Lectures

Disrupting medical anthropology: Views from Kenya and Cameroon on how to build a more inclusive discipline

Medical anthropologists often strive to disrupt typical public health and medical discourses, in part by questioning the broader applicability of individualized psychological concepts and biomedical diagnoses outside of the small, privileged Western circles from which these constructs originate (Henrich et al. 2010). However, within our own discipline, access to theoretical innovations and conversations remain decidedly siloed and one-sided. Scholars have pointed out the ways in which the dependence on anthropological knowledge produced in the Global North reflects longstanding systemic bias and racism within the discipline (Allen & Jobson 2016; Ntarangwi 2010). Theories used to guide research globally still originate in academic departments in the Global North, regardless of where this “thinking” is to be applied. Yet, access to articles and the latest debates is closed to many scholars based in the Global South, even as they are expected to demonstrate their “knowledge” of the discipline through citations of and publication in select peer-reviewed journals. Interviews that appear in these anthropology journals tend to follow a model of junior scholars asking questions of giants in the field whose theories and methods are widely used across the discipline, which further reifies an anthropological hegemony of thought.

In this article, we present a disruption: two Global North-based scholars and practicing medical anthropologists interview and co-create knowledge and guidance with two of our collaborators from Cameroon and Kenya on how to reinvent a more equitable medical anthropology. Our goal is to amplify multiple voices and propose new, participatory ways of expanding our theoretical and methodological toolboxes to transform the discipline. In the following essay, we present some of the highlights from our conversations, critiques, and suggested ways forward. Our methodology consisted of two Zoom calls, where we presented some key questions to think through the ways we need to critique and disrupt the discipline of medical anthropology. The conversations were held in a mixture of French and English, with co-author Yotebieng providing translation between the two to make sure everyone understood each other. We then collaboratively edited our conversation for clarity.

Kelly: “What drew you to the discipline of anthropology?”

Moïse: I became interested in medical anthropology because I was studying healthcare delivery and I realized that so much of the research and care that’s provided on the African continent, as is the case in Cameroon at least, is based on biomedical systems which are relatively new. But most of the care is provided at the community level and employs very, very old medical traditions. I really wanted to find a way to give value to these traditional systems and demonstrate their value to the broader medical community, particularly in understanding how healthcare is delivered and reimagining the ways in which it can be delivered.

Kevin: For me, after high school I was engaged in research as a study participant in Kisumu, Kenya. I slowly gained interest and volunteered my services to act as a community-based recruiter and educator. In doing this, I realized that there was need to better understand and appreciate the culture this study was serving. Being a novel study that would go against the cultural practices of the locals, there was need for an ethnographic approach to be able to get at this foundational information. But it took them a lot of time to find someone to do this, and when they finally did, he was not a local. So, I started thinking to myself: there is need for social scientists to come in and fill the gap and connect both scientific medical research and the community work. I realized that we need that in-depth understanding of the people with whom we work. And I saw that I could act as a bridge. In summary, that’s how I got interested and today I can comfortably take pride in being an anthropologist!

Jennifer: “Speaking about your identity as an anthropologist, do you feel like you are part of a bigger global community of medical anthropologists, and if so, can you tell us how or in what ways you feel connected or not?”

Kevin: Yes, I feel part of the broader medical anthropology community as a field due to the various contributions I have made to health research here in Kenya. The various research and community engagements that I have contributed to make me feel that my work has led to relevant policy changes in the field. There are, however, some challenges that result in our contributions not being felt or seen more broadly. The greatest barrier is that we don’t have fully developed and recognized platforms, associations or networks for anthropologists. An example in Kenya, we currently don’t have a full-fledged medical anthropology discipline or department at the universities offering anthropology. So, for students who are interested in studying medical anthropology, it is hard to get specialized training. Furthermore, even if we are able to figure out how to get the training to become active in the field, there will still be a problem – lack of common front by stakeholders and those who have received anthropological training coming together to share and joining hands to support. Professionals in our field are doing a lot, but it is not recognized for these obvious reasons; with a lack of common bargaining ground, we continue feeling left out of touch.

