Indigenous Healthcare and “Biomedicine” in Uganda

“Biomedicine” is a term used to describe formally recognized medical care that is available in hospitals, clinics and healthcare centers. In Uganda, legitimized by Science (and the State), it is often characterized as Western or “modern” medicine.
The research I am conducting with the MHIRT team in Eastern and Northern Uganda, has led me to see the problematic nature of using this term, but how alternatives are few.

Because of the legacy of missionary medicine under colonialism and the structural violence inherent to the modern-day public healthcare system in Uganda, biomedicine as a term lends itself as yet another tool in a long history of subjugation in Africa.

To associate biomedicine with hospitals, clinics and formal education is to miss an important fact about indigenous medicine: Indigenous healthcare and biomedicine are not mutually exclusive. They certainly are not two opposite points on the healthcare spectrum (a spectrum that includes Chinese herbal treatments, self-care and Ayurveda). Healthcare, whether one is going to a “witchdoctor” to cure a fertility curse or to the local clinic for free HIV testing, should not be strictly divided into fact or fiction.

For example, rural communities in Uganda have been using the bark from a local tree to treat malaria for decades. Herbalists extracted quinine from this tree or people chewed on the bark to treat malaria infections, which proved to be effective. So before quinine was found in stock at hospitals and clinics (and before people built up a resistance to it), indigenous medicine was the principal public health system in Uganda. To talk of just biomedicine and then indigenous medicine is to place the two on a hierarchal scale where biomedicine is supported by Science while the latter is somehow not.

Today, this gives way to the disconnect between indigenous healthcare providers and biomedical providers. When Julia Hanebrink, MHIRT co-coordinator, started her research in southwestern Uganda, she approached her site asking how the two can work together to benefit the community. However, after talking with communities, she found that most members did not want the two to be merged. People enjoyed the freedom they had in choice. If the clinic failed them, they would go to the traditional healer, witchdoctor, herbalist, or bone-setter and vice versa. A merging of the two would limit their agency. And from an outsider’s perspective, the structural violence and inequality inherited from the colonial structure of public health would spill over into indigenous healthcare practices.

So while merging the two would limit agency and choice it does not mean that they cannot and should not inform each other. Right now, part of our team working in northern Uganda is assisting in the development of Hanebrink’s social medicine module. This module will identify all the socio-cultural factors that influence the community’s health-seeking behaviors by “increasing their [biomedical provider’s] cultural competency” so they can “work effectively in cross-cultural situations by improving quality of and access to care in order to improve health outcomes” (Hanebrink 2012).

Community in this way comes first and their socio-cultural experiences as well as economic challenges are incorporated into the education of biomedical providers to illuminate the choices community members make, painting more of a medical syncretic picture rather than one that privileges biomedicine.

Safari on the Savannah

This week marked a few bittersweet changes for our group. Sadly, we said goodbye to our fearless leader of 5 weeks, Dustin, as he traveled back to the States. Also, we parted temporarily with our peer, Jayanni, as she traveled to Gulu and will be working on a project with our 2^nd, yet equally amazing, fearless leader, Julia, who we welcomed back to Uganda last Friday. Despite these departures, this week brought with it some pleasant opportunities as well, namely a few days of rest and relaxation in the capital city of Kampala in addition to my first safari experience. On Wednesday, I along with Madeline and Damaris, traveled by bus to Murchison Falls National Park. After yet another (our third) unfortunate car breakdown, we made it to the park early evening and hiked to the top of Murchison Falls. The view of the natural fall’s waters cascading down the rocks of the mountainside was breathtaking. After sleeping in our tents in fear of unwelcome visits by the wild animals which roam the campsite inside of the park at night, we rose early on Thursday morning and crossed the Nile river by ferry to go on our first game drive. From the roof of our minibus, we were able to view an assortment of animals roaming the savannah grasslands, namely various types of antelope, buffalo, elephants, and many giraffes. Regrettably, the lions were hiding from all of us safari-goers that day. After resting and recovering from the scorching afternoon heat, we cruised the Nile by boat during which time we saw other wildlife in the water and along the banks, mostly hippos and Nile crocodiles. The cruise culminated with another incredible view of Murchison falls. Our final morning of the trip consisted of one last, short game drive, which turned out to be arguably the best one of all because, although a fleeting view, I finally saw what I had been waiting for the entire trip, a lion! Simba in the flesh. :-) Before finally heading back to Kampala, we stopped in Karuma for a short hike and view of the waterfalls there as well. Although I must admit that camping amidst undomesticated animals is not necessarily my cup of African tea, this was truly a once in a lifetime experience that I will never forget. Viewing a giraffe cross the road and sunset on the Nile are vivid images that will be etched in my mind for many years to come. Please see Damaris' post below for some awesome pics! Until next time...

