The Problem of Money: African Agency & Western Medicine in Northern Ghana 9781782388739

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The Problem of Money

The Problem of Money African Agency and Western Medicine in Northern Ghana

Bernhard Bierlich

Berghahn Books NEW YORK • OXFORD

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12/7/07

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First published in 2007 by Berghahn Books www.berghahnbooks.com ©2007 Bernhard Bierlich All rights reserved. Except for the quotation of short passages for the purposes of criticism and review, no part of this book may be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system now known or to be invented, without written permission of the publisher. Library of Congress Cataloging-in-Publication Data Bierlich, Bernhard, 1963The problem of money : African agency and Western medicine in northern Ghana / Bernhard Bierlich. p. cm. -- (Monographs in German history) Includes bibliographical references and index. ISBN 978-1-84545-351-0 (hardback : alk. paper) 1. Medical anthropology--Ghana--Dagomba. 2. Traditional medicine-Ghana--Dagomba. 3. Medical innovations--Economic aspects--Ghana-Dagomba. 4. Medical innovations--Social aspects--Ghana--Dagomba. 5. Dagomba (Ghana)--Social life and customs. I. Title. GN655.G45B54 2007 306.4'61--dc22 2007047612 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Printed in the United States on acid-free paper. ISBN 978-1-84545-351-0 (hardback)

To: My Wife Tamar and my Children Maayan, Naamah and Jonathan My Parents Sabta Iran

CONTENTS

List of Illustrations and Tables

ix

Foreword

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Preface 1 ‘New’ and Enduring Social and Economic Formations Continuity With the Past or ‘Tradition’ 1.1 The Land and the People 1.2 History, Politics and Religion 1.3 A Bilateral People? 1.4 The Local Scene Negotiating the Future and the Global Economy 1.5 Women in a Male-Oriented Society 1.6 Women, the Household and the Economy

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2 Powers of the Person 2.1 The Individual and the Sway of Maternal Kinship 2.2 The Morality of Witchcraft and Medicines: The Contrast of Legitimacy and Gender 2.3 Enchanted Modernity and Witchcraft

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3 Basic Concepts of Health and Illness 3.1 Illness: The Environment, the Living and the Dead 3.2 Common Illness 3.3 Ideas about the Body, Heart, Stomach and Common Symptoms 3.4 What is Illness? 3.5 Diagnosing Symptoms 3.6 Protection and the Occult

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4 Medicines, Modernity and Commoditization 4.1 What is Medicine? 4.2 Tim 4.3 Images of Medicines 4.4 Classification of Medicines 4.5 Naming Medicines

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4.6 4.7 4.8 4.9

Plants, Western Pharmaceuticals and Islamic Medicines Treatment Choices: Magical and Non-Magical Medicines Medicines, Modernity and Commoditization A Note on the Provision of Medical Care in the Nineties

5 The Herbalist, Medical Pluralism and the Cultural Patterning of Illness 5.1 The Local Curer and His Plants 5.2 The Cultural Construction of Medical Knowledge: Becoming a Herbalist 5.3 Medical Pluralism in Dagomba 5.4 Biopower and the Cultural Patterning of Illness 5.5 Medical Knowledge and Medical Culture

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6 Health, Wealth and Magic 6.1 Health, Wealth and Magic 6.2 The Modernity of Divination: The Power of Lotteries

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7 A Woman’s Lot: the Practical Realities of Care 7.1 The Dominant Voice: Men’s Control of Local Medicines 7.2 The Structure of the Quest for Medicine: ‘Begging for Medicine’ 7.3 Ideology and Practice: Women, the Future and Decision Making 7.4 The Ethics of Care and the Female Strategy of Child Care

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8 The Problem of Money: Money and Medicine 153 8.1 Introduction 8.2 Wealth, Health and the Community 8.3 Monetary and Non-Monetary Transactions in Dagomba 8.4 Contexts of Curing or the Problem of Money in Medicine 8.5 ‘Money Spoils the Medicine’ 8.6 The (Im)morality of Medicines: Medicine-Sellers and Drug Peddlers 8.7 ‘Money Spoils the Medicine’: Ideology and Practice 8.8 ‘Money Spoils the Medicine’ Revisited 8.9 Healing and ‘The Problem of Money’ Conclusion

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Appendices 1. The Burden of Illness 2. Patterns of Medicine Use

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References

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Glossary

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Index

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LIST OF FIGURES AND TABLES

Figures 1.1 Dagomba Land in Northern Ghana and its Districts

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1.2 The Dagomba Village

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1.3 Duko Village and its Households

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1.4 Son Accuses Stepmother of Witchcraft

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1.5 Son Accuses Father’s Sister of Witchcraft

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1.6 The Three-Generational Family

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1.7 Building of Yam Mounds by Communal Work Party (Kpariba)

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3.1 The Cultural Model of Health and Illness

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4.1 Medicines and Their Levels of Contrast

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4.2 Kpanalana Holding Basket Containing the Common Kpaga Medicine Balls

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4.3 Mother with Child Whose Sunken Fontanelles Have Been Treated with the Paste of the Kola Nut

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7.1 Women on Their Way to the Savelugu Market

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7.2 Mothers With Their Babies Attending the Monthly Village Clinic

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8.1 Cotton Grown Locally Being Loaded onto a Truck Belonging to the Ghana Cotton Company

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8.2 Alhassan Peddling Medicine from His Bicycle

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A.1 Duko Village Population: August – September 1990

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A.2 The Burden of Illness

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A.3 The Kinds of Illness in the Population

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Tables 1.1 Dagomba Marriages, 1990

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1.2 Seasonal Calendar

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3.1 A Selective List of Dagomba Illness Terms

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4.1 Naming Botanical Preparations (Plants)

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4.2 Naming Pharmaceuticals and Offensive Medicines

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A.1 Cases of Illness (September 1990 to July 1991)

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A.2 Therapeutic Choices in Relation to Different Kinds of Illness

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FOREWORD

My interlocutors in Lower Congo used to say that magic was not a feature of Kongo culture, but that muyeke, the KiKongo derivation of the French magie, was regularly obtained by the power-thirsty who mail-ordered medicines from Europe for money, frequently getting ‘burned’ and overcome by them, resulting in their going mad. Bernhard Bierlich’s book joins the growing anthropological literature on the African phenomenon of magic in perceptions and actions around money, medicine, and power. This phenomenon is a huge paradox in Western thinking, where the writing of Max Weber has conditioned us to see the economic and social action surrounding the extension of capitalism and biomedicine, and other institutions of the West, as a process of extending rationality – that is modernity – to the rest of the world. In this view, Africa is supposed to be the continent whose traditions are steeped in mystical, magical, and exotic practices, and the West is supposed to promote the essence of the modern: means-ends rationality, long-term investment, scientific medicine, in short civilization. So how can it be that the more globalized money and biomedicine penetrate African society, the greater the perception of the occult, of magical manipulation, and of modernity as magical. The paradox can be either explained by a genuine increase in magic, witchcraft, and the occult because of the pervasiveness of destabilizing economic and chemical effects, or Western rationality is not rational at all, but has been pervaded with magic and mysticism from the start. The northern Ghanaian setting of the Dagomba where Bierlich develops his ethnography and analysis of the above-mentioned paradox is based on extensive field research. The Dagomba in Bierlich’s work seem familiar to anthropologists, because they live in the region where the classical British social anthropology of Meyer Fortes (on the Tallensi) Esther and Jack Goody (on the LoWili), and David Tait on the Konkomba (Dagomba) presented West African society as largely stateless unilineal descent group communities, with an array of rituals including healing, all controlled by the male elders. Bierlich gets behind the front of such male dominated society to show the contradictions that may always have been there – which Fortes already noted as the pervasive uncertainty that healing rituals addressed. While the elders continue to promote their

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largely ceremonial exchange relationships, including medicine, the youth and the women – especially desperate mothers with sick children – resort to commoditized pharmacies and fee-for-service clinics. The elders accuse the women of corrupting the old order, of introducing the immorality of a monetary economy that they cannot control. The resistance of women and youths to the mystified ceremonialism of the elders takes the form of opting for money and the medicine that may be had by it. Meanwhile, the men, with their penchant for ritual, have taken to playing the lotto and try through geomancy and other forms of manipulation to cash in on lotteries. Bierlich’s analysis, despite its regional flavour of the Dagomba, resonates with much anthropological work further to the south in Africa. Indeed, it is evident to this anthropologist of Central Africa that there are deep continuities in the practices and trends of society, illness, uncertainty, misfortune, and healing, the way these relate to biomedicine, as well as the medical anthropological analyses that result. The key concepts carry the same verbal cognates as those of Sub-Saharan Africa. Ti (or Tima), the Dagomba term for medicine or tree, appears to replicate the proto-Bantu cognate ti (nti, minti, plural). Similarly, the illness category jogu (black illness, attributed to human causation), is highly reminiscent of the protoand pan-Bantu cognate dog or dok (from which the Kongo verb loka, to curse or bewitch, kindoki, witchcraft, or witch, ndoki is derived; see also Zulu ubukathakani). Linguistic historians suggest these terms and concepts are pervasive in Niger-Congo societies, thus thousands of years old foundation of all these cultures across West and Sub-Saharan Africa. Yet Bierlich’s treatment of the convergence of African traditional medicine with the postcolonial currents of global capitalism and biomedicine, and the dissolutive effects of neo-liberal economics, structural adjustment, global labour migration, monetized economies, global pharmaceutical markets, brings together a potent analytical package which represents the best of Africanist medical anthropology, as he untangles the paradox of magic, medicine, power, and gender in postcolonial Dagomba. Bierlich’s insightful analysis not only applies the current anthropological insights, but also makes important new contributions to a distinctive Africanist medical anthropology that has much to offer African Studies and anthropology in general. John M. Janzen Professor of Anthropology University of Kansas 24 December 2006

PREFACE

This book is about people’s notions and practices of health. It analyses a set of issues about health and healing in Ghana, connected with gender, modernity, magic and the control and use of money. The book is based on many years of medical anthropological research among the Dagomba, who live in northern Ghana. The Dagomba make up the largest ethnic group (estimated to number about 1.5 million) in the north. Their local world is set in various contexts that pertain to larger economic and cultural processes. This study is concerned with relationships between Dagomba men and women and the distinctive patterns of their healing practices. These relations and practices are changing. I question whether they were static in the past. Much in their social rules seems to show a male perspective, and reflect an ideology of patrilineal descent with dominant male control of knowledge. My work will reveal how women constantly challenge this ideology. At this juncture, we recognize that Dagomba society and its economy are inserted in a wider setting of change. Women’s ideas and practices are thus much affected by money and Western medicines. The task at hand concerns bridging the two worlds (the ‘local’ and the ‘wider’, ‘modern’ reality), which are, arguably, opposed to one another. By the actions of individuals (women and junior men) this dualism is subverted, however, and travelling between these two worlds is made possible. The guiding idea in this book has been formulated by Mudimbe in his Invention of Africa: In my view, it [unmediated African philosophy] does not justify the static binary opposition between tradition and modernity, for tradition (traditio) means [always already] discontinuities through a dynamic continuation of possible conversion of tradita (legacies). As such, it is part of a history in the making. (Mudimbe 1988: 189)

When confronted with the power of Western medicine and modernity and its unkept promises of progress, the logic of local African premises (African ‘tradition’) produces various responses of ‘bewilderment’ and the specific ‘magic in/of modernity’ that we shall define later. These

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responses have to do with the arrangement of marriage, the Dagomba understanding of medicines (for curing or producing ill-health), the power of the person and their medical culture. Their approaches define continuities with the past while having a particular configuration in relation to current policies of adjustment (adopted by the Ghana Government in 1983). ‘The road that we are going down’ in this work privileges African agency by presenting various unmediated, African concepts and practices, and proposes that, in their interaction with outside, global forces, a mix of magic and ambivalences on the part of local people comes to shape modernity – ‘Afromodernity’ (Comaroff and Comaroff 2004) as it were. The book divides into two parts. The first chapters in the book (1–5) contextualize subsequent discussions in terms of the social structure, the relation between the sexes and the domestic economy. The Dagomba view and their use of medicine, their understanding of the power of the person, concepts of health and illness, and the local medical culture are also centrally important in this. In writing, I have tried to follow the way they organize their ideas rather than rephrasing them to fit (and translating them into) conventional anthropological or scientific terms. In this way the study hopes to reproduce ‘unmediated’ social and cultural forms. These chapters identify social realities that move, are dynamic, ‘living social entities observed in a state of propulsion’ (Falk Moore 1994: 3), be they in connection with changes relating to the ‘developmental cycle of households’, the ‘two farming cycles’ or in the realm of ‘individualism and maternal ancestors’ . These realities show the strength of local culture and its place in modernity. Local culture and the Dagomba’s own distinctive ideas and practices are strongly involved in their negotiated responses to modern changes. The idea that the traditions, customs and social rules (which some anthropologists term ‘traditional social structure’) are fixed and unchanging may reflect the ideological views of local elders in the society rather than local practice and experience. Local ways are part of modernity, but people experience many ambivalences when confronted with Western culture and its notion of progress. In the home-grown connection, the argument is simply put: magic and local culture are driving forces and, in the face of external, globalizing pressures, they must be recognized as shaping our understanding of what ‘modernity’ is. It is my hope that my discussions of the complexities of modernity will show that ‘…magic belongs [“explicitly”] to modernity’ (Pels 2003: 3). Dagomba magic, relating to the power of ancestors, persons and medicines, articulates clearly with a belief in witchcraft. It also defines a space and a power for these traditional cultural forms that not only shapes and is

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shaped by modernity, but also empowers, even legitimizes modernity itself. This is what we understand by Dagomba magic being modern. The book is replete with examples which convincingly prove that magic and tradition are quite central to the modern Dagomba (and Ghanaians for that matter). The book thus aims to show that magic and tradition are central to the modern Dagomba experience, and to provide new data and ideas on healing, money and morality for the discussion of theories of magic and tradition in response to modernity. A body of literature has emerged that examines changes as they relate to ‘traditional’ beliefs and Africa’s postcolonial situation (Mudimbe 1988; Mbembe 1992; Werbner and Ranger 1996; Werbner 1998), magic/the occult, globalization and modernity (Comaroff and Comaroff 1993, 1999, 2004; Geschiere 1997; Meyer 1998a, b, 1999; Moore and Sanders 2001; Meyer and Geshiere 1999; and Meyer and Pels 2003). I shall refer to these works and many additional studies throughout. Accordingly, in the second half of the book (chapters 6–8) I develop various theoretical themes regarding the complexities of modernity. These relate to ‘magic, wealth and health’, ‘the power of Western medicine and the ambivalence that local people experience towards biomedicine’ and ‘the magic of modernity and money-making’. Their ambivalence in the face of these processes is characterized by a mixture of uneasiness, suspicion and fascination (see section 5.4 on biopower and the cultural patterning of illness and Chapter 7 on women and family health care). I will show how this ambivalence creates a series of dilemmas and conflicts for men and women in their relations with each other and towards money, medicine and magic. The dominant (male) ideology produces a false consciousness among many people ( the juniors and women). A number of works have also pointed to the adverse effects that economic adjustments (the Structural Adjustment Policy set by the World Bank/IMF) have on the health of households (e.g., Sanders 1985; Bijlmakers, Basset and Sanders 1996, 1998; Sen, Germain and Chen 1994; Senah 1989 for Ghana). Gender and the part women play in health care is a theme running through this book. In Chapter 7 I focus on the paradox of men’s delegation of health care (i.e. the use of medicines) to their wives, whom they do not trust but whom they have to trust. What women can do in therapy management depends in part on their position in a household and their control over resources of time and money. We shall also see whether all the children in a household enjoy the same kind of care. As for men’s contribution to health care, it is providing their families with the protection of protective medicines that preoccupies men most.

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These discussions seek to answer a fascinating question, namely how men and women conceive of their ‘future’ in relation to the options they have. Men appear in a very different position from women in terms of the seasons and agricultural work, and the fact that they are men who have primarily male interests in the future. They appear to invest much time converting the cash they are able to accumulate for themselves in friendships and securing their future within the context of polygynous marriages (e.g., Chapters 1 and 5). Problems arise, as Brad Weiss notes (2004), when these futures get blocked by material hardships. This seems to be one of the reasons why men play lotto and hope to ‘strike it lucky’. Women, on the other hand, engage in the monetary economy to secure a quite different future, a future outside marriage but where their children care for them. To engender (not consciously) a feeling of trust and a sense of responsibility on the part of grown-up children to reciprocate the care they received when they were young, mothers buy snacks and bread in the market for their toddlers and pharmaceuticals when they are sick. Both sexes come under fire and are criticized by the elders, however, for through their monetary strategies (e.g., playing lotto, buying pharmaceuticals) they endanger the non-monetary moral economy of gift-giving. We may think of the Dagomba as an ethnic group. At the same time we must not stick to a ‘fixed’ representation of them as a static entity. Globalizing and individualizing pressures are at work, undermining any naive attempt to exclude everything outside the strictly bounded locality. The notion of ‘globalization’ (Meyer and Geshiere 1999), coupled with a focus on the use of medicines, in particular Western pharmaceuticals, forces this study to explore how people are entangled in wider processes. There are no localities (only as imagined constructs [Anderson 1991]) which are absolutely unaffected by global flows. The chapters in part 1 serve, therefore, as a ‘fluid’ background where social-structural arrangements – relating to, for example, marriage and farming – and notions of the person and his/her powers, aid us in ‘fixing’ for a short while the empirical reality in order to discuss in the second part of the book various changes connected with globalization that ‘unfix’ that reality. I find the family or household to be a good place to depart from when exploring the nature of healing and ‘the hard core of therapy’ (Whyte and Van der Geest 1988) namely medicines: local botanical substances, Islamic medicines and Western pharmaceuticals. I am interested in the culture of medical pluralism found in northern Ghana, and in people’s choices of ‘traditional’ (local) medicine (plants and sacrifices) and ‘modern’ therapy (biomedicine, in particular Western pharmaceuticals) according to the ‘burden’ of illness they experience and the social and cultural frameworks

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impinging upon people’s choices. Over the years I have examined and documented medical pluralism – the way Western biomedicine interacts with local systems of healing and African agency (e.g., Bierlich 1999, 2000). In the book I depart from the ‘margins’ of the modern neo-colonial state, the ‘backwoods’ of Ghana: Dagomba-land in northern Ghana. As many rural areas are often on the ‘margins’ of the developmental process (nonetheless affected by change), I find the rural-urban divide to be a fiction. Demarcations are frequently blurred, rural and urban areas merge and become tied together or appropriated by markets, regional economies and national structures. To show how local communities, often located in the countryside, have ties with regions and the state as well as the international community, I will focus on the transaction of Western medicines not only as symbols of healing but also as figures of power connected with money, the market, and modernity in general (see also Bierlich 2007b). As always, I have a great many people to thank for the way I think. With these people I share the bond of being a student writing his Ph.D., of being a Western researcher and father (of two girls at the time) in a foreign land among an ‘exotic’ people and of being an academic influenced by various people, especially with regard to health, gender, money, magic, modernity and medical history, in the context of the slave trade. While preparing for and writing the thesis back in 1991–1993 I incurred many debts. I received help and advice from a great many people in my native Copenhagen, in San Diego (southern California), Cambridge and Ghana. I remain grateful to Susan Whyte of the Institute of Anthropology in Copenhagen. She was my supervisor for the Magister thesis and took a great interest in the topic of my Ph.D.-research centring on medicines (Whyte and van der Geest 1988). Jonathan Friedman, a professor in anthropology at the University of Lund in Sweden had a formative influence on my thinking regarding the person and its social embeddedness (Friedman 1987; Friedman and Friedman 2003). In 1988–89 I spent eighteen memorable months at UC, San Diego as a Fulbrighter. In his seminars, Michael Cole stressed the importance of maintaining the ‘socially and historically bounded activity of the individual as a unit of analysis’ (Cole 1988). This notion is implicit in my discussion in Chapter 7 of mothers as therapy managers. In Cambridge, I received great support from my research supervisor, Dr Gilbert Lewis. I owe him a special debt of gratitude for his kindness and many helpful suggestions when reading through various versions of the thesis. After my Ph.D. I have continued to enjoy his sympathy, support and suggestions. He has been an outstanding guide and helped me with his thorough reading of my book manuscript.

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His many insights and comments helped me giving an enhanced expression of my thoughts. I also owe my thanks to Dr Keith Hart, both as a student and later on. When at Cambridge he both lectured in the Anthropology Department and directed the African Studies Centre. Drs Susan Drucker-Brown and Sue Benson of the Departments of Social Anthropology and Social and Political Sciences in Cambridge also deserve my thanks for their comments and the many stimulating discussions we had while I was writing my thesis. Dr Sulemana Abudulai, alias Mobson, a Dagomba himself but living in Cambridge in the early 1990s, took a lively interest in my project and in helping me write about his people. I am very thankful to him, and as we came to know each other better during my Cambridge years, he and I and our two families became good friends. Many others, in Tamale and elsewhere in Dagomba and Ghana, have made great contributions. They include Palance, Mr Alhassan and his wife Jane, Katie Abu, Mr Tia, the chief of Sozale, Alhaji Abudulai, the workers of the Ghana Guinea Worm Eradication Programme/The Danish Bilharziasis Laboratory in Tamale and Ninbun Na Yakubu Andani II, the chief of Kuko Bila, whose acquaintance I unfortunately only made towards the end of my initial field work. In my subsequent work as an academic, I have been influenced by a great many people, most recently by Professor David Richardson, an economic historian at the University of Hull. In 2001 he offered me a research fellowship under a grant he had received from The Wellcome Trust to study the medical history of the trans-Atlantic slave trade (Richardson 2000). My work in Hull has shown me inter alia the relevance of history/the history of medicine for my understanding of the present and the implications of memories of slave trading and the ensuing force administered, contributing to the ambivalence the Dagomba experience when confronted with the ‘power’ of biomedicine (see Chapter 7). The greatest thanks of all are to the people of Duko village, who tolerated me and my family among them. They have also always warmly welcomed me back when returning to the village, after receiving my Ph.D., on various shorter visits in 1995, 1996 and 1997. At all times, they have patiently listened to my many questions and given freely of their time. Without their patience and co-operation the present study would not have been possible. I owe a special debt of gratitude to Boteng Na, an elder of the village. During my first field work he helped my family and me in many small and big matters and always made us feel welcome in his home, and he never tired of discussing his people’s customs with me. Boteng Na also often accompanied me on my travels and introduced me to many people in Western Dagomba. Zakaria Ibrahim, my untiring assistant and interpreter in the village, deserves special mention. He has

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always been an immense help in collecting and discussing information and in the arduous task of transcribing interviews. While all the people above are to be thanked, the faults when writing this book are, of course, my own responsibility. Here and there, the names of individuals mentioned in the text have been changed so as to protect their identities. To avoid difficulties in writing up the study, I have not used the phonetic alphabet recommended by the International African Institute. I have employed the Roman alphabet to transcribe Dagbani words; they have been italicized and their English translations given in inverted commas (please consult the appended glossary). In the appendices I present the quantitative material upon which many of the discussions in the book are based.

Chapter 1

‘NEW’ AND ENDURING SOCIAL AND ECONOMIC FORMATIONS

This chapter asks what are new and what are persistent features in the lives of the Dagomba, in terms of structures and conditions of inequality that have long been in place in the relation between men and women. Accordingly, this chapter divides into two investigations or parts, ‘Continuity with the Past or “Tradition”’ and ‘Negotiating the Future and the Global Economy’. These unite, however, to produce the compelling Dagomba scene of a social and economic configuration that shapes and is shaped by ‘modernity’.

Continuity With the Past or ‘Tradition’ 1.1 The Land and the People The Dagomba refer to their land as Dagbon. It lies in the Voltaic basin of northern Ghana in the Guinea savanna zone (Boateng 1967: 16). Vegetation cover is light. The land is open, flat orchard country, with plenty of shrubs and a few trees (ibid.: 51–52). The White Volta and numerous minor streams traverse the land. Soils are generally poor. The most fertile lands are found around the regional capital at Tamale in western Dagomba and extend as far as Savelugu, sixteen miles north of Tamale. A large part of the area is covered by the Upper Voltaic rock formation, with a few meters of topsoil (ibid.: 59–60). This leaves only few possibilities of drilling boreholes and using ground water. Thus, the majority of the people who live in the rural areas drink from unprotected water sources, such as ponds and small streams. The Dagomba people number approximately 1.5 million and occupy a total land area of 21,402

2

The Problem of Money

sq. km (Haaber Ihle 2003). Their modern political organization operates with five ‘districts’: – ‘Tolon/Kumbungu’, ‘Karaga/Gushiegu’, ‘Savelugu/Nanton’, ‘Tamale’ and ‘Yendi’. These correspond to the traditional division of the area into chiefships. Geographically, the Dagomba area is located in the northern region of Ghana, between 9˚ 30’ and 10˚ 30’ N. The neighbours of the Dagomba to the north are the Mamprusi. The Gonja live to the south and west. To the east, northeast and southeast are found the Konkomba, Chakosi and Nanumba. See Figure 1.1 below of Dagomba land and its districts, including the Savelugu District (hatched area) where many of the data on the Dagomba were collected.

Figure 1.1. Dagomba Land in Northern Ghana and its Districts

‘New’ and Enduring Social and Economic Formations

3

Climatic conditions are similar to those elsewhere in northern Ghana, with temperatures ranging from a high of 88.1 degrees Fahrenheit in March to a low of 77.7 degrees in August (Boateng 1967: 29). Two main seasons divide the year, a rainy season, or farming season, which extends from April to October (with 800 mm rain on average), and a dry season, November to March, when farm work comes to a standstill and water sources become markedly reduced (Boateng 1967: 75). In the gap between the beginning of the rainy season and the harvesting of the first crops (a period of intensive weeding) the threat of guinea worm infection, a waterrelated disease (Bierlich 1995), and of hunger grows. A few bigger towns, with populations of 5,000 or more, include the important capitals of Savelugu, Karaga, Mion and Yendi (the traditional capital of the kingdom). Tamale, the regional capital, has a population of about 130,000. The population density varies with between 14 persons/sq. km in eastern Dagomba and 61 persons/sq. km in western Dagomba, the highest population density in northern Ghana (Norrip Report 1980; Staniland 1975: Chapter 6).

1.2 History, Politics and Religion The Dagomba, the largest single group of people in northern Ghana, consider themselves to be closest to the Mamprusi and the Mossi, their northern neighbours, whom they speak of as their cousins (brothers’ sons). They say they share descent from a common mythical ancestor, Toha Zee (or Tohajie), ‘the Red Hunter’, whose great-great-grandson, Na Nyagse, is considered to have been the first Dagomba king (Tamakloe 1931; Rattray 1932: vol. 2). Like the Mossi and the Mamprusi and in contrast to the acephalous Tallensi and Konkomba the Dagomba are a centralized people governed by a king and numerous chiefs.1 The present-day Dagomba are believed to have their origins in Hausaland in the northeast and around the bend of the Niger in the northwest. They are assumed to have invaded the Dagomba area, which was occupied by an aboriginal autochthonous population, probably the Konkomba, sometime between the thirteenth and fifteenth centuries (Tamakloe 1931; Blair and Duncan-Johnstone 1932; Fage 1964). The invaders brought with them the institution of chiefship. The tingdanas (‘earth priests’), who are believed to be the original owners of the land, were deposed by the invaders and many were killed. The tingdana-ship was never destroyed, however (Tamakloe 1931: 13–14).2 The Dagomba have developed a centralized kingdom, composed of different social but economically undifferentiated ‘estates’ (Goody, J.R.

4

The Problem of Money

1966b: 143; Drucker-Brown 1975: 14–17). The three estates are those of the royals, na-bihi, descendants of the conquerors; the commoners, dagbandaba, descended from the original inhabitants of the land; and Muslims, musilima. However, only in big villages and towns does one find all three estates. Most villages are composed of people of commoner and chiefly backgrounds, and lack a Muslim clergy; a mosque and a malam are often found, however. According to the deceased Imam (Limam) of Savelugu, Islam was introduced to Dagomba by Malam Mahama Matazu. He is said to have come from the town of Matazu in Hausaland, northern Nigeria, and settled in Savelugu in western Dagomba in 1686 (see also Abdalla 1992: 186). This happened during the reign of the Savelugu paramount chief, Mahama Mogu Woliga, and while Ya Na Gariba was the king. King Muhammad Zangina is said to be the first Dagomba king to have embraced Islam. This is assumed to have occurred in the beginning of the eighteenth century (Tamakloe 1931: 24; Wilks 1965: 87–98). It is possible that the spread of Islam took place a century earlier in the west (seventeenth century) than in the east (eighteenth century) of the Kingdom. Fage notes that western Dagomba was settled by the conquerors before eastern Dagomba and that the first capital of the Kingdom, Yendi Dabari, was established in western Dagomba, about twenty miles north of Tamale (Fage 1961: 25). Levtzion finds ‘evidence for the existence of Muslims in Dagomba before the end of the seventeenth century’ (Levtzion 1968: 86, 103). He speaks of ‘two layers of Islam’, one associated with the Wangara traders from the bend of the Niger, the other with Hausa influence. The study of Haaber Ihle reminds us of the presentday engagement of young people with Islam. According to official figures, Muslims constitute more than fifty per cent of the Dagomba population and Islam serves, Haaber Ihle notes, as a potent vehicle to negotiate modernity by constructing identities among young Muslims and building civil society in Ghana (Haaber Ihle 2003). Nevertheless, ancestor worship remains a (if not the) dominant religious form. It plays a strong part in many aspects of daily life in Dagomba and, without the support of the ancestors, local plant medicines cannot work. The Dagomba worship their ancestors but have adopted many practices of Islam. To the outside world they are Muslims; they attend the mosque and many pray daily, ti puhe jingle, ‘we pray’ . Malams officiate when a new-born child is named and first brought out of the house on the eighth day, and when a person is buried and his (first and second) funerals are being performed, as well as on other important occasions. People also attach great importance to Islamic protective medicines and charms, and celebrate the major Islamic holidays, such as the Ramaddan and the Islamic New Year.

‘New’ and Enduring Social and Economic Formations

5

1.3 A Bilateral People? Among the acephalous peoples of northern Ghana, such as the LoWiili (Goody, J.R. 1956), Konkomba (Tait 1961) and Tallensi (Fortes 1945), unilineal descent groups are of major importance (Fortes 1970; Goody and Goody 1967). Unilineal descent groups are characterized by their corporate lineage organization and by property and office being transmitted unilineally. Unlike the unilineal Tallensi and LoWiili, the LoDagaba, Goody notes, have a ‘double descent system’ (Goody, J.R. 1962, 1969; for a comparative African case see Forde 1967). They transmit property in both lines patrilineally and matrilineally. ‘Immovable’ or ‘fixed’ property (i.e., inherited property), such as land and the homestead, is transmitted patrilineally, while ‘movable’ or ‘consumable’ possessions, including farm produce, money and cattle, are passed down to the matrilineal descent group. Goody links the early fission of LoDagaba homesteads and the tense relationship that exists between mother’s brother and sister’s son to the existence of double descent among the LoDagaba. On the other hand, in the centralized polities of the Gonja, the Mamprusi and the Dagomba, the importance of descent groups is less marked. They are still relevant, however, when transmitting property and with regard to marital residence (virilocal). In their 1967 paper, the Goodys examine the nature of the conjugal and sibling bond in the societies of northern Ghana (Goody and Goody 1967). They compare a number of societies with regard to the nature of marriage prestations, the stability of marriage, widow inheritance and kinship fostering. They find marriage prestations to be high in unilineal descent systems and consequently marriages to be stable. Through the payment of a high brideprice the husband’s descent group acquires rights in his wife’s procreative powers. Widow inheritance is also common. The opposite case is that of the ‘bilateral’ Gonja among whom unilineal descent is of little important, and where the sibling tie is the dominant feature. Agnatic descent groups primarily function as ‘dynastic descent groups’ for purposes of recruitment to high office (Goody, J.R. 1966b; Staniland 1975: 15; Drucker-Brown 1981: 118). Since marriage prestations are almost nonexistent (only twelve kola nuts and twelve shillings), marriages are not binding. This is taken to explain the existence of the high ratio of divorce. Thus ‘a Gonja woman spends a very substantial part of her life not living with husbands’ (Goody 1973, E.N.: 230). Upon divorce, and at ‘terminal separation’, in other words in old age, she returns to live with kin. It is also a common practice for a young mother to leave her husband and return to her kin with her young children for a considerable period of time.

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The Problem of Money

Consistent with the woman’s attachment to her natal kin is the prevalent Gonja practice of ‘kinship fostering’ (siblings rearing each other’s children). This institution is absent among acephalous people. ‘Kinship fostering’ is a strong indication of the strength of the sibling bond as compared with the unstable wife-husband relationship (ibid.: 227). With respect to the institutions and features listed by Goody and Goody (1967) the Dagomba appear to be an example of a bilateral system. Unilineal descent groups play a minor role, there is no transfer of property at marriage, divorce is common and so are ‘woman return’ (to live with brothers and sons) and kinship fostering. The social structure constructs the world people live in unequally and produces many of the images, medicines and notions of female witchcraft , among others, that we shall explore in this study. These ideas and concepts may be thought of as a symbolic ‘structure’ and as figures in a discourse of ‘the social production of knowledge’, including medical understandings, by the elders in society who find support for their positions of power in the ideology of the (maleoriented) social structure and the centrality and the moral authority of the ancestors. By their positions of power they (the elders) come to dominate younger men and women and many are the concepts, including those of medicines and female witchcraft, that achieve moral legitimacy and appear part of the natural order.

1.4 The Local Scene Duko (lit., ‘do not farm’), the village in which I lived and carried out most of my field work in 1990–91, lies in the densely populated western part of Dagomba (Fig. 1.1). It is situated eleven miles north of Tamale, the regional capital (pop. 130,000), and four miles south of Savelugu (pop. 21,000), the traditional capital of western Dagomba. Duko is part of the Moagla ‘administrative zone’, which is made up of twelve villages. During a community registration in 1990, the zone recorded a population of 5,738.3 Duko is exceptional in the sense that it has a piped water supply, whereas most villages in the area, and in northern Ghana as a whole, rely for their drinking water on surface water, stream and dam water. Otherwise, Duko exhibits typical rural features, including a lack of electricity. The following description of the Dagomba village, kinship and households applies best to villages in the Savelugu area in western Dagomba. However, with my knowledge of Dagomba from my many travels, I am led to believe that generalizations to the rest of Dagomba land can be made.

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7

Figure 1.2. The Dagomba Village

The smallest political unit is the tin, ‘village’. It is distinguishable from the surrounding uncultivated land, the mogani, ‘bush’. Unlike the dispersed settlements of other northern peoples, such as the Tallensi, the Dagomba village is a compact, nucleated settlement, consisting of walled houses or compounds surrounded by farmland. The average Dagomba village has a population of 200–400.4 The typical village is socially and economically homogeneous (most people are farmers) and, being small, not subdivided into separate occupational sections or quarters, fonga, as described by Oppong (1973: 24). In the densely settled western part of Dagomba land, villages are separated from each other by anything from small stretches of bush land to up to three miles of land. The primary principle for social identification is the locality or village, often referred to by people as yano, ‘home’. I have never heard people place themselves in respect to ‘zones’, ‘districts’ or ‘regions’ (administrative categories); neither do people identify themselves as ‘Ghanaians’. People say they are Dagomba, referring to ‘Dagbani custom’ or ‘tradition’, Dagbanli, their ‘house’, yili, and ‘house-people’, yin-nima. In 1990 Dukovillage had a total population of 371 (August–September 1990 census). The village consists of a group of houses or compounds, yina (sing., yili), of various sizes. Excluding the Fulani homestead, there are six big households with more than twenty residents (twenty to fifty-one); ten

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The Problem of Money

medium-sized households having ten to nineteen residents; and ten small households having three to nine household members.

Figure 1.3. Duko Village and its Households

The Dagomba village is a tightly knit, homogeneous community where people are related to each other through kinship and marriage and as neighbours. Houses are identified and given names which relate to titles or celebrate occupations, origins (places) or particular attributes of present or previous house-owners. The closeness of houses (often only a hundred yards apart from each other) affords daily interaction. People attach great importance to visiting and greeting (puhe) each other, in particular one’s seniors, including the chief. To live harmoniously together is considered of prime importance. Within this framework, people go about their daily pursuits asking each other for favours and medical services (medicines) when they are sick.

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9

Negotiating the Future and the Global Economy 1.5 Women in a Male-Oriented Society The tension that exists between men and women relates to the arrangement whereby the Dagomba reckon descent patrilineally and marry wives from outside the group. As a result of exogamous marriage and marital residence with her husband, the wife is always an outsider, a ‘stranger in her husband’s house’, and a threat to her husband’s kinsmen. The paradoxical situation of the married woman lies in the fact that she is the daughter of one lineage and the wife and mother of another lineage. Fortes’ discussion of the inherent tensions in the polygynous ‘matricentral’ family, expresses the situation of married Dagomba women clearly. A woman’s apartments make up a self-contained section in the homestead. This is her dug (pl. duget). Basically dug means a single room, but it is extended to mean the single set of rooms belonging to one wife. In the Tale family every woman with children is entitled to her own dug. (Fortes 1949: 58)

Each dug (or duu, Dagbani) in the house represents a mother and her children vis-à-vis other mothers and their children. It is a symbol of the close emotional bond that exists between mother and child. Representing ‘maternal origin’, the duu is also a symbol of segmentation.5 The polygynous Dagomba family divides into groups of mothers plus their children, ma yino (lit., children of ‘one mother’). A child’s loyalties are to the mother who bore him (ma dogo) and not to his stepmothers (ba yino, ka manima konkoba, ‘one father, but different mothers’). This situation is also the context for men’s belief that women are witches (Chapter 3). For fear that women will use medicines immorally (for witchcraft), women are not permitted to handle local medicines. On the other hand, since women endanger the health of the lineage and through their witchcraft introduce illness in the first place, women are considered to be responsible for treating sicknesses occurring in the family, using the medicines (local or Western) at their disposal (Chapter 9). Men’s perception of women is also reflected in pollution-beliefs, according to which menstruating and pregnant women are particularly vulnerable to environmental dangers.

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The Problem of Money

Figure 1.4. Son Accuses Stepmother of Witchcraft

Marriage and Divorce Marriage, leading to the social reproduction of the group, is ordered and organized around the authority of the elders, the guardians of the ‘social contract’ in Dagomba. Marriage is regarded as the natural state of life of adults. Life is a not a success if one is not married and has no offspring. By the rules of clan exogamy and virilocal residence upon marriage, a woman leaves her natal home to live in her husband’s home; the general practice is to marry outside one’s dang, the bilateral group of kindred. Like the Gonja the Dagomba do, however, prefer marriage to a cross-cousin, a mother’s brother’s daughter (MBD) (Oppong 1969: 48; Goody, E.N.: 1973: 76). A son may speak of his MBD as his ‘wife’, paga (wife, woman, or, more precisely, dogari paga, ‘family wife’; dogari is a derivative of dogim, which I translate as ‘family’, ‘kinship’). This preference does not match reality, however. To my knowledge, no one in Duko had married a MBD (Oppong 1969 notes a tendency to endogamous marriage among drummers). Table 1.1. Dagomba Marriages, 1990 33 men (about 2/3) had married one wife 19 men (about 1/3) had two or more wives 3 men were not married TOTAL

55 men had married a total of 69 women

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11

Polygyny is the ideal. In practice, however, far from every marriage is polygynous. In the Duko village sample (1990), out of a total of fifty-five adult males, fifty-two are married, thirty-three have one wife, while ninenteen have two or more wives. The resulting ratio is 52 men : 69 wives, and the average number of wives per husband is 1.2 : 1. Thus, a tendency to polygyny. However, one must take into account the age of husbands: young men are more likely to have only one wife, whereas older men often have two or more wives. Polygyny, therefore, corresponds with the developmental cycle of the family, a local expression of change where sons at one point move out of their fathers’ house (more below; also Chapter 3 on the maternal Wuni ancestors, another homegrown form that induces change). The sample also indicates that many women (forty-five) have married in their natal or a neighbouring village. However, when wives (twenty-five) originate from outside the village, regular visits home and raising a brother’s daughter or sister’s son (‘kinship fostering’) may serve to maintain bonds with natal kin in spite of the distance separating them. The married Dagomba woman remains attached to her natal lineage throughout her life, she often visits home, with her young children, when she is sick and in need of care, and when she is divorced. In contrast to marriages among the Konkomba (Tait 1961) and Tallensi (Fortes 1949), and consistent with the fact that bride payments and the levirate are absent, Dagomba marriages are not very stable. The Dagomba marriage is easily broken: the wife simply leaves (yi, ‘go out’) the husband. A high degree of marriages end in divorce and there is also a strong pattern of women past the age of childbearing ‘withdrawing’ from marriage entirely. Divorced women return to live with their natal kin until they remarry or, if old, to live with a son or brother on whose support they can always count. Elderly women live with kin, not with husbands. In the home of her brother or son she enjoys the prestigious and powerful status as a piriba (a father’s sister) and paga kpiema (senior woman) and – because of her threatening association with authority, a status ideally reserved for men – inadvertently attracts many witchcraft fears, especially among younger men (Fig. 1.5). These apprehensions articulate with general male images of women and their dangerous contact with the market, money and capitalism, forms that imply individualization as well as defiance of men’s rule.

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The Problem of Money

Figure 1.5. Son Accuses Father’s Sister of Witchcraft

1.6 Women, the Household and the Economy Patrilineal descent determines membership of a group of agnates as well as inheritance. The mother does not transmit group membership or property. ‘Kinship’, dogim, on the other hand, represents ‘maternal origin’, ma yili (the mother’s paternal and maternal kin), as well as the principle whereby a child traces ties through both parents, ma yili and ba yili (mother’s and father’s paternal and maternal kin). The parent-child bond is the key connection of kinship. A person’s maternal and paternal kin are his/her ‘kindred’, dang. The dang is an inclusive concept. New members are readily incorporated into a person’s dang: the mere fact that people live together in the same locality may establish them as kinsmen.7 The basic domestic unit is the household, yili, a unit for joint farming and cooking. The household head, yili yidana (lit., ‘husband of the house’) has economic, jural and ritual control over the house and its residents. In addition he is also responsible for protecting and representing them to the outside world, in ritual matters, in his dealings with other householders and the village chief (see Chapter 4). The yili yidana is always the oldest male, either the grandfather, oldest brother, or father. He ‘owns’, suu, all the people who live in the house, yinnima (lit., ‘house-people’), who are his ‘children’, bihi. The ‘ideal’ household has a three-generational depth. It is headed by an old man (a grandfather, yaba), his sons and their descendants (grandchildren). However, households often remain small and monogamous in spite of the ideal of a large family (Fig. 1.6). The nucleus of the household is either the co-residential elementary/polygynous family, consisting of a man, his wife (wives) and their children (including

‘New’ and Enduring Social and Economic Formations

13

foster children), or the joint family, consisting of two or more agnates, brothers or a father and his son(s), their wives and children (including foster children). In the Duko village census nine – out of a total of twentysix – families were found to be joint and fifteen elementary/polygynous families. The mean number of persons per domestic family was 13.8, with a lower and upper margin of three and fifty-one members.

Figure 1.6. The Three-Generational Family

Households vary in size – size being a reflection of particular stages of domestic development and the status and wealth of its head. Every domestic family has a ‘growth cycle’ (Fortes 1949: 63, 1958; see also Goody, J.R. 1958a: 53–91). Dissolution usually takes place sooner or later, so that the ideal three generational household is only temporarily achieved. Although some people practise part-time occupations as barbers, blacksmiths and diviners, the Dagomba are primarily subsistence farmers, using the hoe, and practising intercropping and shifting cultivation. There is little differentiation of wealth to be found. Where land is scarce or infertile, farmers make their farms away from home (often far away). The staple crops are yam, maize, guinea corn, millet and rice. These as well as cotton, groundnuts, bambara beans and vegetables are grown both for subsistence and cash. Vegetables, wild leaves and fruits of the dawadawa, baobab and shea trees form important dietary supplements. The Dagomba also keep horses, cattle, sheep, goats, fowls, ducks and turkeys, but their diets do not include much meat.

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The Problem of Money

Most land is inherited patrilineally. It cannot be purchased with money (Abudulai 1986). Farms are of two kinds, ‘compound farms’, simbani puu, and ‘bush farms’, mogani puu. ‘Compound farms’ are owned by the household head and indivisible. They are always used for growing maize. They occupy an unfenced area around compounds where rubbish is dumped and where goats and other animals provide organic manure. A typical Dagomba bush farm, mogani puu, has a plot with yams and millet. The Dagomba consider yam to be their oldest food crop. The household head may divide the farm in the bush, and allot plots to his sons and wives which they can farm independently and the yields of which are also theirs. The Dagomba say that the morning is supposed to be devoted to farming crops for the consumption of the household as a whole, under the direction of the head of the household, asiba puuni, ‘morning farm’. In the afternoon, sons and women are free to farm their own plots and gardens, zawuni puuni, ‘afternoon farm’. The agricultural cycle divides into two successive phases (dictated by the seasons) or productive (harvesting of crops) and non-productive periods (land preparation, sowing, weeding, ripening of crops). Crops are harvested between August and December. Three to seven months later, at the end of the dry season (about March–April), food supplies come to an end. Whatever surpluses men may have had after the harvest have been used up by this time, often in the celebration of funerals. This period lasts three to four months (April–July) until the new crops have been harvested. It is a period of more or less latent hunger. Abudulai found evidence to that effect in his study of hunger and food security in the Bawku area of northern Ghana (S. Abudulai in personal communication). During the ‘hunger period’ people have less money to spend on Western medicines and rely more on local medicines for the treatment of their ills. As we shall see in Chapter 7, the activities of women fracture this picture of a season of scarcity, and the reality of illness is that they do not recognize a seasonal ‘limitation’ (illnesses occurring within one season only). They are spread out over the entire year. As said, over time the work force changes in that gradually older workers disappear and are replaced by younger people. The reproduction of the ‘productive cell’ is ‘subordinate to the ability to reproduce the relations of production [through men’s control of women] and to recreate the social organisation according to a repetitive scheme and in the same structural form [patrilineal descent, virilocal marriage]’ (Meillassoux 1984: 42). In this materialistic sense, the ability to reproduce is, in the final analysis, subordinated to the ‘constraints of production’ – the climatic, geographical, political and socio-economic conditions related to the land

‘New’ and Enduring Social and Economic Formations

15

Table 1.2. Seasonal Calendar

A C T I V I T I E S

DRY SEASON (No rain): November–March

RAINY SEASON: April–October

Harvesting of crops. Food availability is highest in the first months after the harvest of the first food crops in July.

April: Clearing of compound and bush farms.

Celebration of festivals, including the Damba, and funerals (foodconsumption is high during funerals) take place in the dry season. Building of new and maintenance of old houses (building, roofing, plastering of walls and floors). Mat weaving. No dry season farming possible except near river beds and irrigation dams. Women, on the other hand, produce and sell shea butter, cooked food, farm produce, etc., all year round and thus earn cash to purchase Western medicines. Men have fewer opportunities to earn money. They are farmers and their only cash derives from the sale of cotton (cash crop) and the occasional sale of livestock. However, and unlike other parts of northern Ghana (such as northeastern Ghana), there is little seasonal migration from the area (Whitehead 1984 a: 98; see Tait 1963: 141).

April–June: Sowing and weeding of farms. July–December/January: Harvesting of crops begins in August and carries through into the dry season. Between April and July little food is available. People cut down on food consumption and skip meals. The situation improves with the harvest of the new crops.

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The Problem of Money

people live on, the market and capitalist flows. The fact that households (and available labour) expand and contract over the course of the history of the family has been conceived of as a ‘developmental cycle’ (Goody, J.R. 1958a). This condition of the household has distinct consequences in terms of the economy of the household and, as we shall see in Chapter 7, in terms of its healing resources. The notion of development directs our attention away from ‘structure’ (stasis) to ‘process’ (motion, change). The model of patrilineal society as static is amended, and the focus on the domestic economy leads us to consider the gendered division of labour and the question of generational influences, the manner in which male elders control the labour of women (and junior men). From the perspective of ideology, traditionally, women do not farm but help their husbands sowing seeds in holes dibbled by men, and weed, harvest and carry away the harvest from the field. Men provide the staple that women cook. The cooked staple is generally eaten with soup. Women contribute the soup ingredients (vegetables, leaves and fruits), which they either grow in gardens or collect in the bush; it is also common for women to buy their vegetables in the market. The local Dagomba farming economy is based on an agricultural, non-commoditized mode of production, configured by the requirements of male control of women and the reproduction of the labour power. In other words, kinship and marriage regulate the reproduction of human beings as producers (agricultural labourers) as well as reproducers of society and its designs. On top of this ‘local reality’, however, comes a specific reality (a second level of reality) where the local, domestic economy articulates with processes of commoditization – set in motion by capitalism and a moneyoriented market economy. Despite her essential role in reproducing the society, the social organization is quick in denying the woman a voice. She lives a ‘hidden’ existence behind men (the father, the brother, the husband) and her voice is ‘muted’. Her agricultural labour is appropriated by her husband and through his mediation entered into the domestic sphere. Guyer notes that this view of an exploitation of the woman’s labour, the handing over of her agricultural products to her husband, may usefully be balanced by the concept of diverse ‘cycles’ (of shorter and longer duration) where female farming for personal use may be thought of as a specific ‘female cycle’ of short duration – and on a small plot where the woman cultivates one or the other crop for her own use (Guyer 1991: 267). Similarly, a further set of fields may exist within the dominant ‘cycle’ (asiba puuni), which the Dagomba identify as zawuuni puuni, cultivated by young (often dependent) men and women in the afternoon on various small plots (monocrops or vegetables). On these

‘New’ and Enduring Social and Economic Formations

17

plots, farming appears to be of an even shorter duration: single-season. In the end, these two short cycles where women and men farm single-season plots are embedded within the dominant ‘male cycle’, which is of a longer duration (multi-seasonal) and scale (often depending on collective work – see Fig. 1.7 where a communal work party builds yam mounts) and provides the food items that we generally identify with the products of the domestic economy. The concept of ‘cycles’ may contribute to a more dynamic and detailed understanding of the gendered division of labour.

Figure 1.7. Building of Yam Mounds by Communal Work Party (Kpariba)

Despite ‘recurrent’ structures of inequality, the structure itself acknowledges her independent status when the woman in ‘old age’ (no longer fertile) divorces her husband, withdraws from marriage and returns to live with a brother or son. While still married, the market, however, recognizes her role and grants her the status of producer, a status denied her by her husband and the domestic farming economy. This occurs when the products of her labour are no longer mediated by men in the domestic arena but sold as food stuffs in the market and mediated by the ‘outside’ monetary economy, which assigns her a conspicuous place as active in commerce. Wives earn personal income after thrashing and winnowing the rice, they are given approximately a tenth of the harvest in return for their help. They are also given about a quarter of the groundnut

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The Problem of Money

harvest. They sell these and other foodstuffs, including rice and yams. They also engage in numerous other petty income-generating activities, like selling cooked food, shea butter (oil extracted from the nuts of the shea tree), dawadawa (locust bean condiment) and many other goods. One woman in Duko village bought sugar in Tamale, which she formed to sugar cubes and sold in the village for twenty cedis (five pence, 1990–91) a piece. The same woman also sold Western pharmaceuticals (paracetamol, tetracycline and ampicillin capsules and vitamin tablets) and kola nuts. Another woman sold kola nuts and cigarettes. Kola nuts sold for twenty-fifty cedis (five-ten pence, 1990–91) a piece, depending upon size and quality. Women also practise as midwives, bonesetters and, occasionally, as diviners, although they derive no real income from these services. Macro-economic factors have drawn northern Ghana into the moneybased market economy. This has had a considerable influence on male and female roles. Today, the traditional male-female division is no longer clear-cut (if it ever was). Men still control most aspects of public life, including sacrificing and praying to ancestors and preparing curative, prophylactic and offensive local medicines. Women’s position in society seems, however, gradually to be changing. Women participate actively as traders in the money-based economy, buy pharmaceuticals, and in many places now own their own farms. The introduction of grinding mills in many villages means that women today have more time to pursue their individual businesses (Drucker-Brown 1975: 17 and Drucker-Brown 1993). By generating money through trading, women have acquired the means to enter farming. Many villages in the Savelugu district in which I lived in 1990–91 have established so-called ‘women groups’ who are engaged in cultivating groundnuts, beans, maize and cowpeas. Through loan-giving schemes, IFAD (International Fund for Agricultural Development, United Nations) encourages women to farm their independent farms. The Ghana Cotton Company and the Local Cotton Company also assist junior male farmers with tractor help and fertilizers to grow cotton and cultivate beans, maize and other crops. These services are deducted in the end from the profit of the sales. As we shall see later (Chapter 7), women are better able than men to generate money throughout the year, and farming has provided them with additional income. Moreover, men’s ambitions (they tend to enter business with major aspirations, see Brydon 1999 on men-women and their goals in Nima, Accra) and spending patterns differ from those of women. Men spend their money often outside the house and on themselves and friends, whereby they convert their wealth and

‘New’ and Enduring Social and Economic Formations

19

friendships into long-lasting, male oriented designs for living, such as marriage (see also Chapter 7 on converting wealth, and Piot 1991 on the Kabre ikpanture in northern Togo). Male strategies thus distinguish themselves from those of women who are content with earning a little income. This they not only spend on themselves but on their children’s health and welfare (buying medicines and snacks for them). Children are their source of security in old age. Nevertheless, it must be stressed that in however many ways men’s and women’s worlds seem to differ, the viability of the household is always dependent upon the cooperation between the sexes. The role of treating and protecting the family against illness is performed by both women and men (Chapter 7). The implications of ‘kinship’ may give us a further understanding. The term used for ‘kinship’ in general is dogim, which is cognate with the verb ‘to bear’, ‘to beget’, dogim pua. The Dagomba declare that the mother loves the child more than the father’. The relationship between mother and child is described as a tender and protective one. A child can always reckon on his own mother’s support. Dagomba men look upon their mother, ma dogi ma, ‘the mother who bore me’, as the most important caretaker, n daa yuro, ‘I loved her’: she carried them during pregnancy and experienced pains in labour; she later tolerantly nursed them, was defecated and urinated upon; she carried them on her back and continued to cook for them after weaning. In return for her care, the mother can be sure of her adult son’s support whenever she needs it. We shall return to this premise in the next chapter when we further discuss maternal kinship, as well as in Chapter 7 where we clarify the female strategy of care. In spite of the ‘benevolent’ aspects of maternal kinship, the social structure continuously engages the paradox of men needing women, having to trust them but not trusting them, by directing its (and our) attention away from this paradox to focus on the rules of patrilineal descent and male control over reproduction and production. Nevertheless, through their agency, women negotiate the (enduring) social structure of patrilineal descent and virilocal marriage and thus the local world meets the (wider) reality. Through the gendered division of labour and their contact with the market, women engage their futures as women in a male-oriented society and produce a future based on female agency. They hold a vision of future times to come (post-marital residence) that is mediated by the global economy. A ‘local’ mode of production, the farming household, becomes inserted: a) in a materialist discourse of the domestic economy where older men control junior and female labour; and is shaped by b) ‘production for domestic consumption as well as for the market’ and ‘women’s (contextual) role in farming and the value of her work’. In the production of futures ‘local culture’ is brought

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The Problem of Money

into contact with, shaping and being shaped by, ‘external flows’. This movement from the local to the global level has important epistemological consequences for the way the scientific project (anthropology being part of that endeavour) produces, ‘adds to’ knowledge. If we follow Mudimbe (1988) and others (e.g., Fabian 1983 in Chapter 8) we realize the dual commitment of anthropology having to produce knowledge about these two worlds and also how they connect and influence one another to produce a future, where the modern world needs local culture and women to ‘prove’ that it is modern (more on modernity needing local culture and magic in later chapters). This is why ‘new’ appears in inverted commas in the chapter heading.

