Manual The African Transformation of Western Medicine and the Dynamics of Global Cultural Exchange

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Rules and force thus contribute in this way to the maintenance of a complex system with global reach. The notion of a singular scalar structure built on cooperative and coercive arrangements and comprised of varying types of parts allows disparate proponents of a systems paradigm to bring attention to assorted elements of globalization. These include the consequences of spatial location for actors within the global system Wallerstein , the role of extra-national institutions as rule-makers and enforcers Giddens , and the machinations of geopolitical instruments of hegemony Arrighi Otherwise, coercion and other displays of differential power would not play so central a role in maintaining the system.

Local actors or parts stand in relation to a global system or whole and it is the governing principles giving coherence and order to that system that define the options for local actors as a condition of their location within the global system. On the one hand, the capitalist world-economy was built on a worldwide division of labor in which various zones of this economy that which we have termed the core, the semiperiphery, and the periphery were assigned specific economic roles, developed different class structures, used consequently different modes of labor control, and profited unequally from the workings of the system.

On the other hand, political action occurred primarily within the framework of states which, as a consequence of their different roles in the world-economy were structured differently, the core states being the most. Rules are set and enforced on varying spatial levels with particular attention paid to that which maintains the whole. Local actors, meanwhile, at times engage in anti-systemic activities which thus disrupt a static and narrowly functionalist interpretation of a systems paradigm.

However, in general, the emphasis remains on the structural system and not local actors. A transcendental paradigm imagines globalization as a supra-spatial force bringing local actors and actors at other levels into conceptual-abstract unity with one another Crothers ; Scholte ; Tomlinson By virtue of occupying the same hyper-connected world, local actors are necessarily interconnected, though the degree of this connectivity and its consequences can vary widely across locations.

This global hyper-connectivity is held together by certain economic, political, and sociocultural imperatives that seep through borders via a range of instruments, including financial markets, diasporic migrations, and Hollywood distribution strategies.

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It is recognized that rules of state interaction are essential for such 'instruments' to initially transgress borders. However, once the process of border crossing has begun, it is argued that its continuation and expansion follows a certain metaphysical logic that takes on a life of its own. The logic of choice driving these movements - be it capital accumulation, cultural diffusion, or conspicuous consumption - generally reflects a scholar's home discipline.

Whereas a systems paradigm emphasizes interactions at and across the local, national, and regional levels that comprise the global, a transcendental paradigm emphasizes interactions that supersede the limits of spatial-territorial designations. Globality in the conception adopted here has two qualities. The more general feature, transplanetary connectivity, has figured in human history for many centuries.

The more specific characteristic, supraterritoriality, is relatively new to contemporary history. Inasmuch as the recent rise of globality marks a striking break in territorialist geography that came before, this trend potentially has major implications for wider social transformation. Globality in the broader sense of transplanetary relations refers to social links between people located at points anywhere on earth. The global field is in these cases a social space in its own right. The globe, planet Earth, is not simply a collection of smaller geographical units like regions, countries, and localities; it is also a specific arena of social life.

Unlike earlier times, contemporary globalization has been marked by a large-scale spread of supraterritoriality Scholte Consequently, there is greater emphasis on globalizing structures and processes and less emphasis on - though not a blanket dismissal of - local actors, stable state-based rules, or the coercive force of hegemonic state actors.

Such forces operate via channels that, by definition, beyond any orbit of control for local actors. An abstract-relational paradigm presents globalization as a pattern of spatial-temporal integration that reflects a multi-level set of dialectical relationships between global and local actors Appadurai b; McMichael ; Robertson The dialectical nature of this paradigm follows from treating globalization as an artifact of the cumulative interactions of global and local actors. The global world itself is constituted by these interactions. For example, Robertson's universal-particular relation, Appadurai's production of locality, or Philip McMichael's incorporated comparison introduces not a global system nor a global governing logic but a portrait of dynamic holistic interactions.

Central to this effort is the notion of reciprocal relationships, wherein neither the local nor the global is held to rule over the other. However, this notion merely asserts itself as an abstract premise without ontological foundation. While we hear a great deal about how reciprocal relationships supposedly operate, we learn little about why they should operate in this manner. An alternative to a preconceived concrete totality [a systems approach] in which parts are subordinated to the whole is the idea of an emergent totality suggested by 'incorporated comparison'.

