A Chinese ‘modern’ device transforming the traditional healers’ practices in Cameroon

Abstract

In the field of health, China's contribution is generally addressed either through its cooperation programmes or by the opening of private clinics by Chinese ‘doctors’. In Yaoundé and Douala, some private practices have been opened and various works have highlighted their role in the dissemination of traditional Chinese medicine (TCM) in Cameroon. Yet the craze for these structures did not last long. Today, while signs of their existence are still visible, many of these firms are closed. China's influence in the health field is, however, far from negligible, but it is taking place in unexpected areas. The circulation of goods and knowledge from China leaves more room for local reappropriation. Indeed, some Cameroonian traditional healers include knowledge from China in their daily practice through the use of ‘machines’ coming from China to ‘purify the body’, to ‘eliminate fat’, to regulate the tension, to ‘stimulate acupuncture points’ or ‘make diagnosis’ (using the quantum analyser or a ‘diagnostic machine’). From direct observations conducted between 2014 and 2021, this article presents the issues at stake for the practice of traditional healers by the modernization of the field through specific therapeutic devices and the quantum analyser coming from China into the health Cameroonian landscape. The paper demonstrates that the performance of the diagnostic machine has less to do with the concrete efficiency of the diagnosis of pathologies than with the dynamics of visibility vis-à-vis patients. The quantum analyser is, therefore, an interesting element revealing the constant process of renewal of medical pluralism in Cameroon, in which China is playing a central role today.

Dans le domaine de la santé, la contribution de la Chine se traduit généralement soit par ses programmes de coopération, soit par l'ouverture de cliniques privées par des « médecins » chinois. A Yaoundé et Douala, quelques cabinets privés ont été ouverts et divers travaux ont mis en évidence leur rôle dans la diffusion de la médecine traditionnelle chinoise (MTC) au Cameroun. Pourtant, l'engouement pour ces structures n'a pas duré longtemps. Aujourd'hui, alors que des signes de leur existence sont encore visibles, nombre de ces entreprises sont fermées. L'influence de la Chine dans le domaine de la santé est pourtant loin d'être négligeable, mais elle s'exerce dans des domaines inattendus. La circulation des biens et des savoirs en provenance de Chine laisse plus de place à la réappropriation locale. En effet, certains guérisseurs traditionnels camerounais intègrent des savoirs venus de Chine dans leur pratique quotidienne à travers l'utilisation de ‘machines’ venues de Chine pour ‘purifier le corps’, ‘éliminer les graisses’, réguler la tension, ‘stimuler les points d'acupuncture’ ou ‘ établir un diagnostic » (à l'aide de l'analyseur quantique ou d'une « machine de diagnostic »). A partir d'observations directes menées entre 2014 et 2021, cet article présente les enjeux pour la pratique des guérisseurs traditionnels par la modernisation du terrain à travers des dispositifs thérapeutiques spécifiques et l'analyseur quantique venu de Chine dans le paysage sanitaire camerounais. L'article démontre que la performance de la machine diagnostique tient moins à l'efficacité concrète du diagnostic des pathologies qu'à la dynamique de visibilité vis-à-vis des patients. L'analyseur quantique est donc un élément intéressant révélateur du processus constant de renouvellement du pluralisme médical au Cameroun, dans lequel la Chine joue aujourd'hui un rôle central.

Keywords:

• China Africa
• Chinese medicine
• African agency
• traditional healers
• Cameroun
• Chinese goods

Mots clés:

• Chine Afrique
• médecine chinoise
• agency africaine
• guérisseur traditionnel
• Cameroun
• produits chinois

1. Introduction

In Yaoundé, everyone seems to know Jean-Pierre, a traditional healer who uses the term ‘naturopath’ to describe himself. Displayed outside his spacious shop in the Efoulan district are a wide range of products and therapeutic remedies. Yellow, orange, and bluish PET bottles fill the shelves. Inside the shop are several kinds of preparations. Signs explain the therapeutic indications of certain remedies, such as ‘Sea salt: purifies, 1st use nine days at the same time, then once a month’, ‘Baby face: Anti-aging, anti-pimples, anti-rejuvenating dark circles’, and even ‘Chlamydia’. Another explains the recognized skills of Jean-Pierre: ‘itching, white loss, sterility, painful rule, cycle disturbance, bleeding outside the rules, sexual weakness, etc.’. Below, another sign specifies the cost of an exam (9000 Fcfa) and the phone number of Jean-Pierre's clinic. At the back of the shop, next to the counter, several photos of Jean-Pierre shaking hands with officials during events organized by the National Federation of Natural and Traditional Medicine Practitioners adorn the walls, alongside titles and diplomas he has obtained. Like many successful traditional healers in Yaoundé and Douala, Jean-Pierre has a ‘quantum analyser’ imported from China. A machine – commonly called a ‘scanner’, ‘Chinese machine’ or ‘diagnostic machine’ – that supposedly carries out a full diagnosis in a few minutes.

Among the different ‘made in China’ products and devices used by traditional healers, the quantum analyser is the one we observed the most often in Yaoundé and Douala. This device not only has a strong impact on the appeal of traditional healers, but also changes their practices. For this reason, we decided to analyse this local reappropriation of a Chinese product, allowing us to analyse the evolution of the practice of traditional healers in the competitive working environment.

