Health care decisions by Sukuma ‘peasant intellectuals’: a case of radical empiricism?

Abstract

Health care decisions in Sukuma-speaking rural communities in Tanzania reproduce a practical epistemology that could be described as radically empiricist, rather than just pluralist; their point of reference is the deeper ‘relation’ between events, which collective traditions articulate and subjects may experience, but which escapes the atomistic perception privileged by biomedicine. This analysis relies on a diverse portfolio of ethnographic data, including the use and structure of medicinal recipes, the choices of mental health care according to experienced ‘effectiveness’, and lay discussions on the correct aetiology and treatment of reproductive disorder. Combining two dimensions for a given medical epistemology, the (empirical/ habitual) basis of its transmission and the (open/closed) relation with other epistemologies, four types are proposed: monism, dualism, pluralism, and radical empiricism. The concept of peasant intellectuals, it is argued, needs to be rethought in contexts of medicinal initiation.

Keywords:

• traditional medicine
• ethnopharmacology
• mental health
• Sukuma
• epistemology

Acknowledgements

The author is deeply indebted to the Sukuma traditional practitioners, especially Lukundula, and to Bon Peter, the mental health coordinator of Misungwi district, Tanzania. He thanks the Flemish Fund for Scientific Research and the BOF-fund of Ghent University for financing and ethically accrediting research in 2007 and 2010. The paper benefited much from the input of Elisabeth Hsu, Murray Last and Sushrut Jadhav. It was presented at the conference ‘Medical Anthropology in Europe’ funded by the Wellcome Trust and Royal Anthropological Institute.

Conflict of interest: none.

Notes

1. When searching on the Pubmed database with the terms ‘Traditional medicine OR traditional healing OR traditional healers AND Africa AND mental’ 205 papers in total were obtained. Forty-eight dated from 2000 until 2010. After exclusion on the basis of irrelevance (e.g., other afflictions such as stroke; ‘mental’ as a kind of effect; pharmacological study; other region than Africa), 31 papers were left, the main outcomes of which are presented briefly here.

2. The Chi-square is 17.4 with two degrees of freedom. The possibly higher prevalence of schizophrenia in urban areas cannot fully account for the urban-rural contrast (cf. Mortensen et al. 1999, measuring a disparity of schizophrenia risk with factor 2,4 between Denmark's largest city and the country's most rural area).

3. The author is indebted to Suzy Huysmans of the KU Leuven Laboratory of Plant Systematics for references and plant identification in 2006.

4. This does not refer to Horton's (1967) open predicament of ‘Western modern science’ seeking verification versus the closed predicament of ‘African traditional thought’ fearing falsification (an opposition of predicaments which the author's stance would then seem to invert; see also Trawick 1987). What mattered in this paper is the practical relation – observed in the practice of health seekers – to other epistemologies, and not the position taken by a belief or a theory in relation to data conflicting with it.