The infancy of Edward Shelonga Part I
an extended case study in medical and religious anthropology from the Zambia Nkoya: Introduction; Method; Background
Wim van Binsbergen
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The infancy of Edward Shelonga Part I an extended case study in medical and religious anthropology from the Zambia Nkoya: Introduction; Method; Background Wim van Binsbergen |
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to Part 0 (Abstract)
Part
II (The extended case; Ethics)
Part
III (Interpretation; Conclusion)
Part
IV (References; Postscript on Cognition)
2. The problem and the method
In
modern Zambia, people’s pursuit of health and healing
usually takes place on the interface between on the one hand what
Loudon (1976:4) has called cosmopolitan clinical medicine (the
bureaucratically-organized realm of public health services and
certified private practitioners) and on the other hand a variety
of alternatives: self-medication, intra-family treatment, and the
services of such African specialists as midwives: diviners;
herbalists; priest-healers specializing in the alleged effects of
ancestral wrath, sorcery, or affliction spirits; and leaders of
certain Christian churches specializing in spiritual healing.
There are some social-science studies available, both on
cosmopolitan medicine in Zambia[2]
and on some of the alternatives: herbalists,[3]
priest-healers,[4]
and African midwives.[5]
Whatever the merits of these studies, their major shortcoming is
that they rarely deal with the crucial problem of the interaction
between cosmopolitan medicine and local alternatives.
The importance of this problem is certainly acknowledged in the
work of Frankenberg and Leeson,[6]
but these two authors have so far not published an exhaustive
empirical study on this point. Close came Leeson’s short
paper on ‘Paths to medical care in Lusaka’ (1970),
where she found that ‘nearly two-thirds of all ngangas’
[African healers — WvB] patients had previously consulted
‘‘western’’ medical advisers’ (1970:9).
In a preliminary yet thoughtful analysis, Leeson concludes that
‘to consult [the nganga
] does not imply a total rejection of western medicine’ but
instead should be considered an attempt to assess why western
medicine has failed to be effective, or an attempt to try all
available paths to health (1970:11). Extremely stimulating in
Leeson’s argument is that, here as elsewhere (1969; cf.
Frankenberg and Leeson 1976), she tries to vindicate the African
healers, claiming that greater success in public health will not
be achieved by needlessly attacking the healers who perform many
essential tasks, but by improving the working of the western
health agencies. For a member of the cosmopolitan medical
profession (Leeson is a physician), this is quite a courageous
statement to make.
Leeson’s research was carried out in Lusaka. Here the
Zambian patient is surrounded by easily accessible cosmopolitan
health agencies: the University Teaching Hospital, a number of
urban clinics, and an abundance of private practitioners. The
majority of these (in fact: all except the private practitioners)
are non-fee-paying; also drugs are dispensed free of charge. Yet
even here, despite the overlap between cosmopolitan and nganga
consultation noted above, Leeson found that about 40% of the ngangas’
patients claimed not to have consulted cosmopolitan agencies. And
these are not just patients complaining of illnesses that could
be considered the ngangas’ special
domain: ‘madness’, ‘spirit possession’, etc.
A considerable number of Leeson’s informants consulted the nganga,
at the exclusion of cosmopolitan agencies, for complaints that
(cf. table 1) many Zambians today consider amenable to western
treatment: they allow themselves to be hospitalized on the basis
of these complaints.
Table
1a. The six most frequent reasons for
hospitalization in Zambia (source: Stein 1971; click to access table 1a)
While
these data demonstrate the prominence of these diseases in the
Zambians’ utilization of cosmopolitan medicine, table 1b
indicates that the same diseases constitute important reasons for
the consultation of non-cosmopolitan healers:
Table
1b Consultation of ngangas
for the six most important diseases in Zambia (sample: patients
of Lusaka ngangas;
source: Leeson 1970; click
to access table 1b)
Despite
the availability of cosmopolitan medicine, why do contemporary
Zambians continue to pursue forms of non-cosmopolitan medicine?
Phrased thus, this central question of the present paper may
sound ethnocentric, even smack of cultural imperialism.
Cosmopolitan medicine is just one particular socio-cultural
subsystem, peculiar to a type of industrial society that since
the nineteenth century has spread over many parts of the world.
Wherever cosmopolitan medicine has penetrated, it has encountered
local forms of medicine, often of great complexity and antiquity.
