Local Knowledge: development opportunities coming from the countryside? Methodological and political strategies and challenges in the health area
Date and Start Time 29 June, 2017 at 14:00
The panel proposes to gather and compare research experiences conducting to contrast or to evaluate local knowledge efficacies in the largest sense in African health contexts, focusing in the social sciences contribution. A panel of SACUDA-GESA (Health, Culture and Development in Africa)
The meagre achievements of development policies in Africa and the limited investment expectancies have provoked that many international development agencies (WB, UNESCO, WHO…) come to include Local Knowledge (LK) in their programmes, with the following challenges epistemological (holism versus science) and political (community versus civil society) challenges. The paradox lies in the fact that apparently this "epistemological impurity" is also its source of resilience and adaptability, because LK connect very distinct "technological instances". Then, the activation of Local Knowledge in development contexts requires an associated research focused reconciliatory methodologies and participative scenarios. This second aspect requires a reformulation of the relation between urban and rural spheres, because LK often achieves it maximum coherence and effectivity in this last context, usually considered as "backward" and guide needing. So, the country could be not just an "space to be modernized", but a "technology reservoir". Maybe healh is the field where this research betting arouses more expectations and fears at the
same time, given the importance that all societies attached to it, and the rigor of the control on diagnostic and therapies that modern society intends to apply to it. The panel proposes to gather and compare research experiences conducting to contrast or to evaluate local knowledge efficacies in the largest sense (from traditional pharmacopeia to community health or sociotherapy) in African health contexts, in order to extract lessons to improve both the national health service and the international health cooperation; the panel will focus in the social sciences approach but no exclusively.
This panel is closed to new paper proposals.
Medical pluralism and plural epistemolgy. African lessons from Madagascar
The utilitarian opportunities open by the recent focus of development agencies on medical pluralism depends on the epistemological capacity of searchers to deal with “deep” logical diversity. Africa (and particularly Madagascar) is an excellent field to survey this new challenge.
The medical pluralism well established in Africa has changed from being seen as an obstacle to be proposed as an opportunity by the development agencies, from WHO to UNESCO. This change is beginning to have some effects in the African Health Systems, especially in the cases where it coincides with a previous national or local strategy. Anyway, the first approaches have been generally very instrumentals, either searching to transform traditional and local therapists in something similar to the Chinese "barefoot doctors" or to extract biological principles of customary recipes. Advances are promising, but they announce big problems if the diverse logical implied are not taken into account. The paper analyses the consequent epistemological challenges focusing in some Malagasy cases, contrasted with other well known African examples.
African Traditional Pharmaceuticals: knowledge, markets, museum.
In the last three decades the status of traditional pharmaceuticals has changed. They are now available on the markets and even in the pharmacies. At the same time traditional medicine has become part of the cultural heritage. The paper intends to explore this two new dimensions.
In the last three decades the status of traditional pharmaceuticals has changed. Following for many extents a pattern already experienced in some Asian countries (e. g. China, India), in diverse African countries the traditional pharmaceuticals have gained a new room.
Due to the politics of legitimation of traditional medicine, mainly in the '80s and '90s, and also to the attempts to re-create African identities grounded on a new usages of traditional cultural elements, their circulation is not limited anymore to a simple exchange between healers and clients. Traditional pharmaceuticals are now available on the markets and even in the drug-shops and pharmacies. New factories have been established to process traditional pharmaceuticals in a quasi-industrial way. Their forms and packagings recall those of biomedical drugs. As other spheres of traditional culture, pharmaceuticals are now something marketable. This implies new social dynamics that must be analyzed.
At the same time traditional medicine has become part of the cultural heritage. As such, it founds a room in museums and exhibitions. It is part of a larger cultural heritage and identitarian claim project. When it is stored and exhibited in museums it becomes also a specific cultural commodity, whose meanings need to be investigated .
The paper intends to explore the two new dimensions of the traditional pharmaceuticals outlined above.
Evidence-based policy practice has become pervasive and counterproductive in the global HIV response.
local knowledge in Africa is being delegitimized in preference for ‘scientific’ knowledge which in most cases is premised on overrated, yet very simplistic 'what-works-formulas". We rely on two studies to demonstrate that Evidence-based policy practice has become counterproductive in the global HIV response.
The assumption that "because it worked there, then it must work here" is to a large extent responsible for the exacerbation of the HIV scourge in Sub-Saharan Africa. We show this in two separate studies from Zambia. 1) In the 1st study, we demonstrate that the application of the Human Rights approach as a one-size-fits all concept in Zambia is at odds with local realities and in some instance responsible for the rise in risky sexual behavior 2) In a 2nd study we showed that the act of outlawing Traditional Birth Attendants (TBAs) in Zambia purely on the advice of 'scientific evidence' obliterated the only option available to HIV+ pregnant women in poor rural areas, thereby worsening the situation.
These two studies render the question of "what works" obsolete and irrelevant. Like other scholars have observed recently, the question should no longer be about "what works?" but rather "what are we committed to making work in the given context?". The later question accepts the fact that reality is complex and cannot be summarized in a "cook-book" to be used by many. It is reflective, decentralized, and less authoritative. It allows for use of local practical wisdom; and at the same time, prioritizes processes that give room to local responsiveness, and careful judgement of what might work and how, given the context (rather than following mechanical solutions anchored on 'evidence').
Traditional West African "Physiotherapy"
Traditional African traumatology, since ancient times, enjoys great accessibility and efficiency, being a community health resource. In this work, a comparative study between biomedical physiotherapy and traumatology or traditional "physiotherapy" is carried out.
Traditional African traumatology constitutes a therapeutic resource present in all communities and enjoys a better access, geographic and economic, than traumatology and physiotherapy of a biomedical nature. However, this discipline is still largely unknown even by African governments themselves and international health cooperation agencies. This study is the result of the field work carried out over some years in West Africa, mainly in Gambia and Mali, consisting of participant observation and the collection of clinical data referring to the practice of traditional "physiotherapy" or "traumatology" by one side, and Western physiotherapy, based on the biomedical paradigm, on the other. It is evident, through the use of qualitative and quantitative research tools, the great effectiveness of the techniques and treatment protocols used by professionals called "traumatoleg traditionel" or "setter bone". An analysis of the physical, social and symbolic effectiveness of these practices is carried out, through a comparative study between the same ones and those used by the biomedical system and, on the other hand, making possible a legitimation, from the scientific point of view, of the themselves.
This panel is closed to new paper proposals.