Thus, our research continues the work of attempting to explain how products, knowledge, and techniques from diverse origins are aggregated in traditional medical practices (Ergot and Simon 2012; Hampshire and Asiedu Owusu 2013; Ergot and Desclaux 2015). Indeed ‘Traditional healers  …  selectively adapt, adopt, and modify elements of biomedical “local” and “exotic” healing practices’ (Hampshire and Asiedu Owusu 2013, 247).

Our fieldwork, however, took place in a new context where the ‘modernity’ comes from China. As has been analysed in research on other types of products, the arrival from China deeply transforms not only the modes of consumption but also methods of trading and undertaking (Kernen and Khan-Mohammad 2014).

This research on a specific Chinese device allows for a nuanced examination of the circulation of Chinese knowledge and techniques in Cameroon. In contrast, as we will detail later, most prior research on the influence of China on the health-care sector has focused on the circulation of individuals (Cameroonian or Chinese), traditional Chinese medicine (TCM), or biomedicine that have circulated through different Chinese cooperation programmes.

For this research, we relied on an inductive method nourished by several fields in Cameroon. Our first fieldwork took place between 2013 and 2016, with others occurring more recently between 2020 and 2022 during three different research projects.¹ Our first two research projects had a wider focus. However, they were, on one hand, the starting point of a reflection on the Chinese influence on the health of sub-Saharan African countries and, on the other, established the first contact with informants and first study data. Research fieldworks done between 2020 and 2022 were much more focused on this topic. Together with our research team, we performed new and extensive fieldwork in Cameroon. We, thus, had the opportunity to meet more traditional healers and also re-interview people we had already met. Thanks to the relatively long duration of the fieldworks, we were able to establish relationships of trust with our informants, which allowed for direct and participatory observation in the field, on the one hand, and observation over time of the evolution of their practice over several years, on the other.

Despite the sanitary crisis due to the Covid 19 epidemic, which limited mobility, we were able to go to the field in January 2021, October 2021, December 2021, and January 2022. Between 2013 and 2022, we conducted 37 semi-directed interviews with therapists, including Chinese doctors, traditional healers, naturopaths, and nurses. During those years, we acquired ethical clearance from the Ministry of Public Health Cameroon and Ethical Clearance and Research authorization from the Catholic University of Central Africa.

In the first part of this article, we will focus on the evolution and diversification of the Chinese influences on the health sector in Cameroon. The establishment of diplomatic relations with the People’s Republic of China on 26 March 1971 marked the beginning of governmental cooperation programmes. The arrival of Chinese migrant entrepreneurs in the health sector during the late 1990s paved the way for the diversification of Chinese influence in Cameroon. Those private entrepreneurs initially controlled the import of goods, devices, and even knowledge before a process of selective appropriation took place in the context of increasing circulations of goods, individuals, and knowledge with China. Now, the number of Chinese entrepreneurs’ actives in the health sector but not the influence of China in the sector, have decreased. While the majority of Chinese clinics have closed down, a significant number of traditional healers continue to sell Chinese health products and use Chinese devices.

In the second part of the article, we analyse the uses of the diagnostic machine by traditional healers stressing the importance of this device in the competitive health sector characterized by the diversity of therapeutic offers. This analysis leads us to question the status of traditional healers and the reconfiguration of local medical practices.

2. Evolution and diversity of Chinese influences on health sector

While Chinese modernity² is mostly present among traditional healers in Cameroon today, it is important to remember that the impact of China in the health sector is relatively old. In Africa, the China’s influence in the health sector began in the 1960s, with the development of governmental cooperation programmes (Brautigham 2009; Li 2011). Indeed, in African countries that did not have Chinese communities that had arisen from trade (Zanzibar), colonial economies of mines or plantations (South Africa, Reunion), or the construction of infrastructure (Congo) allowing for the dissemination of medical practices through private networks, the Chinese cooperation programmes initiated this process. In this sense, the nature, image, and methods of circulation of medicines from China differed greatly with those from Europe or North America as the Chinese state played a central role in this process.

In the 1960s, the Chinese government developed a foreign policy in the context of its emancipation from the tutelage of the USSR. Consequently, its engagement in the Non-Aligned Movement and support to recently decolonized African countries assumed increasingly important roles. As a result, through its cooperation, the People’s Republic of China invested in the health sector by sending medical teams, donating drugs, or building and equipping hospitals (Li 2011). However, these interventions essentially operated in a biomedical context.

Cameroon signed several agreements with China from 1975 onward (Wassouni 2010, 2011; Li 2011; Prince Pokam 2011) that allowed the construction of hospitals and the dispatch of medical teams. The district hospital of Mbalmayo (1975) and de Guider (1976) were the first to benefit from Chinese medical aid, followed by hospitals specializing in gynecobstetric and paediatric cases in Yaoundé (2002) and Douala (2014). In all four hospitals, Chinese medical teams currently take turns every two years. The teams consist of a dozen doctors from different biomedical specialities and an acupuncturist.