Rarely is local medicine abandoned overnight, in favor of
cosmopolitan medicine. Moreover, despite its achievements and
power, cosmopolitan medicine itself is increasingly criticised
within the very societies it sprang from; Illich’s recent Limits
to Medicine, Medical Nemesis: The Expropriation of Health
(1977) is an eloquent and convincing example of this tendency.
Yet, in a country like Zambia great national and personal efforts
and dedication go into the propagation of cosmopolitan health
care. The latter does possess reliable therapies or preventive
routines for certain endemic diseases (e.g. malaria,
gastro-enteritis, measles) which cause great suffering and for
which local, non-cosmopolitan medicine has no adequate cure. For
these reasons I feel that my question is a legitimate one —
particularly if the answers we shall find will not lead to a
Pyrrhus victory of cosmopolitan medicine, but to a better
understanding and appreciation of the contributions various
medical traditions, including cosmopolitan medicine, can make
towards the well-being of the people involved.
As regards Zambia, Leeson’s answers were not meant to be
exhaustive. Moreover they were based on a possibly biased sample
survey: her respondents were found in the ngangas’
consulting rooms and might not be entirely representative for the
Lusaka population as a whole. The only other author who has
explicitly raised the same question in the Zambian context, is
Victor Turner. At the end of a general ethnographic inventory of
Ndembu Lunda medicine, he quotes (1967a: 356f) a variety of
reasons for the persistence of local medicine. Local medicine is
said to rest on the same premises as the total world view of the
local society; many illnesses heal themselves, irrespective of
the real or alleged effect of therapy; the healing cults have an
important psychological effect; and illness is so prevalent that
the local culture has no choice but to actively confront it.
These reasons overlap with those mentioned by Leeson and
throughout the literature on the subject (cf. Lieban 1973:
1056f). Le Nobel’s clinical experience in the field of
maternity care at the rural district level in Zambia suggested
that access to the outlets of cosmopolitan medicine also plays a
major part. When a mobile maternity service greatly increased
accessibility, utilization increased threefold (1969: 85f); yet
even so it could not be prevented that ‘only 20% of the
regular antenatal attendants reported within a few weeks after
the delivery’ for post-natal and under-five consultation.
Evidently besides accessibility there were other factors at work,
one of which Le Nobel suggests to be health education —
another point emphasized in a vast body of literature on the
subject.
An increasing number of publications in now becoming available on
the interaction between cosmopolitan medicine and its local
alternatives. Like the few Zambian examples quoted, much of this
literature uses generalized descriptive data, often of a
quantitative nature, to arrive at general but as yet rather
preliminary conclusions. Studies based on two types of data are
overrepresented: those relying mainly on medical records relating
to people already pursuing cosmopolitan medicine (e.g. Le Nobel
1969), and those based on speech reactions: on what people say
they feel, did, do, or may do in future.[7]
It should be noted that both types of data are artificially
restricted to the individual, about whom certain facts (often
artefacts) are recorded without taking into account the social
relationships in which that individual is involved, and the
development of those relationships over time.
In the present paper I shall approach the problem from a
different angel: the extended-case method, to whose development
Turner himself and his sometime Manchester colleagues (foremost
Van Velsen) have so greatly contributed;[8]
moreover the presentation of my data and analysis has been
modelled, somewhat, after Epstein’s paper on urban networks
(1969). In the extended-case method, the fundamental structural
features of a social field are identified not primarily on the
basis of the participants’ statements concerning such
enduring cognitive elements as collective beliefs, rule and
norms; nor on the basis of other generalized data such as
quantitative surveys; but on the basis of a carefully studied
sequence of social events involving the same interacting
protagonists. Applied to the medico-anthropological perspective
(cf. Janzen 1975), I shall contend that cosmopolitan medicine and
its various local alternatives constitute dominant spheres in the
social field within which people, through a complex social
process, are engaged in the pursuit of health. What form the
relations between those two spheres take, and why, shall be
tentatively analysed by reference to one extended case,
describing in detail the health experiences of Edward, a Nkoya
infant. Edward’s experiences largely depend on those of his
parents Muchati and Mary; therefore, the latter will also play
leading in the account that follows.
