Productive Misunderstandings and the Dynamism of Plural Medicine in Mid-century Bechuanaland

Abstract

This article explores innovation in Tswana medicine (bongaka), and examines the effects of language translation in a plural medical world. Since practitioners and patients of bongaka locate medical authority in the language of ‘tradition’, innovation is often hidden under a gloss of semantic continuity that locates knowledge as ancient and immutable; yet Tswana medicine has changed over time, as all medical systems do. Bongaka embraces a historically fluid nosology, and diagnostic logic that attends to social circumstances and bodily symptoms simultaneously. This enables local medical epistemology to incorporate novel ideas and biological events within a larger framework that reinforces the over-arching unity of the bodily, ecological, and social realms – all of which are in flux. The discussion focuses on Tswana diagnostics and epidemiology in post-Second World War southeastern Bechuanaland, where increasingly pervasive experiences of particular forms of bodily misfortune merged with trends in women's extra and pre-marital sexual activity, male labour migration, intergenerational struggles over (blood, semen, money), and collapsing public health became manifest and understood in terms of evolving disease etiologies. Rather than envisioning medical pluralisation as a process that produces hybrids, the case in question suggests that translation creates productive misunderstandings that facilitate the coexistence of distinct medical categories, while patients become adept at moving across ontologically distinct domains of medical practice.

Notes

¹ Throughout this article I use the term ‘Tswana’ as a shorthand for the Setswana-speaking people who called the south-eastern region of the Bechuanaland Protectorate home. My use of this broad term to denote a local world masks its recent historical emergence as an umbrella identity – one that straddles the border between South Africa and the Protectorate, the internal diversity of thought and practice within Tswana medicine and culture more broadly, and the significant presence of minority ethnic groups within putatively ‘Tswana’ communities at the time. I employ it to streamline presentation here.

^*Portions of this article have appeared in my book, Debility and the Moral Imagination in Botswana (Bloomington, Indiana University Press, 2005). I am grateful to Indiana University Press for permission to reproduce that material here.

² See for example, J. Comaroff, ‘Healing and the Cultural Order: The Case of the Baralong-boo-Ratshidi of Southern Africa’, American Ethnologist, 7 (1980), pp. 637–57; Jean Comaroff, Body of Power, Spirit of Resistance: The Culture and History of a South African People (Chicago, University of Chicago Press, 1985); J. Comaroff and J. Comaroff, Of Revelation and Revolution, Vol. 2, The Dialectics of Modernity on a Southern African Frontier (Chicago, University of Chicago Press, 1997); A. Merriweather, EnglishSetswana Medical Phrasebook and Dictionary (Gaborone, Botswana Book Centre, 1965); A. Merriweather, Desert Doctor: Medicine and Evangelism in the Kalahari Desert (London, Lutterworth Press, 1969); A. Merriweather, Desert Doctor Remembers: The Autobiography of Alfred Merriweather (Gaborone, Pula Press, 1999); I. Schapera, ‘Premarital Pregnancy and Native Opinion: A Note on Social Change’, Africa, 6 (1933), pp. 59–89; I. Schapera, Married Life in an African Tribe (London, Faber and Faber, 1940); I. Schapera, Migrant Labour and Tribal Life (New York, Oxford University Press, 1947); I. Schapera, Rainmaking Rites of Tswana Tribes (Leiden, Afrika-Studiecentrum, 1971).

³ S. Feierman, Peasant Intellectuals: Anthropology and History in Tanzania (Madison, University of Wisconsin Press, 1990). See also R. Packard, ‘Social Change and the History of Misfortune among the Bashu of Eastern Zaïre’, in I. Karp and C. Bird (eds), African Systems of Thought (Bloomington, Indiana University Press, 1981).

⁴ S. Heald, ‘It's Never as Easy as ABC: Understandings of AIDS in Botswana’, African Journal of AIDS Research, 1, 1 (2002), pp. 1–11.

⁵ See for example, P.S. Landau, ‘Where Rain Falls’: Rainmaking and Community in a Tswana Village, c. 1870 to Recent Times', The International Journal of African Historical Studies, 26, 1 (1993), pp. 1–30.

