Your Pocket Is What Cures You: The Politics of Health in Senegal (review)
Buy Issue for $25 at JHUP- Your Pocket Is What Cures You: The Politics of Health in Senegal
It is with great enthusiasm that I read Foley's Your Pocket Is What Cures You: The Politics of Health in Senegal. The topic fits well with my interest in health disparities, and the use of qualitative techniques makes the book very reader-friendly. Foley's book title is very fitting. In Senegal, just as in other countries around the globe, your pocket is what cures you—that is, whether you are cured depends upon your financial resources.
Foley's book is rooted in ethnography and addresses the issue of health care in Senegal by means of a community-based approach. The book is clearly and logically structured with 10 chapters, each addressing a sub-topic. The 189-page book includes section notes, glossary, references, and index sections. Structural visual aids such as a Senegal health data table and maps are utilized appropriately to engage the reader fully.
Chapter one presents the African Health Story, a story of increasing poverty, crumbling social services, health systems redesign, shifts in government responsibility, and increasing unemployment rates. An ethnographic framework is used to tell the story of ordinary men and women in Senegal. More than two decades of structural adjustments within the country have not increased citizen access to the most basic forms of health care. Reforms cited include community engagement in hospital and clinic financial management; fee for service; and health care costs shifting from the government to its citizens. As you read the story of Senegal's efforts to grapple with health needs, the plight of the individual citizen is always evident. Foley writes, "… until their crops were sold, villages made the most of the limited medical resources available to them; their treatment decisions were greatly constrained by time, cost, and inability to leave their onion fields for more than a day at a time …" (page 2). [End Page 701]
Chapter one concludes with the observation that the division between the poor and the rich in Senegal continues to increase. This sets the stage for issues addressed in the subsequent chapters: A Brief History of Senegal; Urban and Rural Dilemmas; Global Health Reform in Saint Louis; Market-Based Medicine and Shantytown Politics in Pikine; Knowledge Encounters; Gender, Social Hierarchy, and Health Practice; Domestic Disputes and Generational Struggles over Household Health; Encountering Development in Ganjool; and Believe in God, but Plow Your Field.
Foley conducted a total of 20 months of field research in Senegal between 1996 and 1999, and in 2002, 2005, and 2006, employing sound and suitable methodologies to collect data: a multi-site, multi-method approach including focus groups, semi-structured interviews, and participant observation. Citizen narratives point out the dysfunctionalities of the health systems in Senegal.
The major strength of this volume, in my view, is its transparency about the limitations/challenges of qualitative research and related professional boundary struggles. The author's comprehensive literature review spanning from 1919 to 2008, adds credibility to the field research.
Chapter three (Urban and Rural Dilemmas) was the most intriguing. Urban/rural health access differences have existed around the globe since time immemorial and are evident even within the Western world. In the book, multiple views and experiences are investigated to support comparisons between the outcome of health care reform in urban and rural settings. Economic differences contribute greatly to the divide within the two regions and affect individual and families responses to illness. The problems shared by both urban and rural areas are striking: vulnerability to disease due to food insecurity, flooding, and irregular access to clean water.
Chapter six (Knowledge Encounters) introduces the interplay between religion and health. African healing systems clash with the modern biomedical providers on many occasions. Traditional practices among the community members are alive and must not be ignored. Health care decisions are influenced by multiple factors: availability of medical resources; individual economic situation; and cultural knowledge frameworks. "Leaving things in God's hand" is a common stance. As one community...
