Panel 36

Health, politics and culture in Africa

Panel organiser: Eren Zink, Uppsala University, Sweden

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From local health centers and traditional medical practices, to scientific research facilities and health policy documents, the papers in this panel reveal some of the processes and relationships whereby the promise of good health becomes entangled with politics and culture in Africa. In a context where illness and disease are a continuing burden upon communities across the African continent, access to knowledges, technologies, and practices for producing health and well-being are strategic resources that actors, institutions and other collectives seek to possess, and whose (re)distribution they seek to govern.

Offering both historical and contemporary accounts, this panel investigates the manner in which resources with potential to produce health and well-being are incorporated into broader political and cultural projects within and beyond the borders of African communities. Rather than focusing on the specific sufferers of disease and ill-health, this panels focuses on the politicians, NGOs, scientists, state agencies, religious organizations, unions and other assemblages of actors that incorporate the provision and production of health into their broader strategic endeavors.

Approved abstracts Panel 36

1. Political culture, nationalism and biomedical AIDS care in central Mozambique

Author: Carla Teófilo Braga (Eduardo Mondlane University, Mozambique)

As any other human endeavor, biomedicine is a historical formation permeated by socio-cultural, political and economic relationships . There is no single biomedicine but a multiplicity of biomedicines, and as a cultural construction biomedical practice is imbued with values and norms.

In Mozambique biomedical care is provided mostly by the state through the National Health Service. However, AIDS care in particular, is provided through institutional arrangements comprising the state, aid agencies, international and national NGO’s, churches, and associations of persons living with HIV and AIDS. AIDS clinics - a vertical approach to HIV/AIDS care – concentrated most of AIDS treatment in Mozambique and the ministerial decision to integrate those clinics into primary health care services sparkled quite some controversy. Based in two years ethnographic fieldwork in Manica province, central Mozambique as well as in the country’s capital, this paper suggests that:

  1. Biomedicine, as a symbol of science and therefore rationalism, modernity and “progress” occupies a key place in post-colonial political discourse in Mozambique;
  1. The resurgence and reinforcement of some nationalist discourses during AIDS clinics integration process seem to show criticism of transnational AIDS’ aid as well of the reconfiguration of the relations among territory and sovereignty under a neoliberal paradigm for healthcare provision;
  1. Biomedical authoritative knowledge and hierarchical features coupled with Mozambique political culture marked by authoritarianism, strict hierarchies and “obedience to superior decisions” affect healthcare provision and quality of care within the National Health Services in terms of: i) ministerial decision-making, ii) enforcing and assuring the acquiescence and obedience of health professionals, and iii) displaying rank and exercising power in clinical encounters.

2. Everyday health governance as democratic substance: Public health, party politics and municipal democracy in Burkina Faso

Author: Sten Hagberg (Uppsala University, Sweden)

This paper is about health governance and local politics, particularly how public health dispensaries become assets for political claims and positions. Public health is central for citizens and political actors alike. Dispensaries represent in a sense the substance of municipal democracy, as they may offer citizens benefits and a return from politics.

The Centre de Santé et de Promotion Sociale (CSPS) – or dogotoroso in Jula – has for long time been at the core of political and administrative struggles in Sidéradougou in Burkina Faso. For fourteen years, a local opposition politician chaired the CSPS health management committee in an efficient everyday governance. Over the years, this engagement came to pave the way for his political career. He was opposition leader in the municipal council in 2006-12 and in 2012-14. Yet his political involvement also meant that the attacks from power-holders of then incumbent Congrès pour la démocratie et le progrès (CDP) came through the health management committee. In the May 2016 municipal elections taking place in a changed political landscape of Burkina Faso this politician is running for elections of the Nouvelle Alliance du Faso (NAFA) against the ruling Mouvement du Peuple pour le Progrès (MPP). Hence, this politician is still in opposition against the new incumbent MPP. In conclusion, the paper argues that the ways in which everyday health governance articulates with public health and political culture in Burkinabe municipalities tell us something important about how everyday health governance can become the very substance of democracy in municipal politics. In this vein, everyday health governance may provide legitimacy to municipal democracy well beyond the specific health issues at stake.