Moïse: Yes, I agree. Like Kevin, I see the contributions we are making in the field, so I know we are achieving results. In that sense, of doing actual fieldwork, I feel like I am part of the broader medical anthropology community. But there are some critical issues that hamper our access to the broader community in a more two-way fashion, particularly publications and conferences that are the crux of the valorization of knowledge in medical anthropology. My contributions in the scientific domain have been limited because I haven’t been able to publish a lot, and there are a couple of reasons for that. One is that some journals require you to pay to access them and sometimes even to publish. To have a strong article, you must be able to link your research to the most recent publications in your field, which we don’t always have access to in our countries. There is also a challenge knowing what other researchers in our own space or country are doing, in part because they also are not publishing for these very same reasons! You will see even when we are able to download papers, we find ourselves citing authors from Europe or the United States that have been able to publish. There are several medical anthropology departments at universities throughout the country in Cameroon, but there is no good sharing of information as to who is doing what to build off other more recent research. Those are a few structural issues, and these same barriers serve as barriers to knowing about grants in enough time to submit good quality applications that, again, cite the most recent and relevant research in our field. There also simply are not very many locally-based publishing houses. So, although there are medical anthropologists doing good work, many people outside of our context are unaware of our work. And conferences are expensive to attend, and there are often Visa issues and costs for researchers, so we miss out on important opportunities that conferences provide to both inform others about what your contributions are to the scientific discipline of medical anthropology as well as learn what other people are doing.

Kevin: I am in support of Moïse’s contribution! Here in Kenya many people in the medical and public health fields are so unfamiliar with anthropology, and we have an additional challenge of people really undervaluing our discipline, not understanding what we do, and not always understanding the complexity of anthropological theories and methods, so they just send anyone with no specialized training to do a qualitative work.

Kelly: “Understood! Moving forward, what are your suggestions to disrupt the status quo and make medical anthropology more inclusive?”

Kevin: Number one, there is an urgent need to create more and affordable platforms where early-career medical anthropologists can present papers and contribute to the body of knowledge in the field. There is also a need for more exchange programs, or platforms, or something like that. For example, I am in Kisumu and so happy to meet a colleague from Cameroon during this interview with similar interests and challenges. We need more platforms where we can communicate and critique each other, talk about ethics, and avoid research malpractice. I think it is so important to have these platforms because what often happens is that outsiders come in and critique or comment on what we are doing without necessarily understanding the whole context. These platforms, at least for the Kenyan context, could also help to provide some way to push for the respect, value, and place of anthropology within medical research, and indeed academics as well. We must not sit back and watch those with political goodwill and influence tear this noble discipline to parts for lack of clear understanding of its precepts. It is high time that we go back and sell the idea to policy makers of the importance of medical anthropology in the contemporary world. We are here to dissect and interpret all the different problems that are experienced in this society, so that they can better be understood – we strive to understand in-depth the root causes. Lastly, people forget that those of us in the field have a special relationship and ability to translate and disseminate complicated information in a language and form suggested and acceptable to communities.

Moïse: Building on what Kevin said, it would be helpful to even create journals or somehow make some existing journals more open to anthropologist from the Grand South and not just research that is conducted in our countries by foreign researchers. I am not saying that research doesn’t have its place, but research is made richer by a diversity of perspectives, including that of the researcher leading the study. Furthermore, when you look at research published in these journals, it doesn’t even necessarily represent all of the research being done in the field by local researchers that doesn’t make it to the same journals for reasons we talked about earlier.

I also want to emphasize the last point Kevin brought up. In medical anthropology, we often forget who some of our most important audiences are. We are really focused on publishing and going to conferences for the broader scientific community, which is important to build knowledge and to move science forward, but there are so few real interactions with local communities. And this is something that people who are doing research where they’re from, where they master the language and cultural nuances better, that should be considered an important contribution that should be more highly valued in anthropology.

Lastly, in the spirit of a revolution within medical anthropology, I really think we need to also find ways to reduce our dependency on only using theory generated in the grand north. You know it’s oftentimes obligatory to cite what your theoretical framework is and almost by default, because the majority of theory that is published is developed in Europe and the United States, we’re using these theoretical frameworks and applying them to research that might not necessarily fit, but we have to make it work. Maybe a revolution of grounded theories developed by us holds a lot of promise in terms of more researchers from Africa, or from other places, developing new theories from our different perspectives that can be applied here and elsewhere. In the same perspective, we must engage in a process of intensive production and publication of the results of our research in order to make up for the gap observed in the discipline and to promote the reflections carried out on the crucial concerns in medical anthropology.