Limitations and possibilities of the extended-case method in
medical anthropology will became apparent as my argument
proceeds. The health activities of the protagonists, within and
outside cosmopolitan medicine and extending over several years,
no longer appear as disconnected items but are shown to be parts
of a sustained social process. The significant health aspects of
this social process will be shown to be intimately related to
crucial social, economic and political aspects. But what is thus
gained in depth and width, goes at the expense of
representativity. We shall therefore have to discuss to what
extent the protagonists’ situation is unique. Moreover data
of sufficient depth and detail to be amenable to extended-case
analysis, can only be collected through intimate and prolonged
association between the researcher and the protagonists. In the
context of health activities, at the borderline between
cosmopolitan medicine and other forms of medicine, is it
permissible to use such intimacy primarily for the gathering of
scientific data? Or should such influence as the researcher
builds up through participation, be used to drag off the patients
to cosmopolitan health agencies, thus releasing them from the
clutches of non-cosmopolitan healers? When discussing our own
role in Edward’s case (section 5), I shall briefly consider
this ethical question.
This paper is an anthropologist’s contribution, and makes no
claim to medical competence. When the course of our field-work
forced us to diagnose and treat our informants’ illnesses,
we did so as amateurs, albeit that my wife’s long-standing
experience with medical research as a biophysicist greatly
facilitated our access to medical literature and to medical
practitioners. The plausibility of such diagnoses as my argument
contains has been confirmed in later, detailed discussions with
doctors, including three physicians practising in the area
itself.
However,
as in nearly all cases such tentative confirmation was reached in
absence of the patient involved, no medical authority attaches to
our diagnoses. In view of the centrality of these diagnoses in my
argument this may appear a major weakness, yet it was unavoidable
in a rural area where no cosmopolitan doctor is available within
80 km, there a two-hours drive.
3. Background
The
protagonists in this case belong to the Nkoya people, a small
ethnic group which has its home area in the eastern part of
Zambia’s Western Province (formerly Barotseland), and
surrounding areas.[9]
My medico-anthropological data mainly derive from the Nkoya of
Chief Kahare,[10] a small group of
peasant cultivators and hunters.
Chief Kahare’s is not a healthy area.[11]Situated
on the central western Zambia plateau, at the Kafue/Zambezi
watershed, the area contains swampy streams and fishing ponds
conducive to malaria and bilharzia. Respiratory tuberculosis and
gastro-enteritis are likewise common. In addition to malaria
almost universal hookworm infestation further contributes to the
anaemic condition (cf. King 1966: section 24: 64-66) that greatly
reduces the resistance of children (measles is a major killer
disease here), and of young women in pregnancy and childbirth.
Hypovitaminosis is a common condition. With the virtual absence
of motor traffic, the major causes of trauma are wild animals,
defective bicycles, and human violence. Leprosy and blindness are
infrequent but accepted features at the village scene. A massive
eradication campaign in the 1950s reduced the rate of venereal
disease which before that time was very high.[12]
Infant mortality is high. Moreover, fertility is exceptionally
low.[13] This may be related
to such social factors as high marital instability, polygyny, and
labor migration (cf. De Jonge 1974); and to local practices
relating to sex and childbirth.[14]
Being located at the periphery of the province and even of the
district they belong to, Chief Kahare’s Nkoya have only
recently seen the establishment of a permanent outlet of
cosmopolitan medicine in their own area: a Rural Health Centre
dating from the late 1960s, at about 30 km from Chief
Kahare’s capital village. However, at distances of 80 km and
more, dispensaries, and even (just beyond the district’s
western border) a mission hospital have existed since the 1930s
(Northern Rhodesia, 1930). From the early 1940s, teachers at the
few mission schools in the villages kept some elementary
medicaments supplied by the mission. Minor village sanitation
requirements as enforced by the district administrative staff on
their annual tours; tsetse fly control at the borders of the
Kafue Park; very rare inoculation campaigns, and the habitual
medical check-ups when one registered as a labor migrant at the
distant provincial capital: this sums up at about all there was
of cosmopolitan medicine, and its derivations, during most of the
colonial period.[15] Of the three
hospitals now found in the district, one was established in the
late 1950s and the other two around the time Zambia became
independent (1964). None of these present-day hospitals is within
80 km from Chief Kahare’s village.[16] Although the number
of outlets of cosmopolitan medicine compares favorably with other
districts in Zambia,[17] it is mainly the
people living in that part of the district where the three
hospitals are concentrated (each within only 50 km from the
others!), who more than sporadically benefit from them.
