The infancy of Edward Shelonga Part II: The extended case; ethics
an extended case study in medical and religious anthropology from the Zambia Nkoya
Wim van Binsbergen
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The infancy of Edward Shelonga Part II: The extended case; ethics an extended case study in medical and religious anthropology from the Zambia Nkoya Wim van Binsbergen |
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to Part 0 (Abstract)
to
Part I (Problem and Method; Background)
Part
III (Interpretation; Conclusion)
Part
IV (References; Postscript on Cognition)
4. The extended case
I
shall present the facts of Edward’s [6][1]
and his parents’ health experiences in chronological order
and with such relevant detail as my data allow. Only after this
has been done, shall I, in the subsequent sections, interpret
these facts in the light of the central questions posed in this
chapter.
Diagram 1 presents a genealogy of the protagonists in this extended case. (click for diagram 1)
Muchati [7], born in 1946, had left his father’s village
Nyamayowe in 1961. He had been called to Lusaka by his kinsman
Shipuna [5]. The latter had promised to see Muchati through his
primary-school education, which in the village had stranded due
to lack of money for school fees. Muchati joined Shipuna’s
household, but not until almost a decade later (1969) did he find
an opportunity to actually continue his education. Meanwhile
Shipuna’s urban following waxed over the years, so that by
the late 1960s he found himself the leader of a fenced ward in
Lusaka’s Kalingalinga squatter compound. The ward comprised
six to eight households of close kinsmen of Shipuna, including
Muchati. By that time Muchati had found employment as a cleaner
with a nearby educational institution. In his spare time he ran a
clandestine bar. He had established a stable relationship with a
non-Nkoya townswoman.
1969.
Muchati’s kinsmen in Nyamayowe village prearranged a
marriage for him with Mary [4], a moderately educated (grade 4)
girl living in Jimbando village. Under grave pressure from his
father Shelonga [13], Muchati terminated his relationship with
his urban concubine. Following his father to the village, he
reluctantly married Mary there.
Muchati did not know that Mary was his distant classificatory
sister, and thence a more or less prohibited partner. Both
Muchati’s and Mary’s parents, however, were aware of
this fact. They did not consider it a real obstacle, as marriage
prohibitions in similar cases are believed to be recent
innovation among the Nkoya. Muchati’s parents themselves
were distant classificatory siblings, and their marriage had
lasted for over thirty-five years already. Yet the sibling link
between Muchati and Mary was kept a secret until after the
wedding, mainly in order to deny Muchati a valid argument against
marrying Mary.
There was yet another reason why, according to Nkoya standards,
the marriage was somewhat unusual. Apart from consanguinean
relationship between Mary and Muchati (which referred to a common
ancestor in the distant past), there was a marital link in actual
existence between Nyamayowe and Jimbando village. Kawoma [24],
headman of Nyamayowe village, was married with Mary’s cousin
Kashimbi [40]. Besides being a headman, Kawoma was employed on
Chief Kahare’s royal establishment. He divided his life
between Chief Kahare village (where the household of his favorite
and senior wife was located), and Nyamayowe where his other two
wives lived, including Kashimbi. Nkoya consider it
disadvantageous to contract, within one generation, more than one
marriage with the same village. By entering into marital ties
with as many villages as possible, the village members maximize
the social field where new generations can find residential and
economic support. At the same time avoidance of multiple marital
ties with one village minimizes the probability of chain
reactions in the deterioration of inter-village relationships, in
the (only too likely) case that one of these marriages breaks
down. For divorce is extremely frequent in this society.
Thus the marriage of Muchati and Mary started out with a number
of structural disadvantages. The spouses’ personalities and
their life spheres (town versus village) were not yet attuned to
each other. Contrary to many contemporary Nkoya marriages the
affinal relationships surrounding this marriage lacked the
clear-cut juxtaposition between the husband’s and the
wife’s immediate kin group. Having been recognized as
distant classificatory siblings, both spouses in theory belonged
to the far periphery of each other’s kin group — and
while this may initially have been regarded as a sign of positive
integration, it deprived the parties in this marriage from the
advantage of well-defined kinship positions from which future
marital conflict might be adequately dealt with in a judicial
context.[2]
Nyamayowe village had already received a wife from Jimbando
village, and the vicissitudes of this earlier marriage could have
repercussions on Mary’s and Muchati’s own marriage. The
accommodation of Mary’s and Muchati’s initially quite
district personalities and interests, as well as the development
of affinal tensions inherent in any Nkoya marriage but acerbated
by the confusing overlap in affinal relationships and by the
multiple inter-village marriages, are to form major specific
structural dimensions of Edward’s case.
Just how exceptional was Muchati’s and Mary’s marriage,
involving remote classificatory siblings and multiple
inter-village links? While normative pressures exist against both
structural features, I estimate that either feature is present in
roughly 10% of all marriages. In the Nkoya kinship system,
affinal ties produce classificatory sibling relations in the next
generations; therefore the two features do not occur
independently, and the probability of their combined presence
would be something between 1% and 10%. However, this relatively
unusual marriage does by no means explain any Edward’s case
as non-representative. Beneath the specific details, a more
fundamental and universal principle can be detected: the extreme
optional nature of group formation in Nkoya society, and hence
the incessant competition for followers and associates, with both
medico-religious and other means, inside and outside the
medico-religious sphere.
Immediately after the wedding ceremony in the village, Muchati
took Mary to Lusaka. Only part of the agreed bride-price had been
paid. The rest was to follow in installments over the next few
years. The couple settled in Shipuna’s ward. Now that he was
married, Muchati no longer depended on Shipuna’s household
for the preparation of his food and for other domestic services.
He has passed out of the immediate domestic control of Shipuna
and the latter’s wife Banduwe [2], and no longer submitted
to them a considerable portion of his income. Banduwe greatly
resented these developments. Soon after the wedding she started a
gossip campaign in order to affect Muchati’s relations with
his in-laws. She alleged that Muchati did not feed Mary well, did
not give her proper clothes etc. Alarmed, Mary’s mother
Malwa [28] came to Lusaka to inspect the situation. She satisfied
herself that the accusations were quite unfounded. Meanwhile
Muchati lost his job as a cleaner.
August
1970. While Muchati was unemployed, their
first son Joseph [3] was born without any complications. He grew
up without serious health problems.
November
1970. In Kalingalinga, Mary participated for
the first time in a nocturnal session of the Bituma cult of
affliction. She had never been diagnosed as suffering from this
particular affliction, but when she heard the drums play she
could not control herself and started to dance. As she did not
remove her clothes from the upper part of the body (as is
obligatory in this cult), the cult leader Jilemba accused her of
sacrilege and fined her K1.[3]
Hoping to incorporate Mary in her cult faction, Jilemba continued
for years to harass Mary and Muchati about this offence.
December
1970. Muchati found work again as a domestic
servant with an expatriate member of the academic profession.
November
1971. Muchati entered our employment:
originally as a domestic servant, but soon devoting an increasing
portion of his time to research assistance among the urban Nkoya.
With his family, he moved to our premises. Thus a period started
of 2 1/2 years of very intimate day-to-day interaction.
December
1971-January 1972. For several weeks Mary
had complained of vague, diffuse ailments.[4]
Finally she proclaimed that she wanted to travel to the village
in order to submit to treatment within a cult of affliction.
Muchati could not detain her, and she took Joseph with her.
Relational problems partly explained Mary’s departure. She
had been increasingly unhappy in town. She missed her village
friends as well as the rural economic tasks in which she has been
brought up and which she had learned to regard as inherently
meaningful. She found it hart to accept and enjoy her uxorial
role in the urban environment. For in town her economic power was
very limited. The family lived on the husband’s income. Mary
did not find satisfaction in her very limited domestic chores.