Discussion

The testimonies collected in this work underline the importance of medical anthropology in sub-Saharan Africa; however, they also reveal the barriers that practitioners face on the continent. Despite the dearth of research conducted in their countries, researchers from sub-Saharan Africa find it difficult to promote the results of their research in the major international health journals. This is in part due to the lack of interest shown by the editors of Western journals in research which is not always cutting edge (often linked with limited access to funding) or does not concern the Western world (Dumas 2008). This limited scientific recognition of researchers from the Global South is not without consequences in the practice of medical anthropology. There is a need for greater involvement of medical anthropologists from the Global South in the production and promotion of scientific knowledge in order to impact methodological and theoretical approaches. Anthropologists today are interested in a wide range of topics, including the cultural foundations of health, disease distribution, health beliefs, and practices (Hudelson 2008 or see Yotebieng et al. 2016). Far from its old interest in the quest for the strange and the foreign, anthropology is nowadays interested in rural, urban, and contemporary concerns (Mbonji 2005, 2009). To disrupt and stimulate changes in the discipline, barriers to researchers from the Global South becoming active participants must be broken. In a world of increasingly dire public health issues, medical anthropology can contribute to successfully addressing their scourge, but only within the framework of scientific cooperation, including the development of networks of researchers between the Global North and the Global South.

To push this conversation from the abstract to the concrete, we suggest several interlinked actions as a starting point for anthropologists in the Global North to actively dismantle scholarly imbalances.

First, pertaining to creating community, we suggest that conference participation fees be waived based on income for participants from the Global South. For example, the fee could be waived for international students and reduced for professionals from the Global South. The current health crisis has pushed conference organizers and educators to rethink the formats of these meetings to virtual formats which open a wide range of opportunities to expand geographic coverage and representation. We propose that even once conferences start reconvening in-person, virtual formats should remain an option for both participation in the audience and as a presenter.

Second, to foster the production of innovative and inclusive research, we suggest the organization of virtual meet-ups, in person and virtual mentoring groups, and exchange programs to be implemented during these conferences as well as throughout the year where researchers from either the Global North or Global South can apply to participate as a mentor or mentee. The participation of researchers from the Global North as mentees should be encouraged here as well given the dearth of scholarship and experience from the Global South that has to date been muted because of some of the issues underlined through this paper. We need to expand our vision of what mentoring is and who is able to provide mentorship.

Third, to promote the sharing of knowledge, we suggest that anthropology journals institute fee waivers to publishing open source articles for researchers from the Global South. While these already exist with some journals, not all researchers are aware of these fee waivers, and more journals should offer them. A common database can be created with a simple application form where a researcher needs to provide information on the institution they work for and other documentation to justify their need for a fee waiver.

Fourth, to promote access to knowledge, this same database can be curated by the American Anthropological Association and also be used to allow these same researchers access to a virtual bookshelf or library that can assist them in being able to read books and articles to situate their research in the context of the broader body of work that exists, but which often hides behind pay-walls or does not make it to libraries at their institutions.

Finally, to promote the equity in the capacity to conduct fieldwork, we suggest that more grants and scholarships be opened to researchers from the Global South rather than only to researchers based at Western institutions. Fieldwork is a time-intensive and laborious task which also helps students to establish and legitimize their capacity as an “anthropologist” in the eyes of their peers. However, many students from institutions in the Global South struggle to access the same kinds of stipends and grants available to students at institutions from the Global North.

Concluding thoughts

Where do we go from here? First, we must reflect on a point that came up at the end of our conversation: anthropology permitted the colonial experiment to succeed. In this way, and in turbulent times in which people are challenging the status quo, the realities of neocolonialization and the long-term structural inequalities forged deep into every level of our societies, it seems opportune to reflect on our own institutions as well as identify concrete ways to disrupt and revolutionize our discipline. We need to ensure that we are not continuing the colonial experiment in subtler ways where researchers from the Global North reap the benefits of research conducted elsewhere. Disruption means ensuring that we include, value, and refer and defer to the contributions from colleagues in countries that have long been the subject of anthropological research. Making our field more inclusive will enrich not only our theoretical and methodological toolboxes, but allow us to collectively push the medical and public health fields to which we contribute forward by challenging assumptions and presenting alternative ways of interpreting health behavior and healthcare that are grounded in the lived experiences of the communities in which we work.