Here totality is a conceptual procedure, rather than an empirical conceptual premise. It is an imminent rather than a prima facie property in which the whole is discovered through analysis of the mutual conditioning of parts. A conception of totality in which parts as relational categories reveal and realize the changing whole overcomes the rigidity of world-system theory and builds on its insights As a method of inquiry, a world-historical perspective conceptualizes 'instances' as distinct moments of a singular phenomenon posited as a self-forming whole.

It is an alternative perspective because it views comparable social phenomena as differentiated outcomes or moments of an historically integrated process. Proponents of an abstract-relational paradigm view local actors as neither passive victims swept under by homogenizing global forces nor heroic resistance fighters able to bend the forces of globalization to their will.

Again, this focus on the dialectical relationships between the global and the local, contra the spatial-structural properties of the global and the local or supraterritorial linkages uniting the global and the local, should be understood as a contrasting. Each of these paradigms harbors a singular, fatal flaw.

Each begins with certain a priori assumptions - either the structural-spatial assumptions of a systems paradigm, the metaphysical assumptions of a transcendental paradigm, or the conceptual assumptions e. Consequently, insofar as the rationale for one's conclusions ultimately lie in one's original operating precepts, each set of assumptions suffuses one's analysis with circular reasoning, as seen above in our consideration of glocalization, hybridity, and global flows.

Too often, the cunning of theoretical exposition and modeling is allowed to stand in for the underlying veracity of our findings. To begin, it bears repeating that the argument here is not that the paradigms outlined above are misguided or wrong. It is only that, as formulated, the conclusions they reach fall in upon themselves due to inherently vacuous rationale.

There are two points of difference that distinguish a concrete-relational paradigm from those above in this regard. Insofar as one's treatment of space is a defining feature of the current era of globalization, all notions of globalization begin from certain assumptions about the local and the global. Within a concrete-relational paradigm, the global and the local as analytical-conceptual categories and the relationships between these are not introduced prior to analysis but emerge from the investigation of specific phenomena.

For an extended consideration of this paradigm see Baronov As discussed below, this entails beginning with the ontological premises that permit any analysis of globalization to proceed. Insofar as the spatial-analytical categories of 'global' and 'local' when unexamined present us with empty abstractions, we must begin with some concrete content to give form and substance to these.

Appadurai, in fact, hints at this with his introduction of 'neighborhood' as a spatial-analytical category. He does not, however, ultimately explore this sufficiently to tease out its ontological consequences for the global and the local as abstract categories. Conventionally understood, the local is a spatial-scalar dimension that provides an arena for various forms of community-level social action broadly construed. The scale of the arena permits persons to come into direct contact with one another.

We do not address the notion of virtual communities here.

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The local, however, does not precede social action. Rather, it is a concrete social action that brings the local a sense of place into being - imbues it with form and substance. Consider a church congregation. When the members of a community take steps to form a congregation this brings these community members into relation with the members of other communities who have formed their own congregations.

In this manner, however trivial the example, social action contributes to the ongoing production of locality. The local, thus derived, is no abstraction or empty supposition. Rather, it is a manifestation of the direct lived experiences of particular community members who through their actions constitute the local. This notion of the local as an arena for social action via ongoing forms of direct contact, in turn, distinguishes it from other spatial-scalar dimensions, such as a region.

Insofar as a particular collection of locales e. Importantly, it is only via a sense of affinity among community members at the local level that the concept of a region emerges. Beyond this it has no concrete manifestation, only symbolic representations flags, army posts, language, customs that convey a sense of regional identity among persons at a local level. Similarly, it is only via some sense of affinity by community members at the local level that the national or the global emerge as scalar dimensions. Hence, for a concrete-relational paradigm, the regional, the national, and the global are, perforce, abstract suppositions.

At best, they can be conceived of as pan-local imagined spaces, insofar as certain social actions in one locale may reverberate across other locales e. The distinction remains simply this: The local is a space that is constantly being produced and reproduced through concrete social action; the global is an abstract supposition whose imagined spatiality reflects the local interpretations of community members regarding the impact of interactions between far-flung locales on one another. Globalization, in this sense, refers to the extension and intensification of inter-local contacts across economic, political, and sociocultural spheres of life.

Let us turn then to the ontology of concrete social action at the local level across these spheres. To better bring this into focus let us consider an early morning scene in a small fishing village. Men begin arriving at the dock and putting their nets, hooks, and bait in order before pulling on their boots and other gear and entering an area where they have paid a fee to dock their boats. They stow their commercial fishing licenses and permits and review the latest weather service bulletin.

