Un Peu Perdu: Slightly Lost but Completely Fascinated

6 07 2011

By Kathleen Ridgeway

With two more weeks in Togo solidly under my belt, I find myself adapting more easily to life here in Farendé. Mornings I rise early to drink coffee and sit on the stoop where my room opens onto the homestead’s central courtyard, or, if I’m feeling ambitious,  I rise really early to go for a run while everyone else in the village is heading to the fields to cultivate. I tend to spend my mornings at the Centre Médico-Social, Farendé’s health clinic, except for Wednesdays when I go to Kara to access the internet, and Fridays when I trek up to Kuwdé to visit the Case de Sané – the smaller clinic that serves that village. Afternoons are spent conducting interviews with traditional healers or attending community meetings. Although my day-to-day life has fallen easily into this regular pattern, the more I learn about the health systems currently in place, the less I see the organization and coherency that I expected to find. But that is what makes this setting so absolutely fascinating – the perceptions and understandings of health and disease and the way that they are addressed within and without the clinic are shaped innately by international actors, state-level involvement, and the immensely complex and broad-reaching traditional healing system – which includes both formal and informal sectors, and utilizes herbal remedies to treat illness as well as spiritual divination to ascertain its cause. Just take the seemingly-simple issue of diagnosing and treating malaria in the clinic : First of all, it is impossible to obtain an accurate estimate of the incidence of the disease because some community members preferentially seek treatment from guérisseurs (traditional healers) due to the fact that they are more easily accessible, payment of healers is integrated into the local gift-exchange commodity, and treatment is provided in a way that jibes most seamlessly with local understandings of illness and healing. The Centre Médico-Social (or CMS, as it is widely referred to) receives Rapid Diagnostic Tests for the malaria-causing parasite as well as Coartem (an American antimalarial drug used for standard cases of malaria in both children and adults) from the Programme de Lutte Contre le Palu, a Togolese program that receives funding from the Global Fund. These medications and diagnostics are received (as I understand it) free of charge, and are distributed directly to the CMS. The CMS receives a certain amount of both diagnostic and treatment, and also has the responsibility of distributing lesser allotments to the smaller clinics  (cases de santé) in neighboring villages. If these smaller clinics run out of Coartem or diagnostics, they must apply through the CMS to purchase more from a pharmacy in Kara at a cost that unfortunately makes it prohibitive to both clinic and patient. Unless, as the case is currently, the pharmacy runs out of its supply.  Currently the Case de Santé in Kuwdé has no diagnostic tests for malaria, and is unable to treat patients with the Coartem it does have, since the program requires documentation of a positive blood test before the medication is administered. There are, also, other medications available for malaria, which include quinine and Artimether, but without the diagnostic tests, the Case de Santé is left administering treatment on guesswork alone. In addition to these formal biomedical healthcare resources, I have recently heard about two individuals living in a mountain community near Kuwdé who mysteriously have an independent supply of malaria diagnostics and treatment. I unknowingly visited that very village a week earlier, when I tried out a shortcut to Kuwdé that was said to shorten the three-mile trek up to the village, and offered stunning views of the valley below as I climbed, but mysteriously deposited me in the middle of a terraced cornfield, on top of what I discovered  was entirely the wrong mountain! Next week I head up to that village once more in search of these two mysterious individuals, and I plan to take the same path as before, and trust in my absolute lack of a decent sense of direction to lead me faithfully onward.

I feel this sense of being completely lost, either geographically or intellectually, in the complexity of the local healing system, with astounding frequency. I have barely begun to touch the tip of the iceberg that is the Kabiyé traditional healing system, which utilizes dozens if not hundreds of different herbs to prevent and treat palu, a disease into whose category malaria falls, but also seems to encompass a vast range of other diseases as recognized by the biomedical world. Therefore, palu as it stands in the Kabiyé way of thinking is not directly equivalent to malaria as it is recognized biomedically. Palu here is almost a catch-all term (reminding me of the obscure term “the flu” used in the U.S.)which can include anything from general fatigue to high fevers and vomiting. In the clinics, malaria is referred to as “palu” (short for paludisme), but as the disease sits in broader local understandings, clinical “palu” and local “palu” are not one and the same. Especially in terms of understanding disease causation – here, palu may be caused by sitting too long in the sun, working too hard in the hot fields (both of which seem to explain palu’s more general categoriwation of fatigue) to consuming too much red palm oil, a main ingredient in many local dishes  (which seems to stem from a semi-symbolic linkage between the oil’s vibrant red color and blood).

If anyone has actually managed to follow this blog post thus far, you’re probably just as mystified as I am as to how I will be able to find organization within this seemingly-chaotic setting, full of interactions between the traditional and biomedical, local and international. I hope that with time, I will begin to find my way. Just like the man whose cornfield I haplessly stumbled into when I took the “shortcut”  and ended up on the wrong mountain, who kindly took the time to pause his laughing at my bedraggled and confused state to point me in the right direction – little by little, I will become less lost.

Apologies for the lack of photos in the past two blog posts….. more to come with faster internet

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2 responses

6 07 2011
Lysa Mackeen

Petit a Petit, l’oiseau fait son nid. You’ll get there.

10 07 2011
Cindy

Kathleen, you have never been lost in your life! Your path may take you in unexpected and surprising directions, but you always end up exactly where you are meant to be.

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