⁶ Parallels can be seen in other domains of translation. See for example, D. Peterson, Creative Writing: Translation, Bookkeeping and the Work of Imagination in Colonial Kenya (Portsmouth, NH, Heinemann, 2004); P. Landau, ‘“Religion” and Christian Conversion in Africa: A New Model’, Journal of Religious History, 23 (1999), pp. 8–30; D. Jeater, ‘“Speaking Like a Native”: Vernacular Languages and the State in Southern Rhodesia, 1890–1935’, Journal of African History, 42 (2001), pp. 449–68.

⁷ For a more thorough discussion of this example, see J. Livingston, ‘Pregnant Children and Half-Dead Adults: Modern Living and the Quickening Life-cycle in Botswana’, Bulletin of the History of Medicine, 77, 1 (Spring 2003), pp. 133–62.

⁸ Author's interview: Sebete Phatswana, 2 July 1999.

⁹ S. Anderson and F. Staugård, Traditional Midwives: Traditional Medicine in Botswana (Gaborone, Ipelegeng Publishers, 1986), p. 125.

¹² Mopakwane is another disease that is also associated with sexual promiscuity. For more on the overlapping transformations between different disease categories in this period see J. Livingston, Debility and the Moral Imagination in Botswana (Bloomington, Indiana University Press, 2005), Chapter 4.

¹³ Interview, Masuko Masimo, 12 March 1999.

¹⁰ For a description of some previous restrictions on male sexuality see, I. Schapera, Married Life in an African Tribe (Evanston, Northwestern University Press, 1966), pp. 194–201. Schapera refers to changes in some of these restrictions as they are practised, though he is not describing the rise of a new model of male sexuality such as that described by some of my informants. See interviews: Modise Thebe, 16 July 1999; Ntene Moilwa, 3 August 1999; Mma Mantshadi, 2 July 1999.

¹¹ Interviews: Mrs Pule, Rra Molatlhwa, and friend, 19 February 1999; Sebete Phatswana, 2 July 1999; Mma Mantshadi, 2 July 1999.

¹⁴ In the interest of space I have abbreviated my discussion of medical pluralisation. In the post-war period, both western medicine and bongaka entailed internal variations, and flourished alongside a range of other related therapeutic systems. Most notably, this phenomenon also entailed the growth of prophetic healing practices (boprofiti). This heterodoxy continued a long-term trend in regional medical exchange and pluralisation that began long before the colonial period and ensuing expansion of western medicine.

¹⁵ Bechuanaland Annual Medical and Sanitary Report, 1945, Annual Report, Kanye.

¹⁶ Council of World Mission Archive (CWM), Africa South Africa Correspondence Box AF/13 folder S Africa Corr Sandilands A. 1940–45: letter from Rev. Sandilands to Ronald Chamberlain, December 1, 1945; folder S Africa Corr Sandilands A. 1946–50: Nathan of Churt to Rev. Sandilands cc: Doctor Harold A. Moody Jan 9, 1946; Rev. Sandilands to Dr Harold Moody, n.d.; Sir Nathan to Dr Moody, 16 Feb., 1946.

¹⁷ Ibid.

¹⁸ R. Packard, White Plague, Black Labor: Tuberculosis and the Political Economy of Health and Disease in South Africa (University of California Press, Berkeley, CA, 1989), Chapter 4.

¹⁹ Bechuanaland Annual Medical and Sanitary Report, 1955. TB rates continued to climb in subsequent decades, and the Medical Department spent more money on TB than any other disease. Botswana National Archives (hereafter BNA) S. 590/1, From Ministry of Health to: All Tribal Authorities, Division Commissioners, District Commissioners, Medical Officers, and Medical Missionaries, cc: District Medical Service, 3 March 1961.

²⁶ Interview, Dr Alfred Merriweather, 8 October 1997. This resonates with my own impressions in Botswana in the late 1990s, when I saw many, many adults with extra-pulmonary TB.