Notes 1. The term zulya (‘tribe’, ‘titled class’) is employed as the context demands, to communicate information about a person’s background (Oppong 1973: 33). Zulya in the wider sense (‘tribe’) is used by Dagombas to indicate the common ancestry of all Dagombas. In that sense, all Dagombas are ‘one tribe’, and they can be distinguished from other people in this way. In other contexts, zulya attains a narrower meaning and can be translated as unilineal descent group or ‘titled class’ – ‘a class of titles, a section of the court’ (Drucker-Brown 1981). 2. The Dagomba speak of themselves as Dagbamba (sing., Dagbana) and of their language as Dagbanli (Dagbani). Like the languages of their Mamprusi neighbours and other peoples in the savanna, Dagbani belongs to the MossiDagbani language sub-group of the Gur or Voltaic family (Rattray 1932 vol.1(8): 2–9 and Chapters 3–4; Tait 1955: 185–6; Westerman and Bryan 1970; Naden 1988). Dr. Fisch’s dictionary from 1913, The Language Guide, the Dagbani Language Guide of the Bureau of Ghana Languages (1968), Wilson’s Dagbani, an Introductory Course (1972) and Spoken Dagbani for Beginners (1985) are useful guides to the Dagbani language. As far as history, culture and language are concerned, the Dagomba show many points of resemblance with other groups in northern Ghana, including the Tallensi (Fortes 1945, 1949), the LoWiili (Goody, J.R. 1956), the Gonja (Goody, E.N. 1973) and the Mamprusi (Drucker-Brown 1975). No anthropological monograph is available on the Dagomba people (see, however, Oppong 1973 and Bierlich 1994). Tait’s study of the acephalous Konkomba, neighbours of the Dagomba to the east, includes some pages on Dagomba political organization (Tait 1961: 4–12). Unfortunately, Tait’s unpublished manuscripts on the Dagomba were not available to me while writing up my work. Tamakloe, a colonial officer stationed in the Dagomba area in the 1920s, has written an account of the history of the Dagomba (Tamakloe 1931). Blair and Duncan-Johnstone (1932),

‘New’ and Enduring Social and Economic Formations

21

Rattray (1932) and Manoukian (1952) also include valuable information regarding Dagomba history and kingship. Drucker-Brown’s (1975) analysis of the Mamprusi kingship is a valuable study of the political organization of a neighbouring people. Mention must also be made of Staniland’s The Lions of Dagbon (1975), a study of colonial rule and contemporary politics in the Dagomba area. Fage (1964) and Staniland (1975: 1–39) also contain relevant facts on Dagomba rules of succession to office and pre-colonial political history (see also Goody, J.R. 1966b). 3. The village of Duko is one of twenty villages which fall within the orbit of the paramount chief of Savelugu, who appoints the chiefs in these villages. Because of its importance, Savelugu is also referred to as the ‘Yendi [King’s town] of Western Dagomba’ (Tamakloe 1931: 47). Brothers, sons and grandsons of Savelugu chiefs, as well as men from the king’s own patrilineage or ‘gate’ (duu noli or dundoli, lit., ‘entrance to room’), are eligible to the ‘skin’ of Duko. The skin, gban, of a goat or cow is the symbol of chiefship and also the throne on which the chief sits. Only the king and ‘terminus’ chiefs (paramount chiefs that are not eligible as kings, such as the Nyankpala paramount chief) sit on lion skins (Oppong 1973: 20–21). The Kingdom is made up of a hierarchy of important and gradually less important chiefdoms (Tait 1961: 6; Oppong 1973: 20–24). It may be conceived of as a pyramid in which ‘office’ (naam) travels downwards (Drucker-Brown 1975: 31–43). It is said that in the traditional political system, no man could rise higher than his father (Blair and Duncan-Johnstone 1932: 29). The paramount chiefships of Savelugu, Karaga and Mion define ‘gates’ to kingship in Yendi (or Naya), the traditional capital of the Kingdom. It is from among these three gates that a successor to the paramount post of king is chosen (Oppong 1973: 21). J.R. Goody (1966b) and Drucker-Brown (1975) describe a ‘rotational’ system to High Office among the Gonja and the Mamprusi. This system is not found among the Dagomba, however. The lack of rotation increases competition for office. This forms the background for what has become known as the ‘Yendi skin dispute’, a dispute over succession to kingship (Staniland 1975: 103–68). 4. In 1965 Oppong found that the majority of villages in western Dagomba had less than 200 inhabitants (Oppong 1973: 16). 5. In describing the different marriage and property systems of the Zulu and the Lozi, Gluckman distinguishes the unit of a mother-and-her-children as the ‘house-property complex’ (Gluckman 1967: 195). ‘House-property complex’ refers to the ‘inheritance of [property] rights through the mother’ (ibid.: 196). While the Zulu have agnatic lineages, these are absent among the Lozi. Among the patrilineal Zulu, a woman transmits property to her children in their father’s estate; not so among the Lozi (ibid.: 196–7). There, a man’s children have no rights in his estate; rather, ‘the mother transmits to them property rights in her own homes, paternal and maternal’ (ibid.: 196).

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6. The notion of ‘change from within’, corresponding to an empirical reality, represents a clear critique of modernization theory, according to which – following a simplistic cause-effect model – only external pressures produce change. 7. Kinship reckoning is shallow, with a maximal depth of three to four generations. In general, people show greater familiarity with those of their relatives (e.g., brothers’ children, mother’s siblings’ children) who live in the same village or in nearby villages compared with distant relatives.

Chapter 2

POWERS OF THE PERSON

The aim of this chapter is to identify Dagomba ideas about the person and the powers of the person to do good and evil, sometimes with invisible or available forces for protection and harm. Women and men are associated differently with some of these powers and this chapter seeks to examine why this is so. Their understanding of these powers is often directly relevant to their interpretations of misfortune and illness as well as to much in their approach to treatment and healing (as will become clear in later chapters). Inadvertently, their and our interests zoom in on the power of ‘medicines’ (tima). 1 The control and use of these by men is associated with the health of the group, while women – considered to be ‘outsiders’ are seen to introduce ill health. The prime fear of men is that of female witchcraft directed against themselves and their families. Male use of medicines is considered ‘legitimate’, while the use of medicines by women – except when caring for their children – is condemned as unacceptable.

2.1 The Individual and the Sway of Maternal Kinship A person’s uterine link is an important personal link and children begin early in life (as we noted in Chapter 1) to identify with their maternal kin. The uterine link is primarily a loving and caring bond. The person inherits certain potentialities (powers, skills, manners) from his or her mother. The ability to divine, baga koligu, literally ‘diviner’s bag’, as well as certain occupational skills (to work as a blacksmith, butcher, drummer, fiddler), are generally said to be passed down to the children from their mother or their maternal kin. (The power of witchcraft, sogo, is, however, only passed down from mother to daughter, not to son.). Maternal kinship commands great authority. Even the elders, the guardians of patrilineal ideology, recognize the importance of the

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maternal factor. They speak fondly, in fact, of the ‘mother who bore you’. Maternal kinship fractures or ‘softens’ the ideology of descent through men. As noted above, women identify strongly with their kin and sons. Mothers/sisters return either to their sons or to their natal homes when divorced, widowed or old. Throughout their lives, daughters and sisters retain strong ties with their natal lineage through regular visiting. Dagomba women also return to their parental or foster home for an extended period of time after the births of their first children. Accordingly, the maternal family, ma yili or mapolo, and the matrilateral ancestors are of great importance to the child. The child frequently visits his mother’s brother’s house, and many children grow up not in their parental home, but are fostered by a mother’s brother or another maternal relative.2 Uterine kin are loyal and affectionate to each other; a person can always count on help from his matrilateral kinsmen. Terms for uterine kin follow from distinctions between mother’s kin, ma yili: ‘mother’s brother’ – nahaba, ‘mother’s sister’ – ma-pira. Oppong notes that ‘The mother’s brother is typically loved and respected and does not have the same degree of dislike directed against him as the father’s sister’ (Oppong 1973: 40). The children of the mother’s brother and mother’s sister, nahab-bihi and ma-pir-bihi, are also considered a person’s ‘playing mates’, dachihi. Maternal heritage can be an important asset. It presents the person with a number of possibilities of prospering as an individual in this otherwise socio-centric and male-oriented society. A young man I knew stressed that in one’s endeavours to make it as an individual in this world, the support of one’s maternal ancestors were more important than that of the paternal ones, ‘ma yili bagayuli ngari bayili bagayuli’. This assessment primarily refers to the ‘hardships’ that ‘exploited’ juniors and women may experience in the domestic society where they are subject to the rules of elders and men. Many young and middle aged men (to a lesser degree women) are engaged in or seek employment in the cash economy on a part-time or full-time basis. In competitive situations involving obtaining a job, securing job promotions, passing exams, securing and safe-guarding one’s wealth from envious people or generally advancing and prospering in business and life, many people feel prompted to approach their maternal ancestors, especially their Tia (maternal ancestor) in order to secure success.3 In their endeavours, they negotiate modernity as well as the material reality. Women’s opportunity via the commodity market to acquire an independent economic status outside the male-dominated, domestic farming circuit, results in a fear of female witchcraft and of individualization and money rupturing the local non-commoditized moral economy – so fiercely guarded by the elders. 4

Powers of the Person 25

The Moral Economy: Ancestors and Guardian Spirits Agnatic descent, ba yili, determines a person’s status and social relationships. Agnatic descent confers eligibility to office and the privilege and responsibility to communicate with the ancestors, yanima (sing., yan). Women, having no jural and ritual independence, neither do they hold political offices nor play a role in giving prayers and sacrifices. Fortes (e.g., his 1987 essays in Religion, Morality and the Person) offers very elaborate descriptions of the complex Tallensi set-up of personal versus shared shrines for individual and group access modes of appeal, respectively. Similarly, the Dagomba distinguish between situations where the descent group (the collective) is in action, being mobilized around communal and lineage-oriented goals that demand sacrifices to the ancestors (e.g., in connection with various seasonal and religious festivals), and Wuni ancestor worship in the contexts of maternal kinship and individual concerns (e.g., individuals negotiating their fortune. See also Fortes 1987b: 146–47, 150–51, 154–69). Whether ancestor worship takes place in the structural context of the lineage or in a family and/or individual context, the access mode is that of prayers accompanying obligatory sacrifices. Prayers are the centre of the ritual system. Without these and the support of the ancestors who are thus invoked, any activity, including those that employ local medicines (plants) and other magical objects, remains impotent. Medicinal prayers, for example, may run like this: ‘My father X, I am calling you. I offer you this chicken [the chicken chokes to death, a small incision is made so that its blood may drip on to the medicinal roots]. Please accept this and support these roots’. This brings us to consider the role of the ancestral Guardian spirits and their relationship with the ancestors in the Dagomba moral economy. When an illness gets worse or a condition cannot be controlled, or if witchcraft or other human or non-human intervention is suspected, the Dagomba address their ancestral Guardian spirits, the Wuni, through prayers and sacrifices. Wuni (derived from Naawuni, God) is the Dagbani equivalent of the Talni Yin. Very tellingly, Fortes stresses the significance of the maternal ancestors for the social structure of the patrilineal Tallensi, neighbours of the Dagomba in the savannah: … matrilateral connections spread in an endless web amongst the mutually independent patrilineal descent groups, and matrilateral ancestors are therefore deemed to have the ramifying ties which enable them, ideally, to be in contact with everybody’s ancestors. (Fortes 1987a: 13)

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Wuni is rendered by English-speaking Dagomba as ‘small God’ or ‘Guardian spirit’. Every male person has a Wuni, but the younger he is, and as long as he still lives in his father’s house and under his tutelage, the less likely the person is to be actually praying and sacrificing to it (although it happens). At this stage, the son’s Wuni is still a part of his father’s Wuni. The son’s and the father’s Wuni are the same. The father will take care of the necessary sacrifices for his son. Often a person first becomes aware that he has a Guardian spirit in connection with an episode of illness or other form of distress. When consulting the diviner, the diviner may tell him: ‘This is your Wuni’, ‘A Wuni mbala’, ‘You must make a sacrifice to it’. Although the Wunis are associated with maternal kinship, women do not have their own personal Guardian spirits but – consistent with their status as jural minors – have to go through men to access them. The Guardian spirits are not spoken of as being independent of the ancestors. Rather, the Guardian spirits are thought of as ancestors who, being maternal forebears, are particularly willing to ‘listen’ to the concerns of individuals. People consider them, therefore, very powerful, to the point that they are thought of as more influential than the paternal ancestors. The latter’s (remote) status gets its worldly expression in the relationship between the father and his first-born son, which is regulated by a set of rules confirming the father’s authority over his son as long as the father is alive. Thus, the oldest son cannot shave his head as long as his father is alive. The oldest son’s Wuni is believed to be identical with his father’s Wuni. (The son does not inherit his own personal Wuni until he leaves his father’s house.). The Wunis share in the characteristics of the ancestors; they are, however, particularly benevolent ones. To address one’s Wuni, one goes through one’s paternal ancestors. In this sense, the ancestors function as intermediaries. The Wunis are found at ‘the end of the ancestral ladder’, so to speak. In terms of the ‘individualization’ of Wunis, young brothers have common paternal ancestors. The Wunis of brothers become, however, gradually individualized. One brother may inherit or learn a certain skill from his maternal kin and thus inherit a maternal Wuni (Guardian spirit) specific to the qualification gained. Thus, brothers acquire their individual Wunis. Having different mothers, the maternal Wuni-ancestors of half and full brothers always differ. Finally, the Dagomba do not think of a person’s individual destiny apart from his ancestors. People often attribute an individual’s manners, character or looks to a particular deceased person who has been reincarnated. The importance of the ancestors in people’s lives is also apparent when we consider the fundamental fact that people wanting to address their Wuni always go through their ancestors. Most of

Powers of the Person 27

the time people do not address their Wuni directly but are content with praying to their ancestors. The ancestors share in the supreme power of the Wuni but are more readily accessible. The paternal ancestors lend support to the male descent ideology; their power is seen by men and elders as absolute and basically good and just in the effects they cause. Junior men and women have an opposite view. Being jurally minors, they favour the more benevolent maternal Wunis who are attentive to their feelings and concerns, which often go against the priorities of senior men and the ideology of male descent. From the latter perspective, the male order of things (patrilineal descent) and the (material and metaphysical) powers executed by the seniors, and associated with the patrilineal arrangement (below), are seen by them (senior men) as fully legitimate. Women, on the other hand, are seen as needing to be controlled. Men often accuse them of witchcraft. They are perceived as endangering the male order and the powers that women yield are branded immoral, basically bad in their effects and therefore entirely illegitimate. Men believe that their wives are always plotting against them, and that they resent and envy each other and each other’s children (see Fig. 1.4 of son accusing stepmother). Men’s fear of female witchcraft is omnipresent. The potentiality for witchcraft, sogo, is believed to be passed down from mother to daughter. A woman is easily angered and difficult to control. ‘Her heart is like fire, bugim; she does not have patience, sugilo’, men say. Women are thought to attack their enemies through poisons that they put in cooked food (see for descriptions of comparative situations E.N. Goody 1970 and Tait 1961).

Women, Money and Witchcraft Individualism, in the shape of activities in the farming sub-cycles that we have identified as well as in commoditized transactions of men and women in the market, is perceived by elders in Dagomba as a rupture of the non-monetary moral economy. They express their concern through witchcraft accusations, where witchcraft is linked with the immoral category of money. The identification of individuals as witches and their ‘love of money’ connects with elders frowning at men and women who sell and purchase commodities. Many cases of witchcraft accusations refer to men and women worrying that their health and ‘wealth’ (money, goods, wives, offspring) might be ‘spoiled’ through the evil deeds of envious people. The figure of ‘bewitched money’ (sonya ligiri) features in many different contexts. This configuration of bewitched money and monetary pursuits replicates many of the arguments about witchcraft put

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forward by Birgit Meyer (1998a). She finds that in southern Ghana this construction is given expression by Pentecostalism and its rejection of ‘tradition’. The Pentecostal discourse emphasizes ‘the necessity to break away from local traditions’ (ibid.: 183). ‘Tradition’ (including socioeconomic obligations toward one’s kin) is conceived as belonging to the pre-modern, the past. It is seen as unequivocally ‘evil’, reflecting the ‘Devil’ in the world, being in the way of one’s realization as an individual who is emancipated from his/her kin. Meyer mentions a witchcraftdream where a woman of a prosperous businessman suffers a number of miscarriages. In her dreams, her aunt (paternal), her husband’s adult son and other relatives harm her and kill her yet unborn child out of envy of her and her husband’s wealth (ibid.: 197–98). The image of the immoral (female) witch seems to have been strengthened by recent trends relating to macro-economic changes and changes in the image of the traditional division of labour between the sexes in northern Ghana: traditionally, men farmed and women cooked and provided the soup ingredients. On top of their involvement in a farming sub-cycle and sale of various crops and vegetables, many women increasingly manifest themselves as traders and independent farmers, assuming greater control of the economy (Chapter 7 discusses these economic changes in the context of the introduction and use by women of Western medicines in family health care.) Comparing the situations in the 1960s, when she did her first field work among the Mamprusi (neighbours of the Dagomba) in northern Ghana, and the 1990s, Drucker-Brown (1993) notes that people’s dependency on cash to buy manufactured commodities, kerosene, canned food and Western pharmaceuticals, seems to have greatly increased. Changes in the economy have also produced new images of witchcraft. Rather than consuming their victims, witches are now seen as trapping, storing, and eventually selling them for money. The need for cash and the fact that women are trading to accumulate cash is the background referred to in most talk of witchcraft. The proof of their witchcraft is that they have more cash than they formerly had. (Drucker-Brown 1993: 13–14)

‘Good’ and ‘bad’ powers are thus associated with or biased towards one or the other sex, whether associated with a potentiality for witchcraft, maternal kinship, personal achievements and training, or ascribed as intrinsic attributes of social position, gender and age, features characterizing the social structure and the control by men.

Powers of the Person 29

2.2 The Morality of Witchcraft and Medicines: The Contrast of Legitimacy and Gender The paradoxes we have identified as deriving from ‘maternal kinship’ and ‘individualization’ are perceived by elders to damage the arrangement of patrilineal descent and articulate with witchcraft beliefs. These serve the interests of individuals who feel they have been harmed in one or the other way and are also put to the effective service of elders in their ploys to guard against transgressions of the moral order and ‘destructive individualism’. Individualisms fostered by maternal kinship and the market are seen as suspicious. Accumulation through the farming cycles where crops or vegetables are grown for sale as well as any involvement in the monetary economy draws the criticism of the elders who fear that they are losing their control of the young and women. Zom sala, ‘fear man’, is tellingly written over the entrance to a room storing cotton seeds, fertilizers and pesticides in the village. The author of the inscription (a middle-aged man) explained to me that one always fears that one’s fellow men (women and men) will harm or spoil one’s work through witchcraft and ‘bad’ medicines. Therefore one has to be on guard. Anybody can be a witch, a man or a woman, but normally it is women who get accused of witchcraft (i.e., the ‘unacceptable’ use of medicines) by men. That men should possess and use medicines – which can also be used to kill – is quite acceptable. After all, men use such powers for ‘legitimate’ purposes – to protect themselves and their families, and in their rivalries for power in society.

The Witch A witch is known in Dagbani as either sonya (female or male) or pa-kurugu, literally ‘old woman’. The witch is known to possess ‘witchcraft substance’, sogo. The Dagomba do not have a concept of the unwitting witch. The witch is fully conscious of her (or his) actions and uses medicines with the intention to cause illness and misfortune. As mentioned above, the Dagomba believe that the mother passes down the propensity for witchcraft, sogo (witchcraft substance), to her daughter, not her son. The typical witch, sonya, is a woman – in particular, the co-wife, nyinta, the father’s sister, pirba, and the divorced or unmarried older woman. The aunt is said to pass her sogo on to her daughters and grandchildren (her daughters’ girls). She is also said to pass her witchcraft on to her foster-daughter, who is believed to do the dirty work for the other witches. Witchcraft is thus linked with uterine kinship. It is not

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associated with agnatic descent.5 The term ‘witch’ is negatively laden. It is primarily reserved for women. It is an insult to call a man a witch. That men should possess medicines, tima, is considered fully legitimate. They are not known as witches but as tima-lanima, literally ‘medicine-owners’, which is a highly respectable status for men. Since sons do not inherit witchcraft from their mothers, it is said that sons have to look themselves for the medicines that they will need to further their (legitimate) interests. The son may also inherit such medicines from his father (the information on ‘inheriting’ and ‘acquiring’ medicines will come in the later Chapter 5, which is specifically focused on the herbalist’s work). According to the beliefs constructed by elders to guard their positions of power in society, to be a witch is synonymous with using medicines illegitimately, to harm and kill. Witches use medicines to harm their victims. They do so out of envy and hatred. Witches are believed to operate in teams, not on their own, and to meet at night. The witch attacks her victim either through bespelling objects that her victim subsequently touches or steps on, by leaving witchcraft substance on clothes, gifts (such as kola nuts), money or in food; or by ‘eating’, nubiri, the flesh, nimdi, of the spirit or shadow, shia, of her victim; even the mere look of a witch can cause illness. Witches do not operate in their human, physical form. They often take on the shape of an animal. Men say that ‘before a woman can become a witch, she has to kill either her own children or a grandchild’, paga yi yen nin sonya, o nubiri la o bia, bee o yaana. Dagomba men see women as dangerous to the social order and male authority. Witches are women who challenge men and oppose their rules; elderly women are often accused of witchcraft. Opposite the young married woman who lives in submission to her husband, the elderly woman is considered a threat to men and male authority. ‘Age’ is a determining factor of witchcraft. In her capacity as a senior woman, paga kpiema, in the house, the elderly woman wields considerable power. She supervises and organises the various domestic tasks of younger women, including the fetching of water, firewood, the sharing out of food and cooking. The household head often consults and listens to her opinion. Thus, the older a woman gets, the more she acquires the authority and rights of men (including that of showing an interest in medicine). For this reason, men especially fear elderly women. They feel that they challenge their authority and, therefore, accuse them of witchcraft.

Powers of the Person 31

Double Standards of Male and Female Power Witchcraft and the use of medicines are explicable in terms of the social organization of Dagomba society and the structure of the polygamous family. An analysis of areas of tension in social relationships (categories of people most likely to attack each other with witchcraft) reveals a definite pattern of witchcraft beliefs and accusations. Witchcraft accusations against wives (believed to introduce disorder into the local lineage) is very common and made by the husbands’ groups. Men fear that wives will sabotage and harm the lineage. The in-group of agnates accuses the outgroup of wives of witchcraft. Co-wives also often accuse each other of witchcraft. Co-wives are believed to be envious of each other and each other’s children. It is also said to be quite common that grandmothers attempt to kill their grandchildren. Two remembered cases are Sanatu, who is said to have killed her grandchildren, and Mahama, who accused his grandmother of witchcraft, left Duko and moved to a distant village. Relationships that are also very problematic are those between stepchild and stepmother, between stepbrothers and stepsisters and between mothers-in-law and daughters- and sons-in-law. The father’s sister, pirba, is a particularly feared figure. The relationship between the brother’s son and the father’s sister is one of the most tense relationships; numerous cases of accusations by nephews against their aunts were reported to me. As one man explained, ‘Witchcraft can easily occur. Your aunt will try to pull you down, if you are wealthier [in children and material wealth] than her children’. I have also heard nephews refer to their aunts as ‘tanks’ (military tanks), alluding to their powers. Therefore, a strong ‘armoury’ is needed to defend against such power (Drucker-Brown 1993: 4). Witchcraft accusations never occur in the relationship between the father and his sons. Strong norms of respect prevail: the father rules, the son obeys by responding ‘Naab’, ‘Sir’. As long as the father is alive, the son is subordinate to him. Among the Dagomba, witchcraft accusations against wives are made by the husbands and their brothers. Women, on the other hand, never make accusations against their husbands or in-laws (as far as I know). Accusations against women and men suspected of witchcraft or the ‘illegitimate’ use of medicines are seldom made openly or directly. While the social structure stresses the importance of unanimity and peace in the house, nangban yini (lit., ‘one mouth’), it also encourages the build-up of hostility in the relationship between the married wife and her in-laws. As noted above, the position of the married woman in her husband’s house is particularly problematic. On the one hand, she is powerless because she is under the authority of her husband and/or the household head. On the

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other hand, she wields considerable power in the domestic domain as curer and care-taker of the family (see Chapter 7). Opposite women, men use their powers against ‘outsiders’, non-kin. When women show an interest in medicines, men immediately suspect that they intend to use medicines for offensive purposes. A revealing exception are the ‘princesses’, nabihi-purungsi daughters of paramount chiefs, who have the status of (male) chiefs. They possess, men say, very powerful medicines. When they use their medicines to eliminate enemies, it is considered as legitimate as when men use their powers against their rivals (see Chapter 7, endnote 3). Let us for another moment remain with this male view of reality. Men live with a constant fear of becoming the victims of powerful medicines. Dangers are everywhere and inherent in many activities, in everyday activities of women stirring shea butter, cooking and sweeping the floor, when people gather to celebrate funerals or when men meet in summits convened by elders and chiefs. Men say that when two men are fighting each other with medicines, bystanders (‘weaker’ or unprotected people) are often hurt. I had the privilege to be in Yendi (the traditional capital of the Kingdom) in July 1991 when a council of chiefs was convened by the King to discuss the increasingly tense situation in the town of Gushiegu (Eastern Dagomba) caused by the enstoolment of a new chief there. The meeting was attended by many important chiefs (about forty or fifty). They all arrived well-protected, wearing protective medicines in their clothes. Only a well-protected person can meet with the king, who, of all men, is said to have the strongest medicines. He is able to ward off any attack.6 As illustration of the ‘innocent bystander thesis’, people comment that ‘after chiefs meet and go home, some of the weaker chiefs will just die like chicken’. Weaker chiefs get overpowered and succumb to the power of the protective medicines of stronger chiefs. I did not hear of any such case that might have occurred after the Yendi-meeting, however. Whether a person has confidence in himself – feels protected and immune to danger – can, for example, be seen in the way he comports himself when dancing in funerals and on other ceremonial occasions. Elders and chiefs dance with a lot of confidence. They take big steps when dancing, holding their heads high and always looking at people in the crowd. Younger men often prefer to take smaller steps, holding their heads down and not to look at the crowd. I have been told of young men who have powerful medicines, however. They are said to be ‘like elders’. They are not shy and elders respect them. ‘One can see it in funerals. When the big men dance, these young men also dance’. They are said to comport themselves with great confidence. I was told of one young man, about fifteen years old, in the village who had inherited powerful

Powers of the Person 33

medicines from his deceased father. However, whether old or young, confident or less-confident, the way men dance and move on the danceground is a display of a manly superior attitude. The dance of women contrasts with that of men. Women characteristically dance with very small, constrained, steps moving the hips and their belly muscles. The pelvis is the centre of their movements, it is where their power as women lies. Men, on the other hand, show watchfulness and look beyond their own bodies. The importance attached to the dance lies, therefore, not only in the emotional stimulation it provides. Through their use of movements, men communicate their reaction to perceived dangers and hostile feelings held by others toward them. By contrast to men, women ‘respectfully’ acknowledge and affirm their subordinate status in society, where they have no ‘public’ power. The female role demands that women support their families and nurture their children. They must not challenge men but support them and be respectful.7 How do women feel about men accusing them of witchcraft? While it is difficult for me to answer this question with empirical examples of women ‘complaining’ of being thus accused, one is forced to summarize male attitudes of supremacy as reflecting ‘double standards’ where men accuse women of immoral dealings in witchcraft while reserving for themselves the (‘legitimate’) right to employ medicines. Considering this construction of ‘morality’, we are immediately led to consider the morality question as it is played out in modern life. Witchcraft beliefs, or the ‘occult’ , may appear ‘confined’ to a local context, understood primarily as the empirical reality of the village and the local society (opposite the national society and global flows), and thus really a rather local, ‘traditional’, and ‘tame’ phenomenon. There is, as we shall see in section 2.3, however, nothing local or subdued about witchcraft. The concepts that the previous and the following analysis will provide enable us to insert witchcraft and the occult in the lives of all people in the postcolonial society, whether they live in the rural hinterland or the city. They (The vitality of the ‘occult’ and ‘tradition’) become a commentary on modernity and a central part in the lives of many people. The ‘i/mmorality’ of the power of women is a comment by older men on losing control over women, and seeing the ideology of patrilineal descent crumbling. When accusations against men are made, these accusations are often directed against powerful men and may be interpreted as a means of preventing them from concentrating too much power in their own person (cf. Meyer, 1998b). There is always danger when a ‘centralized power’, in building up a following, no longer strives for popularity and power but for power as the final and only objective (this danger is ever present and part of the very construction of ‘popularity’, see Chapter 6).

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2.3 Enchanted Modernity and Witchcraft The witchcraft-medicine dialectics are a classic case of men accusing women of destructive practices and denying them the use of medicines, while reserving for themselves the right to ‘legitimately’ employ medicines. With this configuration as a platform, this section specifically attempts to push the implications of this arrangement forward and summarize these in terms of the discourse on ‘enchanted economies/modernities’, as they are embedded in and patterned by the culture of ‘the occult’.

The Problem Through their engagement with trade, Dagomba women share a widespread fear of strange things going on in the market. This notion articulates with the idea that, next to the ‘visible’ there is also an ‘invisible’ witch market going on in which meat (meat taken spiritually from human beings) is transacted (‘consumed’).

Witchcraft and/or the occult has not gone away with Africa’s entry into modernity. Neither is it simply a ‘local’ phenomenon that can be reduced to being simply ‘evil’ and a ‘threat to the existing order’. A simplistic opposition of ‘good and evil’ is ‘of limited value’, so is a ‘discourse about the Other as [simply] radically different’ (Geschiere 1997: 219, fn. 4, and p. 221 in ‘Afterword’) steeped in magical, exotic beliefs. It would be wrong ‘to retreat back into the local’, to ignore ‘the challenge posed by the global moment’ (Comaroff and Comaroff 1999: 294). Witchcraft has a rather prominent, fully legitimate, place in modernity as an idiom that ‘make[s] life in modern circumstances more livable’ (Geschiere 1997: 221) and meaningful. It is also a commentary and an expression of all the uneasiness and subtleties connected with a postcolonial reality. The postcolonial moment produces not only many doubts over the costs and benefits and possibilities of individual wealth accumulation and redistribution but also makes many promises about the future for men and women, promises that go unredeemed. This modern configuration of society and the economy produces the context where witchcraft appears to be ‘on the increase’, ‘rampant’, ‘escalating’ as Comaroff and Comaroff (1999) note in their potent discussion of the dynamics and consequences of the ‘occult’ and the shocking forms of structural and economic violence in the South African postcolony.

Powers of the Person 35

On the one hand, modernity and its material realities are authenticated by glimpses of the vast wealth that passes through most postcolonial societies and into the hands of a few of their citizens: that the mysterious mechanisms of the market hold the key to hitherto unimaginable riches; to capital amassed by the ever more rapid, often immaterial flow of value across time and space, and into the intersecting sites where the local meets the global. On the other hand is the dawning sense of chill desperation attendant on being left out of the promise of prosperity, … (Comarofff and Comaroff, 1999: 283–284; see also the ‘Introduction’ and collection of essays in Comaroff and Comaroff 1993)

By reflecting on the nature of modernity, one must admit that any notion we may have of modernity implying unidirectional progress, modernization and steadily increasing rationality is but a negation of the reality of modernity as it inserts itself in an African context and as is described above. We must also acknowledge the idea that modernity has ‘multiple forms’, that there is not ONE ‘master narrative’. Modern realities are multiple. Modernities are produced by specific ‘contexts’ (see Chapter 8 on the specific context of curing and compare it with that of magical money making described in Chapter 6). Modern realities are therefore not construed in relation to or as a reflection of one discourse (science) dominating ‘opposite’, occult and deeply cultural interpretations. As Moore and Sanders note, there is no reason to suppose that the occult should vanish. Such a question would seem no more or less pressing than one that asks why any other feature of our contemporary global landscape might wax or wane. (Moore and Sanders 2001: 19)

In this light, we can understand and appreciate the culturally meaningful and widespread belief in, and resilience of, sorcery or occult forces as a reflection of ‘the occult or magic in/of modernity’ which is being moulded by and forms modernity. Households increasingly depend on/need cash to survive. In this context, tensions between men and women grow, as well as antagonisms between younger and older people, with regard to collective goals and individual strategies. If not age, then gender dynamics are involved in many witchcraft accusations in Dagomba (cf. the Comaroffs [1999] for their comments on the South African postcolony). Accusations are made to diminish the success and wealth of another person, to destroy what elders perceive as ‘inordinate’ wealth that is not used for social reproduction and redistribution to the collective but for individual purposes, which are feared to be harmful to the future of the lineage. The very specific form magic in/of modernity

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takes depends on the particular requirements of contexts – whether curing or money making is on the agenda. But, irrespective of the specific conditions or the contexts in question, there is an underlying structure of local and global flows of collectivism, individualism, capitalism and consumerism competing with one another, although never to the point where one discourse prevails over the other. Witchcraft is therefore modern and cannot be explained away. It is part and parcel of the construction of modernity, and the experience of it at the ‘local’ village level – never quite local but always characterized by localglobal processes. The specific configuration of an impersonal drive for progress (through the offices of the market and biomedicine) adds to people’s sense of uneasiness and ambivalence over the various forms capitalism may take, for example when capitalistic rationality comes to dominate medicine and displace humanistic considerations – see Chapter 7 on women and medicine, in particular Aishatu’s case. Glancing at the Ghanaian postcolony and the role of the occult as a source of political power (see also Chapter 6 on ‘popularity’ and converting wealth to power), we note that Flight-lieutenant Jerry J. Rawlings (who first seized power in a military coup in 1981 and was able to remain in power until the elections in 2000) during his reign – and not unlike many other African politicians and people in positions of power – was often rumoured to get additional support from occult powers, such as shrines, priests, diviners and magical potions. (These occult powers are represented by Pentecostalism as the ‘destructive powers of darkness’, in opposition to the divine, and juxtaposed with the wholesome form of scientific thought.) In this way, the ‘political’ and the ‘occult’ are/were completely intertwined and entangled. This configuration, however, makes the occult very powerful in ‘legitimizing’ postcolonial modernity in Ghana. The postcolonial modern African state constitutes, Mbembe concludes, an arena occupied by power-holders and their subjects, where the language used by the former is understood by the latter since it is made up of and builds on a mix of divine and occult images (Mbembe 1992). The form that modernity in Ghana has taken relates in this study to the ‘specific’ adjustment policies that the Ghana Government adopted in 1983. For many Ghanaians (and Africans) the current juncture is characterized by a ‘retreat of the state’ from providing social services while the Pentecostals in Ghana say that the ‘Devil’ is to blame for the current crisis. The next chapter explores basic notions of health and illness and is required in order to fully comprehend Chapter 4, which will take us further into the world of medicines.

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Notes 1. I must emphasize that here I am specifically writing about traditional (plantbased) medicine that can work both empirically and metaphysically. I am not going into the detail of all that ‘medicines’ mean here. Detailed discussion of Dagomba (botanical and spiritual) medicine, Western biomedicine and Islamic preparations comes in Chapter 4. The present chapter is about powers of the person. 2. Like the Gonja, the Dagomba practise a system whereby siblings ‘foster’ (rear) each other’s children. Thus, about every fifth child (fifty in total) in Duko is a foster child. ‘Kinship fostering’ is an expression of the importance of the sibling bond. Brothers and sisters have rights in each other’s children. In this connection I want to remind the reader that – due to the absence of bride price payments among the Dagomba – marriage does not establish binding ties between husband’s and wife’s kin. The Dagomba send their children – boys and girls alike – away to a brother or sister when they reach the age of about five. They may remain there until they marry or continue to stay there once married. Sons are often sent to maternal kin to learn a craft, such as drumming and divining. Sons thus grow up with a maternal uncle and marry and live in his village and do not return to their natal homes. It is compulsory to send at least one child to the maternal side. Children fostered by uterine kin grow up with a clear awareness of their maternal parentage and descent. They are the vital link without whom maternal and paternal kin lose awareness of each other. Funerals are prime occasions when maternal and paternal kin gather and are made aware of each other by being identified – with the help of foster children – as ‘the mother’s father’, ‘mother’s brother’, and so on. Foster children serve to bind kin together (see also Bledsoe and Isiugo-Abanihe 1989, who write about Strategies of ChildFosterage among Mende Grannies in Sierra Leone). 3. In his description of religious change among the Manjaco of Guinea-Bissau, Gable recounts how some Manjaco youth after a soccer match they had won poured libations to the spirits who had helped them win (Gable 1999: 9–10). Maybe this support derived from the maternal ancestors? That might certainly have been the case if we go by the logic of maternal ancestors in Dagomba backing the individual. Whatever the scenario, ‘pouring libations’ appears to be a good indication of the power of ‘tradition’ in modernity. A good friend and academic living abroad, a Dagomba himself, daily pours libations to his ancestors to ensure their continued assistance. Modern times and living in modern places do not preclude, they demand ‘traditional’ practices. 4. Considering cracks in the moral economy, Lentz’ observations from northern Ghana seem pertinent. Lentz discusses the organizational aspects of youth and development associations in northern Ghana. They are a good example of groups that dynamically forge identities as ‘ethnic movements’ and ‘development-oriented interest groups’ vis-à-vis other groups in the north, including the Gonja, to whom we have already referred, and the national

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government in Accra, and in relation to often vaguely defined notions of ‘common origin’, ‘language’ and ‘culture’, ‘so that we shall also’, in the words of one youth association activist, ‘get our proper share of the national cake’ (Lentz 1995: 407, 409). In this connection there is a substantial ‘problem of money’ in that the groups’ leaders (mostly young and educated men) lead the rest of the community, including the ‘traditional opinion leaders’, elders and chiefs, in these ‘modern’ associations. The young sometimes collect money from the groups’ members for a local- village development project, which may not materialize in the end. Suspicion and mistrust on the part of the elders of the monetary and ‘immoral’ practices of the young, including allegations of theft and trickery, are therefore widespread (ibid.: 411). Youthful and individualized energies come thus to mark modernity. It can be thought of as an attempt to carve out clearly an identity and future, in opposition to the aged and the traditional power structures in (local) society. 5. Among the Konkomba, on the other hand, witchcraft is taught by father to son or mother to daughter, and witchcraft can also be learnt from non-kin (Tait 1967: 166). Agnates often accuse other agnates of witchcraft. The agnatic lineage is not ‘protected’ against witchcraft. 6. To own medicines, to be a ‘medicine-owner’ (tima-lana) is not a specialist role or status with a special Dagomba name. Everybody is really a tima-lana, The name refers only to differences in the degree to which people possess medicines (some, and older men, often own more medicines than others and younger men and/or different men are in the possession of different kinds of medicines). Staniland relates that on one occasion the Savelugu chief invoked his powers and sent a large swarm of bees to attack his rivals meeting in Tamale (Staniland 1975: 149). Tait also refers to a belief that bees in the trees near the Saboba market can punish thieves by stinging them to death (Tait 1961: 54). 7. Goody links the LoWiili belief in women as witches to their ‘role inferiority’. ‘Because of their subordinate position, both in social and physical terms, women are seen as having more frequent recourse to mystical modes of attack than men, to whom other forms of action are available’ (Goody, J, 1962: 60).

Chapter 3

BASIC CONCEPTS OF HEALTH AND ILLNESS

This primarily descriptive chapter seeks to support the debate of magic, modernity, gender relations and the social and economic structures that we have discussed, by demonstrating how these processes are located within a set of fundamental concepts about health and illness. The chapter allots considerable space to the view of ‘common sense’ and the symptomatic diagnosis of illness. This is not to deny the fact that the ‘visible’ and ‘invisible’ are interconnected, but to avoid a one-sided vision and construction of other cultures as, by definition, obscure. To focus only on the ‘exotic’ (invisible), as so many anthropologist have done in the past, would exclude another quite conspicuous aspect of these alien realities, where – maybe surprisingly – matter-of-fact explanations and treatment of disease occupy much time.

3.1 Illness: The Environment, the Living and the Dead There is only one term in Dagbani, doro (pl., dorti), which conveys the English terms, ‘sickness’, ‘illness’ and ‘disease’. Doro applies to somatic symptoms but it also refers to the qualities of a person’s blood, zim, and constitution, naam (lit., ‘creation’), which make him/her more or less susceptible to negative influences coming from outside his/her body. Finally, doro belongs to the broader category of misfortune, zugu biegu (lit., ‘bad head’), which includes the states of being sick, childless, poor and hungry. What lies outside the person’s body refers both to inhabited (the village, the home) and to uninhabited space (the bush). The bush, the village and the home are considered to be full of natural (snakes, scorpions, weather), human and non-human dangers to the person’s wellbeing. While doro is a substantive, a person wishing to characterize his state as one of illness either refers to his ‘lack of health’, n ka alaafee, or uses the verb bEra which translates as ‘being in pain’.

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Illness is considered a natural part of living and growing up. It manifests itself in somatic symptoms, which have their place within the framework of Dagomba notions of illness and health, where numerous ‘visible’ and ‘invisible’ forces shape the world people live in. The ‘visible’ and the ‘invisible’ are complementary and meaningful parts of their reality. A concomitant idea of their epistemology is that dangerous influences to a person’s health may come from the physical environment.1 People speak of the dangers that lurk in the bush, such as snakes, scorpions and spirits. The bush is cited as a particularly dangerous place. Jogu, ‘bush illness’, is said to live in trees in the bush. It can attach itself to people walking in the bush. Some also comment that the nantuo-bird can transmit jogu to humans. Certain categories of people, such as pregnant mothers, are believed to be particularly at risk to such influences. It is believed that they can pass on illnesses to their unborn children. On one occasion I heard an elder complain that nowadays small children are often sick with convulsions (dogu). This he attributed to the fact that pregnant women bath after sunset. It is believed that one must not take off one’s clothes after dark since the naked body is vulnerable to attack from the many dangers of the dark. I have also heard it said that leprosy, kuna, can be transmitted to an unborn child when husband and wife have intercourse during her period. Prayers to God are generally believed to have the power to reduce, baligi, individual suffering (as long as it is not caused by man) (humankind). While adults have strong blood that easily suppresses, nyen li, illness, the blood of old people becomes short. It is believed that their blood can no longer with ease resist disease and withstand ecological, social and mystical dangers. Since, however, illness is also a matter of ‘creation’, naam, and everybody has his/her individual creation, ‘we all have our names’, an illness that attacks one person may not attack another. Moreover, people in different villages and localities live under different conditions (‘they work different works’). Last notes that ‘each group, each ecological or cultural zone, has its own diseases and its own cures’ (Last 1988: 201; see Last 1981). Thus, for example, it is believed that people in ‘my’ village who drink from piped water do not suffer from guinea worm, a parasite transmitted through unclean drinking water. People in the adjacent village of Kpachelo, on the other hand, do not have access to piped drinking water and drink from streams and ponds and regularly suffer from guinea worm. One mother in Duko explained to me that the people of Kpachelo have guinea worm since their water does not come from a tap, ‘their water is not cooked’ but is drawn from the stream and ponds (Bierlich, 1995). 1995a Illness must be seen within a broad interpretive frame. The frame refers to kinship and power relations, as well as to ancestral and ecological

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forces that surround the person. Physical functions/malfunctions point to the person’s body, as well as to the social and non-social (ancestors/bush) field. Health and sickness become a question of order and harmony in worldly and non-worldly relationships.

I = individual and his body Figure 3.1. The Cultural Model of Health and Illness

The ‘cultural model’ describes the cultural conditions which contribute to and generate particular notions of the person in health and illness. As already mentioned, the person is constituted in relation to his paternal and maternal kin, which provides him with juridical and ‘spiritual’ rights and qualities (Chapter 2). In addition, the person defines and identifies him-/herself in relation to non-kin (these relations are often characterized by power-struggles), ancestors, the land and the bush. These are the sources of his identity. These are also very often the factors behind illness. To avoid illness and secure prosperity, the individual has to maintain a balanced relationship with the land on which he lives and with his ancestors (whose protection he needs) through regular sacrifices; he must observe taboos relating to the bush, and not quarrel or compete with kin and non-kin. As noted earlier, the Dagomba believe that people use their witchcraft and medicines against their enemies and rivals. When a person falls sick (and maybe even dies) the implicit understanding is often that he has broken one or the other rule and has therefore lost the protection of his ancestors. No clear distinction can be made between the ‘inner’ and the ‘outer’. The dotted lines encircling the individual in the above model indicate the lack of boundary between the individual and his environment. The arrows indicate the direction of identification and influence, from without

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inwards. The person identifies himself in relation to his social, natural (bush and land) and ancestral space. This space exists undivided: there is no division between the living, the dead, the bush and the land, and the individual. They have no existence as separate spheres but are interrelated. The dead outlives the living, not only in the material objects he leaves behind (hoes, cutlasses, hunting gear, bags, etc.), but also, as I have said, by leaving progeny who bear his name and who ‘continue him, partly physically, but more mysteriously in their personalities and in their relationships with one another, as if he were in some sense still among them’ (Goody, J. 1987: 7).

3.2 Common Illness The Dagomba expect to be sick from time to time. From experience people know small children are frequently sick. Infants develop sores and hernias where the umbilical cord has been severed and around the penis after circumcision. The Dagomba believe that illness is innate and that the person is created with illness. Most kinds of illness, such as fevers, stomach pains and headaches, are common illnesses and cause little concern. They ‘come and go’ (i.e., ‘go back’ to where they came from: the body). The occurrence of illness is a God-given (natural) condition of living, and throughout life the person is susceptible to all kinds of illness. Illness, people say, reminds them of God, Nawuni, their creator, who always has the final say. The Dagomba believe that God creates the person in his mother’s stomach. The idea that illness is innate (but may be ‘triggered’ by external circumstances, including those associated with the dangers implied by commoditized relationships and individual wealth accumulation), provides the basic language concerning trivial illness. It is in terms of this idea that one is to understand the minimal concern that such conditions provoke. Margaret Topley, for example, writes of conceptions and treatments of measles by Chinese mothers in Hong Kong: So far then, we can infer that ideas are involved here concerning the human system, which are certainly different from those of modern medicine: measles is some sort of transition from a relatively sickly to a much more healthy state. Whether it is a ‘disease’ is open to question, but at any rate it is inevitable. (Topley 1970: 425)

Topley summarizes Chinese beliefs, noting that measles in children are seen as an ‘inevitable’ and ‘necessary’ state which ‘cleanses the system of poison acquired in childbirth’. Measles is considered an ‘ambiguous’ and

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‘transient’ state which moves the child from a state of being sick to an ‘unambiguous’ state of health. Topley also argues that the meaning of people’s attitudes concerning illness is to be found in their concepts of health and illness. The relevance of Topley’s comments for the interpretation of Dagomba concepts of common illnesses is obvious. The Dagomba see many illnesses (fever, diarrhoea, pains and aches, sores, congested noses and inflamed eyes) as inescapable facts of living and growing up. They demand no explanation. They are part of people’s everyday experiences. They describe conditions that ‘come and go’. Since they are common and often repeat themselves in certain ages (e.g., malaria and diarrhoea in early childhood), they are accepted as natural or ‘inevitable’ features of living, although they sometimes have fatal outcomes (in 1990–91 I recorded three fatal cases of fever accompanied by convulsions in children under ten). People attribute illnesses to circumstances of work and fatigue and to the season, to heat, cold, wetness, dryness and wind. Season causes many different kinds of symptoms. The notion that human beings are born with and predisposed to attacks from different kinds of illness, is coherently organized around the belief that it will come to the surface (lit., ‘stand up’) sooner or later. This is seen as inevitable. It is said that if the illness in a person’s body ‘fears’ a particular season, it will make its appearance. In the rainy season, shieguni, when the weather is cold, people (including adults) suffer from malaria. During the Harmattan, kikaa (following the rainy season), a hot and dry wind blows from the desert. This is the time for eye inflammations, nin bera, sore throats, lon shi, congested noses, fiegufiegu,, and chest pains, nyogni. Diarrhoeas, binsaa (sing.), are also very common at this time, which people attribute to changes in their diets. Finally, the ‘heat period’ (before the rains set in), wolgu saha, is said to ‘cook’ people’s bodies. If people have ‘pains in the forehead’, dirgu,, or experience other bodily disturbances, kpaga, these can come to the surface. While explanations mostly remain at the level of description, key notions regarding health and illness are the effect of external influences and the occult. Most of the time, however, mothers offer nothing but a description of the symptoms. When one insists to know the cause or circumstances that have led to them or their children being sick, they either answer saying that they ‘don’t know’, ka sheli, or describe particular kinds of illness as being ‘in the body’, ningbuna ni, where they move about until they emerge. Referring to ‘illness in the body’, they also often say that ‘every illness has its time when it will emerge’, and ‘when the life of the illness is about to end it stands up and afflicts you’. At other times answers to questions include references to accidents that have caused the present condition. Common to all answers given is a clear concern with

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‘health’, alaafee, and what leads to ill-health. People explain that some people are more ‘resistant’ to illness than others. This is perceived as a matter of a person’s blood and personal constitution, naam (lit., ‘creation’). The Dagomba view of health and illness expresses the inevitability of illness in people’s lives. With age a person’s blood becomes ‘weaker’ and his ability to withstand illness wanes. Therefore, it is considered quite normal that young children who have not yet attained sufficient strength, or ‘blood’, and old people who have lost their strength should fall sick. One notes the fact that when people talk about ‘common’ illnesses which require no further explanation that these are phrased in terms of observable causes and effects, such as bicycle accidents causing sores (see appendix 1). Reasoning concerning illness takes off from everyday situations and experiences, and posits a resemblance between these and the cause. People’s illness language describes an analogical relationship between the sensed world and that which it seeks to explain, an episode of illness. The explanation of the cause of illness rests on a metaphoric operation where aspects of the known world are analogically mapped onto what needs to be understood. When people talk about causes of illness, they invoke everyday situations and human behaviour (cf. Lewis 1975: 187).

3.3 Ideas about the Body, Heart, Stomach and Common Symptoms The terms for person are nira (pl., nirba) and nin/ninsal/sala (pl., ninsalnima). The person is distinguished from non-persons, such as the fairies, alizinima, and dwarves, kupagisi, who inhabit the bush. The person is born with a body, ningbuna. When sick, it is first of all the body that is affected. Thus, the inquiry from someone who is or has been sick is: A ningbuna bewula?, ‘How is your body?’ The idioms through which the Dagomba communicate their experiences and complaints are those of the human body, the head, the heart, the chest and the stomach (see Table 3.1 and Fig. A.3 in the appendix). In Good’s (1977) sense, Dagomba somatic symptoms constitute ‘syndromes’ or ‘meaning networks’; they refer to disturbances in the person’s social, natural and cosmic relationships. Illness can affect a person’s heart (resulting in palpitations), his head (headache) and stomach (causing stomach pain). The heart, suhu, is believed to be the most important organ of the person, suhu nye yEl kpian nin sala sani. Illness influences the normal state of the heart. The heart becomes ‘hot’ and is ‘moved’. Illness causes uncertainty and fear (dabiEm) which shows itself in palpitations of the heart: the heart ‘shakes’, ‘jumps’

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or ‘stands up’. Thus, the heart is the seat of human emotions, of anger, suhu yigisili, jealousy, suhu zabiri , happiness, suhu peli, sadness, suhu sagangu or suhu garibu, fear, dabiEm, and of the willingness to experiment with new things, suhu yobu. The heart is also the locus of likes and dislikes (e.g., ‘my heart doesn’t like porridge’) as well as human intention and thought, tEha: ‘my heart wants it’ (e.g., ‘my heart told me to come and visit you’). The heart is also the place from which dreams emanate (consult Chapter 7). The head, zugu, is also associated with numerous kinds of illness, such as aches, dizziness and sunken fontanelles in children. Headaches may be light or severe. The head is also considered the locus of ‘luck’ and ‘good rapport’, zugu sun, literally, ‘good head’ (cf. Fortes 1987b: 276).2 The head, brains, zugu puri , and the heart are said to be ‘one thing’, ‘to follow each other’. Reasonable things are associated with a person’s head and brains, but the heart is believed to govern these. The heart lies behind the reasonable, yam, and unreasonable things, yeltoga yoli (lit., ‘bad talk’) that human beings do. The heart being ‘clear’, ne, e,g., ‘clear’ like the sky, is a sign of reason. The heart tells you to do good and bad works. If you do something good, people say that ‘you have brains’. When your heart stands up [in anger], somebody will come and tell you to ‘look at your head and take your time’.

