Raising the Dust: Chapter Reflections
Chapter Eight: Footprints, Pedals and Pathways
In last month’s article, I wrote about the importance of community relationships in maintaining the knowledge and practice of traditional medicine in my study area, that being, Mulanje Mountain in the South of Malawi. The beginning of the forth data chapter of my thesis, Raising the Dust: Exploring Traditional Medicine in a Changing Context, takes us back to Phalombe. It describes how I was waiting in the centre of the boma[i] for the minibus to pick me up and take me back to the guest house on the other side of the mountain where I was living during fieldwork. I waited alongside a woman and her child. We waited for hours. A man joined us but no minibus arrived. It was growing dark. The boma day traders started packing up as the night activities began. Children skipped passed, some still in school uniform. A young herdsman guided his flock. Still we waited. A taxi offered me a lift at an exorbitant price and although I was getting worried, I declined. As often happens in my study area, a complete stranger came to our rescue. The man was driving passed us in a construction truck and stopped and guided us in, driving us to the main road where he was turning in the opposite direction. It was by then pitch black yet luckily I was able to summon a bicycle taxi to take me to the bottom of the hill. The evening’s mountain air was cold and a soft mist had set in. Half way up the hill, a young girl turned around to me and said with a tone of urgency to her young voice, “quick, we must walk quickly now”.
This was the first day of the Phalombe interviews and they had not started until late in the day, once all the required formalities had taken place. Being stranded at the side of the road for hours as the darkness descended was an uncomfortable feeling for me yet it was also a good reminder that in Mulanje, life is often inconvenient, even hard to negotiate. In Mulanje, there is no easy way of moving from place to place so things must be planned in advance. Everything requires effort, energy and forward planning, but plans do not always go as expected and in Mulanje great care must be taken to negotiate these daily challenges.
This then became the theme of my forth data chapter. How do people get from place to place? How do they physically access health care services and what does this mean for the participants in my research who provide traditional medical care to people in both local and more distant villages? Moreover, how do these transport and mobility issues affect the ways in which traditional healers collect their herbal medicines from the forests and other environs, both nearby and further away from home? Aldridge (2004:132)[ii] writes that because healing is itself a journey, it is expressed bodily as a “praxis aesthetic”. Unlike in Western bio-medicine though, in the context of traditional medicine, this bodily expression of health is experienced by both patient and healer; both co-exist in the healing journey.
My participants talked about moving constantly between people, plants and place. For my participants, getting from place to place mostly involved walking very long distances, often with bare feet touching the earth. Some had access to bicycles, especially those who travelled from Mulanje district to Mozambique to find the herbs they needed to treat the sick. From Nessa village it is about a 60kms round trip and from Phalombe on the other side of the mountain, it is about 160kms there and back. There is a main (tarred) road for part of the way, but just to give you some idea of the condition of the “roads” that people must travel, whether by minibus, bike or on foot, here is a picture of the road that I used to walk up on my way to Nessa village. The road to Phalombe was likewise characterised by dusty red dirt that seemed to find a way of getting right into your nostrils, ears, eyes and hair, even whilst travelling by minibus.
Image 1. The “road” to Nessa Village June 2012
Looking at this “road” you can see the problems people would have in both accessing and providing health care in my area of study. There are very few cars in the area, access to vehicles is restricted to those in professional positions, often those employed by international organisations, and car ownership is very rare. Interestingly, the Ministry of Health (MoH) does provide free ambulance services but they are reserved for those who are critically ill, yet despite this, they do not arrive in a timely manner. Furthermore, although women are expected to attend a hospital to give birth, and they are able to call for one of these ambulances to assist when they are in labour, because they do not arrive in time most of the time, this service is not effective in these circumstances either. Women are able to travel by minibus when seeking obstetric care, but only if they have not already started to labour so despite the outlawing of traditional birth attendance practices, many women are often stuck in or near to their home surrounds. There are some busses but they only run between the major regional centres. Most people rely on minibuses for their everyday travel requirements but minibus transport was expensive at the time I was doing my fieldwork, due to the falling value of the Malawi kwatcha[iii]. It is no surprise then, that in the absence of vehicles, and with the high costs of minibus transportation, walking remains a significant way of accessing everything a person needs, including health care.
Some of my participants were well into their seventies, yet this did not stop them covering vast distances on foot during the day. As a walker myself, I used to love walking up the side of the mountain during field research and inevitably came across a number of traditional healers carrying picks and bags of medicine. As they walk, traditional healers are connecting physically, mentally and spiritually with their local regions. Furthermore, in using their own physical bodies directly to treat patients, cooking herbs, moving from home to home in the village and gathering herbal medicines, practitioners are engaging simultaneously in a range of health and natural resources activities. This interrelated aspect of traditional medicine practice was one of the drivers of my research. I wanted to better understand the connections between traditional health outlooks and knowing and caring for the earth. A paragraph extracted from Chapter Eight of my research explains:
Muecke (2004)[iv] argues that all traditional knowledge can be viewed as a way of keeping things alive and in place, through practicing. According to Muecke (2004:36), the best way of doing this is by “following literally in the footsteps” of those who are living it. Khare[v] describes traditional medicine as “practiced medicine” (1996:837), because of the way in which healers literally follow in the footsteps of others. In addition to the knowledge and skills developed through observation, walking becomes yet another method of learning. The picking of leaves, the cutting of bark, the digging of roots and the collection of aromatic plants, connect a healer with the local environment. Learning as they go, like traditional healers in other places, the interview participants in this study combine their harvesting and treatment practices, adjusting their methods according to changes in their local environment.