For an understanding of the extended case, a minimal introduction
to Nkoya social structure is necessary. Throughout my
presentation of the case I shall refer to the principles outlines
here. I shall take them up explicitly in my interpretation of the
case, in section 6.[18]
In terms of social structure, the contemporary Nkoya situation
must be analyzed at two levels. First we have to look at the
relations between this society and the wider social, political
and economic structures within which it is incorporated; and
secondly we need to study the internal structure of this
(part-)society. The two levels will turn out to complement each
other.
In the modern Central African context, ‘Nkoya society’
forms a social-organizational subsystem: the local results of
incorporation into the colonial and post-colonial state, and into
the world-wide capitalist economy. The members of this subsystem
are based partly in the Nkoya homeland and partly in the towns of
Central and Southern Africa. The people in these two segments are
geographically separated, exist in very different residential
environments with varying degrees of multi-ethnic involvement,
and specialize in different modes of production. Capitalism
dominates urban economic relations, while in the village many
pre-capitalist forms still survive, although with difficulty (Van
Binsbergen 1978b). Yet the two segments are linked by very
frequent interaction, making for a constant stream of people,
information, letters, money, food, manufactured articles, between
the urban and rural segments. Despite the differences in economy
and social-structural environment, in both urban and rural
segments of the Nkoya ethnic group the same patterns of kinship,
marriage, ritual, medicine obtain, and almost every Nkoya
individual is involved in social processes in which both urban
and rural kinsmen and tribesmen actively take part. In this sense
it is meaningful to speak of Nkoya society, even though many of
its members live outside the Nkoya rural area.
The political economy of the contemporary Nkoya situation can be
described with Meillassoux’s phrase (1975: 137f) ‘the
mode of reproduction of cheap labor’ (cf. Gerold-Scheepers
& Van Binsbergen, 1978: 25f).
Capitalism brought not only processes of material expropriation
and extraction within the Nkoya homeland (e.g. hut tax, partial
closure of the forest area for hunting and collecting); it
particularly caused, since the 1910s, a drain of locally
reproduced labor force from the Nkoya homeland to the places of
capitalist employment in Central and Southern Africa. With low
average standards of formal education, and as a small ethnic
minority in towns the labor market and the informal sector are
dominated by other ethnic groups, the Nkoya have rarely been able
to become stabilized townsmen who rely entirely on their
capitalist employment. Instead, the insecurity of urban
employment has necessitated a continued orientation towards the
village, and a continued involvement in kinship-dominated social
processes focusing on the village. As the village is the place
where children are born and raised and where the old and disabled
retire, the urban capitalist sector benefits from a labor force
while relegating the costs of its reproduction to rural society.
The latter becomes economically exploited, in fact impoverishes,
and its social organization is eroded since its original economic
base has been greatly affected by capitalist relations of
production (Van Binsbergen 1978b). Yet the survival of this rural
society is obviously of primary importance within the overall
political economy of this part of the world. Only
if rural society remains essentially intact,
can it perform its subservient role vis-à-vis the urban
capitalist sector. Thus contemporary Nkoya village society
reproduces cheap labor, and at the same time provides a niche of
economic, social and psychological security outside the
capitalist sector, for the many Nkoya who despite their past,
present or future involvement in that sector have not been
allowed to become anything but peripheral to it.
While in town, Nkoya migrants in great majority engage in mutual
hospitality and kin assistance. They participate in Nkoya cults
and puberty ceremonies, and send remittances to rural kin. thus
they demonstrate they still identify as Nkoya. Only in this way
can they ensure their stake in the village, in preparation of
their ultimate retirement there. While they live in towns and
while the majority of the men at least are employed in modern
formal organizations, in their free time most urban Nkoya pursue
a social, cultural, ritual and medical life that is largely that
of their rural relatives. The Nkoya therefore, are an example of
the fact that economic and political incorporation need to lead
to complete destruction of pre-existing social and symbolic
structures. These structures may survive as
‘neo-traditional’ (i.e. deprived of their original base
in pre-capitalist relations of production), provided that the
incorporated subsystem which they underpin, has been assigned a
function within the new, wider system. Under the penetration of
capitalism, the Nkoya kinship system has been modified but not
destroyed, because Nkoya rural society has been made subservient
to capitalist structures.
I shall demonstrate that Nkoya medicine is an essential part of
the Nkoya kinship system, and that the continued partial
adherence to the former, depends on the continued reliance on the
latter.
Let us now move on to the internal structure of Nkoya society.
