From Non-Aligned Medicines to Market-Based Herbals: China's Relationship to the Shifting Politics of Traditional Medicine in Tanzania

Abstract

The institutionalization of traditional medicine in Tanzania reveals how strategies for socialist liberation are morphing into strategies for neoliberalization. In the 1960s and 1970s, traditional medicine promised the raw material for the scientific development of an indigenous pharmaceutical industry. At the turn of the millennium, however, traditional medicine has re-emerged in Tanzania as a new path into the fast-growing global herbals market. Tanzania's relationship with China has been central to these dynamics. Development programs rooted in socialist friendship trained Tanzanian doctors in China throughout the 1970s and into the 1980s. These practitioners forged Tanzanian efforts to develop and modernize traditional medicine. In this article, I look with particular detail at one woman who was chosen to start the Office of Traditional Medicine in the Ministry of Health in Tanzania, in order to elaborate the continuities and discontinuities central to the emerging field of market-based traditional medicines.

Key Words:

• China
• neoliberalism
• (post)socialism
• Tanzania
• traditional medicine

ACKNOWLEDGMENTS

The fieldwork on which this article is based was supported by the Fulbright Foundation and research grants from the University of North Carolina, the University of Florida, and Cornell University. I owe my attentiveness to China's influence in the region to Judith Farquhar. Earlier versions of this paper were presented at the annual meetings for American Ethnological Society and the Society for the Social Studies of Science, as well as conferences on biomedicine in Africa held in Kilifi, Kenya, and at the Max Planck Institute for Social Anthropology in Halle, Germany. I thank my colleagues in all these venues, as well as the anonymous reviewers for Medical Anthropology, for their engagement and suggestions. I am particularly grateful to Timothy Choy, Elisabeth Hsu, and Luise White for their close readings and detailed feedback, and to Margaret Lock for her provocative questions and encouragement.

Notes

Yet the practices Tanzanians refer to as “traditional medicine” (dawa za asili, jadi, au kineiyji) continue largely outside the normalizing or standardizing structures of science and the state (Langwick 2001, 2007, 2008a).

On January 23, 2009, the Prime Minister announced the cancellation of all licenses issues to traditional healers by the Ministry of Health through its registration process. A week later, when speaking to a delegation from Chawatiata, he suggested a country-wide “secret ballot” to identify people, especially traditional healers, involved in the harvesting of albino bones and blood to make potions that bring luck, wealth, and power. Mkinga Mkinga, “PM: Yes, killers of albinos should die,” The Citizen, January 28, 2009. “Albinos rally behind Premier on killings,” Sunday Citizen, February 1, 2009.

Elsewhere I traced these articulations through the Daily News and the Sunday News from the early 1970s to the early 2000s (Langwick, Forthcoming). For more on the history of these government run newspapers, see Akhahenda (1984).

For an example of commodification as central to another socialist project and a more detailed argument of the similarities of socialist and capitalism modes of production, see Lampland (1995). Concerning commodification and colonialism in Africa, see Burke (1996). A historically and ethnographically rich discussion on commodification that includes chapters on Africa and begins to situate Africa in broader global trajectories shaping commodification can be found in van Binsbergen and Geschiere (2005).

My approach owes a great deal to the emerging literature on neoliberalism and medicine, including ethnographies examining bioprospecting (Hayden 2003; Peterson 2001), experimentation as a new form of politics and labor (Petryna 2005; Rajan 2006), and therapeutic “needs” crafted in an effort to create the subjects that will benefit particular forms of capital (Dumit 2004; Dumit and Rajan 2007). To date, traditional medicine in Tanzania has not generated the wealth that might elicit these exact trends in Africa rather traditional medicine articulates the dreams of a marginalized economy. Only slowly are new geographies emerging, crafted in the altering of scientific institutions, the fostering of new forms of expertise, and the expanding of bureaucratic technologies; they index Tanzania's intentional efforts to follow China's lead (Zhan 2009).