From the way people talk, as well as its contribution to illness in the population, the second most important organ is the stomach, puuni (lit., ‘inside’). The stomach is said to be like a ‘room’, duu, since ‘everything is in the stomach’. Thus, puuni is the general term for all kinds of stomach pain, including female and venereal diseases, hernias, diarrhoea and dysentery. When a person refers to his diarrhoea/dysentery, binsaa/pumahagu, he simply says ‘n puuni’, ‘my stomach’, or ‘n puuni nbEra’, ‘my stomach pains’. The stomach is an organ of key concern to women. It is connected with the female monthly cycle and reproduction. A menstruating woman says that she ‘has’ or ‘runs with a stomach’, n puuni or n nyeri la puuni, or that she is ‘going to the bathroom’, n chan la shinshagani. A pregnant woman refers to her pregnancy as ‘stomach’, pua. The other term commonly used to describe stomach pains is kpaga. The term is used to refer to a bodily disorder and believed to be the cause in fever, diarrhoea and stomach pains in general. Kpaga may also manifest itself in many different parts of the body as a swelling of the chest, face, neck or scrotum (scrotal hernia) (see again tab. 3).

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3.4 What is Illness? Symptoms and treatment choices involve a network of meanings. Illness is perceived through the dominant symbols of the body – the head, the heart, the stomach and in terms of the environment, living and dead kin, and seasons. (In appendix 1 are included quantitative data examining the questions of who gets sick and with what). Like the Azande, the Dagomba do not systematically organize their ideas concerning illness in a body of knowledge or a single theory pertaining to illness (Evans-Pritchard 1937: 82, 540). Their ideas are implied in utterances and behaviours rather than articulated in explicit ideas. The following characterization of Dagomba ideas concerning illness and health is based on my observation of behaviours and conversations with lay people, young and old, men and women. Boteng Na, an elder and friend, deserves particular mention. I had many stimulating discussions with him. I also held an interview with the wonzam, barber, from Savelugu town, who explained to me his work as a circumciser and incision-maker. The majority of people express little concern with their painful states. What is one to make of conditions that cause little concern and that – most of the time – are treated in the home, with local and Western medicines? To answer this question, let me first take a look at how the Dagomba regard illness in general. Medical anthropologists have distinguished mainly between two dimensions of sickness: disease and illness. 3 The diagnosis of disease is based on external medical criteria, ‘the malfunctioning of biological and/or psychological processes’, while illness is the personal and cultural reaction to ‘perceived disease’ (Kleinman 1980: 72; Lewis 1975). Illness is, by this definition, a personal and cultural construction. Generally speaking, illness can be characterized as an unfortunate event that strikes a person at a given point in time and interferes with his well-being. Illness is said to affect the person’s sleep, his breathing and appetite. Similar notions regarding health are found elsewhere in Africa. Janzen writes about Kongo medical ideas: ‘Eating well and defecating freely are signs of health; obstructed bowels indicate self-abuse or illwishing and poisoning at the hands of others. The physical body is a channel through which nurture should move freely’ (Janzen 1978: 170). People speak of pain in much the same way as we do. They do not feel compelled to distinguish between whether their ‘body’ or ‘they themselves’ are in a state of pain. They will either say that a part of their body (the head, chest or stomach) hurts, or that they (the whole of them) experience pain. People may feel pain in ‘all their body’, ningbuna zaa, and not be able to work or think. Women say that stomach pains can be

Basic Concepts of Health and Illness 47

very painful. They can be so severe that one feels ‘like dying’. At other times it is only a part of the body that hurts; the pain is localized, such as in a headache. The person goes on eating and working as usual. Illness is then considered to be light, or a ‘health illness’, alaafee doro. A young man explained that when he has a headache, he eats local plants or Western medicine (paracetamol). ‘If I eat the medicine and it cools it [the pain], to me it has finished. Congested airways, fiegufiegu, and pain in the forehead, dirgu, are also spoken of as ‘health illnesses’, alaafee dorti. They do not impair the ability to eat and conduct oneself as usual either. Thus, most of the time symptomatic treatment is deemed sufficient. Of course, an illness may develop so that what starts as a localized pain in the head may spread to other parts of the body. Light illness does not prevent people from going about their daily business. High fevers and severe cases of diarrhoea, headaches, and major infections of legs, however, restrict people’s movements. People become ‘forced’ to rest and stay home. When sick, people show a different behaviour and are not their usual selves. They either lie down or sit in a corner in the courtyard or alone under a tree and shun the company of other people. Of course, illness is also a personal definition. It may be light or severe by objective standards, but while some people feel that the illness forces them to rest, others continue to do their work. The ideas held about health – and restated in many contexts of daily life – can be paraphrased as resistance to illness. The idea of resistance is clearest expressed when the Dagomba say that every person has ‘his/her creation’, naam, meaning s/he is created differently, or that every person has ‘his/her illness and blood’. In these words people talk about the person’s individuality and the resemblance between the blood and illness (‘creation’ makes each person a unique human being). In theory, a person resistant to illness has blood that is ‘stronger’ than illness. His or her blood is ‘strong’ or ‘bitter’ and can suppress it. However, with age a person’s blood is said to become shorter and illnesses in the body ‘stand up’. In support of this notion people cite hernia, also called kpaga, as an illness afflicting (male) adults and not children. The general belief is that the illnesses that human beings experience abide in their bodies, where they incubate, so to speak, and from where they emerge to the surface and afflict their hosts from time to time. Referring to the seasons, people explain that some people fall ill during the Harmattan (the period between November and December – characterized by strong winds and cold weather in the morning and evening), others during the ‘heat period’ (February–March), and others during the rainy season (April–October).

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3.5 Diagnosing Symptoms The Dagomba use signs or symptoms to distinguish between different kinds of illness. In diagnosing illness, little attention is given to causes and the question ‘why’ is rarely asked. The procedure people adopt when they fall sick is to look back on previous or collective experiences and summarize the symptoms present and provide them with a name which is often identical to the symptom(s) experienced (Table 3.1 below). Frake’s study of ‘The Diagnosis of Disease among the Subanun of Mindanao’ in the Philippines is particularly relevant for the examination of Dagomba diagnostic procedures (Frake 1961). Frake finds that the Subanun are not much concerned with etiology, and in most cases diagnose disease according to its symptoms. Frake shows how the names given to diseases (i.e., the diagnostic names) are hierarchically ordered and are both inclusive and specific. A taxonomic hierarchy comprises different sets of contrasting categories at successive levels, the categories at any one level being included in a category at the next higher level. (ibid.: 117)

Frake gives the example of nuka, ‘skin disease’. On a high level of inclusiveness, nuka includes baga (ulcer), but, on a more specific level, nuka also contrasts with baga (ibid.: 120–21). With regard to the number of levels of contrast – the depth of the taxonomy – depth expresses the number of social situations into which the names of the taxonomy enter. Like the Subanun, the Dagomba group illnesses hierarchically. People arrive at their diagnoses on the basis of the presence of symptoms, which are diagnosed in relation to their bodily location (internal/external). Other features which are also given consideration are the association of illness with pain, biErem, and whether the illness affects adults, children, men or women. Finally, Dagomba illness terms are descriptive of process, location, sign and origin (cf. Van der Geest and Meulenbroek 1993 and Chapter 4, p. 16 ff. on the metaphorical operation involved in the naming of medicines). ‘Internally’ located symptoms (the stomach, chest, body) lend themselves to inclusive as well as specific naming. Symptoms may also develop and change. They may ‘move around in the body’ and emerge at different parts – a ‘pain in the forehead’ may move to the chest and result in coughing. ‘Stomach pains’, puuni, ‘bodily weakness’, ningbuna nbEra, ‘chest pains’, nyogni, ‘bodily disorder’, kpaga, are diagnostic names of broad meaning. On a more specific level, symptoms, like ‘stomach pains’, are individually named as particular physical sensations and contrast

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Table 3.1. A Selective List of Dagomba Illness Terms Illness Complaint in Vernacular

Illness Complaint

zugu yaari, ‘the head opens itself’

headache

ningbuna nbera, ‘my body pains’

bodily weakness

zugu, ‘head’

sunken fontanelles

puuni, ‘stomach’, ‘inside’

stomach ache

kpaga

bodily disorder

sanpana

swelling of jaws, throat, chest, etc.

morilim, ‘swelling’

pimple, toothache, earache, sore throat

nyogni, ‘chest’

chest pains

jogu, ‘bush illness’

People say that jogu has its origin in the bush. English speakers sometimes refer to jogu as ‘anthrax’, which it is not.

with each other: binsaa, watery diarrhoea, contrasts with pumahagu, diarrhoea with blood, and pua, pregnancy, is distinguished from sobu, menstruation. These symptoms are all inclusively labelled ‘stomach pains’. Other broad symptom groups are those of ‘bodily weakness’, ningbuna nbEra (inclusive of ‘fever’, ningbuna tula), and ‘chest problems’, nyogni (relating to problems with and kinds of breathing, vuhim, such as ‘coughing’, kohingu, and ‘heavy breathing’, nyogni yaalimi, [lit., ‘the chest opens itself’]). Kpaga figures prominently in many different contexts. It indicates a general disorder of the body. Symptoms relating to changes in one’s bodily state (e.g., a bitter mouth in connection with fever) are said to be kpaga. People also refer to a change of their bodily state as ningbuna nbera. Many illnesses are initially described as kpaga. A headache, zugu yaari, in connection with fever is often considered a symptom of kpaga. Thus, kpaga is the Dagbani name given to various bodily manifestations, such as, ‘swellings’, morilim (sing.), for example. A swelling may be big (e.g., hernia, also kpaga) or small, bingo, ‘pimple’. It may develop into a large blister with a malignant pustule or remain hidden. It may be accompanied by pain or be painless. Sores produce swellings and so do broken bones. Kpaga is said to abide in the body. It can manifest itself as ‘white kpaga’, kpaga peli, which is accompanied by different ‘plain’ (visible) and common symptoms: these range from feverish bodies to big swellings (such as

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those relating to hernias). White kpaga may be painful but is not always so. With regard to fevers and abdominal pains as well as hernias, the origin of kpaga is well known and said to be the ‘stomach’ where kpaga is believed to abide. ‘Black kpaga’, kpaga sabinli, on the other hand, implies a ‘hidden’ location. People say, that kpaga can ‘move from one location in the body to another’. It may never manifest itself openly but ‘hide itself’ behind other symptoms: such symptoms include the afore-mentioned symptoms as well as other common symptoms, such as pain in the neck, ribs and waist. By contrast, sanpana is a (mostly) visible swelling of the jaws, throat, chest and, occasionally, hand. It is the collective name given to a number of individually named symptoms. These include a sore throat, lon shi, and ear- and tooth ache, sanpana. Sanpana is considered to be caused by external factors of season and weather. Finally, and unrivalled in the anxiety it produces, is jogu, ‘bush illness’. It is recognized as a sudden, painful and fatal swelling (carbuncle) in animals and humans. It is considered the most dangerous of all swellings. It originates in the surrounding bush. By walking in the terrain, people may ‘absorb’ the illness in them (see Ngubane 1977 on Zulu notions of the relationship between the environment and illness, and note 1 of this chapter). It is said to be ‘like the wind blowing’, pohim chana. It enters the body without the person noticing it. While the fear of jogu is ever present, jogu itself is not very common. Plain, visible and common symptoms are said to be ‘white’, peli. They include common aches, biErem, feverish bodies, ningbuna tula, stomach pains, puuni, diarrhoea, binsaa/pumahagu, external hernias, kpaga, blisters and pimples, bingo, and sores, yuma, on the skin. When ‘white’ symptoms occur, people either point to the stomach where many symptoms are believed to abide, or say that it is kpaga (a general bodily disorder) or that it is because of the ‘blood’ or one’s ‘creation’. A ‘black’, sabinli, symptom, on the other hand, implies a hidden location and obscure cause. The diagnosis of ‘black’ leads to speculation and often to consultation of a diviner, and reintroduces the notions of the power of the occult.

3.6 Protection and the Occult Dagomba illness concepts also call upon ideas about the importance of medicines to protect one self and to ward off noxious influences. Perceiving and acknowledging approaching danger and protecting oneself against threats is part of discourses on the occult in Dagomba and many other sections of Africa (e.g., Geschiere 1997: 4). The Dagomba set a great value on health, alaafee. Health has to be maintained throughout life.

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People fall ill because they are not well protected with medicines. There is an underlying notion that people who are not at home are prone to illness, since they have left the protection that their homes provide. One is protected at home by the medicine of the house but this protection is absent when one travels. Witches are said to wait for people to leave their homes to travel and then to attack them. In illustration of this point, an elder in Tamale gave the example of a man from the town of Diari who lived and worked in Tamale, about twenty miles from home. When he went for a weekend visit to Diari he was attacked and killed by witches. Thus, weaker persons become the victims of the medicines of more powerful persons. Commonly occurring illnesses, such as fever, headache, diarrhoea, bodily swellings, may be configured in relation to the malice and envy of a person’s prosperity and wealth. Many ‘modern’ cases of witchcraft allude to the destructive association of witchcraft and money, where witchcraft substances are put on money to make that medium of exchange additionally ‘evil’. Paradoxically, commoditized medicines involving money are thought of as destructive of the moral order. Contexts of healing with Western medicines may make money im-moral. The healing business may not tolerate the ‘defiling’ mediation of money. Moving beyond this interpretation, which may be seen as lending support to male power structures and their control of healing (Chapter 5), is the general scepticism and uneasiness with regard to the delivery of biomedical health care where medicine, healing, monetary and impersonal relations are linked in an arrangement that is seen by men and women alike as being in opposition to the local culture and its premises (cf. Chapter 7). Thus, on the one hand, Western medicines are very popular. At the same time they may reveal themselves as very dangerous to the local culture. The impersonal approach, often linked to money and capitalism, can be felt as destructive to local designs, and is therefore often part of witchcraft accusations. In this sense, witchcraft is also modern, as Geshiere points out in his discourse (discussion) of witchcraft and the im-morality of power (Geschiere 1997). Globalization and the global market economy add another trope and interpretive structure in the interpretation of modernity in Ghana, in that modernity in Ghana takes on, as we argue in Chapters 7 and 8, the form of a ‘magical modernity’. In the articulation of money with the (im)morality of healing, the victims of witchcraft accusations are women, the ‘usual suspects’. That they should be accused reveals another paradox of the male-oriented social structure. Having to trust women, men also fear them. ‘Illness caused by man’, sambu, using witchcraft or other medicines, is, arguably, almost philosophically, referred to by an Islamic diviner as ‘the

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work of the world’, dunya tuma mbala. People’s language shows how they conceive of such attacks on their health. Analogies between cause and effect are drawn from domestic life, and other spheres of life involving human behaviours and different kinds of interaction. People who fear that they are being bewitched relate that they have had dreams about women ‘putting witchcraft medicine in my food’ or ‘they fed me’. It is interesting to note that harmful medicines are very often ingested with food which, while primarily symbolising nurture and comfort, may also signify the opposite. People distinguish between the witch, sonya, and her methods, which involve putting the medicine of witchcraft (sogo) in food, eating the victim, placing medicine at the entrance to a room and putting it on money, kola nuts, chewing sticks, etc. People chew, nubiri, kola nuts, yam, maize, etc. – the witch is also said to ‘chew’ her victim (victim’s soul). The witch bespells or ‘troubles’ her victim, she ‘gives’, ‘throws’ or ‘brings’ illness as do ‘bad’, biegu, trees, animals and spirits. God, Nawuni, can also cause illness. People with strong medicines as well as witches perceive of and ‘destroy’, sagim, their victim (cf. Chapter 8 on the interpretation that links the destructive influence of witchcraft and money, that ‘money spoils the medicine’, ni sagim tim maa). They can ‘send’ medicine to harm a person no matter the distance. Talk, especially ‘bad talk’, yeltoga yoli/biegu,, can also harm, and the witch can ‘kill’ a person’s wealth, arizichi (another very common reason for many witchcraft accusations). The following chapter is a detailed discussion of Dagomba, Western biomedicine and Islamic medicines. They (Western and non-Western medicines) are, as I will argue, an influential medium transporting us from a representation of an, arguably, static male world with its visions of spiritual medicines, female witchcraft and notions of health and illness, to the processes that men and women through their agency and use of Western medicines engender and set in motion. Female agency, for example, transforms witchcraft to being about female agents who skilfully exploit commoditized healing substances, and thus challenge male authority and men’s presumed control of medicines and healing. Women and their medicinal use bring us one step further in the direction of the market and transactions involving money so ominously perceived of by the elders.

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Notes 1. Ngubane writes of Zulu beliefs concerning the environment: ‘Umkhondo refers to a visible track on the ground left by lightning for example, or by an animal moving over the ground, or “sorcery medicine” placed in a public place with the intention to harm a particular person. It can be “invisible”, “floating in the air” and can be inhaled. It is then rather named imimoya. The implication here is that the undesirable elements in the atmosphere are picked up through inhalation or through contact either by touching or “stepping over”, ukweqa’ (Ngubane 1977: 25). 2. Why ‘luck’ and ‘good rapport’ should be associated with the head cannot be easily determined. However, while the heart is considered the seat of emotions, the head appears to be a metaphor for the life conditions of the individual. 3. Frankenberg and Lesson (1976) and Young (1982) have emphasized a third aspect, ‘sickness’. With ‘sickness’ they draw attention to the socially accepted local categories of sickness and the distinction between the individual’s subjective feeling of illness; the collective recognition and representation of his or her ‘sickness’ in the community in which he or she lives; and the identification of the ‘disease’ by external medical criteria. Our contribution is to insert the disease-illness-sickness distinction in a discussion of social change/modernity and ‘the problem of money’.

Chapter 4

MEDICINES, MODERNITY AND COMMODITIZATION

In the previous chapter I mentioned two broad categories of medicine: female witchcraft medicine and the medicines that men use to protect themselves and their families and to kill their enemies. This chapter expands on the previous discussion and focuses on the various kinds of medicine used in curing, prevention and killing. We have seen that women are assumed to use witchcraft medicines against their enemies. On the other hand (and with the blessing of their husbands), mothers use curative medicines (plants and Western pharmaceuticals) to treat the illnesses that occur in their children. I thus begin this chapter by describing what medicines are. I note the contrast between the biomedical definition of medicine as a substance to treat and prevent disease and the Dagomba notion of medicine. The Dagomba category of medicine refers to a broad spectrum of substances and powers that can be either curative, defensive or offensive. A characterization of perceptions and contrasts between plants, Islamic medicines and Western pharmaceuticals is also made, and consideration is given to aspects of utilization and naming of medicines. The question of ‘experimentation’ with and the ‘efficacy’ of plants and pharmaceuticals (as seen by their users) will be discussed in the next chapter.

4.1 What is Medicine? What is medicine? According to The Oxford English Dictionary (1989 edition), the word ‘medicine’ denotes the ‘department of knowledge and practice which is concerned with the cure, alleviation and prevention of disease in human beings, and with the restoration and preservation of health’. Central to the practice of medicine is the use and application of medicinal substances. Biomedicine conceives of medicinal substances as

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substances used to treat a defined entity, a ‘disease’. The power of medicines is assumed to be inherent. (At the same time it is interesting to note that in biomedicine medicines are often employed in a ‘magical’ way, so to speak primarily for the results they produce since knowledge about how they really work may be lacking; see Chapter 5.) The term ‘medicine’, however, has a broader meaning, the Dictionary continues, when used ‘to represent the terms applied in their native languages by North American Indians to denote any object or ceremony supposed by them to possess a magical influence; a spell, charm, fetish’. Tracing the broad implication of the term, in the anthropological literature relating to northern Ghana, we find many references to the category ‘medicine’. Goody, for example, notes that for the LoWiili tii, medicine, can be many things. It denotes any material that confers special powers upon its possessor. It covers the substances employed in magic both good and bad, both black and white. It refers also to materials European science would regard as having an empirical effect – DDT, aspirin, and the like. (Goody, J.R. 1962: 76)

Fortes notes that the teem, medicines, of the Tallensi are substances or objects that work either to treat illness or for ‘magical’ purposes (Goody, J.R. 1987: 22). Drucker-Brown also finds that The Mamprusi category ‘medicine’ (tiim) incorporates substances which are prophylactic or curative as well as poisonous, and substances which operate both mechanically and metaphysically. (Drucker-Brown 1993: 4)

Finally, Oppong notes that every Dagomba chief possesses ‘medicines’, tima (sing., tim), to protect his status, and that a newly elected king ‘is seated upon the sacred stool of kingship and washed with medicines which imbue him with his power’ (Oppong 1973: 23). She also mentions that after birth the mother and her baby ‘are given medicines to drink to protect and strengthen them’ (ibid.: 35). In spite of our Western bias to speak of medicine in very limited terms, we do in fact subscribe to the inclusive idea that fresh air, sport and exercise are medicines (and do we not say that a healthy mind belongs in a healthy body?). So far, however, there has not been an anthropological study explicitly discussing the category of medicine as it relates to notions and practices of health and illness. We hope that the present work will also contribute to redressing this imbalance. ‘Medicines’, tima, curative and non-curative preparations, occupy a dominant place in people’s lives in Dagomba. Apart from men’s occasional comments that ‘our medicines are more powerful than yours’

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(thus addressing the Western anthropologist and referring to Western medicines), people are reluctant to discuss the topic of medicines. Medicines are very personal and associated with a person’s identity. They imply strong images of personal power, the ability to protect oneself and others, to cure and to harm and kill one’s enemies if necessary. Medicines have a positive and negative side. The subject of medicines, people think, should best be avoided. The topic of medicines borders on the anti-social, since they, when used to injure and kill people, upset the peace that should ideally exist between human beings. Not to mention the transformations brought about by the use of Western commoditized medicines, which lift the discourse about medicines on to a level where one needs to examine these enduring perceptions of medicines and specific changes that relate to the (im)morality of money as well as to the issue of modernity – which introduces the question of ‘tradition’ and ‘modernity’ in the discussion of The Problem of Money. My proposition here is simple: it is not that ‘medicine’ is exclusively concerned with either the empirical or the ‘supernatural’ but often with both at the same time. Turner’s excellent essay on Lunda Medicine (Turner 1964a), which I read before undertaking my doctoral field work, makes exactly this point. Turner clearly shows that medicines must be seen in broad terms. Medicines may be both healing as well as offensive substances, and these relate to people’s understandings of health and illness. If I would focus narrowly on medicines simply as curative substances, I would not be able to grasp the connotations the word ‘medicine’ has to the Dagomba. As we shall stress throughout (cf. Chapter 8), it is the use to which medicines are put or the ‘contexts’ within which they operate that define them as either acceptable or immoral (see also Alland 1970: 137). People often pick upon an association (propagated by the male elders in society) of witchcraft, women and money in a condemnation (through witchcraft accusations) of women. They are believed by their healing activities to defy men and corrupt communal solidarity and social harmony in spite of the fact that they with their actions (often involving money and commoditized medicines) contribute to the health and survival of the lineage. We shall discuss this paradox and other paradoxes and fictitious and deceptive dualisms of ‘magic’ and ‘modernity’, of ‘local’ and ‘global’ scenes and related changes throughout.

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4.2 Tim What we term ‘medicine’ has a single linguistic equivalent in the Dagbani word tim (plur., tima), which is derived from the word for ‘tree’, tia. As a category of thought and action, tim plays a great role in the lives of people in Dagomba. Medicines, tima, can be many things. Medicines are used to treat somatic symptoms; everybody uses them to treat themselves; the midwife uses medicines in her practice and so does the bonesetter. The preparation of medicines is accompanied by prayers and sacrifices to the ancestors from whom they have been inherited (see Chapter 2, p.25). They are applied either topically to the skin, ingested or used to bath the body with. Thus, one aspect of medicine is seen as ‘good’, viela, and deals with curing: the empirical qualities of medicines are directed at treating particular symptoms. However, medicines can also be used for other purposes, to achieve specific goals, to ‘protect’, nguli, the home or a person, or to ‘kill’, nku, an enemy (words spoken, not merely medicines, can harm as well). Such medicines are ingested, worn, placed or buried in the courtyard and outside the house. This is the protective/aggressive aspect of Dagomba medicines. To cure and to harm are two sides of the same coin. Dagbani plant medicines are configured in relation to prayers and sacrifices, which exclude women as agents since they are construed as jural minors and subordinate to men (only men own plant medicines). In this configuration, medicines are not potent in themselves but only rendered effective through prayers and sacrifices to the ancestors. Their power is derived from external sources, the ancestors, and given direction by men’s and women’s (‘good’ or ‘bad’) intentions. The Dagomba say that the efficacy of local plants whether they will work or not – depends upon ‘luck’ or ‘rapport’ (zugu sun , lit., ‘good head’; see also Chapter 3, endnote 2) with the medicine owner cum ancestors. People say, that ‘when there is luck (or rapport) between the curer and the patient, the medicine is powerful (yaa)’. When there is no luck/rapport between the curer and his patient, the curer advises the patient to try his luck with ‘somebody else’.1 Dagomba medicine, as noted earlier, is a broad category. It connotes a wide field of human activities and experiences. Tim (medicine) includes references to the relationship of humans with ancestors, with the bush and their social surroundings (see Fig. 3.1). Medicine has two poles: one is concerned with treating illness and maintaining and protecting health, the other relates to causing harm and inflicting suffering. What can be used curatively or for protection can also be used for opposite, aggressive purposes, to produce illness. As Field notes, medicines are ‘reversible and can be used for either good or ill’ (Field 1937: 112). The medicine used to

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protect a person’s room can also be used to confuse and weaken a rival. Thus, good and bad, curing/defending and harming, are both aspects of tim (some medicines, such as ‘lightning medicine’, sa-tahangu, can treat and cause illness at the same time). Tim implies defence, healing and aggression (killing). Tim has a double reality, both referring to the empirical and to the metaphysical. Those two dimensions are inter-linked and constitute the power of medicine. When the healing aspect of medicine is under discussion, such as in medicinal treatment of common symptoms, that aspect of tim which is empirical, refers to what biomedicine defines, albeit too narrowly, by the term ‘medicine’. Thus the Dagomba do not make a distinction between empirical substance and ritual. Medicines always have both an empirical and a ritual foundation; empirical action does not preclude ritual. Every medicine has a ritual premise in that the permission of the ancestors (through prayers and sacrifice) is needed for the medicine to work. Thus what the Dagomba consider naturally occurring diseases, literally ‘from God’, are treated with medicines that have both natural (empirical) and ‘supernatural’ support. A botanical preparation used in healing always already refers beyond the empirical symptoms they are intended to treat. Medicine, whether for curing or killing, is always prepared with prayers and sacrifices.

4.3 Images of Medicines Medicines call forth associations of different kinds. Men use medicines (botanical substances and charms) to protect themselves and their families and to combat their rivals in the fight for political status. Men are considered (and consider themselves) the legitimate owners and producers of medicines, tima-lanima (lit., ‘medicine-owners’). Women, on the other hand, are thought of as witches but they are also associated with caring and treating the sicknesses of their children. They use the curative plants that men produce to treat themselves and their children and also buy Western medicines from drug peddlers and in the market. Western medicines (i.e., pharmaceuticals) are very popular with most people, not only with mothers. They are thought to be effective in the treatment of many aches and pains. They are considered to have a power to heal. People favour injections, chirga (sing.) over and above other forms of Western medicines. They say that injections produce immediate ‘changes’ and ‘speedy recovery’. The most popular Western pharmaceuticals are paracetamol (and other pain-relievers) and topaya, the colourful antibiotic capsule. Since Western medicines are divorced

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from social relationships, they appear to be potent in themselves. The power of local botanical preparations, on the other hand, is not considered intrinsic but recognized to be conferred from the ‘outside’, by the curer and the original owner ‘behind’ him. The belief that somatic symptoms can be treated with medicines is the determining factor in people’s choice of plant-based and Western medicinal therapy. We must, however, bear in mind that in any symptomatic treatment with plants, additional images are involved, such as those that attribute efficacy to ‘luck’, ‘good rapport’, zugusun, and the goodwill of the ancestors – without whose consent cure will not occur . Being ‘curative’ is just one dimension of botanical medicine, and here the similarity between local Dagbani and Western medicines ceases. The Dagomba notion of medicine does not permit us to treat it like Western pharmaceuticals, which are primarily characterized by their being commodities (Van der Geest and Whyte 1989). The widespread use of commoditized medicines involving money is perceived by the elders as immoral and destructive of the moral order. There is much more to say about this paradoxical view, which seems to deny the obvious fact of the great popularity of Western medicines and obscure the male fear of losing control over women by refusing that they gain access to medicines. Their point of view also seems to contain a portion of scepticism in spite of the general fascination with the power of biomedicine and its medicines (see Chapters 6 and 7).

4.4 Classification of Medicines I now discuss Dagomba conceptions and classifications of medicine, tim, according to whether it is used curatively, for prophylactic or for offensive purposes. Medicine can also be food and it can be poisonous. Medicine, tim, and ‘food’, bindirigu, are similar substances. They both imply ingestion of substances. The affinity between food and medicine is obvious when we consider that one and the same plant may be ingested in a ‘dietary context’ as food, and in a ‘therapeutic context’ as medicine (Etkin and Ross 1982). Food and medicine contrast with ‘poison’, dihili, which literally means ‘forceful/involuntary feeding’ and substances (e.g., witchcraft medicines) that are not conducive to health or the functioning of normal social relationships. The Dagomba would agree that both food and medicines are substances that humans ingest. However, anything counter-productive of a person’s well-being or the harmonious living of people, should not be touched. Goody, E.N. notes the contrast between ‘cooked food’ as a ‘symbol of solidarity’ and witchcraft medicines which ‘isolate and exclude’ (1973: 128–30). Finally, many medicines are, in fact,

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‘poisonous’ and poison is, therefore, also a form of medicine. A common characteristic of food and all kinds of medicine is that they are all taken into the body. To provide a frame for the following classification, the Dagomba category of medicine refers, as stated, to curative, preventive and offensive plants (roots, branches, barks) – known collectively as ‘Dagbani medicines’, Dagban tima – as well as to protective verses from the Qur’an, known as ‘Islamic medicine’, Musulim tim or Afa tim.3 The category tim also covers non-local botanical preparations from southern Ghana and Hausaland in bottles, plastic packages and tubes. Finally, it includes medicines coming from further abroad, such as Western pharmaceuticals or silimin tim, literally ‘English medicine’. People acquire curative, defensive and offensive powers either by eating, drinking or bathing in medicines, wearing them as a talisman, sabili, or a protective waistband, gurum.

Figure 4.1. Medicines and Their Levels of Contrast

On the one hand, food contrasts with poison as something that may be ingested while poison should not. On the other hand, the category ‘medicine’ is broad and covers both curative, defensive and offensive medicines (which are often poisonous). Moving downwards from the most inclusive level of tim, medicines with curative power, ti tibiri li, literally ‘medicines that cure’, contrast with protective, ti guli, ‘medicines that watch’, and offensive medicines, ti biegu, ‘bad medicines’; the latter medicines include charms and metaphysical powers. Islamic medicines,

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musulim tima (also known as afa tim, the ‘malam’s medicine’), are considered very powerful. The Qur’an is the source of the power of Islamic medicines, which consist of verses from the Qur’an written in ink on pieces of paper which are encased in leather and worn as charms and talismans. Islamic medicine is also often referred to as woligu, literally ‘slate’. The reference is here to the slate on which verses from the Qur’an are written in ink; the ink is dissolved in water and the solution used to drink and bath the body. To make the medicine powerful, the malam orders his clients to perform a ‘charity’, while local plants receive their power from a sacrifice to its original owner. The appeal of Islamic medicine is clearly also linked to the fact that it is ‘written medicine’. Writing, in particular its ‘magical’ power, carries great authority in Dagomba society (cf. Goody, J.R. 1987: 125–38; consult also Chapters 6 and 8 on ‘the magic of modernity’). Islamic medicines are primarily employed for personal protection and prosperity and to prevent an unfortunate event from occurring. The Yawu Dudu-verse, for example, is used by people to ‘call’ lotto numbers (see Chapter 6 on lotto-playing). The Ilafe-verse protects people ‘when they are in the company of important or rich people’. One baths in the solution, and then ‘one will not feel shy in the company of important people. One can sit with rich people’. The Fatama-verse is to make you able to ‘see’ a person who is coming to give you poisoned food. Finally, spices, oil and kola nuts are both used in food and as ingredients in medicines. They have healing powers but they are not talked of as ‘medicines’. They are, however, very prominent in the treatment of many minor illnesses in the home. Medicines distinguished on one level as ‘curative’, ‘protective’, ‘offensive’ substances contrast with one another at the next lower level. Thus, curative plants, tihi, ‘trees’, contrast with Western medicines, silimin tima. Moreover, plants are distinguished according to the two colours: ‘red’, zegu, and ‘black’, sabilga. ‘Red’ and ‘black’ relate to modes of production of medicines. 4 When the tree (or trees) has been located in the bush, branches are cut, the bark is peeled or roots dug. Next, the plants are either burnt to charcoal (hence their name ‘black medicine’) or left unburnt (unburnt medicine is known as ‘red medicine’). Botanical substances may also be ground, pounded and gathered as ‘balls’, ti-kpula (lit, ‘medicine balls’), or simply soaked in water.

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Figure 4.2. Kpanalana Holding Basket Containing the Common Kpaga Medicine Balls Plants are stored in different ways. Black medicine-powder can be stored for months, even years, as can dried roots and medicine-balls. Curative botanical preparations are also distinguished according to whether they are intended to treat a child, bia, or an adult, nin kura, a woman, paga, or a man, doo. Western medicines are distinguished as injections, chirga, capsules, topaya, and tablets, ti kpula. Corresponding to their foreign origin, Western medicines are described differently from plants. As we shall see below, naming of pharmaceuticals involves reference to their shape (capsule, tablet, injection), colour, ‘nature’, bihegu, and the way they ‘work’ (injections are believed to travel fast). Tablets and capsules are sometimes ingested, with water or food. At other times, they are applied topically to wounds and cuts. If available, Western medicines are the preferred treatment choice for sores, fevers, aches and stomach pains. It is common practice to treat sores topically with the powder of broken tetracycline capsules, topaya. Local sore medicines are also administered by external application. Internal conditions, such as stomach pains, on the other hand, are treated by ingesting the medicine. The capsule (tetracycline) is often first opened and the contents poured into water before drinking.

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4.5 Naming Medicines Referring to ‘magic’ and the discourse of medicines, Turner notes that Lunda medicines (plants) share an aspect of the condition to be treated. He establishes that medicines often stand in a ‘homoeopathic’, ‘sympathetic’ or ‘contagious’ relationship to the symptoms of disease (Turner 1964a: 12, 54–62). ‘Homeopathy’ and ‘sympathy’ express metaphorical qualities – a similarity or relationship to the disease. ‘Contagion’ refers to past contact with and origin of the disease. Confirming Turner’s point, we note that many Dagomba names for curative plants are metaphorical – they express a relationship to and a similarity with the symptoms, the cause and the cure. Other medicine names are descriptive – they simply describe the symptoms to be treated. Certain names are contagious and refer to the origin of an illness while other medicine names portray the hope for particular results (Table 4.1). Table 4.1. Naming Botanical Preparations (Plants) 1. Metaphorical and Descriptive Names Puuni tim, ‘stomach medicine’: to treat stomach pains, puuni, (‘stomach’). Kpaga tim, ‘medicine for physical disorder’: to treat kpaga, ‘physical disorder’. Nyogni tim, ‘chest medicine’: to treat chest pains., nyogni, (‘chest’). Satahangu tim, ‘lightning medicine’: to treat shock caused by lightning, satahangu. Satahangu-medicine may also be used to ward off an attack on one’s house by a rival. 2. Contagious Medicine Names Jogu tim, ‘bush medicine’: to treat jogu, ‘bush illness’, which is said to originate in the bush. 3. To Produce Results Dabara puu, ‘pregnancy medicine’: to produce pregnancy.

Many names for Western pharmaceuticals are also primarily descriptive of colour, shape and the ‘nature’, bihegu, of the medicine; but some also take their names from symptoms to be treated and may thus be said to be metaphors of these. Finally, names for pharmaceuticals (and indigenous offensive medicines) may be both descriptive and also characterize hopedfor results. Islamic medicines (i.e., Qur’anic verses), which are not used in

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curing, are named after relevant passages in the Qur’an. (I do not have sufficient data to discuss these passages but see p. 14 and Chapter 6 on ‘lotto verses’). Table 4.2. Naming Pharmaceuticals and Offensive Medicines 1. Descriptive and Metaphorical Names Topaya ze, ‘red capsule’, i.e., tetracycline: to treat stomach pains, puuni, and external sores. Mirigili, ‘that can be squeezed’, i.e., tetracycline ointment in tube: to treat eye infection, nin bera, lit., ‘eye pain’. Kobani tim, ‘bone medicine’, i.e., indocid: to treat ‘pains in bones’ after farming, nkobani nbEra, ‘my bones pain’. 2. To Produce Results Daridari, ‘shaking’, i.e., ephedrine: ‘shakes you and you do not feel pain’, biErem. Tahangu, ‘shouting’: to make a noise and confuse a rival who falls or an animal who stands still while a hunter approaches.

4.6 Plants, Western Pharmaceuticals and Islamic Medicines This and the following paragraphs describe and compare the preparation and use of (curative) plants, Western pharmaceuticals and Islamic medicines in greater depth.

Plants In his study of Lunda Medicine, Turner (1964a) primarily focuses on the cultural efficacy of medicines used to treat diseases. Much research over the past two decades has, however, adopted the opposite approach and sought to establish the empirical efficacy of plants their chemical properties (see e.g., Journal Revue de Medecines et Pharmacopees Africaines; regarding Ghana see Ayitey-Smith 1986). Dagomba medicines challenge this distinction by having both an empirical and occult side. They thus also legitimize men’s ideological control of healing (praying to the ancestors). The Dagomba pharmacopoeia includes hundreds of trees and shrubs that are used to treat various symptoms. While people’s naming of trees and shrubs is consistent, their local availability and the private aspect of

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knowledge about cures mean that cures do not have a standard formula upon which they are based (Chapter 5, p. 11). It would not be a simple task to list the ingredients used in the various cures. Limitations of space also preclude such an attempt. A. Preparation and Application of Plants The production of medicines involves a sacrifice or the pouring of libations accompanied by prayers. ‘Our medicines have words’, people stress. Plants are either heated or inhaled, applied topically, drunk or used to bath the body. They can also be ingested with food or introduced by incisions. Oil, spices and the paste of kola are infused as enemas and applied topically, dripped into the ear or eye or applied as a paste to sunken fontanelles and cuts.

Figure 4.3. Mother with Child Whose Sunken Fontanelles Have Been Treated with the Paste of the Kola Nut

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Non-local botanical preparations are also used: papaya and guava leaves are soaked in water and used to bath a feverish body; the seeds of the dried zimbuli-fruit are used to stop the bleeding of the navel when the umbilical cord has been cut. Like spices, oil and kola nuts, these non-local preparations are for sale in the market and from hawkers. One example will suffice to illustrate the empirical nature of Dagbani therapeutics. Boteng Na, an elder renowned for his medicine that treats toothaches, ninvohu tim, ‘toothache medicine’, went early one morning to treat the Earth Priest, who lives in a village ten miles from Duko. The Earth Priest had a toothache for some time. He complained that he could not chew anything, including kola. Neither could he eat cold or hot food. ‘My gums hurt and immediately start to bleed’, he complained. Boteng Na explained that his pain was being caused by thorns, sanguro, in his teeth. He heated the leaves of the sanguro-tree, the fruit of the Dawadawa tree (Parkia Clappertoniana) and termite faeces, yob-bindi, in a small pot. He then poured the solution into a calabash, and asked the patient to inhale the steam. He explained that the steam and heat would ‘call them [the thorns] out’ and the ‘trouble’ would drop into the calabash. With a blanket over his head, the patient began inhaling the steam, from time to time spitting into the calabash. The contents in the calabash were poured onto the floor in the courtyard. The contents included some white fibres which were diagnosed as having caused the toothache. As after-care Boteng Na told his patient to rub his swollen gums with the paste of the sanguro-leaves, which had been ground.

B. Where are Plants Prepared and Stored? Plants, oil, spices, and so on, are used to treat somatic symptoms, including stomach pains, inflamed eyes and ears, sunken fontanelles, fevers, chest pains and sores. Some medicines are prepared inside, others outside the house. Corresponding to the division of male and female spheres of activity, powerful medicines, such as ‘lightning medicine’, satahangu tim, and other protective and offensive medicines (such as those that will make you ‘invisible’ in times of danger and ‘able to fight your enemy’) are prepared by men in the night, outside the house (the male world), along main footpaths, in the bush, or by rivers. These medicines must neither be prepared nor stored in the house. They are known to be able to liberate themselves and turn upon innocent victims. Therefore, they must be kept away from people. The same also applies to powerful curative medicines. For example, jogu-medicine to treat jogu, ‘bush illness’ (Table 3.1), is not kept inside the room, but rather at the entrance under the roof. Dangerous diseases such as jogu must be prevented from entering

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the rooms where people sleep. Medicines to cure common medical problems, on the other hand, are prepared and stored in the house (the female world). The distinction between two spheres of activity, one – the home – where women cure simple medical problems, the other – the world outside the home – centring on men and their involvement with non-curative medicines, follows from Dagomba notions of men’s and women’s differential use of medicines (see Chapter 2). This is also the underlying structure of the ideological or social production of reality, a major theme throughout this work and also a main focus in Chapter 7, which discusses ‘A Woman’s Lot: The Practical Realities of Care’. C. Mode of Application The mode of administration of plants is related to the symptoms to be treated (their location and seriousness). It is characteristic that ‘external’ conditions, such as sores, rashes of the skin and inflammation of eyes, and conditions that can only be treated externally, such as swollen gums, are treated with an application of local medicine topically. For example, as one informant explained, a ‘swollen gum’, nyin zuya mori, is treated by rubbing the cheek (area above the internal swelling) with sanpana(‘swelling’) medicine. He had never heard of sanpana-medicine that could be applied internally. However, stomach pains, fevers (lit., ‘hot bodies’), headaches, earaches, toothaches and pains in the throat and chest are treated both internally and externally. Medicines are either ingested, infused (as an enema), heated (in order to steam sores in the anus believed to cause diarrhoea and piles), incised, or applied externally by rubbing a feverish and aching body, an aching head or chest.

A Note on ‘First Aid Medicines’ Most homes carry ‘first aid medicines’ – medicines to treat common symptoms, such as kpaga (general term for bodily disorder) and dogu: convulsions in children in connection with high fever. These medicines are kept by the head of the household in his room but often mothers also keep small portions of these. When a common illness occurs and the home does not stock the medicine needed, it improvises. An enema is often given to begin with to ‘buy time’ while the parent rushes around to friends and neighbours to find the medicine known to treat the problem. Thus, people’s approach to healing is experimental (see Chapter 5, pp. 98–9).

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Islamic Medicines The production of botanical preparations involves a sacrifice which is absent from Islamic medicine. On the other hand, Islamic healing and its medicines are bound up with notions of ‘charity’. The malams ask their clients to show kindness by giving money, kola or milk to the old, poor, blind and children. This will permit the medicine to work. Islamic medicines also involve ‘money’; they have to be paid for (cf. DruckerBrown 1975: 96–97; see Rodinson 1974 on Islam and Capitalism). Islamic medicines are sold in markets, shops, by village peddlers and hawkers as packaged, bottled and related manufactured items. They are readily available to anybody, man or woman, for money. They do not demand that the consumer enter into a personal relationship with a curer to obtain them. As with Western medicines, Islamic medicines are easily separated from their producers. A small industry marketing Islamic medicines has sprung up. Islamic medicines, in particular the bottled ones, are being sold and transacted by drug peddlers or ‘medicine sellers’, ti-kohanima, everywhere, in markets, villages and towns. In its commercial aspect, Islamic medicine is similar to Western medicine. Men say that there are certain kinds of illness that only local plants and Islamic medicines can treat. The general reference is to illness caused by witchcraft. Mention is also made of a stage of jogu (‘bush illness’) where a boil has developed on the skin and where local treatment is preferred (see ‘case’ in Chapter 5, pp. 106–7). People also prefer local botanical preparations for broken bones, jaundice, epilepsy and blindness. While the Muslim clergy is opposed to ancestor worship, the majority of lay people speak with pride of Dagomba custom, dagbanli. People have arrived at a proposition according to which Islamic medicines as well as Dagbani plants have Qur’anic power (and are thus opposed to Western medicines). They say that all Islamic medicines and Dagbani plants are ‘from/in the Qur’an’, in other words they are mentioned in the Qur’an, or have their origin in the Qur’an and they have thus been given the power to treat illness. The Qur’an is considered to be the source of knowledge about everything,: the languages people speak, the medicines they use. People suggest that Islamic medicines and Dagbani plants can treat illnesses ‘once and for all’, while Western medicines can only treat symptoms. With the exception of surgery, Western medicines only ‘cool’, maari, the symptoms, but do not ‘remove their roots’, doro nyagu. This assertion can, of course, be compared with actual treatment results that contradict this statement. How often have I not heard people say about symptoms treated with plants that they ‘stopped’ for a while, but later ‘came back’. Actual cases do not support the claim and many of the above

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statements are made by men and reflect the ideological stance of male power. The contrast between plants/Islamic medicines and Western medicines exists ‘only’ at the level of ideology. That ideology is very powerful, however, is seen at various points when we explore the complexities of modernity (in Chapters 6–8). In the hierarchy of things, people stress similarities but nevertheless point out that Islamic preparations are more powerful than plants, since they are written, sabirimi, and drunk. One man explained, When an afa [malam] writes for you and you drink it, it is [and remains] in your body. No one can know it [and challenge you]. However, when a Dagomba man makes his medicine, somebody with more powerful medicine can easily know it and spoil it, ban li nsagim li. That is the reason why we prefer Islamic to Dagbani medicine.

Western Pharmaceuticals Western medicines are understood to be potent in themselves. They neither demand a sacrifice, nor a charity, which both imply a wide range of beliefs and experiences concerning the need to maintain and guarantee a balanced relationship with the living and the dead, the importance of popularity and success in one’s earthly life, as well as the power of elders and men over juniors and women. People are not in doubt about Western medicines and their superior power to heal, however. They are familiar with a great variety of pharmaceuticals. Not knowing their intended uses, modes of application and recommended dosages, people reinterpret and re-name them in terms of the pains they experience and the hoped-for results, such as ‘to become fat’, ‘to work hard’, ‘to sleep well’. People agree that ‘red and yellow topaya’ (tetracycline) is efficient in the treatment of stomach pains, puuni, including diarrhoea and dysentery, and for treating sores, yuma. Paracetamol is considered suitable for the treatment of headaches and fevers. When buying pharmaceuticals from the drug peddler or chemist, people point to the part of the body that aches or ask for medicine for the head, chest, stomach. People purchase medicines to treat particular pains. Some people also give a description of some sort about what troubles them: ‘my waist hurts. I am farming’, or ‘I am not making body [putting on weight]. I want some medicine that can make body’. Others produce a brand name or a Dagbani name for the medicine they want. Finally, others describe the medicines they want in terms of its characteristics, behigu (‘nature’), such as colour, size, packing (with picture) and behaviour, such as the medicine that can be ‘squeezed’ [ointment], that ‘washes the sore’

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[iodine], that ‘cuts vomiting’ [tetracycline] (see Nichter 1981; Bledsoe and Goubaud 1988).

4.7 Treatment Choices: Magical and Non-Magical Medicines According to Weber, the world of modernity has been deserted by the gods and is void of magic and broader meanings (on the ‘disenchantment of modern life’, for example, see Weber 1965). Man has rationalized and made calculable and predictable what earlier or in other places, we may add, appears governed by ‘magic (what Weber associated with chance, passion, and commitment, personal appeal and personal fealty, grace and the ethics of charismatic heroes). Weber’s studies of rationalization are hugely important (and serve as a powerful commentary on ‘modernity’, which I discuss in section 4.8). In choosing ‘Magical and non-magical medicines’ as the heading for this section, I want to approach the issue of modernity from a different angle, however. Enchantment is but a different way of referring to magic versus the intrinsic efficacy of materials. To ‘en-chant’ is etymologically to ‘bespell’ (Online Etymology Dictionary, Nov. 2001). If we follow this lead we re-enter the world of prayer and sacrifice, which is centrally important in understanding the ‘medicinal context’ – what medicines are about for the Dagomba. Without the support of the ancestors, who are called upon in the prayers, Dagbani plant medicine remains impotent. By invoking and requesting the cooperation (‘support’) of the ancestors, medicines (plants, roots) are made effective. The words of the prayer are intended to imbue the inert material with power. The visible and invisible features of medicines, their metaphysical and visible, empirical and monetary powers produce medicines as having a magical side to them or being enchanted. To begin with: local curative botanical preparations are founded upon the principle of sacrifice. Sacrifice is opposed to the commodity aspect of Western medicines, Islamic medicines and other goods available for money. The contrast is thus one between saleable and non-saleable medicines, between magical and non-magical medicines. ‘Of course, we don’t make our medicines public’, Dagban tim, nuna ti bi mooni tim mana, men say. Their use is restricted and so is their circulation. They are not found outside Dagomba. They can only be obtained by entering into a more or less formal relationship with another person by ‘asking’ for medicine, suhibu. Men control local medicines. In theory, women have to ask men to provide them with medicines (but see Chapter 7). Suhibu, or asking for medicine, is accompanied by greetings and is generally very informal (see Chapter

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7, section 7.2 on the ‘Quest for Medicine’). Friends and neighbours simply ask each other for a little bit of ‘stomach medicine’ or another medicine needed. In addition to greetings, a gift of kola is sometimes also made, but money never enters into the relationship between the sick and the curer. By contrast, Western medicines involve money and participate in the market of commodities. Thus, they do not involve one person in a social relationship to another person. Western medicines come in packages and bottles, as capsules, tablets and injections. They are transactable and easily administered. One simply has to swallow them. No fowls have to be sacrificed, no words spoken. ‘One can take the money one was going to buy a fowl with and buy Western medicine instead’, people say. It is for these reasons, elders complain, that ‘our young men and women prefer Western to Dagbani medicine’.5 The impersonal nature of the way pharmaceuticals are transacted for money –‘money for services’ – causes grievances among customers at clinics, however (Chapter 7), who express a generalized feeling of uneasiness when confronted with the ‘power’ of Western-style forms of modernity. The attraction of Western pharmaceuticals is, however, their superior power to heal. Western medicines also provide a treatment alternative and a bypass for women around men’s control of plants (see Chapter 7 for a discussion of the ideology and reality of male control of medicine). Western medicines fit into the classificatory scheme of medicines as ‘curative’ substances. The incorporation of new medicines has not changed people’s medical language – their basic language and ideas about illness.6 However, Western medicines as well as manufactured nonlocal botanical preparations and spices from southern Ghana and Hausaland (in northern Nigeria) have introduced new treatment choices and broadened the traditionally available treatment regimen. Local botanical preparations for a headache, for example, were used in the past. Today people use paracetamol instead to treat all kinds of aches as well as fever (see also Whyte 1988 for East African examples). The effectiveness of Western medicines for many complaints is obvious to most people. Western drugs have filled gaps where no medicines existed before, or substituted local medicines with more powerful ones, such as paracetamol, vitamin tablets, antibiotic capsules and other capsules for the treatment of pains and aches. The survey of medicine use (see Appendix 2) shows that mothers prefer Western pharmaceuticals, such as paracetamol, chloroquine syrup, penicillin and tetracycline, to local plants. Mothers often explain that ‘eye pains [inflamed eyes] do not have a [local] medicine’. They prefer a Western ointment to the local alternative in their homes, shea butter. People freely ingest pain killers, vitamin tablets and antibiotics. To boost a ‘loss of blood’ and regain strength,

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people take vitamins, ephedrine and indocid tablets. There are no local medicines to induce such states.7 The resort to Western drugs may also be explained as due to the fact that not every complaint, such as headaches and inflamed eyes, has an (effective) local medicine with which it can be treated. In the rainy season (April–October) for example, colds and inflammations of the eyes are common complaints. One mother explained that the only effective medicine for inflamed eyes is penicillin eye ointment, nin bEra tim (lit., ‘eye pains-medicine’). Another mother said that since ‘there is no Dagbani eye medicine, I use [Western] eye ointment [mirigili]’. However, if Western ointment is unavailable mothers improvise and the powder of tetracycline or ampicillin capsules may serve as a substitute. Thus, the resort to Western pharmaceuticals does not cancel out the possibility of using other kinds of medicine. People often resort to local plants and remedies when they run out of Western medicine or when Western medication produces no betterment. As the survey of medicine use also showed, local and Western medicines are used in various combinations: to complement each other, parallel to each other and in a sequential order (see Table A.2 in appendix). A local botanical preparation may have been tried without avail, the next move being to try a Western drug, or vice versa. When one or the other form of treatment is discontinued, the explanations given are that ‘the medicine was not good for him/her’ (lit., ‘the medicine did not collect him/her’), or that ‘the illness came back’. Interruption of treatment with Western medicines is also often due to the simple fact that people have run out of these medicines. Sometimes people discontinue treatment altogether and simply wait and see for some time before resuming treatment. Following the above formula, we may want to distinguish between magical (local plants and charms and also Islamic medicines), on the one hand, and non-magical scientific substances (Western pharmaceuticals), on the other hand. Surprisingly, commodities may, however, become enchanted when embedded in contexts of action – when adapted to female strategies, for example (see also Chapter 8 where friendships with drug peddlers convert the immorality of monetary exchanges to moral transactions). It becomes then meaningless to uphold a distinction between magic and rationality, and to maintain a picture of ‘fixed’ and ‘opposed’ categories of medicines. Distinctions between empirical, metaphysical and magical substances become blurred and so-called disenchanted commodities may become enchanted once they are embedded in cultural practices, including the healing contexts of Dagomba women, for whom the use of these wholesome Western medicines is always about wider cultural ideas alongside negotiating and securing a future within a magical (male) order. Thus, commodities participate in an ‘enchanted economy’ (cf. Comaroff and Comaroff 1999).8

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4.8 Medicines, Modernity and Commoditization What is modernity about? ‘… the question what it is to be modern is one that Africans and Westerners may ask together. And as I shall suggest, neither of us will understand what modernity is until we understand each other’. (Appiah 1992: 107)

The transnational moment of global capitalism is about local societies being embedded in global flows. To understand local, African, forms we have to understand how global and local flows interact. The multinational generation of capital has been superseded by unrestricted transnational flows (Harvey 2000). According to this argument, capital no longer recognizes boundaries, productive relations have been reorganized so as to transcend any particular place of production or consumption. The term ‘globalization’ refers, according to Harvey, primarily to diverse transformations in the global political economy since the 1970s. These transformations imply a series of conditions that substitute ‘transnational’ forms of capital organization and flows for ‘multinational’ forms and organization of labour, and relate to and express themselves in ways which perceive of ‘national borders’ as nothing but ‘hindrances’ to the flow of capital in the global market place. This ‘global flow’ would seem to work against a conceptualization of sovereign localities. The realities produced by the global are, however, rather more complex than the simplifying ‘global village discourse’ would like us believe. Once we add ‘culture’ to globalization, the global village discourse becomes fractured by a mix of uneasiness, skepticism and fascination, and produces local and complex responses (cf. Meyer and Geschiere 1999: 1–2; see also Hannerz 1987). By being conscious of these flows, the movement of commodities, including Western pharmaceuticals, from the global to the (ever changing) local scene, we are able to take up the challenge posed by globalization. This then is the challenge: while stressing the particularly African terms of the engagement with change and modernity, we are required to distinguish between the present, or specific, configuration of the economy and society as distinguished from long-term, enduring formations of exploitation and inequality of juniors and women. The circulation of medicines is inserted into a global flow of Western pharmaceuticals and many other commodities. They make their way to the local market where they meet the local consumer, who puts them to ‘novel’ use. Observers have described this as ‘bitter pills’ to be ingested by the poor in the Third World (Melrose 1982), a ‘drugging of local people’ (Alubo 1987), and as a

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‘flooding of non-Western cultures with Western, often expired, drugs’ (van der Geest and Whyte 1988). Recently (in 2005), the movie by the Brazilian film director, Fernando Meirelles, The Constant Gardener reminded us of the nastiness and brutality of promoting (and experimenting with) Western drugs among an unsuspecting and very vulnerable local (Kenyan) population. Our ‘fixed’ orientation point within the transnational flows of capital and commodities are medicines. This chapter analyses how Western medicines become inserted into the category of ‘medicines’ (tima) by the Dagomba and how various practices articulate with pursuits of health and wealth. Along the way, and in the following chapters, I comment on diverse aspects of the ‘(im)morality of money’ in connection with, on the one hand, their undeniable value to secure the existence and perpetuation of the lineage, the incontrovertible significance of female healing for the health of families and ultimately for the lineages which they are a part of, and, on the other hand, the negative interpretation money receives when coupled with the interpretation of ‘selfish’ pursuits (not benefiting the wider community) by lineage juniors and women. The analysis of the ‘problem of money’ – or the ‘(im)morality of money’ – obliges us to radically question the reality of the Dagomba, and insists that the arrangement of the social order and related beliefs surrounding the immorality of money, female witchcraft, medicines and the occult, refers to a reality that is socially produced, designed to render support to the positions of power of male elders. In related discussions of wealth accumulation and individualism – especially in Chapters 6–8 – we consider the subtle complexities of modernity that compel us to allot magic with a central role in modernity. And, importantly, only by understanding about global market mechanisms and the flow of capital can we, as Appiah notes, hope to understand the form these flows take in shaping modernity outside the Western purview, in Africa, for example.

