The explosion will not happen today. It is too soon. . . or too late.
I do not come with timeless truths.
My consciosness is not illuminated with ultimate radiances.
Nevertheless, in complete composure, I think it would be good if certain things were said.

Frantz Fanon
Black Skin, White Masks

 Ngoma & Lemba

Ngoma="drum", but in an institutional sense it refers to a "drum/cult of affliction"; a therapeutic association

Lemba is only one particular form of ngoma that developed, other minkisi (plural of nkisi), "sacred medicine cults" existed alongside lemba (Tiriko, Kikokoo)

• lemba comes from lembikisa, which means "to calm"
• "medicine of government", "government of multiplication and reproduction", "calms the villages", "calms the markets"
• A major historic cult of healing, trade, and marriage/social relations
  • Lemba unified many functions of human activity that are usually divided among discrete secular or religious institutions in modern societies.
• How can we look at lemba as a locally developed means of coping with the social/economic/cultural disruptions that the growing Atlantic slave trade introduced into Central Africa?
  • in terms of who participated in lemba as intiates and priests/priestesses?
  • in terms of what lemba regulated and encouraged?
  • in terms of how the commercial trade of slaves affected local human relations and previously held beliefs?

Internalizing vs. Externalizing Healing Systems

• Is the locus of the disease believed to be inside the sufferer's body or outside?
• Externalizing systems are based on diagnostic and therapeutic ideas and techniques which direct attention AWAY from the body; the medical gaze looks outward. Social relations, envy, respect for ancestors, these are particularly relevant.

3 Levels of Analysis of a Healing System

1) Experience of Illness/Afflictions; people's life worlds and "sickness/illness" narratives (PHENOMENOLOGY)

• Important distinction between disease and illness
  • a person's disease can be thought of as their pathologically recognized condition, malaria for example
  • a person's illness is highly individualized and is experienced within and negotiated among their various life worlds

2) People's ideas about causation (etiology) and diagnosis (possibly social) (SYSTEMS OF MEANING)

3) Material conditions under which illness or affliction happens; historical context; disease ecology, including political economy, structural inequalties, etc.

EXAMPLE: Let's try and conduct an analysis of a Ugandan women who recently connects her weakening health to the disease condition of AIDS.

• How does her chronic fatigue, emerging cough and chest pains (tuberculosis is the most common opportunistic infection associated with AIDS in Africa) disrupt her life world of raising 5 children? How would this differ from an upwardly mobile, white gay male's experience of AIDS in a San Francisco tertiary care hospital?
  
  
• What ideas of causation might be present for both cases? What might be actual most likely mode of transmission?
  
  
• Brainstorm about how the material conditions of their different environments contribute to the cause, experience, and/or treatment of their affliction.

Components of a Healing System

1) Medical Traditions

• Do multiple traditions exist in one locale? Where do they come from? Are there syncretic or hybrid forms?

2) Medical Sectors

• How are the traditions institutionalized, regulated, segregated, and located? How informative is a formal/informal binary in discussing the different sectors of health care in local worlds?

3) Patterns of Resort

• What determines an individual's final treatment choice or utilization pattern?
  • Modernization (I select a particular therapy based on its meeting my informed (poorly or otherwise) understanding of the etiology of my disease state)
  • Economic Approach (how much does it cost, and how much do I have?)
  • Homophily
    • the degree to which pairs of individuals are similar in certain attributes, such as beliefs, values, education, social status and like--see Wallman pg. 113.

Household Production of Health (HHPH)

• "A dynamic behavioral process through which households combine their (internal) knowledge, resources, and behavioral norms and patterns with available (external) technologies, services, information, and skills to restore, maintain, and promote the health of its members" (Berman et al, 1994) see Wallman pg. 143
• Particularly important in terms of guarding privacy, avoid public knowledge of members having stigmatized diseases
• What is the women's role in the HHPH? How can this role define her?
• For a bit on the American Context see Social Transformation of American Medicine by Paul Starr

Levels of Analysis (Reynolds)

1) Technical knowledge, materia medica/pharmacopeia
2) Techniques of social analysis
3) Tenets of Psychology
4) Healer's stated code of conduct vs. healer's actual practices
5) Role of trauma in creating illness
6) Role of visions, dreams, childhood difficulties in WHO becomes a healer

Questions?

Parting Thoughts:

Am I going to ask the contemporary white man to answer for the slave-ships of the seventeenth century?
Am I going to try to by every possible means to cause Guilt to be born in minds?
Moral anguish in the face of the massiveness of the Past? I am a Negro, and tons of chains, storms of blows, rivers of expectoration flow down my shoulders.
But I do not have the right to allow myself to bog down. I do not have the right to allow the slightest fragment to remain in my existence. I do not have the right to allow myself to be mired in what the past has determined.

I am not the slave of Slavery the dehumanized my ancestors.

Frantz Fanon
Black Skin, White Masks