2.1. Chinese medicine in Cameroon

Currently, the role of the Chinese state in the circulation of Chinese medicines in Africa is central and focuses largely on biomedicine. However, even though only one acupuncturist in each medical team has been sent to Cameroon since 1975, these practitioners mark the specificity of Chinese cooperation and are more publicized. Thus, most press articles written on Chinese medical cooperation mention the presence of acupuncturists.³

In addition, the scholarships offered by the Chinese government contribute to the diffusion of biomedicines and traditional Chinese medicine (TCM) (Kernen and Guex 2016). Although few scholars have completed a full course on TCM at a Chinese university, many more have become familiar with TCM through short stays in the country..⁴ Indeed, China recently offered three-month foreign exchange courses to allow beneficiaries to familiarize themselves with different aspects of Chinese culture (e.g. martial arts, calligraphy, massage, and acupuncture).⁵ Some of these short courses are organized by the Shaolin monastery for African students. At the end of this training, students obtain a diploma from a Shaolin monk and are encouraged to become ambassadors of Chinese culture in the world as one student recalls: ‘The Chinese told us that on our return, we would have to spread Chinese culture in our country’. Back in Cameroon, some of these Shaolin monks set up kung fu schools and health centres where they practise massage and acupuncture.⁶ Thus, although the timing of when Chinese care practices and techniques arrived in Cameroon is not so different from that of Europe or the United States, the nature of this care and the methods of its dissemination strongly differ.

In the late 1990s, the renewal of China–Africa relations attracted more private traders and companies on the continent (Kernen 2014). Africa became a market for a wide range of Chinese goods (Sylvanus and Foucher 2009; Kernen and Khan-Mohammad 2014), including health and medical products.

At the same time, private doctors arrived from China. This broad movement of circulation of Chinese and Asian medicines has also been observed elsewhere (Hsu et al. 2008; Zhan 2009; Coderey and Pordié 2019; Wang 2019; Candelise 2016), nevertheless, locally it differed significantly due to local socio-cultural situations, national health governance, socio-political relations with China, and temporalities of Chinese migration. Elisabeth Hsu’s (2008) pioneering anthropological work explains, for example, how Chinese medical practitioners have been part of Chinese communities in Tanzania for several decades (Hsu 2008). In Cameroon, the temporality of Chinese migration differs as the first wave only arrived in the early 2000s. However, although the Chinese private practitioners arrived later in Cameroon, similarities can be found in their profiles. The importance of the ‘migrant entrepreneurs’ described by Hsu (2012, 230) in Kenya (2012), Tanzania (Hsu 2007), and Zanzibar (Hsu 2008) can also be observed. The anteriority of the mobility of Chinese medical practitioners in East Africa can be linked to the importance of the bilateral relations with those countries since the 1970s.

The arrival of Chinese practitioners in Cameroon drew the attention of several researchers. A paper on the increase of the private care supply in Cameroonian cities counts four private Chinese clinics in 1999 in the Biyem Assi district, in the centre of Yaoundé (Akoto et al. 2001). Later, François Wassouni (2010) continued this work and identified several more private Chinese clinics in different districts of the capital (104-105). Currently, the opening of private Chinese clinics has generated real enthusiasm in the country (Wassouni 2010 and 2011, Prince Pokam 2011).

Researchers working in this field have attempted to understand the reasons for the rapid spread of Chinese medicine. According to Monteillet (2011), the success of these practices rests as much on the technological dimension as on its proximity to Cameroonian traditional medicine: ‘The attraction of high-tech care that colonization had helped to awaken explains this success as much the old popular or learned naturopathy in permanent search of omnimédicaments and omnidiagnostics’ (223).

Hilaire de Prince Pokam (2011, 58) also addressed the Cameroonian craze for Chinese medicine and stressed the importance of its dissemination in less ‘important’ cities like Bafousam, Dchang, or Bandjoun, through seasonal tours by private Chinese doctors. These Chinese doctors offer inexpensive consultations to sell relatively expensive therapeutic products manufactured in China. In a slightly different manner, networks of ‘Chinese doctors’ were set up at the same time in Burkina Faso with the aim of distributing Chinese medicine. Equipped with a suitcase, stethoscope, and blood pressure monitor, these ‘doctors’ crisscrossed the capital’s neighbourhoods and some rural markets to sell medicines made in China. In Burkina Faso, however, the term ‘Chinese’ did not describe the dealer’s nationality but the origin of the products.⁷

These examples highlight the importance of the products in the dissemination of Chinese therapeutic practices and the blurring distinction between TCM and biomedicine from China. Indeed, it would be a mistake to imagine Chinese clinics as places where only acupuncture was practised and TCM pharmacopoeia sold. For administrative or customs reasons, these clinics generally advertised themselves as such, but practised all ‘medicines coming from China’. In Cameroon for example, as selling drugs was central to their profitability, the deliberately blurred distinction between TCM and biomedicine from China was done with commercial interest in mind.