4.9 A Note on the Provision of Medical Care in the Nineties … a health care system with no medicines and an education system, once an exemplar for the regions, if not the continent, whose teachers spent their time absent from the classroom either farming (in rural areas) or selling (in urban areas) in order to survive. In any case, there were no books, papers or pens. (Brydon 1999: 372)

In these words, Brydon describes the deplorable state of the health care system at the time the first Structural Adjustment Policies (SAPs) were

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initiated in 1983. The situation described by Brydon was basically the situation I encountered when I began my first field work in 1990. The downside of structural adjustment has been massive unemployment in the wake of major layoffs in the public sector and privatization of services – including the introduction of user fees and paying for medicines in connection with hospitalization (Bierlich 2007a). The following sketch of health care in the 1990s applies best, strictly speaking, to the early to mid 1990s. Coping with the hardships attendant on the economic reforms is both about negotiating modernity as well as managing specific material realities. About two thirds of Ghana’s population of more than nineteen million people (Regional Surveys of the World, Africa South of the Sahara 2003) live in rural areas. As elsewhere in Africa, modern health care facilities are unequally distributed and concentrated in larger towns and cities although fewer people live there compared to the rural hinterland (Twumasi and Warren 1986: 117). Since modern health care facilities are often unavailable and/or short of medicines, many people have come to rely on privately sold Western pharmaceuticals (which frequently are of an inferior quality). These are sold to them by untrained private medicine-sellers who are (but not exclusively so) often very concerned with their own profits. (Bierlich 2007a; cf. van der Geest 1988)

Following this characterization of the state of the health sector in the 1990s, the book analyses a critical situation where modern health care is unavailable and where the majority of people rely on private medicinesellers and drug peddlers from whom they buy the Western pharmaceuticals they need. Drug peddlers and hawkers of goods and Western and ‘African’ medicines (botanical preparations) visit villages on market days. In many villages one finds one or two people who operate small businesses in their homes, selling drugs and other commodities, such as sugar and kola nuts. The limitations of space preclude a thorough analysis of the parameters of the macro-context of health and illness, that is the political and socioeconomic forces which influence transactions at the micro-level (see e.g., Twumasi 1979; Patterson 1981; Abudulai 1989; Senah 1989; Brydon 1999; Bierlich 2007a). Our discussion of the ‘complexities of modernity’ and the ‘problem of money’ provide a further platform for such an analysis, however. Throughout this chapter I have made a special point of stressing that local medicines have a critical feature, viz. sacrifices and prayers are involved. Dagomba medicines are configured by and associated with sacrifices and prayers. With regard to plants and roots, sacrifices (sing., bagayuli) are intended to make the former effective, to imbue them with

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the power of the ancestors. In invoking them, it is centrally important to obtain their gbang (support) (Chapter 2, p.25). In the next chapter I will proceed to discuss the configuration of the herbalist and medical knowledge.

Notes 1. The existence of ‘luck’ or ‘rapport’ is an idiomatic expression. The idiom relates to the power of healing and to what must always remain uncertain, namely whether a particular medicine is compatible with the sick and will be given ‘permission’ to work by its original (dead) owner. Prayers and sacrifices to the spirits of the tree whose parts are being used, are given to achieve their permission. Local medicines are not potent in themselves. The concurrence of the ancestors is absolutely necessary for them to work. The curer’s uncertainty has also to do with the fact that, as everybody stresses, nobody knows what is inside the body, sokam ni o doro (lit., ‘everybody has his/her illness’). The reference is to the person’s ‘creation’, nam, and blood, zim, which determine why a particular medicine ‘works’ for one person but not for another. (The mothers with whom I spoke always expressed the view that people are different in their creations.) The medicine-owner is humble and reluctant to commit himself too early. He often denies that he has the medicine one is looking for, or says that he will have to consult his ‘senior’, n kpiema, first – the head of the lineage or another senior person. After all, the medicine is not his – he only administers it. It is the property of his lineage and the ancestors. (See also Kakar 1982: 33 about the Indian pir, wise elder, who is ‘a conduit to Allah and a channel for the Divine Force that did the actual work of healing’.) He may also distance himself from his prospective patient saying that he wants to go and ‘sleep over it’. This may mean that he wants to consult a diviner first to see whether he will be able to work under the auspices of the ancestors (Rattray 1932: 190). The herbalist also looks upon God, Nawuni, as a healer. He informs the patient that the illness can only be cured ‘if God permits’. Finally, and coming full circle, the patient, on his part, also displays uncertainty about the results. He is therefore unwilling to discuss who treats/has treated him. His answer to the question ‘who?’ is therefore simply ‘somebody’. He attaches no importance to specifying from whom he had his medicine, since the medicine could stem from anybody. Consequently, nobody is to blame if the medicine does not work. 2. Victor Turner notes that many Ndembu choose to see the herbalist, who offers an affordable service, compared to expensive ritual treatment. The Ndembu seem to hold that plants do not need ritual to work (Turner 1964a: 3; see also Whyte 1988 regarding the Nyole of Eastern Uganda).

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3. Here, I follow Abdalla who suggests that we speak of ‘Islamic’ rather than of Arabic medicine. The term ‘Islamic medicine’ conveys a greater breadth of meaning. ‘Islamic medicine logically includes the medical experience of all the people of the Islamic world [and not just of those who speak Arabic], wherever they might be’ (Abdalla 1992: 179). 4. Medicine intended to inflict injury or death upon another person is also referred to as ti sabilga, ‘black medicine’, whereas medicine used in curing is known as ti peli, ‘white medicine’. 5. Along with Western pharmaceuticals, oil and spices and other curative nonDagomba (southern Ghanaian, Nigerian) botanical preparations are obtainable in the local market and from hawkers. 6. Warren (1979), in his study of the Bono medical system in Brong-Ahafo (north-central Ghana), finds the majority of diseases to be classified as having a natural cause. He argues that the introduction of Western medicine has been facilitated by indigenous perceptions of ‘natural’ disease causation. Western medicine has been incorporated into the medical system of the Bono as ‘an extension of the number of alternative health systems for treating naturallycaused diseases’ (Warren 1979: 247; see also Alland 1970: 158; Janzen 1981: 192). 7. In the words of Tamale chemists, the attraction of Western medicines rests on their ‘fast working’ (efficient) and ‘fast moving’ (transactable) qualities. They also stress the factor of season as shaping the demand for certain pharmaceuticals. One chemist notes that when the farming season (rainy season) begins, people experience fatigue and body pains from hard work. This reflects on the sale of pain killers (paracetamol and indocid) and medicines that give added strength (vitamins and ephedrine) (Bierlich 2007a). 8. We may want to compare this argument with the one made by Meyer, who notes that only through prayers, according to the Pentecostals of southern Ghana, can commodities be stripped of their ‘evil’ nature as ‘fetishes’. ‘They [ Pentecostalists] represent the modern global economy as enchanted and themselves as agents of disenchantment: only through prayer can commodities cease to be fetishes and become mere commodities in the sense commonly accepted by social scientists and economists’. (Meyer 2003: 152)

Chapter 5

THE HERBALIST, MEDICAL PLURALISM AND THE CULTURAL PATTERNING OF ILLNESS

The first section characterizes the Dagomba ‘herbalist’, tim-lana (the local medical practitioner) and his work. I describe kinds and modes of acquisition of medical knowledge: a) knowledge acquired locally and passed on from father to son, and b) knowledge acquired through apprenticeship and customary ‘greeting’. The second half of the chapter is on medical pluralism, choice and the assessment of efficacy, as well as the cultural patterning of illness. Different kinds of ‘medicine-owners’, tima-lanima (sing., tim-lana), are engaged in providing health care. They may be divided into four groups: herbalists (curers using botanical substances), medicine-sellers (chemists, drug peddlers), diviners and ‘technicians’ (barbers, bone-setters, midwives). (‘Technicians’ also use botanical preparations and belong to the group of herbalists but they have undergone some form of specialization.) The following discussion focuses on the herbalists, who are mostly men.

5.1 The Local Curer and His Plants Major socio-economic, epidemiological and medical changes have affected Ghana since its first encounter with the European maritime powers (Wolf 1982). Depleting the continent of human beings during the days of the slave trade, the Europeans also introduced new infectious diseases to many parts of Ghana. Smallpox and syphilis from the European ships and castles quickly spread due to increased long-distance trade, local commerce and warfare. In the twentieth century, modern transportation and a network of new roads have had a tremendous impact

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on the general health of the population. Increased mobility and travel and the growth of wage labour have produced increased risks of disease being transmitted from the crowded slums of the cities to the rural hinterland. With the increase in the scale of communication, the country has been transformed ‘into a single epidemiological unit; a unit with growing ties to wider African and world disease pools’ (Patterson 1981: 9). These changes appear, however, to have had only little impact on Dagomba herbalists, who primarily operate on the domestic level. They are first of all healers and not involved in finding causes but in getting the person well. Irrespective of the changes that have occurred over the past 400 years, they have gone on treating the existing illnesses, more or less successfully. Herbalists are local residents. They do not make a living or earn an income from their practice of healing. They are part-time curers. There are, in fact, in Dagomba society, very few full-time professional groups (Oppong 1973: 18). Knowledge about healing with plants is distributed among most members of the community. Any man (not woman) can be a curer or herbalist (tim-lana) and everyone has some knowledge of plants.1 Most illnesses are common and self-limiting (the body is self-healing), and people can therefore often actually simply wait and get better. Most kinds of illness are treated at home. Everybody makes diagnoses, attempts explanations and performs treatments. People do not need a diviner to tell them what to do (on diviners see Chapter 6). The domestic level is occupied with people who have healing know-how and possess cures for common ailments and complaints.2 A senior compound head generally possesses one or more remedies to treat common complaints, such as stomach aches, fevers and diarrhoeas. Since most adults know what to do, their know-how serves as an effective check against a particular person abusing his powers and people’s confidence. A person’s claims of medicinal power are legitimated by the community of which he is a part (Last and Chavunduka 1986: 269) and the plants he uses are given power by the ancestors. Finally, people subscribe to the same model of health and illness in which reference is made to health and its maintenance through the observation of good relationships with other people, with the land, the bush and the ancestors (Fig. 3.1). Women may say that they do not possess medicines (botanical preparations). Men stress that this should not be otherwise. However, women’s substantial knowledge and use of home remedies, such as spices and oil as well as Western pharmaceuticals, make them ‘latent’ curers. They emerge as actively in charge of family health care (Chapter 7). The criteria used for assigning a diagnostic name to a symptom have mostly a clear empirical basis. Only in five out of 253 instances (in the survey of illnesses and their treatment in 1990–91) was

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additional causal information drawn upon, such as ‘bad money’ or ‘bad food’, which were thought to have caused the symptoms (see Chapter 2). The local curer is not much concerned with causation. He examines and treats symptoms with medicines. He does not want to know that the patient went to a funeral and that he thinks that the cause of his illness is witchcraft-related as a result of something he ate. For information on such questions, the herbalist refers the patient to a diviner. The herbalist does not want to know who gave the patient the food but what he has eaten, what happened when he ate it, and how he feels now. To arrive at his diagnosis, the herbalist begins by examining the patient as a whole – his physical appearance. He will ask the patient to relate what is wrong with him by asking such questions as ‘where does it hurt’?, ‘a yi pulo nbEra ?’, ‘how does it pain you?’, ‘wula ka di be?’. He will feel the part(s) that hurt(s) and interview the patient to find out about the origin and history of the present illness. He may note the existence of a link between aches and symptoms in different parts of the body the existence of parallel and multiple symptoms. Having localized the part(s) of the body that hurt(s), and bearing in mind other information he has been given, the herbalist concludes the examination by initiating treatment with medicines. In addition to such treatment, he may advise that a sacrifice be made or refer the patient to see another herbalist regarding aspects of the illness that he cannot treat with his medicines (or because he does not have the medicines to treat the symptoms himself). He may also recommend that a patient consult a diviner for further investigations of the cause of the present illness. Of the trees that grow around villages, many have one or several uses as medicines (in the form of bark, branches and roots), and as food or soup ingredients (fresh or ground seeds and fresh, dried or pulverized leaves) (Chapter 4, Fig. 4.1). Common medicinal trees are the locust bean tree, duo, the shea or silk cotton tree, tana, and the ebony tree, ga. People emphasize that the trees that grow in western Dagomba, where I lived, are not different from the ones that grow in the Yendi- and Karaga-areas in the eastern part of Dagomba. They serve the same medicinal and other purposes. Naming of trees and shrubs is consistent, but many shrubs used in the preparation of medicines are only locally available. Knowledge about shrubs, therefore, tends to be localized. This is consistent with the fact that knowledge about medicines is dispersed. Medicines are inherited in individual families or acquired after periods of apprenticeship. Stomach-, fever- and diarrhoea-medicines are very common but are not based on standardized formulas. The recipes (ingredients) are unique and differ from house to house. There are individuals, mostly men, in every village and all over Dagomba who possess exclusively inherited or

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acquired knowledge of specific trees that treat particular diseases (on ‘inheriting’ and ‘acquiring’ medicine below). As one man explained to me, It can happen that your and somebody else’s medicine is the same. They treat the same illness but some of the trees that you dig have different names, and therefore it is not the same medicine. Somebody may have three trees in his medicine and inside your medicine there are two trees absent. His and your medicine treat the same illness.

Each Medicine-Owner and His Medicine Medicine is often prepared and ingested with food. Even when the ingredients are the same, medicine-owner ‘A’ may prepare his medicine in a different manner from ‘B’. ‘A’ may prepare it with a fowl while ‘B’ does not, and ‘C’ may taboo dawadawa (condiment derived from the locust bean tree) and not use a fowl in its preparation. Some people inherit or acquire their ‘medicines with fowls’ (medicines are prepared with fowls), others do not. Directions with regard to length of treatment and dosage (quantity of, for example, ‘black’ medicine powder to be used) are given by the individual herbalist and thus vary greatly. Treatment with medicines is first of all symptomatic and a course often only lasts as long as symptoms persist. Treatments with botanical solutions generally have a fixed length of five to seven days, however. Finally, some herbalists are bigger curers than others; they have ‘more medicines’. Some are known to have effective cures for particular complaints and illnesses, such as snake bites, jogu-infections, convulsions, epilepsy, pregnancy disorders, labour pains, fractures, etc. Cures consist of ingesting plants, cleansing the body, applying enemas, rubbing affected parts, massaging and sometimes bandaging them with botanical preparations. From what we have said so far, it is clear that Dagomba herbalists are not professional practitioners. Unlike Western doctors they do not form professional corporate bodies which have specialized knowledge about an illness and its treatment (Freidson 1970). Neither do they cooperate with each other in finding cures for patients. They work on their own, and patients are entirely free to choose between herbalists as they see fit. Herbalists do not compare each other’s medicines and discuss the strengths of each other’s cures. Herbalists are either consulted by the patient himself or by a relative on his/her behalf. If the patient cannot come himself the herbalist decides to treat the sick person in his/her home. For the treatment of ‘supernatural’ illnesses, herbalists often advise that the sick be moved out of danger, out of the house, the neighbourhood

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or village. He then treats the patient in his own or a relative’s home. If the herbalist is not a diviner himself, he may also advise the patient to consult a diviner or suggest that he seek hospital-treatment for the illness. Herbalists always feel uncertain whether their medicines will work. When a herbalist feels incompetent to treat a patient he simply says that ‘there is no luck/rapport, zugu kani, literally “head”, between you and the medicine. You should try somebody else’ (see p. 77n1). Herbalists serve their families, neighbours and the community with their knowledge and do not charge money for their services. They make no financial gains3 and are not particularly prestigious figures in their communities (cf. EvansPritchard 1937: 183–201). They simply provide a community service, the way lay people ‘charitably’ rendered each other small medical services in sixteenth- and seventeenth-century Europe (Thomas 1971: 12). To understand the herbalist’s community-orientation one must also bear in mind that when producing his medicine he always invokes his ancestors. The power to heal is not his, but comes from the ancestors who do not ask for money. In preparing his medicine, he makes use of the things that the ancestors ‘eat’, kola nuts, chicken, etc. Because of the nature of their work (which deals with the uncertainty of whether a treatment will succeed or not), herbalists are supposed to be spiritually and morally upright, otherwise their medicine would not work. They usually do not charge fees, but gladly accept ‘donations’, literally ‘what your heart tells you’ (Chapter 8, pp. 168–8; see also Rattray 1932: 190–91). It is believed that charging money would ‘weaken’ the power of the medicine. The herbalist also shows humility when he speaks about his medicines: ‘it is my grandfather’s medicine’. He would never say ‘it is my medicine’. 4 He does not openly declare that he actually possesses cures or medicines, ‘n mali tim’, but rather says when asked that he has got ‘medicines for this and that’ and that he ‘will do his best’, ‘n nin dabara’, literally ‘I will use my know-how’.

5.2 The Cultural Constuction of Medical Knowledge: Becoming a Herbalist Exploring how one becomes a medical practitioner is a good example of the cultural patterning of medical knowledge – of how medical knowledge is imparted and produced as well as the constitution of the world of healing. In Good and Good’s terms, the construction of ‘illness realities’ (Good and Good 1981).

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Inheriting Medicines Curers are not organized into associations or groups, or along kinship lines sharing a monopoly of curing and practising plant medicine. A person’s healing powers are validated by having inherited the medicines. Certain medicines, such as medicines to ‘call’ rain, to treat epilepsy or blindness, are inherited and prepared within particular families; they are non-transferable. These medicines are said to be ‘in your blood’. The chief of Sozale explained to me, If somebody is not well and he comes to me, I can help him to be cured, or cure him. But if it is a family thing, I cannot transfer it. Even a small child in the family, once he gets the plants he can work with them. But somebody who is not within that family, who hasn’t got the blood, cannot do it.

Daughters acquiring witchcraft knowledge from their mothers (see Chapter 2 on ‘Powers of the Person’) has its ‘parallel’ in sons inheriting medicines from their fathers. The father shows his sons the trees in the bush so that he can later send them for medicines. When he prepares his medicines the sons ‘see’ and learn how to prepare the medicines. It is very difficult to determine what actually motivates a father to pass on his medicines and the way he does it. He often disperses his medicines among his sons. It appears from some remembered cases that the father did not want to discriminate against his children and leave all his medicines with only one son. Another factor is the perception the father has of his wives and his sons; he passes on his medicines to sons of mothers he likes. His decision to pass on his medicines also relates to the way he has named his sons – whether he sees them as reincarnated ancestors (Chapter 2, p. 26). Divination plays an important role assisting the father to determine what his sons are like, their characters, and whose incarnations they are. A grandfather may have been reborn in his grandson. This puts the grandson in a privileged position with regard to inheriting his medicines. He is his grandfather’s reincarnation. He embodies the grandfather and has a right to inherit his medicines. Afa Adam, a Tamale diviner born in Savelugu (eleven miles north of Tamale) (Chapter 6), relates his relationship to his grandfather, ‘We were always together. I knew all his secrets, o daa sheli. Therefore, I can always dream his dreams [about him] but it is nothing to me [not dangerous]’. However, as long as the father ‘sits’ (is alive), the son cannot practise his father’s medicine since the act of producing medicines involves invoking the deceased father’s permission.

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Apprenticeship ‘Opposite inherited medicine’, the Sozale-chief continued, ‘there is the ordinary type, which you can get from somebody, and you can also, which is trust [emphasis mine], you can also transfer it to somebody. To use it for curing. I have a nephew who had epilepsy. He had to go through some of these things [an apprenticeship] and then a diet. He followed the man [herbalist] for almost a year, farming for him. He [the herbalist] cured him but he did not transfer the medicine to him. Only when he was about to go, did he transfer the medicine to the boy, telling him that until he reaches a certain age, he should not be doing it [produce and administer the medicine]. He can now treat epilepsy, but he hasn’t reached the age where he can come out openly and treat it.’

The power of healing often derives from a teacher who has his power from his father or another teacher. People decide to become herbalists for the purpose of curing others and protecting themselves. Skills of healing are gradually acquired. The learning process may take a couple of years.5 The decision to become a healer involves seeking out a medicine-owner and establishing a more or less long-lasting relationship with him. He may become his apprentice, living with and farming for him (Oppong 1973: 52), or ‘greet him for medicine’, nti suhi . As a rule, senior men instruct junior men in the art of healing (an important exception are the na-bihi purungsi, elderly princesses, whose powerful medicines are muchcoveted by men, p. 150n3). The apprentice goes to live with the herbalist and works for him. ‘If I farm, he will also farm. If I butcher, he will also butcher. He will do my work’, as one herbalist explained. When somebody comes to ask a herbalist (who has an apprentice) for treatment, the teacher sends his pupil to the bush to dig roots. The pupil will thus gradually come to know his teacher’s medicines. ‘That is how he will see my medicine.’ Since the teacher had ‘suffered’ (worked hard) himself, diri ti wuhala pam, before he obtained his medicine, the pupil likewise has to go through a process of learning. ‘Remembering how he toiled, the new herbalist will always before he treats a patient mention God’s name and the work he did before he acquired his medicine. Then the medicine will work’, one herbalist explained.

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‘Greeting for Medicine’ The model for the production of medical knowledge (and related healthseeking behaviour) is derived from an underlying cultural structure of ‘greeting for medicine’. A person may cultivate a relationship with a herbalist by, for example, ‘greeting’, puhe/suhe, him every market day, offering him small gifts, such as kola nuts, money to buy pito (beer) or money for his wife to buy salt, food, soup ingredients or other necessities for the management of the house. The herbalist will know that he is being ‘worshipped’. The supplicant, however, never openly states his request. Greeting is, Esther Goody notes, an acknowledgement by the one who greets of the authority and superiority of the ‘recipient’ (of the greetings). Through greeting, a ‘claim’ or ‘debt’ is established which cannot go unredeemed and obliges the recipient to make a return gift, in the form of medicines (Goody, E.N. 1973: 50). Greeting for medicines may go on for a year or longer. Then, one day the herbalist calls the supplicant to his house or, alternatively, the supplicant goes on his own accord but with more kola nuts than usual:. ‘Uncle (or “father”) so-and-so, I have come to greet you’, he begins his speech. If nothing comes of it, another visit will be made. Eventually, the curer will ask the supplicant what he wants. The supplicant may simply say something like this: ‘I have been sick. I hope you can help me’. It is characteristic that the supplicant does not state a specific request.

5.3 Medical Pluralism in Dagomba Medical pluralism typically connotes a plurality of systems, where one system, usually Western medicine or biomedicine, is being added onto an existing treatment repertoire or range of alternatives. The story is, however, somewhat complicated since the concept of a ‘system’, as in a ‘medical pluralistic system’, is often taken to imply that medical systems are per definition solid, monolithic organizations. The following discussions demonstrate that Dagomba medicine cannot be seen to constitute ‘a system’ comparable to an ideal ‘scientific configuration of biomedicine’. Probing into the ‘system’ concept leads us, therefore, to substitute ‘medical culture’ – as in the ‘pluralistic medical culture of the Dagomba’ – for the former notion of ‘system’. From the sick person’s point of view, his practices do not constitute a system. People make use of a wide variety of different kinds of medicine – Western, local and Islamic – without knowing or being committed to the technical or philosophical premises of one or the other system. People are generally uncertain about

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the cause and outcome of illness, and act in advance of evidence about the cause. Their practices are not homogeneous, but diverse or ‘unsystematized’, and highly innovative. People are primarily concerned with finding cures to current problems – they are rational, pragmatic users of medicines. Murray Last elegantly argues that ‘medicine’ is not a ‘system’ and that ‘not-knowing or not-caring-to-know can become part of a medical culture’ (Last 1981: 387). Following Last, we note that people often do not have a theory to guide them. Their ‘medical culture’ does not constitute a ‘system’. It does not exhibit a single consistent body of theory regarding the causes and treatments of illnesses, one which is adhered to and applied by lay people and a professional group of practitioners alike (ibid.: 389). For this reason I prefer not to speak of a ‘medical system’ but rather refer to a ‘medical culture’, which does not imply the formalization that the term ‘system’ does. To support the ‘medical culture’ concept, we further explore another category within their medical configuration, the Dagomba ‘sick role’, a role which, we note, is very different from the one that many Western cultures encourage. Dagomba medicine is diverse. There is not a single department of knowledge specifically concerned with practising, diagnosing and treating illness. Medical practices are part of the medical culture, which is not a bounded domain. Medical practices expand into different spheres: the social structure, the economy, gender relations, notions of the person and his powers (Chapters 1–2). The right to health is a community right. There are no institutions, no ‘gate-keepers’ – professional doctors – who label deviance, make the ethical decisions regarding people’s health rights and decide what people’s legitimate claims are. Everybody diagnoses and treats illness. While more or less knowledgeable herbalists can be found, nobody is thought a medical expert.

The Sick Role Noting this aspect of the local medical structure, a feature that is clearly culturally patterned, we now proceed to analyse how this shape is translated into patterns of social relationships with regard to the ‘sick role’. The Western medical profession has the right and power to label deviance, to define illness and the legitimate ‘sick-role’ (Parsons 1951, Ch. 10). In the sick role described by Parsons, the sick has a contract with his doctor. According to that contract, the doctor provides care and exempts the sick from work, while in return the sick person is expected to follow his orders and agree to get well and not to malinger. The sick person is stripped of his usual individual and social characteristics, is no longer an

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independent and social person, not permitted to make individual decisions, and takes on the role of a child that has to be taken care of. In this model, the medical practitioner is superior to the patient. He is in charge of him. The Western doctor is seen as a technical expert and authority, as trustworthy, ethical and responsible, and who above his own interests has those of his patients in mind. He is judged by a collectively held set of ideas about his ‘vocation’: he is expected to be ‘affectively neutral’, to treat an ‘objective problem’ in an objective manner, to be ‘collectivity-oriented’ and not ‘self-oriented’, and finally to put the ‘welfare of the patient’ above personal interests (the counter image is that of the businessman who does it for money) (Parsons 1951: 435). Opposite the doctor, the patient is seen as ‘technically incompetent’ and too emotionally involved. Parsons emphasizes that the situation of the patient is such as to make a high level of rationality of judgment peculiarly difficult. He is therefore open to a whole series of ir-or non-rational beliefs and practices. (ibid.: 446)

The sick is like a child in need of care. In order to be cured, he must put himself in the hands of the doctor and obey his orders. The sick individual is converted into a patient who is completely subject to the authority of the doctor and other medical personnel. The sick is exempt from normal obligations. To be sick is legitimate as long as the sick person seeks to overcome his illness and cooperates with the doctor (ibid.: 437). The Western doctor is a ‘gate-keeper’ who licenses illness. Illness is not a crime nor is the sick role in itself made unpleasant. It can, in fact, be an extremely pleasant role, with a hospital -bed waiting for the sick who is let into the hospital. Indeed, the sick deserves to be treated if he makes an effort to get well. This sick role is culturally patterned: the patient is under the control of the hospital system where s/he is required to don a specified hospital gown. In these surroundings, the sick person loses his identity as an individual and social agent. That model is one found in many Western countries. In Dagomba culture we find a very different sick role. It is not particularly unpleasant to adopt the sick role (cf. Lewis 1975: 144–46). On the other hand, and in contrast to Western societies, no benefits accrue to being sick either. It is rather the case that people cannot afford to be sick, in particular during the busy farming season and during harvesting when everybody is needed on the farm. The Dagomba do not live in a society with a security system which would allow them to ‘take a day off’ without difficulty. The Dagomba sick role is an active one, not a passive one (child role). The sick person is motivated to get well. Of course, the point at

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which people decide that they are sick is culturally defined. They may be ‘sick’ in our terms, but go on working. With no professionals to define illness, the decision to behave ill is also a personal choice. Secondly, one must remember that in Dagomba land, as in many parts of the Third World, most illnesses are experienced by children (Appendix 1). This leads one to ask about children and their sick role – whether Dagomba children have a sick role. Is it conceivable that children be partners to a contract with a curer? Probably not. On the other hand, children do have to be cared for (Bierlich 1998). According to Dagomba concepts of childhood, the newborn un-named child is a ‘stranger’, sana. Child mortality is high. People believe that when a child dies in infancy or later, s/he has ‘gone back’ to where s/he came from (God). This does not lead to a neglect of children; on the contrary, mothers are very involved in their children’s health (Chapter 7) and they suffer the most when their children die. Finally, in Dagomba society, the curer has no claim to a superior position as a professional vis-à-vis the layperson. The curer is a layperson himself and is merely providing a service; his medicines do not have a monetary value. With no professionalization and institutionalization having taken place, it is not attractive to be sick. Costly medicines do not have a prestige-value since medicines do not have a price. (In the eyes of sick people in Western societies the more expensive the medicines that doctors prescribe, the greater is their presumed value. To raise the cost of being sick may improve the actual attractiveness of the sick role). At the same time, the medical culture of the Dagomba also produces very particular patterns of patient care and diagnosis of illness. As Janzen (1978) notes in his analysis of ‘therapy management’ in Zaire, patient care is, in contrast to the Western model, given over to a ‘therapeutic triangle’ (consisting of various kin members in addition to the healer and the sick) where kin not only manage but also diagnose the patient’s illness. We note the similarity between the ‘social analysis’ of divination (Turner 1964b) and ‘kinship therapy’ (Janzen 1978). The sick person is seen as a kin member, a person having to be cared for by the family. Janzen’s excellent study of the delegation of authority in decision making and therapy management in Lower Zaire documents how people move back and forth in their therapeutic choices of self-care, visits to health clinics and chemists, visits to local healers, diviners, and meetings with kin or clan. While in Dagomba, the individual (often women and mothers) most of the time is competent to treat herself or her child at home. Occasionally visits are made to the clinics (Chapter 7, pp. 24–29). There, mothers with their children enter into dyadic relationships with nurses and other ‘specialists’, including dispensers. In all these cases the sick role demands

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that people variously interact with specialists and kin. Therapy may be seen as a ‘social process’ where rights of ‘therapeutic decision-making’ are conveyed (Janzen 1978: 129–30). The patient has faith in his/her kinsmen making the right decisions on his/her behalf.

The Efficacy of Medicines A. Subjectivity Dagomba curers are characteristically uncertain about the effectiveness of their medicines. I have explained this uncertainty as a feature of indigenous healing (see again Chapter 4, endnote 1), and of a culture that has no professional practitioners making exclusive claims on medical knowledge. The same uncertainty can be found among Western medical practitioners. Parsons notes that the application of scientific thought to medicine is incomplete. Within biomedicine itself, the problem of controlling the ‘unknown’ factor, illness, is at the heart of the matter (Parsons 1951: 446; Freidson 1970: 163; Kakar 1982: 223). The medical practitioner himself is very often uncertain about what to do, and has to rely on faith and his own experiences to support his actions. Medical training acknowledges this problem and the practitioner is therefore taught that he should first and foremost always base his decisions on his personal, clinical judgment rather than on text book knowledge and general scientific rules (Parsons 1951: 464). The medical imagination of lay people (and some scientists) in all cultures, Western and non-Western, is informed by faith and credulity. The physician-anthropologist, Gilbert Lewis, notes that it is undeniably difficult to meet scientific standards of evidence. It is hard to strike a fair balance between trust and distrust; we have to take many things on trust because it is impossible, in practice, to question everything and put it to the test. (Lewis 1993: 192)

With regard to the ‘perception of the effect of treatment’ there appears to be no difference in their and our ‘predicament’ (situation characterized by uncertainty). Confronted with sickness, we are ready to let ourselves be persuaded by believable, non-scientific evidence, including magic and trickery. The ‘only’ thing which distinguishes our situation from theirs relates to the medical culture we Westerners live in, which forces science and compliance with the ‘doctor’s orders’ upon us, and which strips us of our individuality and social characteristics when we are hospitalized.

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Accordingly, Dagomba laypeople are subjective in their approach to treatment. The sick person’s situation is one of uncertainty. S/he does not know what brought about the present illness, nor is s/he certain what future actions should be taken; in particular, whether to start treatment or whether to do nothing at the moment and wait and see, knowing that symptoms often disappear by themselves; or, if so, when to start treatment and which kind of treatment to choose. When beginning medicinal treatment, people often use medicines in advance of evidence of cause. However, lack of precision of diagnosis to guide action does not seem to pose a problem. In the following pages, I discuss the question of how much sick people know/want to know about the medicines that they are using. B. ‘Lay’ and ‘Expert’ Knowledge To begin with, one cannot differentiate between ‘lay’ and ‘expert’ knowledge in the sense of patients’ and curers’ knowledge about illnesses and medicines differing. Everybody has medicinal knowledge, and everybody subscribes to the same model of health and illness (Fig. 3.1). Factors determining whether people possess local cures or not are those of sex (in theory only men possess botanical cures) and age. Older men are more likely to possess plant-based cures than the younger members of the community, who, elders say, ‘prefer’ Western medicines. Reality does not always match this interpretation, however. One man of about fifty years of age explained to me his own preference for Western pharmaceuticals. He had been a boy when his father died, and too young to learn and inherit medicines. In other words, young men and women, but also sometimes middle-aged persons, seem to be on a par in terms of their (lacking) knowledge of local Dagbani medicines. C. Credulity and Faith Medicines can, of course, be studied for their chemical (‘inner’) components but the aspects which relate to therapy and efficacy are difficult to study in scientific terms. The question is how medicines ‘work’ and whose criterion is applied to determine efficacy: the Western doctor’s (speaking as a scientist) or the patient’s and/or his family’s. The patient may say that the medicine has ‘worked’ not because his symptoms have reduced, but because he experiences less anxiety and more attention by kin and family. According to Frank, the efficacy of healing also depends upon the healer’s ‘capacity to arouse the patient’s hopes for cure’ (Frank 1964: x).

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The ability of placebos – pharmacologically inert pills that serve as symbols of the physician’s healing power – to reduce pain even in patients with organic disease is further evidence of the healing properties of emotions and attitudes aroused by the physician. (Frank 1964: x–xi)

The placebo effect depends on its ability to arouse feelings of hope. The placebo can be a medicine or a symbol that the curer manipulates (LeviStrauss 1979: 186–205). The efficacy of healing with medicines can be quite unrelated to its chemicals. It can be measured not only in actual relief or reduction of symptoms but also in the manner in which healing exploits the patient’s credulity and faith, and arouses his hope for cure and expectation of relief. The efficacy of healing – involving interaction between ‘medicine-persons’ (herbalists, diviners, bonesetters, midwives) and the sick person – is measurable in terms of the skills with which the curer manipulates shared cultural symbols and understandings. The curer’s explanations and treatments are understandable and known by all. The Dagomba do not have professional curers. Everybody is a herbalist and a normal citizen as well. Herbalists do not enjoy enhanced prestige or power that could imbue their cures and healing methods with greater credibility. On the other hand, the secrecy surrounding the preparation of cures (sacrifices and prayers are said) prepare the sick for a cure. Herbalists stress that they cannot disclose the ‘medicine’s name’, tim maa yuli – the ingredients used to prepare a medicine – to the sick person. They will only mention some of them. When a man comes and asks, suhi, the herbalist for medicine, he is instructed to go to the bush and cut roots and bark of certain trees. To these the herbalist adds roots or bark of his own. These represent ‘the secret’ of his medicine with which he does not part. Thus, the sick never exactly knows what the medicine is that he ingests. Given the healer-patient ‘bond’, the Dagomba herbalists are legitimized ‘from below’, by their patients. The services that herbalists render are widely known. In fact everybody is a curer. The test of their expertise is effected through seeing them at work. A multitude of people exist at the domestic level who know a great deal. They function as controls on medicine-people not ‘going over the top’. Medicine-sellers (chemists, drug peddlers), on the other hand, lack legitimacy. People are sceptical about them and their interest in money. As part of a general proliferation and specialization of occupational roles that is currently taking place, medicine sellers are at the moment multiplying. Their services are not seen as entirely ‘evil’, however, in particular if they are ‘adapted’ to the local culture (see Chapter 8, p. 169). They also serve a complementary role as medicine-providers since public-sector distribution of medicines is inadequate. In terms of the existing ‘plurality of treatment options’

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(‘medical pluralism’), Dagomba healing makes use of both plants and Western pharmaceuticals, and people have the same basic hopeful attitude to treatment. Men consider healing and the control of botanical preparations a male activity and prerogative. In practice, however, everybody, male and female, is a curer. Mothers and grandmothers are the key practitioners of family medicine (Chapter 7; the female specialist par excellence is the midwife). Sometimes medicines fail to treat the symptoms. People do not reject local healing for that reason, however. People simply say that it is the particular curer and his medicine that ‘didn’t work’. That’s all there is to it. As Evans-Pritchard and Levi-Strauss have also shown, failures do not shake people’s beliefs (these are safe from criticism, while individual practitioners are not). The Zande and Northwest Coast Indians in the US know many ‘witch-doctors’ and shamans to be fraudulent and that they only pretend to suck objects out of patients’ bodies, which they have hidden in their mouths (Evans-Pritchard 1937: 148–201; Levi-Strauss 1979: 175). Whatever their trickery, the methods of the witch-doctor and shaman impress their patients and arouse their feelings of hope. The Dagomba never question their curers about the ingredients in medicines ordained, nor the curer’s orders with regard to their use. ‘If you want to recover you don’t ask “why”, you obey’, an elder explained. People do not have knowledge of (or show an interest in) each others cures and their composition. It is understood that these must not be revealed. People know that the medicine of one curer differs from that of another in respect to the number and kinds of ingredients used. The formulas are unique but often the formulas only differ a little from each other. The same medicine has different brands. The particular ingredients used in kpaga-medicines for example, differ from home to home but they are all common ones and often include the roots of the shea tree and hot red pepper, nansuchirga. Like the Zande witch-doctor, the Dagomba herbalist creates a persuasive situation by uttering incomprehensible words when he performs the sacrifice to the medicine and adds an ingredient which he has kept concealed. The sick person’s faith in the herbalist and his medicine has to do with the fact that everybody is a curer and is familiar with many of the ingredients used. An underlying understanding is also that the medicine cannot be poison since nobody expects to be given something poisonous to ingest. Healers often ordain medicine to be eaten in food. Since cooked food is eaten by everybody in the house, often not just the sick is being treated but his ‘house people’ as well and nobody would want to poison an entire household. Finally, the Dagomba, like we, do not want to know the composition of the medicines they are taking. They just want to get well.6 Therefore, the less people

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know about a cure, the more powerful it is thought to be. The herbalist’s ‘magic’ (prayers, his secrecy) prepares the patient psychologically for a cure or for a relief of his symptoms. The healer has certainly faith in his medicines and in everything he is doing and saying. For that reason he does not charge his patients money. He believes that ‘money spoils the medicine’ (Chapter 8, pp. 164–68). D. The ‘Inner’ Substance of the Cure People are not interested in the ‘inner’ substances of the medicines they are using. They experiment with medicines, often in advance of solid knowledge of what is actually wrong. Abukari, for example, treated his wife, Azara, who was complaining of stomach pains and a ‘hot body’ (malaria-symptoms), with jogu-medicine (against supernaturally caused ‘bush-illness’) that he had obtained from his uncle. ‘It worked’, he said. I questioned him why he had treated his wife with jogu-medicine since she was not suffering from jogu but complained of fever and stomach pains. ‘Could it not be harmful to treat symptoms with the wrong medicine?’ I asked. Abukari explained that ‘I didn’t know which illness she had. If you don’t know the illness and treat her with any medicine, it will not harm her.’ He admitted that such a treatment approach might not lead to a cure either. This attitude also characterized the grandfather who administered jogu-medicine to his grandson who complained of ear aches. The grandfather was concerned and since he had just prepared jogu-medicine for himself, he reasoned – in advance of the evidence – that ‘if jog [often manifesting itself as a boil] is present, the medicine will treat it’. He simply believed that it could not harm to try.

Experimentation and the Efficacy of Local and Western Medicines The descriptions of ‘efficacy’ offered so far centre on the fact that medicines are often taken on faith, people are credulous, acting in the context of a medical culture that is not a system. We may take the evidence presented so far as an indication of the existence of an ‘experimental’ structure, so central to this medical culture (and many other medical philosophies, including Western forms). This structure is characterized by a fundamental system of meaning in which people experience an ‘imperfect fit’ between cause (the treatment) and the effect or treatment outcome (improvement). The longer it takes for cause and effect to connect, the greater the doubt on the part of laypeople as to the effect of the treatment. Focusing his attention on responses to long-term treatment

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of leprosy in New Guinea, reactions that could also have been registered among lay people in Dagomba, Lewis notes: Any long-term treatment puts its own merits in doubt because of the wait and the lack of obvious results. The time allowed from cause (the treatment) to effect (improvement) is short, and the longer it takes the less likely the people are to recognize an effect. (Lewis 1993: 205)

This appears to be the situation inducing Western doctors to perceive of this behaviour as ‘non compliance’. In terms of our insights in the underlying structure of cause, effect and time producing uncertainty, we are likely to see non-Western illness behaviour, such as that of the Dagomba, in a different light. As a ‘by-product’ we also note similarities in the structure of medical knowledge among laypeople in general, irrespective of the cultural patterning of such knowledge (Young 1981).7 A. Treatment in the Home The structure of identified medical knowledge leads people to experiment with medicines in advance of solid proof. Treatment choices very often become explicable in terms of past experiences of illness and of medicines that proved efficient in the past. A child with fever who has previously had convulsions, dogu, in connection with fever, is often, for safety’s sake, treated with ‘convulsion medicine’ as well as ‘fever medicine’. The treatment of emergencies also provides examples of this approach (Chapter 4, p. 68). In emergencies, people treat symptoms in advance of a diagnosis. With ‘first aid medicines’ people ‘buy time’ so that they may be able to make further investigations to establish a diagnosis before treating the symptoms more directly. When a child gets sick with high fever in the night and cries, the response is that ‘something must be done’. The treatment consists of eliminating the immediate danger as people perceive it, as well as giving protection to the child. People keep first aid medicines in their homes for the treatment of general bodily pains, kpaga, and convulsion, dogu. Treatment takes place mostly in the home (Table A.2). Usually the sick person only needs a little stomach medicine or medicine to treat a fever or a sore. This can often easily be provided. He may choose to start treatment with a household remedy, using sheanut oil, spices, kola or kerosene. He may also purchase or ask a friend for plants or Western medicines, such as an anti-malarial, a febrifuge (e.g., paracetamol) or an antibiotic. If he is still young, he may ask the household head who – in his capacity as the head of the family – should possess one or more botanical preparations for common symptoms. If the household head cannot help him the sick

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person asks around. He asks a friend or neighbour. Somebody in the village is likely to have the medicine that he needs. Simple medical problems are generally not hospital-reported (Bugri 1990). Few people visit the clinic in Savelugu town (four miles away) to buy their medicines there. Such a visit, people explain, involves considerable costs, in terms of time, energy and money spent. It often entails the cost of motor-transport and payment of out-patient fees. For the same reason, the hospital in Tamale, eleven miles away, is very rarely visited. The obvious alternative for many people is to buy their medicines from drug peddlers and hawkers who visit the village, or to purchase them in the market. Not every village is regularly visited by drug peddlers, however. It is likely that the reliance on Western pharmaceuticals in more remote areas is less significant. Local availability, proximity to urban centres, and access to money determine resort to Western medicines. B. Experimentation The field of medicine is a field of experimentation. While the ‘ancestral premise’ remains (ancestral permission is needed for medicines to work) people constantly experiment with curative botanical preparations (but also with protective and offensive medicines). A medicine, which does not produce the desired effect is discarded for another that proves more/or is considered more powerful. When referring to this experimental activity, people say that they use their ‘knowledge’, bansim, to arrive at cures; their knowledge may be based on personal experiences, residence in foreign countries, and contact with foreigners. One man explained that when a hand is swollen (and the swelling is hard to burst), I use my knowledge, bansim. This is not medicine, din nuna bansim nnyeli, ka tim. I will find the faeces of fowls, no bindi, and the soot from the fire, burnin, inside the room, grind them and apply them [the mixture] to the swelling. Then the swelling will become soft [and easy to penetrate]. Nobody knows that it is medicine.

The boundaries between medicinal categories are also fluid and easily manipulated. Roots, for example, may be washed in ink and converted to Islamic medicine. This is unproblematic since both local and Islamic medicines have their ‘roots’, people say, in the Qur’an (Chapter 4, p. 73). By the same process, Western pharmaceuticals are culturally redefined and re-named. For the treatment of sores, local medicines are externally applied. Tetracycline capsules (topaya ze, literally ‘red capsule’) are broken and the powder is applied topically as yum tim, ‘sore medicine’. The

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powder of a capsule may also be mixed with a pain killer (tablet) that has been ground, to treat an infection and the accompanying pain. People arrive at cures that work through ‘trial-and-error’. They believe that all healing substances, local and Western, work for the same purpose: to treat symptoms. People’s use of local and Western medicines is characterized by a readiness to experiment, literally ‘I just try’. Most episodes of illness are not severe, and treatment of symptoms is deemed sufficient. Not knowing about contents and directions, people buy Western medicines to ‘try and see’. People evaluate the efficacy of plants and Western pharmaceuticals in similar terms. When buying Western medicines most people buy only one or two tablets or capsules at a time for treating the acute pain (see Bierlich 2007a). They simply treat the pain and hope that one or two tablets/capsules is all that is needed to overcome the symptom. This approach is understandable when one considers that traditionally botanical treatment only lasts as long as symptoms persist. Like Abron healing, Dagomba treatment is ‘single-symptom oriented’ (Alland 1970: 117–28) in that symptoms are treated separately and not as a syndrome. Where available, Western pain and fever relievers are often used to treat aches and fevers, while local medicines are used for the treatment of ‘accompanying’ symptoms of diarrhoea, eye infections, and so on. In other instances the order is reversed. This is what medical pluralism implies in Dagomba. The sick person is hopeful. He simply treats the symptoms and hopes that they will disappear. His use of medicines is experimental. He tries medicines ‘to see whether they will work’. He is said to be ‘motivated by his heart’, suhu yobu. Fabricating a dichotomy, elders (who as laypeople themselves display an ‘experimental’ attitude) comment on the morality of exchanges within the customary non-commoditized economy, and note that the ‘try-and-see’ attitude is particularly typical of the way ‘people today use medicine following their heart; they just collect it, dee li, and use it any way they want. They guess, bugisirimi’. Young men and women are criticized for not following the traditional way of obtaining medicine through apprenticeship or greeting but increasingly treating themselves with Western pharmaceuticals that they buy in the market. ‘Guessing’ and ‘the way of the heart’ as symbols of the commoditized-monetary approach are contrasted with ‘greeting for medicine’ and ‘apprenticeship’, which pattern the ideological construction of medical knowledge. Tibu la di soli zugu, ‘treating the way of the head’ – is the, ideologically speaking, ‘appropriate’ approach (see also Chapter 6 on the perceived rupture in the moral economy when individuals accumulate wealth through lotto playing).

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C. The Use of Western Medicines People know Western medicines produce good results, literally ‘it collects me’, ‘it is good for me’. Not unlike many rural areas of the Third World, modern health facilities in northern Ghana are few.8 Hospital medicine is under-funded; and the government health sector is inefficient and confronted by a chronic drug shortage (Bierlich 1999, 2007a; see also Van der Geest and Whyte 1988). Western pharmaceuticals sold through ‘informal’ channels (by private chemists and drug peddlers) are often the only form of Western health care available to rural people. The medicines sold may have expired and their uncontrolled circulation may lead to ‘misuse’ with serious consequences for the user. Medicine-sellers do harm but they also do good. They undoubtedly alleviate a lot of suffering in many rural areas. People know medicine-sellers to be more interested in their own profit than in the concerns of their customers recommending expensive drugs – and often the wrong ones (see, however, Chapter 8 on the ‘immorality of medicines’, pp. 168–72). It would not be wise to forbid the private distribution of medicines entirely, however. It must rather be hoped that the free circulation of medicines can be limited to comprising only the most essential ones (cf. WHO Model List of Essential Medicines, revised April 2003: www.who.int/medicines). Doctors and hospitals are not unfamiliar concepts in Dagomba, but for common complaints people do not see a doctor. When people do visit clinics, it is not to see the doctor but to obtain pharmaceuticals and injections. People often walk away when they learn that they will not be given medicine. People buy pharmaceuticals for immediate use or store them for a future occasion. They obtain their medicines from various sources. They buy them in the markets at stalls, in privately-owned chemists’ shops, at the clinics, from medicine-sellers peddling drugs, and in village ‘shops’ (some villagers sell a few drugs, such as topaya [tetracycline] and paracetamol, in their homes). Most people obtain their knowledge about and skills in administering Western medicine from these sources and from having ‘seen somebody doing it’. One man in the neighbouring village of Kanshegu explained that he had learnt to inject (chirga, injection) from a friend, a nurse (neesi), and that he used to inject the sores of his children and villagers. He never charged money for his services, he said. Many villagers also know from first-hand experience or the experience of others about the Western medical system. They cite surgery as well as the treatment of yaws as examples of the power of Western medicines. People say that silimin tim ni tib-li, ‘English medicine [Western medicine] will treat it’. Western obstetrics also enjoys great popularity (cf. Maclean 1976: 312). Women attend the clinics and hospital in Tamale in obstetrical emergencies. Hospital medicine may be costly but pregnant mothers want first of all

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good results. People do not see Western medicines as potentially harmful. They cannot read and do not know how the manufacturers intended their medicines to be used. They are interested in results not in knowing how the medicines actually work. People do not fear that they may accidentally take a wrong, poisonous medicine. This attitude has its parallel in people’s approach to local plants. Several examples cited to me refer to antiseptics used in relieving stomach pains. The Westerner knows them to be poisonous and that they should not be taken internally. Local people note that they have proved effective in treating stomach pains, which justifies using them. People use what works. Another example is that of a woman using a household bleach, tangasi, to kill a guinea worm emerging on her leg. I asked her whether she had noticed the smell? Yes, when you smell it, it goes to your head [making a movement with her hand]. It is powerful. When you work and you get tired, you can use it and your tiredness will go, she said.

