Cultural Organization and Guidance: Choice without Understandings

For more than three-quarters of those interviewed, the decision about what help to get must be made on a basis other than a personal set of understandings about what sort of treatment would be most likely to produce desired results since they share few understandings about treatments and how they work. There is a good deal of sharing, however, of understandings about the signs of being ill. These include pain, sleeplessness, weakness, fevers, loss of appetite, changes in eliminatory activities, and, occasionally, aberrant behavior. There is, people say, some judgment involved in deciding one is ill because sometimes these signals can occur and persist without anything consequential following. Most people say that they come to the understanding that they are ill from the severity of the initial symptoms, from their persisting for an extended period, from the similarity of the symptoms to those leading to familiar illnesses, or because someone—usually a member of their household—convinces them that they are ill.

There is also fairly uniform sharing of the understandings that indicate a variety of types of medical help is available. Even though all believe that expert medical care for the sick is often needed and that many kinds are available, most lack a schema that directs them in what choices to make once they decide they are ill. Many have no understandings of their own which make it obvious that one sort of care is to be preferred above another.

In situations where there are no perceived alternatives, where all medical help is viewed as "the same" or different but in unclear ways, the individual need only understand that competent help is needed and where it can be got. When, however, there are sources of help that are taken to differ in important ways, the individual must be able to choose among them to avoid suffering the fate of the fabled donkey between equidistant and equally attractive bales of hay. As table 14A shows, there is a strong basis for believing this problem is present since the Swahili are aware of the availability of quite different types of medical care but understand little of their nature or specific differences.

Not much help in choosing among available therapists is provided by language. Many of the most commonly used names for illnesses are quite inclusive. Homa can be glossed as "fever" and applies to all conditions in which the patient has an elevated body temperature as evidenced by sweating,

being warm to the touch, and, sometimes, having chills. Kohoa refers to a cough and is used for all illnesses involving that symptom. Kitwa , a word meaning "head," is used for any disorder involving head pain; pua , nose, is used for the symptoms often described as a cold in the United States; and all chest pain or difficulties in breathing can be called kifua , chest, or pumzi , lungs.

It is notable that none of these disease terms carries with it any intrinsic suggestions for action other than to seek medicine identified by the name of the illness. Thus, if one has a headache, one may buy dawa ya kitwa from a Western drugstore or one of the two herbal medicine shops. Even this, however, depends on deciding between the two kinds of medicine, and some basis for this decision is necessary. The decision could be—and sometimes is—made on the basis of the distance to the shops selling the different types or on their relative price. This is likely to be effective, however, only if the medicine chosen performs as the patient hopes it will. If it does not, the patient must decide what to do, and this may lead him or her to seek guidance. Lacking understandings about how the illness comes about, this guidance must be derived from sets of understandings of other kinds including, especially, the advice of those whom the patient trusts.^[11]

There are names for specific conditions, such as baridi kuu (lit. great "cold" with the last word referring to the Galenic element) for stroke, wito for infections, presha for high blood pressure, kipindupindu for seizures and cholera, and moyo (lit. heart) for all heart diseases. These last, however, are experts' names and become known to many only after they or those close to them have undertaken treatment for them with herbal or hospital doctors.