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9 Leaning on the Cow's Fat Hump Medical Choices, Unshared Culture, and General Expectations
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Why Advice is Followed

The advisers are older than the patients in almost every case. On this basis alone, the formers' advice is to be taken more seriously than that of younger people because of the understandings concerning the wisdom of those who are older. Two proverbs state this quite clearly:

Aliyeona jua kabla yako hata kwa siku moja ana akili kuliko wewe : He who sees [the] sun before your [seeing it] even for one day has sense more than you.

Asesikiza la mkuu kuvundika 'guu : He [who] does not listen [to the words] of [an] elder [is] breaking [his] foot.

There is evidence from other societies that older people may generally share more medical knowledge with one another and with medical specialists than younger ones do (Garro 1986), but it is not just knowledge that makes them important in the Swahili community. The influence of the understanding that those who are older are wiser is enhanced by the fact that the advisers are not just older than the patients, in many cases they are also their parents.

The parent status includes the widely shared general expectation that its occupants are genuinely concerned about their children, and this is surely closely related to the fact that patients say they "trust," "believe in," or (in a few cases) "obey" their adviser. In the numerous cases where the patient follows advice in getting medical care, the connection between his or her understandings about being ill with understandings about what sort of help to get and from whom derives from the general expectations just mentioned and derives its strength from the strength of the relationship.

A few patients and a slightly larger proportion of advisers do share either Western or Galenic medical understandings with each other and with the doctors. For these people, the organization of understandings that leads to getting medical care, and to advising about it, is intrinsically organized and not dependent on general expectations in relations with others for its effectiveness


in guiding behavior. These fairly unusual individuals have multiplex relations with others who do not share the medical understandings, so they are in a position to meet the expectation that they show concern and provide help by providing a link between their partners' view of themselves as ill and the understandings concerning what to do about it.

The interview data suggest that sometimes there are chains of individuals linked together by the general expectations in particular roles and that one or a few participants in the chain have elaborate sets of understandings about medicine and use them to provide advice to a less-versed partner in a multiplex relationship. The latter, then, in time, passes on the same advice to others who may, in their turn, pass it on to yet others. In most cases, the advice will be effective even though none of those currently associated with it has a developed set of medical understandings. This is because effectiveness derives directly from general expectations of concern and help rather than from specific understandings about particular things.

Another group of advisers do not share the experts' medical understandings in any substantial number, but in the past, they have had personal experience with the therapist or kind of therapy (usually both) they recommend. These advisers form chains as well as the more knowledgeable ones do, except that these advisers often originally went to the therapist they recommend on someone else's advice. There seems always to be some kind of link between the therapists and the patients which does not depend solely on general expectations of help from people whose cultural competence in the area is not very different from the one needing help. This link, however, can be mediated through a substantial number of relationships, none of whose participants need have either much experience or much knowledge of the medical understandings at issue. A little knowledge may or may not be a dangerous thing, but through social transmission, it can go a long way.

Looking at this from the perspective of the social structure of the Swahili community, it is that structure, rather than the cultural elements concerning illness and treatment acting directly as a guide to behavior, that accounts for the choice of therapy and therapists in many cases. This social structure, the connections among statuses based in the mutual references in the understandings that constitute the expectations and salience understandings in those statuses, is a product of culture. Through statuses having different expectations, culture is distributed among actors so that some have understandings about Galenic or Western views of medicine, while others do not. Some have generalized expectations in their relations with particular others, and others do not have them in those relations.

But the social structure does more than distribute culture. It provides, as we have just seen, a basis for organizing elements of culture and providing schemata for individuals who have no means of forming them on intrinsic grounds. Through the mediation of social relationships—most specifically,


the general expectations that are part of the statuses of those involved in the relationships—understandings are linked together so that people have a basis for action even though they do not share the understandings essential to that action.

Nor is this social structurally based cultural organization limited to medical understandings or to the Swahili community. It seems likely that the same sort of organization operates for Fernandez's West African participants in ritual who share few understandings about that ritual with ritual specialists in their group and Keesing's Solomon Islanders who know little of what their community's specialists know about what lies behind the ways they act toward the dead.

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9 Leaning on the Cow's Fat Hump Medical Choices, Unshared Culture, and General Expectations
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