Murchison Falls National Park

Giraffe on the savannah

Sunset on the Nile

On the Nile, near Murchison Falls

Hippos on the Nile

An experience that is changing my life

Dr. Fitzgerald said that we were about to have an experience that will change our lives. Men was she right! Six weeks have now passed and I continue to learn a lot here in Brazil. Lesson #1: Patience and kindness go a long way. So I knew that people speak Portuguese in Brazil. However I didn’t except that only a few number of people speak English. Yeah I went through my Portuguese lessons but I didn’t master the language. So here I am in Belem and hardly anyone speaks English. Only the college students and other professionals who have gone through a higher education. I was shocked when I went to the bank and no one spoke English! NO ONE. IT’S A BANK! I quickly realized that I had to rely on what I learned in my Portuguese lessons, the Portuguese dictionary, Google translator, hand gestures,  and pen and paper (for drawing when all fails).   

There have been so many times when Monique and I could not communicate effectively in Portuguese. That’s after using all our resources! It sometimes gets very frustrating. I remember one incident where we went to the supermarket to buy some groceries. We also needed to get some matches for our gas stove. We forgot to look up the name using Google translator and the Portuguese dictionary didn’t have it. So I decided to walk up to the store manager and try to explain what I needed using hand gestures. That didn’t go so well. The guy just kept smiling. I didn’t have any other choice other than drawing a picture of a stove and matches on a piece of paper! The manager luckily understood my drawing. He took me to the aisle that had the matches. He smiled, shook my hand and wished me a good afternoon. I was so amazed by his kindness and patience.

That simple incident made a big impression on me. It got me thinking, how many of us are kind and patient with non English speakers back in the U.S? I have read and heard so many stories of people who are outraged by non English speakers in America. There are even blogs where people can vent about such things. Some people are even outraged that there is a Spanish option when calling banks and other businesses! I am glad that the ATM machines here have English options. I am so thankful to all the Brazilians I have encountered that have been so kind and patient with an English speaking person like me in their Portuguese speaking country. I hope that I will have the wisdom to extend the same patience and kindness to others in America who do not speak the nation’s language.  

Homesickness Really Bites

      After posting my pictures for the blog this week, I thought I would mention some things about homesickness. Everyone seems to have some great stories and photos about all of the fun we are having. I am truly having an awesome time myself, and I actually adjusted quite easily. The buses are a breeze in Floripa compared to the transportation I have experienced in NY and Chicago. Samantha and I were very lucky to have such a beautiful pousada in a great, relatively inexpensive place (first Guatemala at Heifer, now here!) I honestly have felt a complete lack of culture shock which has surprised me more than anyone. I have knocked so many things off my bucket list here and have been so busy having fun that it is ridiculous. I looked back at the journal I have been keeping, and there is really just an air of simplicity about life here. I go to the lab, I come home, I hang out with people--my life outside of MHIRT is so much more work and stress! But I really, really, REALLY want my hectic, stressful, headache of a life back now.
      I don't know about anyone else, but when I'm not working or out with my friends, there is this really sad feeling I get. It happens when I am going to bed at night, and my mind isn't occupied with Portuguese and biochemistry lab protocols. I miss my family a lot. It doesn't even matter that I am in another country! If I were just an hour away from home, I would feel exactly the same. My daily routine involves 14 people, not including my friends or coworkers. It's my mom, dad, aunt, little brother, two brothers-in-law, my two oldest sisters (my third sister is serving in the Army and stationed at Fort Bliss, TX), and six nieces and nephews. I see them all daily, especially because we all live down the street from one another. I have such a close family, and the biggest emptiness I feel is at night when ordinarily, I would be going home after work to join my thirteen-year-old niece with late night Frosted Flakes and Criminal Minds episodes. There are no early mornings of toting kids to soccer or afternoons with my mom here. My little brother is too far away for me to help prepare for his starting college, and I can only do so much via Skype. My aunt and I have a biweekly tradition of Outback Steakhouse, and I felt so sad when she told me the other day about how she went by herself and got some dinner to-go.
      I don't mean for this post to be such a downer. I guess I'm just making the point that sometimes, it can be really hard to be away from home, even in one of the most beautiful places in the world! I brought comfort food (as suggested), but my main comfort food is fruit, and I have plenty of that here. What would make all the difference is if my brother or my best friend were here with me, but there is no replacement for either of those. But make no mistake; I do not allow myself to mope or be unhappy during my days. The best way to get through this homesickness is to be as adventurous and busy as I can! Besides, I'm sure when I get home, there will be a morning when my niece wakes me up at 7 AM for a ride to school, and all I will be saying then is, "Gosh! I wish I was in Floripa!"