Walking is cost effective and promotes learning through observation however, it is neither time nor energy efficient and as I described in last month’s article, my participants were utilising my research as an opportunity to lobby for more resources. In this month’s article I will focus on these issues, leaving my reflections on harvesting practices and the impacts of these on the local environment for next month’s article. The lack of transportation became a key theme in my research participant’s interviews. One participant said he had to “cross up to Mozambique” to keep up his supply of plant medicines. Another said he travelled from Nessa to both Mozambique and Phalombe, because “there are no many trees of medicine” in his local area. He said it took him about seven hours to get to Phalombe so he stayed overnight, walking back again a day or so later. He described the forests as being very different and said that the uniqueness of each area provided him with a diversity of medicines. Raising concerns about being away for long periods of time though, he stated “if I go far to fetch the medicine and on my way back they will come with the sick one, when I was away, and he will die because I am away”. This was a concern for many of my participants, that people would die or become more unwell whilst they were out gathering medicines and treating people in places that were further away.
To put it into perspective, the participants in my study treat patients and gather medicines over a linear distance of more than 100 kilometres. However, they do not gather medicines and treat their patients in a straight line; they travel into the forest, around the villages and across rivers and other landscape features. Collectively, their practices cover hundreds of square kilometres and it is not surprising that they value any means of transport that saves them time and energy. For many, bicycles provide a practical answer to the long distances they must at times cover and many of my participant’s asked for bicycles so that they could be more efficient in providing more accessible traditional health care. For example, one participant emphasised that, it is not only traditional healers who struggle with the lack of transport, their patients have just as much difficulty. Making a direct plea for bicycles, she said that since very few villagers had access to bicycles, if healers were provided with them;
it could be very easy for the traditional healers to take that patient back to his home, or her home. It is also very difficult for these traditional healers to be moving here and there just because of mobility, that is transport problem. Had it been that they are having more pushbikes, they would have been travelling [to] various places, for different activities as well. (Phalombe, 23 June 2012)
More participants on the Nessa side of the mountain had access to bicycles ‒ both owned, and more commonly, borrowed ‒ than on the Phalombe side of the mountain. As noted in last month’s article, the Nessa community appears to be better resourced than the Phalombe healers. Since it is quite a distance from Phalombe to Mozambique ‒ where traditional medicines resources are still in plentiful supply ‒ some of the Phalombe healers spoke about relying on having someone they know pick up medicinal herbs for them. One person said that she was not able to travel to Mozambique herself to source herbs but that:
I do write a list of those tree species on a piece of paper. Once these people have visited Mozambique they do meet traditional healers there and they do ask “where can I get this tree species, where can I get this tree?” (Phalombe, 15 June 2012)
Lack of transport makes finding the right herbs difficult and sometimes it can also impact other aspects of practice. For example, a participant in my study had participated in a mental health trial at a hospital in the Malawian town of Zomba, and her input had been found to be so valuable that she was invited to take part in similar trials in South Africa. Being without transport, or indeed the funding for transport costs, she was unable to attend this cross border collaboration. Although she would not have been able to travel to South Africa by bicycle, she was highlighting how the lack of transportation, and poor social mobility, is stopping some local healers from participating in the broader health debate.
Once again, through reflecting on this data chapter, I see the common threads in the patterns of how we as holistic healers practice; how we access resources and how we must overcome challenges to provide services to our clients who are themselves, often under-resourced. Of course in a country like Australia the health needs of our population are vastly different to the people of Malawi, where poverty is extreme and the average life expectancy at the time of my research was estimated to be around 35. These realities to the side, are our issues really that different, given that in both cases we are talking about a dual system of care? What can we thus learn from traditional health outlooks in contexts where there is a dual system of care? For instance, in a place like Malawi where bio-medical health care is affordable only for some, or in places like Australia where there is an excellent pubic health care service but where this is delivered to the exclusion of almost all complimentary heath care modalities and techniques, much of which remains the health care of choice for so many? How do we reconcile these systems to ensure best health practices as well as best health outcomes for everyone? Moreover, how do we ensure that health care is delivered in ways that do not harm, not just humans but the planetary systems on which we all depend on for life? These are the questions that motivate my research, and my practice. I will discuss them further next month in Part II of my reflections on chapter eight, as I explore local harvesting practices and the impacts they have on local environments and the life they support. In the meantime, if you would like further information about any aspect of 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] This is the judicial area of the district
[ii] Aldridge, D. (2004). The Breath in Healing. In Health, the Individual and Integrated Medicine: Raising an Aesthetic of Health Care. (pp 149-162). London: Jessica Kingsley Publishers.
[iii] The kwatcha is Malawi’s currency, which at the time of my fieldwork was at a rate of 28 to one Australian dollar
[iv] Muecke, S. (2004). Ancient and Modern: Time, culture and indigenous philosophy. Sydney: UNSW Press
[v] Khare, R. S. (1996). Dava, Dakar, and Dua: Anthropology of Practiced Medicine in India. Social Science & Medicine, 43(5), 837-847.