Tangasi was a Western household bleach that circulated in the local market. It had been rebottled so that I could not tell its origin. The woman certainly had no idea about its intended usage. She used it to ‘kill’ the guinea worm and also for bleaching her skin to make it more beautiful (women rub their skin with shea butter to make it shine). I advised her not to use it anymore, explaining that it is ‘not a good medicine, it is intended to be used for cleaning dirt’. Moreover, in what sense can the versatile paracetamol tablet be said to be effective? As we noted above, the sick is not concerned to know the ingredients (or properties) in the medicine s/he is applying. The biomedical specialist knows that while paracetamol does not do any harm, it only gives temporary respite from fever (and may prevent convulsions) but it will not cure anything. For laypeople, however, what matters is that a medicine ‘works’ here and now. They are generally satisfied to note that the symptoms have disappeared. As far as they are concerned, paracetamol ‘works’ because it has treated the symptoms even though they may ‘return’, labana. Confronted with this configuration of ‘notknowing’ and ‘not-caring-to-know’, the researcher is always faced with the difficulty of obtaining reliable medical information (Kosa et al. 1967). This being said, and noting the parallels of reasoning and medical behaviour, when comparing Dagomba and Western patients and laypeople, one must remember that the Dagomba (like many Africans) share a basic ambivalent attitude towards the power of Western progress and medicine. Their ambivalent stance shows a further, different side of the assimilation of new practices.

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5.4 Biopower and the Cultural Patterning of Illness9 It takes imagination and courage to picture what would happen to the West (and to anthropology) if its temporal fortress were suddenly invaded by the Time of its Other. (Fabian 1983: 35)

The ‘Time of its Other’ denies other cultures the time we live in. We see our time as ‘natural’ defined by progress, science and rationality. By extending the biblical chronology to include a much longer time span, evolutionist theory created a ‘scientific’ and ‘objective’ time for us, and, by implication, a ‘non-scientific’ time for them. According to this conception they live outside our time, in a mythological, magical, primitive, cyclical, ritual time. In order to overcome this opposition one must recognize other cultures as being equals and sharing ‘temporal relations’, ‘sharing present Time’ with us. This is what Fabian refers to as ‘co-evalness’ (Fabian 1983: 32, 34). Co-evalness refers to ‘a condition without which hardly anything could ever be learned about another culture’ (Fabian 1983: 33). In the context of the local and global flows and their interconnectedness that we have described, ‘co-evalness’ is about magic entering modernity, shaping and being shaped by modern times (one has to abandon dualistic notions which would preclude magic from acting together with modernity). By not denying co-evalness, the implication is not to negate magic in modernity, in other words people engaging modernity with their notions of the metaphysical powers of persons and the power of medicines – an understanding grafted upon men’s and women’s diverse ways of ‘shaping a future’ for themselves (see Chapter 1). Men often convert the cash they generate to build up power, a following and/or friendships that may result in an exchange of wives and the perpetuation of marriage and local descent structures. Women, on the other hand, are bound to want to convert the wealth they generate through trading in the market and selling cooked food into buying (tasty) food and medicines (pharmaceuticals) to care for their children, their ‘security’ in old age. At the same time, importantly, co-evalness is also about not denying or negating that magic defines their and our lives in great measure. In the following paragraphs we shall chart the terrain where the ‘other’ (negated a place in our descriptions of modernity, science and rationality) steps onto the scene and expresses his/her uneasiness with Western medicine (and its cousins, science and rationality). These uneasy feelings represent a subtle critique of the reifications produced by Western science, including biomedicine. They embody the ambivalence of/in modernity.

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Western biomedicine is very powerful. Through its language it transforms or objectifies diffuse subjective experiences of symptoms into a concrete perception of ‘a’ disease (an ‘it’) that fits an unequivocal disease category. This is what is meant when disease is described as an ‘it’ (Cassell 1976) and when researchers discuss the ‘transformative power’ of Western pharmaceuticals (Whyte 1988). Van der Geest and Whyte note that Western medicines exercise a great attraction on many non-Western people: they ‘charm’ them (Van der Geest and Whyte 1989). They argue that since Western medicines are divorced from social relationships, they appear to be potent in themselves. Whyte and Van der Geest also note the high esteem in which injections are held by many laypeople (Van der Geest and Whyte 1988). Supporting this narrative, Patterson (1981) and Megan Vaughan (1991) refer to the ‘spectacular success’ achieved in the 1920’s by injecting yaws with arsenicals in Ghana (the former Gold Coast and the Northern Territories) and Malawi (then Nyasaland) (Vaughan, M. 1991: 46). This achievement produced a subsequent demand for injections of all sorts and an accompanying ‘needle mentality’ in many Africans (ibid.: 146). This mentality or faith in Western Medicine lingers on. Many Dagomba I have talked to are greatly impressed by the missionary doctors10 working at the Nalerigu Baptist Mission hospital in the Mamprusi-area of northern Ghana. They have nothing but praise for their technical capacities. Western surgery and obstetrics also enjoy great popularity (cf. Maclean, 1976: 312). At the same time, some researchers observe the ‘lethal attractiveness of (Western) drugs to an illiterate population (unable to read warning labels)’ (Scheper-Hughes 1993: 200; see also Reeler 1990) and drug-resistance caused by ‘misuse’ (Ferguson 1988: 39). However, one aspect is often ignored: the ambivalence characterizing people’s approach to biomedicine, its drugs and injections (Bierlich 2000). The aim of the following discussion is to explore the limits of ‘the popularity of biomedicine’ (structured by respect and fear) and to delineate a field of uncertainty in social relations and a resistance by culture against the concretizing, exposing tendency of external forces such as injections and biomedicine. Culture seems to insist that certain things remain hidden and do not become transparent at the hands of biomedicine. In terms of the present argument, the problem arises most clearly in the application of the transformative power of biomedicine to illnesses that resist (lit., ‘do not want’) this transformation. The relationship between ‘their’ (‘non-scientific’, ‘magical’) and ‘our’ (‘scientific’, ‘rational’) approach to health and illness is at the heart of the matter. Strong documentation of their point of view can be seen in the case below. In stark contrast to a demand for injections to treat illness stands the fear of injecting jogu, a Dagomba illness-category that translates as

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‘bush-illness’ (Table 3.1). This fear, a fear of death (‘As soon as you inject jogu, your blood clogs, your heart stops, and then you are dead’) relates to the concreteness of injection-therapy, a concreteness that not only heals but also exposes what culture prefers to remain hidden. The anxiety surrounding jogu, injections and hospital-medicine refers to circumstances where people with painful boils that may have been caused by a variety of infections have reported too late and therefore subsequently died in hospital (the ‘stronghold’ of biomedicine). This has shaped the notion that injections can kill and that hospitals may be sinister places where people are not only cured but also die (cf. Patterson 1981: 28). In this context, the case of jogu not tolerating injections serves as an illustration of the difficulties of the use and acceptance of biomedicine. Cultural premises (concepts of health and illness) have a strong power and thus there is illness, such as jogu, that does not tolerate injection-therapy. Sometimes people show an intense interest in illness causation. It is therefore not satisfactory to portray concepts and practices relating to health and illness from the perspective of ‘common illness’ alone. Jogu refers to multiple notions of location, disease process and causation. Local people perceive of jogu as one illness, doro, and do not distinguish between an ‘underlying’ disease (infection) and its ‘manifest’ symptoms, especially the development of a painful (bierim) swelling (morilim). In diagnosing jogu, account is taken of the circumstances that may have caused the illness. Causation is then related to the location of the disease as well as the pain experienced. Subsequently a treatment plan is decided upon. As long as jogu is visible as a boil, biomedicine and injection-therapy is rejected as lethal. Referring to this fear of injection and the route injected medicine takes, the chief of Sozale explains: Actually, it has many kinds [symptoms]. When you have a boil, you must be careful what boil it is. If it is irritating, and the swelling gets hard and painful and you happen to take an injection, for example in the morning, by evening we will bury you. That is jogu. I have seen it. One of my brothers died like that. And I know. A.P.C. [Western pain-killer] and other things do not kill [but injections do]. They just mix with the blood, and then you are cured. Once they jab you, however, there is no way out. It [jogu] doesn’t match with injection. Because it is in your blood, it is within the system. It goes through the blood, and then, as soon as you have an injection, your blood clogs immediately, your heart will stop, and then you are dead.

In Ghanaian English, jogu is often referred to as ‘anthrax’, which it is not. It is rather a general term for an infection where the cause is yet to be determined. It is believed to originate in the surrounding bush where it lives invisibly in holes of trees. As long as jogu is ‘white’, peli, locals say it

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is ‘just’ like any other swelling, morilim, which when rubbed with a palliative (shea butter or a local soap) disappears. However, jogu is perceived as ‘black’, sabinli, and ‘attacking the flesh’ when it appears as a ‘visible’ and ‘painful’ swelling in the head. Whereas ‘white’ is often seen as naturally caused (‘by God’), ‘black’ jogu is ascribed to a ‘supernatural’ agent and typically understood to be caused by the envy of people, ‘witches’. Thus, while incubating jogu is ‘hidden’ – it cannot be seen – prepatent jogu, with headaches and body pains, is treated with local palliatives and/or Western medicine. However, if pains persist and a painful boil, bingo, develops people start treatment with local medicine only. Once the boil has burst the patient may again consider Western drugs, including injections. Consistent with the general view that illness is a part of the human anatomy, ‘an innate part of the body’, jogu is believed to be in every person’s body. It is described as blood going round in the body and when jogu wants to trouble you it will lie in one place and become a boil. Jogu can give a headache but it is not until it appears as a painful boil that you will know that it is jogu. [However], if it doesn’t want to appear as a boil, you know that it is in your bones (kobili) since it produces pain in your body, zabiri o ningbuna (a general Dagomba perception).

Since jogu in its full-blown, visible state often indicates a social cause, the perceived efficacy and desirability of applying injection-therapy ends. Often people develop symptoms (aches, pains, swellings) which do not need explanation and are treated in a straightforward empirical manner with medicines, local as well as Western. However, when such symptoms occur in loaded social situations, such as during a funeral or in an everyday situation involving men and women (e.g., in the home), ideas of human agency (food poisoning and destructive medicines) are invoked and etiology changes from natural (‘from God’) to supernatural (‘from strangers’) disease causation. Individual problems become redefined as issues that are of concern to others than merely the sick, and the sick person’s kin (fathers, brothers, uncles) become involved in diagnosis and therapy since broader diagnostic notions are involved (cf. this Chapter on the sick role and therapy management by kin).

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Case: Jogu on the Forehead I first met Asana [not her real name], a woman about fifty years of age, in January 1996. At that time she had a very big and painful swelling (‘fullblown jogu’) on the forehead. A year later when I revisited Dagomba, her jogu (full-blown) had disappeared but had left her with a major sore in the spot of the previous swelling. The following are excerpts from my interviews in 1997 with her: Asana told me (January 1997) that the condition which eventually developed into full-blown jogu, had begun when one afternoon (about a year and a half earlier) she was praying. She suddenly felt great pain in her forehead, got dizzy, and over the next two months a major swelling in her forehead developed. She experienced an excruciating pain, a pain that enveloped her entire face, in particular her eyes and nose, and that extended down to her neck. She could only crawl in her room - because of the pain. She was about to go to the hospital for treatment and ‘receive an injection’, but her family advised her not to go, since they thought of her condition as jogu and suspected witchcraft. Following their advice, she began smearing the condition with plant medicines to make the swelling burst. She also bathed in Islamic medicines that she received from a malam to protect her against the witchcraft. A month later (February 1996) her swelling, having been treated with plants, burst. Out came black ‘water’. She still (Jan 1997) experiences some pain, but nothing compared to the all-enveloping pain she used to feel. In my interviews with her she stressed that her forehead still aches and for this reason she applies a number of Western (nonantibiotic) ointments, including ROBB (also known as ‘tiger balsam’) and an ointment (depicting an eye/face behind a veil) in a Western-looking tube with Arabic writing. I suggested that she might now also consider to go to the hospital and have her pains treated [antibiotics may be able to treat the infection – the ‘real’ cause for jogu – which was probably still present]. She said she would go, but I knew that the cost of going to the clinic and purchasing medicine would keep her from attending and she would probably continue to rely on local treatment. I was not able to continue my interviews with her.

The present argument is that injection-therapy (one of the most powerful exponents of biomedicine) occupies an ambiguous position in people’s minds because of it being not only powerful but also foreign and not ‘attuned’ to local notions and practices of dealing with illness. Based on the analysis of this case, we note that people are not only charmed by but may also become opposed to biomedicine and come to fear the power of injections. As stated, people are constantly engaged in constructing certainty; in this they do what biomedicine does – they apply techniques

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(‘divination’, ‘local healing based on plants’) to grasp the invisible or inchoate, to concretize it;. This may put local and biomedical healing on a similar footing.11 There is, however, a crucial difference between the two forms of healing, which both concretize an illness as an ‘it’. While divination and therapy based on plants is part of the local culture, biomedicine, being an external power, is not. It is perceived as a threat since it applies its powerful objectifying gaze to all stages of an illness, without respect for supernatural forces, notions/treatments of illnesses, and people’s cultural premises. The threat from biomedicine is perceived as greatest when injections are being applied at ‘critical moments/stages’, in other words when the ancestors are felt to be at work and/or ”‘final”’ disease causes are being considered. But why are jogu and injections incompatible? Why may injections not attack jogu directly? In addition to the contexts of respect and fear (produced by biopower and the power of cultural premises), an immediate answer to these questions has to do with the relatively simple but general belief that (like many other illnesses) jogu is in the blood and that is also where injections (or injected medicine) travel (they bypass the digestive system). And their direct confrontation can only mean ‘one’ thing, death. People ‘ignore’ that death in hospital may be caused by the fact of latereporting. They rather concentrate on the lethal meeting of jogu and injections in the bloodstream. This encounter is fatal because what is considered a ‘hot’, tulim, state (full-blown jogu is hot) meets with injections which are also seen as being hot (see also Etkin 1992 on ‘efficacy’ and Nichter’s [1981] important studies of Multiple Therapy Systems and hot medicines/hot foot/human bodies in the Indian context). Dagomba culture resists being made overly concrete by an excessively concretizing biomedical science. Injections represent not only the possibility of dealing with biological death but also manifest the frightening spectre of social death, of society dying because it has its innermost secrets, including witchcraft, revealed by a foreign science. For that simple reason people reject having jogu (which to them represents more than a mere disease) injected. People reject that jogu be ‘caught’ (made tangible) by biomedicine. Jogu is in this way a symbol of aspects of social life (witchcraft and the antisocial: hidden human intentions and machinations) that may be dealt with through the local idiom of divination but which must not be made tangible by an external power such as biomedicine. This ambivalent position towards biomedicine has, as has been said, deep roots and a depth that connects the apprehension of the Dagomba to memories of Western medicine being practised in a very different, but also overpowering context – that of the slave trade. The power of biomedicine is a modern phenomenon but is also shaped by memories

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that reach via colonialism back to the trans-Atlantic slave trade. Shaw notes that ‘many of today’s images of occult extraction are mediated by colonial memory, but also that in some parts of Africa, experiences of colonialism were themselves configured by memories of earlier transregional processes, such as the Atlantic slave trade’ (Shaw 2001: 50).

5.5. Medical Knowledge and Medical Culture Located in specific ideological frameworks claiming superior moral legitimacy, this chapter serves as a ‘case study’ of how medical knowledge is constructed. Medical practices are embedded in the socio-cultural system of the Dagomba and are thus part of social-structural, gender and economic arrangements. The culture of healing cannot easily be distinguished from these aspects of society and culture. Elders (the keepers of tradition and the power holders in society) tend to equate customary behaviour with ‘the ways of the ancestors’ and thus with what is ‘good’ or ‘right’. Their interpretations come to shape people’s consciousness and interpretations of various norms and behaviours. There are, however, many examples (relating to various action contexts, such as the female quest for healing – see Chapter 7) where women undermine the male order of things. This chapter also stresses that people do not hold a readily available explanatory model of illness. In order to avoid improper double standards in the evaluation of Western and non-Western medicine, ‘one lot for them, another for ourselves’ (Lewis 1993: 190), we must ask a set of questions that we would also ask about Western medicine or biomedicine. The focus is the origins and nature of people’s medical knowledge, in other words how people build up (obtain, learn and transmit) their knowledge about healing, how this knowledge is validated by the community, and the manner in which people test their knowledge and seek proof. We note certain patterns and commonalities in terms of laypeople’s medical reasoning (Lewis 1993). This demonstrates that at the ‘structural level’ of medical reasoning laypeople in most cultures are uncertain about causes and effects. Medical knowledge becomes explicable in the light of medical practices, and the efficacy of healing is based on the principle that ‘it works’ and that people see ‘improvements’ in their condition. I place an emphasis on the significance of viewing explanations provided in the light of local culture. In this sense the analysis follows Ohnuki-Tierney’s (1984) approach in her study of illness and culture in contemporary Japan to show how the medical culture of the Dagomba is culturally patterned. I also follow the requirement formulated by

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Mudimbe (1988) in The Invention of Africa to study and represent local culture in its own terms (see also Mudimbe in the ‘Preface’). In the following chapters we shall examine these uncertain feelings and attendant behaviours in greater depth as we explore magic and modernity. In this vein Chapter 7 explores the uneasiness that women as curers experience when confronted with the impersonal and business-like attitudes at Western clinics.

Notes 1. The term that I translate as ‘herbalist’, tim-lana, literally ‘medicine-owner’, implies a much wider field of activities than those of the herbalist. As the literal translation indicates, a tim-lana is an ‘owner’, lana, of medicines, tima, and medicines may, as mentioned earlier, be used to do good (to heal) as well as to do evil (to destroy). In this chapter, I restrict the discussion to healing, so that we may be better able to discuss how people assess the treatments that they receive. I have no doubt, however, that the notion that curers can also destroy is part of their powers. 2. Not all herbalists base their cures on local plants alone. Some make use of ingredients, such as spices, bark of trees (e.g., kalwopagu) and dried fruits (e.g., zimbuli) which come from southern Ghana and which are available in the local markets. 3. Calabash divination is also a community service. While the calabash diviner, baga, does not charge money, the Islamic diviner, afa, and the Islamic medicine seller, afa ti-koha, on the other hand, do. (Please consult the following chapter regarding the configuration of divination.) 4. Field notes in her study of Religion and Medicine of the Ga People that whether a medicine will work or not depends primarily upon the character of its owner (Field 1937: 112). 5. Oppong notes that learning to become a butcher, barber, blacksmith or malam may take a number of years (1973: 52–60). 6. As we noted earlier, Dagomba cures are not patented. This seems to conflict with the situation found in Western medicine where labelled bottles and packages keep patients informed about contents. However, Western consumers very often do not understand the labels. They, like their Dagomba counterparts, take medicines on faith. They simply trust that the doctor is not ‘messing around’ with their health and that he is not a charlatan (Parsons 1951). Generally, people do not know the chemical components of medicines. They may be placebos but people evaluate medicines first of all according to whether they ‘work’ or not. Of course, the medical specialist or doctor knows whether a medicine is a placebo or not. If it is, he also knows that ‘at least it does no harm’. A German study highlights the doubtful therapeutic value of many drugs that physicians prescribe, in particular to the elderly (Professor Christian von Ferber, 2nd European Colloquium on Ethnopharmacology,

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ESE, March 1993). What works for the lay person (faith) is therefore different from what works for the specialist (chemical components). For the lay person, medicines work, be they placebos or not. Over the past two decades, much research has focused on the ‘empirical’ efficacy of plants (Etkin and Ross 1982; for Africa see Revue de Medecines et Pharmacopees Africaines [Journal]; regarding Ghana see especially AyiteySmith 1986). Concurrently, there is a steadily growing body of literature examining the ‘cultural’ premises of local and Western medicines. In his 1980 study of Patients and Healers in the Context of Culture, Arthur Kleinman explained this principle by discussing the complexity of the question of how we evaluate therapeutic efficacy. He notes, that, while Western-style doctors often think in terms of ‘technical problems that can be answered with simple biological explanations’ and ‘overcome with the appropriate technology’ (Kleinman 1980: 312), for some patients ‘symptomatic change’ may be the chief determinant of efficacy, while for others ‘behavioral change’ may be taken as a sign of efficacious treatment (ibid.: 328). Focusing on the process of healing with plants, Etkin (1988) also notes how efficacy is culturally constructed. She advocates an emic, contextualizing approach to supplement the etic (biomedical) perspective on efficacy. Etkin (1992) further shows how people locally define effects of medicines and that these often cut across biomedical distinctions of ‘primary’ and ‘secondary’ effects (or ‘side effects’). She points out that what biomedicine labels ‘side effects’ may be desired and seen as primarily effective by local Hausa people. In 1990 (and probably the situation has not much improved), there were few modern health facilities to serve the more than two million people who lived in northern Ghana (excluding the ‘Upper West’ and the ‘Upper East’ administrative regions). The total number was fifty-eight. The figure included six hospitals, one Medical Centre at Nalerigu (Baptist Mission), two leprosaria, four health centres, twenty-five clinics and twenty health posts. The ratio was less than one health facility to 30,000 people. Duko village, which lies in the Savelugu/Nanton district, had two clinics at Savelugu, one at Diari, and a health post at Nanton (Bugri 1990 Annual Report; see also Chapter 1). See Chapter 3. This uneasiness has its early origin in the forceful subjugation and dehumanization of Africans in the days of the slave trade, preceding the actual colonization of the continent – which continued this brutal and utterly ruining treatment, in the name of another ideology (colonialism). The implications of the slave trade and colonialism are more than obvious in people’s suspicions and health-related behaviour. ‘Lack of compliance’ has certainly nothing to do with it. In her book, Curing Their Ills: Colonial Power and African Illness (1991), Megan Vaughan examines how colonial power in Africa (in particular in British East and Central Africa in the period 1890–1950) was exercised through biomedicine and its practitioners. Colonialism constructed an alliance between Medicine and Christianity (or Missionary Medicine). In its attempt to control Africans, ‘biopower’ produced (often violently and in a strongly

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‘dehumanizing’, ‘pathologizing’ and ‘degrading’ manner) stereotypes of the colonial subjects by projecting a sexist, evolutionist and racist image of uncontrolled sexual, infantile and foolish appetites onto ‘the [healthy as well as sick, male and female] African’ (Vaughan, M. 1991: x). 11. More than twenty years ago Cassell (1976) pointed out that culture through its language appears to objectify illness as an ‘it’. Confirming his point, the Dagomba note how illness comes from outside the body, violates it and penetrates it. When a Dagomba is sick, one of the most common expressions is that ‘sickness has caught him/her’, doro gbaago, or ‘sickness has him/her’, doro-mal-o (for examples see Chapter 5).

Chapter 6

HEALTH, WEALTH AND MAGIC

This chapter concerns itself with lotto/lotteries and the hopes that the Dagomba have of being able to get great riches by playing lotto. They hope that by some magic they might win. Lotto is something modern but uncertain. It reveals Dagomba attitudes to modernity and shows that magic beliefs are alive and part of modern attitudes. Magic is alive in lotto and magic is thriving in their attitudes and hopes of healing or curing. There is uncertainty in healing as well as uncertainty of success at lotto. Divination is sometimes a help or guide in such circumstances. This chapter will thus also describe how they use divination. Revealing the hidden and invisible causes of illness and misfortune through divination serves as a passage or means of access in our consideration of the link between magic (divination, witchcraft, the power of persons and medicines) and modernity (progress, modernization, rationality, commoditization [e.g., health care based on the use of Western pharmaceuticals] and money). On the face of it, lotteries may be difficult to accept as having to do with medicines and responses to illness. I argue for its relevance by stressing the importance of understanding the Dagomba’s attitudes to good fortune and misfortune in the conditions of the modern world. Lotteries reveal peoples’ hopes and values and perceptions of the (changed but ongoing mystical) forces that affect (or may be critical for) health and well-being in general. Lotto shows the continuing vitality of magical attitudes to uncertainty. Both health and wealth are important to the Dagomba; medicines in their sense may help one to gain both health and wealth.

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6. 1 Health, Wealth and Magic The Dagomba give great salience to health, alaafe and wealth, buni. That health and prosperity is not just a personal value, but a value achieved through relationships with others, can be seen by the common practice of ingesting and bathing in medicines. Thus, a person’s wealth consists of his health, material possessions and personal assets, including children, wives, family and friends (Chapter 8, ‘8.1’). To maintain his wealth, however, a crucial medicine is the ‘medicine of popularity’, which is intended to ensure a person of material wealth, of support and of friends. The use of popularity medicines is expressive of a holistic, or socio-centric, view according to which health and wealth are about the whole of the person and his/her relationships. Chiefs know the importance of having supporters. Without supporters chiefs cannot reign. The gathering of family members during funerals is also a clear message about support for the deceased’s wife/wives and children. Dances (simpa, and sometimes a bamaiah in the final funeral night) are staged by the sons-in-law in a celebration of support. The widow receives help from kinswomen (daughters and granddaughters) and friends in cooking for the funeral guests and collecting firewood, and daughters-in-law contribute soup ingredients. As noted earlier, the Dagomba recognize that they have a self and a body (Chapter 3). After all, people are sick and their symptoms are the basis for most diagnoses. On the other hand, people do not have a strong conception of their own individuality since they always identify themselves in relation to others, kin and non-kin, elders, ancestors, the bush and the land on which they live. In a sense, the person’s identity (and body) is continuous with this ‘external’ environment (see Fig. 3.1 on the ‘Cultural model of health and illness’). The person and his environment partake of the same order. The nature of all his social and non-social relationships affects his well-being. Health and prosperity are achieved when the person’s relationships are in harmony. Disruptions of the relationships cause ill-health and misfortune. Therefore, it would certainly be misleading to say that illness for them is the same as what it signifies to us. The Dagomba subscribe to a broad view of illness and health. Minor illnesses make up the bulk of the illnesses experienced by the Dagomba (Chapter 3: section 3.2 and Appendix 1). The ‘cultural model’ helps us place these findings in a broader perspective, however. It demonstrates that people’s ideas regarding illness causation fit within a wider interpretative framework. In the context of modernity, wealth may be applied towards gaining or maintaining political power. Mbembe (1992) and others (e.g., Werbner and

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Ranger 1996) have commented very persuasively on the ‘banality of power’ in the postcolony. The underlying theme of the conversion of wealth to power is, however, not banal. It speaks of the self as a social being and his/her need of support and popularity. People regularly consult diviners. After a consultation, verses from the Qur’an are copied onto a slate, the ink is then dissolved in water and the client is asked to drink or bathe in the solution. Some verses are protective, others are to win people’s support. The mubila-verse is a ‘popularity verse’. ‘People will like you, you will get the majority’, one diviner explained. People give great salience to being popular, to enjoying the support of others, to having a following. Hence the great demand for ‘popularity medicine’ (Murray Last in Medical Anthropology Seminar, Cambridge 1993; see also Last 1988). Popularity medicine refers the individual to a larger context of relationships that determine the person’s well-being and identity. With this in mind I offer in the following an analysis of wealth gained in the lotteries. Lotto playing exposes modern beliefs and values about wealth, wellbeing and uncertainty. The Dagomba see well-being and health merging into ‘good fortune’, as opposed to illness and misfortune which merge into ‘ill fortune’. It is sometimes hard to distinguish methods and medicines to cope with sickness from those designed to cope with misfortune. Therefore, there are grounds for considering the questions of well-being and misfortune along with questions of health and illness – lottery and good fortune are relevant features since they are part of the Dagomba’s overall view of well-being and morality in this modern world. Our investigation of ‘tradition’ and ‘modernity’ in the lotto-complex is situated in a context of ‘occult economies’ (Comaroff and Comaroff 1999), where wealth is conjured up and generated through a combination of magical (non-transparent, divinatory) and rather scientific techniques of lotto forecasters establishing numbers to be drawn and advertising formulas and winning numbers (see Bierlich 2007b). The data on lotteries offer very credible evidence of the centrality of magic in Ghana and, as Pels notes, ‘magic … can be modernized to such an extent that it works as a counterpoint to liberal understandings of modernity’s transparency and rational progress’ (Pels 2003: 3). Modernity needs magic to ‘prove’ that it is ‘modern’. Modern magic works both ways: it looks forward to modernity but is, at the same time, very much about powers of the person, witchcraft and medicines in the traditional sense. The ‘problem of money’ is its connection with magic.

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6.2 The Modernity of Divination: The Power of Lotteries The remaining sections in this chapter describe and analyse lotteries, which are interesting in their own right but also offer special insight into Dagomba responses to modernity, their views on modern morality – especially concerning money – individual responsibility to others, success and social responsibility. Magic is a pervasive discourse in the discussion of the present time in Ghana (and other parts of Africa) and in the domain of health as well as the adjoining fields of wealth, politics and power (Mbembe 1992; Geshiere 1997; Meyer 1998b). Magic plays a central part in the discourse of modernity by defining a ‘magical modernity’. Since the search for evidence to establish a diagnosis occurs on different levels and magic is always ‘in the air’, this chapter ties the diagnosis by divination to the particular form it takes when the quest for certainty joins the pursuit of wealth in the lotteries (which are configured in relation to current adjustment policies, adopted by Ghana in 1983). The following will throw light on the generation of wealth, money-making and magic in contemporary Ghana. I will argue that playing lotto is a form of magical money-making whereby people negotiate modernity and their material circumstances, and thereby subvert the (externally imposed) dualism between ‘tradition’ (magic) and ‘modernity’ (progress). Like the opposition between ‘nature’ and ‘culture’, there is an equally strong tendency to look upon ‘science’ and ‘magic’ as disparate categories. This opposition is also applied to postulate a contrast between ‘tradition’ and ‘modernity’ (perceived as progress and rationality). Nothing could be further from the truth – as we have seen with regard to medical reasoning, and as we notice in the subsequent analysis of a modern form of magical money-making when people play lottos. To be modern in postcolonial Africa means that when pursuing a monetary strategy and following the impersonal forces of capitalism, people fall back on traditional notions of the power of people, the community and the concept that being truly successful can only be realized through redistribution among ones kin and through generation of support. If divination represents a ‘traditional’ search for certainty, this quest is given a ‘modern’ expression in lottoplaying, where a person strives for economic success. In this endeavour, collective and individual ways of achieving riches and prosperity appear opposed to one another. However, the promises of the market, capitalism and individualism also carry an obligation to redistribute one’s wealth among kin; without showing ones respect of collective ways, individual success means very little (cf. Chapter 8: section 8.1: the discussion of the jilma-lana and the bun-dana). The following investigation examines the

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accumulation of wealth (= health) and refutes the understanding that collective and individualistic orientations are opposed to one another. We learn that collective and magical ways are inextricably linked with modernity and individual money-making (see Comaroff and Comaroff 1999). Wealth and health go together. In many ways (certainly in terms of the broad category of ‘misfortune’, Chapter 3, p. 2), the absence of poverty, fara, implies health. Achieving individual wealth through lotto playing is surely neither from the point of view of a ‘collectivist’ ideology nor seen as a proper path, although, as we shall see, many people choose to travel that path.

Lotteries and the Moral Economy of the Dagomba Lotto-playing is perceived by elders in Dagomba as a split in of the nonmonetary moral economy. They are distrustful of magical means of money –making, symbolized by lotteries and divining dreams as ‘lotto dreams’. They express their concern through witchcraft accusations, where witchcraft is associated with the immoral category of money. During my first field work in 1990–91 many people in Dagomba consulted diviners about lotto numbers that they (or others) had gained through dreams. One man had dreamt that he had seen the Tolon chief (paramount chief in western Dagomba) driving his car. He asked the diviner to help him identify the numbers on the number plate of the car (see below). Another man dreamt of two women. The interpretation in this case said that a woman represented the number ‘4’, and two women were therefore ‘44’ (According to Dagomba categorizations a woman is always represented by ‘4’, a man by ‘3’. Thus, when a female child is born one hears four undulating cries). The advice given was to play ‘44’, ‘7’ (the client’s house number) and ‘16’ (his neighbour’s house number). Many supplicants were also concerned with witchcraft and some made a link between the envy of witches and money. One person explained that his daughter was ill but had recovered and that he suspected the wife of his brother of being a witch. She had denied the accusations. Another man explained that he had lent a friend money to buy cement. He wondered whether he would see the money again. He was told to make a sacrifice so that his money would come back. Consulting diviners to interpret ‘lotto dreams’ connects with the general divinatory quest, where people see diviners (bagsi, sing., baga) about different aspects of their destiny (success, prosperity, fertility, health, sickness, death).1 In their quest for individual prosperity and wealth, many Dagomba seem, however, to go against the principles and

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ideology at the basis of divination, which stresses non-monetary, community-oriented living. By playing in the lotteries and asking diviners to interpret their dreams as lotto dreams people reject the non-monetary philosophy. Abandoning traditional non-monetary practices, many people (especially, though not exclusively so, non-elders) play lotto, a ‘magical means of modern money-making’, imagined by these as an opportunity to overcome the ‘hardships’ of life and to access the promises of progress and riches made by modernity. Lotto-playing, a ‘modern’ form of divination, primarily associated with urban life in the towns and cities of southern and northern Ghana, spills over into rural areas. There the ‘competition’ from more traditional ways of non-monetary predictions based on divination appears strong and the individualizing strategy is given less weight. In towns and cities both forms, traditional divination and lotto-divination, are found but there individualizing tendencies are more marked than in rural areas. In the final analysis, no clear-cut distinction between ‘rural’ and ‘urban’, ‘northern’ and ‘southern’ Ghana can be made, however. Lotto-playing cuts through rural-urban, northernsouthern divisions; it is a truly country-wide phenomenon. Demarcations are frequently blurred and of which ever type or location a specific area, rural and urban areas merge and become tied together or appropriated by a postcolonial, capitalist discourse of local markets, regional economies and national structures – frequently emerging in local African places as well as having their origin in global markets and multinational quarters. The identification of individuals as witches and their ‘love of money’ connects with elders frowning at diviners who ask for money to interpret dreams people have as lotto dreams. Many of these diviners (how many I cannot tell) do not emanate from the immediate local community and are thus not ones with whom one shares bonds of kinship or who deserve particular respect. Elders also criticize people who employ magical (divinatory) means to make money in the lotteries. Their criticism is couched in the powerful idiom of witchcraft. Witchcraft accusations are made to express a concern with modernity and a distrust of the individualizing ways implied by lotto playing, which involves a mix of magic and money-making. These ‘modern’ fears blend imperceptibly with ‘traditional’ apprehensions concerning home-grown individualizing activities entailing a lack of respect of normative behaviour and a corruption of collective life and principles. The cases of witchcraft accusations that I collected in 1990–91 can be illustrated by the example of the young man worrying, as many did, about his health and fearing that women (seen as a general challenge of male authority) in his home might bewitch him and make him insane or sick. In that specific case, the young man feared that one of the wives of his elder brother might harm him. He

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approached a diviner about a woman appearing in his dreams offering him money. The diviner interpreted this as meaning that a woman in his home wanted to harm him through offering him ‘bewitched money’ (sonya ligiri). To protect himself, the diviner advised him to sacrifice a chicken to his ancestors and show charity by giving children in his home milk and donuts.

Lotto Dreams and Lotto Verses Dreams people have are often about lotto numbers. Forecasting numbers becomes an excellent example of how magic (prediction by divination) interacts with modernity and money-making. It makes no sense to distinguish between traditional and modern forms of divination (lotto forecasting). Magical money-making subsumes both forms. The various examples in the following of people dreaming up numbers, taking down numbers of licence plates of cars, consulting diviners and lotto magicians, supplicants receiving interpretations and lotto verses, all attest to ‘the power of magic’ (the occult).

A Lotto Dream and its Interpretation Many people seem, in fact, to get interpretations from one another and not to approach diviners. I met some diviners, however, who stressed that they needed money to buy food since the yields from their farms were not sufficient to support their families and/or since there was no one in the family who was able to help out. For them, interpreting dreams for money was quite acceptable. These diviners overstepped, however, the bounds of what elders considered appropriate behaviour (it being modest, disinterested in personal gain, respectful and community-oriented) since they were willing to divine dreams for money. A woman related to her family that she had had a dream about the Nyankpala-chief (paramount chief in Western Dagomba). In her dream she had seen the chief sitting in his car, which was being pushed by a crowd of people and accompanied by drumming and dancing. When she finished relating her dream, a young man got up and asked her about the car numbers which she, however, did not remember. He then approached a diviner asking him to divine the ‘missing’ numbers (which he wanted to stake in the lottery in addition to two pairs of numbers he already possessed).

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The divinatory search for the missing numbers proceeded in a manner characteristic of divination in general: the diviner asked the young man to write his two numbers (pairs) on two pieces of paper, to which he then added the missing car numbers, also scribbled on pieces of paper. He placed all the pieces of paper underneath his cowries/seeds lying on the mat on which he sat. Next, he examined the cowries/seeds (representative of the numbers), arranged in five to six rows, consisting each of four to five groups with four to six cowries/seeds in each (all in all more than eighty cowries/seeds). If a particular column and/or row did not ‘add up’ (saha ni kane), the diviner freely rearranged the groups by taking away or adding one or more cowries or seeds. He examined each new configuration that thus arose. The diviner explained, about cowrie-divination, that he always read his cowries and seeds from the top downwards, a column at a time. Briefly, cowries or seeds had a meaning on their own as well as in combination with other cowries/seeds. The colour and the position of these were also important – cowries with holes might lie either with their openings upwards, downwards or sideways. In divining the missing lotto numbers, one seed/cowry out of the more than eighty seeds/cowries was selected, searchingly moved around and eventually used to point out or ‘knock’ the seeds/cowries (numbers) that were ‘winners’.2

Lotto Verses In theory, one malam explained to me, Islam (and ‘traditional’ Dagomba ideology, we may add) does not approve of lotto-playing and considers it ‘bad’ (di be) to play lotto and divine lotto numbers. According to Islamic tenets, what really matters is to have faith in God and only to rely on him and his blessings for one’s good luck. In practice, many Muslim Dagombas fall short of the injunction of Islam preventing them from playing lotto, however, and many malams are prepared to divine lotto dreams, lotto verses or lotto numbers. One malam explained he could use his divinatory apparatus to foretell numbers for others but not for himself.3 Along with prescriptions for sacrifices and alms, some malams (I do not have a more exact number) also provided ‘lotto verses’ which were not to be found in the Qur’an but derived, according to them, from certain books of Islamic divination (which I have not been able to locate). These lotto verses were apparently invocations of angels who were supposed to come to the dreamer in his/her dreams and whisper or ‘call out’ (nbohi) lotto numbers. Lotto verses to be recited before going to bed ran like this: ‘In the name of Allah, Yatohanatu…’ (name of angel in verse which was to be

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recited 301 times before going to bed), ‘In the name of Allah, AkubuzilloTazekabiro-Kunfayakulu…’ (the names of three angels). The latter verse was for protection against enemies as well as for ensuring lotto luck. The invocation of the name of Allah and the recitation of the name of the angels was always prefaced by a declaration of one’s ‘intention’ (niyyat, Arabic, nia, Dagb.) to achieve success. That ideology frowns upon individualism does not come as a surprise. Ideology-oriented elders will always voice criticism of new and especially of individualized ways that people, particularly the young and women, adopt. The elders (men) realize that they are losing their control. These days Western medicines, for example, provide a treatment alternative and a popular bypass for women around men and their control of botanical preparations (see Chapter 7). That money should ‘spoil’ social relationships is a reminder of the anxiety experienced by men and elders considering the possibility of the breakdown of male authority through commoditization and transactions involving money. They are opposed to the corrupting influences of capitalism, and highlight the ‘traditional’ value of respect and sharing. Elders frown at diviners, supposed to stick to the ‘right path’, who ask for money to interpret dreams people have as ‘lotto dreams’.

Negotiating Modernity and Coping with Hardship Coping with hardships in connection with the policies of Structural Adjustment adopted by the Government of Ghana in 1983, is both about negotiating modernity as well as material realities at this specific moment in time (Moore and Sanders 2001; Comaroff and Comaroff 2004). A few vignettes from northern and southern Ghana illustrate how people cope with the effects of adjustment. Many Dagomba farmers experience (1991) strong pressures from having to sustain their households throughout the year (see Abudulai 1989 regarding the adverse effects of Structural Adjustment in northern Ghana; regarding Dagomba seasonal changes see Table 2). They sometimes fall back on, for example, money-based trade in pharmaceuticals as a secondary occupation during the dry season (November–March) when farming comes to a standstill. In the eyes of elders this does not necessarily make these part-time traders less respected members in their communities as long as they continue to pay allegiance to common values; it is understood that they are simply forced at certain times of the year to engage in monetary transactions. Nevertheless, part-time trade involves ‘money’, which is generally seen

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by the elders as having a dangerous allure and being destructive of longestablished non-monetary interactions. The use of money to buy or transact commodities often comes under fire. Elders in Dagomba society fear that they are losing control, and voice a distinct concern with modernity. They are opposed to what they perceive as the corrupting influences of capitalism, and highlight the ‘traditional’ value of respect and sharing. Greeting (puhe), and asking for and receiving favours and assistance (suhe) constitute the essence of traditional social relationships in Dagomba. Like the sharing of cooked food, greeting is seen as a key expression of companionship and solidarity. If somebody is in need of help or a service (e.g., food, weeding one’s farm, house-building, thatching the roof of a room, plastering the floor of one’s home), s/he approaches a person who may be able to assist, and simply greets and asks that person for the service, or other necessity. This philosophy is able to absorb the part-time traders described above. All the same, the elders are alarmed by the challenge presented by progress, development and the power of money, the antithesis of traditional non-monetary exchanges. For many of the people (migrants from northern Ghana, the Sahel, the Volta Region and southern Togo) living in the low-income neighborhood of Nima in the capital, Accra, in southern Ghana, coping with the current crisis implies diversifying their sources of income through, for example, trading and farming, and through a mixture of regular and private/‘informal’ jobs and monetary and non-monetary transactions (Brydon 1999). People told Brydon that ‘with a little luck’ they would get out of their current situation. The International Monetary Fund (IMF) and the World Bank’s instructions for successful adjustment by relying on a manufacturing industry that is producing export articles (Leechor 1994; World Bank 1994), is not brought out in the Ghanaian case. ‘Ghanaians are actually continuing their lives much as they have in the past’, they focus on ‘...strategies for networking and getting a break: striking it “lucky”, in fact’ through supplementing their incomes with various earnings (Brydon 1999: 367). By extension, such a diversifying strategy may also come to include playing lotto to obtain wealth. Lotto playing can, so the argument goes, be perceived as an additional coping mechanism.

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The Lotto Magician: Magical Practices in Modernity Magical money-making through lotto playing, a country-wide phenomenon, feeds into the coping strategies found in northern and southern Ghana. Thus, managing the material realities combine and interact with magical strategies. But why are we witnessing an apparently increasing use of magic in modern Ghana, and how does magic define the current modern moment? According to a report in the weekly, West Africa, the rise in popularity of lotteries in Ghana may be seen as reflecting ‘the deepening economic crisis and poverty in homes across the country’ (West Africa, 19–25 Dec 1994: 2159). According to the owners behind the private lotteries (in addition to the formal National Lottery more than a dozen private lotteries are run at the moment, 1997) their aim is, among other things, to mobilize resources for the provision of health care, which is inadequate under the current health-care system (Senah 1989). The proliferation of private lotteries and the multiplication of ‘Lotto Doctors’, ‘Lotto Professors’, ‘Lotto Malams’ or ‘Lotto Magicians’, as well as numerous lotto newspapers (bearing such glorious names as the ‘The Lotto Key’, ‘Lotto Wonder’, ‘Atlantic’, ‘Lotto Digest’, ‘Lotto Broadcast’, ‘Ali Musah’, ‘Lotto King’) – all of which claim to possess formulas and ‘sure bankers’ (winning numbers) to hit the jackpot – may be seen as reactions to the fact that the formal public sectors in Ghana are inefficient because of their big overheads and other bureaucratic features. In this situation, informal, private enterprises such as lotteries have emerged to meet the hopes of people to become wealthy, as well as a response to the needs for funding of public welfare.4 The numerous lotto forecasters or ‘Lotto Malams’, ‘Lotto Professors’, and so on, seek to convince their clients that luck can be controlled and predicted. The lotto magicians operate in a climate of uncertainties accelerated by the ineffectiveness of formal governmental structures. They employ a combination of magical and modern, scientific and rational techniques (approaches that one associates with ‘modernity’) to convince their audiences. The Ghanaian lotto magician is a money magician.5 There is a popular need for the lotto forecasters to solve people‘s problems. They are not necessarily consulted in person, but many (in Dagomba and elsewhere in Ghana) study the lotto newspapers in which various winning schemes are being explained. Lotto forecasting comes to represent a way for many to cope with the fact that modernization and progress has not delivered on its promises of ‘a better life’, as seen from the perspective of the masses.6 As stated, there is no opposition between ‘lotto divination’ and ‘traditional divination’. Not unlike other features in

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the culture of divination (it is always uncertain whether a sacrifice, verse or medicine will work for the supplicant), lotto forecasting is cloaked in a shroud of success-failure. This does not, however, defeat people’s general faith in the system of lotto forecasting. The legitimacy of lotto teachers comes from them resembling diviners. They also draw on notions that make sense to people. They recognize (or, at least they do not negate) the existence of risks in human and non-human relationships and the importance of popularity and success. A very obvious link between divination and lotto forecasting is the divination of lotto verses and the attempt by many diviners to divine lotto numbers with their traditional divinatory tools.

The Lotto Game The lotto game shows how magical ways of wealth accumulation are inextricably linked with modern and scientific ways, giving lotto-playing its legitimate place as belonging firmly to modernity. The game refutes a dualistic understanding whereby magical (divinatory or ‘traditional’) and scientific (‘modern’) practices are opposed to one another. To ‘strike it lucky’ (Brydon 1999) in the lotteries becomes a way for many to cope with the adverse effects of adjustment. On one Friday afternoon in 1996 I watched two lotto teachers at work, teaching their lotto plans behind the place where they draw the National Lotto numbers in Accra on Saturdays. They were jumping up and down, explaining their methods in loud voices and adding and subtracting numbers on a blackboard – for a description of these lotto plans see Bierlich 2007b. They were drawing large crowds of people, thirty or so each, who attentively watched their gratis demonstrations and were ready to be impressed. People were all present ‘for the same causes’, as a man in one of the crowds explained to me. The same man urged me to teach them ‘my lotto plan’ (since I must surely have numbers, why would I else be in the crowd): ‘We are all here trying to do something. Now it’s your turn, teach us, try and help us!’ New numbers always arouse people’s interest since there is, after all, the possibility that these may succeed. People attending these demonstrations or lessons are filled with optimism and ready to believe any (convincing) explanation anybody may have. The proof of the validity of the teachers’ plans derives from the elementary fact that the teachers are always able to point to past successful events. (After such demonstrations of skills, convinced people can come forward and for 500–1000 cedis [40–60 pence, September 1996] consult the teachers about Saturday’s draw).

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Wealth, Health and the Subtle Complexity of Modernity When people accumulate riches through monetary means elders construct this ‘coping mechanism’ as a transgression of the traditional pursuit of prosperity through non-monetary ways. Legitimating their apprehension, they exploit the collective imagination to produce powerful images of money associated with witchcraft and cause the wealth and respectful behaviour of individuals to be scrutinized. Divination, where the supplicant thanks the diviner with a gift, is recognized by the elders as the proper (or ‘traditional’) way to achieve what is desired (prosperity, success, a ‘good’ fortune and personhood). For lotto-players the moral economy of gift-giving is, however, coupled with a notion of backwardness to be overcome by the modern form of lotto-playing and the consultation of lotto diviners about lotto dreams and verses. The above reveals central questions about modern Dagomba views of modernity and morality, wealth, well-being, fortune and misfortune – though not about health and illness in a conventional medical limited sense. The purpose of this chapter is to focus our thoughts on the magic of/in modernity, especially with regard to money-making in the lotteries. Why lotteries and why now? The current situation is producing immense hardship and this time where many people are turning to lotteries is perceived by elders as a deep crack in the moral economy. The ‘generational tensions’ alluded to above primarily reflect changes in the moral economy and changing expectations about the use of resources, either to be redistributed or to remain with the individual accumulator. The condemnation of ‘destructive individualism’ helps us to think more broadly about the perception of individualized and commoditized interactions as endangering human transactions. Individualization, not necessarily generation (juniors-elders) (although that is also highly relevant in understanding the disapproval of elders), is seen by the elders as the main menace to the economy.7 For many Ghanaians (and Africans) the current juncture is characterized by a ‘retreat of the state’ from providing social services while the Pentecostals in Ghana say that the ‘Devil’ is to blame for the current crisis. Flight-Lieutenant Jerry Rawlings’ coup in 1981 came at a time when the Ghanaian society was in a deplorable state, failing to deliver goods and services. In this climate people turned their back on the state and turned in great numbers to the many Christian Churches that had sprung up everywhere to meet the failing state’s responsibilities (e.g., Meyer 1998a, 2003). The inclination to play lotteries also feeds into the material reality, in particular as it is configured in relation to structural adjustment. Lotteries appear to have experienced a dramatic increase in popularity over the past fifteen years

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since in late 1989 private lotteries at the district level were legalized (West Africa, 19–25 December 1994). One notes the very similar distribution of lotto-playing in rural and urban areas and its strong appeal to all members of society. This is not to deny that lotteries were not also important in the seventies and eighties, but this statement (‘dramatic increase’) may help analyzing the ‘modern’ phenomenon of lotto-playing in terms of the ambiguous and subtle complexity of modernity, especially with regard to the accumulation of wealth. The lotto-complex signifies the intangible and complex form the Ghanaian response to progress, development and modernization takes. Lotto-playing is not a simple construct but an intricate situation where ‘traditional’ notions and practices of non-monetary wealth accumulation, health and notions of a person’s ‘good’ and ‘bad’ fortune mix with the demands of the markets and monetary transactions and the ultimate aim of wealth conversion in order to produce a future (Chapter 1). Lottoplaying (and curing involving money) is a feature of the ambiguous and subtle complexity of modernity (e.g., Comaroff and Comaroff 1993, 1999; Werbner and Ranger 1996; Meyer 1998 a, b, 1999; Moore and Sanders 2001; Meyer and Pels 2003). It cannot be explained as reflecting a situation that simply produces anxiety and witchcraft accusations. My argument about the complexity of modernity is opposed to the cause-effect explanations made by early texts, which related how colonialism (modernity) made people more unhappy and witchcraft accusations increased. Forty years ago Margaret Field documented the strains, anxieties and insecurities that the new cocoa industry (the cocoa industry expanded greatly between 1910 and 1925) produced in southern Ghana (Field 1960; see also Jahoda 1962). A few years later Ari Kiev (1964) edited a volume with the title Magic, Faith, and Healing, which was also intended to examine the stresses and pressures (and available indigenous therapy) produced by development and westernization with their novel demands on individuals. Based on his Yoruba-material (southwestern Nigeria), Raymond Prince (1967) confirmed feelings of blame, guilt and anxiety among the Yoruba produced by westernization and related social changes. ‘Money’ plays a central role when interpreting modernity. We are required to acknowledge that money partakes in the ‘moral economy’ of the Dagomba as a very powerful medium in the generation of respect, jilma. With money people generate respect and a respectful following, prestige and esteem (all signs of ‘good’ fortune and hopes for an agreeable future). The rich and powerful people are hailed. In this sense, money has a ‘positive’ side. For many people in northern as well as in southern Ghana the issue of money and political power, the ‘conversion of

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economic success into political power’, has, therefore, a familiar ring to it. In the context of a critique of individualizing tendencies, the fears and the tropes of the elders connect, however, with an anxiety about money’s ‘destructive aspects’ (damaging customary and non-monetary living) in an articulation of witchcraft fears: ‘eating “bad food”’, ‘touching bewitched money (sonya ligiri)’, ‘dreams about women as witches’. Like witchcraft, individualization in connection with the market and a moneybased economy is seen as destructive of, ‘spoiling’ (sagim), collective ways and social solidarity (Bierlich 1994). As a figure of individual wealth accumulation, lotto-money is also seen as damaging social harmony. Lotto-money not only sets off a discourse about the ideology and power of elders (cf. Chapter 5 on the ideology of medical knowledge being in the exclusive hands of male herbalists) but also a debate about ‘tradition’ and ‘modernity’ as key symbols in an analysis of an ‘occult economy[ies]’ (Comaroff and Comaroff 1999) where wealth is conjured up and generated through a combination of magical (non-transparent, divinatory) and rather scientific techniques – where lotto forecasters establish numbers to be drawn and advertise formulas and winning numbers. In order to establish its claim of truly belonging to modernity, magic employs scientific and mathematical assumptions and calculations (revealed by the lotto plans and related computations) Bierlich 2007b. But what is the relationship between magic and modernity in postcolonial Africa? Magic, divination and the belief in spirits imbuing material objects and ancestors, is hardly ‘a hangover from the past’ but rather an attempt to locate meaning and prosperity in a modern, postcolonial world characterized by monetary forms and global market economies. Therefore, ‘modernity’ cannot be said to have displaced magic, quite the opposite is the case. Magic provides, as Moore and Sanders note, ‘a new context in which [it] make[s] perfect sense’ (Moore and Sanders 2001: 16). For Boteng Na (a Dagomba elder), the young man from Kpaling (village behind the district capital, Savelugu) and for many other lotto players in Dagomba ‘magic’ (e.g., lotto playing and forecasting) certainly ‘moves the world’, just like development, education and modernization. What then is lotto-playing in Ghana really about? Is it simply another of those money-making-schemes, a get-rich-quick plan? ‘Yes’, it is a moneymaking scheme, but we must renounce any attempt to interpret it in simplistic, Western terms. We must refrain from interpreting a nonWestern configuration in terms of one big master narrative of modernity, implying increasing progress, development and rationality, and rather acknowledge the existence of ‘modernity beyond “modernization”’ (Pels 2003: 19). Lotto-playing in Ghanaian society defines a specific form of magical money-making, a ‘magical modernity’ (see Moore and Sanders

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2001 in their introduction) where the person’s fortune is being negotiated. Magical money-making articulates with a perception of Western capitalism as very powerful and as enabling a lot of people to make a lot of money, to accumulate ‘untold riches in the market economy’. However, the present economic policies of adjustment block – for the overwhelming majority of people, amongst them many young people, in Dagomba and Ghana (and the entire African continent in fact) – the path to riches, and represent the story of ‘poverty in modernity’. Only few people enjoy the benefits of development and modernity by having unimpeded access to the riches that capitalism promises. The vast majority of people in Ghana, and elsewhere in sub-Saharan Africa, barely manage to survive, and exists in deplorable poverty. Lotteries and the magic of money-making feeds into this. At the same time, it carries a promise to all Ghanaians, wherever they live (village/city) and whatever their orientation (localist/cosmopolitan), solutions to one’s problems can be found within this modern-magical complex where the person’s prospects are on the line. The ‘magic of modernity’ is not only about a continuity with the past (‘tradition’ as it were) but modern magic also signifies something specifically new, where money-making is configured in relation to lotteries and Structural Adjustment . In other words, magic is being ‘invented and reinvented in modernity’ (Pels 2003, p. 30). It would be unacceptable to them (Ghanaians) and to us to attempt to negate the power magic has. This chapter introduces us to a context where the magical imprint on the lives of the Dagomba and the society in which they live is structured in relation to a fundamental concern with wealth and prosperity (which includes health). Our specific concern in this chapter is lotto-playing, seen as a way of redeeming the promises of modernity and as a complex discourse about ‘tradition’ (divination, magic) and ‘modernity’, and how the domestic society and economy relate to change, including modern changes in the postcolony. The chapter has not only shown how imaginary an opposition between magic and science is, it has also expanded from a ‘pure’ consideration of health-related matters into the adjacent, defining field of wealth, understood as including material as well as moral assets – both ‘constituting aspects’ of health. Westerners claim to adhere to scientific cause-effect explanations. We have in our analysis of the core medical structure of uncertainty (Chapter 5) noticed that Westerners do not follow the rationale of science in actual fact. To understand modernity in Africa is, therefore, as Appiah (1992) notes (see citation on p. 74 in Chapter 4), about understanding oneself in order to comprehend ‘others’. Many people in Western societies may propound scientific theories which they in practice do not follow. Medical practice is a good example of the configuration of magic, trickery and

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credulity structuring ‘scientific’ thought. Oppositions between two types of societies, the ones who are scientific and those which are ‘steeped in magical beliefs’ are not to be postulated. That magic informs our and their lives is not to be reasoned away by reducing it in one or another way. Rather this study seeks consistently to examine contexts, contexts of morality and immorality, in healing and adjacent fields of society and the economy in our test of magic and modernity. As Geshiere (1997: 22) notes in his study of The Modernity of Witchcraft, It is only thus that one can hope to somewhat loosen the vicious circles of witchcraft reasoning [and the postulated and imaginary opposition between magic and science] from which it appears so difficult to break away.

