Sunday, 11 December 2011 21:22

Book Review: The African Transformation of Western Medicine and the Dynamics of Global Cultural Exchange

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 Author: David Baronov. Publisher: Philadelphia: Temple University Press, 2008. Pages 248 

I just picked up this book The African Transformation of Western Medicine and the Dynamics of Global Cultural Exchange written by David Baronov (2008) with a view to doing some pleasure reading much like I commonly surf the internet. But this book turned out to be different to me. It held me up reading and thinking with the narratives until I finished it. I am just happy to have read the work and gained some deep critical and historical grounded insights from the ontological arguments. A book of 248 pages, the author David Baronov set out to show that African Medicine like the Western Medicine is a cultural system steeped in different missionary and colonial platforms of conception and development.

The book argues that African medicine and cultures served as a transformational conflict and agenda to biomedicine on the one hand, and on the other hand, biomedicine equally rendered the African medical system to face inevitable opportunity and analysis in formulating research and focused need on the development scale. The writer declares that it is important to understand the historical grounds of the colonial expansionist urges that placed the African and Western biomedicines on that pedestal for each other. In other words, African Medicine is a prodding and a provoking area of interest and more so in this age of global medical pluralism and western domination of the biomedical sphere.

Not outlined or discerned in the book is the many Pentecostalistic rocket attack launches against anything indigenous when it comes to addressing ways of knowing and healing  – namely spiritual and oracular, magic and sorcery, divination, supernatural and naturalist fields of disease attributions, including forms of remedial approaches. Except the scathing Christian Missionary activities at the time of colonial incursions on African beliefs and values, I seem to have seen little drawn to show a glimpse to capture the Pentecostalist challenges to indigenous knowledge and its impact on the ongoing shared medical systems in the global scene. By Pentecostalism, I mean the Neo-Christian or born-again radicalism that protests against using cultural resources such as spirits and oracles as a source of meaning.

The author highlights that at the beginning of colonialism and following the course of intercultural exchange, Western biomedicine went out when it was compelled to save lives and expand the frontiers of Europe. In the circumstances that prevailed, medical initiatives resulting from African focused needs radically transformed African medical beliefs and practices. But while it was doing so to protect Europeans in Africa, Africa became engaged in using Western biomedicine and in turn, transformed the Western biomedicine in itself. The typical intercultural dynamics that flowed has enhanced the mercantilist or capitalist focus of the western medical pragmatism. Basically, the book is arguing that the African transformation of Western Medicine and the dynamics of global cultural exchange – posits the fact that contemporary African medical systems are in no way less "biomedical" than Western medicine. In fact, both "greatly enrich and expand the notion of biomedicine, reframing it as a global cultural form deployed across global networks of cultural exchange."

I found several themes within the chapters of the book fascinating such as the origins of African biomedicine, the emergence of tropical medicine and African medical campaigns, including African biomedicine as being a stream of ontology – that is, (a) as a whole medical sphere; and (b) as a consequence of Africa's incorporation into the capitalist world system.

I enjoyed the systematic analysis brought to bear on this theme; the ontological whole, which is, moreover, outlined as a sum total of saying that African medical pluralism has become a global biomedicine that is currently inseparable from the life history of the capitalist world system. What that indicates, in the view of the author, is that African biomedicine has become enjoined in a web of interdependent and mutually conditioning relationships. Therefore, it will be an error to see or frame African medical pluralistic conjoining as if it is a single stream of knowledge. It is not. Rather, we make effort to analyze and portray African biomedicine as both an ontological whole and a multi-faceted singular historical cultural conjecture. In other words, the African biomedicine is a multilayered form of incorporated or borrowed cultural formation. That is also arguably true when we analyze and connect the dots by which African biomedicine is the source as well as a function, like the western biomedical sphere, of a healing enterprise. In addition, African biomedicine is central to symbolic-cultural expression as much as it is equally an expression of social power.

