The concept of flow in Rwandan popular medicine

Death in an Ordinary Time: Reflections from Rwanda

Meanings and processes of death in Rwanda have changed dramatically in the 25 years following imvururu, the Kinyarwandan term for "interruptions" that signifies the numerous episodes of violence between the late 1950s and mid-1990s. Reflecting on experiences of elderly Rwandans who witnessed imvururu in adulthood, this article traces how death is perceived and practiced in old age, a phase of the life course that is marked with relative political calm. Although traces of imvururu permeate the present, these ordinary times-ibihe bisanzwe-afford opportunities for the elderly to alter their notions of death as an event by making it a personal process, reviving valued preparation practices from the past and creating new ones with the young. This peopled account invites alternative ways of thinking about time and recognizing death's role in infusing meaning back into life in contexts where accounts of the everyday remain frozen in an apocalyptic imaginary. [aging, death, ordinary, temporality, Rwanda].

Local experience of using traditional medicine in northern Rwanda: a qualitative study

BACKGROUND

The popular use of traditional medicine in low-income settings has previously been attributed to poverty, lack of education, and insufficient accessibility to conventional health service. However, in many countries, including in Rwanda, the use of traditional medicine is still popular despite the good accessibility and availability of conventional health services. This study aims to explore why traditional medicine is popularly used in Rwanda where it has achieved universal health coverage.

METHODS

The qualitative study, which included in-depth interviews and participant observations, investigated the experience of using traditional medicine as well as the perceived needs and reasons for its use in the Musanze district of northern Rwanda. We recruited 21 participants (15 community members and 6 traditional healers) for in-depth interviews. Thematic analysis was conducted to generate common themes and coding schemes.

RESULTS

Our findings suggest that the characteristics of traditional medicine are responding to community members' health, social and financial needs which are insufficiently met by the current conventional health services. Participants used traditional medicine particularly to deal with culture-specific illness - uburozi. To treat uburozi appropriately, referrals from hospitals to traditional healers took place spontaneously.

CONCLUSIONS

In Rwanda, conventional health services universally cover diseases that are diagnosed by the standard of conventional medicine. However, this universal health coverage may not sufficiently respond patients' social and financial needs arising from the health needs. Given this, integrating traditional medicine into national health systems, with adequate regulatory framework for quality control, would be beneficial to meet patients' needs.

Nasa dugo ('It's in the blood'): lay conceptions of hypertension in the Philippines

Introduction

Understanding explanatory models is important for hypertension, a leading risk factor for cardiovascular disease and stroke. This article aims to determine what adult patients with hypertension in the Philippines attribute their condition to, how these views might be explained and what the implications are for hypertension management.

Methods

This is a qualitative study drawing on 71 semistructured interviews (40 initial and 31 follow-up) and four focus group discussions with patients diagnosed with hypertension. The setting was urban and rural low-income communities in the Philippines.

Results

Four prominent perceived causes were identified—genetics, heat, stress and diet—for what patients refer to as ‘high blood’. We propose a ‘folk physiology’ that rests on local understandings of blood and blood flow, draws from broader cultural notions of illness causation and accounts for a dynamic, non-chronic view of hypertension that in turn informs the health behaviours of those affected.

Conclusions

By understanding that hypertension is frequently seen not as a chronic constant condition but rather as an episodic one triggered by external influences, although in those genetically predisposed to it, it may be possible to address patient’s beliefs and thus adherence to treatment.

Four delays of child mortality in Rwanda: a mixed methods analysis of verbal social autopsies

OBJECTIVES

We sought to understand healthcare-seeking patterns and delays in obtaining effective treatment for rural Rwandan children aged 1-5 years by analysing verbal and social autopsies (VSA). Factors in the home, related to transport and to quality of care in the formal health sector (FHS) were thought to contribute to delays.

DESIGN

We collected quantitative and qualitative cross-sectional data using the validated 2012 WHO VSA tool. Descriptive statistics were performed. We inductively and deductively coded narratives using the three delays model, conducted thematic content analysis and used convergent mixed methods to synthesise findings.

SETTING

The study took place in the catchment areas of two rural district hospitals in Rwanda-Kirehe and Southern Kayonza. Participants were caregivers of children aged 1-5 years who died in our study area between March 2013 and February 2014.

RESULTS

We analysed 77 VSAs. Although 74% of children (n=57) had contact with the FHS before dying, most (59%, n=45) died at home. Many caregivers (44%, n=34) considered using traditional medicine and 23 (33%) actually did. Qualitative themes reflected difficulty recognising the need for care, the importance of traditional medicine, especially for 'poisoning' and poor perceived quality of care. We identified an additional delay-phase IV-which occurred after leaving formal healthcare facilities. These delays were associated with caregiver dissatisfaction or inability to adhere to care plans.

CONCLUSION

Delays in deciding to seek care (phase I) and receiving quality care in FHS (phase III) dominated these narratives; delays in reaching a facility (phase II) were rarely discussed. An unwillingness or inability toadhere to treatment plans after leaving facilities (phase IV) were an important additional delay. Improving quality of care, especially provider capacity to communicate danger signs/treatment plans and promote adherence in the presence of alternative explanatory models informed by traditional medicine, could help prevent childhood deaths.

