Raising the Dust Chapter 12 Reflections: Wrapping Up Part I

Towards the end of fieldwork, I met with a research colleague I had become close to. He’d supported my initial interests in the study and had guided me during fieldwork. The meeting was an informal debriefing session focussing on some of the technical aspects of fieldwork. The first topic to arise was the time it had taken to negotiate some of the essential official aspects of the research ‒ like getting approval for the study to go ahead and gaining the relevant research permits. We also discussed the potential for enhancing relationships between locals and researchers, through better matching their particular research interests (in my case this had not gone so well). Nevertheless, the technical aspects are managed by official regulations, and in this case, they were beyond either of our control. After discussing these issues for a while, my research colleague inquired as to how my fieldwork had progressed overall. I responded that it felt as if I had barely scratched beneath the surface of what it means to practice traditional medicine in the Mulanje Mountain Biosphere Reserve. The research officer paused, and after some thought, he ventured that perhaps what I had been doing was “raising the dust” about it.

The metaphor resonated instantly because much of my study was conducted with me walking around in the local area, literally raising the dust with my feet ‒ as traditional healers do in their everyday practice. It also reminded me once more of the impermanence of my role, stated frequently in the phrase, “not you but others who will follow”. I prepared to leave the field reassured that, despite the contingent nature of my role, by following in the footsteps of others, I had managed to tread new ground on the practice of traditional medicine in a changing place.

The metaphor impressed me enough for it to become the title of the study. The metaphor of raising dust in this way brings together the main themes, linking the data back to the study’s initial ecological ideas of connection to earth, exploration, curiosity, possibility and change.

Possibility and change

I embarked on this research journey as a western woman with a passion for understanding the ways in which others approach health and wellbeing. Since I wanted to appreciate the value of their knowledge about these important matters, I arrived in Malawi with an open heart and an inquiring mind. My attitude towards my research was influenced by a number of things. Firstly, the fact that I’m a woman impacted on how I was received, both by my study participants, and by the local community. At times this was advantageous because I could relate with half of the interview participants on a shared level. I found that being a woman did not, however, mean that the women in my study, both the interview participants and the other women whom I encountered, were automatically comfortable sharing their experiences with me. Some of the women in my study seemed hesitant in their interactions with me, and with few exceptions, it took time for me to establish a meaningful rapport with them. By contrast, the men were generally responsive to my need for assistance with transportation, translation, directions and a range of other research tasks and I was able to develop friendships with a number of them.

Although I was particularly attentive to maintaining positive relationships with others, I nevertheless remained an outsider, a white woman, an umzungu[i]. Despite my position as an outsider, I was able to overcome some of the strangeness of conducting research in a foreign place because of my attachment to the rural areas of Africa. My personal experiences of also growing up in the mud and the dust of the African landscape prepared me on an unexpected level. This was both reassuring and confronting for me. It was reassuring to re-connect with the familiarity of what I am drawn to, and knew as a child growing up in Africa. The simplicity of rural life and the warmth of the people provided a brief reprieve from some of the things that trouble me about living in a wealthy industrial country, nourishing me on a number of levels. My comfort at being surrounded once more by the things that give meaning and purpose was nevertheless overshadowed at times by an ominous sense of threat ‒ if not fear ‒ for the future.

The growing threats to traditional medicine come from both inside and outside the region.   They can be smelt, felt, tasted and touched. They are real and they are part of people’s daily struggles and joys. In this study they relate most notably to the health needs of the population, the influence of the church on people’s beliefs, the loss of resources due to deforestation, the ongoing threat of mining and ‒ for women in particular ‒ poverty and a lack of opportunity. These are complex issues. They cannot easily be separated. They require an understanding of the layered intersections and the complex ways in which these tensions influence the knowledge, practices and beliefs about health experienced by those living in rural Africa today.