²⁰ Bechuanaland Annual Medical and Sanitary Report, 1955. This is part of a gradual downward trend in the proportional reporting of extra-pulmonary cases. For example, in 1943 the Annual Medical and Sanitary Report found 183 extra-pulmonary cases out of a total of 420 reported cases of TB. This may in part represent increased diagnostic capacity for pulmonary TB, and perhaps also a greater tendency for Batswana to send pulmonary cases to western medical sites.

²¹ For more on the relation of technology to the social construction of diagnosis see K. Wailoo, Drawing Blood: Technology and Disease Identity in Twentieth Century America (Baltimore, MD, Johns Hopkins University Press, 1997).

²² BNA S. 438/2/2, Tuberculosis in the Bechuanaland Protectorate: Annex I: Plan for Control Programmes: Suggestions for the Control of TB in Countries with Undeveloped and Underdeveloped Programmes, World Health Organization n.d. (this document was undated, but located in a file in which all other documentation was from the period between 1943 and 1955).

²³ For example, in Dr Alfred Merriweather's 1969 memoir about his experiences at the United Free Church mission hospital in Molepolole he takes a very expansive rather than narrow view of tuberculosis. He opens his chapter on TB, entitled, ‘Captain of the Men of Death’ with the following description, ‘Tuberculosis is still the greatest medical problem facing Botswana. No other disease causes so much morbidity or mortality. It is the greatest deceiver, presenting itself in many forms; affecting lungs, glands, kidneys, intestines, bones, joints, covering membranes of heart and lungs, and the central nervous system. Whenever a patient complains of a cough or weakness or fever or swelling, we say, “This is tuberculosis until proved otherwise.”’ Merriweather, Desert Doctor, p. 50.

²⁴ Bechuanaland Annual Medical and Sanitary Report, 1950, quote p. 7.

²⁵ Interview Dr Alfred Merriweather, 8 October 1997; see also Bechuanaland Annual Medical and Sanitary Reports for this period. I should note that this continues to be the case well into the present, though the dialogue is now driven by a national medical service and the language of international health.

²⁷ For an excellent example of the uneasy comparison and entanglement of biomedical and Indian diagnostic nosologies in both popular and professional discourse, see L. Cohen, No Aging in India: Alzheimer's, the Bad Family, and Other Modern Things (Berkeley, University of California Press, 1998).

²⁸ P. Landau, ‘Strategy and Selfhood among the Samuelites of Thaba Nchu, South Africa, 1928–1940’, (paper presented at the Northeastern Workshop on Southern Africa, Burlington, VT, 2000).

²⁹ BNA DCL 18/11, Draft of talks on TB and smallpox by H.F. Hilson – Government Inspector of Health, Lobatsi, 1947. A. Merriweather, SetswanaEnglish Medical Phrasebook (Gaborone, Pula Press, 1992), p. 64.

³⁰ Anderson and Staugård, Traditional Midwives, p. 125.

³¹ In the late 1990s I never heard the term thibamo used by patients to describe a tubercular spine or cerebral TB, though given the fluidity of diagnosis, it is possible for the association to yet arise. Anderson and Staugård only mention the bloody cough of tuberculosis as a sign of thibamo, not symptoms of other possible types of tubercular infection. Anderson and Staugård, Traditional Midwives, pp. 123–6.

³² BNA DCL 18/11, Draft of talks on TB and smallpox, by H.F. Hilson – Government Inspector of Health, Lobatsi, 1947.

³³ Interview, Dr Merriweather, 8 October 1997.

³⁴ BNA DCL 18/11, Draft of talks on TB and smallpox by H.F. Hilson – Government Inspector of Health, Lobatsi, 1947.

³⁵ Interview, Ntene Moilwa, 3 August 1999.

³⁶ J. Tom Brown, Among the Bantu Nomads (London, Seeley, 1926), p. 158.

³⁷ For an anecdotal example see, Merriweather, Desert Doctor, pp. 51–5.

³⁸ Interview, Mma Rabasimane, 22 January 1999; Thuso Lekile, 22 January 1999; Kekgabile Molife, 24 June 1999.