The formal principles governing personal intra-ethnic social
relationship in the urban segments (i.e. outside the domain of
participation in formal organizations) largely derive from the
rural situation. It is therefore sufficient for our present
purpose to describe the latter.
Chief Kahare’s area consists of a number of river valleys,
separated by extensive light forests where much hunting takes
place. Each valley derives a separate identity from rain ritual,
an unofficial neighborhood court of law, and concentration of
rights to riverside gardens and fishing grounds mainly in the
hands of the valley’s inhabitants. Each valley contains
about a score of tiny villages, whose sizes range from one to
twenty households, a minority of which are polygynous. Each
village is headed by a headman, whose title and office is
ritually inherited at the village shrine. After the death of a
headman, a successor is chosen from among a large pool of
patrilateral, matrilateral, and sometimes affinal kinsmen of all
previous incumbents of the office; very often, senior men are
attracted from a distant village or called back from town to take
up the vacant headmanship of a village. Names and titles of
persons other than headman are inherited in a similar fashion.
Usually inhabitants of a village are real or putative kinsmen of
the headman. However, the Nkoya reckon descent bilaterally;
moreover, intra-village marriages have become exceptional and are
now frowned upon; and consequently an individual’s maternal
kin and paternal kin (either of which he may opt to reside with)
tend to be spread over a number of different villages; and in
addition to real and putative genealogical links, joking
relations between pairs of clans[19] may lead to close
personal relationships that in effect contain the same claims and
rights as actual kinship.
For all these reasons each junior Nkoya has potential claims to
residence and assistance with regard to a large and
geographically very extensive set of senior tribesmen, who all
compete for a following of juniors in order to establish
themselves as village headman (or to remain successful in that
office). In addition to urban-rural migration, intra-rural
geographical mobility is therefore very high. All individuals
except the aged continually try to improve their
kinship-political position by moving from village to village.
In this extremely flexible, competitive and
conflict-ridden set up, the village is the
main conspicuous unit of the kinship-political process. Yet the
village is not a monolithic whole. As inhabitants come and go,
they are rarely bound by the fact that they have grown up
together or have interacted with each other for many years at a
stretch. Usually the village headman spends much of his time and
energy to keep together a village consisting, with some
exaggeration, of virtual strangers whom only opportunity and
calculation have brought together. Bilateral kinship enmeshes and
confuses consanguinean and affinal ties to such an extent as to
preclude the emergence of stable kin groups above the village
level. Clans are now too dispersed and too devoid of corporate
interests (apart from matters of chiefly succession) to form
enduring social groups. In the course of kinship-political
processes of coalition and opposition, vaguely-defined
clusters of kinsmen tend to emerge beyond
the scope of one individual village. Such clusters manifest
themselves through the members’ repeated association, over a
few years, for the purpose of marriage negotiations, court cases,
ritual, and inheritance to prestigeous titles connected with
headmanship and chieftainship. Although these clusters have to
fixed boundaries nor ascriptitious recruitment of members (i.e.
their shifting composition cannot be predicted just from a
genealogy or a village map), they are not completely ad hoc
structures. In each cluster, one or two clans tend to prevail,
and often a cluster is primarily (but never exclusively)
associated with one particular village, including those of its
members who temporarily reside in town. Such a village may even
loosely lend its name to the cluster. The definition of such
clusters of temporarily solidary individuals is largely
situational (Van Velsen 1964, 1967), in that the present state of
any one cluster’s composition and internal structure can
only be determined when, for one specific social event
(particularly conflict), the cluster sets itself off against one
or more rival clusters. In the next event, confronting some
different cluster over some different problem, the cluster’s
composition may be different except for a small but firm core
membership.
Much of the social process among the Nkoya revolves around the
definition, mobilization and confrontation between such blurred,
shifting and ephemeral clusters. It is them I have in mind when
in the following account I shall speak of the protagonists’
‘kin group’. Specifically, Muchati’s kin group in
so far as mobilized in Edward’s case, focussed on Nyamayowe
village, which is located in the Mushindi valley. The kin group
of Mary, his wife, focuses on Jimbando village, located in the
Mema valley within 100 m from Chief Kahare’s capital. Over
the road the distance between Nyamayowe village and Jimbando
village is about 10 km.