A growing body of literature on “alternative modernities” (e.g., Gaonkar 2001; Ivy 1995; Rofel 1999), or what Bruce Knauft (2002) prefers to call “vernacular modernities,” explores the diverse ways in which refiguring tradition has been central to the production of “non-Western” modernities in Africa, Asia, and Latin America. This work dovetails substantively with postcolonial critics striving for histories not bound to the modernist categories of colonialism and encounter (Chakrabarty 2000, 2002). Brian Larkin (1997) first popularized the concept of alternative modernities in Africanist literature with an article exploring how Hindi films in Nigeria presented an alternative to Euro-American images of “the modern.” Ferguson (1999, 2002) has been particularly important in his insistence on politicizing the academic and colloquial references to “modernity” and “modernities” in Africa.

Comparing a close reading of Nyerere's second paper published after the Arusha Declaration, entitled “Socialism and Rural Development,” with collectivization efforts in China, Russia, and Mexico, McHenry (1976) concludes that such appeals to tradition are central to justifications for all these collect initiatives (352–355).

Tanzania and China formalized their relationship in the Sino-Tanzania Treat of Friendship of 1965. For more on these early relations, see Yu (1965, 1968).

In reference to the import of the Chinese model in Africa more broadly, see Bibeau (1985).

Quoted in Iliffe (1998: 202) who in turn is quoting P.S. Mganga (1968) ‘Visit to China’, Afya, 2(2): 4–7. This observation was made in the throes of the Great Proletarian Cultural Revolution in China (1966–1976). While the integration of “Western” and “Chinese” medicine began as a policy debate in 1912 (Croizier 1968), it emerged as central to the set of practices that came to be known as TCM by the Communist party between 1945–63 (Taylor 2005). The Cultural Revolution turned attention away from the earlier disciplinary work of the 1940s and 1950s by closing down many of academic and research institutions, professional journals, and other forums for study, research, and debate (Farquhar 1994). Some argue that TCM became more clinically focused through communist party policies that sent many teachers of Chinese medicine to rural areas to practice and through initiatives to train “barefoot doctors” (Scheid 2002). It would not be until the 1980s that the drive to scientize and modernize TCM motivated ambitious new programs in theoretical and clinical research. The Tanzanian team, then, went to China at a time when intellectual and theoretical pursuits were repressed and the field of Chinese medicine was seen as a tool for socialist development (Iliffe 1998: 211).

Iliffe (1998:203) citing A. M. Nhonoli, “Problems of promoting healthy living in East African rural areas with particular reference to Tanzania,” in P. Correa and others, Biomedical Lectures: 1970–1973 series, Afro Technical Papers No. 11 (Brazzaville, 1975), Pp. 39–47.

The promise gathered momentum and seemed more feasible as of the mid-1980s. See more below in the section on the “Shifting Politics of Traditional Medicine.”

Charles Kulundu, “New role for Africa's healers?” Sunday News, July 31, 1977, p. 7.

“Drugs from local herbs ready soon,” Daily News, June 25, 1985, p. 1.

“Herbs enter conventional medicine,” Sunday News, July 28, 1985, p. 5.

They collected samples of over 1,000 medicinal plant, animal, and mineral substances being used by traditional healers in Tanzania.

Hsu (2007a) presents a five-category schema of TCM in Tanzania, which includes the research project at Muhimbili. My own observations support Hsu's claim that the businesses selling TCM in Tanzania have grown substantially since the mid-1990s as a result of Dengist reforms (also Hsu 2008). Hsu (N.d.) describes the complicated transnational trajectories of some individuals striving to ride out these reforms.

For more on Chinese healers in East Africa, see Hsu (2002, 2005, 2007b).

Despite their seeming popularity with patients, experts in the Tanzanian National Institute for Medical Research and the Institute of Traditional Medicine in Muhimbili can barely conceal their skepticism when asked about their Chinese colleagues. My questions drew curt responses, such as, “They do not work with us,” and “They are just using us [Tanzanians] as guinea pigs.” In 2003, the Institute of Traditional Medicine initiated a substantial research project of its own to look at herbal medicines that might alleviate some of the secondary infections of people living with AIDS. While it is difficult to trace, I cannot help but wonder if the innovativeness of this project on Tanzanian traditional medicine—the fact that healers and their patients, not just their plant materials, moved through the Institute—was not at least partly a product of working amidst “healers” of Traditional Chinese Medicine.

