Therapy as a system-in-action in Northeastern Tanzania

Abstract

This article is an attempt to find the systematic bases of therapeutic organization in north-eastern Tanzania, based on recent research in Galambo, Lushoto District. The whole of Tanzania suffered a long period of very low investment in either health care or public health during the colonial period. During that time the costs of reproduction of labor were borne in the countryside, mostly by women and children. Neglect by the colonial powers left a sphere of rural autonomy in medical matters, in which a number of therapeutic systems and sets of ideas fourished side by side, with no one therapeutic tradition establishing an effective monopoly. How then is a socially approved course of therapy determined? One possible answer to this question—based on shared world-view and shared assumptions about the causes of illness—is rejected. Evidence shows clearly that individuals disagree fundamentally on theories of illness causation. Radical scepticism concerning the validity of spirit-causation of illness, and of sorcery-explanation, is common. The boundaries of the system are shaped by the power of the government and (among those who are Christians) the authority of the church. The government has decided that cholera and tuberculosis must be treated within the biomedical tradition. The chruch tries unsuccessfully to limit its adherents to the use of hospital medicines or simple herbal therapies. The system as it works in actual practice is shaped by two principles. First, treatment is diagnosis. The only way to know with certainty the cause of a particular illness is to treat that cause and see if the condition improves. In many circumstances therapies are tried primarily to advance the process of diagnosis. Some treatments are structured so that only a part of the treatment need be tried initially, for diagnostic purposes, with the rest completed if the initial results are positive. The second principle is that the range of therapies is determined by the range of therapy managers. Therapeutic options supported by a relative or neighbor of the patient are almost never rejected, even if the patient or other therapy managers disagree with the assessment or therapeutic theory. Because of this each individual whose illness continues over a period of time tends to be treated by a wide range of practitioners.