Raising the Dust: Chapter Reflections
Chapter Seven – Building Community Relationships
Last month I wrote about some of the tensions between traditional healers and the Ministry of Health (MoH) in Malawi. In this month’s article, I explore these relationships further, indicating some of the ways in which these stakeholder tensions impact traditional medicine practices in my area of study, that being Mulanje Mountain in the South of Malawi.
In my study area, relationships are very important, and I remember getting into a vehicle one morning with a group of other people who were also on their way to work. One of them asked me how I was. I answered in my usual way, to which he repeated his question, adding “here in Mulanje”, we greet each other “s-l-o-w-l-y”. The man explained that in Malawi, when people ask someone how they are, they actually want to know. Relationships matter, and how others are, is important. His comments can be seen in a broader African philosophical context where “community” must be seen as an interactive relational space. This ties in with the notion of Ubuntu, the idea that “I am because we are”. How you are doing, reflects directly on how I am doing, because we are connected. This now widespread concept of Ubunthu originated in Malawi in the concept of Umunthu. The concept is particularly relevant to sickness, where, as Mehl-Madrona explains “my sickness is your sickness, for we are connected. I cannot separate your suffering from my suffering. We are in this together” (2007:41[i]). We are ‘healthy’ through our connections.
The whole idea of ‘community’ then, in an African philosophical view, is that it is through connectedness, not only between people, but within all aspects of life, that keeps us healthy and functioning well as a whole. Sindima explains this worldview as an “African concept of the world and manner of living … informed by the understanding that all creation is bonded to each other and the maker” (1998:538[ii]). Chilisa explains it as a communal way of life, “based on a connectedness that stretches from birth to death, continues beyond death, and extends to the living and the nonliving” (2012:3[iii]). It is within these same living connections that my research participants hold their knowledge, practices and beliefs.
As I pointed out in previous articles, the participants in my research are facilitators of the relationships between local people and the spiritual and material worlds that they inhabit. The role of the traditional healer, in my study areas, consistent with traditional medicine practices around the world, is to care for the sick in their community in the context of their physical, mental, spiritual and emotional health. Furthermore, they are seen as being the ecological brokers, modelling healthy relationship between people and the places they inhabit. This is why I set out to include in my study a group of traditional healers involved in conservation, and was able to do this with my Nesssa group, who were restoring an area of the mountain that had been destroyed by heavy rains in the months prior. Conservation is very important to traditional healers because nature, and particularly their local forest environs, holds the majority of the medicine that they need to heal the sick.
In both of my interview groups working together to promote health and wellbeing and use local resources wisely was important to all of my research participants. They talked about “being as a club”, and “working hand in hand”, and there were times when ‘stakeholder language’ came into their interviews. Some used stakeholder terms, when calling for “collaboration” and “capacity building” initiatives. Many saw coming together as a chance to share knowledge and expertise. One participant said “as you meet, you do share knowledge, and in sharing those knowledges, maybe you can learn a lot from your friends”. Another participant pointed out the limitations of individual traditional healers. He said it was important to connect with other healers because “one person cannot go here and there, healing people”. He explained that he could only be in one place at a time but that his patients often called on him from different locations. By encouraging other healers to work beside him, they become familiar with his practice standards and can “keep his ideas” while he is attending to patients in areas further away. Another participant said:
“one person cannot manage. They want to be a group and share their knowledge, that is important … if he has got another tree which I am not know, I share the knowledge from that one. They must also take my knowledge. I share the knowledge [with] that one. There is some tree which I know and the sick which I know to recover.” (Nessa village, 26 June 2012)
Some participants said that because they were spiritual healers they could only learn from, or share knowledge with, other spiritual healers. Others said it did not matter and, in fact, it was beneficial to work alongside those who practiced a different type of traditional medicine because this greatly expanded a healer’s skills and expertise. This tendency to be somewhat ‘eclectic’ is more consistent with holistic health practices and beliefs in general.
One participant said she purposefully sought out healers who were from different religious beliefs to her own. She was not a Moslem herself but had sought out a teacher on the other side of the mountain who was, thereby deepening her knowledge and skills. Having such a profound impact on all areas of life, in the area religion is one of the ways that knowledge is passed on between healers and influences health outlooks. It is this sharing of knowledge; both horizontally and vertically, across regions, religions and modalities, that makes the traditional medicine practiced by my research participants, so culturally rich, complex, dynamic and diverse. It is a local health outlook, yet over time has developed a complexity and a richness that makes it both ‘traditional’ and relevant today.
