The Management of Illness in an East African Society : a Study of Choice and Constraint in Health Care Among the Pokot

THE MANAGEMENT OF ILLNESS IN AN EAST AFRICAN SOCIETY : A STUDY OF CHOICE AND CONSTRAINT IN HEALTH CARE AMONG THE POKOT DAVID C.jjT/AMWAYA FITZWILLIAM COLLEGE A dissertation submitted to the Faculty of Archaeology and Anthropology, Cambridge in partial fulfilment of the degree of Doctor of Philosophy. November 1932. umv ERSITYI OF NAIROBI LIBRARY Preface I collected the substantive material for this dissertation during fieldwork among Pokot which lasted for a period of fifteen months. I have also made reference to both primary and secondary sources relating to the research problem all of which are listed in the bibliography. I have analyzed this material within the framework of the sociocultural orientation in the sub-discipline ot medical anthropology. This is not just an ethnographic account of the management cr illness among Pokot because I also discuss a number of theoretical issues regarding their responses to Western medicine and also the process of health development. >i I have also made reference to some of the implications of the research findings for the provision of health seivices to Pokot and similar societies. V Although various people have contributed in different ways (mentioned in the acknowledgements) to this research, this dissertation is the result of my own work and includes nothing which is the outcome \ of work done in collaboration. It does not exceed 00,000 words. \ t David Nyamwciya I 0 r-\ m f r - 1 0/ 3 6 E 4 0 SUDAN „.<■**., t. .***<. a |i k. >.4»' ■♦ • " '7 / M ANDER& i / i ♦ 01 + O -I ♦ ♦ i + i f X) ♦ m ♦ •0 4 c f f CD \ r~ + f GARISSA o «■ i \ X KtUFI T A ! T A Boundaries:— INDIAN -x . / w AS Internotionol..............+-+-f.+ •x. t0V MOMBASA V ' K A A L E V } Provincial................... .............. / OCEAN D istrict................................... V v / */U' Study a re a ..........................jt f jf t t I > 50 toe ■50 200 250 300 *i't?"*ttr€s i < ( 50 too • 5 0 2C0N» let t e r ___ 1_ i _______ r m a p 3 HEALTH FACILITIES QPEfiftTlMG \M P 0 KO} IS8I * A i r\ Vu. / \ { V/ . ') /Disp ‘^NA'UYAPONG \ N \ \ \ / ' \ \ \ Boundoriesr- \ .KAURIONG V Internationol. f District......... .............. < \ KASEI Hospital.............. h . f Q < Health Centre ... HC. Dispensary.......... Diop. < Towns................. ... a O 3 f KONYAO t NASOLOTV i AMOLEM. Disp. V-v f Disp. i KOD1CH © P.TOYO • ORWA Dl&fi • CHEPNYAL r HP t « KACHELIBA CHEPKOPECH H® S:G° ^ r p * H* ORTUM r Disp s> LOMUT ,KANYARUS o -Disp / \ \ D'S£cHEPARERiA •• KANYARV/AT . I:\SP. CHESOGON t,/ i >. g KAPENGURIA \ I rO/)s }0,s£ morkwijit o 0 KA!B!CH3iCH/' i S 10 I "V. —i--- l _ _ i HC s QJ Kilometre! < , •/KAPSA!T i Acknowledgements I would like to express my gratitude to a number of institutions and individuals for the assistance they accorded me during various stages of my research and writing up. Financial grants from various institutions enabled me to cover all my tuition, subsistence, fieldwork and travel expenses. I wish to express my appreciation for such support'from the University of Nairobi, Ford Foundation, the Smuts Fund, the Wyse Fund, Fitzwilliam College and the Nyamwc ya family. A number of people have assisted me in different ways during the last three years. I wish to thank in a special way my supervisor, Dr. Malcolm Ruel for his critical guidance throughout my fieldwork and writing up and also for letting me use a desk in his office. As my guru he introduced me to anthropology which has come to occupy a special place in my life. Various other members of the Faculty have.encouraged me in ways too numerous to be mentioned. Dr.David Kerridge, Tutor for Graduate Students at Fitzwilliam College has wholeheartedly assisted me in coping with a number of non- academic matters during my stay in Cambridge. I cannot forget to thank all the members of the Institute of African Studies, University of Nairobi for their assistance during my fieldwork. I mention especially the Director, Dr. Benjamin Kipkorir for his commitment to my studies. Many thanks go to Norman Scotney, David Gmambia, Ayuka Oendo and Mrs. Violet Kimani for the interest they have shown in my research and for the time they spared to discuss witn me various issues relating to health development. Without the cooperation of the Pokot people, this dissertation vc-ui not have been written. To all of them I say src nyoman. Seme cf them made special contributions to my study and I thank with special warmth the families of Parklea, Dowan, Tomkou, Jenet Loyongo, Angar, Loturianyang, R. Daimoi, Lochomorok and Lukchu. The maendeleo ya wanawake deserve special mention as do the thirty households who formed the core sample at Chepareria. Some Pokot young people spent a lot of time teaching me their language - Roda Loyatum, Daniel Loyatum, Abednego Kachongil and