Dilemma with the local perception of causes of illnesses in central Africa: muted concept but prevalent in everyday life

The author of this study aims to explore people's perceptions of the cause of illnesses in the Democratic Republic of Congo using qualitative methods, namely case studies and focus group discussions, to gather data from participants. He identifies seven main categories of causes of illnesses and describes the relations between them. The local concept of the causes of illnesses does not absolutely respect the biomedical framework. As the popular saying puts it, Congolais hakufi na microbe, meaning "Congolese people do not die by microbes." The perception of witchcraft is strong as a cause of illness among the Bira of Mobala and the Nande of Mukulia. The author argues that health professionals should take this view into account instead of rejecting it.

Popularité et scepticisme : opinions contrastées sur les médicaments1

Les auteurs de cet article discutent de deux points de vue différents sur les médicaments. Leurs propres recherches ainsi que d’autres études indiquent une grande popularité des médicaments dans les sociétés prospères comme dans les sociétés pauvres. Ils sont parvenus cependant à constater en même temps une attitude plus sceptique et réticente vis-à-vis des médicaments pharmaceutiques. Ils perçoivent ce scepticisme comme l’expression émergente d’une sorte de politique médicinale, qui se formule en termes de catégories individuelles et culturelles. Cette étude examine les raisons de la popularité mondiale des médicaments, et suggère ensuite que certains de ces mêmes facteurs peuvent aider à comprendre certaines réticences dans d’autres circonstances.

Planning reproductive health in conflict: a conceptual framework

A conceptual framework for planning reproductive health services for refugees is presented for use by those involved in planning field activities. Secondary sources of data are recommended to describe pre-existing patterns and trends in reproductive health status and likely determinants of any change in status, for populations which have been subsequently affected by conflict. The interaction between these patterns and the conflict itself is then analyzed, taking into account the shift in health status and service availability as the conflict progresses through various recognized phases. The potential impact of conflict is thus hypothesized in order to make initial plans for incorporating reproductive health services into standard relief packages. Two case studies are presented: Rwanda demonstrates the use of the framework in a relatively short but dramatic conflict, for which there was also substantial prior evidence on reproductive health status; Cambodia is used, in contrast, to demonstrate the use of the framework in a much more complex conflict which has been occurring over the last 20 years.

Abortion traditions in rural Jamaica

Abortion is not condoned in Jamaica. Its meaning is linked to the meanings of kinship and parenthood, which are expressed through procreation and involve altruism and the assumption of responsibility for the well-being of others. Abortion subverts these ideals but indigenous methods for it are known and are secretly used. The inconsistencies between abortion talk and abortion practice are examined, and the structural functions of abortion (and of its culturally constructed, ideological meaning) are discussed. The distinction--and the overlap--between abortion as such and menstrual regulation is explored. The use of the culturally constructed 'witchcraft baby' syndrome to justify abortion is also investigated. Traditional abortion techniques follow from (and can illuminate) general health practices, which focus on inducing the ejection of 'blockages' and toxins, and from ethnophysiological beliefs about procreation and reproductive health, which easily allow for menstrual delays not caused by conception. The latter understanding and the similarity between abortifacients, emmenagogues and general purgatives allows women flexibility in interpreting the meanings of their missed periods and the physical effects of the remedy.

Internal body perceptions of Ethiopian Jews who emigrated to Israel

Previous research regarding knowledge about internal organs among school-age children tied this knowledge to the development of cognitive capabilities. Studies have rarely considered the impact of culture on this knowledge. The purpose of this study was to examine internal body perceptions among Ethiopian Jews who emigrated to Israel. A total of 65 children (stratified according to age) and 19 adults were interviewed. Findings indicated that Ethiopian children reported fewer body organs than did Western children. Further, Ethiopian children and adults, unlike people from Western societies, did not think about the body in terms of different biophysical functions. Rather, they perceived the body as a holistic system in which a divine providence was responsible for body organs working together harmoniously. Implications of the differing perceptions about internal body organs, health, illness, and treatment are discussed.

AIDS action-research with women in Kinshasa, Zaire

AIDS has assumed epidemic proportions in Central Africa. Knowledge of culturally constructed gender relations and sexual meanings is crucial to developing prevention strategies and reducing the impact of AIDS. CONNAISSIDA, a transdisciplinary medical anthropology research project, developed culturally appropriate community-based empowerment workshops. These used cognitive, emotional and social stimulants to provoke critical reflection and action. Collaborative relationships developed in workshops were used to study sexual relations in many contexts. Significant changes in knowledge and action were observed. Nevertheless, economic necessity and inequality limited the ability of many women to avoid sexual risk. Economic crisis, structural adjustment and debt reimbursement policies have exacerbated poverty, particularly among women. Linking macrolevel political economy to microlevel sociocultural analysis shows how strategies adopted for survival contribute to sexual risk. Therefore broader socioeconomic changes that reduce poverty and gender subordination are necessary to control the HIV/AIDS epidemic. Findings from Zaire are widely applicable in the region.

Health-seeking behavior of Rwandan women

The responses of Rwandan women in a highland region to their own and their children's illness episodes are examined. Over 85% of diarrhea cases from monthly morbidity recalls were treated by health-center visits, use of Western medicine, or no treatment. Factors such as the age of the child at the time of the illness, previous child death in the household, and the women's control of various categories of household expenditures exert some influence on health-seeking behavior, according to results of cross-tabulations. Women at the highest altitudes tend to respond less actively to children's diarrhea, possibly because of the relative difficulty of their journey to the health center. Recommendations are offered for policy and further study.