Finally, the Nkoya have a richly developed ritual culture, much
of which is reminiscent of that of the Ndembu, so eminently
described and analysed by Turner (1957, 1961, 1962, 1967a, 1967c,
1968). Most Nkoya rituals have strong medical connotations: they
are meant to cure people from illnesses considered to be caused
by ancestors, sorcery, the spirits of the wild, etc. Since the
early twentieth century, cults of affliction have emerged as the
dominant ritual complex throughout Western Zambia, including the
Nkoya area. The historical conditions under which this happened I
have indicated elsewhere (Van Binsbergen 1976a, 1977a). Building
upon previous authors (foremost Turner), I defined such cults of
affliction as
‘characterised
by two elements: (a) the cultural interpretation of misfortune
(bodily disorders, bad luck) in terms of exceptionally strong
domination by a specific non-human agent; (b) the attempt to
remove the misfortune by having the afflicted join the cult
venerating that specific agent. The major ritual forms of this
class of cults consist of divinatory ritual in order to identify
the agent, and initiation ritual through which the agent’s
domination of the afflicted is emphatically recognized before an
audience. In the standard local interpretation, the invisible
agent inflicts misfortune as a manifest sign of his hitherto
hidden relationship with the afflicted. The purpose of the ritual
is to acknowledge the agent’s presence and to pay him formal
respects (by such conventional means as drumming, singing,
clapping of hands, offering of beer, beads, white cloth and
money). After this the misfortune is supposed to cease. The
afflicted lives on as a member of that agent’s specific
cult; he participates in cult sessions to reinforce his good
relations with the agent and to assist others, similarly
afflicted, to be initiated into the same cult.’ (Van
Binsbergen 1977a: 142)
This
basic pattern is found in all the many individual cults of
affliction of contemporary Western Zambia, including those
featuring in the present paper. Most cults of affliction
occurring in the Nkoya area have, moreover, in common that their
adepts are organized in small factions headed by an accomplished
cult leader. Ties of kinship and co-residence are used to
reinforce the relationship between leader and adepts; and just
like village headmen, cult leaders compete with one another for
the allegiance of followers.
The expansion of these modern cults of afflictions seems to be
not unrelated to the introduction of cosmopolitan medicine, at
the periphery of Nkoya life. It is remarkable that whenever
informants remember these cults’ original founder-prophets
(cf. Van Binsbergen 1977a: 155f), the latter are depicted as
having tried, at some state, cosmopolitan medicine before
founding their own healing cult. Oral traditions concerning one
such prophet, Ngondayenda, invariably stress the lack of clinics
and hospitals in the district in the 1930s, when severe human and
cattle epidemics occurred.
More historical research is needed on this point. But it can be
safely stated that, from its first entrance in the Nkoya area,
until the present-day fervent competition for the allocation of
Rural Health Centres over the various administrative wards of the
district (Kaoma Rural Council n.d.), cosmopolitan medicine has
been recognized by the local people as highly valuable and
desirable. Yet throughout this period it has been forcibly
confronted by Nkoya medical alternatives. This paper tries to
understand why this should be so.
[2]Jayaraman
1970; Shattock n.d.; Frankenberg and Leeson 1974; Nur et al.
1976.
[3]Apthorpe
1968; Turner 1967; Gilges 1964; Symon 1958; Frankenberg and
Leeson 1976; Leeson and Frankenberg 1977.
[4]Reynolds
1963; Turner 1967b; Colson 1969; Van Binsbergen 1977a.
[5]Le
Noble 1969: 31f; Spring Hansen 1971; Munday 1945; Barnes 1949;
Stefaniszyn 1964:74f.
[6]1974,
1976; cf. Frankenberg 1969; Leeson and Frankenberg 1977; and
Leeson 1967, 1970.
[7]E.g.
Ademuwagun 1974; Leeson 1970; Imperator 1974; Maclean 1971.
[8]Turner
1957; Van Velsen 1967, 1964: xxiiif and passim.
[9]Cf.
Van Binsbergen 1975; 1976a, 1976b, 1977a, 1978b, and n.d. (b);
McCulloch 1951; Clay 1946.
10People’s personal names and titles have
been altered in this paper, as have those of localities in
Western Zambia.
[11]The unfavourable conditions summarized here
contrast remarkably with the picture emerging from the undp Nutrition
Status Survey (National Food and Nutrition Programme, 1974).