A cleric moves among the docks blessing the boats and crew members and the men's wives hand off food they have prepared along with colorful beaded wristbands. As the boats set off, the younger fishermen are expected to allow the older fishermen to take the lead. The women wait along the dock until the boats disappear into the mist, while a handful of indigenous peoples - forbidden, like the women, to work on the boats - clean and repair the docks. The day has begun. There is much to gather from this account and, for this, our observations can be distributed across three categories of ontological content.

First, there is the physical environment the bay and shore and the physical items that the fishermen make use of, including the boats, nets, hooks, bait, docks, boots, and food. We refer to such items as the material content. Second, there are those phenomena that invoke some type of political, economic, or social institutional forms, including the fee-based dock, the commercial fishing licenses and permits, the coast guard post, and the weather service bulletins.

We refer to this as the social-political content. Third, there are those phenomena that invoke some type of symbolic-cultural beliefs and practices, including the cleric's blessings, women preparing the food and seeing the men off, older fishermen leading younger fishermen out of the bay, the use of beaded wristbands to avert poor weather, and discrimination against the indigenous population.

The African Transformation of Western Medicine and the Dynamics of Global Cultural Exchange

We refer to this as the symbolic-cultural content. The material content, the social-political content, and the symbolic-cultural content thus comprise three ontological spheres. Two critical features of this content stand out. First, the ontological spheres are interdependent. On the one hand, each is necessary for a complete understanding of the scene above. Omitting either the material, symbolic-cultural, or social-political content from our representation of the fishing village would inevitably leave us a partial and distorted understanding.

On the other hand, insofar as a change to any one sphere impacts the others, each enters into reciprocal relationships with one another. For instance, as weather bulletins improve, this can alter the role of beaded wristbands. As women enter the workforce, this can alter their early morning role on the docks. As laws ban discrimination, this can alter attitudes toward the indigenous population. As the safety of boats progresses, this can alter the role of the coast guard. These multiple ontological spheres are thus embedded with one another and cannot be understood when treated as discrete.

Second, we have access to the content of each ontological sphere only via particular instances of concrete social action. We are aware of the social role of women on the dock due to the specific actions and treatment of women. We are aware of ethnic prejudice due to specific, observable acts of discrimination.

We are aware of certain metaphysical beliefs due to the use of beaded wristbands. In each instance, human beings are bearers of this material, symbolic-cultural, and social-political content via their concrete actions. In this sense, our explicit ontological premises necessarily precede and thus make possible both our empirical findings and our theoretical assertions. Consequently, at a minimum, our account necessarily entails three elements: Consider the following cases.

These have been adapted from Baronov Here we have Patient X. Blood work confirmed significant levels of HIV in the body's bloodstream. Further diagnostic tests later revealed the full progression of the ailment attached to this patient's body. Given the predominance of biomedical influence reflected in this account, it appears that the Mozambican medical interpretations of this ailment depictions of its material content are decidedly filtered through a strong Western gaze.

In this sense, the patient's body contributes to our understanding of - and mediates between - the complicated relationships between Mozambique and Western medicine. Hence, Patient X links Mozambican medical care and Western biomedicine. And it is, in part, via the body of Patient X that we have a concrete instance of this relationship.

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My family isolated me and even went so far as to separate the utensils I used; they were afraid of becoming contaminated', said Nussanema Samuel, She has had to build a new life since she revealed her HIV-positive status to her family and friends in Machaze, in the south of the province, three years ago. It is via her daily experiences that these social attitudes are made manifest. At the same time, the material content is also present insofar as community members are responding, in part, to the sight of her frail and ravaged body.

The content of each ontological sphere thus informs the other and Nussanema herself mediates between the two. The following account is a composite sketch and not an actual person. Xolisile Gwatura was a year-old Zimbabwean soldier who had arrived in Mozambique to assist government forces to battle anti-government rebels in He first felt ill in , while stationed in Chimoio in the central province of Manica. Like most of his fellow Zimbabwean soldiers, Xolisile had lived an adventurous life in Mozambique.

Intermittent bouts of heavy drinking, a series of semi-regular girlfriends, and rounds of brutal fighting with anti-government rebels proved both exhilarating and exhausting. However, along with his promiscuous lifestyle, he had suffered a serious shrapnel accident in and this had required a number of blood transfusions. Xolisile had grown too weak to travel home and he was sent to rest at a government military post where he received palliative care for several weeks before succumbing.