In the following chapter on women as therapy-managers and users of money to buy Western pharmaceuticals we continue to analyse the conflict between Western medicine and the local culture. The chapter primarily shows how medical knowledge and practices are configured in relation to male power and knowledge and that the imperative of biological and social reproduction permits women to bypass men and male authority and obtain curative commoditized medicines – Western pharmaceuticals – to treat themselves and their sick children. In the female healing quest, the local culture and its premises is, however, confronted with the impersonal system of biomedicine and a platform for eventually considering the (im)morality of healing in Chapter 8 is established.

Notes 1. There are two main forms of Dagomba divination: calabash and Islamic divination. The ‘traditional’ diviner uses his calabash, while the divination of the ‘Islamic diviner’ (afa, also ‘malam’) is based on seeds/cowries that are placed on a mat. The search for evidence to establish a diagnosis occurs on different levels. In the previous chapter we saw how people arrive at their diagnosis by observing symptoms. Divination represents another, complementary approach to establishing a diagnosis (see, for example, Fortes’ excellent essay on ‘Divination’, Fortes 1987a). 2. Interestingly, this method of determining success is identical to the one used to identify witchcraft suspects, where the diviner is asked to point out which twigs/stones/other objects, representing the client’s suspicions, confirm these. It is also characteristic of this form of consultation, that the choice of names or meaning of the objects are always at the discretion of the client and kept secret from the diviner (Mendonsa 1982: 7 ff).

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3. At the same time, the malam complained about the ‘dishonesty’ of many (Muslim and non-Muslim) diviners who divine lotto numbers for money, they ‘sell themselves for money’. Other men I have talked to stress that in the past consultations of diviners were not money-based, diviners stuck to the ‘right’ path and were not interested in material gain. ‘A cowry or coin that was all that the diviner would accept. But these days [1990’s] urban people spoil (my emphasis) diviners. They give 200–500 cedis [the equivalent of 50 pence–1£, 1991]’. These complaints refer to male fears of loosening their control over the moral order and the commercialization of divining. This commercialization is, however, primarily to be seen as an adaptation to the exigencies and doubts created by modernity (e.g., Bierlich 1999 on the commercialization within the Ghanaian health sector). 4. A comparable situation in the UK has given rise to the fear that the success of the funding by the National Lottery of areas that are considered Government responsibility, may be used by the Government as an excuse to make cuts in housing and education benefits as well as other national and foreign aid programmes (The Guardian, Sept 29 1995: 1; see also O.Vaughan 1995 for further West African examples of the ‘efficiency’ of the private, nongovernmental sector). 5. The generation of wealth reveals central questions about modern Dagomba views of modernity and morality, uncertainty, well-being, fortune and misfortune. Wealth may be applied towards various ends and it may also be converted into generating support and a following, through skillfully managing various ‘registers of power’, ‘traditional’ and ‘modern’ (Lentz 1998). 6. It probably also functions to exempt people from blame for their difficult situations. Here I think of Snow and Anderson’s (1993) fine study and analysis of how street people in Austin, Texas, USA perceive of their situation and how they attempt to exempt themselves from responsibility for their difficult plight by referring to ‘twists of fate’ and related factors (Snow and Anderson 1993: 208) (on ‘exemption from responsibility’ see also Wagenaar 1988: 87). 7. There is a growing body of literature concerning ‘youth’ and addressing its distinct predicament at the present time. Consult, for example, Cruise O’ Brien 1996; Gable 1999; Weiss 2004. In the words of Cruise O’Brien ‘“youth” is [seen by young unemployed people not able to create an “independent” life for themselves] as something which is at risk of becoming indefinitely prolonged’ (Cruise O’Brien 1996: 58).

Chapter 7

A WOMAN’S LOT: THE PRACTICAL REALITIES OF CARE

Women look after most problems of everyday illness except when men think they may involve serious matters of kinship or require an appeal to the ancestors. Most of the time individuals treat themselves at home and mothers are deeply involved with the health of their children. In this context the use of Western pharmaceuticals in self care and in the treatment of children play a dominant role. Healing by women using pharmaceuticals equates illness as an ‘it’ that can be treated with commodities. But most importantly, their care-giving activities are made meaningful by an underlying structure whereby women produce a future for themselves, a specifically female future (see also Chapter 1). Western medicines involve monetary exchanges and individualized, commoditized relations. The elders see such healing practices as immoral. The circulation of pharmaceuticals in local Dagomba markets is a feature of the globalization of the economy and consumer capitalism. The use of Western medicines adds another dimension to local peoples’ approach to modernity: ‘money and commoditization of exchanges and relations’. A complex relationship is formed between individualism (available as a ‘plan of action’ through maternal kinship, Chapter 1) and the accumulation of wealth, the market and the expansion of commoditized relationships, alongside the ambivalence in/of modernity. In particular, this chapter discusses the paradox of men marrying women whom they do not seem to trust but whom they entrust with the care of their children. The focus is that of the relationship and inter-connectedness of men and women, of male dominance and female autonomy, of power, ideology and practice. The discussion is set in the context of an examination of the role of women as decision makers regarding family health care. An attempt is made to outline the major issues raised by an ideology which emphasizes men’s control of medicine and a reality where women are the dominant decision makers concerning the family’s health. In producing

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her future as a mother and woman, patterns of curing and caring, divorce and post-marital residence with sons and brothers are interconnected. Accordingly, the imperative to care is culturally patterned. In this connection I also identify the ethics of care – who is responsible for caring for children. One may feel tempted to conclude that men’s control of local medicine is a vision that men like to entertain. Men ‘preoccupy’ themselves with fantasies of female witchcraft and with local and Islamic offensive and prophylactic medicines although these medicines do not offer cures for sicknesses. Men celebrate Islam in the dresses they wear and speak with conviction of the superiority of Islamic charms. Women, on the other hand, attend pragmatically to the very real problems of health for which men’s medicines (i.e., the non-curative ones) are inadequate as a treatment.1 I find, however, that this impression is inadequate, not only in terms of the designs of marriage and descent that men seek to reproduce (their future) but also based on the fact that men’s participation in health care is invisible. In fact, men provide important ‘ritual’ protection for their children.

7.1 The Dominant Voice: Men’s Control of Local Medicines Let us first consider the ideology of male control of local medicines, a philosophy embodying the social production by men of knowledge, including medical knowledge, in Dagomba society (see Young 1982 on the social production of knowledge). In theory, male authority is complete. It is linked to the man’s status as household head, yili yidana. The head of the household has a right to the labour force of resident males who must work on his farm, and he is entitled to be given respect and greeted daily by the residents of the house. In return the householder is responsible for the domestic group. If a person in his house is sick he is informed so that he can meet his obligation and provide the necessary care. Men say that only men are able to produce local medicines (botanical preparations). They consider themselves the legitimate ‘owners’ of local Dagbani medicines. Procuring and preparing them, men say, demand skills and knowledge about trees. ‘Women’, men say, ‘cannot find the trees. The trees are in the bush but they do not know all their names.’ In addition, words have to be spoken and sacrifices made. Women have no right to pray or sacrifice to men’s medicines. Men fear that if women had access to men’s medicines they would use them immorally, to harm them. Ideology thus effectively excludes women from the domain of healing. In a show of deference to male authority and control of elders over juniors and women, a person in

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need of a particular medicine must enter into a ‘begging-relationship’, suhibu (see below), with the person who possesses the medicine s/he needs. Men hold that only men can engage in the activity of begging (or, asking) for medicine from other men. Local medicines are produced and transacted between men only. If a woman, a wife, a mother or a sister, is in need of a local medicine she must approach her husband, son, or brother and ask him to request medicine on her behalf. In theory, men control women’s access to Dagbani medicines. We don’t have Dagbani [i.e., local] medicine. When your child is sick, you tell your husband, who will then beg (suhe) for Dagbani medicine to give to you, women explain.

The male perspective has come to dominate the beliefs of women (but not their practices, however). As Comaroff notes, male views have ‘become seamlessly incorporated in the set of tacit assumptions [that women express] about reality’ (and that some anthropologists take over and reproduce in their texts) (Comaroff cited in Lindenbaum and Lock 1993: xii). In order to be able to appreciate why men should think of themselves as providers and owners of medicine, one must consider the consequences of virilocal marriage. Upon marriage, the woman leaves her natal home. The man does not leave home but marries and, ideally, lives with his wives in his father’s house (see also Chapter 1). The father passes his medicines on to his son and not to his daughter. The underlying idea is that the brother should be able to take care of his sister, who is expected to return to live with him in old age. This is the ‘social structural’ context for the ideology of male control over medicine.

7.2 The Structure of the Quest for Medicine: ‘Begging for Medicine’ Dagomba men like to reproduce a narrative that will accord them a place as the legitimate and morally upright keepers of the social order, an order they represent as the ‘natural’ order of things, but which is socially produced (see, for example, Foucault 1994: 128 on ‘natural history’). As part of what men perceive as an acceptable ‘quest for medicine’ they emphasize sharing and redistribution. If Isifu [(male) speaker’s cousin] comes to ask me for kpaga-medicine [botanical preparation used to treat general bodily disorder], he will offer me kola. I will break the kola nut into two, so that we may both have a piece to chew.

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Requesting or asking for medicine (‘begging’, in the local gloss) can best be understood as anchored in the all-important ‘greeting behaviour’ of Dagomba social relationships. According to Goody (1973: 2) characteristic greeting and begging behaviour among the Gonja (group living in proximity to the Dagomba who display very similar forms of social interaction) is composed of three elements: (1) ‘verbal salutations’ (alluding to circumstances of weather, time of day, etc.); (2) ‘physical gestures and movement’, which express a junior’s (and a woman’s) respect of his/her senior through ‘abasement gestures’, such as crouching, kneeling and clapping of hands; and (3) ‘prestations’, such as kola nuts or other objects representing kola, such as palm wine, beer, sugar and money. ‘Greeting’, puhe, is the idiom through which children approach their parents, juniors their seniors, wives their husbands, and through which a favour (small or big) can be asked from another person. It is also the idiom through which the sick requests medicine. In ‘begging for medicine’, suhe tim, a combination of ‘greeting’ (puhe) and ‘requesting’ (suhe) by offering a material gift, kola, gule, is employed. (When addressing the ancestors or God, suhe also translates as ‘praying’.) This arrangement of authority and respectful behaviour permeates all spheres of social life. Offering one’s respect implies that the recipient of respectful attention is obliged to reciprocate by sharing, and by extension also contributing and applying his wealth and success to the common good of his community (by this logic a person’s wealth and resources are converted into respectful support – see also Chapter 6 on the key role of ‘popularity-medicine’).2 When people ‘beg for medicine’, ‘begging’ can best be translated as ‘asking for’, ‘requesting’. In making a request, one is asking for something that the other person has – which may be his medicine or a less tangible object (his knowledge or skill). Situations are numerous in which people ask each other for favours. One may think of such common situations as when a person who is known to be a specialist at house building or roofing, is asked to come and help build or roof one’s house. Similarly, women ask each other for assistance in stirring shea butter or plastering the inner court yard and house walls. The request for medicine is accompanied by the offering of greetings and respect, kneeling down and making a gift of kola. There are, however, several ways in which a person can ask for medicine. There is the direct approach, asking for medicine from the medicine-owner himself. At other times the person whom one intends to ask for medicine (a person of high status) is not approached directly. Etiquette may demand that one be properly introduced. One has to be ‘guided’, zang, by somebody of the right status (an elder, an office holder). However, no matter who the person asking for medicine is, whether young or old, whether of chiefly or

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commoner status, of an illustrious or unknown background, the requirement to go and greet the medicine-owner in his home and make a gift of kola is always the same. This is primarily so because, in asking for medicine, one is not only dealing with the medicine-owner but with the force ‘behind’ him – the ancestors. These original owners demand respect, for it is they who make the medicine powerful. While in theory a request for medicine should always be accompanied by a gift of kola, such formalities are only observed when one goes to ask for medicine for the first time. In the majority of cases the quest for medicine is therefore quite informal. Friends and neighbours who regularly help each other do not observe the formalities of greeting behaviour. In many cases all that the sick person does is to seek out a person who may be a lineage member or a friend asking him: ‘Do you have something/something left over to treat stomach pains?’, or ‘I want medicine for chest pains’. There is a continuous exchange of medicines. People very often have medicines left over from a previous case of illness. These form a considerable portion of the medicines in circulation. There is no necessary obligation to give friends and people one knows kola in exchange for medicine. The point to be noted is that asking for medicine is in general quite relaxed. There is certainly no formality attached to requesting medicine from the household head whose responsibility it is to care for the people in his house. The quest for medicine also remains informal as long as the sick person’s request can be met by medicine that has already been prepared, whether in the form of a ‘ball’, charcoal, fresh leaves or roots, or a part or parts of a formula (a root, a number of roots or leaves) – see Figure 4.2. If, however, one’s request implies that a medicine has to be especially prepared, a gift of kola may be called for. The medicine-owner then goes and finds the ingredients, tilahi, literally ‘medicine pot’, such as roots and leaves, and prepares them. He asks the supplicant to ‘go and come back’ at a later time with a sacrificial fowl for the medicine. When the supplicant returns he is also expected to make a gift of kola.

When Women Ask for Medicine Men’s general fear of women prompts them to say that women are not allowed to ask for medicine. However, this statement deserves qualification since women who are not married can and do ask for medicine. A widow or divorced woman has the same needs as a married woman. There is nothing mysterious or ominous in her requesting medicine. The married woman on the other hand, has given up this right. By marriage, a woman places herself in the power of her husband. The

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married couple has certain rights and obligations to each other. The woman is expected to provide sexual and domestic services, including child-rearing, cooking and housekeeping. The man must provide shelter, food and other means of support. Ideally it is also his duty to go and request medicine on his wife’s behalf, lest people should think that his wife is being insubordinate. The immediate reasoning is that a married woman who shows an interest in medicine is looking for witchcraft medicine. A woman who frequents people with medicines is often automatically dubbed a witch. The unmarried woman, who asks for medicine is not above suspicion of witchcraft, however. No woman is.3 A woman must always satisfy public opinion. She must be well respected in the community, be a woman of good background and reputation. Her aim in begging for medicine must be transparent: it must be clear that she is begging for medicine because she is sick and not for other less pure reasons. This having been said, in practice however, all women, whether married or not, go about asking for medicines to satisfy their daily needs. Although men deny that this occurs observations confirm that women are not afraid of approaching men in the village for medicine. There is nothing suspicious about that. The husband will not object if he hears his wife saying: ‘I will go and beg Adam for kpaga-medicine and come back’.

7.3 Ideology and Practice: Women, the Future and Decision Making Dagomba men consider themselves the providers of medicine. Women are subordinate to men and not supposed to take individual action to obtain medicine. This is not a tenable position from women’s point of view nor does it accord with reality. Women’s freedom may be restricted by the ideology of male control over medicines but in practice women bridge this control of their freedom. Through their actions they subvert the unequal construction of the world by those (men) holding positions of power in society. Female narratives give therefore legitimacy to a discourse of praxis and their voice or perspective has considerable resonance. According to Pierre Bourdieu (1977: Chapter 4 on structures, power and habitus) the respect shown men, elders and ancestors represents a marked dimension of their ‘symbolic political power’ whereby they impose the principles of the construction of reality, in particular social reality. Female actions, however, confront the dominant male discourse and challenge its supreme status. Women may be seen to undermine the male discourse in their more immediate access of the market and, judging by the popularity

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of markets among young men, there appears to be something very similar in the way both sexes seem attracted by its ‘charm’. Young men and women have, however, very different agendas when frequenting markets where women’s activities as sellers of foodstuffs, vegetables, shea butter, cooked food and a variety of manufactured commodities of African and Western origin occupy the largest space and dominate the marketplace. Ultimately women envision a very different future (need for support of sons and kin in old age) than men who primarily focus on making friends in the market and converting these friendships to marriages that will lend support to the patrilineal descent and power structure. We note the place of ‘traditional’ trading activities in modernity and again we obtain confirmation of ‘modernity’ (capitalism and the market) needing ‘tradition’ to prove that it is modern; it cannot do without men’s and women’s traditional/conventional agendas either. The ‘public’ and the ‘domestic’ worlds of men and women appear separate, but are in fact inter-connected. Oppong (1983) calls attention to the ‘complementarity’ of gender roles in West African societies. The worlds men and women live in appear separate but in praxis their lives interconnect and they collaborate in the social and biological reproduction (including healthcare) of society and its core unit, the family. One strong illustration of this point is Enid Schildkrout’s analysis of the ‘hidden trade’ of secluded Muslim Hausa women in Kano-city in northern Nigeria (Schildkrout 1983). Schildkrout shows that in spite of their constrained lives (they live in seclusion in their homes), women are able to produce for the market. They run with the help of their children – who sell their products outside the home – a trade from indoors. They thus ‘subvert some of the implications of purdah’ (Schildkrout 1983: 108). However, male and female worlds come together in the fact that secluded women sustain their families with the incomes from their ‘hidden trade’ (see also Clark 1994 regarding the ‘good’ mother who is also a trader). In producing their futures women and mothers invest their energies in caring for their children. And this often means the use of various commodities, including frequent use of pharmaceuticals, and visits to clinics for health care and check-ups. Women’s quest for medicine is partly patterned by Dagomba customary greeting and begging. Their medically pluralistic behaviour is grafted onto that structure which allows individuals (often women) to expand their ‘traditional’ needs for healing medicines to treat themselves and their children and to exploit the opportunities created by markets and commodities, including Western pharmaceuticals. Women’s actions are part of a specifically female strategy of producing a future. These are additionally configured by the present structural adjustment policies that Sanders and his colleagues in their studies of

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Zimbabwean households have shown to have had a negative effect on child health and nutritional status. Child health severely suffers because of the reduced quality of food intake producing stunting in one-two and threeyear-old children (Bijlmakers, Basset and Sanders 1996 and 1998).4 We have seen how medical knowledge is produced. Given its production by men and the ideology surrounding the healing quest, which does not accord with the reality or praxis of female health care, it is necessary to explore the relationship between ideology and the actual caring practices of women. This may be done by throwing light on their strategy and looking at the steps of caring they take, which follow from certain basic seasonal constraints embedded in the yearly farming and seasonal cycle. These actions proceed over to health checks and visits to the Western clinic. Looking at these various steps (which often involve a great deal of self-treatment with medicines), we note how their quest is marked by season, residence pattern, needs of reproduction in relation to the size of households, and the inconsiderate, rude, often condescending, attitude women as patients experience at the clinic. These experiences at the clinics transform their pursuit by inserting a ‘distance’ between the health personnel and their ‘scientific’ views on the one side and women as patients, held to be ‘ignorant’ and adhering to village (and ‘outmoded’) ways on the other side. One senses a juxtaposition of ‘science’ and ‘local culture’ (by this biomedical definition, ‘unscientific’), this time performed by black health professionals wearing ‘white masks’ (Fanon 1968), replicating this division. The distance is one created by the biomedical system teaming up with capitalism to produce an impersonal discourse. By the power invested by capitalism, the system moulds medicine as an often rather uncaring structure sharing the impersonal language of capitalism and the same premise: it is only prepared to deliver care and dispense medicines when immediate payment of fees and costs are forthcoming. The healing quest transforms into one where patients submit to the biomedical figures of power and authority. Nurses and dispensers come to symbolize fields of power. We may thus speak of a transition from ‘healing in the context of a culture’, which is both more ‘considerate’ (person-oriented and culturally-sensitive) and marked by the claim of men to be in control, and ‘healing in a biomedical context’ with its corresponding distant and aloof forms of medical (scientific) knowledge, ideology and power seamlessly backed by a technical and medical language.

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Seasonal Constraints and Access to Money As we noted in Chapter 1, women perform differently, have different plans and are better able than men to generate cash throughout the year – spanning a wet and dry season. The Dagomba also appear to maintain a sharp division between male and female worlds (but see Oppong 1983). ‘Men farm and women cook’, they say. Men compete for political offices, engage in religious activities and head households. Women are considered jurally minors and confined to domestic activities, including cooking and childcare. As I also noted in Chapter 1, husbands and wives keep their sources of income separate. Women have various independent sources of income. They pick shea nuts all year round. Shea nuts are used in the production of shea butter, the major source of cash for many village women. Other petty income-generating activities include the selling of vegetables, surplus farm produce, cooked food, and so on, in the market (Fig. 7.1). Apart from trading and marketing, women nowadays also farm. Of the women in Duko that I knew, at least eight had their own farms. Men expect their wives to use their own money to grind the corn for the evening meal at the grinding mill. Women are also expected to use their

Figure 7.1. Women on Their way to the Savelugu Market

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own money to buy vegetables and spices for the soup. It is understood that husbands contribute to household expenses and child care. Wives know, however, that husbands are often not present and do not always have money that they can give them. Men are primarily farmers. Some men also own cattle while most men own sheep, goats and fowls. They occasionally sell their livestock or fowls to pay a hospital bill or to meet another major expense. Compared with women, men’s incomeearning possibilities are limited. The agrico-climatic conditions do not support farming throughout the year. During the prolonged dry season (November–March) only those who live near river valleys engage in farming (Table 1.2). Cotton is the only cash crop men grow. The occasional cash that they generate they often spend on entertaining other men and converting their resources into male-oriented and ideology-supporting schemes, including building up and maintaining marriages and diverse customary obligations to spouse and kin. Women, on the other hand, appear to be differently affected by the dry season than men. Women do not lead a constrained life but engage in numerous income-generating activities as farmers, hawkers and traders (see also Clark 1994). They always have a little cash to buy Western medicines. Women cooperate economically (e.g., they come together in so-called ‘women-groups’ to produce shea butter), but not over child care (which is often performed by kin or co-wives one is friendly with) or otherwise (Nelson 1978; Ardener and Burman 1995). Women-groups are not, however, in any way expressive of women attempting to organize themselves politically, to express female solidarity. In theory, the household head controls the medicines (or, at least some of them) needed for treatment in his home. In daily life, however, the control of the male head (and men in general) is continuously questioned. Most of the time people do not report their symptoms to the head. They simply treat themselves with Western or local medicines. They may have medicines left over from ‘last time’. Many local medicines are storable, including charcoal medicine and medicine balls. (At one point I stored kpaga-medicine balls for months on my kitchen shelf.) Moreover, men’s ability to pay for Western medicines is limited. Men’s lack of cash causes them to be peripheral to family health care and a great part of the moneyeconomy, especially the one centring on local markets, seems to be in the hands of women. It seems as though women are increasingly taking over the traditional male role, looking after the health of the family. (In areas of northern Ghana where Western medicine is a remoter possibility, the challenge posed by commoditized medicine is less felt and the use of local medicines greater.)

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Residence Pattern Can we translate circumstances of residence into involvement in health care? In her study of ‘Attitudes to Diarrhoea in Ghana’, Abu argues that men’s greater or lesser involvement in decision making concerning treatment is relative to residence patterns (Abu 1990). Where fathers are not jointly resident with their wives and children, as among the matrilineal Ga and Akan of southern Ghana, they are not ‘involved at all in decision making, only in paying for drugs’ (ibid.: 18). According to the same study, fathers’ involvement in decision making appears to be greatest in villages in the Upper Region, the northernmost part of northern Ghana, where fathers are co-resident with their wives and children and where the reliance on local medicines is greatest (Western medicines not being obtainable in the remoter villages). In this case, men are regularly informed by their wives of their children’s sicknesses, and they provide the botanical preparations needed in treatment. Corresponding to the greater reliance on men and their medicines, male control may be greater in that region. ‘Regional variation’ seems to qualify the picture. When we consider the Dagomba living in the middle of northern Ghana we are again compelled to ask whether residence pattern is a relevant factor when determining men’s involvement in health care? In Dagomba, fathers are co-resident with their wives and children and the reliance on local preparations is considerable. However, fathers do not seem to be much involved in decision making concerning ‘minor illnesses’. The caretaking responsibility rests with wives. Only rarely do fathers pay for medicines. Men are peripheral to the daily health care of the family which, in theory, it is their duty to provide. In practice, mothers are the primary caretakers of small children, who sleep with them. Mothers, for example, say that ‘If your child is sick, you will try to treat it. Because when night falls, you are alone in the room with your child and if s/he doesn’t sleep …’. A prompt response is required when a child is sick. Mothers feel there is no time or need to inform their husbands. They are also very often absent from home – on their farms or in the company of other men – or they may simply not have the means (money) to help. Thus, women emerge as the main decision makers concerning their children’s health.5 However, as we noted in our discussions of the ‘sick role’ in Chapter 6, men do get involved when a case gets out of control, when they are asked to use their contacts to provide medicine and when diviners and other specialists, such as bonesetters, have to be consulted.6

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Coping with Illness and Family Size The question of women’s decision making has so far been examined with reference to the sexual division of labour, men’s delegation of child care to women, seasons and the differential incomes of men and women, as well as residence pattern. Another factor of possible relevance to the issue of decision making is household size. Meillassoux formulates the problem to be explored by observing … it is the necessity to face the hazards of illness and premature death which tends to enlarge it [the small nuclear family]. A unit constituted solely for production functions is too small to guarantee its own continuous and regular reproduction. (Meillassoux 1984: 43)

In pursuing the implications of his commentary, the question is whether the size of households influences decision making and men’s involvement in health care. More specifically, is a big household better equipped to cope with sickness than a small household, or are men more involved when households are smaller? Last notes that among the non-Muslim Hausa, or Maguzawa, of northern Nigeria men are not much involved in the daily care of sicknesses (Last 1976). The Maguzawa live in dispersed farmsteads, small and big, composed of few-many household ‘units’ (groups of people eating from a common pot). The degree of exposure and experience of different kinds of illness varies. Small farmsteads experience less exposure to sickness than big farmsteads. Small farmsteads – because of their size – also appear to be more united, while big farmsteads are internally differentiated along sex-dichotomous lines into separate units of men and women-plus-children. According to Last, men’s involvement in health care depends upon the ‘ratio of men to women-plus-children’ (ibid.: 137). In small households with fewer women and children (and a 1:1 ratio of men and women) there is less of a tendency of women-plus-children forming separate units. Mutually interdependent, cooperation between the sexes is relatively great. Consequently, men’s participation in healthrelated problems is significant. Testing Last’s point about household size and illness management, and bearing in mind the specific stages households have reached in their developmental cycle (Chapter 1), one can – based on the census data from 1990 – divide the households in Duko village, the site of my field work at various times in the 1990s, into two groups, ‘young’ and ‘old’. ‘Young’ households comprise married men of an average age of 25–45 years, while the average age of men in ‘old’ households is 45 years and above. The

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following picture emerges: fifty per cent of households (comprising three to nine residents each) are ‘young’ while the other half is ‘old’. Small households display a ratio of 0.7 man: 1woman-plus-children. Next, there are slightly more ‘young’ than ‘old’ households of a medium size (with ten to nineteen residents). In such households women outnumber men by a ratio of 1.7:1. Finally, in most ‘old’ households (more than twenty residents) women outnumber men by a ratio of 2:1. In other words, Dagomba households are both monogamous and polygynous; this generally depends upon the age of the householder. Fifty-five men were married to sixty-nine women when the census was taken in 1990 (Table 1.1). The average number of wives per husband was 1.2:1. Attesting to the complex composition of households, these variously include mothers, sisters and visiting daughters, often bringing with them their small children. Households may also be composed of the wives of the head, their married and unmarried children, the householder’s brothers and their wives and children, and various sets of foster children. Big households are more composite and differentiated than smaller households. Generally, men head households. In 1990 only one household was headed by an old, terminally separated (divorced) woman. The dominant patterns was for mothers (eleven at the time) to reside with sons, sisters (ten in 1990) with brothers, and daughters (thirteen, 1990) to return to live with their parents for a period of time with their young children and/or when divorced. Household size may be a relevant factor when measuring exposure to and experience of sicknesses. Clearly, small households experience less sickness than households with many women and numerous children. As noted, the large household is more differentiated than the small household and includes different sets of wives. At times co-wives work peacefully together and share their spices and vegetables and store them together. Cooperation between wives also means ‘free time’ to pursue other tasks, such as individual farming and trading. However, jealousy easily builds up between co-wives and can prevent cooperation and sharing. A small household where husband and wife depend upon one another in the pursuit of daily tasks appears more vulnerable in times of crisis. On the other hand, and consistent with the fact that the small household is less internally differentiated, men appear more involved with the minor illnesses of their children when households are smaller, however (cf. Fortes 1949: 133). At the same time size is probably a less relevant factor when looking at the management of the bulk of sicknesses that are not incapacitating and ‘minor’ and permit people to go on working. The small household is not badly equipped to deal with sickness compared to the big household (with its many helping hands). Support

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can namely always be mobilized from outside the home. Opportunities to meet and exchange experiences of sickness and ideas concerning treatment are not lacking outside the home. Women exchange ideas on the farm, when working together in the market, when visiting each other and when they meet on the village path. Young women consult older, experienced women for their advice on the treatment of symptoms. When they are in need of medicine women use their personal contacts. The little household is as able to cope with sickness as the big household. It is possible that the big household is better equipped with medicines to treat common symptoms but it also experiences more sicknesses than smaller households. If therapeutic resources are not available from within, kin, neighbours or friends are asked for assistance (the quest for a cure can easily take a person outside the village). As we noted above, ‘asking for a favour’, suhibu, exists as an informal behaviour around which spring up networks of cooperation for purposes of work and the management of sickness. Such networks ramify into different parts of the village and beyond. There is, therefore, no immediate pressure for women to be able to act self-sufficiently within the household. A neighbour or friend is always close by and nobody is afraid to ask a friend or kinswoman for a little medicine, oil or spices. Knowledge about sicknesses and access to health care is evenly distributed in the village. Sharing and exchanging medicine is as widespread outside the home as it is inside the home. Help is never far away (see Fig. 1.3 of Duko village, a typical village, where the distance between individual houses is often less than 150 yards).7 The fact that help is never far away in the Dagomba community becomes most significant when evaluating biological as well as social reproduction. In the light of the discussions on ‘medical uncertainty’ in Chapter 6, Last’s (1976) comments in his study of ‘The Presentation of Sickness in a Community of Non-Muslim Hausa’ are very appropriate. Last notes the problems of obtaining accurate information about sickness. People are uncertain, and those other than the sick person are generally badly informed about his or her condition. Sickness is not talked about by the patient, though word may spread haphazardly around the farmstead; haphazard because there is no ordered system of who tells whom. Chance encounters govern the spread of news, or, as often, non-news. Misinformation is common if there is no good reason to tell the truth; the questioner does not have a prescriptive right to the proper answer if the question is not itself proper. Leading questions are assented to, and wrong interpretations allowed to pass: in this way quite erroneous accounts of an illness may grow up within a small group. It does not matter, as nothing comes of the talk; but scepticism about such details becomes habitual. (Last 1976: 116; see also Last 1981)

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We still need a statement, however, that unequivocally answers the question of whether it is ‘natural’ to care? Again Meillassoux reminds us It is the procreative powers of a woman that are the subject of [marriage] negotiation when she is taken into another group for a period generally held a priori to last as long as her fertility. (Meillassoux 1984: 43)

Defining the strategy of care in Dagomba, at menopause (indicating the end of her reproductive career) a woman often divorces her husband and goes to live with a son or brother.

Biomedicine and Cultural Premises Biomedicine is as diverse and has as many forms as there are different cultures and societies and cultural milieus within which it operates. The practice of biomedicine in the U.S. distinguishes itself clearly from the way it is being performed, for example, in Japan (Ohnuki-Tierney 1984) or Zaire (Janzen 1978). Often, operating alongside a local culture of healing introduces us to a rich scene of medical pluralism. Studying biomedicine and culture means, however, also studying biomedicine as a system and in terms of the ‘distance’ it creates between itself and the ‘other’, in this case local mothers. As the following case shows, Dagomba mothers carry the primary responsibility for the health of their children. They must be able to make prompt decisions regarding treatment. Often they do not think there is the time or the need to inform their husbands. They simply treat the symptoms with local or Western medicines. Western medicines afford a popular ‘bypass’ around the need to engage in greeting and begging.8

Case: Aishatu Takes Her Sick Baby to the Clinic The following is the case of Aishatu, a thirty year-old mother (1991) who decided to take her four-month-old baby to the Western clinic at the district capital of Savelugu, four miles away. Aishatu explained to me: My baby had a high fever and was vomiting and running with diarrhoea continuously for four days. She was restless and cried a lot at night. I asked Kpanalana [neighbour] for medicine. He gave me kpaga-medicine [medicine for general bodily disorder, often used as a ‘first aid medicine’]. Her [baby’s] situation did not improve. I realized that if I don’t go [to the clinic], people

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will start to talk. Something may also happen. I didn’t know what to do. I was afraid. Then I sent her to the hospital [clinic].

The Savelugu Health Centre, referred to by local people as ‘hospital’, ashibtini, was built in 1965. In 1991 it had no electricity. It was staffed with a medical assistant, a health inspector, a number of public health nurses, an injection nurse and two or three midwives. It had four beds. It also operated a maternity ward and an ante- and post-natal clinic. It was primarily an out-patients’ clinic. People visit the clinic with the same complaints as are treated at home, such as fevers and diarrhoeas but which have become difficult to control. Infants and children under fifteen years of age and adults between the ages of sixteen and forty-four make up the greatest number of patients at the clinic. Relatively few people over the age of forty-five (five per cent) attend. As the village survey shows, infants and adults over forty-five are the segments in the population most susceptible to illness (Fig. A.2). Mothers are particularly concerned with the health of their children. Similar, but mostly less dramatic medical problems in adults do not cause the same concern. There is the general difficulty for a sick adult to reach the clinic while a baby can easily be carried on the back of its mother. Older people are therefore reluctant to go and cite the distance and the cost of motor transport. They explain that there is no point in going to the clinic. The medicines which are prescribed at the clinic are the same as those that can be bought with no additional effort from the drug peddler (Chapter 8 e.g., pp. 168–72). This also explains the general attitude of people to Western health facilities, which people know are often short of medicines (see Chapter 4, p. 76). Let us return to Aishatu and her baby. The medical assistant diagnosed malaria and prescribed a chloroquine injection to treat the fever, ORS (Oral Rehydration Salt) and additional paracetamol and chloroquine syrup. Aishatu paid 50 cedis (the equivalent of 10 pence in 1991) for the injection. However, she did not have enough money to pay for the rest of the drugs (575 cedis, approx. £1, 1991). The dispenser said that he could only sell her some of the drugs and that she would have to come back later with money to buy the rest. Aishatu pleaded with the dispenser to give her the rest ‘on credit’. He asked her why she had come to the clinic without enough money. Aishatu: You and I, we are both Dagomba. Why do you say that? The Dispenser: What you are saying doesn’t mean anything (lit., ‘isn’t anything’). When you go to the clinic, don’t you bring money with you? I have given people

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medicine on credit before but they did not pay me back. Therefore, I will not sell on credit. All village women are the same [i.e., they all want to buy on credit].9 Aishatu: I know you and your father. The Dispenser (unyielding): If you don’t have the money, you must go home for the money first. The Dispenser (summing up the situation, saying that since Aishatu does not have enough money to buy all the prescribed drugs, she should pay for some of the drugs now and return with money later to buy the rest): Choose the drugs that you want. Which one do you want? There are two bottles [paracetamol and chloroquine syrup]. Which one do you want to buy? The Assistant Dispenser interjects that one cannot sell medicine like that, splitting up the items on the prescription. One has to buy the whole lot: You are not supposed to collect something and leave something. Come back tomorrow with all the money. Aishatu: I can’t go without something. The Two Dispensers: When you come home, you can send somebody to come and pay and collect the medicine [i.e., the remaining preparation]. Aishatu: If I send somebody he will not reach you [before you close].

At this point I interrupted the discussion. I lent Aishatu the money so that she would not have to come back to the clinic the following day. Aishatu’s case illustrates a mother’s concern and response to the sickness of her child. It shows the woman as decision maker, her decision to go to the clinic without consulting her husband, and to spend her own money. Aishatu’s discussion with the dispenser demonstrates that people do not understand the rationale of the Western medical system, which is disease- and not person-focused and premised on the paradigm of ‘fees for services’. Local people are bewildered. This focus is antithetical to the culture of ‘begging for medicine’ and greeting behaviour in general. Greeting is a symbol of solidarity and the idiom through which people

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affirm existing social relationships. This explains then why Aishatu appealed to the dispenser stating that she knew him and his father (see also next chapter on the ‘adaptation’ of health care to the local culture).

7.4 The Ethics of Care and the Female Strategy of Child Care On the surface women appear unimportant, dependent upon and dominated by men. However, surface impressions belie the reality of women’s economic independence and freedom in the realm of family health care. Women have their own discourses or strategies: they grind, pound and cook food, they trade, and provide for their children’s health. Sicknesses are part of their everyday experiences. They treat these confidently with medicines. They do not need experts (and there are no experts in the local culture) to tell them what the symptoms are a sign of and how they should be treated. Care is moulded by kinship. A deep emotional bond exists between a mother and her children. She sleeps with them when they are small, cooks and feeds them. Fortes notes that ‘Kinship relations are essentially moral relations, binding in their own right’ (Fortes 1949: 346). These relations are modelled on the ‘inevitability of human interdependence’ as first experienced in the family by the child who is dependent upon his parents’ care and affectionately trusts them. Like the Tallensi Fortes studied in the very north of Ghana, the Dagomba attach the greatest importance to children. They are the very centre of a woman’s existence and represent her chief asset in old age. A mother does not neglect her children. She always fears sickness in her children and grieves when her child dies. The relationship between parents and children is characterized by ‘mutual trust’. Being guided by Fortes the argument is that parents are devoted to their children and entitled to respect on the grounds that they have begotten them: ties of kinship exist. ‘Filial piety’ (the duty of the child to support his parents) springs from ‘the fact of birth’; it is ‘the counterpart of parental duty and devotion’ (ibid.: 171–86; Goody, E.N: 1973: 173–81). Moreover, and reflecting the interests and solidarity of each ‘matrisegment’, duu (i.e., each unit of wife/wives and their children), within the domestic family, each woman thinks of her own children first. She takes care first of all of her own children who will be better cared for and fed than the children who are not her own – those of her co-wives. Dagomba mothers care for, feed and protect their own children with devotion (Although I have heard men express a preference for boys, I have never heard or seen mothers deliberately treating boys differently from girls.) In Chapter 1, I noted the independence of each matri-segment vis-à-vis other

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matri-segments in the polygynous family. This observation is crucial for determining the existing pattern of care. A mother invests first of all in her own children and not in her co-wife’s children or her foster children. Thus, a category of children that easily gets neglected is foster children. They are often not cared for the way a parent cares for his/her ‘real’ children. Some adults report that their foster parents did not feed them well and that they were often beaten (cf. Bledsoe and Isiugo-Abanihe 1989). Orphans also endure a difficult lot. They often go hungry (I do not have sufficient data on this, but see Oppong 1973: 40; consult also Bierlich 1998 about child care among the Dagomba in general). Feminist anthropologists have questioned the ‘naturalness’ of mothering and called attention to the cultural patterning involved (e.g., Moore 1988: 25–30, 1994). Most writers agree that the fact of having given birth to children implies a strong urgency to care. Following their argument and testing it against our Dagomba material in order that such a claim not simply remain another of those unquestionable truths, we must investigate how this may accord with other social facts. In the present context we note the particular social circumstances in Dagomba, such as low marriage stability (and the absence of bridewealth payments) and women’s post-marital residence with sons and brothers, that may explain women’s motivation to care for their children. Mothers know the importance of having children that can support them when they are no longer married. They spend their energies and money on their children’s health. They cultivate their relationship with their children, and in their old age their regular ‘payments of instalment’ towards their children’s welfare ‘pay off’, just like a good pension scheme. While expecting no support from their husbands’ group (husbands easily divorce their wives and vice versa), wives know that they can count on their adult children (sons) reciprocating the care they received when they were young by taking care of them when they come to stay with them in their old age (when they are past the age of child-bearing). The Dagomba consider it a moral duty to support the mother ‘who bore you’. Since women have no public power, they invest their personal wealth and other resources elsewhere, in their children. Children are a woman’s wealth. She is proud of her children, they give her respect and the more children she has, the more helping hands there are. Children are also a woman’s future. She invests in her children rather than in marriage. By investing in their own children and fostering them to their kin mothers give expression to the importance they attach to their children and their kin. Through fostering, the mother ‘draws’ her children nearer to their maternal heritage. The brother-sister bond appears to be stronger than the relationship between husband and wife.

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The chapter considers the paradoxical situation of the married woman: she is an outsider to her husband’s kin. At the same time her fertility is of vital concern to her husband. He has a vested interest in the health of his wife and children. On the one hand she is thought of as a witch and foodpoisoner, on the other a sexual partner, a food-giver, care-taker and curer. Since wives as ‘strangers’ threaten their husbands’ groups, and through their witchcraft introduce illness in the first place, it may seem only natural to men that their wives should take care of illnesses in their families. Thus, on the one hand, men fear women placing poison in food and using medicines to kill them. On the other hand, men have no choice but to trust their wives and eat the food they cook. They know that women and surviving offspring are indispensable to the perpetuation of the lineage. Men have – even though this challenges their power over women and their control of medicine – delegated the business of taking care of small children to women, which involves their frequent use of medicines (Fig. 7.2).

Figure 7.2. Mothers With Their Babies Attending the Monthly Village Clinic

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In this connection we identify a specifically female strategy of caring and making decisions, a strategy that often involves bypassing men. Healing thereby becomes associated with money and has a commoditizing approach, which contrasts with local, personal and non-monetary transactions. This approach is contextualized in the ideology of male control of the healing quest and the reality of female curing and caring. The female actions also bring her into contact with the biomedical system, its medical knowledge and power holders. In this way, ambivalences are accentuated and the ‘problem’ of money and commoditization made more noticeable. While women make individual decisions concerning treatment, and use money to access the power of Western medicine, they are bewildered (e.g., Aishatu’s case) when confronted with an entirely impersonal discourse. In fact, both sexes are, and come together in their reaction, which is characterized by ambivalence (cf. section 5.4). Men may, however, have most to lose, not only in terms of their control with local healing but also their power over women. Finally, it would be wrong to dichotomize the field of medicines into ‘healing’ and ‘prophylactic’ (or ‘defensive’) medicines. Both types of medicine are interrelated in the definition of Dagomba medicine, tim. Prophylaxis is essential for strengthening the person. Without the necessary strength he falls sick and must be treated with healing medicines (botanical preparations and/or pharmaceuticals). In the next and final chapter I consider the relations between women and men in the context of healing, the economy and the market. The conflict between the sexes in the realm of healing connects with the way monetary and non-monetary exchanges appear antithetical and the manner in which ‘tradition’ seems opposed to ‘modernity’. Interpretations are ‘contextual’; modern and traditional practices are often interwoven and an understanding of money and its uses as moral/immoral depends upon the specific situation in which it is involved.

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Notes 1. The non-curative medicines that appeal to women (i.e., aphrodisiacs) are made and sold by men. 2. ‘Begging’ is, however, not synonymous with what suhibu, ‘begging’, means in other contexts, where begging is associated with asking for money or food as a gift or as a charity. The beggar, baramanga, makes his living from begging. Begging for food or money is below most people’s dignity and begging is generally looked down upon. 3. The exceptions are the ‘princesses’, na-bihi-purungsi, literally ‘daughters of chiefs’, who have nothing to lose and everything to gain from acquiring reputations of possessing powerful medicines, in particular prophylactic and aggressive ones. They can go anywhere at any time to ask for medicines, just like men. They in their turn, are visited by men who come to request medicines from them. These princesses are mostly advanced in age and because of their chiefly status foster pride rather than fear. Men speak with great respect and pride about these women, most of whom, I was told, live in the eastern part of Dagomba, in the Gushiegu division. 4. What the Nordic Africa Days in 1999 and the session on structural adjustment I participated in showed, with excruciating clarity, was the need to emphasize the consequences of Structural Adjustment in the realm of health, and with regard to gender and population policies (Sen, Adrienne and Chen 1994). In the light of the present argument, men and women collaborate in the working of the family while engaging two different futures. To achieve sustainable human development, population policies have to be envisaged not as a narrow and one-sided project but one that includes both voices. Both genders need to be engaged and ‘empowered’ within a context where the social structure and economic flows always matter. 5. In the Bawku- and Bolga-areas of northern Ghana it is the norm rather than the exception that women provide the necessary health care. Due to migration men are very often absent from home (S. Abudulai in personal communication). 6. But even this may be changing. Today consulting diviners is no longer the prerogative of men. Many (Islamic) diviners in Tamale are being consulted by women as well. In urban centres like Tamale, women have attained a relatively high degree of economic independence. Many keep small businesses. They consult diviners regarding their fortunes and how to avoid bad luck. Men complain that the diviners are selling themselves for money. ‘It’s all about money. That’s why they are here.’ Men note that in the past consultations were not money-based. ‘A coin or cowry that was all that the diviner would take. But these days, the urban women have spoilt the diviners. Not just women but the rich urban people.’ They give 200–500 cedis (the equivalent of 50 pence to £1, 1991), where a villager will give 20 cedis (5 pence, 1991) – see also next chapter on ‘money spoils the medicine’: ideology and the contexts of curing.

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7. While women stress that children never go hungry, it would be interesting to know whether this is indeed the case and whether or not children in small households are more exposed to hunger than children in big households. It would also be relevant to know whether children’s health and that of the family suffers more in the hungry period (April–July) than at other times of the year. The massive occurrence of guinea worm (causing incapacity) at this time of the year suggests that this may be the case. The full elucidation of these questions, however, requires further field research concerning food, hunger,and its management at the household level. Such an analysis may complement the investigations of Bijlmakers, Basset and Sanders (1996, 1998) into health and structural adjustment in Zimbabwe. 8. But, as Leslie points out, it is not only a question of the mother providing care to her children. Her own health is always in question as well for the simple reason that it takes a healthy mother (a mother who is nutritionally fit) to have a normal pregnancy, to deliver a healthy and normal baby and sustain lactation. This is a particularly serious problem in countries of the Third World where about 500 million women are anaemic (Leslie, J. 1991: 4; see also note 4 above). 9. To understand the argument, one must bear in mind that local herbalists do not demand money. They say that ‘money weakens’ (or ‘spoils’) the medicine, which they have inherited from their fathers who did not ask for money either (see also Chapter 5 and next chapter).

Chapter 8

THE PROBLEM OF MONEY: MONEY AND MEDICINE

Money poses several problems to us. We Westerners say that money, as the medium of buying and selling, is opposed to ‘genuine’ social relationships. If it is we who think that cash subverts moral categories, we must explain why the Dagomba, like many Africans, do not think like we do. For the Dagomba money causes no moral confusion. Old men may see money as subversive of social solidarity but they themselves can be seen to use it: money may be necessary to the survival of the family or the maintenance of the social structure. In this final chapter I examine and take a fresh look at the so-called ‘problem of money in medicine’ in relation to socio-economic processes and gender dynamics. This exploration shows that monetary and nonmonetary exchanges in the domain of healing cannot be equated with individualism (money) and altruism (gifts) in a straightforward fashion. Exchanges and purposes are made meaningful by the ‘contexts’ in which they occur. Exchanges may involve money and be commoditized. However, the very fact that the exchange is made in a ‘benevolent and considerate manner’ (which often means selling/buying on credit), transforms otherwise impersonal relationships between healers and patients at local clinics (previous chapter) and those between medicinesellers/drug peddlers and their customers (this chapter) into moral exchanges and displays of solidarity with the communal goals of Dagomba society. At the same time the power of impersonal and commoditized ways is overwhelming and produces many ambivalences in locals.

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8.1 Introduction In the following we place the previous discussion of illness management at the household level in the wider context of women’s and men’s monetary and non-monetary activities. Parry and Bloch make a useful distinction between the existence of ‘short-term’ and ‘long-term’, ‘separate’ but ‘related’ exchanges in society. One sphere is designated as concerned with ‘short-term’ exchanges of moveable goods (such as money and surplus grains) – ‘the legitimate domain of the individual’. The other sphere, depending upon the first, refers to a ‘cycle of long-term exchanges concerned with the reproduction of the social and cosmic order’ (Parry and Bloch 1989 1989b: 2). Parry and Bloch note that shortterm individual acquisitiveness and a long-term collectivity-orientation can be found to exist side by side, in different spheres, in many societies. Therefore, The problem seems to be that for us money signifies a sphere of economic relationships which are inherently impersonal, transitory, amoral and calculating... But clearly this awkwardness derives from the fact that here money’s ‘natural’ environment – the ‘economy’ – is held to constitute an autonomous domain to which general moral precepts do not apply. Where it is not seen as a separate and amoral domain, where the economy is ‘embedded’ in society and subject to its moral laws, monetary relations are rather unlikely to be represented as the antithesis of bonds of kinship and friendship, and there is consequently nothing inappropriate about making gifts of money to cement such bonds. (Parry and Bloch 1989 1989b: 9)

It is not money as such that is a problem for the Dagomba, rather what money can do to personal relations. Monetary and non-monetary exchanges exist side by side in Dagomba society. There are ‘opposed’ but ‘related’ ways of obtaining medicines: a) through the idiom of greeting, and b) through money. Non-monetary activities based on greeting are ‘opposed’, but ‘related’ to transactions involving money. Individual exchanges involving money are evaluated and harnessed by the family, lineage and society. Money is employed by individuals to achieve ‘short-term’ exchanges in the mundane world upon which the more permanent edifice of the ‘long-term’ moral order (patrilineal descent) rests. As we saw in the previous chapter, mothers make individual decisions and buy Western medicines to protect the health of their children, upon which the continuity of the lineage and their future rests. Like the interests of society and the individual, women’s and men’s activities (whether economic or medical) are only superficially opposed to each other.