Peter Rotino. Daniel and Abednego need special mention for introducing me to all the people in Chepareria. Mrs. Diane Quarrie deserves mention for typing the manuscript. Last, but not least, I say mbuya mono goko to my wife Trufena Bosibori for enduring my absence from our home for many months, to her this dissertation is dedicated. TABLE OF CONTENTS Pace Chapter One : Introduction 1 1.1 Origins and Objectives 1.2 Methodology 2 1.3 Difficulties and Justification 4 '1.4 The Research Problem 7 1.5 Literature Review 9 Chapter Two : The Research Area Background Information 19 2.1 The Land and the People 19 2.2 Social and Political Organization 23 2.3 The Economy of Agricultural Pokot 29 2.4 Education and Religion 34 2.5 Western Health Services 41 " 2.6 The Research Site 46 ! Chapter Three : Pokot Traditional Concepts and Practices relating to Health £ Q 7 , —3-1 pokot Concepts of Health and Illness 51 3^.2 Treatment and Prevention 66 3.3 Roles in the Management of Illness 16 -"3^4. 'Indigenous Medical Practices 7h Chapter Four :_Intra-Socletal Variation in Illness Behaviour 90 4.1, General Arguments 90 4.2 Episodes of Illness Illustrating Variations in the Management of Illness 98 >4.3 Case 10 : Infantile Diarrhoea in Chepareria 122 y4.4 ;The View of Illness and How it Facilitates Variation in the Health-Seeking Process 12S i Chapter Five : The Relationship Between Traditional and Western Medicine » 138 5.1 General Discussion \ 138 5.2 The Cognitive Response to Western Medicine 141 5.3 Physical Organization 149 5.4 Pokot Behaviour in Relation to Western Medicine: Curative Services 152 5.5 Pokot Behaviour in Relation to Western Medicine: Prevention 159 \5.6 Categories of Pokot and How they Relate to Western Medicine 170 5.7 How Many Systems? 188 Pacre Chapter Six : Issues in Rural Health Development 194 6.1 Indigenous Beliefs and Practices and Health Development 196 6.2 Economic Development and Health 200 6.3 Policies and Approaches of Western Health Services as Constraints to Health Development 204 6.4 Indigenous Resources in Health Development 215 Chapter Seven ; Summary and Conclusions 235 Appendix I : Medicinal Plants commonly used in Chepareria 250 Appendix II : Summary of Major Episodes of Illness 253 Bibliography 255 Tables and Figures Chapter Two Table 1 : Modern Health Facilities in West Pokot 44 Table 2 : Modern Western-trained Health Workers in West Pokot 44 Table 3 : Traditional Medical Practitioners Resident in Chepareria 1981 47 Chapter Three Table 1 : Diseases and their Biological Causation 54 Table 2 : Pokot Indigenous Healers 75 1 Figure 1 : Causation on the Biological Plane 60 Figure 2 : Causation on the Interpersonal Plane 60 . Figure 3 : Causation on the Spiritual Plane 61 Chapter Four » Table 1 : Therapy used per Region 112 ( Table 2 : Distance travelled to Dispensary 113 t S Figure 1 : Factors influencing Therapeutic Decisions 135 Chapter Five Table 1 Spheres of Intervention by Traditional and Western Practitioners 143 Table 2 Pokot Classification of Conditions Requiring Medical Intervention 146 Chapter Six Table 1 Top Ten Causes of Morbidity in West Pokot District 203 Table 2 : Medical Personnel (1980) 208 Table 3 : Health Facility per Population 211 Table 4 : Health Centres and Dispensaries in West Pokot (1980) Map 1 : Kenya Showing Districts (i) Map 2 : West Pokot District (ii) Map 3 : Health Facilities Operating in West Pokot 1981 (iii) Plates ifletutkd in iRii Plate 1 : Jenet (iv) Plate 2 : Patients helping Jenet with farmwork (iv) Plate 3 : Child wearing tumurowon 18A Plate 4 : Herbal medicines at Chepareria Market 18A Plate 5 : A herbalist examining a patient 48A Plate 6 : A stage in the performance of Kisoyonet 48A Plate 7 : A stage in the performance of Putat 89A Plate 8 : A stage in the performance of Moi Chepkompis 89A Plate 9 : Mothers and children waiting to see a chepsaktian 137A Plate 10: Patients waiting their turn at Chepareria Dispensary 137A Plate 11: Maendeleo women dancing on Madaraka Day 193A Plate 12: A child's feeding bottles on the ground 193A Plate 13: Pokot women walking to Kapenguria Hospital 234A Platfe 14: The District Hospital at Kapenguria 234A Summary of Dissertation The Management of Illness in an East African Society : A Study of Choice and Constraint in Health Care among the Pokot David C. Nyamwaya This dissertation deals with the way Pokot respond to illness given their traditional forms of therapy and Western health services. The Pokot view of the causation of illness is discussed and their notions regarding the prevention and treatment of illness outlined. Various roles, both lay and specialist, in their health-seeking process are discussed. In spite of concepts of health and illness shared by members of the society, it is shown that Pokot responses to specific illness are not fixed by custom but vary over time and space.

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