Although Malawi is a very small country, there is a high tolerance for social diversity. One of my research advisors explained that people from different cultural backgrounds had always co-existed alongside one another peacefully. He said “you know in Malawi we [Moslems and Christians] have no problems living next to each other, and we even marry and raise families together”. Religion, health and family are all connected, socially.
Family is the core to social life in Malawi. As in Australia, and in most other parts of the world, there is a tiered response to health care there. Patients access medical services through a network of relationships, beginning with the nuclear family, and extending out to professional services. Just as we have a referral system here in Australia to deal with the complexities and specialities of people’s health care need, the same is the case in Malawi. There are two distinct systems in Malawi and they exist side by side, the biomedical and the traditional. Consulting a biomedical practitioner in my area of study is much like consulting a GP in Australia, except over there, waiting times for treatment are extensive and getting to appointments is often an arduous task. Traditional healers are, on the other hand, very accessible since they are numerous amongst the local village communities. In addition, they are able to provide people living in their villages with affordable health care.
I found it interesting that some of my participants talked about sharing “knowledges” and not “knowledge”, and thought that it pointed to the plurality and depth of traditional and other holistic and complimentary health practices in our modern, science-based world.
Despite the importance of traditional medicine having long been recognised by the WHO (World Health Organisation[iv]), the health promotional benefits of it have unfortunately not yet been adequately recognised. This is mainly because its health promotion benefits are difficult to quantify. Some of my research participants nevertheless, pointed out clearly, the disease prevention aspects of traditional medicine. One interview participant gave the example of sexually transmitted diseases saying: “there are some diseases, like HIV and we sat down and shared the knowledge that we can’t, don’t go to another woman. We must be with one woman … we can share our ideas”. He stressed that it was important that traditional healers did not give out health and safety information without discussing it together first, as a group. Other participants also emphasised the role of public health information and the need for consensus amongst healers about what should be shared.
The known impacts of traditional medicine on personal health is limited by quantitative studies that fail to take into account the complex biopsychosocial health needs of the person, in scientific studies. The impacts of traditional medical outlooks on public health more generally, is even further unknown, due to the lack of ethnographic, locally placed, cultural studies, like my own. This is something both my research participants, and socio-culturally focussed traditional medicine researchers like myself, would like to see change. This is important because locally practiced traditional medicine is still the only affordable health care for most people in poor countries, and the only accessible care for many others.
The way the participants in my study had organised themselves to leverage social capacity was as obvious as it was impressive. Stakeholder engagement had been important to them and they were still working to enhance relationships with two key social groups, the MoH and the Department of Forestry. The church, in all its forms, is the other public stakeholder group that traditional healers engage with. Stakeholder relationships with the MoH impacted on the participants in my study due to the breakdown in cooperation, some of which I described in last month’s article. They said it was particularly frustrating in situations where traditional medicine was known to be more effective than biomedicine, like in cases of infertility and mental health issues. Other participants stressed that it went the other way too, pointing out that there were some diseases like HIV/AIDS that required biomedical support, and that it was important for healers to refer in these cases. My participants felt that they were working with the MoH, yet this was not being reciprocated. They were making referrals to the hospitals, but they were not getting anything back.
In general, the breakdown in relationships between traditional healers and the MoH was more pronounced on the Phalombe side of the mountain and I wondered if this was because the participants at Nessa were already engaging with a nearby MoH teaching facility. They had previously secured an MOU partnership agreement with the Blantyre College of Medicine and were working on future collaborations. They had also been engaging with a number of key NGO programs in the region for some time, like the well-funded one that I did my research through. Some had existing relationships with bigger traditional healing associations. For instance, the Chairman of the Nessa group had worked alongside the Chairman of one of Malawi’s national traditional medicine registration bodies, the Herbalists Association of Malawi. It seemed that the participants in the Phalobme group were still trying to strengthen these community relationships.
The other important stakeholder group in my study was the Forestry Department, and this is where the trust seemed to have really broken down. The origins of the tensions between these two is obvious. For both groups, it is about access to, and management of resources, most notably, forest resources, which are under increasing threat. The conflict between the two goes back a long way and at the time of my research, the relationship between the Phalombe participants and the Department of Forestry was still strained. The Nessa participants were already revegetating their local area, through resources secured through the organisation I did my research with. On the other side of the mountain, the Phalombe group were still asking for resources that would offset their dependence on local forest stocks. They were requesting round table discussions, but they were also asking directly for things like seedlings and seeds so they could establish woodlots and medicinal gardens near to their homes. This way of engaging with stakeholders and NGO’s is something that is a way of life for people living in poor countries, especially in places like my study area.