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The discussion in this chapter consists of two parts. I begin with an examination of Dagomba notions of money and wealth, and I discuss the impact of capitalism and the market on male and female roles. Next, I analyse the total field of Dagomba monetary and non-monetary exchanges. One particular form of exchange, that of giving and selling medicines, is the focus of a longer discussion. I conclude by pointing to the inter-connectedness of individual and social goals and activities. Society is made up of individuals following individual strategies without which society’s existence is inconceivable. The complexities of modernity are inserted in an economic context, where individual and collective wealth accumulation is seen as opposed but also interlinked. Ambivalences over individual wealth accumulation as well as the power of biomedicine and the nexus of money and healing refer individuals to the collective culture and society from which they stem – the social structure and the notions of the person and his powers (see, e.g., jogudiscussion in Chapter 5). Modernity is shaped by comprehensive epistemologies, the key role of kinship and magic. Society cannot exist without ‘individualism’ which may be constructed as ‘destructive’ of (local) collective ways and personal relations but also indispensable to the existence and perpetuation of the society and its families. Individualism, capitalism and local ways are interconnected. Money and its use may be moral and approved in one context but immoral and outlawed in another. It is, in the end, contexts that define what is moral and immoral. Thus, occult practices – magic – and inclusive notions and behaviour do not signal ‘a return’ to traditional practices, ‘backwardness’ or a ‘lack of progress’. Rather they belong in no uncertain way to the modern world but involve a great deal of uneasiness and moral disquiet, and reflect the fact that the promises of the market are only accessible to an elite few.

8.2 Wealth, Health and the Community To illustrate my point about the contextual value of healing exchanges, I begin by considering Dagomba notions of money, ligiri, and wealth, buni, arizichi, and their representation. The concept of wealth is inclusive and refers not only to a person’s material wealth, but also to his social status and reputation. It is often couched in the language of health/its absence and thus refers to the broad, wide-ranging nature of Dagomba thoughts on health, illness, the person and the symbolic structure of society and the economy. A central interpretation in Western culture is that ‘money is the root of all evil’. At the same time, money is also a ‘necessary evil’.

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The foundations [of society] are laid on individual acquisitiveness, the love of money and pursuit of profit. Thus, good and evil [acquisitiveness] are mixed in the roots of modern society. (Macfarlane 1985: 71)

That money should be ‘the root of all evil’, as Western thought describes it, has no direct parallel in Dagomba thinking. The ‘closest’ one can get is the notion that money corrupts curing, which is held to be a communityservice (see pp. 164–8). In order to characterize Dagomba representations of money, one must broaden one’s focus and look at notions of ‘wealth’ and how it is represented, however. In Dagomba culture money cannot be discussed independently of ‘wealth’ (buni or arizichi, a Hausa word). When people list what makes somebody a ‘wealthy person’ (bun-dana), they list animals, yields (‘he has food’), money, and the fact that he has soand-so many children and wives and that he is generous, ‘helps people’. In fact, all Dagomba married men with children are considered to be wealthy and, by implication, to be in a strong and healthy shape. Being subsistence farmers, there is little differentiation of wealth. This is not to say that individual differences in the possession of property do not exist, however. O kpagisiri ven yielinga, ‘he manages well’, people say admiringly when referring to somebody who is thrifty and a good manager of his resources. However, only people who know you well may be willing to disclose information about their wealth, and only after questioning do people distinguish between individual possessions and family property.1 Within a cattle herd, for example, there may be both family- and individually-owned cattle. One must therefore always enquire whether the person acquired the cattle ‘by his own sweat’ or whether they have been inherited and thus belong to the family, dogim (Oppong 1973: 19).2 The Dagomba do not count ‘land’, tingbani, among a person’s riches either. Most land is acquired by patrilineal inheritance, family or ancestral land passing to the eldest son, bi-kpema, or to the father’s most senior brother, dogari-kpema, who then is responsible for the cultivation of the collective property of the family (Abudulai 1986: 83–86).3 Land is not conceived of as a commodity, a thing that produces wealth (and has a monetary value) – the way it is often conceived of in Western cultures. Land is ‘what gives us food’, people say. According to customary Dagomba law of land tenure the absolute right or ownership of the land belongs to the community. No individual can sell a piece of land he is occupying. Land is not transferable. The land ‘belongs’ to the chief, who represents the king and the community. One cannot sell land, because one cannot cut off the king’s, the chief’s and the community’s absolute right to the land.4

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With regard to the assessment of wealth (and health), people are always reluctant to discuss and assess their own or their neighbour’s possessions or the condition s/he is in. To begin with, people do not believe that an individual’s circumstances are necessarily permanent. The one who is poor today may become rich tomorrow, and the one who is rich now may experience poverty in the future (Hill 1970, 1972). Second, attributes such as ‘wealth’ and ‘reputation’ can mean different things to different people and can be stretched to describe oneself or portray others. There is also a tacit understanding or orientation among the Dagomba that one must not strive to be better or richer than one’s neighbour, lest s/he becomes envious, which could lead to personal disaster and misfortune for one’s family. There is thus a tendency among many people, regardless of their objective wealth, to consider themselves to be poor, fara, ‘poverty’. Fara mal ma, ‘I am poor’, is also a very common response when one inquires about people’s health. (I am grateful to S. Abudulai [1992] for giving me the chance of reading his report on ‘wealth ranking’ based on local concepts of wealth in the Bawku-area in the Upper East of northern Ghana. His findings accord with my own data collected in the Dagomba area.) A person who has material wealth, who is a bun-l/dana, is not automatically a respected citizen, a jilim-lana. One may be rich, but poor (not respected) at the same time. If one is rich in wealth (animals, yields, money), but lacks respect (in particular the unmarried and childless person and the individual who accumulates wealth without redistributing it) one is as good as a poor person. In this connection, Bohannan noted almost half a century ago that the Tiv are scornful of a man who is merely rich in subsistence goods (or, today in money). If, having adequate subsistence, he does not seek prestige in accordance with the old counters, or if he does not strive for more wives, and hence more children, the fault must be personal inadequacy. (Bohannan 1959: 498)

To be a jilma-lana is to be a respected, honest person. People judge a person by his biehigu (lit., ‘being’), his character, the way he comports himself and helps others. A jilma-lana is somebody without any scandals attached to him. He is a good and charitable person, a generous neighbour and often an elder. Therefore, a bun-dana (a person rich in material possessions) is not necessarily a jilma-lana, and often elders make a connection between money and the corrupting forces of witchcraft (sonyaligiri, ‘witch-money’). This is to illustrate their point about wealth accumulation being ‘destructive’ if riches are amassed by the individual and not redistributed among kin and people and converted into

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popularity in the local community.5 In this case the use of money and Western pharmaceuticals in healing symbolizes to the elders the allure of money and the dangers to the collectivity of human relationships becoming commoditized. By extension, it relates to a fear that the respect enjoyed by the jilma-lana ‘traditionally’ may succumb to the impersonal, alienating forces of money and the market, and to the ‘destructive’ desires they evoke. One can therefore be poor, but by virtue of the kind of life one leads one becomes a jilma-lana. The modest and unassuming person who is no different from his neighbours is the ideal. Finally, it must be noted that attributes such as ‘wealth’ and ‘reputation’ can mean different things to different people and can be stretched to describe oneself or portray others. People are always reluctant to discuss and assess their own or their neighbours’ possessions out of a fear that such evaluations might attract the destructive witchcraft of envious people.

A Note on the Value of Health The Dagomba put a high value on their health, alaafee, but it is not a monetary value. It is said that alaafee nyela arizichi/buni, ‘health is wealth’. Wealth and health are conceived of in broad (holistic) terms (see Chapter 3). Health is not only the absence of disease but relates to the person’s harmonious relationships with others and his/her place and status in the community (as a generous neighbour and a person with wives and offspring). Like questions about their health, people generally find questions about their wealth improper, since such questions suggest that it may be absent.

8.3 Monetary and Non-Monetary Transactions in Dagomba This section relates individuals and their activities of generating and maintaining wealth and health to the collective interests of the family, the lineage and the community. The focus is the total field of monetary and non-monetary exchanges in Dagomba society. In broad outlines, we may distinguish between two different forms of activity. One is based on giving and social interaction, ‘greeting’ (cf. the healing quest described in Chapter 7) – an activity with ‘long-term’ implications; the other on money and the expectation of immediate returns. Western medicines are procured through monetary exchanges which are divorced from social relationships, while local Dagbani medicines (botanical preparations) are obtained through face-to-face exchanges (‘begging for medicine’ in the

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local gloss). However, it is simplistic to think that two sharply contrasting transactional orders existed. The orders of individualistic activity and decision-making, sometimes money-based, and that of collective goals (reproduction of the lineage and society through social interaction) are inter-connected.

Monetary Transactions In Western thought, money is often associated with impersonal, abstract, anonymous exchange relationships. Money is seen as fundamentally opposed to personal, face-to-face, non-monetary interactions, which presumably exist in so-called non-monetary societies. In monetary economies, products become commodities which are transacted through the impersonal ‘all-purpose’ medium of money, and not through face-toface interaction. This interpretation of money has motivated economic anthropologists to postulate the existence of two opposed kinds of economies. It is said that indigenous and capitalist economies are different in the way they exchange things. Indigenous economies are described through the key notion of the ‘gift’. The face-to-face exchange of inalienable things, ‘gifts’, creates reciprocal relations between people. According to Mauss, in a given thing there is an inbuilt force which compels the recipient to make a counter-gift. The gift can never be fully separated from its giver. ‘Even when abandoned by the giver, it still forms part of him’(Mauss 1980: 9). In this sense, Western economies are ‘commodity economies’ while non-Western economies are characterized by giving and exchanging gifts (Gregory 1982: 10–24). This understanding of two separate economies underlies Bohannan’s classic analysis of the impact of Western money on the non-monetary subsistence economy of the Tiv of Central Nigeria (Bohannan 1959). According to Bohannan, the pre-colonial Tiv economy contained three separate but ranked spheres for the exchange of goods: at the bottom was a sphere for the exchange of subsistence products through markets. Next, was a sphere of prestige items, of cloths, brass rods, slaves, medicine and magic. The top sphere was reserved for the exchange of marriageable women between agnatic lineages (ibid.: 493–94). Exchanges within spheres, ‘conveyances’, were far the commonest forms of exchange (ibid.: 496). These were morally neutral. Exchanges between spheres, ‘conversions’, were also quite common and the preferred form of conversion was ‘upwards’, trading food for brass rods and brass rods for wives. The Tiv told Bohannan that ‘the man who successfully converts his wealth into higher categories is successful – he has a ‘strong heart’. He is

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both feared and respected’ (ibid.: 498). However, Bohannan stresses, brass rods did not represent a general currency. They were not money although they shared some aspects with money. They were a media of exchange within the prestige sphere but outside that sphere the barriers between the spheres prevented brass rods from becoming more than a method of payment (and not a method of exchange). The introduction in the nineteenth and twentieth centuries of an ‘all-purpose’ money changed all that (ibid.: 499–503). Money broke down the barriers between spheres and transformed the Tiv economy from a ‘multi-centric’ into a ‘unicentric’ economy (ibid.: 502). By providing a ‘common denominator’, money allowed all goods to be exchangeable against a standard scale. Money certainly had profound consequences for the Tiv economy. It did not reduce everything to a common scale, however. In the 1950s land was still considered by the Tiv a non-transferable item (Parry and Bloch 1989a: 13). One crucial question remains. Was the introduction of money the sole cause for the breakdown of the multi-centric economy of the Tiv? Or, to put the question differently, is the contrast one of societies with and without monetary exchanges (before and after colonization), or do individual and competitive exchanges always already exist in so-called ‘non-monetary’ societies? Parry and Bloch stress that the point is not that there is a difference between societies, between ‘gift economies’ and ‘money-based economies’, but that the difference is one found within any society, capitalist or non-capitalist (Parry and Bloch 1989a).6 Let us now consider the various ‘monetary’ transactions found in Dagomba society. We will first look at exchanges involving money that represent kola (the chief item in and a key symbol confirming many nonmonetary exchanges in Dagomba); next, we examine activities where money is generated or used to buy medicines and other commodities, where crops are grown for cash as well as for subsistence. There are many occasions where money is given and disguised as kola, gule. ‘This is kola’, one hears people say when asking their neighbours for medicine with money, or when making suuna-contributions (when the newborn child is first brought out and named on the eighth day) of 50 cedis (the equivalent of 10 pence in 1991). In fact, many items may be used as kola. On one occasion I was given two pieces of candy as suuna gule, ‘suuna-kola’.

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A. Money Given When the Child is First Brought Out On the day the child is first brought out and named, food is cooked for visitors coming to see the newborn child and its mother. Visitors typically make gifts of 50 cedis to the householder (or husband). These contributions are redistributed to the visitors when they are about to go home (to cover their travel-expenses).7 Out of the money-contributions, the non-resident barber who circumcises and provides the infant with incisions and tribal marks, also receives money to cover his travel expenses back to his village since he lives elsewhere. In addition, he is also given cooked food to take with him home to eat with his family. The resident midwife who holds the baby during circumcision also receives a payment of 100 cedis (about 10 pence, 1991).

B. Praying on Money Money is also often used instead of kola. The Friday prayers in connection with ‘greeting the chief’ (a weekly-recurring ritual validating his political authority) are said on 5 cedi coins (the equivalent of half a penny in 1991). The court officials, elders and household heads pray by casting coins on a straw mat in front of the chief. (Coins have, I was told, substituted kola, cowries and cereals.) They pray for health, prosperity, good rains, food and sleep for all. Kola nuts are then distributed by the chief to all people present to conclude the prayers, and hands are shaken.

Money has ‘achieved’ the status of kola, and is, therefore, not opposed to local practices of giving kola. Money is simply used in continuation of what used to be kola. The representation of money as kola is also facilitated by the simple fact that kola is often used as a means of measurement. Because of their common features, the use of kola and money side by side is unproblematic. First, people pray on money, then kola nuts are shared and hands are shaken. Suuna-contributions are made in the form of money, which is redistributed when guests return home. Contributions and gifts given to the chief or a head of the family, whether during the greeting ceremony on Fridays or on suuna-days, have to be recycled. This also applies to contributions that the funeral-owner, ku-lana, receives from guests during the celebration of a funeral. There are obligations to give and there are responsibilities to redistribute. When representing kola or when offered with the expectation of receiving a counter-gift, money does not have any morally negative significance (cf. Bloch 1989: 166).

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For Cash or Subsistence? The money-oriented market economy has not replaced the subsistencebased economy of the Dagomba. Cotton is the main crop grown on a commercial basis by men (Fig. 8.1) although men and women also derive some income from farming small vegetable gardens in the afternoon. Men, in particular junior men, have their individual agendas and generate cash by growing vegetables, grains and tubers that they ask women to sell for them in the market. These constitute private, not communally generated, pooled wealth which may be converted into both money and more enduring wealth such as wives (see endnote 6, cf. also Lentz 1998). In addition to growing food and vegetables, some people (mostly men) also peddle drugs. Others sell Islamic medicines, while women trade, grow vegetables for sale and increasingly farm monocrops, all within a minor farming cycle that is subordinate to the main or ‘dominant farming cycle’ of growing food for subsistence (see Chapter 1). Many people are engaged in both a subsistence and money economy and thus engage in numerous individual income-generating activities and earn personal income.

Figure 8.1. Cotton Grown Locally Being Loaded onto a Truck Belonging to the Ghana Cotton Company

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While men are primarily subsistence farmers and farm on a collective basis, many junior men also engage in vegetable farming and turn over surplus food, which they ask women to sell for them in the market. The market is a place which fits women’s traditional marketing role, a role that capitalism and the commodity economy allow them to further exploit and which is grafted onto their female agenda that relates to the future and to the discourse of women in a male society. Thus, men’s and women’s ‘production for own use’ (often for cash) occurs side by side with production for ‘collective consumption’ (subsistence) (cf. the description of the ‘two farming cycles’ in Chapter 1). Men and women are engaged in both collective and individual enterprises, in a dual economy. Subsistence activities and cash-generating activities are inter-related. It is likely that men and women have always (not just since the advent of capitalism and the market) been engaged in private (today: money-generating) activities. However, people’s involvement in markets in northern Ghana has clearly grown over the past thirty to forty years. Many items not previously known or thought of as commodities have become saleable items: kerosene and batteries from southern Ghana are sold in northern Ghana, while yams and groundnuts from northern Ghana are marketed in southern Ghana (Drucker-Brown 1993). The existence of money and the market in Dagomba have had a strong impact on male-female relationships. Women’s more active participation in the cash economy as traders and as buyers and sellers of Western medicines have weakened men’s control of the economy, of healing and of women. Drucker-Brown notes that among the Mamprusi, women appear to be in charge of the cash economy and that their ‘cash income has become more essential to the maintenance of the domestic economy’ (Drucker-Brown 1993: 25–26).

8.4 Contexts of Curing or the Problem of Money in Medicine Examining the contextual aspects of the economy, its dual nature, leads us to explore the local interpretation that ‘money spoils the medicine’. The aim is to arrive at a proposition about the all-important function of ‘contexts’: ‘co-existing monetary and non-monetary exchanges’ and ‘moral-immoral social relations’ in Dagomba society. In examining this suggestion, I distinguish between the decidedly non-monetary, personal relations involved in local healing – the male affirmation of its power in society – and the monetary, but often also personal and benevolent dealings involved in the informal distribution of Western medicines by medicines-sellers (private chemists and drug-peddlers). The most

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detached monetary relations centre on interactions between patients and biomedical healers, and the formal distribution of drugs by health posts, clinics and hospitals. The guiding idea is the co-existence of money-based and non-monetary transactions in society. The putative contrast between the ‘moral’ (non-monetary) exchange of botanical preparations and the ‘immoral’ (money-based) transaction of pharmaceuticals (commoditized medicine) fades and becomes modified by the agendas of the actors and by the ‘contexts’ of curing. Accordingly, the following discussion divides into two parts. First is an examination of healing based on plants and the interpretation that ‘money spoils the medicine’ in the context of local healing. Next, we examine this statement in the context of the sale and use of pharmaceuticals. The contrast in the relations involved in curing with plants and with pharmaceuticals becomes modified by a society (Ghana) that is undergoing change and creatively responding to the current situation of Structural Adjustment. The determining criterion for viewing healing as moral or immoral seems to be whether the person discharging healing and distributing its key symbols, medicines, does so in a considerate manner (extends credit for example) or not. This consideration is analysed in the paragraph on selling medicines and peddling drugs. It can be related to and compared with the concepts and practices involved in interactions at clinics.

8.5 ‘Money Spoils the Medicine’ To begin with, we must examine the ‘theory’ of men controlling healing with plants and providing medical care and the local interpretation of the relationship between medicine and money. In Western culture, the notion that money should come between the patient and the physician, who is expected to set the welfare of his patient above his own interests, usually receives strong moral condemnation. Money is characterized as being directly opposed to altruism (Parsons 1951; Stein 1983). An apparently similar notion is the Dagomba (male) idea that money corrupts curing, literally ‘spoils the medicine’. (That money should be ‘the root of all evil’ as Western thought describes it, has no direct parallel in Dagomba thinking, however.) Local herbalists serve their families, neighbours and the community with their knowledge and do not charge money for their services (see also Shipton 1989 on the concept of ‘bitter money’ among the Luo). When one is in need of medicine, one simply asks, suhe ni puhe, a friend or neighbour or formally requests the medicine needed. Treatments do not cost. Medicines have no price. This is an expression of the

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importance that the Dagomba attach to helping one another and to being charitable. The underlying notion is clear: money corrupts social relationships based on greeting and generosity. Local botanical cures cannot be sold and purchased through the medium of money. Fuseini, the Bonesetter (man), Sets a Broken Leg Fuseini, the bone-setter, had recently treated the Duko chief’s son’s broken leg. He explained that the chief ‘worked much’ and sent him a fowl, 600 cedis (the equivalent of 1£, 1991), a few coins and a calabash for keeping the medicine. The chief’s payment was ‘too big’, Fuseini explained. His father from whom Fuseini had inherited his medicine, had never worked for money. Therefore, it would ‘spoil the medicine’, ni sagim tim maa, if he were to accept money. ‘Then I put my hands into the money and removed the coins. That is how I know it. Then I took the 600 cedis and gave them [back] to Duko-Naa [the chief]. That is not seen like that’.

Only small fixed amounts, for example a few coins, not money, enter into the relationship between curer and patient. Men say that, traditionally, relationships between people, whether for healing, help on the farm or support for political office, did not involve money. Today the local curer is confronted by a reality where people buy medicines, political offices, farm labour, and so on, with money. Consistent with the image of the jilma-lana (respected person), the herbalist is strongly committed to providing services to his community. His services are legitimated by the ancestors whom he feeds with fowls and kola. He does not accept money for his efforts. The healer’s service-orientation is associated with the dominant mode of face-to-face interaction in Dagomba: greeting and asking for favours, puhe ni suhe (see Chapter 5). The chief of Sozale emphasized that with regard to Western medicine You can prescribe anything. You go to the drugstore, buy it and take it. You know that if you take paracetamol, your headache will go. But local medicine is not like that. It is now that money is so used. People never cured by heart [self-care]. You came and told him [herbalist] your ailment. He would tell you: ‘Ok, I’ll go and sleep over it’. He would go to investigate through the soothsayer. If he knew that he could cure you, he would tell you. He would never say he himself [could cure you], but ‘I will approach my senior man’. It was always sort of mysterious, they didn’t like to disclose it. They still say it [success] depends on rapport between them and the supplicant.

The chief’s use of the past tense to describe the approach of the Dagomba herbalist reflects his concern over seeing what used to be the dominant mode of therapy – healing with plants (and the reliance on senior

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authorities, elders, diviners, ancestors) – being challenged by processes of commoditization within biomedicine, Western pharmaceuticals being a key symbol of these processes. Notwithstanding the chief’s comments, healing with plants is still extremely common and the ideology of nonmonetary curing persists. This justifies the following analysis of notions and practices surrounding the use of botanical substances. These practices qualify further what it means for the Dagomba to be modern ( to engage with the present moment) but also bear witness to the powerful hold of the male ideology in controlling the realm of healing. Local curers (such as Fuseini, the bonesetter) believe in what they are doing and people have faith in them. Local curers say that their power to heal comes from their ancestors. Contrary to Western medicines ‘our medicines have words’, Fuseini explained. When local curers prepare their medicines, they use a fowl and kola nuts to perform a sacrifice (lit., ‘to feed the ancestors’). Prayers are also said after or while they place the fowl on the medicine, slit its throat with a knife and let the blood drip onto the medicine. The ancestor whose medicine one is using is called in the following (or similar) words: ‘If your medicine works then raise from your grave and let it be shown’. In asking for treatment, the common man and the chief, the young and the old, must conform to the basic demands of the medicine: a gift of kola or a fowl. The logic for making such gifts is that the sick is not dealing with the curer as such but with the ancestors from whom the medicine derives its power. The healer views his medicines as his ‘personal’ (ancestral) property. It cannot be revealed to strangers since that would ‘spoil’ its power. ‘It is my grandfather’s medicine’, he says. ‘How can I take it and show it to people? It would spoil the medicine. I have no right to give the medicine [that I have inherited] to people.’ This is not to say that he cannot treat a person who is ill. He sends him to the bush ‘to find’ the ingredients and then treats him. Local healers view their services as a community service and their medicines do not demand fees (the ancestors do not ask for money).

‘Whatever your heart tells you’ Dagomba curers do not charge money for their services. Some people just find black [i.e., charcoal] medicine and go around and sell it. We don’t know that. Since your grandfather did not do that, then why should you do it? Dagbani medicine is not for sale. It does not have a price. The reason why Dagbani medicine is powerful, yaa, is that we treat without charging money for it. We just treat him [the sick person]. When he recovers, kpan, anything he gives us is all right, ka ti a binshiegu, di pa la taali.

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Fuseini, the bonesetter, continued Yes, that is why we say ‘it doesn’t cost’. When the patient recovers and wants to thank me, suhu palgi, literally ‘white heart’, for having done [solved] his doing [problem] and reaches his hands into his pocket and takes anything and gives me, that one I will collect. Because you give me. This thing, if I collect it, it is right, alali mbala.

Fuseini’s friend summed up the explanation just given in the following way: You see, when your leg is broken can you find [work]? Since you cannot find, he helps you and sets your leg. Therefore you want [to help him], you are happy. It is not the medicine’s price, yoo.

In other words, patients express their gratitude and thanks and acknowledge the treatment they have received by giving a charity. It has nothing to do with ‘payment for services’, the basis of many transactions within Western medicine. Therefore, as a chief explained to me, When you are going, anything you give, ehe, is for it [i.e., the treatment received]. They [the curers] say you have given them dash (Ghanaian gloss for ‘tip’).

The local curer is community-oriented and when he offers his services, he is putting himself on the line. The Western doctor, on the other hand, Fuseini stressed, collects his fees whether the patient recovers or not. We don’t do that. We, when we treat a person we work hard, literally ‘fight’, and if the person does not recover, it troubles you. When I do it, I never do it, then leave and show people to find something like this [money] to give me.

The local curer is ‘paid-by-results’, the payment being conceived of as a charity. The curer receives gifts – tokens of appreciation – from patients who have recovered. The size of the gift will depend upon whether the patient has recovered (full recovery results in a fowl) or not (lack of recovery only results in kola nuts, or some other small gift). All the local curer needs for his medicine to work are kola nuts and fowls to feed the ancestors. To understand the local curer and his community-orientation one must bear in mind that when producing his medicine, he always invokes his ancestors. The power to heal is not his but comes from the ancestors who do not ask for money. Because of the nature of their work

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herbalists are supposed to be spiritually and morally upright, otherwise their medicines would not work. They usually do not charge fees but gladly accept donations, ‘whatever your heart tells you’. They (and in particular men and those espousing male ideology) believe that charging money would ‘weaken’ the power of the medicines.

8.6 The (Im)morality of Medicines: Medicine-Sellers and Drug Peddlers According to the male ideology of control of healing, the person who demands money for his medicine is not respected, he is not a jilma-lana (see section 8.2). The ‘contexts of curing’ question and resist this ideological control by the elders, however, and permit us to see an alternative mode of knowing and conceiving of healing in the 'context of society and economy'. A contextual approach provokes us to explore the social and economic processes as they related to gender and determine the field of healing, now no longer in the ideological hands of men. Pharmaceuticals are sold by the formal government system as well as privately, by medicine-sellers owning shops (chemists) and peddlers who sell their medicines from stalls or tables in the market and peddle in villages. As in Uganda (Whyte 1992), Dagomba private distributors of pharmaceuticals often show solidarity with social and cultural premises of greeting, and respect society’s norms. In many cases they demonstrate a willingness to extend credit to their customers. While from a ‘traditionalist’ point of view (cf. the chief of Sozale, above) practices involving money must be rejected, these (practices) may be quite consistent with the basic orientation of solidarity in society, however. Thus, it is first of all contexts that matter – whether a service is rendered in a spirit of solidarity or not (sometimes transactions of curing include money, at other times, traditionally, they do not). Contexts make services moral or immoral/antisocial. Whether medicines are distributed for money or not is of secondary importance. The ‘contextual’ interpretation also better matches a reality that recognises the value of individual and female actions as well the specific moment of structural adjustment of the economy. Curing based on botanical substances is based on a ‘contract’ and shared understanding between the (male) practitioner and his patient of the values of the culture (solidarity and the lack of money involved in the transaction between these). Biomedical therapy (based on pharmaceuticals), on the other hand, appears to contrast with the former approach by involving money and not demanding a show of solidarity

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between the healer and the patient (see Aishatu’s discussion with the dispenser at the Savelugu clinic and her bewilderment in the previous chapter). However, in many ways this contrast does not reflect changes in social and curing relations in Dagomba, or Ghanaian society at large. Responding to changes of Structural Adjustment (implying weakened social welfare and the powerlessness of formal structures in general), a ‘pharmaceutical practice’ has developed in the folk sector (comprising private chemists and peddlers) (Whyte 1992: 170). Whyte argues that in the 1990s in Eastern Uganda the traditional distinction between a professional and a folk sector became meaningless: ‘professional medicine (using pharmaceuticals) is adapted to local social relations, and especially to relations of kinship and friendship’ (ibid.: 170). The growing inefficiency of government-distribution of Western pharmaceuticals has led to the emergence of a private sector with a large number of people, more or less qualified – including shopkeepers, market vendors, hawkers and peddlers – engaged in providing people with Western medicines, including dangerous and expired ones (e.g., see Ferguson 1988; Vogel and Stephens 1989; Bierlich 2007a). A differentiation between two sectors, one comprising professionals, the other folk practitioners, cannot be posited as having an important effect for the analysis of the Dagomba case either. Oshiname and Brieger (1992), Whyte (1992) and Senah (1994) summarize the situation of pharmaceuticals ‘flooding’ or ‘invading’ developing countries. According to them, the situation is contextualized by developing countries struggling with public health institutions that often lack the needed medicines and employees receiving inadequate wages, lacking the motivation to serve the sick and displaying an unfriendly and condescending behaviour towards the patients, while doctors fill in prescription forms for medicines that are difficult to obtain. Against this background, many people turn to medicating themselves, sometimes incorrectly. My data from northern Ghana supports this portrait. They are based on a particular study of the private sector in Tamale and its medicinesellers, which was conducted towards the end of the Ramadan, in the middle of April 1991 (Bierlich 2007a). All identifiable medicine shops in the town were included in the study, which confirmed the picture of the circulation of pharmaceuticals in developing countries. The private medicine-sellers (forty-eight of them), only licensed to sell ‘common’ medicines, such as pain killers, vitamin tablets and chloroquine syrups, also sold antibiotics – in sharp contravention of formal regulations which make it illegal to sell such medicines. The general pattern was for frequently requested medicines – assorted antibiotics, chloroquine syrups and pain relievers – to be stored and on display in plastic containers or tins on the counter. Most shops also carried great quantities of ‘blood medicine’ or

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blood tonics (vitamin tablets and herbal bitters) (cf. Senah 1994: 89). Generally, people did not have the money to buy a whole course of pills or capsules. Rather, they bought these in small quantities, one or two at a time. However, in contrast to the impersonal formal system of health posts, clinics and hospitals (which all demand ‘money for services’), private medicine-sellers (although strongly concerned with selling medicines and earning money) accepted local norms of behaviour, sometimes sold medicines on credit and did not doubt people’s health-illness concepts. The study of the transaction of pharmaceuticals in Tamale challenges the experiences of people as patients in the formal health system of clinics and hospitals. Thus, all the Tamale medicine sellers interviewed said that they always asked the customer his/her complaint and provided advice and instructions before selling medicines to him/her. A source of information about how to treat illness was, one chemist related, the book, Where There Is No Doctor (Werner 1989), which he himself used to arrive at the right advice (medicine) for his customers. Like the Tamale chemists, medicine peddlers primarily think in business terms and compare the medicine-sale with that of the sale of commodities, including chewing gums, plastic bags, batteries, etc. They do, however, fulfil an important function by providing health care to a rural population who might otherwise not receive any. They are also a good example of how business and individual and social survival can be inter-connected. Upholding a distinction between a folk and professional sector is, therefore, pointless. When I first conducted field work in 1990–91, two drug peddlers and numerous hawkers of medicines and other goods visited the village in which I lived, more or less regularly (Figure 8.2). On a number of occasions, I had the opportunity to follow and observe the drug peddlers as they visited house after house. The drug peddlers meant business. The peddlers were always polite and greeted people, but had little time to chat and did not spend more than one or two hours in the village at a time. Using the horn of his bicycle, one medicineseller would announce his arrival at every house. He would greet people hastily as he entered houses or passed by. The selling of medicines was conducted openly. Sometimes the sellers did not enter the house and transactions took place outside in the clearing in front of the house. Most of their customers were women. When visiting houses the sellers, therefore, always first sought to establish whether the women were home, on the farm, or in the market. If they were absent they left immediately. The drug peddlers made their sales from a box on the luggage carrier of a bicycle or from a leather bag. They wrapped pills and capsules in pieces of paper or plastic for their customers. Everything was always very business-like. However, the peddlers never questioned people’s basic

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Figure 8.2. Alhassan Peddling Medicine from His Bicycle

notions of health and illness. The medicine-sellers would also provide a little advice on dosage to women. In one case, that of a pregnant woman with diarrhoea, one of the drug peddlers advised her not to take medicine at all but to go to the hospital instead. Women normally bought small quantities, one or two tablets or capsules of paracetamol, tetracycline, ampicillin at a time. Most of the time they knew what they wanted, as the many requests for specific medicines such as topaya (tetracycline), and brand names, such as ‘Drastin’ and ‘APC’ (both are pain-relievers) showed. Women stressed to me the advantage of being able to buy medicines from the village peddlers ‘on credit’, samli. Generally, they did not question the price of the Western medicines they were buying. They may not always have been happy with the cost of medicines (see Aishatus’ discussion with the dispenser, Chapter 7) but they never discussed the cost and value of Western medicines from a philosophical point of view. Neither have I ever seen or heard women saying when buying Western medicine that they had/had not received good value for money, or express the idea or hope that high fees were proportional to the power/value of the medicine, as many laypeople in Western cultures do (see Chapter 4 on the evaluation of medicines). In some situations people also develop personal relationships to peddlers, who often emanate from the local culture and maybe even from neighbouring villages (with which

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people have relations of kinship and marriage in the first place). People come to value such relationships almost like friendships. That these often also include credit is evident. We must therefore appreciate that it is contexts and not money that determine whether exchanges of curing are moral or immoral. It remains clear from our previous discussion that the local herbalists who do not charge for their services are the moral ideal. However, chemists and peddlers willing to extend credit to their customers upset the image of the immoral medicine-seller by selling medicines on credit. The most ‘anti-social’ persons are not the medicinesellers but the ones in the formal biomedical health sector who disrespect local culture and are unwilling to extend credit to customers.

8.7 ‘Money Spoils the Medicine’: Ideology and Practice There are many cases that document if not resistance to then neglect of the male ideology of control. People (men and women) sometimes, for example, fail to greet with kola, to give kola in exchange for a local service received. I recorded two cases which are particularly revealing. Both cases are examples of behaviours that neglected the idiom of giving kola and greeting. Mahama, an elder, was called to treat a young woman who did not have enough milk to breast-feed her baby. The woman’s mother, Samanta, wanted to give him 50 cedis (5–10 pence) for his help. Mahama refused the money and said that he would only accept kola. Samanta rushed to her neighbour who was running a small business selling kola nuts. Samanta returned with two pieces of kola. Mahama explained to me, ‘I don’t take money. I have come to help. If I were to accept money, people would think I am doing it for the money’.

Why did Samanta make this mistake in the first place, offering the elder money and not kola, as custom (ideology) demands, for his service? To understand this, one must bear in mind the fact that Samanta’s husband is the village-malam. As a malam, he often dispenses Islamic medicine which people pay for, and his services at naming-ceremonies and in funerals are always remunerated with money. Samanta is accustomed to the idea of people paying for her husband’s services. This is consistent with people’s general perception of Islamic medicines (and other nonlocal items) as transactable through the medium of money. One may recall the affinity that exists between Islamic medicines and money (Fig. 4.1). Once an elder, the same person who was only willing to accept kola for his service in the above case, came to show me a bottle with lizard eggs that

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he had collected. He said that he would sell them as ‘Islamic medicine’. He noted, ‘It is with Islamic medicine as with your medicine [i.e., Western medicine]. We pay for it’. Accordingly, even elders recognize limits to the ideology of non-monetary exchanges. In this case, Islam provides an ‘excuse’ for ideology to make an exception, to permit money to enter society by implicitly or explicitly, and sometimes carefully thought out, linking Islam – and its implicit social embedding of the economy (Rodinson 1974) – to local male ideology, and contrasting it with ‘destructive’ capitalist transactions. This, men may see as legitimate but in general they maintain a rigid understanding of the immorality of money so as to prevent juniors and women from using money and eroding their control. The other case is that of Majid who had a fever and experienced bodily pains (probably malaria). He went to ask Baga, the diviner in the village (to whom he is not related), for kpaga-medicine to treat his symptoms. However, neither did he visit Baga in his home, nor did he ask him with kola. He simply approached Baga who was visiting in another house and asked him for medicine. Baga refused his request.

From Baga’s point of view, Majid was a ‘lazy person’, too lazy to go and buy kola to give him. (I had myself noticed that Majid often tried to avoid communal work tasks. On one occasion all the household heads were busy helping Mahama roofing his house, with the exception of Majid, who looked on without helping.) But this was not Majid’s only mistake. He had ignored to state his request in a humble manner. One cannot ask somebody (and somebody who is not one’s good friend) for a service in somebody else’s house. Etiquette demands that one goes to the person’s home and states one’s request there. If we choose to interpret the case from the point of view of a dissatisfied junior (Mahama being at the time in his early thirties) in a lineage and descent system dominated by the elders (Baga was an elder, though as an unmarried person somewhat marginal), one might end up feeling sympathy or an understanding for the resistance of a junior person. I do not have the data to pursue this speculation further but the implications of a junior defying ideology are challenging. The problem these two cases allude to relates to men’s belief in the supremacy of their views of healing. This constitutes a configuration of explanations and meanings regarding healing and related behaviours. This view represents also the dominant ideology serving as the bench mark in the evaluation and interpretation of reality. The reality of healing is thus a social construction. The cases also refer to the additional confusion introduced by money. People do not always know how or how

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much to pay the curer. The case of the Duko chief paying the bonesetter 600 cedis for his services is one case in point. The bonesetter returned the money, saying that he could not accept the money, as his father did not demand money for his medicine (see above).

8.8 ‘Money Spoils the Medicine’ Revisited Men, in particular older men, are quick in condemning the use of money to obtain a local service. Old men tell the anthropologist that ‘money spoils the medicine’. This statement refers to several aspects of healing, in particular, a ‘specific interpretation of capitalism’ as being ‘destructive’ of social arrangements, including the patrilineal descent structure and the power of elders over juniors and men over women. Face-to-face exchanges of local medicines (plants) are contrasted to the ‘impersonal’ method of paying with money for Western medicines. However, in practice, such interpretations are ignored by all, in particular by women and the younger members of society. The statement ‘money spoils the medicine’ also helps us expose changes that induce a greater ‘experimental’ attitude in people. People use what they perceive to ‘work’, whether it has to be paid for or not. In the final analysis, only the context can define whether money and paying for a service is immoral or not. Recent changes, economic hardship in connection with the Structural Adjustment Programme adopted by the Ghana government in 1983 (Chazan 1983; Brydon 1999), and innovative responses (to these pressures) are also affecting the roles of men and women in Dagomba society. Herbalists (traditionally male, often elders) realize that they are losing their control of healing, which women seem to be taking over. Western medicines provide a treatment alternative and a popular bypass for women around men and their control of botanical preparations. Women are great users of Western medicines, and it is they and their children who suffer the bulk of common illnesses (see Appendix 1). The statement ‘money spoils the medicine’ is therefore also a reminder of the anxiety experienced by elders considering the possibility of the breakdown of authority over women through the commoditization of health care (see also Drucker-Brown 1993). A related dimension of money and local healing concerns the definition of medicine, tim. Medicine can be used to do good as well as bad. Preventing, curing and causing illness are inter-related aspects of medicine. Men may see money as impersonal or antisocial, since it renders engagement in social relations – symbolised by ‘greeting’ (puhe) – superfluous. Thus, anyone who buys medicines can be said to be

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corrupting the ideal of greeting. In a sense, the person who is prepared to use medicines that have been obtained not through greeting is suspect. His/her powers can no longer be controlled for the common good. In this interpretation, money redirects (‘spoils’) medicine from curing to harming. Just like witchcraft and food cooked by strangers, money makes medicine offensive to social relations. In 1991 a female medicine-seller came once a week or every two weeks to the village, selling various botanical preparations and a certain Western product traded as faarma, apparently a panacea (‘it treats every illness’) that women were rubbing their bodies with when experiencing aches and pains. She also sold tangaasi, a Western household bleach that women rubbed on their skin to make it shine and used for other purposes. The woman was not a Dagomba and the preparations that she sold were foreign medicines. Men I talked to (married men, not elders in this case but expressing male and a non-monetary ideology), stressed that they would ‘never buy from her’; they would rather ‘ask an old man, ninkurugu, for medicine’ (the local curer is often represented as an old man). What they meant was that they had little faith in a person selling medicines. While people (men) express faith in their local curers, put themselves in their control and promise to obey their orders, money carries no such obligation. This study’s emphasis on ‘contexts’ that shape practices as moral and/or immoral permits us a ‘more complete’ view of reality, however. The ‘monetary reality’ is gendered. It does not merely exist as the negative side of male ideology but recognizes multiple actions, by males, seniors and juniors, as well as women. These derive their moral significance from the fluid nature of the economy and society, not from an ideology producing and imposing its (one-sided and static) view of reality. The woman selling bleach may thus be part of and a figure in women’s views of reality and their narratives. The very interpretation of the category of ‘medicine’ often comes to reflect male views, however.

8.9 Healing and ‘The Problem of Money’ So, what is the ‘problem of money’? I have shown that it is not that monetary and non-monetary transactions necessarily contrast. They are inter-connected. The medicine-seller, for example, may be businessoriented and sell his goods for money. Is he, however, considerate of local ways and willing to sell ‘on credit’? The fact that he works for money carries no moral significance. These monetary transactions are consistent with a culture and a healing tradition that stresses solidarity and ‘credit’ (waiting for payment, donations, alms-giving, paying/giving according

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to ability). What ultimately matters is not money but the contexts of transaction. These can make exchanges morally acceptable or not. In other words, if money (and biomedicine) denies local agency, then they are disapproved of and cause concern. In assessing the role of biomedicine and the conflict between biomedicine and local cultural factors in northern Ghana, I have shown that people experience ambivalence over the power of biomedicine and its impersonal ways. This feeling of uncertainty has to do not only with its (remembered) power, referring both to its successes and failures to fight disease in the colonial and present contexts. It relates also to its inability to appreciate the limitations to its power when confronted with a local culture and its premises of diagnosing and treating illness. Biomedicine may be attractive. However, by introducing its scientific language, concepts and technologies, it may also force people into submission. People become obedient and say what is expected of them, without really understanding (or caring to understand) the implications of, for example, the germ theory, disease prevention, or diseases (worms, parasites in the blood) that can only be diagnosed under the microscope (yet another powerful biomedical tool). Understanding and appreciating that local people by answering in the affirmative often only pay lip-service to the concepts that Western science introduces, while retaining their nonscientific (‘magical’) beliefs, may be the first step to appreciating the link between ‘tradition’ and ‘modernity’ and to becoming aware of the active place of tradition/magic in modernity. To avoid being authoritarian and inflexible, an improved relationship between non-Western and Western science (including biomedicine) must refrain from insisting on the validity of only one point of view. Of relevance to a discussion of the complexity of the healing-complex are Whyte’s (1992) comments regarding the changing social relations of health care in Uganda. She describes a context of structural adjustment – not unfamiliar to researchers in West Africa (e.g., see Bledsoe and Goubaud 1988; Van der Geest 1982, 1988; Etkin 1993; Brydon 1999) – where the relations of healing centre on whether a service is commoditized or not, and where the circumstances/contexts of transactions always determine what counts as moral/immoral healing. This study also stresses that the circulation of Western pharmaceuticals outside formal biomedical institutions (being sold privately and for money) is part of a process of privatization, which, among other things, means that ‘private’ vendors of pharmaceuticals give greater attention to the customer’s points of view than the practitioners in ‘formal’ government service. We note that the relations of healing outside formal biomedical structures may be quite humane/considerate and lead to an

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improvement in the efficacy of communication between patient and healer (e.g., see Kleinman 1980: Chapters 3 and 8). The problem of money is a fascinating topic. On the one hand, money is indispensable to upholding life and the acquisition of many of life’s necessities. On the other hand, as witchcraft-accusations and related fears show, money is also seen as ‘evil’ and associated with the a-social, corrupting force of witchcraft and an ‘unbearable’ female agency. Western pharmaceuticals become also a figure of modernity by symbolizing the tension which places the ‘love of money’ opposite traditional communityoriented, non-monetary giving. In exploring this conflict, one has to realize that while money may be the root of great evil, it is also a ‘necessary evil’. One must also rid oneself of ‘false consciousness’, the social and ideological production of ‘knowledge of things and their order’ (Foucault 1994) by old men fearing to lose their power in society. Monetary exchanges in healing reflect not only the appeal money has but an apprehension that human relationships will become commoditized. This uneasiness relates to a fear that the respect that the jilma-lana traditionally enjoys may succumb to the impersonal and alienating forces of money, alongside the market and the ‘destructive’ desires they evoke. Women are the major suspects and culprits. The fear of modernity, with its focus on the individual and on women, is particularly felt by the elders in society – the ‘keepers of tradition and cultural norms’. Being accustomed to a life where people feel mutually responsible, return favours, help one another and ultimately respect the social arrangements of power and ideology, they feel threatened by modern individualizing trends. These refer, as stated, to the selling of crops grown on personal fields, vegetables, as well as new social relationships mediated through money. That ideology frowns upon this behaviour does not come as a surprise. Ideology-oriented elders will always voice criticism of new and especially of individualized ways that people, particularly the young and women, adopt. The elders (men) realize that they are losing their control. That money should ‘spoil’ social relationships is a reminder of the anxiety experienced by men and elders considering the possibility of the collapse of male authority through commoditization.

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Notes 1. Fortes notes that for the Tallensi land, livestock and the homestead constitute patrimonial property, faar. This is opposed to individual property which has ‘no name’ (Fortes 1949: 157). Patrimonial property is transmitted to the deceased’s brothers, while individual possessions are inherited by sons, daughters and grandchildren (ibid.: 279). The Dagomba follow a system of inheritance resembling that of the Tallensi. Patrimonial property is always first passed on to the brothers of the deceased, before junior generations, sons, nephews and grandsons are considered. 2. Unlike other people in northern Ghana, the Dagomba do not make marriage payments in cattle (Chapter 1). There is doubt whether they have a bridewealth system at all. Small occasional prestations of kola, grains and firewood are made to the in-laws during courtship and this ‘feeding of inlaws’ continues throughout marriage. However, and as in other areas of northern Ghana, cattle is generally part of the family holding. The majority of people do not think of cattle as having a monetary value. But, undoubtedly, people keep cattle as a future asset, and when they need money they sell their cattle in the market. 3. The acquisition of land by newcomers, saamba, literally ‘stranger’, follows the same pattern that characterizes acquiring medicines through greeting and apprenticeship described in Chapter 5. A newcomer uses his ties of friendship, zo, ‘friend’, to acquire land. If he wishes to farm on his friend’s (friend’s father’s) land, all the friend normally says is, ‘This is my land, you can cultivate this part’. If, however, the newcomer also wants the gift of land to be recognized by the community at large, he must go through the customary channels. He first visits and greets the elder of the ward in which his friend lives with kola or another gift. Then the elder takes the newcomer to the chief and introduces him as the friend of so-and-so, saying that so-andso has given him land to farm. The chief welcomes the newcomer, and if he also intends to settle in the village, allocates to him land for the building of a house (Abudulai 1986: 80). 4. During the ‘Green Revolution’ (introduction of commercial rice farming in northern Ghana) in the beginning of the 1970s, people from the major cities of Tamale, Kumasi and Accra realized that land could be acquired gratis from the chiefs. They acquired tracts of land which they then registered as leases with the Land Department in Tamale. Some people also used these leasehold titles as securities to take out bank loans. Abudulai notes that ‘leases in their present form appear irrelevant to the majority of indigenous farmers’ who have never heard of or applied for leases (Abudulai 1986: 92). 5. The modern urban context produces an additional layer where these concepts retain their significance and the support of kin becomes particularly essential for survival: ‘although people might be poor in terms of cash and material goods, if they had [referring to adjustments in the period 1975–1990] a wide network of kin they would somehow survive’ (Brydon, 1999: 381).

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6. Piot suggests that ‘analytical attention be focused on the relational implications of various exchanges’ (Piot 1991: 405). In his study of the Kabre, a Voltaic people of northern Togo, Piot identifies a set of exchange spheres similar to those Bohannan describes for the Tiv. Piot stresses that the important thing to note is that ‘exchanges within each sphere have social consequences...they establish relations between persons’ (ibid.: 411). Often exchanges go nowhere but sometimes exchanges between two people, which begin with small exchanges of subsistence goods, grow into enduring relationships or ‘friendships’, ikpanture, characterized by people eating in each other’s houses. Friendships may eventually culminate in the highest sphere of long-term transactions where the two houses give each other wives to cement their bonds (FZD marriage being the preferred form of marriage) (ibid.: 411). Long-term relationships, such as marriages, give the Kabre man a sense of ‘immortality’ since a relationship has been established that will endure beyond his life-time (ibid.: 416). This is, I argue, also the rationale of Dagomba men in converting their wealth and stressing the importance of popularity and male supremacy. Their future is directly linked to their successful placement within the descent system. Women, on the other hand, negotiate their future by subverting some of the implications of male supremacy. 7. An elder complained to me about this practice (adding money to a customary form of redistribution) ‘introduced by the young people’. His son’s motherin-law and sisters-in-law had been visiting after the birth of his grandson (before the suuna). ‘We cooked a fowl for them but I also had to give them 400 cedis [the equivalent of approximately 80 pence, 1991] when they were departing.’ This is new, ‘adding money’. This example shows that money may now also be entering the sphere of visiting and ‘greeting’.

CONCLUSION

Rivers pointed out more than eighty years ago that medical beliefs and practices are socially anchored and part of the ‘social process’ (Rivers 1924: 55). He saw diffusion and culture contact as contributing to new ideas and practices (ibid.: 55–117). Rivers characterized the process whereby new ideas and practices are received by the host culture and are culturally patterned, as ‘transmission’, ‘transformation’ and ‘modification’. In Rivers’ or in a diffusionist sense, the Dagomba people can be said to have acquired many of their current medical practices from neighbouring cultures and people, as well as through contact with the Europeans in the twentieth century and previous centuries. One also notes how ‘experimentation’ among the Dagomba relates both to a structure of ‘medical uncertainty’ (using medicines in advance of evidence or a diagnosis) and a specific configuration of society and the economy. The focus on medicines takes issue with key concerns in medical anthropology. It is consistent with the basic orientation of most medical anthropological studies on healthy and sick individuals in relation to their society (Lieban 1977: 15). The book demands that we engage with two requirements: 1) to identify what is historically specific about the current social and economic formation and the responses to these; and 2) to acknowledge that an everpresent struggle of change to secure a future for oneself is going on, as expressed, for example, in the ‘developmental cycle of households’ (Chapter 1) – most recently experienced as ‘modernity’ under colonialism and postcolonialism. Given these specific and universal conditions, this is a study of healing, gender relations and the ‘problem of money’. These formations and actions engage with questions of magic and the complexities of modernity. The study itself is based on doctoral fieldwork in 1990–1991, later field research in 1995, 1996 and 1997, and various writings over the years (especially Bierlich, 1994, 1998, 1999, 2000 and 2007a, b, c). The focus is medicines – botanical preparations, Western pharmaceuticals and Islamic medicines – and the way in which these

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relate to notions and practices of health and act as metaphors for local and global transactions. While library studies may lead one to believe that the African context contains many exotic cases of illness, the actual field work situation proves one wrong in this assumption. Injuries and common illnesses, such as diarrhoea, fever and headaches, are the norm. People seem little concerned with explanation and simply treat the symptoms that occur. They are competent to help themselves with medicines, either local botanical preparations or Western pharmaceuticals. Everybody performs as a curer; self-care with medicines is the dominant form of therapy. The introduction of Western medicine seems not to have displaced traditional therapy. It has rather been ‘added’ as an additional therapeutic option people have. As a result we may think of the Dagomba medical culture as ‘pluralistic’. In spite of their experiences and treatment of routine health problems, people do, however, take a great interest in finding explanations for what they consider to be disruptions in their relationships with the world. People regularly consult diviners on issues of concern to themselves and their families. They are much concerned with dangers inherent in inter-personal relationships, and with all kinds of environmental risks. One also notes the question of personal power and the legitimate and illegitimate use of medicines. In this context, the position of men and women in Dagomba society relates clearly to patterns of control and use of medicines. These configurations and relationships bring out what Foucault (1994) and others before him see as the ‘false consciousness’ of those exploited, junior men and women, by elders and their ideology. The ancestor cult, ideas regarding the occult and the dangers inherent in interpersonal and gender relations, images of witchcraft and bewitched money are part of the narrative by which elders dominate the consciousness of all and support the social system and their power positions. To phrase this observation in another way: the social structure of the Dagomba consists of more than one level (cf. Evans-Pritchard 1969: 214–16). The ‘official’ level is that of agnatic descent, the frame of political organization and the ideology of male supremacy. This frame, as we have seen, does not, however, have a perfect fit with the world. The ideal picture of the social structure, which would include only agnates, is contradicted by the ‘reality’ of social life, which comprises not only men but also women. The fundamental problem of men having to trust women but not really trusting them either, relates to the paradoxical situation created by marriage, which introduces one stranger to another stranger. Upon marriage the Dagomba woman leaves her natal home and takes up residence with her husband. She remains, however, economically independent and strongly attached to her natal kin, and she appears to

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take a greater interest in her children than in her husband or in preserving the marriage (a woman easily divorces her husband). This situation prompts men to say that women are witches and must not be allowed to handle medicines, which they will use illegitimately to harm men. Men’s use of medicines, on the other hand, is considered legitimate. The hierarchical arrangements between people at the village level, and between chiefs, foster competition and an ideology of men’s legitimate use of medicines, in particular in their rivalries for power. The power of women is ‘hidden’ and centres on the home, where she cares for her family and its health, while men’s power is ‘public’. According to male ideology, medicines that have the power to cure can also destroy. These are related dimensions of medicine. Take for example the situation where medicines intended to protect its owner or to kill a rival turn upon an innocent bystander and harm him/her. The focus on medicines and medicinal power provides a window, however, not only on health and illness behaviours, but also on society, its dominant features and power-relationships. The notion that medicines and people have power contains also the idea that ‘external’ forces (such as the market, capitalism and global flows) may be responsible for patterning notions and practices related to health and illness. To begin with, power is an attribute of persons. It characterizes their capacity and propensity to use medicines to protect, cure and to harm. Power is also an attribute of medicines. Medicines are powerful; they can function both curatively, preventively, and offensively. Taken together, these powers originate in and relate to a social system characterized by latent hostility between the sexes and by male competition for status. Medicines play a dominant role. The key cultural image is that of two chiefs that fight each other with medicines. Following the central belief in ancestors, we note how traditional healing is embedded in a society where relations are not direct but always mediated by representatives between the living and the dead, seniors and juniors, and men and women. Such healing is always directed at showing solidarity with one another and upholding the existing social order and descent system. Through the agency of maternal kin, maternal ancestors and peoples’ individualized ‘spirit guardians’ (Wunis), however, individualizing tendencies are given recognition. In coping with life, people often turn to this source, their Wunis, for support. Coping becomes a way of managing one’s situation based on an available cultural template of living and dead maternal kin. Local culture and tradition are dynamic and in a continuous process of (re)invention. This view stresses the significance of African agency as opposed to change only being propelled by external (e.g., Western) influences.

