmopolitan medicine is no paradox: it was an action forced upon us by the people’s continued appeal to us for drugs and medical advice. Within the very narrow limits of our resources and skills we accepted such responsibility as they entrusted us with; but as we struggled along in our own difficult field-work roles as researchers, spouses, parents, and finally as patients ourselves, we felt that it was not primarily on our shoulders that the responsibility for Edward’s well-being lay.

     On the other hand it should be clear that the interest in cosmopolitan medicine among our urban and rural Nkoya contacts was not exclusively or primarily due to our intervention. The interest was there; but we intensified this interest, and by our own action (facilitated by our greater knowledge, and higher status in the wider Zambian society), we were in a position to take away some of the barriers that hindered their access to cosmopolitan medicine. In Edward’s case, the protagonists’ pursuit of cosmopolitan medicine was not really dependent upon us: at several crucial moment we were not available, or not consulted.

     Having thus dealt with our own place in Edward’s case, I shall now proceed to derive from it such medico-anthropological insights as it has to offer.



[1]Numbers within brackets [ ] that follow people’s names in the text, correspond with the figures in diagram 1. They are not to be confused with the raised footnote numbers, nor with four-digit numbers referring to years. While the names are pseudonyms, the genealogical relations as shown are, to the best of my knowledge, correct.

[2]For Central African societies, the structural principle involved here was most explicitly argued by Marwick (1965: 199f); cf. Van Binsbergen 1977b.

[3]K. Kwacha, the Zambian currency. K1 equaled about £ 1.30 in 1973.

[4]On re-reading it occurs to me that at this time, as in March 1973, Mary’s moodiness may partly have been due to her being in the early stages of pregnancy. However, at both times her husband and her wider social environment were as yet ignorant of her condition, and could not make allowance for it.

[5]Cf. Turner 1976c: 19f on the culturally closely related Ndembu.

[6]For the contradiction, in Nkoya social organization, between bilateral descent and payment of bridewealth, cf. Van Binsbergen 1977b: 43f, 56f; and n.d. (b).

[7]Table 3 gives the clinic’s official returns for the 1972. the data were scrambled in the same way as those presented in table 2. This leaves the order of magnitude of the figures intact. The original figures appear to be fairly reliable. The majority of the patients must have come from the immediate vicinity of the clinic, within a radius of a few km. Participatory and quantitative evidence (cf. Van Binsbergen, n.d. (b)) have convinced me that, at 20 to 30 km distance, the population of the Mema and Mushindi valleys contributed very little indeed to these figures.

[8]This had nothing to do with her divorce as such. Chief Kahare’s area abounds with young female divorces. Locally Enesi’s conditions was explained as follows. She had married her former husband [34] shortly after the latter had become a widower. However, upon his first wife’s [36] death the latter’s kin group had refused to ritually cleanse the widower: they blamed him for her death. The husband’s dangerous state of pollution was transferred his new wife, Enesi, upon their marriage. When Enesi’s condition of madness became manifest, her husband divorced her, and she settled in Jimbando village. I did not get to know Enesi well and have no idea how cosmopolitan medicine would diagnose her condition; nor do I have the specific sociological data to interpret the failure of her marriage.

[9]Even with proper dosage and under adequate clinical conditions, the great dangers of such an injection are well-known (cf. King 1966: section 13:6).

[10]My appreciation of cults of affliction in Lusaka and Western Zambia was related to the fact that I was no newcomer to this class of religious phenomena. Before coming to Zambia I had spent some years studying regional cults and cults of affliction in rural Tunisia.

to Part 0 (Abstract)
to Part I (Problem and Method; Background)
Part III (Interpretation; Conclusion)
Part IV (References; Postscript on Cognition)


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