She declined any suggestion made by her husband that she could
try en engage in some useful activity outside the house
(marketeering, making a garden). Frequently she would drive
Muchati to exasperation with her sulkiness and her taste for very
expensive clothes.
The cults of affliction stipulate actions that the (almost
exclusively female) adepts must undertake for the sake of their
own physical and spiritual well-being. Usually these actions run
counter to the short-term interest of their husbands or male
relatives. Cult obligations comprise expensive nocturnal
sessions, exceptional and luxury foods and clothing, inconvenient
absences from the family home. The expenses of all this are to be
borne by men. While the men resent these cultic actions they,
too, take the idiom of the cults of affliction seriously, and
seldom oppose them. Therefore the women can manipulate their
cultic claims as an expression of domestic conflict. Thus the
cultic idiom provided a context in which Mary could temporarily
retreat to the village without any over display of marital
conflict. Another reason why Muchati was unable to hold her back
, was that he still owed her kin group the final installment of
the bride-price.
In Jimbando village, Mary participated in a Bituma session,
directed by her mother’s sister, Masholi [26]. After a
month, Muchati went to collect her and paid the outstanding
amount.
Early
1972. In Chief Kahare’s area
Muchati’s cousin Kwambashi [18] died. She was one of the
leaders of the Bituma cult of affliction. Kwambashi’s sister
Nchamulowa [20], a widow of the cults founder, still fostered the
latter’s relics and now intended to succeed to the name of
Kwambashi. Thus she hoped to effectuate her latent leadership
claims in the cult.
May
1972. Mary participated in a Bituma session
in Matero suburb, Lusaka, led by her original cult leader,
Jilemba. About this time, Mary’s second pregnancy became
manifest. On instigation of Muchati, she once or twice visited an
antenatal clinic in Lusaka. These visits were frowned upon by the
elderly Nkoya women in Lusaka.
August-September
1972. Two nocturnal mourning rituals were
held among the Nkoya in Lusaka: one for a recently deceased Nkoya
townsman of Shipuna’s ward, another for Muchati’s
brother’s child [16] who had died in the village. Being
highly pregnant, it was taboo for Mary to attend. For pregnant
women, unborn of small children, and chiefs are not to enter into
the sphere of death. However, Muchati found herbal medicine for
her that was supposed to lift the taboo and protect her, so she
could go mourning.
13
September 1972. Mary’s labor had begun
in the afternoon, and Muchati went on a quest for herbal medicine
which allegedly would ensure a speedy delivery. He sent his
younger brother to Kalingalinga, in order to collect a midwife
and her assistants from among his Nkoya relatives there. Soon
four women arrived, including Banduwe [2] who was to play the
women insisted that they would rather first try for themselves,
at home. However, the midwife and her assistants appeared to
become unnerved by Muchati’s lack of faith in them. He
repeatedly point out the availability of allegedly superior
alternatives: the hospital, which our car could reach within ten
minutes; or, in our main building, my wife, who was however far
from eager to interfere. During the delivery, the women in
attendance kept Muchati out of doors. Repeatedly he came to
request our advice in matters which these women must often have
carried out with perfect confidence when on their own, e.g. the
tying and cutting of the umbilical cord. Finally, around nine
o’clock, an alarmed Muchati urged us to take full control:
the child had been born, but the placenta had failed to be
produced. Although the women greatly resented Muchati’s
interference, we were finally allowed to take Mary to the
University Teaching Hospital, were she was admitted She was
discharged again early in the morning, i.e. nine hours later,
without any follow-up appointment.
Recent newspaper reports had brought out the shortage of school
places in Zambia, and the preference given, in the matter of
registration of pupils, to children who could produce a birth
certificate. Therefore Muchati decided to formally register the
new baby (something he had not done in the case of his first
child). Forced to publicly name the newborn child at a moment
that this is still immature according to Nkoya custom, he
haphazardly gave him the name if Jimbando, his maternal
grandfather [30]. ‘Mary’s family will like that
name,’ Muchati said. Little could he know what haunting role
the child’s name, and the attendant affinal relationship,
were yet to play. For domestic use, Muchati decided on the name
of Edward [6].
After a few days, a Nkoya man was called in from Kalingalinga to
ritually cleanse the conjugal bed and to provide birth amulets.
This action was meant to terminate the puerperal avoidance
between father and child. It was all post-natal care the child
received. Despite hospital delivery, the parents refrained from
visiting the hospital or the nearby under-five clinic. Elderly
women in town, including Banduwe [2], insisted that such visits
would be to the child’s disadvantage, particularly if taking
place before he was three months old. These were the same women,
among others, who had assisted in Mary’s confinement. We got
the impression that, feeling slighted about their failure or
humiliation then, they now aimed to assert their medical
authority over Mary and her newborn child.
18
October 1972. Edward developed an alarming
lump on his head. Although Muchati urged Mary to take the child
to the under-five clinic, she was reluctant in view of the
elderly women’s attitude. Muchati was at a loss: he felt he
could not force her to go.
20
October 1972. When in addition to the lump
on his head, Edward ran a fever, Mary went to the clinic out of
her own will. Edward was referred to the University Teaching
Hospital. The doctor there urged her to admit that she had
dropped the child on the ground, but this she denied strongly. (A
Nkoya mother whose infant incurs serious harm is liable to
physical punishment by the child’s kin group and by the
elders in general. People therefore agreed that Mary could not
afford to speak the truth, if in fact she had dropped Edward.)
Edward was admitted to hospital on a diagnosis of pneumonia,
possible related to Mary’s habit of bathing the baby
out-of-doors in cold water. In addition, the baby was said to
have developed ‘brain trouble’. Edward was too weak to
suck, and was therefore tube-fed. In accordance with general
Zambian practice in the case of hospitalized children (cf.
Boswell 1965), Mary stayed at the hospital premises, in the
relatives’ shelter, where she was daily visited by Muchati.
The frustration of having to spend two weeks without any
meaningful activity, in the company of equally displaced and
frustrated women whom she had not known before, in a crammed and
ill-accommodated shelter, added to her worry over the baby and
made this a very unhappy episode for Mary.
The hospital staff did not give the slightest attention to the
continuation of Mary’s lactation. In combination with the
worry over the baby, and the frustrating experience at the
relatives’ shelter, this resulted in Mary being unable to
breast-feed Edward any more, when after two weeks he was
discharged. Raised in a culture where breast-feeding is very
strongly emphasized as a mother’s main link with her child,[5]
the impairment of this function was a very heavy blow for Mary,
and a cause of intense feelings of guilt. Mary and Edward were
sent home without anyone on the hospital staff noticing the
problem or trying to do anything about it. Alarmed, Muchati and I
referred to the hospital. We were anxious to have Mary’s
lactation function restored. Although bottle-feeding would not be
impossible, it would mean an enormous burden in terms of hygiene,
expense and maternal role patterns (cf. Raphael 1976). At the
hospital a doctor told us, rightly, that nothing specific could
be done to restore lactation. We were advised to try a
protein-rich diet for Mary, as this might have some success. Upon
our request we were told that there was no powdered milk
available for distribution to out-patients: neither did we get
the feeding schedule we asked for.