2.2. China in Cameroonian medical pluralism

Indeed, the excitement over the sale of Chinese-made therapeutic products goes far beyond discussions between the Chinese and doctors. During the 2000s, a large number of Chinese traders in Cameroon (and in Burkina Faso and Ghana) imported and resold such products. Chinese health products are also sold on intercity buses where Cameroonian dealers extol the multiple virtues of their product to passengers. In most cases, these health products include massage balms, magnetic tapes, and green creams, rather than real remedies from Chinese pharmacopoeia or Chinese-made biomedical drugs. Their ability to deal with several pathologies make them interesting to more customers (Wassouni 2011; Ngawa Mbaho 2018).

However, this craze did not last. After interviewing Chinese doctors in 2013 and 2014, we realized that many Chinese doctors had left the country or changed their professional activity. One reason was due to the strong reaction from the National Order of Doctors of Cameroon and the administrative and political health authorities: ‘They would have obtained the closing of some Chinese clinics’ (Akoto et al. 2001, 11). Another reason was the increased risk (and cost) of importing drugs illegally to Cameroon. A strong campaign against ‘fake medicines’ was launched on September 6, 2011 to limit the illegal import of drugs from China. This operation, called Cobra, was conducted by Interpol and implemented simultaneously in various West and Central African countries. Not only did Cobra seem to disrupt existing networks for a while, but many Chinese traders also decided to reorient their activity towards less risky businesses. This repressive moment marked a turning point in the development of Chinese-run private clinics. Difficulties in importing and selling therapeutic products decreased their profitability. Today, signs of some clinics are still visible, but many are closed or idle in the absence of a Chinese therapist.

Consequently, this moment marks the end of a new medical offer almost exclusively dispensed by Chinese ‘migrant entrepreneurs’ (Hsu 2012). Indeed, over a very short period, the medicine coming from China proposed by Chinese doctors in Chinese clinics transformed the medical pluralism by proposing a new offer. The term ‘medical pluralism’ has been used by various anthropologists for several decades to explain the parallel use of biomedicine and African traditional medicine (Dozon and Sindzingre 1986; Dozon 1987; Benoist 1996). Nowadays, Chinese doctors are much less numerous and no longer represent a specific offer within the Cameroonian medical pluralism. Indeed, this new medical offer did not survive in the competitive health market in Cameroon. Of course, the disappearance of Chinese doctors and clinics in Cameroon does not mean that Chinese knowledge, techniques, or products are no longer present in the country. Rather, Cameroonian traditional healers have appropriated the products and knowledge into their daily practice. Because we are assessing the shift from the circulation of people to the circulation of Chinese medical knowledge and products, we chose to focus on the logic of why Cameroonian traditional healers have appropriated products and knowledge arriving from China.

Indeed, for many Cameroonian healers, Chinese products, devices, and knowledge have become a new source of inspiration and differentiation. In this sense, studying Chinese products used by traditional healers offers a new perspective on the dynamics of borrowing and of the hybridization of work in the health sector. In other words, traditional healers in Cameroon, as elsewhere, transformed their own practices by integrating new elements. This process has been described with the concept of medicoscopes, ‘which aims to grasp analytically the embedding of medical pluralism within worldwide distinct and asymmetrical dynamics in the (re-)formation of topographies of power through new configurations of actors interacting across the globe’ (Hörbst, Gerrets, and Schirripa 2017, 17).

Acting ‘in a very competitive healing market’ (Beneduce 2011), traditional healers in Cameroon sought to reposition themselves within a dynamic of constant reinvention of tradition (Bayart 1989; Hobsbawm and Ranger 1983). We are, thus, in line with studies showing appropriation mechanisms at work by traditional healers in different parts of the continent (Beneduce 2011; Filakota 2011; Baxerres and Simon 2013; Bourdarias, Dozon, and Obringer 2014) and their diversity (Digler, Kane, and Langwick 2012). Langwick (2010) also shows how the circulation of products and individuals with China has affected the vision of local traditional medicine in Tanzania. Following the Chinese medicine model, it became ‘a very specific kind of national (economic) “health”’ (32).

Even so, very few researchers have specifically addressed how products and techniques from China have influenced the practices of traditional healers. However, Bourdarias, Dozon, and Obringer (2014) argues that these products and techniques are the origins of a ‘new medical syncretism’, marking the evolution of traditional healers’ practices in Cameroon. Ergot and Simon (2012) also mention in their research on ‘neotraditional drugs’ that are now exported from China. In a more recent work, Ergot and Desclaux (2015) analyse how dietary supplements are occasionally transformed into ‘drugs’ or, for Kernen and Mounpe Chare (peer review), a new alternative therapy.

Besides therapeutic products, numerous devices are also imported from China. Some are based on TCM, including how to locate or stimulate acupuncture points. Other devices break away from Chinese medical conceptions of the body or health such as a device communally referred to in Cameroon as ‘Detox’ that claims to eliminate the toxins stored in the body by putting patient’s feet in liquid. Very little research has been done on this profusion of Chinese devices with supposed therapeutic or preventive virtues, although Hampshire and Asiedu Owusu (2013) were interested in quantum analysers with magnetic resonance. They studied the pathway of Ghanaian traditional healers, who ‘adopt, adapt and incorporate’ elements of biomedicine and local and ‘exotic’ medicine (including the quantum analyser) into their daily therapeutic practice, giving rise to changing situations of medical pluralism. In these contexts, the authors showed how the discourse of traditional healers always oscillates between ideas of modern and traditional order to legitimise their practice.

