Ugonjuw.4: Concepts of Illness and Transformation among the Tabwa of Zaire

Begmning with the description of a single instance of problematic illness, this paper moves toward the comprehension of Tabwa therapeutics by placing them in their most complete conceptual context. Decisions made regardmg methods of treatment. the loci of therapy (both physical and social). and the means of assessing therapeutic effectiveness reflect an epistemology which includes the overlapping domains of physiology, diagnosis. divination and religious and magical practices: domains whose different contents are nevertheless tightly interwoven by a relatively small number of underlying principles. The articulation of these principles makes clear that Tabwa concepts of illness and transformation form a coherent whole within which both traditional and European medicines take their appropriate and complementary places. In Tabwaland, as elsewhere, the medical system exists and is experienced not as the discursive, analytic prose of the specialist or the observer. but rather as the narrative or saga of specific illness occurrences, episodes which cut to varying depths across the normal Bow of life. For this reason. it is perhaps appropriate that we begin our study of Tabwa medical thought with the telling of one such tale. Embodied within it are the concepts of process, of materiality and of transformation which underlie not only the medical system. but also the definition of reality itself. Through an examination of these, we will be able to accurately locate within the epistemologic system the therapeutic alternatives from among which BaTabwa regularly choose [I]. KAPL’TA’S DAUGHTER’S ILLNESS Early in 1977, Malaika, the three-year old daughter of a close friend. Kaputa. developed two fluctuating swellings on the back of her head. These first emitted pus. then developed lesions which would not heal. During the course of the succeeding months Malaika’s parents, her extended family, and my husband and I applied all the therapeutic means at our collective disposal in an attempt to effect cure. Creams, ointments, and penicillin injections were alternated with the application of powdered plant substances and herbal washes, but to no avail. By the end of six months’ time, Kaputa and Kalwa. his wife, were beginning to ask themselves what sort of illness could be so resistant to treatment with both traditional (~,a n&i) and European (J.U Kizungu) medicines (Dada). Though they felt they should seek divinatory insight into the cause of their daughter’s affliction, they postponed doing so because the illness was not life-threatening and they had many other social and financial obligations. In June, 1977, I acquired some capsules of tetracycline, and. with these, again attempted treatment of Malaika’s illness. After five days, the pus and swelling stopped; and though the medication ran out shortly after this, by the end of the month the child’s lesions had closed. At about this same time, however, Malaika began to have other symptoms. Every morning upon awaking, she would begin to scratch, and swellings would appear all over her body; sometimes especially affecting her eyes and face. Though the swellings would disappear after an hour or so, the itching would remain, a sequence of events characteristic of the illness >na.soli (‘urticaria’ or ‘hives’ [2]). 1~ addition. Malaika began suffering nocturnal fevers which were so severe that they caused mild convulsions (ku.sf~&.stuku) and prompted her parents to sit up all night (kuli&~u) watching over her. Though the fever would remit during the day. the child’s temperature was never normal. and my initial efforts to treat the fever with chloroquine were only partially successful. This limited response, coupled with the presence of the hives and the character of the fever led me to eliminate malaria as a possible diagnosis and to instead suspect that Malaika had contracted bilharziasis when visiting her mother’s natal village in the mountains [3]. My diagnosis was all but useless. however, for the dispensary was without medicines. and I myself had none of the niridazole required for treatment. On July 6. 1977, a message was sent to Kaputa while he was at our house, to the effect that Malaika had just been stricken with ‘convulsions’ (n&ye) while playing al home. What he found when he got there was that his daughter had suffered a series of particularly violent shudderings or tiny seizures which had been controlled on the spot by his mother. who had used the traditional medical treatment of throwing herbal infusions over the child with a broom (/URNwmpulu). Against the background of Malaika’s ongoing nightly fevers, this incident precipitated Kaputa’s decision to seek divination immediately, and also to search the village for itinerant traders who might have niridazole to sell or to exchange for dried fish. By the next day, both problems had been fortunately resolved. In the afternoon, Kaputa had located people down from Kalemie who were selling niridazole at a price which, though expensive, was still within his reach. He bought ten tablets, and began