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Local Maasai Perceptions of the Common Health Landscape in Narok South

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Local Maasai Perceptions of the Common Health Landscape in Narok South A COLD WIND: LOCAL MAASAI PERCEPTIONS OF THE COMMON HEALTH LANDSCAPE IN NAROK SOUTH by BRAD A. CASUCCI Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Anthropology CASE WESTERN RESERVE UNIVERSITY August 2015 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the dissertation of Brad A. Casucci candidate for the degree of Doctor of Philosophy* Committee Chair Atwood D. Gaines, MPH, PhD Committee Member Lee Hoffer, MPE, PhD Committee Member Vanessa Hildebrand, PhD Committee Member Jonathan Sadowsky, PhD Date of Defense April 29, 2015 *We also certify that written approval has been obtained for any proprietary material contained therein. Copyright © 2015 by Brad A. Casucci All rights reserved Table of Contents List of Tables iv Figures v Maps vi Acknowledgements vii Glossary xi Abstract xiv 1. “I have no idea!”: The Maasai and the Popular Health Landscape 1 a. The Cultural Landscape of Health 7 b. The Importance of Common Sense and the Popular Sector of Health 9 c. From Trachoma to the Landscape of Popular Health Etiology 12 d. Setting and Settling In 15 i. Research Site 17 ii. Challenges and Community 20 2. The Maasai and Health Research in Africa 30 a. Maasai in the Western and African Gaze from the Colonial Period 31 b. Introducing the Purko Maasai of the Siana Valley 36 c. The Cosmology of the Maasai 43 i. Enkanyit and the Age Grade System 46 ii. Enkai, Divine Providence, and the Unknown 49 d. Health and Illness among the Maasai 51 i. Laibon: Divination and Curse 56 ii. Olchaani: Maasai Herbalism 56 e. Social Science Studies of the Popular Health Sector 58 i. The Evolving Study of Popular Etiology 59 ii. Contemporary Studies of Popular Etiology 62 f. The Importance of Etiology, Rationality, and Hygiene in Africa 63 i. The Study of Rationality in Africa 66 ii. The Study of Hygiene in Africa 69 i 3. Designing and Applying Research in Maasailand 73 a. Theoretical Assumptions 73 b. Cultural Consensus Theory and Free 74 c. Fieldwork Overview 76 i. Fieldwork with Family 77 ii. Translating Research 79 d. Developing strategy in Losho in Consideration of Initial Findings 80 i. Designing Interviews: Questions and Strategy 81 1. Defining the Health Domain 81 2. Contrasting the Health Domain 82 3. Re-Defining the Health Domain 85 4. Contrasting with Biomedicine 86 e. Methodological Challenges 88 4. Emoyano: Common and Significant Illnesses among the Maasai 92 a. Introduction to General Results 92 b. Tables and Their Significance 93 i. Common or Significant Health Problem Listing 94 ii. Symptoms 97 iii. Causes 98 iv. Treatments 103 v. General Health Maintenance or Illness Prevention 106 vi. Illness Specific Prevention 107 vii. Interview Series 2-4 113 5. “Only God Can Know”: Mystery, Ambivalence, and Orthopraxis 120 a. Emerging Issues and Questions 121 b. Methods of Analysis 123 c. Nosography and Etiology of Common Illnesses 128 i. Nosography 129 d. Siana Valley Health Landscape 136 i. Ambivalence in Maasai Notions of Illness Prevention 142 e. Prevention and Avoidance: Hygiene Where Illness ‘Just Comes’ 148 f. Locus of Responsibility 157 6. Cosmology and Causal Attribution: Respect and Reality 163 a. Further Research 167 b. Significance of Research 169 ii c. Priorities and Relevance 173 d. Post Script The Treacheries of Text 174 7. Appendix 175 a. Research Guides 175 b. Demographic Breakdown of Interviews Informing the Frequency Tables 180 c. Outline of Fieldwork and Fieldwork Design Process 189 8. Bibliography 198 iii List of Tables 1. Percentage of Interviews Listing Each Illness 94 2. Oltikana Cause Listing Frequency 99 3. Olkirobi Cause Listing Frequency 100 4. Nang’ida Cause Listing Frequency 100 5. Lemunya/ Pneumunia Cause Listing Frequency 101 6. Taifoid/ Typhoid Cause Listing Frequency 102 7. General Maintenance/ Prevention Listing Frequency 106 8. Oltikana Prevention Listing Frequency 108 9. Olkirobi Prevention Listing Frequency 109 10. Nang’ida Prevention Listing Frequency 110 11. Lemunya/ Pneumonia Prevention Listing Frequency 111 12. Taifoid/ Typhoid Prevention Listing Frequency 111 13. Listed Causes and Category 144 14. Total Interviews and Participants 180 15. Age Range/Gender (not counting the 6 disqualified participants) 180 16. Participants per Initial 27 Interviews 181 17. Surrounding Communities Age Range/Gender 182 18. Oltikana Symptom Listing Frequency 183 19. Olkirobi Symptom Listing Frequency 184 20. Nang’ida Symptom Listing Frequency 185 21. Lemunya/ Pneumonia Symptom Listing Frequency 186 22. Taifoid/ Typhoid Symptom Listing Frequency 187 23. Fieldwork Research Stages Timeline 188 iv Figures 1. Popular Sector and Cosmology 44 2. Maasai Etiology 