Explanation and Uncertainty in the Medical World of Ghaambo

One of the central questions about African healing practices, a question asked many times during the past sixty years, is how they can be compared to science, and particularly to science-based medicine. E. E. Evans-Pritchard, in his famous study of 1937, assessed the worth of Zande oracles and therapeutic magic as a system of natural observation and prediction. He observed Zande practices, and from them he abstracted chains of causal reasoning, which he found to be flawed when evaluated according to the standards of "science" and "logic." Thirty years later, Robin Horton returned to the same issues. In an article section entitled "Divination versus Diagnosis," he argued that African folk-reasoning about disease leaves no room for disproof. He described traditional African reasoning as "closed," so that it systematically blocked out alternatives to accepted causal explanations. Science, by contrast, is "open." In the decades since then, positions have changed, but the core scientific comparison lives on. In 1997 Roy Porter described colonial attacks on African and South Asian healers. His own assessment of popular medicine was sympathetic, but he continued the practice of measuring it by scientific standards. "Popular medicine," he wrote, "has by no means always been misguided or erroneous. Recent pharmacological investigations have demonstrated the efficacy of many traditional cures." ¹ A 1999 exploration of twenty Web sites on "African traditional medicine" found that three quarters of them were concerned with the efficacy of herbal medicines; the underlying assumptions about efficacy were materialist/mechanistic ones. ² In this latest generation the rhetoric of multicultural participation is new, but the core comparison of "traditional" thought and Western science persists, from Evans-Pritchard to the World Wide Web.

The story of this persistence raises serious questions. Are the underlying criteria appropriate ones, or do the very standards of efficacy miss the point? Would the people who actually used "traditional" medicine judge it in the same way? Within African societies where local forms of healing were practiced, were the actions of herbs as material objects seen as having a direct effect on the body-as-mechanism? When patients or practitioners assessed the value of a course of therapy, were they interested in it primarily as a set of actions in the material world, or were they assessing therapy (and the underlying problem) on some other basis? There appears to be a substratum of universal experience--the universality of pain and the desire for relief--but even this is misleading, for "pain" and "relief" change from one society to another, even from one individual to another. In an important sense the questions asked here are unanswerable, because they are cast in terms of the African continent, which has more than three times the land area of the United States, is enormously diverse in its cultures, and is occupied by people who speak between 750 and 1,000 languages.

Because of this complexity, and because of the difficulties of cultural translation, ³ I can offer no more than a sketch, with reflections, on one small place--a single village in northeastern Tanzania where, for a period of two and a half years (between 1979 and 1981), three researchers recorded interviews with patients and their caregivers about the causes of illness and the efficacy of therapies. Ghaambo was then a village of about seven hundred people, all of whom spoke the Shambaa language, and most of whom also spoke Swahili, the national language of Tanzania. I was one of the record-keepers during the first eleven months of the period (from July 1979 to June 1980). Each day I walked from household to household, visiting as many as I could, asking people about their current illnesses, what healing actions had been taken, who had decided on them, who had paid, and what the patients or caregivers understood to be the causes of the illness and the nature of the therapy. I...