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Itinéraires Thérapeutiques Et Représentations De La Santé À L’Enfance Chez Les Nzèbi Du Gabon Amélie Blanche Ngombo Lepopa

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Itinéraires Thérapeutiques Et Représentations De La Santé À L’Enfance Chez Les Nzèbi Du Gabon Amélie Blanche Ngombo Lepopa Itinéraires thérapeutiques et représentations de la santé à l’enfance chez les Nzèbi du Gabon Amélie Blanche Ngombo Lepopa To cite this version: Amélie Blanche Ngombo Lepopa. Itinéraires thérapeutiques et représentations de la santé à l’enfance chez les Nzèbi du Gabon. Sociologie. Université de Lorraine, 2016. Français. NNT : 2016LORR0245. tel-01752397 HAL Id: tel-01752397 https://hal.univ-lorraine.fr/tel-01752397 Submitted on 21 Jan 2020 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. AVERTISSEMENT Ce document est le fruit d'un long travail approuvé par le jury de soutenance et mis à disposition de l'ensemble de la communauté universitaire élargie. Il est soumis à la propriété intellectuelle de l'auteur. Ceci implique une obligation de citation et de référencement lors de l’utilisation de ce document. D'autre part, toute contrefaçon, plagiat, reproduction illicite encourt une poursuite pénale. Contact : [email protected] LIENS Code de la Propriété Intellectuelle. articles L 122. 4 Code de la Propriété Intellectuelle. articles L 335.2- L 335.10 http://www.cfcopies.com/V2/leg/leg_droi.php http://www.culture.gouv.fr/culture/infos-pratiques/droits/protection.htm UNIVERSITE DE LORRAINE École doctorale Fernand-Braudel 2L2S – Laboratoire Lorrain de Sciences Sociales – EA3478 (Sociologie, Ethnologie, Art, Philosophie) Itinéraires thérapeutiques et représentations de la santé à l’enfance chez les Nzèbi du Gabon Thèse pour le Doctorat en Ethnologie Présentée et soutenue par Ngombo Lepopa Amélie Blanche Virginie VINEL, Professeure des universités, Université de Franche-Comté, directrice Florent SCHEPENS, Professeur de Sociologie, Université Franche -Comté, rapporteur Doris BONNET, Directrice de Recherche Emérite, IRD, examinatrice Marie-Pierre JULIEN, Maitre de conférences, Université de Lorraine, examinatrice Novembre 2016 1 DEDICACE Nous dédions ce travail à tous nos parents, qui de près ou de loin, nous ont toujours apportés leur soutien moral, matériel et financier pour la réalisation de ce travail. 2 REMERCIEMENT Nos remerciements vont à l’endroit de notre directrice de thèse, Madame VIRGINIE VINEL, sans qui ce travail, n’aurait jamais vu le jour. Elle a suscité notre esprit à la recherche, nous a inculqué la rigueur scientifique. Aussi, nous la remercions pour sa patience et sa disponibilité. Nous remercions également, tout le corps professoral de l’université de Lorraine, grâce à qui les enseignements reçus lors des séminaires et ateliers de formations de l’école doctorale tout au long de ces années, nous ont été d’une grande utilité. Nous ne saurions terminer cette rubrique de remerciement sans les mentionner, nos informateurs sans qui ce travail aurait manqué de consistance originale. Merci, aussi à tous nos amis. 3 TABLE DES MATIERES DEDICACE……………………………………………………………………………………2 REMERCIEMENT…………………………………………………………………………….3 INTRODUCTION…………………………………………………………………………..…9 APPROCHE THEORIQUE.………………………….……..……………………………..16 Objet d’étude …………………………………………………………………………………16 Champs d’étude et état de l’art………………………………………………………….........25 Problématique…………………………………………………………………………..…….42 Hypothèses…………………………………………………………………………………....44 APPROCHE METHODOLOGIQUE……….…………………………….....…….………45 Limite du terrain ……………………………………………………………………………...45 Les centres de santé maternels et infantiles observés……………………………………..