The Modern Traditional Healer: Locating ‘Hybridity’ in Modern Traditional Medicine, Southern Tanzania

Abstract

This article explores how ‘modern traditional’ healers, working in Kyela District in the south west of Tanzania, attempt to challenge and transcend a widely-recognised dualism that places forms of biomedicine as ‘modern’ and all varieties of indigenous healing as ‘traditional’. Drawing on the notion of ‘intentional hybridity’, the article analyses conversations with healers, which reveal how their practices and aspirations operate to destabilise the boundaries that are so essential to the way that they and their medicines are imagined. Framing their practices in terms of competition for business between both mission medicine and government-employed biomedical practitioners, the healers worked to reposition themselves within this ‘modern’ and moral space by emphasising the similarities between their own medicines and biomedical pharmaceuticals, for instance, or claiming that biomedical personnel are jealous of their ability to attract patients (or customers). They were also prepared to support a local government initiative that, if effective, may reduce the incidence of witchcraft-related illness – a stance which in theory does not make good ‘business sense’, yet that places them firmly in opposition to some forms of ‘tradition’. Finally, the article details the technical innovations which healers would like to appropriate from biomedicine. In conclusion, the material presented demonstrates the ability of the healers to transcend, contest and make use of the constructed categories through which they are imagined in Tanzania.

Notes

^*An early version of this article was given at ‘Hybrids and Partnerships: Comparing the Histories of Indigenous Medicine in Southern Africa and South Asia’, Wellcome Unit for the History of Medicine, University of Oxford, September 2005. The research on which this article is based was supported by the ESRC (award numbers R00429934295 and PTA-026-27-0770) and the 2004 Firth Award. Thanks are due to members of CHAWATIATA (Chama cha Waganga/Wakunga Tiba Asilia Tanzania – The Tanzanian Society for Traditional Healers and Midwives), in particular Dr Kungaipe M.C. Nombo. Many other people in Kyela also assisted my research, most notably my husband Timothy Mwakasekele and his father, the mganga Mzee Richard Mwakasekele. Finally, Tracey Luedke and two anonymous readers offered valuable comments, for which I wish to thank them.

¹ Waganga (singular, mganga) can be translated from Kiswahili as doctors or healers. The word can be used to refer to either ‘traditional’ or biomedical practitioners, but in this article I use it only to refer to practitioners of indigenous forms of medicine.

² B. Latour, We Have Never Been Modern (trans. C. Porter) (New York, London, Harvester Wheatsheaf, 1993).

³ H. Englund and J. Leach, ‘Ethnography and the Meta-Narratives of Modernity’, Current Anthropology, 41, 2 (2000), pp. 225–39. J.-F. Lyotard, The Postmodern Condition: A Report on Knowledge (Minneapolis, University of Minnesota Press, 1997).

⁴ S. Beckerleg, ‘Modernity Has Been Swahili-ised: The Case of Malindi’, in P. Caplan and F. Topan (eds), Swahili Modernities: Culture, Politics and Identity on the East Coast of Africa (Trenton, Eritrea, Africa World Press, 2004).

⁵ The original research aimed to develop an ‘ethnography of malaria’ – R. Marsland, ‘Ethnographic Malaria. The Uses of Medical Knowledge in Tanzania’ (PhD thesis, SOAS, University of London, 2005). As part of this project I became interested in the relationship between ‘traditional’ healers and the government-run health services. The material presented in this article was collected towards the end of almost two years of fieldwork, and a one-month return visit in 2005.

⁶ The waganga concerned were members of the Kyela group of Chama cha Waganga/Wakunga Tiba Asilia Tanzania (CHAWATIATA) – the Tanzanian Society for Traditional Healers and Midwives. It should be noted that members of this organisation, who have formalised their practice through membership of CHAWATIATA, are likely to have stronger motivations for considering their identity as healers in comparison to those healers who are not members and may specialise in just one or two ‘minor’ cures or techniques.

⁷ S. Feierman, ‘Struggles for Control: The Social Roots of Health and Healing in Modern Africa’, African Studies Review, 28, 2/3 (1985), pp. 110–12. M. Last, ‘The Professionalisation of African Medicines: Ambiguities and Definitions’, in M. Last and G.L. Chavanduka (eds), The Professionalisation of African Medicines (Manchester, Manchester University Press in association with the International African Institute, 1986), p. 5. H.G. West and T.J. Luedke, ‘Introduction. Healing Divides: Therapeutic Border Work in Southeast Africa’, in T.J. Luedke and H.G. West (eds), Borders and Healers: Brokering Therapeutic Resources in Southeast Africa (Bloomington and Indianapolis, Indiana University Press, 2006), pp. 4–5.