3. The Chinese quantum analyser by traditional healers

During our field-work observations, we were fascinated to see that the quantum analyser is used in a plurality of therapeutic contexts by a great diversity of Cameroonian healers. We also observed that even if it was not used, it was, nevertheless, known and sometimes perceived as an object of desire and a guarantee of success. In other words, everyone in Cameroon, patients and practitioners alike, know of the quantum analyser but only certain traditional healers make use of it during their practice. It also became clear to us that, traditional healers with this diagnostic device used Chinese techniques and knowledge to improve their positioning in an increasingly competitive care supply market.

Moreover, this Chinese device does not refer to the principles of so-called ‘traditional’ Chinese medicine either. Its user manual refers to quantum medicine, which claims to rely on quantum physics to explain a form of intercellular electromagnetic communication. Commonly called a scanner, diagnostic machine, or a Chinese machine, the machine claims to be able to carry out a diagnosis earlier and faster than biomedicine through the ‘bioresonance’ technique. However, very few people seek to understand the principles on which this imported device claims it is based. The main thing seems to be its ability to make a full diagnosis in a few minutes.

Among the traditional Cameroonian healers we met, many sought to ‘modernise’, that is, make their activity more technological and make themselves and their care more competitive. The meaning of ‘modern’ for these healers becomes clear when they use the quantum analyser. The analyser is a metal case containing a device to which various cables are connected, one connected to a computer and another with a metal electrode at the end. The quantum analyser, therefore, functions via a computer on which the ‘image is balanced’, and interacts with the patient through the metal electrode that the patient squeezes in their hand for two minutes while the quantum analyser scans the patient’s body. In the meantime, the patient observes a silhouette of a human on the computer screen, represented with red lights that pass from top to bottom. The images of internal organs, vascular system, skeleton, brain, etc. also appear alongside the human figure to show which part of the body is being scanned every moment. The quantum analyser emits a specific beep during its analysis of the patient. This ensures that these two minutes are timed by a technical sound and several animated images on the computer screen.

For traditional healers, this means two minutes for setting in motion the power of this technology, and delegating the assessment of their patient’s health to the machine. For patients, it is two minutes of trusting the healer, having their health judged, and scanned. During these two minutes, the patient has the sensation of being physically traversed by a kind of vibration. The image which appears on the screen can be interpreted by the patient as their own body. Step by step, the device analyses their organs, their circulation system, and so on. This moment is often used by the traditional healer, who does not explain to the patient how the device works, to better capture the patient's attention through the evocative power of the images that appear on the computer screen.

Once the scan is complete, the quantum analyser delivers tables with numerous values between 33 and greater than 50, depending on the model. These values, the scale of which is not very clear, give indications of cardiovascular function, gastrointestinal function, brain function, tendencies of bone diseases, the presence of heavy metals, vitamin deficiency, deficiency of trace elements, reproductive functions and much more. For each function, the quantum analyser also produces an ‘expert opinion’ giving advice on healthy living, such as eating, drinking, and playing sports. All this information, sometimes redundant, is interpreted by the traditional healer to formulate a diagnosis consistent with the remedies that he can offer to the patient.

Upon their arrival, the machines became part of a logic linked to the resale of food supplements. By identifying the weaknesses of the patient before they turn into a disease, the machine articulates food supplements that seek to treat these weaknesses.

Gradually, however, the use of the quantum analyser was no longer exclusively linked to the resale of (Chinese) dietary supplements but, instead, taken up by certain traditional healers seeking to distinguish themselves and modernize their practice. Since its appearance in Cameroon, the quantum analyser has been sold outside the official circuit by Cameroonian resellers of herbal teas and Chinese remedies or in places where products for hairdressers or beauty salons are marketed. Most often, the quantum analyser arrives in Cameroon in the suitcase of a trader who has established commercial relations with China. The quantum analyser is then sold by word of mouth in specific places of commerce in the country’s major cities. Because of its price in Cameroon, this instrument is only accessible to healers who have been established for some time, have a good clientele, or have parallel activities that allow them a little more financial comfort.⁸

4. A Chinese modernization of traditional healers’ therapeutical practice

Beyond its concrete use, the quantum analyser delivers results in biomedical language, which necessarily differs from that of a Cameroonian traditional healer’s. This device puts the practitioner (traditional healer or naturopath) at the crossroads of several languages and, Thereby, of several approaches to health and illness. The use of this device offers them the opportunity to refer to biomedicine, traditional African medicine, and potentially also quantum medicine. In what Lamont and Molnár (2002) define as ‘boundary work situations’, the analytical categories lose their characteristics linked to a specific discourse and expand to other interpretative logics. As Hampshire and Asiedu Owusu (2013) demonstrate for Ghana, the use of devices such as quantum analysers, like that of other technical devices, allow healers to use broader registers of traditions and modernities. They can, thus, present themselves on the health market not only offering traditional remedies but also as having recourse to modern technological instruments.