All of this, the author notes systematically defends the argument that African medical context is relational and expansive, revivifying and re-inventing itself in the global biomedical capitalist sphere, sometimes proving it can be on the extreme spirituality, as it may seem, whereby the ontological atomism marks the western view of biomedicine – the pick-up basis of which forms the capitalistic analytical view of health and medical practice in a condensable structured relationship.          

On the specifics of what led to the origins of African biomedicine, the author focuses on the features that heralded it in the first place. However, in his 1994 article captioned "On the creation and dissolution of ethnomedical systems" by Robert Pool published in Africa: Journal of the International African Institute, it is shown that between the mid-1970s and mid-1980s a number of publications appeared in which earlier ethnographies of illness and misfortune in Africa were criticized for placing too much emphasis on supernatural causation and neglecting natural causation and practical medical behaviour. Warren in 1974 also criticized the field by taking note that Africans traditionally recognised a separate medical domain in which they interpret illness primarily in empirical and practical rather than in social and moral terms. This raises the question: why the sudden desire to delineate discrete medical systems, and why so much emphasis on natural causation and practical activity in the view of Robert Pool?

African biomedicine, as contended by David Baronov along with the coming of the Europeans to Africa is a benevolent gift. The purpose of which is to improve the health of Africans. Biomedicine has therefore been credited with indirectly "civilizing" the African mind and spirituality by introducing modern scientific principles to supplant African superstition and rational therapeutic poverty and witchcraft. Although biomedicine is foreign to Africa and is portrayed as western on the one side, and on the other angle, it claims to embody principles that are applicable to all societies and peoples.

Certainly, the western oriented biomedicine focuses on the physical dimensions of the human body and seeks to heal what physically troubles the physical body from functioning properly. It does not necessarily dwell on the inner mind and environmental influences such as the supernatural field. The biomedicine's transformation of Africa is essentially a partial rendering of a much larger process, argues David Baronov. Furthermore, Baronov shows that there is something that is lost or diminished in the above depictions such as the contributions of local African societies and cultures to the development of biomedicine in Africa, including being able to grasp the fact that there is a profound African transformation of biomedicine itself as a global cultural form.

Baronov equally painted the notion that some critics of biomedicine decry its role as a typical cultural imperialism, that is controlling and domineering – one in which Europe emasculated Africa and redressed it with western beliefs and values. As a force for positive change, Baronov makes a case that by allowing Africans to enter the scientific age by biomedicine, it has thereby vivified and improved their health and general well being. As such, the introduction of biomedicine is viewed as something the Europe does to Africa. Whether resisting or responding favourably to biomedicine, ultimately it is the Africans that are transformed as they touched on the lives and societies in the western world given the missionary and colonial cultural encounter.

Concluding the characteristics and experiences which explain biomedicine and its role, David Baronov states that the story of biomedicine in Africa has been told in three (inter)disciplinary ways. He outlines the disciplines as follows: (a), medical history; (b), medical anthropology; (c) and African political economy. Yet, as he claims, each of these disciplines fails to ask the fundamental question; how Africa has transformed biomedicine instead of focusing on how biomedicine transformed Africa? The problem here is the limited perspective with which each discipline conceptually frames biomedicine in Africa as a scientific, cultural or political process.   

What turned my curiosity the more is the discussion on tropical medicine in Africa. I really enjoyed this part. Hence, of what formed the basis of tropical medicine in the province of Africa than in any other colonized part of the world? The analysis moves on and provides details around the evolution of factors that prompted its emergence. Tropical biomedicine was not born before critical incidents of diseases and afflictions which now and again devastated the crusade of sharing and exploiting Africa of what it had as resources to be used by the west to solve and sustain its develop-mentalist cause and other disruptive social challenges at home. It became obvious in the pursuit of missionization and evangelization of African cultural spheres along with colonialism, that death rates and culture shocks resulting from peculiar diseases in Africa called the shots to launch a critical medical campaign to face the challenges. The author highlighted the historical stages and activities in different colonized regions of Africa. Contending, he shows that the notion and strategy of tropical medicine came into being in the context of focusing on Africa as a source of knowledge system and with a high cultural resources potential to benefit the western expansionist drives. Literature interchangeably tends to use colonial medicine and military medicine to depict tropical medicine. The purpose of tropical medicine, the author points out, was to transform those colonies from being the "Whiteman's Grave" into becoming productive regions across Africa and India, namely to see to it that they could be where the Europeans need to thrive while developing other colonies.