In addition to these two key stakeholders, churches play a huge role in the practice of traditional medicine in my study area. This impact is so important that I devote significantly more attention to it in later descriptions. Here, it is enough to say that 80 percent of Malawians who associate themselves with a religion of any kind identify themselves as Christians. Some religions are more tolerant than others of people’s traditional medicine practices and beliefs. The Pentecostal church seems to be the one that is the least tolerant of local health outlooks and is causing the greatest health tensions and issues for people. It is also causing the most concern for a lot of my research participants.
The participants in my study have certain collective needs and they saw my research as yet another opportunity to capitalise on capacity building and getting more resources. Through my research they have expressed a need for resources that include; better working relationships, better public information, more government recognition and access to resources (like seeds, seedlings and ‘shelters’, or clinics from which to work). As I listened to my interviews, I realised that the participants in my study are no different from holistic healers and complimentary therapists anywhere in the world. How we go about building our healing capacity in our communities might be different, yet essentially, as holistic practitioners, and traditional healers, we all basically need the same things to do our work.
In addition to their relationships with various stakeholders, my participants talked about their relationship with time, noting that time changes and that it is rhythmic and seasonal. It can be a problem when it is short supply (due to the demands of juggling making a livelihood as well as providing healing services to the community), and it is always temporary. My participants described the cycling, changing impermanence of everything, even themselves. I loved all the different ways that time was described to me by my participants. This is one aspect of my study that one of my examiners thought I should have expanded on a bit more. What can I say, already I had to chop out 80,000 words!!
Just as I have described how traditional healers learn their skills from others, this is how they teach. One of my participants explained how they pass their knowledge on, saying that it’s not through “book learning” but everyday experience. He said in a community like Mulanje “a child is born in the same family and sees whatever each and everything the father or mother is doing concerning traditional medicine”. When a child learns through watching their parents, when they eventually die, “that child knows each and every corner that the late father or mother was doing”. He said this made it easy for them to follow in their footsteps. Many, if not most, of my participants were teaching others, mostly younger family members but some were teaching interested community members. All were doing so, in order to pass their knowledge and practices on to future generations.
One of the participants described the importance of teaching as such:
“it is very important to teach somebody, for the sustainability of the activities because if it happens that even your relatives is not willing to learn what you are doing, it is better, or you better teach any outsider, for the sustainability of that activities … [if she] does not teaching anyone, once she is gone it means also, everything has gone.” (Phalombe, 23 June 2012)
As with most traditional ecological knowledge, much of the teaching of traditional medical knowledge is done orally, and in situ. One participant emphasised how, in Mulanje “people are well taught” because the medicines are found locally. He said this was not always the case and in some places, they “act the way we do in school, a teacher brings a book and teaches that this plus this it equals this”. The problem is, when the teacher leaves, so does the knowledge. It is not attached to the place so the student is not “fully backed”.
Interestingly, family members are taught free of charge, but for anyone outside of the family there is a cost. Notably, provision is made when teaching young relatives, for their schooling, healers work around their relative’s schooling needs. Another point of interest is that healers tend to teach others so that if they get sick, they are able to call on someone close by who they know has good healing skills because they have taught them themselves.
A few of my participants had been recording their treatments and other observations, as a reference. The chairman of the Nessa group had kept all his records since 1980 and was still using them as a teaching aid. This is not the norm though, due to low literacy levels.
My fieldwork, and then putting together this chapter reminded me of the common ties between traditional healers and other holistic and complimentary healers all over the globe. We seek to serve our communities through providing safe, accessible, and affordable care. We come up against the same issues with our mainstream health models and have to justify our knowledge, practices and beliefs. For many of us holistic health practitioners here in Australia, we too have to work outside of our holistic health interests to pay the bills. We are good at what we do, yet many of us do not have anywhere from which to do it. Like the traditional healers in my study, we are driven by our passion, yet we are restrained due to lack of resources and lack of community understanding about our worth. Like the participants in my study, we group together to gain social leverage and to provide each other with support. My own personal thoughts are, the more connected we are, not just here within our own communities, but across the world, the more relevant we will be.
Next month I will reflect on how traditional medicine is accessed in the community. Through the theme of travel, I will look at some of the ways people negotiate the health care system in my study area and what this means for them. In the meantime, if you would like further information about my research please email me at firstname.lastname@example.org
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] Mehl-Madrona, L. (2007). Narrative Medicine: The Use of Story in the Healing Process. Rochester: Bear and Company.
[ii] Sindima, H. (1989). Community of Life. The Ecumenical Review, 41(4), 537-551.
[iii] Chilisa, B. (2012). Indigenous Research Methodologies. London: SAGE.
[iv] World Health Organisation. (1948). Constitution of the World Health Organisation. Retrieved from http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1