After he died, rather than returning his body to his home village in Zimbabwe, his remains were burned for fear of contagion. From this brief sketch we learn several things. The widespread devastation of such factors in Mozambique has been well documented Abrahamson and Nilsson ; Collins ; O'Meira Again, we come to know these things only through the concrete life experiences of Xolisile.

These include the embedded nature of the multiple ontological spheres constituting phenomena, our dependence on concrete manifestations for access to this ontological content, and the essential mediating role of the concrete. As with the fishing village above, the material, symbolic-cultural, and social-political content are embedded and interdependent.

At the same time, as changes in the material content. At the same time, in each account it is only by means of some concrete expression e. This in fact is true for all social phenomena across all societies.

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Hybrid explanations that result from the former approach cannot, therefore, account for local contributions to ongoing developments beyond superficial descriptions of hybrid sociocultural forms. Let us further consider the implications of this. It is via the diagnosis of bodily symptoms that we become aware of the degree of penetration of Western medicine into Mozambique or into Africa more generally.

It is via the treatment of this body that we may learn of hybrid medical practices that extend and transform the insular Western understanding and applications of biomedicine. In addition, Mozambique has transformed Western biomedicine via its syncretic beliefs and practices.

Western biomedicine has become global biomedicine. And it is the beliefs and practices of local community members that act as the agency for this transformation of Western. When one is present all are present. Hence, depicting Western scientific medicine and indigenous medical practices as parallel and separate ontological content precludes grasping the emergence of hybrid medical beliefs and practices in Mozambique.

First, hybrid medical practices in Mozambique are no less biomedical than Western scientific medicine. These constitute an intentional Mozambican variant of Western biomedicine. Second, such hybrid beliefs and practices equally reflect forms of cultural resistance and ongoing political battles.

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Concrete expressions confer local agency. The embedded nature of these spheres, likewise, confers an inherently unstable phenomenon that is ever subject to change. However, the reception of this information is filtered through local customs and beliefs pertaining to the behaviors identified in these campaigns. Hence, the stigma and prejudice directed toward these people results from hybrid cultural forms that again mediate between the cultures and beliefs of a local community in Mozambique and a primarily Western understanding of disease transmission as culturally neutral.

In this sense, this content the life and death of Xolisile is a bearer of regional and global geopolitics. In point of fact, we only know the details of this geopolitics via the life and death of Xolisile - or that of some equivalent person. Xolisile is thus, in part, a bearer of this insurrection and of internecine Cold War politics. And it is only through the details of his life and death that we have a concrete manifestation of the relationships between Mozambique and various regional and global actors.

It is via these circumstances that we are given a glimpse of the role of Mozambique in Cold War geopolitics.

As noted above, for Appadurai, the individual emerges as the 'last locus' within his account of disjunctive global flows, set just beneath the local and the neighborhood Appadurai a: Within his general schema, this suggests a problematic resolution for the dilemma of infinite regress when moving below the level of the local. After all, one can always find a further segment between two ungrounded points along an infinite axis.

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That is, the need to locate the origin of their conceptual premises in concrete and purposeful social action - and not in a priori assertions such as reciprocal relationships. Heterogeneity is not a trait, not a description, and certainly not a premise of globalization.


It is an inherent outcome resulting from the concrete actions taken by local actors responding to their world and, thereby, giving form and substance to a great range of phenomena constituted by multiple, embedded ontological spheres. Disjuncture and Difference in the Global Cultural Economy. It is not just African healing that is given short shrift; Africans are as well. A major problem is the lack of any acknowledgment of African agency in the book.

Indeed, there are no Africans at all: However, most of this generalized discussion offers nothing novel, and is in fact so general as to be misleading. Again and again the author equates the introduction of biomedicine with the colonial state, and also decries its scientific perspective and lack of spirituality, when the history of missionary medicine in Africa, which is well-developed and contradicts his argument, is ignored.

It is not just Christian elements that are ignored: Islam is not mentioned until page and then is not discussed until much later. By the time the topic reappears, however, world-systems theory has disappeared. Baronov could have succeeded with this topic and this approach, but they would have required detailed data from one or a small number of case studies, and meticulous analyses of the perspectives, thoughts, and actions of African healers and consumers over time. But with no evidence other than what was gathered from dated secondary sources, and with an undeveloped explanation of how the claims relate to world-systems theory, this is a book most Africanists will bypass on their way to more complete works.

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