A crisis in health

It should be noted once again that this study was designed to allow the themes to emerge. Although I was aware of the prevalence of HIV/AIDS, malaria and other life threatening health illnesses, I excluded questions directly related to any particular diseases because I wanted to leave it to the interview participants to raise specific issues. Nevertheless, the impacts of HIV/AIDs and other serious diseases became a reality in the field through: conversations with people who were HIV positive; when visiting sick children in the overcrowded ward at the local mission hospital; by noticing the frequency of funerals; and by observing people’s daily struggles, not to be healthy, but to survive. In spite of these realities, notably few of my interview participants mentioned HIV/AIDS. Simwaka, Pelzer and Maluwa-Banda explain that witchcraft is viewed as being “by far the most common cause of illness” (2007:156)[ii] and given that it is such a rural part of Malawi, it’s likely that when my participants were referring to “diseases caused by witchcraft”, they were including life-threatening illnesses like HIV/AIDS.

The ethnographic methodology chosen for the study adds strength because without an intersubjective, interpretive framework, the data has little meaning. It is limited, however, by my etic position, as a white researcher exploring traditional knowledge in a changing context. Interpreting the data through an outsider’s position, while remaining aware of the meaning behind people’s everyday experience was a constant challenge. For this reason, I could not draw any definitive conclusion as to why a discussion of HIV/AIDS had been left out but I interpreted it in a number of ways. For instance, I wondered if my interview participants were uncomfortable discussing these important health issues with an outsider like me. Alternatively, I thought that perhaps it reflected the status of traditional medicine in Malawi, where traditional healers are practicing within a public health framework that does not recognise their knowledge, practices and beliefs, particularly in cases of HIV/AIDS. It’s possible there are other explanations I either didn’t notice, or was unable to interpret appropriately at the time.

At a gathering to celebrate the end of the Phalombe interviews, one of the participants read out a letter on behalf of the Chairman of the local healer’s association. In the letter, he challenges the perception that traditional medicine is of no benefit in treating HIV/AIDS. The letter states that practitioners would like the opportunity “to ask the government of Malawi to give chance to traditional healers to cure a patient suffering from HIV/AIDS”. It also states that traditional healers have found “a real medicine to cure Aids. We mean HIV/AIDS”. The chairman’s letter states that people working at the government hospitals are “not happy with our doings so they feel jealousy”. After reading this letter out loud on the day, he passed it on to me. While the efficacy of traditional medicine in treating and managing HIV/AIDS remains an important health issue in Malawi, it has purposefully been left out of this study because it was not raised in any significant way in any of the interviews. Nevertheless, acknowledging the chairman’s letter was my way of recognising the importance of these issues to the current health and wellbeing debate around HIV/AIDS, particularly in the more rural areas of southern Africa.

Whilst not addressing these issues in any depth, this study sheds light on the need for further research that explores the role of traditional medicine in managing both the physical and the biopsychosocial needs of people living with HIV/AIDS in rural communities in Africa. Traditional medicine does play a significant part in treating both the physical symptoms and the psycho-social impacts of HIV/AIDS. This relates to both people’s beliefs about the disease and the availability of resources. While exploring these issues in any depth remains outside the scope of the current inquiry, they are key to understanding both the ethical and the political issues that define traditional medicine in the region. Although this study did not focus on the political landscape, it’s clear that it affects the everyday experiences of people living in the area significantly. These issues are multifaceted and the ways in which they influence traditional medical outlooks locally are profound. Some of these impacts have been highlighted in my study but my chosen methodology did not allow for a thorough investigation of these themes.

Another point to note is that this study was restricted to the views of registered, practicing traditional healers. There are many other local practitioners who do not participate in these formal activities. They do not become registered with any association since they view their knowledge and practice as being an inherited/God given right. Mostly they make their presence known by displaying flags on bamboo poles around their homes in the village. This study did not include the views of those who choose to practice in this way, but it acknowledges that they might be very different from those of the traditional healers who participated in this study.

There is no other system that replicates exactly the complexities of the traditional medicine practiced by the interview participants in this study. No other healing system connects the physical, mental, spiritual/ancestral and ecological aspects of health and wellbeing in quite the same way. In light of these local practices, traditional medicine is tied to the whole community ‒ both spiritually and materially ‒ through relationships with the ancestors, the plants, the rivers, the forests, family and friends. I found it to be an active, breathing, moving medicine that not only mirrors ecological processes for the community, it connects the living and the dead, mediating between the realms of the spiritual and the material. I sought to show how it does this, not in an ‘otherworldy’ way, but in an everyday, living and constantly changing way.