With his nearly-completed primary school education (recently,
through evening classes, he had reached grade 6), and his
previous experience with expatriates’ infants including our
own daughter, Muchati accepted the absolute necessity of
sterilization of bottles etc., and he conveyed this insight to
Mary. With all our modern comforts at her disposal (pied water,
kitchen dresser, refrigerator, electrical stove, sterilizing
tablets, brushes, several glass feeding bottles, teats,
containers etc.), and determined to see her child through, Mary
quickly absorbed and accurately performed all the necessary
routines. Initially she feared making a fatal mistake in these
rather complex operations whose rationale she did not understand
in detail. Also was she embarrassed about her nurtural inadequacy
and her dependence on members of the opposite gender to rectify
this condition. But all this gradually gave way to relief and to
a measure of pride. In conversations with friends and relatives
Mary would often tell how her lactation function had become
impaired and how she could yet manage to fee her child. Yet her
dealings with Edward seemed somewhat mechanical, formal, and
lacked the spontaneous generosity so typical of Central African
patterns of breast-feeding. An important factor in this was no
doubt the fact that Mary’s bottle-feeding forced her,
several times a day, to work in the kitchen of the main house.
Here she was doubly an intruder: both vis-à–vis us, who
lived there, and vis-à–vis here husband, whose professional
domain it was. In relation with Muchati, Mary’s presence may
have brought to the fore a typical domestic servants’ role
conflict: that between being a wife’s husband, and doing
low-status work commonly reserved for women. Mary’s
preparation of the bottles would often happen to take place under
our joint scrutiny, and would very infrequently give rise to such
petty friction as may be inevitable in a confined space where so
many parental, domestic and employment roles of two families
intersect so confusingly. On a deeper psychological level it
would appear as if Mary was subconsciously reproaching Edward for
causing her to fail in her nurtural duties. The lessened
affection to which this condition may have led, seems also
detectable in Mary’s later behavior towards him, which
directly relates to the series of health crises he was to go
through.
Edward responded well to be bottle-feeding, and became quite
healthy again. Meanwhile, we did put Mary on a protein-rich diet,
but (apart from an occasional few drops of milk, which Mary would
insist on offering her child)with no other effect than greatly
improving her general condition. For the latter reason we yet
continued the diet until Edward was about one year old. The costs
of this diet and of Edward’s powdered milk amounted to over
20% of Muchati’s wages, which was much more than he cold
afford. Therefore we subsidized about 80% of the extra amount
needed.
December
1972. Muchati’s mother, Munyonga [11],
another leader of the Bituma cult of affliction, visited Lusaka
to look into the marital and religious problems of her daughter
Jenita [9], Muchati’s full sister. Munyonga staged a Bituma
session in Kalingalinga, in which Mary, Edward and Jenita were
the main patients. We were not surprised to see Jenita feature as
a patient. Jenita lived in Chaisa squatter compound, where she
and here infant daughter Lusha [15] were extremely poorly
provided for by Jenita’s husband [10]: a shop assistant in a
butchery, he would squander his relatively considerable income on
beer and girl-friends. Not only had this state of affairs
noticeably affected Jenita’s and Lusha’s health. Also
had the husband (quite exceptionally) refused to pay the fees for
the cult leader Kashikashika, to whose treatment Jenita had
subsequently subjected herself and Lusha. A conflict with this
cult leader had ensued, and Jenita feared that Kashikashika would
punish here by making her illness come back. Treatment by her own
mother, Munyonga [11], would greatly reduce that risk, at the
lowest possible costs (for no fee would be required). At the much
better diet, may have had much to do with this. However, within
the idiom of the cults of affliction she, as an adept, was still
to be considered a patient. Initiated by her mother’s sister
[26] in the village, Mary was still a potential member of that
leader’s cult faction. Moreover, there was still a lingering
claim on Mary from the side of the leader of her very first
session, Jilemba. Munyonga resented Jilemba’s insistence,
not only because Mary was Munyonga’s daughter-in-law but
also because it had been Munyonga who installed Jilemba as a
Bituma cult leader. Jilemba should yield to Munyonga when told to
do so. The fact that Mary now joined in the session staged by
Munyonga meant that Mary, too, denounced the claims that here
previous cult leaders, Masholi and Jilemba, might have over her,
and that she joined Munyonga’s cult faction.
On the extra-religious plane this move is another manifestation
of a process that runs as a red thread through this case:
Mary’s gradual dissociation from her kin group of
orientation, and her increasing incorporation into her
husband’s effective kin group.
Finally Edward’s parents justified his inclusion in the
ritual by saying that this initial illness and hospitalization
and demonstrated his proneness to illness. Among the Nkoya, such
proneness is considered the main sign that one is predestined for
a leading career within the cults of affliction. Although
Edward’s health was now satisfactory, an occasional cold and
slight cough were stressed as demonstrations that all was not
well yet.
Meanwhile, Muchati and Mary had again taken up sexual relations.
Mary’s ovulation had resumed and, without having menstruated
after Edward’s birth, she conceived again.
March
1973. Mary claimed that she should go to the
to assist her sickly parents, and moreover to seek treatment for
her own affliction and that of Edward. Mary’s sulkiness had
come back, and she was very angry with Muchati for not letting
her go immediately. However, an additional reason for going
presented itself. Muchati’s kin group began to suspect that
Edward’s initial illness and minor later complaints all
referred to his deceased aunt Kwambashi [18]. An ancestral ritual
at the village shrine of Nyamayowe village might need to be
performed, in order to confer Kwambashi’s name upon Edward.
When told about this, we pointed out that Mary would not be able
to keep up her exemplary standard of hygiene and bottle-feeding
when on the road or in the village, where there were no modern
comforts whatsoever. But this did not deter Mary.
With a supply of powdered milk and sterilizing tablets she set
out for Chief Kahare’s area. In the village it was publicly
ascertained that she was pregnant again. Menstruating women must
not cook or handle fire: so a woman of childbearing age who
continues to perform her domestic work for over four weeks must
be pregnant, and she will be questioned about this by the other
women in the village. During this visit, Mary participated again
in a Bituma session stage by her mother-in-law, Munyonga [11]. No
ancestral ritual was performed for Edward, however. Edward’s
paternal grandfather, Shelonga [13], had formally welcomed
Edward, calling him by the name of Kwambashi [18]. But for a
proper name-inheriting ritual Kwambashi’s only surviving
sister, Nchamulowa [20], should have been present. Shelonga had
written to her in Lusaka, but she had not replied, as she was
still hoping to inherit the name herself.
April
1973. Banduwe [2] went to the village in
connection with the prospective marriage between her son [1] and
Mary’s aunt [35] in Jimbando’s village. Muchati, who
was anxious for Mary’s return, gave Banduwe money towards
Mary’s return journey to Lusaka. Although Banduwe’s son
was from a previous marriage of hers and thus no consanguinean
relative of Shipuna [5], as a long-standing member of
Shipuna’s ward in Lusaka he was yet considered a member of
the Nyamayowe kin group when interacting with Jimbando’s kin
group. Therefore Shelonga [13] accompanied Banduwe to Jimbando
village for the marriage negotiations. However, Jimbando rather
unexpectedly began to abuse Banduwe and the whole kin group she
represented, claiming that ‘These people do not care
properly for the women they marry.’ Not aware of any recent
friction, the Nyamayowe delegation tried in vain to pacify
Jimbando. Only afterwards it became clear that Jimbando’s
anger had little to do with the Nyamayowe kin group’s
treatment of the women from Jimbando’s village but... with
the fact that some time before I had refused to take Jimbando to
Lusaka for eye treatment. By that time we had still been
strangers to the rural scene, unwilling to commit ourselves to
one particular family be bestowing relatively big favors upon
them; Muchati, Jimbando’s son-in-law, did not insist when we
turned the request down, and we understood that he was not eager
to have his sick father-in-law stay in Lusaka, where he would
have to look after him. From Jimbando’s reaction it would
appear that the latter considered us as members of Muchati’s
kin group, at least in so far as confronting his own kin group.
