Abstract: It is known through anthropological literature that African countries are distinguished by a category of medicine that many specialists call ethnomedicine or traditional African medicine. Faced with biomedicine, ethnomedicine has often been relegated to the background in the resolution of health-related problems. However, ethnomedicine resurfaces in African countries, particularly in Cameroon, when there is no biomedical solution to a disease. This is the case, for example, with the novel coronavirus, where communities have developed therapeutic solutions from herbal beverages or through individual and community rituals. This article, therefore, proposes an epistemological analysis, i.e., the conditions of production and validity of the solutions suggested by anthropologist on health issues. In what follows, we show the role of anthropologists in the implementation of health solutions and propose new approaches for understanding the practices of medicine in African countries. Some pathways to the complementary use of biomedicine and ethnomedicine will also be developed in this paper.
Background and rationale
In many African countries, cultural heterogeneity has made medical pluralism a key characteristic of African health systems. This creates cultural diversity in health behavioral patterns and approaches. In this context, illness and health have become privileged fields of anthropological research in Africa. Anthropology has long observed and analyzed medical practices, particularly the link that each people build with disease and therapeutic orientations from every angle (e.g. Benoist 1996, 2002; Fassin 1992, 1996; Kleinmanm 1980, 2019; Olivier de Sardan 1998, 2003). This different knowledge has enabled these researchers to build models of understanding and theories of interpretation. According to Mbonji (2009), anthropological studies have shown that disease and medicine are dependent on the given culture. Moreover, anthropological studies have also made it possible to elaborate on the notion of the medical system, to pluralize the concept of disease and medicine, and to describe itineraries, etc. Overall, several anthropological research studies have made it possible to understand diseases and therapeutic systems from an anthropological view point.
However, the approach of anthropologists is often mild, or even unsuitable in the eyes of biomedicine, its practitioners, and development program managers (Gruénais 2007). In many African countries, anthropologists are often called upon by government authorities to conduct ethnographic studies that will provide community insight relating to the healing of illness and sickness, and enable them to set up interventions that can compel them to integrate a new healing culture. This article proposes to analyze the assets of medical anthropology as an agent of mediation in health systems. Indeed, the assets of this science allow us to show why and how it could facilitate responses to requests for care. To achieve this objective, we will rely on the following methodology:
I. Methodological approach: Medical Anthropology Health Models
This work is based on a desk review of publications, consisting, in part, of content analysis of documents related to the theme. In other part, we draw on two medical anthropology models of understanding developed by Smith (cited in Amer Eltwati Ben Irhuma 2008) have allowed us to better explore this work. The first is the performance model, which states that health is indicated by the ability to fulfill social roles. Secondly, we used the Eudaimonistic model which embodies the interaction and interrelationships between physical, social, psychological, and spiritual aspects of life and the environment. These different models of analysis will enable us to determine the role and strength of anthropology as a mediator in health systems in Africa.
II. Health Systems and Medical Anthropology Mediation
Successful health systems around the world are health systems where medical anthropologist have a say in health issues. These health systems have realized the role medical anthropologists play in mediating and maintaining a good relationship between the people and the health of institutions. To a medical anthropologist, every health system completes the other. An example can be seen in Kenya, where anthropologists played a great role in exploring community perceptions and beliefs relating to abortion, clients of abortion services, and abortifacients. In Cameroon, anthropologists have helped set up a sustainable community of practice for the care and cure of Burili Ulcers in several communities suffering from this morbidity.
Medical anthropologists make use of different theoretical approaches, with a shared emphasis on increasing the health system’s understanding of the diverse ways in which cultural, social, and biological factors influence human experiences of pain, illness, disease, suffering and healing in different settings. In addition, medical anthropologists also investigate the social, political, and economic contexts in which health behaviors and health systems are shaped to help better health decision-making and interventions. By so doing, medical anthropologists find themselves at an intersecting position within the health system as they inform the health system of cultural understandings of bodies and bodily processes, risk and protective dimensions of cultural norms and behaviors, illness experience and social meanings of disease, health effects of human ecology and adaptive processes and bio-social factors related to disease distribution and health disparities.