People's Daily (China), October 11, 2000 reported that: “Over the past decades, China has dispatched 16 groups of medical experts, totaling some 858 people to Tanzanian (sic), to help uplift the level of medial service in the country.” http://english1.people.com.cn/english/200010/11/print20001011_52355.html.

Compliance with this task was marked by President Bush's visit in February 2008 and the accolades that Tanzania received for its work to create a “business friendly environment.”.

For the original description of the “Washington Consensus,” see Williamson (1990).

For more investigations into ways that witchcraft becomes a form of critique of changing patterns of accumulation in contemporary African states and thereby linked with development practices throughout Africa, see also Abrahams 1994; Austen 1993; Bastian 1993; Comaroff and Comaroff 1993; Englund 1996; Masquelier 1993; Mesaki 1993; Sanders 2003; West 2001, 2005.

For further analysis, see Sanders 2001.

“Tanzania leader condemns witchdoctor killings,” Reuters Africa, April 3, 2008. Khadija Yusuf, “Deadly harvest of body parts, The Standard, May 5, 2008. “Tanzania albinos targeted again,” BBC News, July 27, 2008.

Daniel Dickinson, “Tackling ‘witch’ murders in Tanzania,” BBC News, October 29, 2002. “Tanzania suffers rise of witchcraft hysteria,” The Independent, November 28, 2005. The HelpAge International brought this issue to the attention of the UN Convention on the Elimination of All Forms of Discrimination against Women. The submission is available under the title “Help Age urges action on older women's rights in Tanzania” at http://www.helpage.org/News/Mediacentre/Pressreleases/m7BO.

One example of such research is Hedberg et al. (1983).

“Malaria: Boil leaves,” Daily News, May 3, 1985, p. 4.

Throughout the 1990s, the need for a framework to review the ethics of health-related research remained acute (Kitua, Mashalla, and Shija 2000). While COSTECH served academic researchers, no government office held the task of monitoring non-academics collecting herbal medicines. Only in 2001 did the Tanzania National Health Research Forum publish the Guidelines on Ethics for Health Research in Tanzania developed by the National Health Research Ethics Committee. Still more recently, the NIMR established an ethical review board for all medical research involving human subjects. Mechanisms for enforcement remain unclear however (Ikingura, Kruger, and Zeleke 2007). Without adequate capacity to monitor more public research efforts, botanical poaching poses a particular challenge.

“Nigerian herbalists to cure AIDS?” Sunday News, October 13, 1985, p. 1; “Local herbs ‘usable in hospitals,’” Daily News, March 21, 1987, p. 3; “Medicinemen in AIDS research,” Letter to the editor, Daily News, October 20, 1987, p. 5; “Give Funds to our herbalist,” Letter to the editor, Daily News, November 3, 1987, p. 5; “‘AIDS victims free to see medicine men’,” Daily News, May 12, 1988, p. 3; “Herbalist allowed to treat AIDS patients,” Daily News, October 14, 1988, p. 3; “Herbalist ask to treat AIDS patients,” Daily News, October 20, 1988 p. 3; “Hospitals now to dispense herbs,” Daily News, November 9, 2002, p. 1.

The nurse-trainers running the HIV/AIDS workshops for Traditional Healers, Traditional Birth Attendants, and Initiation Specialists that I observed in southern Tanzania (May 2003) catalogued the dangers of certain practices in their lessons.

TAWG's original set of treatments grew out of a collaboration between these interested biomedical staff and a healer named Waziri Mrisho, who shared three herbal treatments for AIDS patients (McMillen 2004).

David Scheinman (2002) “Traditional Medicine in Tanga Today: The Ancient and the Modern Worlds Meet,” IK Notes (51). Reprinted in Daily News, December 5, 2002.

Interview with Scheinman (March 1999). Shaman Pharmaceutical has since closed and reopened under the name Shaman Botanicals.

This topic also captured the attention of the first (and to date only) social scientist to work at the Institute of Traditional Medicine, Edmund Kayombo. He conducted his dissertation research on healers' treatment of HIV/AIDS patients in southwestern Tanzania (Kayombo 1999).

Lucas Liganga, “Hospitals now to dispense herbs,” Daily News, November 9, 2002, p. 1.

Ibid.

