Laymen's Understandings about Illness and Body Functioning

As table 13B shows, more than 85 percent of those interviewed had not heard of any substantial part of the Galenic scheme. Eighty percent were without most of the understandings that are basic to the Western scheme. This being so, an organization of the understandings connecting those concerned with the body to those concerned with social morality through the common presence of a belief in the positive effects of balance is not possible for most of those interviewed.

The forty people in the survey provided information through conversational interviews. That is, they were not asked questions with multiple choice responses but were encouraged to discuss freely the issues brought to their attention. After saying that what was wanted was their views on how the body worked and what was mainly responsible for illness, they were encouraged to say whatever they wished.

If they had not mentioned the four bodily characters or elements fundamental to the Galenic view, they were told the names of the elements and asked to comment on them and what, if anything, they had to do with body functioning and illness. Those who did not mention the elements and how they worked in their "free" responses and did not identify two or more of the elements when their names were mentioned were taken not to have "heard of the elements in the Galenic scheme." If, however, their discussion of illness showed that they had a clear idea that particular sorts of foods had particular kinds of effects on the body, in the general way Galenic understandings indicate, they were taken as having heard of the elements of the Galenic scheme even if they did not mention or recognize the names of the elements.

In discussing the Western view, a basically similar approach was taken following from the same question about body functioning and illness. Informants who did not mention them in their spontaneous remarks about the sources of illness (even if they did mention the Galenic elements) were asked to identify presha (high blood pressure), tell what organs were involved in it; identify ambuzika or wito (infection) and comment on its working or origin; discuss afia nzuri (good health) with attention to what promotes it and what interferes with it; and discuss food with attention to its role in health and body weight. Those who spontaneously mentioned any two of the following six terms or otherwise indicated some knowledge of them were taken to have some understandings from the Western scheme. These six were "vitamins," "calories," "cholesterol," "virus," "bacteria," and "germs."

Whether they mentioned two or more of the six terms or not, understandings from the Western scheme were taken as present in those who were able to discuss blood vessels (mishipa ya damu ) in a way that suggested a dis-

tinction between arteries and veins or, in discussing the heart, indicated they were aware of the heart's pumping action or muscular composition. All those who participated in the study were given as much time as they wished to take to discuss illness, health, and the body's mechanics, and all were encouraged to comment on both Western and Galenic views.

Despite this encouragement, less than 15 percent of the sample indicated familiarity with the understandings basic to Galenic medicine and only 20 percent with the Western scheme. Given this lack of familiarity, a reasonable inference is that they could not choose among types of medical care on the

basis of selecting therapists who shared their views of the body and its workings.^[9] Not only were most informants immune to influence by the common importance of balance in social morality and the Galenic scheme of body functioning but they also could not be affected by whatever understandings in the Western approach might make it attractive since they did not share the elements of that scheme either.

In fact, patients usually consulted therapists without regard to whether or not the patients' own understandings were taken to have any correspondence to those they might attribute to those therapists. Table 13C shows that of the thirty-two patients and former patients who have consulted an herbal doctor at least once, twenty-seven (84%) share few or no understandings about the Galenic scheme followed by those therapists. Of the thirty-seven interviewed who have consulted a hospital doctor, thirty (81%) shared few or none of the understandings involved in Western medicine.

The situation regarding knowledge of medical understandings is similar in an important way to what Willis (1972) found among the Fipa in southwestern Tanzania. There the medical practitioners have an elaborate set of understandings about illness resulting from injury to social relationships as a result of the activity of spirits or sorcerers. Laymen understand illness differently as being the result of sorcerers poisoning food and drink because they are jealous of their victims. As with the Swahili, Fipa laymen and experts do not share understandings about illness. There is, however, an important difference between the Fipa and the Swahili laymen: Willis reports the former as having a fairly elaborate set of understandings about the causes of illness,^[10] while the Swahili laymen have no such set.

In some ways, the situation is closer to that Keesing (1987b ) found among the Kwaio, where experts have a rich set of understandings about dying and going to the land of the dead, but those not especially concerned with such matters do not share these. The differences he found between experts and laymen led him to say, "Such diversity of knowledge in religious matters is perhaps not surprising, but it seems to me to render deeply problematic premises about culture as system [sic ] of shared understandings" (ibid., 163).

This is not to suggest that the Swahili patients interviewed had no understandings at all about illness and the working of the body. They did have what Roy D'Andrade suggested was "default knowledge" in that they rejected some suggestions as to how disease occurred and accepted others as possible (pers. commun.). For example, I mentioned to several young and early middle-aged informants that during my first year of visiting Old Town, twelve years prior to talking to them, I had been told by elderly Swahili that many people believed that paving Mombasa's streets with asphalt caused illness by reflecting the sun's heat up and into people's bodies. None of those whom I told about this thought it was likely, and several of them thought the idea was laughable. At the same time, my account of having been told by the same elderly

informants that oven-baked white bread (bofulo ) and other Western foods caused illness was heard with interest. All agreed that such food might be harmful, although none save the few who shared Galenic understandings offered explanations of how it might produce disease.