Anyway, the marriage negotiations had failed, and Shelonga and
Banduwe returned to Nyamayowe village.
Mary had not approved of her father’s attitude, and very
soon after this episode she returned to Lusaka. She brought back
a thoroughly weak and emaciated Edward. However, the
bottle-feeding routine was resumed in the proper manner, and
rapidly Edward got well again. Meanwhile, in Lusaka,
Muchati’s cousin Nchamulowa [20] had found a job as a
cleaner. In order to have a free hand she sent her children to
relatives in a peri-urban area. She claimed to have taken the job
in order to save money for the massive and expensive
name-inheriting ritual in which she hoped to take
Kwambashi’s [18] name. In anticipation, she had my wife make
a splendid white robe for her, to wear during the ceremony.
May
1973. Mary’s mother, Malwa [28],
visited Lusaka, mainly in connection with the marital problems of
another daughter of hers [29]. Malwa refused to visit with
Muchati and Mary. They went to see her at Mary’s
sister’s place. There Malwa treated them very coolly.
Obviously the relation between Malwa and Mary was still very
strained, as a result of the recent events in Jimbando’s
village.
Edward had by now recovered from his stay in the village, but
whereas he was physically fit, his motoric development seemed
somewhat retarded. Edward’s relatives suspected that he was
suffering from shikoba,
the result of a presumed mystical competition between a young
child and his next sibling who is still in their mother’s
womb; the younger child is supposed to launch murderous attacks
upon his elder sibling. (Physiologically, this idea of
competition may the based on the fact that a woman’s body
does not easily combine the tasks of breast-feeding an older
child and building up a new child in the course of pregnancy; but
this does not strictly apply here since Mary was not
breast-feeding Edward.) On a less mystical plane, the fact that
Edward would not walk by the time his next sibling would be born,
distressed the elders; still referring to the none too distant
past when slave-raiding was common and people had to hide in the
forest at very short notice, Nkoya consider having two children
who both cannot walk yet, an impossible, dangerous burden for a
mother.
In this period, fears of Kwambashi became increasingly
pronounced. There was the idea that Edward, under attack from his
unborn sibling and his deceased aunt, would have little chance of
surviving anyway. Moreover the restricted, formalized way of
feeding Edward which was so alien to Mary’s socialization
into motherhood, continued to estrange her from her child. In
combination these factors made that Edward’s mother was
still markedly apathetic and unstimulating in dealing with him,
and while he received all necessary material care, the relation
between mother and child seemed too deficient for proper
development.
Meanwhile we had made two short research trips from Lusaka to
Chief Kahare’s area. We prepared to move the site of the
research to this area. We discussed whether Mary and her children
should accompany us, or should stay in Lusaka. Now another fear
of Mary manifested itself. She had not menstruated after the
birth of Edward and before the new pregnancy. Therefore the new
child would be surrounded with all the gruesome properties
locally attributed to menstrual secretion. Allegedly, Mary would
not be allowed to stay in the village when giving birth, but
instead would have to give birth alone in a hut in the forest.
This prospect was most terrifying her. (Fortunately the issue was
never raised again; when her time came, she was confined in her
parent’s village.)
July
1973. Munyonga [11] visited Lusaka again.
She had been feeling very ill, and this time she came not only as
a healer but also in order to seek treatment herself, in the
context of cults of affliction similar to Bituma. In addition,
and despite Munyonga’s very strong opposition, Muchati [7]
and Shipuna [5], with our help, took her also to the main urban
hospital and to a private physician. Munyonga sought treatment in
town because she found the village an unsuitable place for
staging the cults session deemed necessary for her recovery. All
her surviving children resided in town (except the youngest [17],
a mere schoolboy). Moreover her husband, Shelonga, belonged to
the Moya cult of affliction which was opposed to all medicines,
including those featuring in the cults of affliction. Although
the two roles of patient and healer merge and imply each other in
the cult of affliction idiom, Munyonga perceived herself
primarily as an exceptionally gifted healer, much more than as a
patient. Therefore, while seeking treatment from other healers,
she felt she had to make up for this painful loss of status (and
money!) by organizing a series of extremely successful and
massive Bituma sessions in Kalingalinga. At these sessions Mary
and Jenita [9], among others, appeared again as major
patients/adepts. Thus Munyonga tried to strengthen the urban
ritual faction she had begun to develop in December, 1972.
Meanwhile it became known that Kwambashi’s relatives (by and
large Muchati’s kin group) had formally decided that
Nchamulowa [20] was not to succeed to Kwambashi’s name. They
pointed out that, with other relatives surviving, it would be a
shame if someone were to succeed his or her full sibling —
as if left alone in the world. But obviously more was involved,
for succession of full siblings is by no means exceptional among
the Nkoya. Probably the kin group resented Nchamulowa’s
independent character and her successful adaptation to urban
conditions — having a job where many mature Nkoya men had
failed to secure one. This social and financial independence,
moreover, largely enabled her to escape from control by her kin
group. Yet, without the kin group’s consent and ritual
cooperation, Nchamulowa was absolutely unable to succeed to her
sister’s name.
August
1973. We gave up our urban residence and in
several trips moved our two households to Chief Kahare’s
area. In the evening when we reached Chief Kahare’s village
after the last trip, Mary’s niece [43] die din nearby
Jimbando village. She was a daughter of Kashimbi [40], who in a
later marriage had become the wife of the headman of Nyamayowe
village [24]. Her death appeared to be due to extreme dehydration
resulting from untreated gastro-enteritis. A young widow, she had
only a few days previously settled in Jimbando’s village,
having moved from the distant village where her husband [44] had
recently died under similar conditions. Malwa [28] and Jimbando
[30] had hoped that Muchati and Mary would settle in their
village for the duration of the research But now this was out of
the question. In view of this ominous death and the lingering
conflict with her parents, Mary absolutely refused to live in
Jimbando village. In Chief Kahare village, at barely hundred
meters distance, we had to arrange accommodation for Muchati and
Mary, next to our own house. Joseph [3] was sent to his paternal
grandmother Munyonga in Mushindi valley, while Edward [6] for the
time being stayed with his parents. Some weeks before, he had
been weaned. Therefore his feeding was not likely to cause
particular problems in the village, despite the absence of modern
comforts.
From our new rural base the research continued as before.
19
September 1973. Mary’s labor began in
the morning. Muchati went to inform Malwa and Munyonga, who were
working in the riverside gardens at considerable distance. The
confinement was kept a secret from women in the surrounding
villages, for fear of sorcery attacks on the mother or the child.
Malwa, Mary’s mother, acted as midwife. Rather against her
will, Mary had been taken into her parent’s house, where
until now she had refused to stay. Munyonga arrived only after
Mary had given birth. That was however several hours later, as
Mary’s labor was to be very protracted. A trusted kinswoman
living in a nearby village had given her herbal medicine to speed
up the delivery, but without success. Also Muchati’s own
medicine, allegedly successful when Edward was born, failed this
time. Labor took exceptionally long, probably partly as a result
of the baby being oversize due to Mary’s exceptionally good
diet during pregnancy. The relatives began to suspect a
supernatural influence. Mary’s sister-in-law, Emeliya [25],
married with Mary’s brother [27], was asked to divine.
Divination took place in the same room where Mary was lying.