Taylor (1998) argued that after the “West's” strong critique of the 1989 crackdown in Tiananmen Square, Africa took on a renewed importance in Chinese foreign policy. China found allies in African leaders who agreed that “the emphasis by the West on human rights [provided] a pretext to undermine China's development and interfere in its own path to modernization” (448). The increased scope of Chinese aid in Africa consolidated relations with countries who stood by China after Tiananmen with the awareness that a block of African votes hold significant sway in international organizations, such as the United Nations. More recently, the principle of non-interference in state sovereignty—especially non-interference due to national government's human rights records—has been further articulated in relation to China's expanded trade for natural resources including oil with Africa (Taylor 2006).

Tanzania's status has recently changed with the substantial loan and aid packages that China extended to central African countries with larger reserves of oil, timber, and gems. Eisenman, Heginbotham, and Mitchell (2007) “China and the Developing World.” Presentation at Institute for African Development at Cornell University, October 11, 2007. For more on China's increasing interest in Africa over the past decade also see Eisenman, Heginbotham, and Mitchell (2007).

A special issue of Africa edited by Pitcher and Askew (2006) on “African Postsocialisms” argues for expanding the traditional theoretical and geographical boundaries that focus postsocialist debates on the former Soviet Union and Eastern European states. My evocation of “frictions” here owes a great deal to Tsing's work (2005).

Kiswahili and English are the official languages of Tanzania. Kiswahili, which is the language of primary education, is widely spoken throughout the country.

At more than US$401 million, the Tanzania-Zambia (TANZAM) Railroad was the largest project China had financed in Africa to that date. Moreover, it became an icon of China's commitment to Africa as well as a marker of a new turn in Chinese foreign policy (e.g., Yu 1971).

For work on the way that a turn to the market cultivated a new politics of consumption and forms of individualism in China, see Farquhar (1996).

Lake Victoria Research Initiative (VicRes) annual conference in Arusha Tanzanian in May 2008 brought together scientists from Tanzania, Kenya, Uganda, Rwanda, and Burindi through a program funded by the Swedish government to support scientific research that will contribute to reducing poverty and enhancing livelihoods in the region. In the first five years (2003–2007), VicRes “has supported 88 interdisciplinary, multi-institutional and multi-country research projects involving just over 400 scientists from more than 60 institutions” (Lundgren and Natura 2008). The initiative includes an ethnobotany cluster, which has particular interest in traditional medicines. The focus of this annual conference directed special attention to issues of commercialization of scientific research findings. The keynote address entitled “From research to wealth creation: experiences from East Africa” by Professor Huru Hatibu the Executive Director of Kilimo Trust in Kampala generated discussion throughout the three days of the meeting.

Paper originally given at the Launching of the NIMR-CINS Laboratory for Herbal Research, in Ngongongare Village in Arusha District on February 2, 2008. Viewed February 26, 2008.

Interview with Mnaliwa (April 13, 2000).

This resonates with Hsu's (2002) study of Tanzanian patients in TCM clinics in Dar es Salaam, in which she quotes a patient who connects being “open” with commercialization and “[t]he ‘look’ of the medicines…[which] made them [appear more] similar to biomedical drugs” (307).

There is some indication that this phenomenon is not limited to Tanzania or to formerly non-aligned states. See “FG Seeks China's Cooperation on Herbal Medicines,” This Day (Lagos) September 20, 2007. In addition, it is consistent with broader shifts in China's foreign policy toward Africa in the 1990s as described by Taylor (1998) and Brautigam (2003).

Mnaliwa argued that such packaging elicits a “tendency to accept” the treatment, yet she never specified among whom. If Lugakingira's medicines are an example, it appears that these new commoditized medicines will circulate among a fairly restricted group. The prices of his vials and capsules (Tsh 40,000 per box) put them out of the reach of all but an elite professional population.

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Stacey Langwick

STACEY LANGWICK is an assistant professor in the Department of Anthropology at Cornell University and an associate with the Max Planck Institute for Social Anthropology. Her book, Bodies, Politics, and African Healing: The Matter of Maladies in Tanzania, is Forthcoming with Indiana University Press. In addition, her work has appeared in journals such as American Ethnologist and Science, Technology, & Human Values, as well as in edited volumes on healing in Africa.