137 v Maps 1. Map of Kenya xvi 2. Map of Maasailand xvii 3. Map of Narok South xviii 4. Map of Losho 193 5. Map of Olkiloriti 194 6. Map of Embiti 195 7. Map of Megwara 196 8. Map of Oloolaimutia 197 vi Acknowledgements This dissertation has been a terrific ordeal. One that I could never have accomplished without the help of many people, only a few of whom I can name here. I owe them all an enormous debt of gratitude. I would like to begin by thanking my dissertation committee, Dr. Atwood Gaines, Dr. Lee Hoffer, Dr. Vanessa Hildebrand, and Dr. Jonathan Sadowsky. Their guidance and feedback were indispensable. I would also like to thank former committee members, Dr. Charlotte Ikels and Dr. T.S. Harvey for guidance in the development of my dissertation prospectus. I would like to particularly thank Dr. Harvey. His mentorship, honesty, and unflagging encouragement kept me going over the many rough patches. I would not be where I am today without his concern and astute advice. He introduced me to Professor Lea Pellett, and the Maasai American Organization, and first suggested that I work with the Maasai people. Without his help I would never have received the Maasai American Organization Dissertation Award. I will always be in his debt. In Maasailand, I would like to thank Daktari James, Daktari Henry, Pharmacy Tech Tololo, for being very good friends. Daktari James put himself in real danger, defying local political bosses by openly being my friend, and I will never forget him and our friendship. Henry and Tololo welcomed me to their home like a brother, and helped me keep my sanity amid all of the challenges of fieldwork. Tuko pamoja! To the lady teachers of Megwara, you also counselled me like older sisters, and made me feel at vii home. Nariku welcomed my children with love, and I will never forget that. Simon, Boniface, Ranger Mike, and Ong’udi, you made us welcome in Olosirua (a place of wonderful people!), introduced us to your families (and homes) and showed us real friendship. Chairman, you treated me as an agemate and I am proud to be your friend. I must give a special acknowledgment to Nashipae. Nakerrai! She also put herself in danger for us, and became my daughter’s dearest friend. Your daughter misses you! Your family, Tim and his wife and children, your son Lemaiyan, your twin Kirui, and all your other brothers and sisters redeemed our faith in humanity and we are proud to call you our friends. The staff of the Case Western Reserve University Anthropology Department, Kathleen Dowdell and Barbara Reebel, helped me negotiate the bureaucratic wasteland of graduate school. Barb has particularly been a good friend even before I met her in person. I had emailed her about coming to CWRU and mentioned a health condition under which my wife was suffering. Her offer to pray for my wife touched me and will never be forgotten. She and I have finished school together, and her encouragement and camaraderie were a highlight of my time in the department. I would also like to thank my colleagues for their support and advice, Dr. Sarah Rubin, Dr. Joseph Galanek, Janelle Highland, Dr. David Kaawa-Mafigiri, Dr. Shyh-wei Yang, Dr. Jon Wolseth, Dr. Ben Willett, Dr. Gudrun Willett, Dr. Colleen Walsh, and Dr. Chad Uran. In particular, I would like to thank Dr. Rubin and Dr. Galanek. Both of them continue to provide me with extensive mentoring and advice. Sarah has become a part viii of our family and has helped us with her friendship throughout my time in graduate school. Joe has also been a reliable friend and drinking buddy from the start. It doesn’t get any better than that. Dr. Kaawa-Mafigiri, and his family here and in Uganda, have become a part of our family as well. Doreen Bamanya, his wife, Barbara Bamanya, her sister, his daughters Daniella (my son Frankie’s oldest friend) and Diana, his son David Jr. (my godson), as well as his and his wife’s mothers, have especially become dear to us. In Kenya, I have too many people to thank, and I could never name them all. First I would like to thank Geoffrey Pembe Kombe. His friendship and advice have always been blessings. In addition to being my very close friend for the last 18 years, he is a member of a wonderful family that made my family feel at home in Ganze. His wife, Mamake Amos, and their children, Amos, Lydia, Moses, and Baraka, and all of the cousins welcomed us with open arms. Geoffrey’s brother, Dickson Kombe, opened his home to us in one of his many acts of amazing generosity. His children were also a pleasure. I would like to thank all the people of the compound in Ganze, especially the eldest and youngest brothers, Edward and Samuel, respectively, Babake Ray and Mamake Ray, Rama and all the rest. I would like to thank the Fulbright organization for the Fulbright Hayes Doctoral Dissertation Research Award.
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