Emeliya used the standard method of the axe handle: moving an axe
handle to and from on the ground, names are recited of people who
may be responsible for the evil influence, and when the correct
name is found, the movements of the handle are supposed to halt.
Begin a member of the family, Emeliya knew all the relevant
names. She first recited those of the living, then those of the
dead. Kwambashi was found to be responsible. Next the diviner
found that Kwambashi, though very irate, was prepared to be
approached by Muchati, for whom she had had a special liking when
alive.
Muchati was called and was told to enter the delivery room (which
under normal circumstances a man is never allowed to do). He
performed the water ritual of ablution and libation without which
the supernatural cannot be approached; the he implored Kwambashi
to take mercy upon her living relatives, and release the baby
Mary heard her husband pray. Five minutes later the child [8] was
born.
When they tried to interpret the outcome of the divination, the
members of Muchati’s kin group arrived at the following
view. Kwambashi died between the time of Edward’s conception
and his birth. Thus Edward had acquired Kwambashi’s
‘shade’ in the most direct way: ‘from his
father’s hands into his mother’s womb’. Kwambashi
would be his name, no matter what other names might be given to
him. This name of Kwambashi had still to be publicly confirmed in
a naming ritual; however, that step had until then been
postponed. Even had Kwambashi’s relatives (except Shelonga
[13] failed to ceremonially welcome Edward as Kwambashi when he
had visited their village recently.
Kwambashi had sufficient reason to feel slighted, and tried to
take revenge on the next baby.
Nkoya individuals have several names. The Kwambashi who died in
1972 had inherited that name when her mother [19] died — her
‘own’ name had been Kafungu. The name of Kwambashi
would be reserved for Edward [6]. Munyonga [11] however, the
boy’s grandmother, had dreamed of a new name for Edward, the
day after Kafungu’s birth. She claimed that the Kwambashi
name did not seem to fit Edward. His illnesses and retarded
development were cited to substantiate this. She therefore
proposed the name ‘Heva’ she had heard in her dream
— a biblical name which (contrary to many other biblical
names) is hardly used among the Nkoya. Being an illiterate
non-Christian, Munyonga may have picked up this name in her
dealings with the syncretistic prophet Ngondayenda.
Although Mary and Kafungu were by this time staying in Jimbando
village, Mary’s parents had hardly any part in this
discussion. Everything revolved around Muchati’s kin group.
Yet it was a diviner from Mary’s kin group who had
identified the influence of Kwambashi and thus had laid the
‘blame’ for the difficult delivery on Muchati’s
kin group.
Next morning, when Muchati, his father Shelonga, and a niece
arrived to ceremonially thank their affines for the birth of
another child, relations were markedly strained. Under the
pretext that all work had been done within the family, and no
costs had been incurred, Mary’s mother refused to accept the
ceremonial payment that the mother’s family is to receive on
such occasions. Muchati had no choice but to leave the money on
the ground in the middle of Jimbando village, for anyone to take
it.
Many present were aware that a similar situation had occurred
thirty-five years before, in Munyonga’s [11] home village,
when Shelonga had tried to pay bridewealth for his wife. His
prospective affines had then refused to accept the money,
pointing out that Munyonga was his classificatory sister; driven
to exasperation, he had left the money on the ground, and left.
One of the implications of this refusal of ceremonial payments is
the following. By offering money, Muchati and his kin group tried
to offset themselves as a distinct social unit against
Jimbando’s kin group, in a bid to secure disproportionally
greater rights over the newborn child. They had already made the
proper payments in connection with the child’s mother, Mary.
The mother’s group, on the other hand, in refusing the birth
payment, declined such juxtaposition, claiming that in actual
fact Muchati’s kin group and their own kin group were one,
and thus refused to accept the other kin group’s exclusive
rights over the newborn child.[6]
As the tensions between these two kin groups became increasingly
pronounced, Mary had several quarrels with her mother and
prematurely left Jimbando village to join Muchati in Chief
Kahare’s village. So rushed was her departure that no
medicine had yet been prepared to ritually cleanse Muchati’s
and Mary’s conjugal bed.
Since Mary could not mind two infants, Edward was sent to
Munyonga in Nyamayowe village, to join his brother Joseph. Under
the circumstances it was unthinkable that he should be sent to
his maternal grandmother Malwa, in nearby Jimbando village. Mary
stayed behind in Chief Kahare’s village with Kafungu, a
pathetically plump and healthy baby whom she had not the
slightest difficulty to breast-feed. We got the strong impression
that, indulging in the delights of this new and splendid baby,
Mary tried to forget Edward and the troubles she had had with
him.
With Edward’s departure, and with Kafungu to replace him, a
burden fell off Mary’s mind and she entered a period of
euphoria. A remarkable change came over her. In town we had
always known her as shy and awkward, giving the impression of
being lost and uprooted. However, having returned to the village
we found that she commanded considerable prestige on the basis of
her four years of urban experience. In Mary’s case, her
urban features could be displayed all the more freely as she
lived as a young matron in the village of the chief (her
classificatory elder brother), under the relaxed control of her
husband Muchati but (contrary to most young women) outside the
direct control of her senior consanguinean of affinal kin. The
greatest threat in this respect came from her parents in nearby
Jimbando village. But by refusing to stay with them, by
quarreling and ostentatiously siding with her husband’s kin
group against her father, Mary ensured that she retained her
independence vis-à-vis her parents. In town Mary had always
refused to engage in business, but now, in Chief Kahare’s
village, she began to augment her household budget by selling
beer and tobacco, attracting and entertaining male customers with
her urban ways, and (with the aid of a record player)
occasionally turning our corner of the village into a bar!
20
October 1973. Soon after our settling in
Chief Kahare’s village the people’s insistent demands
for medical attention had forced us to establish an improvised
bush clinic. So Mary called on us when she was worried over
Kafungu’s slight cough at night. Along with some of the more
serious patients calling at our clinic, we took the child to the
distant Rural Health Center.[7]
There we learned that the staff could do previously little, as
they had run out of all essential supplies. (That situation was
not to be mended soon. A few weeks later, for a boy with a
fractured thigh-bone, no plaster of Paris was available, and we
had to drive the patient all the way to a district hospital,
another 60 km).
23
October 1973. From Nyamayowe, Edward was
brought to our bush clinic. His breathing at night was reported
to be difficult and noisy; he was weak and apathetic, and had a
mild conjunctivitis. After our earlier experience with the Rural
Health Center, we decided to apply our own medicines. We urged
Edward’s relative to bring him along daily for eye
treatment: we were so short of Terramycin eye ointment that we
could not afford to give each patient a package to take home.
However, we did not see Edward back before three days later, and
again four days later.
Early
November 1973. In Nyamayowe village,
Edward’s health deteriorated steadily. As soon as Muchati
had left to accompany us for a week’s work in Lusaka, Edward
was immediately declared critically ill by his kin group.
Shelonga sent a letter to Muchati urging him to come back. From
Nyamayowe village the Rural Health Center is only at a distance
of 20 km, i.e. only two hours of cycling along the bush paths.
And there were bicycles available in the village. Moreover,
Muchati had left some money to cope with eventualities like this.
Yet for two reasons Edward was not taken to the Centre. First,
recent experience had shown that, however useful at other times
(cf. note XXX above [was 14]), the absence of supplies made it
now useless to go there. And secondly, after the events
surrounding Kafungu’s birth it was so overwhelmingly obvious
to his kin group that the determinants of Edward’s illness
were not primarily somatic but supernatural, that it was
considered a waste of precious time to refer to the outlets of
cosmopolitan medicine. Instead, Edward’s kin group decided
to invoke the help of a Nkoya healer who happened to visit a
neighboring village. This healer lived far away and was, in Chief
Kahare’s area, primarily perceived as a member of
Jimbando’s [30] kin group. Muchati’s kin group felt
that this was advantageous as it meant that the responsibility
for Edward’s well-being in this critical situation was not
exclusively carried by themselves but shared with Edward’s
maternal kin.