As the focus to turn things around continued, special culturally adjusted drugs and medications derived from African healing herbal resources was invented, such as quinine, to treat malaria – which was unknown in the western nature of disease list and causal factors and the treatment profiles. Not until the British assault on the Ashanti Empire in 1874 a point from where to get to the interior of Africa was a staggering task. With war on the Ashanti of Gold Coast (now Ghana), a convenient starting point for the history and modern tropical medicine in Africa was realized as has been documented by various writers such as Bynum in 1994, Curtin in 1996 and Barononv, our present writer, in 2008.

From here, it is fascinating to learn that tropical medicine particularly paved the way for cultural globalization we have today. How, one may again ask? Drawing from our author's (David Baronov) account in African history of colonial medicine in Ghana, he reports of the insight given by C. Goods in 1991 whereby John Vanderkemp, a Dutch physician was generally credited with establishing the First Medical Missionary in Africa in 1799. From that time, medicine in the hands of the missionaries became a vital instrument for Christianizing the people involved in colonizing. With the medical feat on the cultural ground noted, moving inward Africa was the most extreme change required to challenge the restless African mosquitoes that naturally turned to be biological exercise of destruction against the white missionists and colonists. By 1805 through 1841, the book points out that Six Major Expeditions by the British took place with an average mortality rate of 50% orchestrated by malaria. In 1988, Macleod reported similar expeditions into Ghana and Nigeria of 1881 through 1887 with death rates of 5% to 8 % as significant. By and large, the expedition in 1874 whereby 2,500 British troops that received quinine to ward off malaria before being sent to the West African interior to battle the intransigent Ashanti people and the return of the troops with victory and little loss of their lives marked a new era of colonial rule, western powers and influence in Africa. From its inception, tropical medicine was recognized as an essential tool for western expansion and therefore of the globalization of the world we currently live in.                                         

The "European medicine" and its "handmaiden", in addition to "public health" – as the author notes, served as critical "tools of Empire" with typical transformative, symbolic and practical consequences. The western powers under colonial dispensation deployed tropical medicine – first of all (a) to protect European soldiers and administrators from tropical diseases such as malaria, second (b) to protect settlers, civil servants and labourers in key economic sectors of profit earning capacity, and third (c) as an ideological weapon to foster the superiority of western culture, beliefs and values over the African patterns. I found interesting the author's depiction that other African areas un-reached by the invading and colonizing Europeans were considered like lost markets and apparently that frantic efforts were geared up to occupy them for the good of the western exchange with African raw materials and cultures. Until the later part of 19th century, tropical medicine was not formally organized. The need to structure tropical medicine as a development challenge found a voice and administrative skill in the argument that to understand the extension of biomedicine to Africans to be useful – both as a utilitarian need and as a device to introduce western norms it must be truly and scientifically regimented. The view here suggests that development we are talking about, and of any kind, must first of all be anchored on the single and complex needs and challenges of peoples and their times. For that reason, it was viewed that even the Africans that rejected the Christian culture being extended to them by the missionaries and colonists' enterprises still had interest in the white man's medical system and opportunity offered.   