II.1. Strong points in Medical Anthropology Mediation in Health Systems
Medical anthropologists apply research geared toward solving specific problems related to the delivery of health care, including improving health care policies and systems, enriching approaches to clinical care, and contributing to the design of culturally valid public health programs in community settings in Africa. As aforementioned, medical anthropologists have made patients feel a sense of belonging to any health system inasmuch as they achieve health and wellbeing Awah et al (2008). Different cultures have different moral codes and, as such, different health behaviors and different health systems. These codes determine which health intervention is right and appropriate within a given society. Therefore, there is no objective “truth” in morality. For medical anthropologists, right and wrong are only matters of opinion and opinions vary from culture to culture. There is no objective standard that can be used to judge one society’s health system as better than another’s. That is there is no universal health system that holds for all people at all times.
According to Muller (1994), there are 4 main approaches that strengthen the role of medical anthropologists: a) the contextual nature of health systems, where the anthropological position sees the definition of a medical dilemma and the ways in which it is handled as inextricably bound to broad cultural conditions that influence health and illness behavior generally; b) the cultural embeddedness of moral systems, where different cultural systems have different standards for behavior and different expectations for relationships that are played out in health care systems; c) the multicultural character of many health systems, where the anthropological approach places emphasis on the dilemmas resulting from cultural pluralism; and d) the challenge of examining cultural phenomenon.
II.2. Drawbacks in Medical Anthropology Mediation in Health Systems.
In the African context, many physicians look at medical anthropologists as a nuisance in public health activities; but when public health experts take courses in anthropology, they understand its key mediating role in health. Generally, data generated by medical anthropologists are not considered when setting up public health interventions and funding for anthropological studies is not as robust as public health-oriented studies. Most of the time they are not considered until failure sets in.
III. How Health Systems could have been with Medical Anthropology’s Mediation:
The impartiality of anthropology, as well as its holistic vision in the context of mediation, would have made it possible to develop an institutional collaboration between biomedicine and ethnomedicine. Indeed, it is known through the WHO (2003: 2) that more than 80 percent of Africans use traditional medicine. However, when it comes to promoting good health practices or health care itineraries, it is biomedicine that is regularly highlighted and prioritize. Without wishing to criticize or give primacy to one medicine to the detriment of another, the collaboration of health systems framed by anthropology as a mediator could have highlighted a solid system of care.
To better illustrate the importance of this mediation, the work of the anthropologist Awah K.T (2019) in the city of Yaounde-Cameroon has shown with precise and concrete examples that the care for newborn babies is a phenomenon that is too complex to be handled by one system of care. When it comes to the care for newborn babies, every health care pattern has its role to play. Depending on the socio-culture of the newborn baby or the morbidity the newborn is experiencing, there is an appropriate ethnotechnology that, from a cultural viewpoint, solves the health problems of the newborn deemed otherwise impossible to solve by biomedicine. Based on this example, and many other cases of similar phenomena, anthropology as a mediator would or could, thanks to its knowledge of cultures, propose the appropriate care itineraries for each category of pathology, thus limiting suffering and the loss of human lives.
To achieve this collaboration, the anthropological training of physicians will allow health specialists to be both doctors and anthropologists. Before continuing our discussion, it is important to point out that anthropology is taught in several Faculties of Medicine in Africa, but its practical application is still absent. The anthropological training of physicians will enable the health system to improve health care and, above all, to give the place of each system of recourse to health care, when we know in particular that a health system alone is not sufficient to treat all cases of pathology. As we have already stressed above, the etiology of the disease and the attribution of its causes must be elucidated, as well as re-situated in broader social contexts.
Awah Kum Tchouaffi holds a Master’s (MSc) in Medical Anthropology from the University ofYaoundé 1 (2019) and is currently a PhD Candidate at the University of Yaoundé 1. He is an Anthropological Researcher for the National Center for Education at the Ministry of Scientific Research and Innovation and a Researcher for the Health of Population in Transition (HoPiT), Yaoundé-Cameroon. Prior to this, he worked as a Research Assistant and as a Consultant for several NGOs, such as Clinical Research Education Networking and Consultancy (CRENC) and the Center for Population Studies and Health Promotion (CPSHP). He has extensive fieldwork and field testing experience, including testing Cultural Compelling and Cultural Inclusive research approaches as rapid responses to emerging epidemics, pandemics, and other challenging health problems in Cameroon, Africa, and globally.
NDIPHO TATOU Christian Kitchener is a PhD candidate in Medical Anthropology at the University of Yaounde 1. He has been a researcher at CASS-RT (Center for Applied Social Sciences Research and Training) for several years. He is also a researcher at the Anthropological Study Laboratory “Sahel Consulting” in Cameroon. He has carried out several anthropological research projects and is deeply interested in African epistemology and health issues in Cameroon, Africa and the world.
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