⁸ J. Nyerere, Freedom and Socialism: A Selection from Writings and Speeches (Dar es Salaam, Oxford University Press, 1968). Also compare with socialist Mozambique: H.G. West, ‘Working the Borders to Beneficial Effect: The Not-So-Indigenous Knowledge of Not-So-Traditional Healers in Northern Mozambique’, in Luedke and West (eds), Borders and Healers, p. 21.

⁹ P. Caplan, ‘“Struggling to be Modern”: Recent Letters from Mafia Island’, in P. Caplan and F. Topan (eds), Swahili Modernities: Culture, Politics, and Identity on the East Coast of Africa (Trenton, Eritrea, Africa World Press, 2004). M. Green, ‘Participatory Development and the Appropriation of Agency in Southern Tanzania’, Critique of Anthropology, 20, 1 (2000), pp. 67–89. C. Mercer, ‘The Discourse of Maendeleo’, Development and Change, 33 (2002), pp. 101–27.

¹⁰ W.C. Bissell, ‘Engaging Colonial Nostaliga’, Cultural Anthropology, 20, 2 (2005), pp. 215–48. Caplan, ‘Struggling to be Modern’. B. Weiss, ‘Thug Realism: Inhabiting Fantasy in Urban Tanzania’, Cultural Anthropology, 17, 1 (2002), pp. 93–124.

¹¹ See Marsland, ‘Ethnographic Malaria’.

¹² This is comparable with Latour's ideas of ‘purification’ (Latour, We Have Never Been Modern, p. 11).

¹³ J. Iliffe, East African Doctors: A History of the Modern Profession (Cambridge, Cambridge University Press, 1998). Last, ‘The Professionalisation of African Medicines’, pp. 10–11.

¹⁴ On the crisis in the biomedical sector see Last, ‘The Professionalisation of African Medicines’, p. 11; J. Pfeiffer, ‘Money, Modernity and Morality: Traditional Healing and the Expansion of the Holy Spirit in Mozambique’, in Luedke and West, Borders and Healers, pp. 81–100; D. Simmons, ‘Of Markets and Medicine: the Changing Significance of Zimbabwean Muti in the Age of Intensified Globalization’, in Luedke and West, Borders and Healers, pp. 65–80. For the positioning of ‘traditional medicine’ in relation to the AIDS epidemic see: J. Murchison, ‘From HIV/AIDS to Ukimwi: Narrating Local Accounts of a Cure’, in Luedke and West, Borders and Healers, pp. 125–42; P. Probst, ‘Mchape ’95, or, the Sudden Fame of Billy Goodson Chisupe: Healing, Social Memory and the Enigma of the Public Sphere in Post-Banda Malawi', Africa, 69, 1 (1999), pp. 108–38; C.B. Yamba, ‘Cosmologies in Turmoil: Witchfinding and AIDS in Chiawa, Zambia’, Africa, 67, 2 (1997), pp. 200–23.

¹⁵ P. Werbner, ‘The Limits of Cultural Hybridity: On Ritual Monsters, Poetic Licence and Contested Postcolonial Purifications’, Journal of the Royal Anthropological Institute, 7 (2001), p. 137.

¹⁶ P.P. Mhame, ‘The Role of Traditional Medicine (Medicinal Flora and Fauna) in the National Economy’ (unpublished paper, National Institute for Medical Research, Dar es Salaam, Tanzania, 2002).

¹⁷ West and Luedke, ‘Introduction’.

¹⁸ ‘Modern traditional’ clinics have also been noted in Dar es Salaam. E. Hsu, ‘Time Inscribed in Space, and the Process of Diagnosis in African and Chinese Medical Practices’, in W. James and D. Mills (eds), The Qualities of Time: Anthropological Approaches (Oxford; New York, Berg, 2005), p. 165.

¹⁹ Also see M.C. Gessler, D. Msuya, M.H.H. Nkunya, A. Schar, M. Heinrich and M. Tanner, ‘Traditional Healers in Tanzania: Sociocultural Profile and Three Short Portraits’, Journal of Ethnopharmacology, 48 (1995), pp. 153–4.

²⁰ This is a common complaint. Compare West, ‘Working the Borders to Beneficial Effect’, p. 23.

²¹ These referrals do occasionally take place if a good relationship has developed with an individual biomedical doctor. See also Gessler et al., ‘Traditional Healers’, pp. 152–3.