Kevin Oware is an adjunct lecturer at Maseno University – Kenya in the department of Sociology and Anthropology. He holds a master’s degree in Anthropology. He has over ten years of practical reproductive health research in different capacities.

Moïse Mvetumbo est un chercheur de nationalité camerounaise, doctorant en anthropologie médicale à l’Université de Yaoundé I, Cameroun. Il mène depuis une dizaine d’années des recherches sur les questions relevant de l’anthropologie médicale.  Ses centres d’intérêt sont entre autres les représentations culturelles de la maladie et de la santé, la valorisation de la médecine africaine dans un contexte de globalisation de plus en plus assumé, les systèmes de croyances, le genre, les peuples autochtones, l’évaluation des projets. Il est aussi un fervent partisan du rapprochement entre les anthropologues médicaux des Pays du Sud et du Nord. Il est chercheur associé au Center for Population Studies and Health Promotion (CPSHP) et au Musée Ecologic du Millénaire du Cameroun. (French)

Moïse Mvetumbo is a researcher of Cameroonian nationality, doctorate student in medical anthropology at the University of Yaoundé I, Cameroon. For the past ten years, he has been researching on questions relating to medical anthropology. His areas of interest are, among others, cultural representations of disease and health, the promotion of African medicine in a context of increasingly assumed globalization, belief systems, gender, indigenous peoples and project evaluation. He is also a fervent supporter of the collaboration between medical anthropologists from the countries of the South and the North. He is an associate researcher at the Center for Population Studies and Health Promotion (CPSHP) and at the Ecologic Millennium Museum of Cameroon. (English)

Kelly Yotebieng is a medical anthropologist and sexual and gender-based violence subject matter expert with over 17 years of experience leading programs and applied research across more than 35 countries in Africa, Asia, Eastern Europe, Latin America, and the United States. She holds a Ph.D. in Cultural Anthropology from the Ohio State University and a Masters of Public Health from Tulane University. Her work has been recognized with several prestigious awards including a Fulbright Fellowship and as a United States Institute of Peace Jennings Randolph Peace Scholar award as well as her solicitation as an expert consultant with international organizations. Currently, she works as a Senior Gender Consultant with the World Bank, ensuring adequate research and subsequent measures to mitigate and respond to sexual exploitation and abuse across West and Central Africa.

Jennifer Syvertsen is an Assistant Professor of Anthropology at the University of California, Riverside. Her current research and teaching focuses on global health inequities, the construction of drug “epidemics,” access to healthcare, subjectivity, and equity in knowledge production.


Works Cited

Allen, J.S., & Jobson, R.C. (2016). The Decolonizing Generation: (Race and) Theory in Anthropology since the Eighties. Current Anthropology, 57(2), 129-140.

Dumas Michel, (2008). Recherche médicale en Afrique subsaharienne: ses contraintes et ses potentialités», in AJNS 2008, 27 (2).

Henrich, J., Heine, S. J., & Norenzayan, A. (2010). The weirdest people in the world? Behavioral and Brain Sciences, 33(2-3), 61–83. https://doi.org/10.1017/S0140525X0999152X

Hudelson, P. (2008). Que peut apporter l’anthropologie médicale à la pratique de la médecine?.  Santé conjuguée – octobre 2008 – n°4.

Mbonji E. (2005). L’Ethno-perspective ou la méthode du discours de l’Ethno-Anthropologie culturelle, Yaoundé, PUY, Collections les Connaissances.

Mbonji E. (2009). «Ethnologie, l’Anthropologie et l’Afrique: pistes pour une refondation heuristique», in Annales de la FALSH, UYI, Vol.1, Nouvelle série, Deuxième semestre 2009, (10), 107-129.

Ntarangwi, M. (2010). Reversed gaze: An African ethnography of American anthropology. Urbana: University of Illinois Press.


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