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

1. My research on understandings concerning the body and illness was in two distinct phases. I spent a good part of the time I was in Old Town during summer 1987 interviewing three practitioners of what they and others said was "traditional Swahili medicine." I also talked to a number of other informants who viewed themselves as "interested" in medical matters and who proved to be remarkably well informed. This last group included women who are known for their medical knowledge by their families and neighbors and who sometimes actually treat the latter, something men who were not "doctors" seem never to do. I returned in summer 1988 and spent most of my visit interviewing people, chosen because they were willing to be interviewed and had reported themselves as ill or having recently been ill. These informants were not screened for their knowledge of or interest in medical matters or their lack of it. I also interviewed some who advised the first group on how to deal with their illnesses. [BACK]

2. The Republic of Kenya provides its citizens with free medical care at government facilities including a number in Mombasa and a large hospital in Old Town itself. Medications have to be bought, however, and a considerable number of the members of the Swahili community consult private physicians and use one of the several private hospitals in Mombasa. Private physicians were charging between $2 and $5 for a consultation in 1987. Medications are mainly imported but are not subject to import duty and seem slightly less expensive than in the United States. Given the incomes of Swahili families where more than $3,500 a year is considered prosperous and half of that is taken as an acceptable income for a small family, these fees and costs are by no means low, but many people manage to meet them anyway. [BACK]

3. This herbal doctor rejected my offer of $12 for an hour or less of interviewing but, in the end, saw me and answered my questions willingly and without charge. The other two herbal doctors were obviously quite pleased with their honorarium, and I am quite sure I would not have been able to continue interviewing them had I not paid it. [BACK]

4. These twigs are sold at small shops throughout the Swahili section of Mombasa. They are typically cut from either one of two trees, Salvadorus persica or Dobera loranthifolia , but vendors sometimes substitute others when these are not available. [BACK]

5. All treatment involves the danger of side effects resulting from the excessive effectiveness of the treatment or from an unwanted interaction of the disease and its treatment. Excess success in removing an excess can result in the appearance of symptoms of a new excess that is opposite to the one originally being treated. For example, the attempt to lessen excess hot can produce symptoms, or even full-blown illnesses, of excess cold or the treatment can lead to excess hot, manifesting itself in abdominal difficulties and expressing itself in pain in the teeth, neck, and jaws. Some part of the tabibu's skill consists in his or her ability to compound medications that, together with the prescribed diet, will correct the existing imbalance without inducing a new one. [BACK]

6. A "penny" is a Kenyan ten-penny piece that weighs approximately 28 grams. [BACK]

7. The Swahili do have understandings that hold individuals can be harmed by the malice of others in rather the same way the Azande do. Some of these have been

mentioned in chap. 7 where envy was seen to be a destructive force through the operation of mato, the evil eye. In addition, Swahili understandings include those that see persons of bad will as able to use jins as agents or to employ sorcerers from other ethnic groups to harm their enemies. When people whisper of an illness, kuna makono wa mtu (there is the hand of a person), they are referring to sorcery in most instances. However, most Swahili do not understand most illness to result from "the hand of a person," and a considerable number believe that illness is never caused in this way. [BACK]

8. The hypothesis that the relationship goes the other way--that the views of social morality are strengthened by the importance of balance in body understandings--cannot be dismissed, of course. My evidence about this hypothesis is slender, but it may well be true or, as is even more likely, the understandings strengthen each other through an interaction. [BACK]

9. It could be that the patients had no very well formulated view of how the body worked but, nevertheless, thought that herbal doctors--or, equally possibly, hospital doctors--had views they approved of. There is, however, no evidence to support this view. Patients seemed either surprised at or uninterested in the implied suggestion that they might have substantial views of the body's functioning and illness's sources or that they should be concerned about the correspondence between their own understandings of how illness comes about or is cured and those of the therapists who treat them. In most cases, informants seemed indifferent to differences in approaches to illness and were concerned only with success in treating it. [BACK]

10. My work with the Bena who live several hundred miles south of the Fipa shows that Bena laymen have understandings about disease similar to those of the Fipa, but, unlike the Fipa, many of the same understandings were held by Bena experts as by Bena laymen (Swartz 1969 b ). It is notable that jealousy is understood by laymen, experts, or both as a major source of illness in such diverse African societies as Fipa, Bena, and Swahili as well as in societies on other continents such as the Gujerati of India (Pocock 1973). The relation of jealousy to illness suggests the presence of some cultural organizations of similar sorts in quite different societies despite differences in economics, religion, kinship, and politics. [BACK]

11. Advertising provides a set of understandings that can be used in place of those allowing the patient to choose a course based on his or her view of what is causing the illness. These understandings conveyed by advertising are often very broad, suggesting the suitability of what is advertised to a variety of problems. One of the most commonly encountered ads in Kenya is for Aspro, a headache, fever, and cold medicine. Its motto is Aspro ni dawa ya kweli (lit. Aspro is medicine of truth/genuine[ness], i.e., Aspro is genuine or true medicine). [BACK]

12. The Walimu pray in the ordinary way for a sick person's recovery or for the preservation of his or her health. A few of them also provide a sort of medicine by writing Koranic verses in henna on plates and then putting water on the plates. The patient drinks the water with the dissolved henna in it. [BACK]

13. As noted in the preface, the difficulties in getting informants in this community makes all data-gathering difficult. It would have been preferable to have as many male informants as female, but there is no evidence to indicate that what is said here applies only to women and that men have a broad and general set of understandings about medical care or get advice from people with whom they have simplex relationships. Similarly, the advisers of the patients in the original sample I was able to talk with

were all parents (8) or spouses (4), and I was not able to interview any advisers who were neighbors, siblings, or co-workers. I do not believe this affected the findings. [BACK]

14. Garro (1986) found that there was little difference between curers and noncurers in the specific cultural elements shared, but curers and older people shared more with one another than young people shared among themselves. This latter part of Garro's findings are similar to those here in that advisers, who are older than patients in the Swahili group, do share more medical understandings with curers than young people share among themselves. It is not true in the Swahili group, however, that curers and others differ little in what they share. This may well be true because of the technical nature of what the "curers" (i.e., herbal doctors and hospital doctors) share in Mombasa as compared to what is shared among the comparable group in Garro's study. [BACK]

15. The Swahili, as noted in chaps. 1 and 2, speak the Kimvita dialect of the Swahili language. Older people sometimes complain about outsiders (i.e., those who are not Swahili from any of the recognized communities along the coast) misusing the language and, especially, its form as taught in the schools of Kenya and used in public life. Everyone understands standard Swahili, and all but the oldest people can speak it without difficulty, but some are not pleased by it and avoid situations where they must use it. [BACK]

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