²² T. Ranger, ‘Godly Medicine: the Ambiguities of Medical Mission in Southeast Tanzania, 1900–1945’, Social Science and Medicine, 15B (1981), p. 262; S. Langwick, ‘Geographies of Medicine: Interrogating the Boundary Between “Traditional” and “Modern” Medicine in Colonial Tanganyika’, in Luedke and West, Borders and Healers, pp. 143–65.

²³ Ranger, ‘Godly Medicine’, pp. 261–77.

²⁴ S. Mesaki, ‘Witchkilling in Sukumaland’, in R. Abrahams (ed.), Witchcraft in Contemporary Tanzania (Cambridge, Cambridge University Press, 1994); Yamba, ‘Cosmologies in Turmoil’, pp. 200–23; M. Green and S. Mesaki, ‘The Birth of the “Salon”: Poverty, “Modernization” and Dealing with Witchcraft in Southern Tanzania’, American Ethnologist, 32, 3 (2005), pp. 371–88.

²⁵ S. Hausmann-Muela, R.J. Muela and M. Tanner, ‘Fake Malaria and Hidden Parasites – the Ambiguity of Malaria’, Anthropology and Medicine, 5, 1 (1998), pp. 43–61. M. Wilson, Divine Kings and the Breath of Men (Cambridge, Cambridge University Press, 1959), p. 7.

²⁶ Medical anthropologists would usually categorise malaria as a biomedically-defined disease, that does not form part of a local classification of diseases. I am not so sure, and argue elsewhere that ‘malaria’, as a category, has been ‘localised’ and has taken on meanings that are not part of biomedicine (Marsland, ‘Ethnographic Malaria’).

²⁷ For more details, refer to R. Marsland, ‘Intervening in Witchcraft: Public Health and the Nyakyusa in Tanzania’, submitted to Africa for consideration.

²⁸ S.J. Tambiah, ‘The Magical Power of Words’, Man N.S., 3, 2 (1968), pp. 175–208.

²⁹ Also see M. Wilson, ‘Witch Beliefs and Social Structure’, American Journal of Sociology, 56 (1951) pp. 307–13.

³⁰ M. Green, ‘Discourses on Inequality: Poverty, Public Bads and Entrenching Witchcraft in Post-adjustment Tanzania’, Anthropological Theory, 5, 3 (2005), pp. 247–66.

³¹ Green and Mesaki. ‘The Birth of the Salon’.

³² C. Msoka, ‘Re-Emergence of African Traditional Medicines in Cities: Weaknesses of the Western-Modern-Global Medicines?’ (unpublished paper, presented at ‘From Western Medicine to Global Medicine: The Hospital Beyond the West’, Wellcome Institute for the History of Medicine, University of Oxford, 2004). The mass production of herbal medicines has also been reported from Zimbabwe: Simmons, ‘Of Markets and Medicine’.

³⁴ A. Appadurai, ‘Introduction: Commodities and the Politics of Value’, in A. Appadurai (ed.), The Social Life of Things: Commodities in Cultural Perspective (Cambridge, Cambridge University Press, 1986), p. 34.

³³ O.B. Rekdal, ‘Cross-cultural Healing in East African Ethnography’, Medical Anthropology, 13, 4 (1999), pp. 458–82. Also see Iliffe, East African Doctors; S.R. Whyte, ‘The Power of Medicines in East Africa’, in S. van der Geest and S.R. Whyte (eds), The Context of Medicines in Developing Countries (Dordrecht, Kluwer Academic Publishers, 1998), p. 226; M. Vaughan, Curing Their Ills: Colonial Power and African Illness Cambridge, Polity Press, 1991), p. 24.

³⁵ Werbner, ‘The Limits of Cultural Hybridity’, p. 136.

³⁶ A. Appadurai, Modernity at Large: Cultural Dimensions of Globalization (Minneapolis, University of Minnesota Press, 1996).

³⁷ Gessler et al., ‘Traditional Healers in Tanzania’, p. 155 also reports that many healers would like some training in biomedicine.

³⁸ For razors and gloves see also West, ‘Working the Borders to Beneficial Effect’, p. 31.

³⁹ L. Manderson and L. Whiteford, Global Health Policy, Local Realities: The Fallacy of a Level Playing Field (Boulder, CO, Lynne Rienner, 2000), p. 3.

⁴⁰ J.N. Pieterse, ‘Hybridity, So What? The Anti-Hybridity Backlash and the Riddles of Recognition’, Theory, Culture and Society, 18, 2–3 (2001), p. 220.