Medical syncretism with reference to malaria in a Tanzanian community

Abstract

What happens when new health information is introduced into a community? We have explored this question in a semi-rural community of Southeastern Tanzania whose population has been in contact with biomedicine for many decades. With the example of malaria, we illustrate how biomedical knowledge transmitted in health messages coexists, interacts and merges with local pre-existing ideas and logics. The results are syncretic models, which may deviate considerably from what health promoters intended to transmit. Some of those may have implications for treatment of malaria, which may include delay in seeking treatment and non-compliance with therapy. Analysing this medical syncretism clearly demonstrates that even if comprehension of health messages is accurate, the way in which people interpret these messages may not be. Disentangling syncretic processes permits us to understand the dynamics of how information is processed by the recipients, and provides orientations for health promoters for adapting messages to the local context.

Introduction

“The perception of malaria on the part of the population is one of the most critical factors in determining if the disease, be it malaria or not, will be treated effectively” (WHO, 1993, p. 15). The emphasis on people's perspectives is in the line of the current WHO strategy on early identification and prompt treatment of malaria. It has been reported from different regions throughout Africa that community understanding of malaria may diverge considerably from the biomedical model. A number of studies, mainly in rural areas, called attention to two critical findings. Firstly, significant parts of the study populations were not aware of the malaria–mosquito link (e.g. Agyepong, 1992; Aikins et al., 1993; Mwenesi, Harpham, & Snow, 1995; Ongore, Kamunvi, Knight, & Minawa, 1989); and secondly, people often did not associate severe manifestations of malaria—convulsions, anaemia and splenomegaly—with the disease. This is well documented in the case of convulsions, which in some areas have been found to be attributed to “supernatural” agents and require the consultation of a traditional healer (e.g. Bonnet, 1986; Makemba et al., 1996; Mwenesi, 1993; Winch et al., 1996).

These findings have received growing attention among health professionals. But while they are increasingly taken into account in the development of health messages, little seems to be documented about what happens once information on malaria has been transmitted to the local population. It is clear that people process new information on the basis of what they already know. But does this new information simply coexist with pre-existing concepts, or merge with them? And when concepts merge, how is the new knowledge incorporated into people's illness models? And finally, does the resulting knowledge in a particular community, if it deviates from the original meaning of the messages, eventually lead to practices that are different from what health promoters intended to encourage?

To investigate these questions, we carried out a study in Ifakara, a community in Southeastern Tanzania which has a long history of intensive health information campaigns. The focus of this article is on analysing patterns of information about malaria and their relevance for treatment behaviour. We have called the process of developing these patterns “medical syncretism.” “Syncretism,” defined as “the combination or blending of elements from different religious (or cultural) traditions” (Seymour-Smith, 1993, p. 274), is a term usually applied to religious phenomena. Nevertheless, it is also suitable to describe the blending of biomedical with indigenous concepts. Our intention is to illustrate that the analysis of medical syncretisms not only contributes to a more detailed understanding of local perception of malaria but also permits us to understand the logic which underlies health- and treatment-seeking behaviour, and consequently to design health promotion activities more effectively.