The need to understand the complexities that define traditional medicine, as a unique body of everyday knowledge, practices and beliefs is evident in the reliance on traditional health care in rural parts of Africa today. To this point however, commercially motivated, scientific approaches have overlooked the wider socioecological implications of local people’s knowledge, practices and beliefs. Other studies have focussed on the potential for integrating traditional medicine into the existing public health system. My study does not argue against any of these studies, instead it seeks to add to them by showing that traditional medicine is very different from biomedicine and that integrating it into the existing public health system might further marginalise its status as a culturally appropriate, accessible and reliable form of care.

This study looks beyond politically dominant development models of health. By speaking directly with traditional healers and others about their knowledge, practices and beliefs, it seeks to move away from the Eurocentric, ‘west knows best’, approaches that have so far driven ethnomedical research interests ‒ if not health research in general. Etkin and Elisabetsky (2005:24)[iii] explain that the “privileging [of] bioscientific ideologies” not only limits our understanding of traditional medical practices, it also “reproduces a Euro-American tradition that discounts traditional ways of knowing and managing resources”. By exploring the topic through participant observation, and by conducting interviews with traditional healers, this study recognises the significance of people’s lived experiences and considers what this means for the future of traditional medicine in a rapidly changing world. It seeks to open the debate up to a broader discussion of the nexus between human and ecological health, considering what more we might learn about these ecological links by exploring people in-context approaches.

In light of the Eurocentric approaches that have dominated so far, Sachs finds it ironic that the north (and now the developed parts of the south) is responsible for causing much of the current socioecological crises, yet it continues to present itself as the “benevolent provider of solutions” (1999:32)[iv]. Seeing the benefits that the ‘Third World’ has to offer, Hirt and M’ Pia (2008:7)[v] point out that when President Nehru first came up with the term, he was not referring to a backward or ‘underdeveloped’ way of life, but a better way of being in the world. Hirt and M’Pia state that this ‘Third World’ has everything to be proud of since it provides us with “nature-orientated guidelines on how to cultivate this earth” (2008:7), which can guide us now “in the means by which our globe could easily survive for another few million years”.

In an African context, the renewed interest in re-discovering sustainable ways of living corresponds with recent calls to an African Renaissance (Reihling, 2008)[vi]. It’s not yet clear what influence this growing interest in African culture will have on traditional medicine but Connell (2007)[vii] cautions researchers against responding too quickly, arguing that calls like these can be interpreted in two ways. One is to see them as an effort to renew pan-Africanist interests in recovering traditional knowledge. The other is to view them as part of neoliberal efforts to further develop Africa along global free market lines. There’s clear need for a cautious and critically informed discussion that adds to our understanding of the experiences of others. To this regard, Bignall distinguishes the “postcolonial” (2010:3)[viii] from the “post-colonial”, which she argues “suggests premature claims to an already lived temporal and moral distance from the process of colonization”. In other words, rather than conveying a time we have left behind, postcolonial engagement as a “positive task”, one that we’ve barely begun.

Traditional medical research can either threaten local resources and practices, or alternatively, it can create opportunities for transformation and change. Langton argues that the process of globalization means that local communities can now combine “ancient ways of human life” (2003:82)[ix] with novel market forces in ways that can benefit of all of society. Buenz (2005)[x] adds that the renewed interest in traditional medicine thus promotes the values of traditional medical systems as an important aspect of modernity. People can be proactive in protecting local knowledge, practices and beliefs and at the same time promote collaborative dialogue that engages with the research community. Posey explains that the challenge for researchers, therefore, is not to “abandon their most treasured theories or research topics” (2002:39), but to learn new ways of negotiating with people that also benefit their communities. Ethnomedical research must not only benefit science, it must also empower indigenous peoples. The present study has sought to achieve this by; establishing contact with the field some years prior to commencing fieldwork; by engaging in local events and activities through participant observation; by developing strong social networks with stakeholders and other participants; by listening to the needs of the interview participants; and by observing closely the things that influence the everyday experiences of people living in the villages on and around the Mountain.

