Medicine and anthropology in twentieth century Africa: Akan medicine and encounters with (medical) anthropology.(Report)

Introduction

In twentieth century southern and eastern Africa, "traditional" medicine was the dominant healing system and often regarded as the more appropriate mode of treatment by specialists and recipients. [1] Stretching from Ethiopia, Tanzania, South Africa, and Zambia to Cameroon, Nigeria, and Ghana, indigenous African healing systems remained highly utilized by large segments of the (rural) populations surveyed. [2] These perspectives on and use of indigenous medicine were shared by parallel populations in geographically distinct places such as New Zealand, Hawaii, and the United States among persons of African ancestry. [3] Overall, indigenous healers in Ghana and elsewhere rarely translated their knowledge of medicine into social practices that emphasized the omnipresent dichotomies of "spiritual" and "natural" disease causation nor did their praxis revolve around the debates on witchcraft and the existence or denial of African "medical systems" found in medical anthropology. Akan healers in central Ghana, and I would suspect elsewhere, were unaware of and perhaps would care little about the substance of those debates. Since the 1920s, there has been a foreground of fluctuating perspectives on indigenous African medicine and therapeutics in the medical anthropology of Africa. These circular perspectives in medical anthropology have stubbornly focused on the ubiquity of "witchcraft," the natural or supernatural basis of African therapeutics, integration between biomedicine and indigenous systems of healing, but have failed to excavate African perspectives on or the relevance of these issues in the background of African societies. [4]

This essay argues the failure to locate African perspectives on therapeutic matters that may or may not be important concerns in African societies is the academic quest for "ethnographic cases" that lend themselves to issues in the field of medical anthropology rather than African knowledge and perspectives of the field (i.e., Africa). This contention is critical for it argues for a strategic distinction between two sites of knowledge production--field of medical anthropology and the "field" of Africa where fieldwork is conducted--on the larger canvas of global health issues using the local case of the Bono (Akan) therapeutic system of Ghana. Contextually, global health issues in Africa were conditioned by the failed structural adjustment and Highly Indebted Poor Countries initiatives of the 1980s and 1990s, collapsing health structures, the emergence and spread of HIV/AIDS, the global confrontation between pharmaceutical companies and African governments, and the lawsuits brought by pharmaceutical multinationals against these governments for seeking less-expensive drug alternatives. The guidelines issued by the World Health Organization (purported to ensure the sustainability and safety of the sixty billion dollars herbal medicine industry) were more than humanitarian as issues of herbal medicine--poisonings, heart problems, addition of steroids to plant medicines, poor plant quality and collection practices--continue to plague the United States, China, and Europe. The U.S. pharmaceutical industry spent $4.1 billion on drug research and development in the 1990s and consumers purchased in excess of eight billion dollars. Since 74 percent of the chemical compounds of the 119 known plant-derived drugs have the same or related use as the plants they derive, this pharmaceutical industry exploits medicinal "claims from alien cultures" in the "discovery" of new drugs. [5] As industries in the United States and Canada, the European Union, and Japan become more knowledge-intensive, and "as what constitutes national wealth shifts from the natural resource endowments toward the acquisition, manipulation, and application of knowledge," the ownership and marshaling of indigenous knowledge in and by African societies have perhaps never been so crucial. [6] In the consideration of the foregoing, and as the "Western" world extracts African medicinal knowledge to be brokered between academic and business interests and African ministries of health perpetuate colonial ideas of "traditional" medicine, the contention of this essay could not be more timely.

In this essay, I use the Bono, an Akan society of central Ghana, because they provide but one of many significant case studies in the encounter between African therapeutics and medical anthropology in the twentieth century, and an African perspective on the substance of those foregoing issues in the (medical) anthropology of Africa. The Bono have occupied an ecological zone between the dense forest and the savannah and, more importantly, have maintained an ancient and complex "ethnomedical" and nutritional system since at least the 1000 CE. After centuries of refinement, the therapeutic basis from which indigenous Bono healers contemporarily operated were dynamic and often did not function in the manner prescribed by or constructed in the minds of anthropologists, and indigenous healers appeared to draw upon a composite spiritual-temporal perspective in their day-to-day healing work uncluttered by the foregoing preoccupations in (medical) anthropology. [7] The potentialities of the indigenous therapeutic system offer an invaluable therapeutic option in addressing issues of health and healing in Ghana. Moreover, the Bono case implies that knowledge produced on such systems are less the realities on the ground than they are the representations of "authorities" who fail to fully grasp an unmediated picture of healing (in village or urban life) with and without the presence of the anthropologist, medical doctor, or NGO worker over time. In the last few decades, the ways in which indigenous (medicinal) knowledge has been "discovered" by these brokers of knowledge is cynically remarkable, and the appropriation and reduction of that knowledge for vested academic and pharmaceutical interests calls into question the vital issues of representations, authority, causation and therapy dichotomies, and the ubiquity of witchcraft.

The (Medical) Anthropologist and the Akan

In medical anthropology, it has become somewhat popular nowadays to have cultural "conversations" about medicine and healing in ethnographic representations of those therapeutic "non-systems" studied. [8] In these ethnographic representations, the ultimate goal is some sort of negotiation "between the insider and outsider perspectives." [9] Yet, as this goal or the mode of illness conversations seeks the foreground of healing discources, vital issues that threaten this very same quest are simultaneously pushed to the background. Two of these key issues will suffice. First, relations of inequality and power are glossed over and presented as a given, that is, white university doctors or professors linked to "established" educational or medical institutions are supported by grant-giving agencies to conduct research in African or largely African populated societies in which enslavement and colonialism are a part of the living fabric and memory. Whatever research related discussions or conversations occur, they most likely are "artificial dialogues" configured by the power relations historically situated, in the broad and multilayered scope of historical encounters, between the African and the European. The intent here is not to reduce the matter of research to white power and African subjugation, but rather to remind us that race (variously defined) is itself ubiquitous in ethnographic encounters in Africa and its Diaspora and cannot be simply ignored in any serious consideration of those encounters.

Robert Pool mentions, as one of several constraining factors, a fragment of this issue of power relations; however, this fragment is presented as a featherweight contender in the super heavyweight fight of his conversations about illness. Perhaps, his preoccupation with "witchcraft" obstructed this issue during his mediated dialogues. Secondly, Paul Brodwin talks much about the goal of ethnographic research as one of representation between "insider" and "outsider" perspectives, yet he does not say much about money in terms of limited options in the availability of biomedicine for most of the rural population that he studied in Haiti. He also does not say much about his payment for witness treatments and consultations, which calls into question what actually occurred during his fieldwork and the dubious picture of village life he presents. In other words, Brodwin wrote as if he was absent from village life when his presence alone affected whatever normalcy existed prior to his periodic arrivals. This is not to suggest that anthropologists have the power to shift the meaning of an entire medicinal system by their mere presence, but that the representation of those systems by such researchers is not the reality they purport but a snapshot conditioned by their foreign presence and the fulfillment of academic interests. Brodwin's aim, therefore, appears to have not been one of clarifying the reality of healing in rural Haiti but rather a convenient ethnographic exercise linked to issues in medical anthropology.