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Local and Global Flows The study of the utilization of medicines provides a particularly interesting perspective for ethnographic research. It necessitates placing a local society in a broader macro-economic context, while at the same time requiring attention to be given to a local culture of healing and individual attempts to interpret and treat suffering. The focus on medicines allows us to relate healing to wider issues, the ‘intrusion’ of money and the market, and changing female and male roles vis-à-vis healing. The capitalist economy has penetrated northern Ghana and changed what men and women do now. Has money become opposed to kola? Does greeting and money contrast with one another? We note how money is used side by side with kola nuts. The reliance on the market and Western pharmaceuticals may be great, but it is far from complete, however. Local botanical preparations are still used, and forms of non-monetary exchange have not died out. Individual and collective healing measures are separate but inter-related. We also note that so-called primitive people are not necessarily as altruistic and giving as anthropologists often have depicted them. Mothers first of all care for their own children. A characteristic of manufactured medicines, such as Western pharmaceuticals, is their ‘concreteness’. Their healing power is inherent. Being ‘things’, commodities, they have no local or spiritual value, but are transacted through the impersonal medium of money. They signify an individualization of healing (grafted onto the traditional structure of maternal kinship, Chapter 2) whereas the exchange of plants usually involves the sick in face-to-face, social interaction (Van der Geest and Whyte 1989). Contrary to Western pharmaceuticals, Dagbani medicines operate both empirically and non-empirically. In their empirical aspects, Dagbani medicines are similar to Western medicines. They are primarily used to treat symptoms not causes. Men’s alleged control over medicine is challenged by women, who bypass men by buying Western medicines. The point, however, is that in the field of healing, men’s and women’s interests are inter-connected. They share the common goal of health for their families. The viability of the family (its reproduction) depends on the health of its members and the cooperation between men and women. Men and women perform separate but complementary roles. The field of medicine cannot be dichotomized into a department concerned with ‘curative medicine’ (a female domain), and a department of ‘preventive medicine’ (a male domain). The two spheres, the female and the male, the individual and society, are interrelated. While the use of Western medicines provides a way around social interaction, face-to-face relationships have not died out. A major concern of this work is to show

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that the cooperation between men and women is needed and that both monetary and non-monetary exchanges, individual and collective goals, co-exist in Dagomba society. While villagers relate differently to their local curers, compared to the medicine peddlers in whom they have less faith, they also judge these (as well as private chemists) on the principle of whether they show themselves to be ‘considerate’ of their life and culture. Peddlers who sell their drugs on credit approximate in their practices to the services rendered by local herbalists. In terms of contrasts, the practices of the medicine sellers (chemists and peddlers) vary from those of local curers who would never use their medicine ‘just like that’ – like Western commodities. Fuseini, the bone-setter, stressed among other things that he would take it very personally (lit., ‘be disturbed’) if his medicine would not work. The ‘cultural model’ (Fig. 3.1) is consistent with the ‘popular epistemology’ discussed by Francis Nymnjoh (2001: 28–49). It refers to a general magical orientation that posits no ‘artificial boundary’ but describes one, unified domain where the visible world partakes of the invisible, magical realm, referring to the powers of persons and medicine, the ancestors and various invisible and occult forces of the wild. This orientation is encircled by a non-monetary and noncommodifying collective ideology which leads to misunderstandings and ambivalences when confronted with monetary, impersonal, and a-social forms (at, for example, clinics and hospitals). Related to the question of female-male relations is the issue of which ‘futures’ men and women seek to secure for themselves. We could be tempted to look upon the current situation as ‘a recurring feature of an enduring structure of gender inequality’. I propose here to identify an additional frame of reference for men and women, one that relates to the way the sexes go about securing their futures in different ways. Men show great interest in accumulating riches through, for example, lotto playing (Chapter 6), in order to convert earnings into power and secure a future with wives and offspring – by their actions affirming patrilineal descent and basic male ideology and power positions. Women, on the other hand, access the market and employ the money they generate through trading to purchase things that will ‘make their children happy’, and buy Western medicines to treat them when they are sick (Chapter 7). Both sexes engage in monetary strategies considered by many elders to rupture the local non-monetary economy. The specificities of their actions allow us, however, not only to ask about enduring structures but also to situate their acts in relation to historically specific configurations of the society and the ‘transnational’ economy (Harvey 2000) permitting their members to produce their futures.

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To accomplish its goal, modernity (the ‘global’ and/or the ‘local’ scene) appears to rely on a mix of force (enslavement in the era of the slave trade) and submission (produced by colonialism) as well as various ‘magical’ notions and practices and traditional social forms (e.g., polygynous marriage) to prove that it is truly modern. This is what is meant when we refer to the ‘the magic of modernity’. This is not to be understood in terms of modernity simply retreating to pre-modern ways, but rather as an unequivocally modern form configured in relation to the local, to magic, to uncertainty as well as the unredeemed promises of the market, capitalism, industrialization, and Western education. This study is intended to stimulate our conceptualization of modernity, as made up of local and global flows. Modernity’s magical practices witnessed in the lotto complex and its aim of wealth accumulation are revealing and relevant for the study of health, good fortune and modernity. Lotto magic involves a mixture of magical and scientific techniques for the conjuring up of wealth. It is particularly well-suited as a commentary on modernity and its material realities, implying for the masses devastating poverty and hardships. To conceptualize the modern moment we must both interrogate (i.e., critically question) the contours and claims of modernity (which professes growing progress, rationality and development) and how these match a local structure, and the material reality producing ‘magical practices and interpretations’. Confronted with the homogenizing effect of the ‘global village discourse’, the simple requirement is to show how culture continues to pattern the interactions, that contexts determine their morality and that ideology may compromise a description of health and illness in the context of social and economic configurations that admit to the interrelatedness of local and global flows, irrespective of whether the study is that of modernity at the village or urban level. What is the relationship between magic and modernity in postcolonial Africa? Magic, the belief in spirits imbuing material objects and ancestors, is hardly ‘a hangover from the past’ but rather an attempt to locate meaning and prosperity in a modern, postcolonial world characterized by monetary forms and global market economies. Therefore, ‘modernity’ cannot be said to have displaced magic, au contraire. It provides, as Moore and Sanders note, ‘a new context in which [it] make[s] perfect sense’ (2001: 16). For Boteng Na (an outspoken elder who we have encountered throughout), a young man from Kpaling (village behind the district capital Savelugu) and many other lotto players in Dagomba, ‘magic’ (e.g., lotto forecasting) certainly ‘moves the world’, just like development, education and modernity.

APPENDIX

The statistical data collected in regular household visits provide important information regarding the medical problems faced by people. They can be analysed independently and give a useful understanding of demographic factors of illness, such as sex and age. Judging from the systematic inquiry (household visits), people’s concern with explanation does not surface often. Most of the time people simply treat symptoms with medicines. The quantitative material regarding people’s medical problems and their use of medicines forms the background against which the qualitative statements in chapters 1–8 must be seen. The qualitative perspective, based on observations and interviews, presents a quite different picture. People are, it is argued, in fact much concerned with their relations to the ancestors, kin, wives and fellow human beings in general. At the time I did my original field work in 1990–91 I did not find HIV/AIDS to be a specific issue which people in the community were discussing or aware of. Neither was there a campaign to make people aware of the infection nor was there a campaign that did not reach them. Over the span of my contact (up to 1998) with them HIV/AIDS did not surface as a threat in the area, so that we cannot speak of the scale and awareness of the problems changing. Neither did the Dagomba show awareness of a special category of ideas on sexually transmitted disease.

1.

The Burden of Illness

From August to September 1990 I conducted a census of Duko village. At the time the village consisted of twenty-seven big (more than twenty people), medium-sized (eleven to nineteen people) and small households (fewer than ten). The total population was 371. Over the following year, August 1990 to August 1991, the population increased by more than sixteen per cent to 394 people. During that period I recorded twenty-four births (including one still birth) and seven deaths, while one foster girl left

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the village and returned to her natal home. Adding to the population’s growth were also two sisters living in other villages but who had been divorced and had come to live with their brothers. Furthermore, three married women living in other villages returned home – according to custom – with their new-born children. The village population and its composition according to age and sex is shown in Figure A.1.

Figure A.1. Duko Village Population: August–September 1990

The figure reflects the high mortality of infants and young children. One finds that women over sixty-five years of age markedly outnumber men in that age group. Based on the census information, it appears that mothers come to live with their sons, while sisters live with their brothers in old age, at divorce or at the death of their husbands. Whether women outlive men or not, the census material does not reveal. I recorded a total of seven deaths between September 1990 and August 1991. The number includes one infant, who died – highly malnourished and dehydrated – of pneumonia, one still-birth, two children under five (who died following convulsions in connection with fever), a young woman (who was considered mad), and two elderly women (over sixty-five). To ensure some degree of good recall I systematically visited a sample of families (eleven out of twenty-seven) every two to three weeks, between September 1990 and July 1991. In this manner I was able to collect systematic information on a wide range of illnesses and their management. People expected to be sick from time to time. The following table is a list of 253 cases of illness that occurred in the village over fortyfour weeks: September 1990-July 1991. The list is made up of symptoms with a possible diagnosis in Western medical terms in parenthesis.

Appendix 189

Table A.1. Cases of Illness (September 1990 to July 1991) A. ‘Chest pains’, ‘coughing’, ‘sore throat’, ‘congested nose’ and ‘pains in forehead’ (Respiratory Tract Infections) B. ‘Feverish body’, with/without accompanying symptoms of ‘headache’, ‘stomach pains’, ‘vomiting’ and ‘body pains’ (Malaria) SUBTOTAL

44

31 75

COMMON SYMPTOMS A. ‘Stomach pains’, with/without ‘fever’ and with/without ‘stomach pains’ B. ‘Pains in the head’ C. ‘Inflammation of eyes’ D. ‘Pains in body’, with/without accompanying symptoms of ‘headache’, ‘stomach pains’, ‘pains in joints, side and waist’ and ‘feeling cold’ E. ‘Swellings’, or bodily disorder (kpaga) 1. ‘Pains in ears, teeth, jaws and throat’. These symptoms are spoken of as sanpana 2. ‘Bush illness’ (anthrax) and ‘pimple’, jogu/bingoo 3. Guinea worm, nierifu 4. ‘Swollen breasts’ 5. ‘Heatrashes’ F. ‘Sores’(caused by burns), ‘cracked feet’ and scorpion stings SUBTOTAL MISCELLANEOUS COMPLAINTS

49 23 23

13

10 4 2 1 2 40 167 11

Including ‘pains in joints and neck’ due to old age (2)’; ‘shivering and bodily pains’ due to old snakebite (2); ‘swelling’ (kpaga, here: hernia) (2); ‘child does not grow’ (appears dull and anaemic) (1); ‘head’ (zugu, sunken fontanelles) in babies (2); ‘swollen leg of baby’ (1) and ‘madness’ (yinyahali) (1). GRANDTOTAL

253

The list makes no claim of being a complete or accurate representation of all the illnesses that people experienced. It does, however, give a good indication of the kinds of medical problems that people faced. The case count is based on sixteen visits to eleven households each between September 1990 and July 1991. On average, I visited eleven households, or 167 people, every 2.7 weeks. The list is made up of ‘new’

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cases only. In recording cases of illness, one problem concerned deciding what counts as a case. Some people would draw attention to an old ailment while at the same time reporting a ‘fresh’ complaint. I had daily contact with many people and would systematically visit a number of families every two weeks. I was therefore able to form a good idea of what was a new illness, or new manifestations of an illness which had already been recorded in a previous visit. In support of a ‘continuing case’, people themselves would comment, for example, that ‘my cold has moved from my forehead to the chest. I cough a lot’, or that ‘my pain, [in connection with kpaga, a general bodily disorder] moves around in the body. It was in my neck but it has moved to my waist now’. Based on the case count, Figure A.2 describes the total burden of illness in the village (1990–91) according to age and sex.

Figure A.2. The Burden of Illness

Appendix 191

The figure indicates relative amounts of different kinds of illness in different segments of the population. The amounts are fairly equally distributed among men and women. While I had expected women to experience more sicknesses than men, in particular during their fertile years, this was not brought out by the survey. I have placed the percentage of particular age and sex groups out of the total population next to amount of cases provided by the same groups. By taking the ratio between amounts of illness and number of people in different age/sex groups, one gets the relative susceptibility of particular sex/age groups to illness. It can be seen that infants and small children (up to four years old) are very susceptible to illness, in particular to ‘fever’ and ‘stomach pains’ (malaria and diarrhoea). About a third of the reported cases of illness fall within this age-group, which represents about a fifth of the total population (20 percent). In relation to their percentage of the population (14 percent), however, adults over forty-five are the segment most susceptible to illness. They contribute twenty-six per cent of all cases. The ratio between age and illness in the zero to four year olds is about 2:1, approaching 1:1 in the remaining age groups of five to fifteen and sixteen to forty-five years of age. The most marked difference with regard to sex occurs in the ages five to fifteen. As compared to females (1.6 percent), males between five and fifteen contribute by far the most cases of illness (10.2 percent). These are mostly made up of sores caused by hoe-, axe- and bicycle accidents. Females, whose lives are more constrained, experience much fewer injuries. In later life, sores and injuries are less common in both sexes. Sores from scorpion stings and lesions of the skin from walking bare-foot continue to occur from time to time throughout life. However, sores from injuries have throughout life a considerably higher occurrence in males than in females.

Figure A.3. The Kinds of Illness in the Population

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Figure A.3 shows the contribution by sex of different kinds of illness to the total amount of illness in the population. Stomach pains rank highest in the hierarchy of reported illnesses (49 cases = 19 percent), followed by respiratory complaints (44 cases = 17 percent), sores (40 cases = 16 percent), fever (31 cases = 13 percent), pain in the head (23 cases = 9 percent), inflammation of eyes (23 cases = 9 percent), swellings (19 cases = 8 percent), other bodily symptoms (13 cases = 5 percent) and miscellaneous behavioural and physical signs (11 cases = 4 percent). ‘Fever’, ningbuna tula, accompanied by apathy is the most serious complaint in the area, followed by ‘stomach pains’, puuni, and ‘pains in breathing’, nyogni. These local terms may be translated – following Western medical terminology – as malaria, diarrhoea, and respiratory infections, respectively (Bugri 1988). Locally, there are no practices to prevent malaria and other water-related infections from occurring (MacCormack 1988). In particular, young children experience repeated infections of malaria and diarrhoea. The disease burden also shows a marked seasonal pattern, with fevers (in adults), chest pains and other bodily symptoms particularly common in the rainy season (April–October). Inflammation of eyes and diarrhoeas often occur at the transition from wet to dry, and dry to wet, weather. Finally, season also has an influence on the availability of water: during the dry season (November–March) most water sources dry up or become drastically reduced. The water source, its quantity and quality, has been shown to have an effect upon many aspects of health, including diarrhoea, malaria and other water-related infections (White et al. 1972; Bierlich 1995a).

4

31

12

TOTAL CASES

TOTAL PERCENTAGE

3

NO RECORD

NO TREATMENT YET

2 (i)

4

LOCAL & WESTERN (1)

TREATMENT OUTSIDE HOME (2)

18

10

LOCAL

19

49

4

13

0

7

7

8

WESTERN

17

44

7

5

1 (ii)

1

21

9

18

46

11

5

0

4

10

16

8

19

2

0

1 (iii)

0

13

3

16

40

8

3

0

3

17

9

5

13

3

1

0

2

2

5

4

11

2

0

1 (iv)

3

3

2

253

41

30

5

24

94

59

FEVER STOMACH RESP. HEAD SWELLING SORE OTHER MISC. TOTAL & SYMP- CASES NO. EYES TOMS

100

16

12

2

10

37

23

TOTAL %

2.

CHOICE OF MEDICINE

Appendix 193

Patterns of Medicine Use

Table A.2. Therapeutic Choices in Relation to Different Kinds of Illness

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The table summarizes the results of the survey of patterns of medicine-use regarding eight different kinds of complaints. The survey was carried out in connection with the regular visits of families in the village. The table indicates how the Dagomba respond to commonly occurring symptoms and how they select between the different systems of treatment available to them: local Dagbani botanical preparations and home remedies and Western pharmaceuticals. A total of 253 treatment choices were sampled. One notes that home treatment with medicines is the dominant therapeutic choice. In the majority of cases (76 percent) treatment takes place in the home, and in 72 percent of cases treatment is medicinal. Local medicines (plants) and remedies (spices, oil, pastes, kerosene) are the preferred choice (37 percent of cases), followed by Western medicines (23 percent) and combinations of local and western medicines (10 percent). To say that medicines are taken in combination means that various therapeutic steps are taken, including parallel treatment of symptoms with Western and local medicine. Moreover, symptoms at different stages are treated with different kinds of medicine, and so on. Western pharmaceuticals are purchased in the market town of Savelugu (4 miles away), from drug peddlers who visit the village and in the village ‘shop’ run by an older woman. Local medicines and remedies are freely available in the home. If unavailable, inquiries are made from friends and neighbours. Occasionally, somebody is formally approached with a gift of kola, is ‘ begged for’ medicine. Only in two per cent of cases (five cases) was a condition treated outside the home. All these cases, with the exception of one, concerned sicknesses in infants and children. Professional help was sought at the clinic in Savelugu in one case, at a diviner in one case and at a barber in three cases. The clinic was visited and medicines purchased for an infant with malaria (Chapter 7). A barber was consulted to have incisions made in joints against fever and a swelling. Where a case of illness was not more than a few hours or a day or two old, treatment had often not begun yet (12 percent). If an emergency was not present, treatment might not be started immediately. However, if a pain killer, such as paracetamol, was available, it was often given. ‘No treatment yet’ may also reflect the fact that indeed no medicine was taken, or only rudimentary self-treatment occurred (e.g., massaging of aching body part, washing of sore, tying of a piece of cloth around wound). Therapy also sometimes consisted of no medicinal treatment at all. In that case certain foods were avoided. In general, diarrhoea patients avoided oily dishes based on groundnuts – a light diet of corn porridge (kokoo) was preferred (Abu 1989). Finally, in sixteen per cent of cases I was not able to obtain a treatment record. This may partly be explained as due to a failure to report treatment since the symptoms caused little concern.

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——— 23–29 January 1995. ‘Sapped Resources’. London: West Africa Publishing Company. ——— 6–12 February 1995. ‘West Africa Severely in Debt’. London: West Africa Publishing Company. ——— 13–19 February 1995. ‘Hovering on the Edge’. London: West Africa Publishing Company. Westermann, D. and M.A. Bryan. 1970. Handbook of African Languages. Part 2: Languages of West Africa. Folkstone: International African Institute. White, G.F., D.J. Bradley and A.U. White. 1972. Drawers of Water: Domestic Water Use in East Africa. Chicago: University of Chicago Press. Whitehead, A. 1984a. ‘“I am Hungry, Mum”: The Politics of Domestic Budgeting’, in K. Young, C. Wolkowitz and R. McCullagh (eds), Of Marriage and the Market. London: CSE Books: 88–111. ——— 1984b. ‘Women and Men; Kinship and Property: Some General Issues’, in R. Hirschon (ed.), Women and Property – Women as Property. London: St. Martin’s Press: 176–92. WHO Model List of Essential Medicines, revised April 2003: www.who. int/medicines Whyte, S.R. 1981. ‘Men, Women and Misfortune in Bunyole’, Man 16: 350–66. ——— 1988. ‘The Power of Medicines in East Africa’, in S. van der Geest and S.R. Whyte (eds), The Context of Medicines in Developing Countries: Studies in Pharmaceutical Anthropology. Dordrecht: Kluwer Academic Press: 217–33. ——— 1992. ‘Pharmaceuticals as Folk Medicine: Transformations in the Social Relations of Health Care in Uganda’, Culture, Medicine and Psychiatry 16: 163–86. Wilks, I. 1961. The Northern Factor in Ashanti History. University College of Ghana, Institute of African Studies. ——— 1965. ‘A Note on the Early Spread of Islam in Dagomba’, Transactions of the Historical Society of Ghana 8: 87–98. Wilson, W.A.A. 1972. Dagbani, an Introductory Course. Tamale: SIL. Wolf, E.R. 1982. Europe and the People Without History. Berkeley: University of California Press. World Bank. 1994. Adjustment in Africa: Reforms, Results, and the Road Ahead, A World Bank Policy Research Report. World Bank: Oxford University Press. OUP. Young, A. 1981. ‘When Rational Men Fall Sick: An Inquiry into Some Assumptions Made by Medical Anthropologists’, Culture, Medicine and Psychiatry 5(4): 317–35. ——— 1982. ‘The Anthropologies of Illness and Sickness’, Annual Review of Anthropology 11: 257–85. Zempleni, A. 1977. ‘From Symptom to Sacrifice: The Story of Khady Fall’, in V. Crapanzano and V. Garrison (eds), Case Studies in Spirit Possession. New York: John Wiley: 87–139.

GLOSSARY

Dagbani A afa ala[a]fee alaafee doro alali alizinima asiba puuni B ba ba yili ba yino, ka manima konkoba baga baga koligu bagayuli baligi bamaiah ban bansim baramanga bewula E.g., A ningbuna bewula? bia (plur. bihi) bi-kpema biegu, be bierim

English Islamic diviner health, I/we am/are well (answer to question: ‘How are you?’) light illness, lit., ‘health illness’ right fairies morning farm

father patrilineal descent, paternal origin, the father’s paternal and maternal kin stepmothers, lit., ‘one father, but different mothers’ calabash diviner divination, literally ‘diviner’s bag’ sacrifice (to ancestors) reduce, e.g., suffering bamaiah, dance know knowledge beggar How? How is your body? child eldest son bad pain

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biEra bihegu bingo bindirigu binsaa binsaa binshiegu bugim bugisiri buni, arizichi (Hausa) bun-dana burnin

being in pain characteristics, nature painful boil food diarrhoea (watery) diarrhoea (watery) something fire to guess wealth wealthy person the soot from the fireplace

C chirga

injection

D dabiEm dachihi Dagbamba (sing., Dagbana) Dagbanli Dagban tima dang daridari dash dee li dihili dirgu diri ti wuhala pam dogari-kpema dogari paga dogim dogu doo doro (plural, dorti) dunya duu duu noli or dundoli, F faarma fara

fear playing mates The Dagomba Dagbani-language, -culture, -tradition Dagbani medicines, that is botanical preparations bilateral group of kindred ‘shaking’ (ephedrine) Ghanaian gloss for ‘tip’ take it poison, lit., ‘forceful/involuntary feeding’ pains in the forehead ‘suffer’ (work hard) father’s most senior brother mother’s brother’s daughter (MBD), lit., ‘family wife’ kinship, family convulsion (often in connection with a high temperature), lit., stick man disease, illness, sickness world room, ‘matri-segment’ (i.e., unit of wife/wives and their children) patrilineage or ‘gate’ to office, lit., ‘entrance to room’

apparently a panacea of non-Dagomba origin (‘it treats every illness’) poverty

Glossary 215

E.g., fara mal ma fiegufiegu G gban gule

‘I am poor’ congested nose

gurum

skin, throne kola nut (used in greeting and other ‘traditional’ exchanges) sleep I/we am/are well (answer to question ‘How are you?’) protective waistband

J jilma jilma-lana jogu

respect respected person ‘bush-illness’

K ka sheli kikaa kobili kpaga kpaga-tim kpiema kobani tim kohingu kokoo kpan ku-lana kuna kupagisi

for no reason harmattan bone general bodily pains, hernia medicine used to treat general bodily disorder senior bone medicine (indocid) coughing corn porridge recover funeral-owner leprosy dwarves

L labana ligiri lon shi

return money sore throat

gom gom beni

M ma ma yili or mapolo ma yino ma-pira ma-pir-bihi mirigili mogani

mother maternal family, maternal kinship biological mother, lit., ‘children of one mother’ mother’s sister mother’s sister’s children ‘… that can be squeezed’ (tetracycline eye ointment in tube) bush

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mogani puu morilim musilim musulim tim or Afa tim (or woligu, literally ‘slate’) N n-bohi n-di n-gbaai n-gbang n-guli n-ku n-maari n-male n-sabiri n-suhi n-zang n-ti n-ti suhi na na-bihi naam Naawuni na-bihi purungsi

nahaba nahab-bihi nangban yini nantuo-bird Naya ne nierifu nimdi nin/ninsal/sala (pl., ninsalnima) nin bera nin bEra tim ningbuna ningbuna ni ningbuna nbera ningbuna tula nin-kurugu ninvohu

bush farm swelling, pimple, toothache, earache, sore throat Muslim Islamic medicine, that is. verses from the Qur’an

whisper eat catching, e.g,, enstooling a chief, an illness support protect kill cool having, being (e.g., being sick, doro-mal-o) write requesting a service, praying to God guide give requesting medicine chief, king (Ya-na) royals, lit., ‘children of chiefs’ constitution, lit., ‘creation’, political office God daughters of paramount chiefs (elderly princesses whose powerful medicines are much-coveted by men) mother’s brother mother’s brother’s children unanimity, peaceful living, lit., ‘one mouth’ mystical bird inhabiting the bush and inflicting ‘bush illness’ (jogu) Yendi, the traditional capital of the Kingdom clear, e.g., as in ‘the heart is clear’ guinea worm flesh person, human being eye inflammation ‘eye pains-medicine’ (penicillin eye ointment) body (sickness is) ‘in the body’ bodily weakness, lit., ‘my body pains’ fever, lit., ‘hot body’ elder, lit., old man toothache

Glossary 217

ninvohu-tim nira (pl., nirba) no bindi nubi nyin zuya mori nyinta nyogni nyogni yaalimi

toothache medicine person, human being faeces of fowls chew swollen gum co-wife chest, chest pains heavy breathing, lit., ‘the chest opens itself’

P pa-kurugu paga paga kpiema puhe pirba pito peli pohim E.g., pohim chana pua puuni E.g., n nyeri la puuni pumahagu

witch, literally ‘old woman’ woman senior woman greeting (somebody) father’s sister beer white wind wind blows pregnancy stomach, lit., inside. I am menstruating diarrhoea with blood

S sabilga sabili sagim sambu samli sana (plur., samba) sanpana sa-tahangu shia shieguni silimin tim(a) shinshagani simbani puu simpa sobu sogo soli sonya sonya ligiri

black talisman (witchcraft) ‘destroys’ its victim, (money) ‘spoils’/’defiles’ healing ‘illness caused by man’ (buying on) credit stranger swelling of jaws, throat, chest, etc. lightning spirit or shadow rainy season (April-October) Western pharmaceuticals, biomedicine, literally ‘English medicine’ bathroom compound farm simpa, dance of young people menstruation witchcraft way, road witch bewitched money

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sugilo suhu suhu peli (palgi) suhu sagangu or suhu garibu suhu zabiri suhu yigisili suhu yobu suuna

patience heart happiness, lit., ‘white heart’

suuna gule

sadness jealousy, lit., ’the heart fights’ anger, lit., ‘the heart stands up’ ‘motivated by the heart’ out-dooring (when the newborn child is first brought out and named on the eighth day) suuna-kola

T tangasi tEha tia, tihi (plur.) ti biegu ti tibiri li ti guli ti-koha (plur., nima) ti-kpula ti peli ti sabilga tibu tilahi tim (plur., tima) tim-lana tim maa yuli tin tin-dana tingbani topaya topaya ze tulim tuma

Tangasi (brand name for a household bleach) thought tree, curative plant offensive medicines, lit., ‘bad medicines’ curative medicines protective medicines, lit., ‘medicines that watch’ medicine seller (chemist, drug peddler) medicine balls, tablets curative medicine, lit., ‘white medicine’ offensive medicine, lit., ‘black medicine’ treatment ingredients in medicine , lit.,‘medicine pot’ medicine medicine-owner the medicine’s name land, village, earth Earth priest, lit, ‘owner of the land-earth’ land topaya, colourful antibiotic capsule ‘red topaya’ (tetracycline capsule) hot work

V viela vuhim

good, nice, beautiful breathing

W wolgu saha wonzam Wuni

‘heat period’ (before the rains set in and the rainy season starts in April) barber ancestral (maternal) Guardian spirit(s)

Glossary 219

Y yaa yaan (ima, plur.) yaana yaba yam yeltoga yoli/biegu yi yili yano, yina yili yidana yin-nima yinyahali yob-bindi yoo yum yum-tim Z zabiri o ningbuna zawuni puuni zegu zim zo zugu zugu biegu zugu sun zugu puri zugu yaari zulya

power ancestor, the dead grandchild grandfather reason unreasonable things, lit., ‘bad talk’ divorcing, leaving the husband, lit., ‘go out’ house home household head members of household madness termite faeces price sore ‘sore medicine’

pain (lit., ‘it fights’) in your body afternoon farm red blood friend head, also ‘sunken fontanelles’ misfortune, lit., ‘bad head’ luck, good fortune, good rapport, literally, ‘good head’ brains, lit., ‘the head farms’ headache, lit., ‘the head opens itself’ tribe, titled class

INDEX

Abdalla, Ismail, 4, 78n3 Abu, Katie, xviii, 139, 196, 217 Abudulai, Mobson (and Sulemana), 14, 16, 76, 119, 150n5, 156, 157, 178n3, 178n4 adjustment, policy of, xii, xiv, xv, 56, 75, 76, 114, 119, 120, 122, 123, 126, 136, 150n4, 151 (note 7), 164, 168, 169, 174, 176, 178n5. See also effects on health Africa, The Invention of, xiii, 107 African, philosophy, premises, agency, xiii, xiv, xvii, 20, 59, 96, 102, 105, 108n7, 116, 120, 127, 130, 136, 143–6, 168, 176. See also tradition, customs, concepts and practices, post-colonial situation, globalization, witchcraft, magic/the occult, money, medicine, modernity, divination, lotteries, power Afromodernity, xiv agency, female, 20, 52, 129–51, 177. See also future; African premises agricultural, cycle, xiv, 16, 136. See also seasonal calendar; gender Alland, Allexander Jr., 57, 78n6, 97 Alubo, Ogoh, 74 ambivalence, xiv, xv, xviii, 36, 100, 101, 129, 149, 153, 155, 176, 185 ampicillin, 18, 73, 171. See also pharmaceuticals ancestors, moral authority, xiv, 4, 6, 19, 25–7, 41, 58, 59, 60, 106, 134, 182 healing, 105, 165, 166–8

maternal or Wuni-ancestors xiv, 11, 24, 25, 26, 27, 36n3, 182 modernity, 125, 186 plants, 65, 69, 71, 77n1, 80, 83 prayer, 25, 58, 59, 66, 71, 77, 77n1, 78n8, 92, 94, 161, 166 See also individualism Anderson, Benedict, xvi, 197 Appiah, Kwame, 74, 75, 126 April–July (hungry period), 151n7 April–October (rainy or farming season), 3, 15 (Table 1.2), 47, 75, 98, 194 Ardener, Shirley and Burman, Sandra, 138 Ayitey-Smith, Edward, 65, 108n7 bad medicines, 29, 61. See also witchcraft ba yili, 12, 25. See also ma yili ba yino, ka manima konkoba, 9. See also ma dogo bewilderment, xiii, 169. See also ambivalence Bierlich, Bernhard, xvii, 3, 21n2, 40, 76, 97–98, 101, 113, 125, 128n3, 147, 169, 181, 194 Bijlmakers, Leon, Mary Basset and David Sanders, xv, 136, 151n7 bilateral, 5–6, 10. See also conjugal bond biomedicine, experience of, xv, xvii, xviii, 36, 100–107, 108–9n10, 143–49, 176. See also ambivalence; bewilderment

222

Index

Blair, H.A. and A. Duncan-Johnstone, 3, 21n2 Bledsoe, Caroline and Monica Goubaud, 71, 176 Bledsoe, Caroline and Uche IsingoAbanihe, 147 Bloch, Maurice, 161 Bohannan, Paul, 157, 159–60, 179n6 botanical, substances (plants), xvi, 37n1, 59, 60. 61, fig. 4.1, 62, 63, 64 (table 4.1), 69, 71, 72, 73, 76, 79–83, 90–6, 130–4, 149, 164–8 Boteng Na, xviii, 46, 67, 125, 186 brothers, residence with brothers and sons, 6, 11, 18, 37n2, 130, 131, 141, 143, 147, 188 (appendix). See also kinship fostering Brydon, Lynne, 19, 75–6, 120, 122, 174, 178n5 Bugri, Sam, 96, 108n8, 194 burden, of illness, xvii. See also appendix I capitalism, market-individualismlocal-global flows, 11, 17, 36, 51, 74, 114, 129, 155. See also gender; magic; medicine; modernity; moral economy cash, xii, xvi, 13, 15 (Table 1.2), 24, 28, 35, 100, 137, 138, 153, 160, 162–3, 178n5. See also money; future Cassell, Eric, 101, 109n11 change, xiii–xvii, 11, 16, 22n6, 28, 74, 79–80, 111, 126, 164, 169, 174, 181, 183. See also modernity Chazan, Naomi, 174 Chen, Sen and Germain, xv child, parent-child bond, 12. See also trust; dogim (kinship) children, care of, xvi, 19, 23, 59, 100, 129–51 and hunger, 151n7 and welfare, 19, 89, 129–51 See also appendix 1 choice in treatment, see medical pluralism Clark, Garcia, 135, 138

Cole, Michael, xvii Comaroff, Jean and John, xiv, xv, 34–5, 73, 113, 115, 119, 124, 125, 131 commoditization, 17, 24, 28, 159, 160, 162–3 moral economy, 27, 51, 97, 111, 119, 120, 123, 127, 158, 165–6, 174, 177 illness, 42 pharmaceuticals and women, 52, 55, 57, 61 (Fig. 4.1), 70–1, 71–3, 74, 75–7, 153 contexts of curing, 164, 170, 176–7. See also capitalism; the market; women-men compatibility, between the sick and medicines, including injections, 77n1, 105 complexities, of modernity, xiv–xv. See also ancestors; globalization; magic; medicines; the power of persons; witchcraft conjugal, bond, see brothers consciousness, false, xv, 177, 182 control, of knowledge, xiii, 6, 83, 119, 124, 127, 129, 130, 134, 136, 149, 163, 168, 177, 182 of healing by men, 51, 65, 79–86, 174 of women by men, 16–7 by women of the economy, 28 See also control of knowledge conversions, see future; polygyny; future outside marriage Cruise O’Brien, Donal, 128n7 culture, medical, xiv, 86–7, 89, 90, 94, 106, 182 local culture (=‘the occult’, ‘tradition’), xiv, 20, 34, 51, 88, 74, 75, 90, 92,100, 101, 102, 105, 106, 107, 122, 127, 136, 145, 146, 155, 156, 168–9, 172, 176, 181, 183, 184 Western culture, xiv, 90, 100, 105, 127, 136, 156, 164, 172, 181 See also modernity custom, xiv, 7, 69, 172. See also tradition cycle, developmental cycle of households, xiv, 11, 13. See also the two farming cycles

Index 223

dagbandaba, 4 Dagbon, 1 Dagomba medicine, see botanical substances; the power of the person and medicines dang (bilateral group of kindred), 10, 12 descent, patrilineal, xiii, 6, 9, 12, 20, 24, 25, 27, 29, 33, 37n2, 100, 130, 154, 173, 182, 185. See also male control of knowledge; ideology; women’s practices divination, 13, 19, 107n3, 182 authority of divination and power structures, 165–6 causality, 111, 113 compatibility between the sick and the medicine, 77n1 curing, 80, 81 efficacy of healing, 92 kinship therapy, 89, 105 lotteries, 114–28 powers of the person, 23, 26, 36, 50, 52 women consulting diviners, 150n6 divorce, 6, 10 (Fig. 1.4), 11, 18, 24, 29, 130, 133, 141, 143, 147. See also sibling bond dogim (kinship), 10, 12, 30, 156. See also chapter: 2.1 Drucker-Brown, Susan, 4, 5, 19, 21n1, 21n2, 21n3, 28, 31, 56, 69, 163, 174 drug peddlers, 168–72. See also money; medicine dry season (November–March), 2, 16, 119, 137–8 illness, 194 (appendix) See also seasonal calendar; agricultural cycle Duko, xviii, 6–8 (Fig. 1.3), 10, 11, 13, 18, 21n3, 31, 37n2, 40, 108n8, 137, 140, 142, 165, 174, 187 (appendix) duu, 9, 21n3, 45, 147. See also kinship

practices; pharmaceuticals; the magic of money-making; moral economy efficacy, 58, 60, 65, 79, 90–9, 105, 106, 108n7, 177 elders, authority of, xiv, xvi, 6, 10, 16, 23–4 accusing women of witchcraft, 57, 75, 123, 125 condemning lotteries, 115, 116, 119 money and modernity, 123, 125, 158, 161, 166, 173–7 moral economy, ideology and power, 27, 29, 30, 32, 35, 40, 53, 57, 60, 72, 75, 97, 106, 119–20, 125 women as agents, 129–51, 182, 185 Etkin, Nina and Paid Ross, 60, 108n7 Evans-Pritchard, Edward, 46, 83, 93, 182

economy, xiii, xiv, xvi, 12–7, 18, 19, 20, 24, 28, 29, 34, 51, 73, 87, 125, 126, 129, 138, 162, 163, 181, 184, 185. See also men-women relationships; healing

Gable, Eric, 37n3, 128n7 gender, xiii, xv, 16–7, 28, 29, 87, 106, 135, 150n4, 153, 168, 175, 185. See also modernity; magic; medicine; money;

Fabian, Johannes, 20, 100 Fage, Jon, 3, 21n2 Fanon, Frantz, 136 farming, two cycles, xiv, 16–7. See also seasonal calendar father’s sister, and paga kpiema, 11, 12, 24, 29, 31. See also witchcraft Ferguson, Anne, 101, 169 Field, Margaret, 58 Fisch, Dr., 21n2 fix-unfix, xiv, xvi Forde, Daryl, 5 Fortes, Meyer, 5, 9, 11, 13, 21, 25, 45, 56, 127n1, 141, 146, 176n1 Foucault, Michel, 131, 177, 183 Frake, Charles, 48 Frank, Jerome, 91–2 Frankenberg, Ronald and Joyce Lesson, 53n3 Friedman, Jonathan, xvii future, men and women, outside marriage, xvi, 20, 34, 35, 73, 124, 129–51, 154, 163, 179n6, 181, 185

224

Index

moral economy; men-women and their future Geschiere, Peter, xv, 34, 51 Geschiere, Peter and Birgit Meyer, 74 gift-giving, xvi, 30, 72, 86, 123, 132–3, 153, 159–60, 161, 166–8. See also moral economy global(ization), xiv, xv, xvi, 20, 34, 36, 51, 57, 74–5, 100, 116, 125, 181–6. See also individualizing pressures Gluckman, Max, 22n5 Gonja, 2, 5, 6, 10, 21n2, 21n3, 37n2, 37n2, 37n4, 132 Good, Byron, 44 Good, Byron and Mary-Jo DelVecchio, 83 Goody, Esther N., 5, 10, 21n2, 27, 60, 86, 132, 146 Goody, Esther N. and Jack R., 5, 6 Goody, Jack R., 3–4, 5, 13, 16, 21n2, 21n3, 38n7, 42, 56, 62 Gregory, Christopher, 159 Guardian, The [newspaper], 128n4 Guyer, Jane, 17 Haaber Ihle, Annette, 2, 4 Hannerz, Ulf, 74 hardships, ‘strike it lucky’, lotteries, xvi, 24, 76, 116, 119, 122, 123, 174, 186 Hart, Keith, xviii harvest, 3, 15 (Table 1.2), 16, 18 illness, 88 See also agricultural cycle Harvey, David, 74, 185 health, 1, 7 women and health care, xii–xv, xvii, 9, 19, 27, 28, 39–53, 55, 75–7, 79–109, 111, 112–3, 123, 124, 129–51, Appendix See also gender; modernity; magic and money; magic, wealth and health; modernity Hill, Polly, 157

ideology, xiii, 6, 16–17, 23–4, 27, 33, 70, 72, 108n9, 115–6, 119, 125, 129, 130–1, 134–6, 149, 166, 172–4, 175, 177, 182, 183, 185 illness-health, concepts, xiii–xv, 9, 19, 39–53, 146, 158, 186, appendix 1. See also powers of the person; medical culture individualism and maternal ancestors, xiv, 23–7, 183, 184 individuals, women and junior men, xiii, xvi, xvii, 11, 19, 27, 29, 34–5, 41 (Fig. 3.1), 75, 119, 123, 134–6, 153, 159, 162–3, 177. See also individualism and maternal ancestors intercropping, 13. See also farming economy; seasonal calendar Islamic medicines, xvi, 55, 61, Fig. 4.1, 62, 64, 65, 69–70, 71, 73, 96, 104, 162, 172–3 Jahoda, Gustav, 124 Janzen, John, 46, 78n6, 89, 90, 143 junior men, and women, xiii, xv, 16, 19, 20, 24, 27, 70, 74, 75, 130, 132, 162–3, 173, 174, 182, 183 Kakar, Sudhir, 17 Kiev, Ari, 124 kinship, see dogim Kleinman, Arthur, 46, 108n7, 177 knowledge, control of, xiii, 6, 79, 83, 106–7, 136, 177 Kosa, J. et al., 99 kpariba (communal work party), 18 Last, Murray, 40, 80, 87, 113, 140, 142, 148 Last, Murray and Gordon Chavunduka, 80 Leechor, Chad, 120 Lentz, Carola, 37n4, 128n5, 162 Leslie, Joanne, 151n8 Levi-Strauss, Claude, 92, 93 Levtzion, Nehemia, 4 Lewis, Gilbert, xvii, 44, 46, 88, 90, 95, 106

Index 225

Lieban, Richard, 181 Lindenbaum, Shirley and Margaret Lock, 131 local Dagomba farming economy, 17, 18 local-global flows, xiii, xiv, xvi, xvii, 17, 20, 33, 34, 35, 36, 46, 51, 57, 74–5, 100, 105, 116, 129–1, 184–6. See also ruralurban divide; modernity local systems of healing, xvii, 163–4 lotto, xvi, 62, 111–28. See also magic and money; moral economy LoWiili/LoDagaba, 5, 21n2, 31n7, 56 MacCormack, Carol, 194 Macfarlane, Alan, 156 Maclean, Una, 98, 100 magic, magic in/of modernity, xiii, xiv, xv, xvii, 25, 34, 35, , 55–7, 71–3, 75, 90–1, 94, 100–1, 111–28, 155, 176, 181, 185–6. See also modernity; gender and money; western medicines malam, 4, 107n5, 127n1 lotto and money, 118, 121, 128n3, 172 medicine, 62, 69, 70, 104, Mamprusi, 2, 3, 5, 21n2, 21n3, 28, 56, 101, 163 Manoukian, M., 21n2 Mauss, Marcel, 159 Mbembe, Achille., xv, 36, 112, 114 medical pluralism, xvi, xvii, 86–99, 143 medicines (tima), local and Western, xiii, xiv, xv, xvi, xvii, chapters 1–8 passim Meillassoux, Claude, 20 Meirelles, Fernando, 75 men-women, xiii, xv, xvi, 1, 6, 9, 17, 27, 34, 35, 51, 52, 72, 91, 97, 129–51, 162–3, 174, 182, 183, 184–5. See also gender; ideology; control of knowledge; western medicines; the market; magic; witchcraft Mendonsa, Eugene, 127n2 Meyer, Birgit, xv, 28, 33, 78n8, 114, 123, 124 Meyer, Birgit and Peter Geschiere, xv, xvi, 74

Meyer, Birgit and Peter Pels, xv modernity, xiii, xiv, xv, xvi, xviii, 1, 20, 22n6, 24, 34–6, 37n3, 52, 55–78, 100, 111, 113, 114–5, 116, 117, 119, 121, 122, 123, 124–6, 128n5, 129, 135, 149, 155, 166, 176, 177, 186. See also Afromodernity; globalization; gender; future; magic in/of modernity; magic and money; western medicines money, xiii, xv, xviii, 24, 72, 117, 119–20, 124–5, 159–61, 162–3 ‘bewitched money’ (sonya ligiri), 27, 117, 125 gender and season, 15 (Table 1.2), 16, 19, 137–8, 144–5, 149 lotteries and magical money-making, chapter 6 passim the market and capitalism, xvii, 11, 17, 19, 51, 72, 126, 158 medicine, 60, 69, 71, 72, 153–8, 164, 172–4, 174–5, 175–7 ‘money “spoils” the medicine’, 83, 88, 107n3, 156, 164–8 women and witchcraft, 24–38, 51, 52, 57, 75, 81, 115, 116–7, 123 See also moral economy; modernity; future; magic and gender; western medicines Moore, Henrietta, 147 Moore, Henrietta and Todd Sanders, xv, 35, 119, 124, 125, 126, 186 Moore, Sally, xiv moral economy, xv, xvi, 24, 25–7, 29, 51, 60, 73, 74–5, 97, 115–7, 123–7, 128n5, 129, 130, 153, 154, 155, 164 Mudimbe, Valentine, xiii, xv, 20, 107 Na bihi purungsi (princesses), 32 Naden, Tony, 21n2 Nelson, Nici, 138 Ngubane, Harriet, 50, 53n1 Nichter, Mark, 71, 105 NORRIP Report, 3 November–March, see dry or farming season; seasonal calendar Nyomnjoh, Francis, 185

226

Index

Occult (magic), xv, 33, 34, 35, 36, 50, 51–2, 65, 75, 113, 117, 155, 182. See also magic; modernity Ohnuki-Tierney, Emiko, 106, 143 Oppong, Christine, 7, 10, 21n1, 21n2, 21n3, 21n4, 24, 56, 80, 85, 107n5, 135, 137, 147, 156 Oshiname, Francis and William Brieger, 169 (The) Oxford English Dictionary, 1989 Edition, 55 paga kpiema, 11, 30. See also witchcraft Parry, Jonathan and Maurice Bloch, 154, 160 Parsons, Talcott, 87–8, 90, 107n6, 164 patrilineal descent, ideology and power, xiii, 3, 6, 9, 12, 16, 20, 21n1, 24, 25, 27, 29, 30, 33, 37n2, 100, 130, 155, 154, 173, 174, 179n6, 182–3. See also dogim (kinship) Patterson, K. David, 76, 80, 101, 102 Peil, Margaret, 135 Pels, Peter, xiv, 113, 125, 126 Pels, Peter and Birgit Meyer, xv, 124 pharmaceuticals, xvi, 18, 19, 28, 55–60, (Fig. 4.1), 63–5, (Table 4.2), 70–1, 72–3, 74, 76, 78n4, 78n7, 86–99, 100–1, 119–20, 129–51, 153, 158, 164–8, 168–72, 181–2 Piot, Charles, 19, 179n6 piriba (father’s sister), 11. See also witchcraft polygyny, 11 popularity, 33, 70, 112–3, 122, 158, 179n6 positions, of power, see elders post-colonial situation, Africa’s, xv, 33, 34, 36, 113, 114, 116, 125, 126, 181, 186 power, of the person, xiv, xvi, 23–38, 51, 52, 57, 79–80, 113, 157–8, 182, 183 Prince, Raymond, 124 puhe (greeting), 8, 86, 120, 132, 164, 165, 175 puuni, asiba (morning) and zawuni (afternoon), 14, 17. See also seasonal calendar

puuni (stomach), 45, 49, 50, 64 (Table 4.1), 65 (Table 4.2), 70, 194 (appendix) rainy season, see April–October Rattray, Robert S., 3, 21n2, 77n1 reciprocate care, xvi Reeler, Anne, 101 Regional Surveys of the World, Africa South of the Sahara, 76 reproduction, biological and social, 10, 16, 17, 20, 35 female agency, 129–51, 159 Revue de Medicines et Pharmacopees Africaines, 65, 108n7 Rivers, William, 181 Rodinson, Maxime, 69, 173 rural-urban, xvii, 16 Sanders, Todd and Henrietta Moore, xv, 35, 119, 124, 125, 126, 186 Savelugu, 1, 2, 3, 4, 6, 19, 21n3, 38n6, 46, 84, 96, 108n8, 125, 137 (Fig. 7.1), 143, 144, 169, 186, 196 (appendix) Scheper-Hughes, Nancy, 101 Schildkrout, Enid, 135 seasonal calendar, 15 (Table 1.2) Sen, G., G. Adrienne and L.C. Chen, xv Senah, Kwame, xv, 76, 121, 169, 170 Shaw, Rosalind, 106 Snow, David and Leon Anderson, 128n6 social structure, xiv, 6, 20, 18, 31, 52, 150n4, 153, 182–3 Spoken Dagbani for Beginners, 21n2 Staniland, Martin, 3, 5, 21n2, 21n3, 38n6 Stein, Howard, 164 Tait, David, 5,11, 15 (Table 1.2), 21n2, 21n3, 27, 38n5, 38n6 Tallensi, 3, 5, 7, 11, 21, 25, 56, 146, 178n1 Tamakloe, Emmanuel, 3, 4, 21n2, 21n3 Tamale, xviii, 1, 2, 3, 4, 6, 18, 38n6, 51, 78n7, 84, 96, 98, 150n6, 169, 170, 178n4 The Language Guide, Dagbani Edition, 21n2 therapy managers, mothers as, chapter 7 passim

Index 227

Thomas, Keith, 83 Topley, Margaret, 42–3 tradition, xiii–xvi, 37n1, 37n3, 72, 97, 106, 113, 114–5, 116, 122, 126, 135, 149, 183, 184, 186 healing, 164–8, 174–5, 175–7, 182, 183 male-female relations, 16, 19, 28, 33, 129–38, 162, 163, 165 traditions, customs, social rules and patrilineal descent, 1–9, 21n3 wealth, 123, 124, 125, 126, 124n5, 135 See also modernity trust, in men-women relations, xv, 20, 52, 129, 148 child’s care of parent in old age, xvi elders’ mistrust, 38, 115–6 and faith, 58, 90–4, 107n6 See also men-women Turner, Victor, 57, 64, 65, 78n2, 89 Twumasi, Patrick, 76 Twumasi, Patrick and Dennis Warren, 76 uncertainty, in illness, 44, 142 efficacy of medicines, 95–9 in healing, 77n1, 83, 86, 90–4, 106, 122, 126 lotto, 111, 113, 121, 128n5 modernity, 155, 176, 186 social relations, 101 uneasiness, xv, 34, 36, 51, 72, 74, 100, 108n9, 155, 177 in healing, 44, 77n1, 83, 90–4, 95 social relations, 101–3, 142, 176 wealth and ‘good fortune’, 111, 113, 128n5 See also bewilderment, ambivalence, uncertainty unmediated, social and cultural forms, xiii, xiv. See also tradition Van der Geest, Sjaak, 60, 76, 176 Van der Geest, Sjaak and Anita Meulenbroek, 48 Van der Geest, Sjaak and Susan Whyte, 60, 75, 98, 101, 184–5

Vaughan, M., 101, 108n10 Vaughan, Olufemi, 128n4 Vogel, Ronald and B. Stephens, 169 von Ferber, Christian, 107n6 Wagenaar, Willem, 128n6 wealth, 13 female future, 100, 129, 162–3 health, xv, 115, 155–8, 186 lotteries, 111–28 male future, 19, 162–3, 179n6 morality, 34, 35, 114, 132, 175–7 witchcraft, 24, n27, 31, 51, 52 See also health; magic Weber, Max, 71 Weiss, Brad., xvi, 128n7 Werbner, R., xv Werbner, R. and Ranger, T., xv, 112–3, 124 Werner, David, 170 Westermann, Dieter and Bryan, M., 21n2 western, medicine, power, medical pluralism, xiii, xv, xvii, 46, 57, 59, 60, 61 (Fig. 4.1), 62, 63, 70–1, 72, 73, 75, 78n6, 78n7, 86–7, 91, 94–7, 98–9, 101, 103, 107n6, 108n7, 182, 184 ambivalence, 104–6 contexts, 163–4, 168–72, 172–7 double standards, 106 and Islamic medicines, 69, 71 morality, 51, 119, 164–8 women, 15 (Table 1.2), 16, 28, 52, 59, 72, 73, 129–49, 162–3 See also money; modernity West Africa [Journal], 121, 124 Western pharmaceuticals, see pharmaceuticals Whitehead, Ann, 15 (Table 1.2) WHO Model List of Essential Medicines, 98 Whyte, Susan, 78n2, 101, 168, 169, 176 Whyte, Susan and Sjaak, Van der Geest, xvi, xvii, 60, 75, 98, 101, 184 Wilks, Ivor, 4 Wilson, W., 21n2

228

Index

witchcraft, xiv–xv, 6, 9, 10 (Fig. 1.4), 11, 12, 125, 157–8, 175, 177 powers of the person, 23–38, 41, 51–2 medicines, 55–60, Fig. 4.1 jogu (‘bush illness’), 104–6 lotteries, 115–6, 127n2 Wolf, Eric, 79 women, and family health care, xv, 80, 129–51 women and men, see men-women. See also juniors and men; money; medicine and magic World Bank, xv, 76, 120 Yakubu Andani II, Ninbun Na, xviii Young, Allan, 53n3, 95, 130