This means that any practitioner using a quantum analyser uses different registers of knowledge or develops new ones of their own, juggling the analytical categories of various systems of interpretation of illness and disease. This allows them to broaden their therapeutic offering.

As numerous authors show (Dozon 1987; Fassin and Fassin 1988; Tonda 2001, 2002; Beneduce 2010), traditional healers in search of legitimacy in contemporary Africa countries constantly need to renew their dialogue between traditional medicine and modernity. The configuration of traditional medicines, therefore, becomes multipolar (Tonda 2001) by bringing into play different poles (political, religious, economic, and medical) complicated by the dynamics of hybridization and a plurality of approaches. As a result, from the 1970s on, these traditional healers have worked to obtain better recognition as naturopaths with the creation of associations or federations that increase the visibility of their practice. More recently, these same therapists have found themselves engaged in procedures to improve exercise conditions and, above all, professionalization. These approaches remain individual as they correspond to personal journeys, ranging from the need for professionalization to safeguarding their symbolic healing power (Beneduce 2010).

This approach is a form of neo-traditionalism, as described by Pordié (2008). In fact, ‘The discourse of these therapists is systematically based on tradition, whether it was effective or invented. Resolutely forward-looking what they see as progress, the traditional healers concerned are committed to both defending and transforming their medicine’ (Pordié and Simon 2013, 13). In this direction, traditional healers working in the main Cameroonian cities aim to renew their traditional therapeutic exercise by passing through modernization and technologization and positioning their offer more closely to official medicine.

This results in complex if not contradictory situations, as these traditional healers sometimes try to use disparate care techniques to better meet the needs and demands of their patients. As studies on plural (Benoist 1996), holistic (Baer 2001), and alternative (Cant and Sharma 1999; Schmitz 2006) therapies show, the therapeutic configurations can change quickly under the influence of social, cultural, political, and economic dynamics. The mobility of these therapeutic configurations and the fluidity of the boundaries between what is considered modern or institutionalized and what deviates from a scientific standard is unique to medical pluralism. These dynamics often generate somewhat paradoxical situations, as in the cases we observed. Indeed, during their search for a personal and professional identity, these traditional healers and naturopaths risk bringing their identity as local healers into question by introducing modern and scientific elements. Modernity could be put to work to the detriment of their image as traditional healers; they are inserted in a precise social and cultural network that technology and science could oppose (Dozon 1987; Fassin and Fassin 1988; Beneduce 2010). Finally, traditional healers develop what Marsland (2007) calls an ‘intentional hybridity’ when presenting the position of waganga in Tanzania:

The waganga are challenging this vision of themselves [incorporating aspects of biomedicine] as outside of the mainstream. By taking on (or aspiring to take on) aspects of modern medicine, they are challenging the representation of themselves by others as ‘traditional’, since they are open to innovation from ‘outside’. One could even argue, from within its own constructions of ‘tradition’, that it is biomedicine itself which is more ‘traditional’ of the two medical systems. Although it draws on scientific knowledge, its borders are (more or less closed) to innovation that does not take place within its own community of knowledge. (2007, 756)

The notion of intentional hybridity leads to the idea that the boundaries between traditional and modern medicine are ‘incompatible’ (2007, 755). Traditional healers create another way to legitimise their practice that is more innovative than biomedical therapists’ practice.

With this in mind, during our observations and meetings with our Cameroonian informants, it appeared that the quantum analyser was perceived by Cameroonian traditional healers as a guide or bridge for connecting their traditional practice to the ‘scientific modernity’ coming from China.

Claude, a Cameroonian ‘Chinese doctor’, one of the first to use this device and the director of one of the best known private traditional Chinese medicine clinics in Yaoundé, uses the term ‘bridge’ to describe the quantum analyser:

It provides a more exact orientation on the continuation of the diagnosis, it does not abbreviate the diagnosis which one can pose on the patient. It gives an opening on the diagnosis. This machine steers, it makes bridge. Now if you have a patient with heart palpitations, that doesn’t mean they have heart problems. The machine helps you to understand why they have these palpitations … they can be undernourished, or have the blood pressure too high or too low. So, when you ask for an exam, it’s just to complete the diagnosis. You didn’t say anything, it’s like the machine is giving you advice.

Philippe, a naturopath who worked in a Chinese clinic selling dietary supplements in Douala, told us, ‘It is a guide, a guide – an orientation machine. The machine is not enough, it is just to complete the diagnosis, but with that I still have results. That said, a machine cannot do everything’.

In the discourse of these practitioners, this device does not contradict with their practice as traditional healers or naturopaths. According to them, making a diagnosis with or without a diagnostic machine does not change their therapeutic practice. We also know that the traditional healers we have met are part of an urban universe created by the circulation characteristic of globalization. The modernization of their practice is, therefore, aimed at a clientele that fits into Cameroonian urban modernity. In this regard, this machine is part of a device for selling not only traditional decoctions and remedies but also imported dietary supplements.

4.1. A performing device in the competitive medical pluralism

When we arrived in his shop, Jean-Pierre, who greeted us with a big smile, recognized one of us who had already met him during a previous field study. Jean-Pierre is one of the naturopaths in the city of Yaoundé who has obtained different titles and national diplomas by the Cameroonian state as part of its strategy to promote indigenous medical knowledge. It is with the title of doctor that he establishes his legitimacy as a healer with a large clientele.

