Tuesday, July 17, 2012

Indigenous Healthcare and “Biomedicine” in Uganda

“Biomedicine” is a term used to describe formally recognized medical care that is available in hospitals, clinics and healthcare centers. In Uganda, legitimized by Science (and the State), it is often characterized as Western or “modern” medicine.
The research I am conducting with the MHIRT team in Eastern and Northern Uganda, has led me to see the problematic nature of using this term, but how alternatives are few.

Because of the legacy of missionary medicine under colonialism and the structural violence inherent to the modern-day public healthcare system in Uganda, biomedicine as a term lends itself as yet another tool in a long history of subjugation in Africa.

To associate biomedicine with hospitals, clinics and formal education is to miss an important fact about indigenous medicine: Indigenous healthcare and biomedicine are not mutually exclusive. They certainly are not two opposite points on the healthcare spectrum (a spectrum that includes Chinese herbal treatments, self-care and Ayurveda). Healthcare, whether one is going to a “witchdoctor” to cure a fertility curse or to the local clinic for free HIV testing, should not be strictly divided into fact or fiction.

For example, rural communities in Uganda have been using the bark from a local tree to treat malaria for decades. Herbalists extracted quinine from this tree or people chewed on the bark to treat malaria infections, which proved to be effective. So before quinine was found in stock at hospitals and clinics (and before people built up a resistance to it), indigenous medicine was the principal public health system in Uganda. To talk of just biomedicine and then indigenous medicine is to place the two on a hierarchal scale where biomedicine is supported by Science while the latter is somehow not.

Today, this gives way to the disconnect between indigenous healthcare providers and biomedical providers. When Julia Hanebrink, MHIRT co-coordinator, started her research in southwestern Uganda, she approached her site asking how the two can work together to benefit the community. However, after talking with communities, she found that most members did not want the two to be merged. People enjoyed the freedom they had in choice. If the clinic failed them, they would go to the traditional healer, witchdoctor, herbalist, or bone-setter and vice versa. A merging of the two would limit their agency. And from an outsider’s perspective, the structural violence and inequality inherited from the colonial structure of public health would spill over into indigenous healthcare practices.

So while merging the two would limit agency and choice it does not mean that they cannot and should not inform each other. Right now, part of our team working in northern Uganda is assisting in the development of Hanebrink’s social medicine module. This module will identify all the socio-cultural factors that influence the community’s health-seeking behaviors by “increasing their [biomedical provider’s] cultural competency” so they can “work effectively in cross-cultural situations by improving quality of and access to care in order to improve health outcomes” (Hanebrink 2012).

Community in this way comes first and their socio-cultural experiences as well as economic challenges are incorporated into the education of biomedical providers to illuminate the choices community members make, painting more of a medical syncretic picture rather than one that privileges biomedicine.

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