Based on a national sample including a large number of rural
villages, that study carefully maps out the distribution of such
somatic conditions as either indicate, or are considered to
cause, malnutrition. For the purposes of the survey, the Zambian
territory was divided into a number of ecozones. The twelfth
ecozones, to which Chief Kahare’s area belongs, compares
rather favorably with most other ecozones, in terms of:
children’s weight against age; arm circumference; most of
many serum, haemoglobin etc. levels that were measured (except
packed well volume and ascorbid acid, with regard to which this
ecozones scored low); and particularly malaria, where children in
this ecozones were found to be least affected among the whole
national sample. (Malaria incidence in adult males, however, was
average, and in cult females even very high). The report did not
attempt a systematic interpretation of these patterns, except for
seasonal variation in diet. The main explanation for the
difference between this moderately positive picture and the
situation in Chief Kahare’s area, becomes clear when we
trace the origin of the data in this ecozones (Schültz 1976:
figure 30). They derive from four villages in the central part of
the ecozones, where not only different ecological conditions
obtain (particularly a different hydrography and much greater
human encroachment upon the forest), but which is also the
region’s centre of gravity in terms of medical facilities,
cooperatives, communications, exposure to mission and school
education, etc. (cf. Van Binsbergen: 171f; incidentally, this
bias also affects Schültz’s own analysis of the area’s
ecosystem (1976: 103f).) For an early yet thorough examination of
the health situation in a area adjacent to Chief Kahare’s,
cf. Newson 1932. Sadly, present-day health conditions in Chief
Kahare’s area are still rather similar to what Newson
described.
[12]Northern Rhodesia 1956: 95,100; Northern
Rhodesia 1955: 110; cf. Evans 1955, who deals with the
Nkoya’s eastern neighbors, the Ila.
[13]Cf. Ohadike & Tesfaghiorghis 1975; Central
Statistical Office 1975: 6 and passim; Van Binsbergen n.d. b.
[14]On the causal significance of such practices,
cf. Central Statistical Office 1975: 21; in the Nkoya case they
include: intra-vaginal medicine used to ensure a dry milieu for
intercourse (the harmful nature of this substance is indicated by
the hemorrhages it frequently causes); and infanticide on various
occasions, e.g. when the mother is a girl who has not gone
through puberty ceremonies.
[15]In addition, migrants returning to the village
had often gained considerable experience with cosmopolitan
medicine at their places of employment.
[16]The 1968 returns of one of these hospitals
corroborate the disease patterns summarized below (table 2):
Table
2. The seven most frequent reasons for
hospitalization and hospital deaths in a rural hospital near
Chief Kahare’s area, 1968.
Source:
Republic of Zambia 1972; in order to avoid easy identification in
the printed source, I imposed upon the original data a random
scatter with mean = 0% and standard deviation = 10% (cf. Van
Binsbergen 1978a; click to access table 2).
A
further brief summary of the local health situation is to be
found in: Republic of Zambia, 1976: 191f; Imasiku 1976.
[17]Cf. Republic of Zambia 1967, 1968, 1976;
Blankhart 1966: 6f.
[18]A peculiar methodological problem arises here.
An extended case is normally used to bring out more general
structural principles that presumably have a rather wide
application in the society in question. These principles concern,
in the present argument, the relationship between cosmopolitan
and non-cosmopolitan medicine. However, in order to make the case
study amenable to such interpretation, other structural
principles must be invoked; these other structural principles,
relating to the internal social structure of Nkoya society and
its incorporation in the wider world system, can be seen to work
in the present case study, but they derive primarily from a much
wider set of data, as presented in my other publications on the
Nkoya and on Central Africa in general.
[19]Nkoya clan affiliation is ambilineally
inherited. Every Nkoya belongs in principle to two clans: his
father’s and his mother’s. The paternal clan
affiliation tends to be submerged, and a Nkoya usually identifies
with his maternal clan. In the case of close kin relations,
membership of the same clan is often regarded as prohibitive for
marriage. Certain chiefly titles are owned by specific clans.
Finally inter-clan joking often forms a starting point for
individuals to engage in prolonged dyadic contracts. Today, the
membership of the various Nkoya clans is scattered all over the
Nkoya homeland. Before the expansion of political and economic
scale, around 1800 (which radically altered chieftainship and
boosted interregional relationships), Nkoya clans are claimed to
have been much more localized, exclusively matrilineal, and with
a clan chief discharging major ritual and redistributive
functions within the clan area.
to Part 0 (Abstract)
Part
II (The extended case; Ethics)
Part
III (Interpretation; Conclusion)
Part
IV (References; Postscript on Cognition)
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