At the same time, in another village, a cousin [45] of
Muchati’s reported dreams in which she was harassed by
Kwambashi crying ‘My relatives do not respect me. Even if my
name comes to Muchati’s child they do not accept it.’
Therefore, despite Nchamulowa’s [20] absence, the Nkoya
healer staged the long-awaited naming ritual for Edward. In
addition he gave him herbal medicine to cure the concrete,
somatic manifestations of the affliction. Mary came to attend the
ritual. As the rains had started, she proceeded to make a garden
on the land of Nyamayowe village. Later she returned to Chief
Kahare’s village, leaving Edward in the care of his
grandmother, Munyonga [11]. By that time we had returned from
Lusaka.
22
November 1973. From Nyamayowe, Edward was
again brought to our bush clinic. He ran a slight fever, had
diarrhea, and showed initial signs of dehydration. We sent him
back to Nyamayowe, with a supply of powdered milk and with drugs
to cure his suspected gastro-enteritis.
15
December 1973. Still in the care of his
grandmother at Nyamayowe, Edward gradually developed unmistakable
symptoms of malnutrition. His worried relatives declared him ill
once more, and had the illness diagnosed by a diviner. However,
this time the diviner, Loshiya [23], through marriage and
subsequent incorporation belonged to their own kin group. She was
the wife of Muchati’s cousin [22]. The outcome of this
divination carried out by Edward’s paternal kin was
strikingly different from the divination his maternal kin had
carried out at Kafungu’s birth. This time it was again a
deceased relative who was declared responsible for Edward’s
illness, but now not a member of Edward’s patrilateral kin,
but of his matrilateral kin! Jimbando [30] was generally known to
seriously neglect Enesi [32], the young daughter of his deceased
brother [31]. Enesi had settled in Jimbando village after a
divorce, and there had been treated as mad and as an outcast.[8] None of her
fellow-villagers had bothered to improve her ramshackle house of
to build a kitchen for her. On a recent occasion the headman of a
neighboring village had been allowed to beat her after she had
allegedly insulted him. (Instead, the headman should have sued
her before the neighborhood court of the local Court; cf. Van
Binsbergen 1976b: 51f). Now the diviner Loshiya alleged that
Enesi’s deceased mother [33] had made Edward ill, in order
to revenge the suffering of her own child, Enesi, at the hands of
Enesi’s patrilateral kin, who were at the same time
Edward’s matrilateral kin. Edward was now again subjected to
an ancestral ritual, this time directed at Enesi’s mother
(Edward’s classificatory grandmother). People claimed
however that this ritual could only lead to an improvement of
Edward’s condition if at the same time Jimbando would
actually put an end to Enesi’s suffering. For Mary, who
accepted the pronouncements of this diviner, new fuel was added
to her conflict with her parents. She was furious that her
father’s shortcomings should cause harm to her son Edward.
It is not possible, though, that Mary accepted this
interpretation of Edward’s misfortune, and eagerly joined in
the general indignation vis-à-vis Jimbando, because in doing so
she would not have to admit that she herself had been neglecting
Edward since Kafungu’s birth.
The subsequent events must be placed against the background of a
high incidence of sudden deaths among adults and children in
Chief Kahare’s area during the second half of 1973.
Mortality always soars high in this area after the onset of the
rainy season, when food is scarce and resistance low. Most of the
children involved in this mortality crisis died in the course of
a measles epidemic which ran through the district. Although
measles immunization was propagated at the district’s
under-five clinics, in this remote area virtually no children had
been vaccinated. Our bush clinic (where such preventive measures
were beyond our means and skills) was frequented by mothers who
wanted treatment for the secondary infections their children had
contracted while having measles. I have no reliable comparative
data to indicate that in this period a truly exceptional number
of adults died. At any rate, the population had become virtually
paralyzed with fear. Coupled to the prevailing interpretation of
death as being invariably caused by sorcery, this rate of
mortality had a downright paranoiac affect. For several weeks
parents refused to send their children to the village school for
fear of the alleged presence of murderers hiding in the forest. A
massively attended public sorcery trial was staged at which Chief
Kahare and members of his royal establishment were accused of
having caused the recent deaths, so as to procure powerful
chiefly medicine. The Mema and Mushindi valleys were in the grip
of unsettling rumors, a state of dramatic insecurity which was
also related to the national general elections which took place
on 5 December, 1973.
I have pointed out how beyond a small core the composition of kin
groups is extremely flexible. This enables people anxious to
detect a meaningful pattern behind common misfortune, to
rearrange recently deceased members of the local community in
such a way that many of them appear as close relatives —
even although they would rather be reckoned as members of rival
kin group when still alive. Thus it becomes possible to interpret
many sad events as a direct attack from some other kin group
(which then has to be identified upon one’s own. Now with
the spate of sudden deaths, this mechanism was particularly
manifest among the members of the kin group focusing on Nyamayowe
village. As indicated in diagram 1,
this kin group, after substantial losses already in the years
1972-73, literally within a few weeks saw itself deprived of
seven of its members. In addition, the third wife [37] of
Nyamayowe’s headman, Kawoma [24], was confined of a
stillborn child in mid-December 1973. Diagram
1 shows that, though scattered over various
villages, the people who died in the last quarter of 1973 were
actually rather closely related to our protagonists. The
resulting paranoia, therefore, was not merely due to an optical
illusion. The surviving members of Muchati’s kin group felt
deeply and personally threatened and continually feared for their
own lives. Proceedings were set in motion to divine the identity
of the rival kin group that would have caused the deaths.
26
December 1973. For over a week, Patrick [41]
had suffered from measles. He was a four year old boy in Jimbando
village, a grandchild of the second wife of Kawoma [40]. His
condition had not prevented him from taking active part in the
Christmas celebrations, which form a major social event in the
area. On the morning of Boxing Day Patrick was very sick,
probably because of the food he had eaten on Christmas. However,
against the background of recent losses, his relatives were
convinced that Patrick was dying; they panicked, and as a result
he did die. Only immediate injection, people claimed, might save
Patrick’s life. They did not refer to us, for several
reasons. Although people had very often asked us for injections
(which here as elsewhere are considered the most powerful
technique in cosmopolitan medicine), we had never given any.
Moreover, only a few days previously we had returned from one of
the district’s hospitals, where my wife and I had been found
to be so seriously ill that we had been referred to the Lusaka
hospital; we had mainly stopped at the village to collect some
personal effects, and were not in a condition to see patients. So
we were not told about Patrick’s condition until it was too
late.
The headman of a nearby village possessed an old syringe, which
in the past he had wielded with sad results. At least two people
were known to have died under his hands in recent years. Yet
Patrick’s relatives were prepared to take the risk once
more. The boy’s grandfather, Kawoma, was absent, but in his
locked suitcase inside his house he was keeping a box containing
vials of chloroquinphosphate, bought at the black market during a
visit to Lusaka. Kawoma had recently quarrelled with his senior
wife, Munjilo [38] (i.e. the co-wife of Patrick’s
grandmother [40]). Eager to help and thus in ingratiate herself
with her husband, Munjilo now broke open the suitcase and took
the medicine to the headman-healer, who injected vials (a
manifold overdose).[9]
The boy went into a coma, and the healer fled. Patrick was
already considered dead, many people had streamed to Jimbando
village and had started mourning, when Muchati told me what had
happened. He had finally called on me because he was puzzled by
the fact that the ‘dead’ boy still had a pulse and felt
warm. In vain I tried to revive Patrick from his coma, and he
died in my arms. His mother wailed: ‘The witches have waited
to kill him until after the injections, so that now everyone will
say that he died because of the injections, but I know it is not
true...’