Indeed, from his cabinet, we saw passers-by wishing to buy a product they knew of, asking for information, or wishing to make an appointment, while neighbours merely passed by to discuss something.

Addressing the issue of using the scanner, Jean-Pierre showed us his two devices and was happy to explain the operation of the one he had just bought in detail:

I’m going to explain to you, it’s not very complicated, when a Chinese person sets up their machine, he doesn’t do it like the French, he doesn’t bureaucratise it; he makes it accessible to someone who has done the CM2. That means that you shouldn’t have done the university … , no. It’s accessible to everyone, to almost everyone, you just need the B, A, BA and you’re done. … In fact, if you are a doctor, that means that you have a few notions. When you have a few notions, he explains to you how it works and it is over. It’s the scanner, the magnetic resonance.

For a naturopath like Jean-Pierre, the simplicity of using the machine is an important argument. A whole rhetoric is set up in his speech to explain to us how the French make medical and commercial procedures difficult, while through interaction with the Chinese everything becomes simple and achievable: ‘If in France you are looking for that, we will ask you for some papers and documents, I don’t know why  …  Give me the machine, and that’s it!’

We visited the office of another healer in Yaoundé who did not have this diagnostic machine. He shared with us his vision of technology and modernity, as well as his desire to acquire a diagnostic machine: ‘It’s a matter of trust in science! I would like to have this machine  …  If there was a machine [in my office], I would be proud to be able to receive patients by modernity. Everything must be mixed with modern and traditional things’. In Cameroon, such a machine is expensive, and not everyone has sufficient means to acquire one.

Traditional healers who have this device recognize its contribution to satisfying customers without hesitation, highlighting how modernity becomes a guarantee of notoriety and, thus, appeals to patients. However, in the same speech, they typically stress the importance of the practitioner’s abilities in diagnosing and taking care of patients: ‘The machine we buy because people have a little more confidence in the machines, when you use a diagnostic tool, he is happy. Otherwise, we can work without it, there is no problem!’ (Jean-Pierre). Or again:

The quantum is a device that gives exact assessments; it provides a more exact orientation on the rest of the diagnosis. It does not shorten the diagnosis that can be made on the patient, it just gives an opening on the diagnosis. (Alvin)

In the end, healers who possess this device claim that their knowledge does not need to be supplemented or validated by modern instruments as their usefulness lies in the fact that they legitimise the healer’s work in the eyes of patient. Though without any specific usefulness to the healer, the machine makes it possible for them to stand out from the competition.

As Hempshire et al. show in their article on Ghana and Tanzania, ‘Signalling theory to health-related trust problems’ (2017), the emergence of the quantum analyser in private herbalist clinics in the two countries is an ‘indicator of trustworthiness’. We observed a gap among traditional urban healers between those who have the machine and those who cannot acquire it. By giving modern and scientific performances to the healer, the machine’s presence for most customers is a guarantee of respectability and competence.

4.2. A device between diagnosis and the sale of remedies

Importantly, that the quantum analyser is intended as a diagnostic instrument for quantum medicine. This alternative medical theory, developed in North America and Europe beginning in the 1970s, is based on the idea that magnetic resonance, or human bioresonance, allows cells to communicate with each other through electromagnetic signals. In the hands of traditional Cameroonian healers, the theoretical references of this device produced in China change completely. From cellular bioresonance, Cameroonian healers have kept only the name. We, therefore, witness a diversion from the use of this device that, as Françoise Bourdarias says, is ‘an object that symbolises the power of Chinese medical technology and knowledge’ (2014, 15). Furthermore, this technological and quite expensive device does not fundamentally modify the therapeutic practices of traditional healers, but essentially strengthens their authority to facilitate the sale of local therapeutic products or imported dietary supplements. The result of a quantum analyser gives the practitioner complete freedom to interpret its results. Moreover, when we are told that ‘the quantum analyser gives only indications, just diagnostic trends’ (Alvin), we see that the traditional healer retains the power to complete the diagnosis, which is merely provided by device. This space of interpretation claimed by the traditional healer allows them to have the last word concerning the outcome of the diagnosis and, of course, the therapy to follow.

During our fieldwork, we set up participant observation⁹ by taking part in two diagnoses using the quantum analyser at a distance for one day in two different naturopathic offices. The first diagnosis was made where dietary supplements were sold. We met a reseller of these dietary supplements who accompanied us to where they distributed these preparations. They sold a wide range of dietary supplements ranging from spirulina algae to vitamin complexes. Upon talking to the staff, we were told that Pascal (a healer with a lot of experience who had worked with them for some time) would pass by to make diagnoses with the quantum analyser. After being introduced, Pascal told us about the wonders of this device, offered us a test for 3000 Fcfa each, and in a few minutes, delivered two fairly complex diagnoses read from his computer screen, which he summarized in a few words: We are both healthy people, with some tendency towards cholesterol problems. Still, he strongly advised us to buy spirulina algae.