While respecting the unique value of local knowledge, expressed in people’s everyday experience, this study aims to extend this understanding to highlight the significance of the links between human and ecological health. So far health and ecology have been studied as two separate disciplines but as Pullin and Knight point out, both are crisis disciplines, making them equally useful for confronting the “moral and ethical dilemmas” (2001:51/52)[xi] facing society today. A major strength of this inquiry is that it takes a transdisciplinary approach to the topic and then explores the interconnections that emerge. Furthermore, my study presents the data chapters in such a way as to reflect this, starting with a definition of traditional medicine (and what it means to become a traditional healer) and then exploring wider relationships and the ways in which they influence local life. Whilst I hope my research will be of benefit, I understand that these benefits are limited and there is a need for further research and more resources to address the threats and opportunities to traditional medicine that have been raised.

My study is not a case study, but a narrative inquiry, which raises the dust on the ways in which traditional healers go about their business; helping to bring new life into the community; attending to the sick with bare feet touching the earth; gathering herbs from the forest and transforming them into healing remedies using fire and water; transplanting medicinal plants; listening to the ancestral spirits; making offering to them on behalf of the sick; mixing remedies and teaching others. It seeks to understand why they choose to continue doing so in a rapidly changing world. It also considers how these practices and beliefs might enhance our knowledge of the links between human and ecological health. This study is open ended; on the one hand it seeks to deepen our understanding of the practices and beliefs of others, whilst at the same time encouraging us to challenge our own beliefs and behaviours toward more ecological ways of being in the world, which Halsey describes as an “ongoing journeying” (2009: 248)[xii].

Next month’s article is my final reflection on this study. In this final reflection, I drawn my concluding remarks and suggest a way forward but in the meantime, if you’d like further information about my research, please email me at hippygolucky@hotmail.com

Dr Theresa Jones (PhD) is an intuitive counsellor, incorporating holistic principles and energy healing in her practice, Inner Sense Intuitive Counselling Services. You can contact her on 0458268605 

[i] Umzungu is a colloquial term for a white person. An informant explained that depending on the tone with which it is used it can have either a neutral or a derogatory meaning.

[ii] Simwaka, A., Pelzer, K., & Maluwa-Banda, D. (2007). Indigenous Healing practices in Malawi. Journal of Psychology in Africa, 17(1), 152-162.

[iii] Etkin, N., & Elisabetsky, E. (2005). Seeking a transdisciplinary and culturally germane science: The future of ethnopharmacology. Journal of Ethnopharmacology, 100, 24-26.

[iv] Sachs, W. (1999). Planet Dialectics: Explorations in Environment and Development. London: Zed Books.

[v] Hirt, H., & M’Pia, B. (2008). Natural Medicine in the Tropics. Germany: anamed.

[vi] Reihling, H. (2008). Bioprospecting and the African Renaissance: The new value of muthi in South Africa, Journal of Ethnobiology and Ethnomedicine 4(9), 1-10.

[vii] Connell, R. (2007). Southern Theory. Cambridge: Polity Press.

[viii] Bignall, S. (2010). Postcolonial Agency: Critique and Constructivism. Edinburgh: Edinburgh.

[ix] Langton, M. (2003). The ‘wild’, the market and the native: Indigenous people face new forms of globalisation. In W. Adams., & M. Mulligan, (Eds.), Decolonising Nature (pp 79-107). London: Earthscan.

[x] Buenz, E. J. (2005). Country development does not presuppose the loss of forest resources for traditional medicine use. Journal of Ethnopharmacology, 100, 188-123.

[xi] Pullin, A. S., & Knight, T. (2001). Effectiveness in Conservation Practice: Pointers from Medicine and Public Health. Conservation Biology, 15(1), 50-54.

[xii] Halsey, M. (2009). Deleuze and Deliverance: Body, Wilderness, Ethics. In B. Herzogenrath, (Ed.), Deleuze/Guattari & Ecology (pp 233-249). United Kingdom: Palgrave MacMillan.