Furthermore, I liked the effort of the author when he discusses the role of anthropology and other disciplines in constructing African knowledge systems and their medical inclinations and temerities or so to say some reckless attempts that offended the African values in order to position the western ones. Here he talks about using ethnography to study and understand the people to be redirected, ruled and transformed. Issues such as sorcery, magic, witchcraft, superstition compared to the level of rational knowledge system and all else are highlighted. The retention of pre-modern beliefs and practices is attributed to either a lack of resources to fully evolve biomedicine or some worth delayed, or made an inevitable geographical change.

Other areas the book discusses which are useful and good to read include the features of biomedical system in an African domain, the pluralism of African medical system and western dualism. In the rendering, the author shows that African societies have each what is called plural worldviews or cosmologies around the issues that define and explain causation and remedy to illnesses. Each cosmology, like all cosmologies, is to construct a broad based explanatory narrative that logically incorporates varied interpretations of reality. As such, African healing systems – methods and theories – must therefore be acknowledged as efforts that have not remained frozen in a timeless ethnographic present; but will have indeed, the capacity to change and adapt with the times. This remark was also observed by Schoepf in 1992.

To understand African therapies, philosophies, herbal and animal resources, healers and patients alike, and their health care support groups, it is vital to discard biases, ancient prejudices and stereotypes and trivialized notions and benefits, and then be able to study what practitioners conceive of medical realities to mean in their cultural context of therapy. Social, class, social networks, community level conflicts, role of supernaturalism, kinship medicine and types of healers that pertain to explaining sources of misfortune and illness, as well as healing domains are nicely outlined by the book and they really made sense in the context of a changing African and western biomedicine, realities and challenges.

A couple of areas can be criticized in this book. For example, the analysis of the book is often arduous whereby repetitions are evident; and that alone, diminishes the concentration of the material. In certain areas where some specific examples are required the author carefully ignored them. For instance, in the west the history of biomedicine or even that of African therapeutic systems as exercised in the 1970s should have been amplified with cases. There is also a problem with grounding his discourse with a relevant theory and make effort to recognize the numerous and dynamic changing nature of African healing systems. But apparently David Baronov chose to point to some relatively modern examples steeped in African methods of treatment. In doing so, he relied on focusing on previous circumstances of African medical syncretism. The structure of the book itself organized in chapters is easy to follow. But I had expected to read in the final chapter some evidence to forge together the work's claims such that a demonstration of how African biomedicine changed Western biomedicine and vice versa will be clear.

Other reviews of this work such as the one by Karen Flint of the University of North Carolina point out that given the author's perspective, the African plural medical cultures which made a case for incorporated biomedicine, the study can be argued to attest to or reflect any other growing regions or societies where medical cultures are not only open but also pluralistic, multiculturalistic in the natural world. Another critique offered by an African historian who writes about the history of African therapeutics is that this book might better look more critically and persuasively at the influence Africans had on Western medicine through their role in introducing African remedies and medicinal plants pharmacopeia, or perhaps, African influences on the agenda of the World Health Organization.

Let me conclude this review by stating that apart from these shortcomings, this book is a go. It is vigorously written and well portrayed from the very historical point of view of the author who shows that biomedicine is an inevitable cultural history, a depiction of medical cultural interchange. In this case, how Africa has transformed and in turn transforms the western society by the consequences of the critical colonial encounter. In particular, the effort at initiating tropical medicine in an African context of plural health care is remarkable. The purpose of which is, namely to protect the colonial and missionary soldiers, the administrators and by extension the civil society of the time and to further penetrate the interior to engage the Africans in the emergent global capitalist community.

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Patrick Iroegbu Ph.D

Patrick Iroegbu is a Social and Cultural (Medical) Anthropologist and lectures Anthropology in Canada. He is the author of Marrying Wealth, Marrying Poverty: Gender and Bridewealth Power in a Changing African Society: The Igbo of Nigeria (2007). He equally co-ordinates the Kpim Book Series Project of Father-Prof. Pantaleon Foundation based at Owerri, Nigeria. Research interests include gender and development, migration, race and ethnic relation issues, as well as Igbo Medicine, Social Mental Health and Cultural Studies.