The next day, we went to Jean-Pierre as patients and asked him to show us how the quantum analyser worked. He was very happy to do so, and he offered a personalized diagnosis for 3000 Fcfa each. After the diagnosis with the quantum analyser, Jean-Pierre spent some time commenting on all the data received. He was faced with results that were undoubtedly much closer to biomedical (or scientific) language than to local medical practice. Despite this, Jean-Pierre obviously wanted to show us that he had no problem interpreting the results of the diagnostic machine and that he had mastered the tool perfectly. He proposed a very different diagnostic framework to each of us and he recommended a series of personalized actions to treat our health problems.

Comparing the values of our two diagnoses done over two days from Pascal and Jean-Pierre, we noticed that the data was practically identical. Our values had not changed overnight, but what had changed was the practitioner’s interpretation. The results of the quantum analysis in their specific contents were marginalized, even put aside, and were not offered to us under the pretext that they were only indicative values. Nevertheless, the same results were perfect levers to try, even succeed, to sell their therapeutic products, remedies, or the dietary supplements of the company they worked for. We had identified the heart of the ambiguity of the diagnostic device’s use by the traditional healers we observed.

Finally, China’s contribution to this evolution of local therapeutic practice in Cameroonian cities is mainly due to its technical appearance and the contribution of modern knowledge and practices in a context where traditional healers or naturopaths embody the roles of ‘cultural couriers’ (Benoist 1996, 12). Thanks to the fluid borders between various theories and expertise in a transcultural dimension, which are specific to contexts of medical pluralism, cultural couriers are developing their practices by updating their degree of hybridization day by day.

5. Conclusion

The presence of the quantum analyser in the daily practice of traditional healers is only one revelation of a wider trend of Chinese presence in the Cameroonian health sector that corresponds to Balandier's notion of ‘techno-imaginary’: ‘that is to say of an imagination which no longer works “in the old way”, but which works by making room for techniques and knowing how to govern them’ (Balandier and Chanial 1994, 124).

The performance of this device confronts traditional healers with the risk of questioning their identities as local healers with therapeutic secrets, leading an ambiguous attitude between tradition and modernity – an attitude that could work against them sooner or later, but which simultaneously positions them in a process of constant dynamic innovation.

However, the practices of traditional healers who have undergone a modernization process and defy official medicine do not result in more patients who wish to be scanned using the famous quantum analyser. Therefore, this modernization does not affect the evolution of medical practices but, instead, is aimed at the dynamics of visibility vis-à-vis patients.

Finally, the appearance of the quantum analyser in the Cameroonian therapeutic landscape, therefore, is a step towards Cameroonian medical pluralism, which is constantly redefining itself, rather than an innovation in the medical environment that is intended to change the status and the practice of traditional healers in major Cameroonian cities.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Statement of Ethics

At the time this study was conducted, University of Lausanne did not require ethical approval to be sought for this type of research.

Additional information

Funding

This work was supported by Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung [grant number Chinese medicine in African medical pluralism].

Notes

1 Agence National de la Recherche (ANR), ‘Space of Chinese Culture in Africa’ directed by Jean-Pierre Dozon 2011–2015. (https://esca.hypotheses.org/), hosted by Fondation maison des Sciences de l’Homme.

Swiss National Science Fondation (SNF) ‘the Revolution of Chinese products in Africa’ directed by Antoine Kernen hosted by University of Lausanne (2013–2016).

Swiss National Science Fondation (SNF) ‘Chinese medicines in medical pluralism in Africa’ directed by Antoine Kernen (2020–2024) hosted by University of Lausanne.

2 We use the expression ‘Chinese modernity’ to explicate the fact that part of the modernization and change in practices of traditional healers are now influenced by the circulation of Chinese individuals, goods, and knowledge. We are, of course, aware that the ‘local medical tradition’ has always been nourished by multiple borrowings. Moreover, these processes of modernization of the ‘Cameroonian medical tradition’ are not new. However, the role of the circulations from China is recent.

3 See, for example, the website actucameroun.com: ’Coopération médicale : Déjà deux hôpitaux de référence construits par la Chine au Cameroun’, 21 March 2018.

4 Interview with Roger who completed a full course on TCM in China 21.11. 2014, 09.03.2018, 17.11.2021

5 Field research in Cameroun 2019, 2021.

6 Interviews in Douala, Yaoundé, Penka-Michel, Bafoussam, Foumban, (October 2019) with students that spent three months in Shaolin (China) undertaking Chinese scholarship.

7 Fieldwork in Burkina Faso, November 2013 focused on the circulation of Chinese product in the country during the Swiss National Science Fondation (SNF) research project ‘the Revolution of Chinese products in Africa’ directed by Antoine Kernen, hosted by University of Lausanne (2013–2016).

8 The same machine is sold in China, Europe, and the United States at a much lower price.

9 We volunteered ourselves for a diagnosis with two traditional healers according to the recommendation of Russel Bernard’s ‘Skills of a Participant Observer’: ‘The strength of participant observation is that you, as a researcher, become the instrument for data collection and analysis through your own experience’ (2002, 338). The object of our research was not medical treatments, but a diagnostic process. Consequently, our personal involvement in the field ended with the end of the data collection. Our field research respected the ethical rules of participant observation.