This was the second sudden death in Jimbando’s village
within a few months. The rumor started that the senior members of
the village, Jimbando and Malwa, were sorcerers intent on killing
off younger inhabitants. Moreover, these deaths involved the
stepchild and stepchild’s child of Kawoma, i.e. potential
members of Muchati’s kin group, which had already suffered
so many losses recently. It was now no longer possible even to
pretend friendly affinal relationships between the two kin groups
associated with respectively Nyamayowe and Jimbando village.
Realizing this, and fearing an outbreak of violence, Malwa urged
her daughter Mary to leave neighboring Chief Kahare’s
village and fly to Nyamayowe village, in order to bring herself
and Kafungu into safety. Thus Mary rejoined her sons Edward and
Joseph. this move dramatically completed the process, extended
over four years, in which Mary gradually dissociated herself from
her parents’ village and became more and more closely
incorporated into her husband’s kin group.
January
1974. Edward’s condition worsened
again, and again a healer from elsewhere was consulted, a woman
this time. She staged a divining ritual and began pointing out
the responsible person — who, she insisted, was not a
deceased relative but a living sorcerer. When she claimed that
this sorcerer lived in the neighborhood and was a full sibling of
Edward’s paternal grandfather Shelonga, the latter told her
that she could stop, collect her fee, and go: his last surviving
siblings had died a few months previously (cf. diagram
1).
February
1974. Edward’s condition seemed
critical and his parents, themselves now suffering from Malaria,
took him to one of the district’s hospitals. There Edward
was found to suffer from pneumonia and malnutrition. After
initial treatment, and instructions as to diet, Edward returned
to Nyamayowe. Muchati was now caught in a role conflict as a
father and a research assistant. Although he saw that Edward
needed to return to town, he did not want to abandon the field
while my wife and I were very ill in Lusaka. However, when
hearing of the situation we wrote a letter urging him to collect
his family, return to Lusaka and take Edward to hospital there.
This he finally did.
March
1974. After the usual hours of queuing,
referral, queuing again, completing forms, etc., Edward was
admitted to the University Teaching Hospital in Lusaka. The two
medical officers (one European, one Indian) who successively
examined Edward prior to admission, were reluctant to hospitalize
him. One said: ‘What is the use of trying to fix up this
child, as with these people he will be the same within a few
months?’ The other doctor tore at Edward’s hair and
squeezed his limp cheeks and leg muscles, shouting at Muchati
with histrionic indignation: ‘Look what you have done, you
stupid man. Is this the way you people raise children?’
Utterly shocked by this humiliating confrontation with the health
agency whose excellency he had always advocated among his people,
and to which he was now applying as a last resort, Muchati rushed
out of the ward, to the parking lot where I was waiting. For the
first time in all the years that we had worked together, he cried
out my first name, without the usual titles of address. Finally
he was an equal who in his distress appealed to his friend. He
told me to explain to the doctor Edward’s complex medical
history, including his earlier hospitalization in the same
hospital and its disastrous effects on his mother’s
lactation, the trouble and expense of bottle-feeding, the health
hazards of village life, etc. This I did, throwing in such weight
as my racial and academic status happened to carry in Zambia at
that time. Obviously my intervention did much to improve the
doctor’s attitude towards the case. Edward was well looked
after in the ward, and we received regular reports on his
progress.
Once again Mary stayed at the hospital’s relatives’
shelter, in order to help with the feeding of Edward. As she was
still breast-feeding Kafungu, she had to bring the latter as
well. Muchati asked a related girl in Lusaka to come and assist
Mary, since the hospital staff did not offer her any assistance.
However, this girl could not be spared from home, for she had to
attend to her sick mother who claimed to be suffering from
Bituma.
Children other than patients were not allowed in the
children’s ward. Therefore those mothers who had both a
child patient in the ward, and a suckling baby on their backs (a
very common situation), were required to leave the baby outside
in the porch on the ground. Here, at the ward’s entrance, no
accommodation was provided (yet hardly any mother would have a
perambulator to leave her baby in), nor any supervision. So
within a short while Kafungu caught pneumonia and could be
admitted too. It was a time of agony for Mary.
After a few weeks the two children were discharged and the family
joined Muchati in his Kalingalinga house. Over one and a half
years old now, Edward still showed no signs of beginning to walk
or to speak. But at least he showed more motoric activity than
ever before, and had started to crawl.
When she had both children safely at home again in her
Kalingalinga house, Mary vowed that never again would she go and
live in the rural areas. ‘Now I know that I can only keep
them healthy in town. The village is no place fit for
children,’ she said.
This
complex and detailed account of Edward’s infancy, while
pertinent to the medico-anthropological questions I raised in the
introduction, at the same time offers a picture of the wider
social dynamics that set the framework within which Edward’s
health experiences must be understood. Edward’s case brings
out recurrent themes that dominate the health situation of
contemporary Nkoya society, in both its rural and urban effects.
But before analysing the data presented here, let us first
consider those aspects of the case that render it not only
unique, but also, to some extent, non-representative. And by this
I mean our own involvement, as expatriate and temporary members
of the Zambian elite, in the lives of Edward and his family.
5. Edward’s case: An artifact?
Contrary
to current ethnographic conventions, I have refrained from making
ourselves (my wife and me) invisible in the preceding account
— not (I hope) out of undue self-indulgence, but because we
were major actors. Repeatedly we offered alternatives that helped
to shape the course of event.
An example of this is our intervention at the birth of Edward:
but then our role was not different from that of most elite
employers of domestic labor in Africa. By subsequently providing
the means to put Edward onto bottle-feeding we contributed to his
vulnerable nutritional status and indirectly to the inhibitions
that surrounding Mary’s relationship with him. But short of
letting the child starve to death there was no real alternative.
The next major intervention was the move of Muchati’s and
our own household from Lusaka to the village. Many urban Nkoya
families occasionally return to the village for longer or shorter
periods. This is especially the case after the husband has lost
his urban job. However it also occurs while urban employment
lasts. In the latter case not directly economic reasons prevail,
but reasons such as local leave, family visits, healing,
attendance of life-crisis ceremonies. Especially since the
completion of the tar road into Western Province (1972), movement
between Lusaka and Chief Kahare’s area is frequent and
relatively cheap: there are several daily bus services. Before
our moving to the village, Mary had twice gone there on her own
initiative, both times taking an infant with her. Therefore
Edward’s prolonged stay in the rural area (September 1973
— March 1974), even if ultimately instigated by our
research, was not really a-typical. What was a-typical was that,
due to Muchati’s position as a research assistant, he and
Mary should be living in Chief Kahare’s capital, i.e.
outside direct day-to-day scrutiny of and control by their senior
kin. However, in Chief Kahare’s village Mary lived within
earshot from her parental home, where after Kafungu’s birth
Edward might have been looked after, had it not been for the
increasing friction between Mary and her parents. Edward’s
dismissal to distant Nyamayowe, and the dramatic decline of his
condition there, had very little to do with our presence in the
area.