3. Mobile phone texting and the facilitation of ethnomedical response at the time of Ebola

Author: Ivo Ngade (Department of Anthropology, Rhodes University, South Africa)

Based on qualitative research about local responses to disease spread, especially ebola conducted in Limbe, Cameroon, this paper examines the rise of mobile technology on health information dissemination. Meanwhile ebola never occurred in Cameroon, reports of the first cases in neighboring Nigeria created widespread panic, fear and uncertainty among locals in Cameroon. As a result, news of Garnicia, a fruiting of west African tropical plant found to contain bioflavonoids (known to have inhibitory effects with various pathogens), xanthones (with insecticide capacity) and benzophenones (with anti-allergen qualities) (Iwu, Duncan and Okunji 1999) as purported remedy went viral through mobile phone texting. As mobile technology has brought about changing culture in Africa, this paper also attempts to highlight the relevance of telephony usage in local culture as this creates means of social responses during a fear-inducing crisis such as ebola. Findings for this research have implications on the role of technology on health in a particular cultural context.

4. Reducing inequalities in development practice: a case study of water and sanitation sector

Authors: Hisayo Katsui (Helsinki University, Finland)
Nathaly Guzmán Figueroa (Helsinki University, Finland)

This research aims at reducing inequalities through research process particularly for persons with disabilities (PWDs) in the Global South.

We focus on water and sanitation sector which is fundamentally important for any human being. However, even when one of the Millennium Development Goals of access to clean water has been achieved in time, the need of such access for PWDs in the Global South is paid little attention to.

When it comes to development cooperation, disability mainstreaming has been challenged in most development practices. The UN Convention on the Rights of Persons with Disabilities has been ratified by 150 countries. However, even after the era of the Convention, PWDs in the global South have often been left behind from practice of development efforts. For instance, less than 1% of the Finnish Official Development Aid goes for disability-specific projects and programmes, while 99% of mainstream development activities rarely include those at the risk of inequalities such as PWDs. Therefore, the research investigates on disability mainstreaming in water and sanitation sector.

Continuous personal interviews to stakeholders, focus group discussion and observation are essential methods in comprehending the complexity of both mainstreaming and disability-specific development practices and their impact to each other. In Tanzania, a slum was visited to interview PWDs and stakeholders on their experiences on water and sanitation. In Nepal, a Finnish-Nepalese bilateral development cooperation project on water and sanitation was visited to clarify challenges and opportunities for PWDs in participating in water management. The paper presents preliminary findings from these fieldworks.

5. The medicinal use of land mark trees of Mbundu Villages in Kwanza Norte Province, Angola; The indigenous healing practice’s contribution to the primary healthcare sector

Author: Éva Sebestyén (Universidade do Porto, Portugal)

Due to the Angolan Land law of 1994-revised in 9 November 2004 the process of land delimitation, and title emission has been started a decade ago with collaboration of FAO and NGOs in order to recognise officially the rural communities land borders. This national task also deals with the protection of customary right of rural communities to land use and adjacent natural source uses. My paper has a special link with the rural land demarcation process, namely, the trees used as land mark between the villages in my fieldwork area, in Samba Cajú, Kwanza Norte Province proved to have properties of several kind of economic use, and most dominantly in the field of traditional healing. Angola has an very rich and poorly studied botanical diversity with 250 families and 6961 species. The recent studies focus on the recognition of this diversity in Bengo Province, North Angola and a special research on anti/malarial plant in South Angola try to answer this huge demand. My contribution to the local primary health center in Kwanza Norte aims to give a historical contribution with the written record of land mark trees in village chiefs “archives” produced between 18th and 20th centuries and the medicinal use of these trees identified with the help of the Botanical Centre of Tropical Research Institute in Lisbon.

Key words: land mark trees, medicinal use, , preservation of traditional medicinal practices, primary health centres.

6. Deviant and disease-ridden sexualities - a study on Twitter as a tool for reframing sexual minority status in Uganda

Author: Cecilia Strand (Uppsala University, Sweden)

Post-colonial Uganda has witnessed a surge of persecution of sexual minorities with the notorious Anti-homosexuality Bill introduced in 2009 as a culmination of legal and institutionalized state-condoned discrimination. The Anti-homosexuality Bill of 2009 also further entrenched negative media discourses on sexual minorities. Rights that are indisputable for other Ugandan citizens most notably rights to privacy, health and indeed life, were openly questioned in relation to sexual minorities in mainstream media. Although the causalities behind this change in public policy and increasingly negative opinions on sexual minorities are contested, the features of media discourses are better understood. Traditional media has repeatedly provided space to both religious leaders and elected public officials to frame sexual minorities as vectors of moral vice and disease, most notably HIV.

The following study analyses a Ugandan sexual minority networks’ utilization of Twitter to bypass traditional media’s negative othering and failure to provide space for self-representation, as well as actively challenge negative discourses by supplying the domestic public with counter-narratives in connection with the 2016 general election. The analysis of the network’s 407 tweets (Nov 2015-Feb 2016) indicates that although Twitter is used as a space for highlighting organizational activity in general, activities and information sharing are often connected to health and healthy living beyond HIV. But even more notable is the high proportion of tweets celebrating the Ugandan LGBT community and its members. In fact, almost a third of the tweets were dedicated to showcasing the communities’ accomplishments and instilling pride in its members despite a pronounced discriminatory context. Tweets celebrated the LGBT community’s resilience in adversity, courage, as well as honored its fallen heroes. Twitter as a platform, was thus not only a space for organizational coordination, and one-way information sharing, but a space that is used to actively challenge discriminatory and negative othering of sexual minorities by featuring inspirational and psycho-social supportive messages. The study finally discusses the importance of access to alternative public platforms for developing a sense of collective and individual self-efficacy in discriminatory environments.

7. Traditional healing, biomedical practice, and mental illness – in search of intercultural medical practices

Authors: Annika Teppo (Nordic Africa Institute, Sweden)
Yanga Zembe (South African Medical Research Council, South Africa)

Post-apartheid South African policy pronouncements on mental health care emphasize a shift towards universal primary health care. Universal primary health care places the integration of mental health services in primary health care and the development of community-based rehabilitation services at the heart of decentralization and de-institutionalization processes. The call for a re-imagined mental health system is based on the reality that the current system is inadequate, under-resourced and incompetent in meeting the demands of its client base, particularly in hard to reach areas.

South Africa’s inadequate mental health system fails to reach the most vulnerable among people with mental disorders. South Africa’s goal of universal primary healthcare requires innovation in the way in which mental health services are provided to poor and hard to reach populations. Presently, nearly half of the people with mental disorders use traditional healers as well as medical clinicians to address their condition. Traditional healers and biomedical mental health practitioners understand the contributing factors of mental disorders differently and apply different diagnostics and treatments.

In this paper, we will discuss problems and opportunities regarding a possible collaborative engagement between traditional healing and biomedical health systems. We claim that this co-operation is imperative for South African mental health system. So far, there has not been sufficient culturally sensitive health systems research on how this could be achieved in practice. We suggest that policies on mental health and traditional healers may change once it has been demonstrated that new models of integrative medicine that help to establish practices of mutual, intercultural learning are possible and implementable.

8. Double burdens and multiple opportunities: Disease and international research collaborations in sub-Saharan Africa

Author: Eren Zink (Uppsala University, Sweden)

In universities and research centers in cities like Harare, Entebbe, Kampala and Accra, tropical diseases link an array of local and foreign scientists, research institutions, funding agencies, and governments together under the mantle of international scientific collaboration. This paper draws upon ongoing ethnographic fieldwork and surveys amongst biomedical researchers in three African countries to interrogate the narratives and ambitions that contribute to the stability of these networks. It demonstrates how beneath the veneer of accounts tailored to fit the expectations of international financers of research and Northern scientific partners, there remains a robust and oftentimes contradictory repertoire of meanings and purposes for carrying out medical research in sub-Saharan Africa. The stability of the collaborations rely upon the strategic hiding, unknowing, or deletion of alternatives at critical moments (such as the application for funding), thereby facilitating the cohesion and persistence of the actor-networks.

In addition to being an anthropological exercise in understanding how diseases are known by actors with different histories and sets of social ties, this paper offers a practical contribution to understanding the composition of contemporary models of bio-medical research collaboration in sub-Saharan Africa.

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