Finally, our operating a bush clinic in Chief Kahare’s
village introduced an additional health agency in Chief
Kahare’s area. The characteristics of our clinic included
its proximity, novelty, availability of simple but essential
medicines, our informality, use of the local language, attention
for social and relational aspects of the patients’
complaints, and considerable success in the treatment of the most
frequent complaints. For these reasons our activities amounted to
unintended competition with other health agencies, particularly
herbalists in the surrounding villages, and the more distant
Rural Health Centre. Soon we were seeing about forty patients a
day. Naturally, however, we frequently referred people to the
district’s hospitals and (until this proved useless) to the
Rural Health Centre. Often we would take the patients there in
our care, which was for most of the time the only serviceable
motor vehicle within a radius of over twenty km. Just as our
medical activities did not prevent Edward’s kinsmen from
consulting local healers, they did not really block the way to
the distant, more formal cosmopolitan health agencies. Therefore,
although we were major actors in Edward’s case, I do not
think that our intervention was such as to wholly distort the
picture of the health situation among the Nkoya peasants and
urban poor. I would rather describe our influence as catalytic,
or perhaps as a not too well controlled social-science
experiment.
Obviously, our personal involvement and commitment did not stop
short at the limits suggested in some handbooks on participant
observation. This raises the question of ethical responsibility,
which always pervades social research in the domain of illness
and death; as it does clinical medical research. Let me try to
make our position clear. It was not as if we cynically allowed
Edward’s health to decline in order to study his
parents’ and kinsmen’s reactions in relation to various
Nkoya and cosmopolitan health agencies. But could we not have
done more to prevent the near-fatal outcome? Throughout our
association with Muchati and his family we had advocated the use
of cosmopolitan health agencies including under-five clinics. We
warned against the use of black-market drugs and we emphasized
that in serious cases, consultation of Nkoya healers should
always be accompanied by visits to cosmopolitan health agencies.
Yet by continually discussing Nkoya medicine; by making cults of
affliction a pivotal element in our research; by helping to
organize cult sessions and participating in them — by all
this we conveyed the impression that we took Nkoya medicine
seriously, considered it eminently valuable, and did not want to
see it wiped out entirely by cosmopolitan medicine. In view of
strategies of participatory research, it was of course absolutely
necessary to give that impression. But it was not merely a
façade. From our first confrontation with them, we could not
help taking Nkoya cults seriously, both as amazing
psycho-therapeutic achievements, and as powerful and creative
symbolic configurations, betraying great musical and dramatic
virtuosity, and expressing suffering and remedy in a very moving
way.[10]
Did our admiration encourage Edward’s relatives to look to
these cults for a solution of their health problems? I hardly
think they needed any encouragement on this point. Might a more
negative attitude of ours, particularly if militantly propounded
in conversations and advice, have helped to keep them on the
straight path to cosmopolitan medical care? I very much doubt it.
More likely, such an attitude (which would moreover be contrary
to our own awareness of the limitations of cosmopolitan medicine)
would have estranged us from Edward’s relatives, would have
deprived us of such limited means as we had of intervening in his
health situation, and would have made us utterly impossible as
participant researchers.
At the time we did not consciously develop this attitude and
weigh it against alternatives. Frankly, we felt as if we had no
choice in the matter. Our main guidance lay in a professionally
cultivated sense of trans-cultural humility which (being the main
stock-in-trade of anthropologists in the humanist tradition) may
well be the greatest contribution anthropology could make to
cosmopolitan medicine in Third-World settings. Ours was not a
research project in applied anthropology. We tried to gain
understanding of the nature of Nkoya contemporary society. In the
process, we were confronted head-on with its economic and medical
misery. We did not allow the temptation of easy answers and
solutions to wedge in between ourselves and our Nkoya friends.
For better and worse, we were not prepared to extend our
intervention in their lives beyond the limits that had implicitly
been agreed, and gradually extended, in our interaction with
them. That yet we set up an improvised local outlet of
cosmopolitan medicine is no paradox: it was an action forced upon
us by the people’s continued appeal to us for drugs and
medical advice. Within the very narrow limits of our resources
and skills we accepted such responsibility as they entrusted us
with; but as we struggled along in our own difficult field-work
roles as researchers, spouses, parents, and finally as patients
ourselves, we felt that it was not primarily on our shoulders
that the responsibility for Edward’s well-being lay.
On the other hand it should be clear that the interest in
cosmopolitan medicine among our urban and rural Nkoya contacts
was not exclusively or primarily due to our intervention. The
interest was there; but we intensified this interest, and by our
own action (facilitated by our greater knowledge, and higher
status in the wider Zambian society), we were in a position to
take away some of the barriers that hindered their access to
cosmopolitan medicine. In Edward’s case, the
protagonists’ pursuit of cosmopolitan medicine was not
really dependent upon us: at several crucial moment we were not
available, or not consulted.
Having thus dealt with our own place in Edward’s case, I
shall now proceed to derive from it such medico-anthropological
insights as it has to offer.
[1]Numbers
within brackets [ ] that follow people’s names in the text,
correspond with the figures in diagram 1. They are not to be
confused with the raised footnote numbers, nor with four-digit
numbers referring to years. While the names are pseudonyms, the
genealogical relations as shown are, to the best of my knowledge,
correct.
[2]For
Central African societies, the structural principle involved here
was most explicitly argued by Marwick (1965: 199f); cf. Van
Binsbergen 1977b.
[3]K.
Kwacha, the Zambian currency. K1 equaled about £ 1.30 in 1973.
[4]On
re-reading it occurs to me that at this time, as in March 1973,
Mary’s moodiness may partly have been due to her being in
the early stages of pregnancy. However, at both times her husband
and her wider social environment were as yet ignorant of her
condition, and could not make allowance for it.
[5]Cf.
Turner 1976c: 19f on the culturally closely related Ndembu.
[6]For
the contradiction, in Nkoya social organization, between
bilateral descent and payment of bridewealth, cf. Van Binsbergen
1977b: 43f, 56f; and n.d. (b).
[7]Table
3 gives the clinic’s official returns for the 1972. the data
were scrambled in the same way as those presented in table 2.
This leaves the order of magnitude of the figures intact. The
original figures appear to be fairly reliable. The majority of
the patients must have come from the immediate vicinity of the
clinic, within a radius of a few km. Participatory and
quantitative evidence (cf. Van Binsbergen, n.d. (b)) have
convinced me that, at 20 to 30 km distance, the population of the
Mema and Mushindi valleys contributed very little indeed to these
figures.
[8]This
had nothing to do with her divorce as such. Chief Kahare’s
area abounds with young female divorces. Locally Enesi’s
conditions was explained as follows. She had married her former
husband [34] shortly after the latter had become a widower.
However, upon his first wife’s [36] death the latter’s
kin group had refused to ritually cleanse the widower: they
blamed him for her death. The husband’s dangerous state of
pollution was transferred his new wife, Enesi, upon their
marriage. When Enesi’s condition of madness became manifest,
her husband divorced her, and she settled in Jimbando village. I
did not get to know Enesi well and have no idea how cosmopolitan
medicine would diagnose her condition; nor do I have the specific
sociological data to interpret the failure of her marriage.
[9]Even
with proper dosage and under adequate clinical conditions, the
great dangers of such an injection are well-known (cf. King 1966:
section 13:6).
[10]My appreciation of cults
of affliction in Lusaka and Western Zambia was related to the
fact that I was no newcomer to this class of religious phenomena.
Before coming to Zambia I had spent some years studying regional
cults and cults of affliction in rural Tunisia.
to Part 0 (Abstract)
to
Part I (Problem and Method; Background)
Part
III (Interpretation; Conclusion)
Part
IV (References; Postscript on Cognition)
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