….46 Pré-enquête ……………………………………………………………………………….......49 Méthode d’analyse ……………………………………………………………………….......51 Difficultés rencontrées ……………………………………………………………………….52 PPREMIERE PARTIE : Présentation du contexte culturel, social, et économique du traitement de la maladie infantile chez les Nzebi au GABON……………………...…….55 Chapitre I : Présentation de la société nzèbi…………………………………………….....….56 a : Origine mythique…………………………………………………………………………..56 b : Origine migratoire...…………………………………………………………………….....62 c : Les différentes relations de parenté ou d’alliance………………………………………...66 d : Représentations de l’univers magique nzèbi………………………………………………71 e : Les sociétés secrètes………………………………………………………………….........73 4 Chapitre II : Contexte social, économique et médical contemporain…………………….…..77 a : Situation générale actuelle…………………………………………………………….…..77 b : Structure de la population…………………………………………………………………79 c : Contexte économique des soins……………………………………..…………………….81 1 : Prise en charge de la maladie soignée dans une structure sanitaire…………………..…...81 d : Les cadres de soins biomédicaux au Gabon……………………………………….……...89 e : Le type de structures de soins qui existent au Gabon…………………………….……….91 f : Les structures de soins existantes en zone rurale…………………………....…………….95 Chapitre III : Contexte thérapeutiques des soins de guérison……………………………….102 A : Les soins biomédicaux…………………………………………………………………..102 a : Structures sanitaires : Centre de santé maternel et infantile et Centre médical……….....104 1 : L’accueil…………………………………………………………………………………104 2 : Le dispensaire……………………………………………………………………………107 3 : Le service de santé maternelle et infantile (SMI)…………..............................................108 4 : La maternité…………………………………………………...........................................117 5 : Le laboratoire…………………………………………………………………………….118 6 : La pharmacie…………………………………………………..........................................120 7 : La fréquentation des structures sanitaires……………………..........................................124 B : Les soins locaux ou traditionnels…………………………………..................................127 a : La structure de soin traditionnel…………………………………………………………………..127 1 : Accueil…………………………………………………………………………………...128 2 : Approvisionnement……………………………………………………………………....129 5 3 : Prise en charge du soin local ou traditionnel…………………….....................................130 4 : Fréquentation des structures de soins traditionnels……………………….……………...132 DEUXIEME PARTIE : Représentations de l’enfant et des maladies infantiles….….136 Chapitre I : Représentations de la maladie et de l’enfant……………………………………137 a : L'enfant…………………………………………………………………………………...137 b : Typologie des enfants……………………………………………………………………140 c : Rituel de sortie de la réclusion ou d'intégration de l'enfant……………………………...143 d : Statut local de l’enfant dans la communauté nzèbi ……………………………………...149 e : Statut de l’enfant sur le plan légal………………………………………………………..152 Chapitre II : Désignation et description des maladies infantiles……………………….......154 1 : Identification et définition…………………………………………………………….….154 a : Définition selon les gens ordinaires……………………………………………………...155 b : La maladie définie par les tradipraticiens………………………………………………..158 c : Définition de la maladie selon les agents de santé……………………………………….160 2 : Différentes nosographies………………………………………………………………....166 a : Nosographie domestique…………………………………………………………………166 b : Nosographie Savante………………………………………………………………….….172 Chapitre III : Représentation des causes de la maladie infantile……………………………174 1 : Les causes énoncées par les populations Nzèbi ordinaires……………………………..174 2 : Les causes se rapportant à la tradition nzèbi……………………………………………..181 a : Interprétations liées aux interdits alimentaires…………………………………………...181 b : Interprétations liées aux interdits comportementaux…………………………………….183 3 : Les causes énoncées par les agents de santé………………………..................................187 4 : Les différentes catégories de maladies…………………………………………………...191 6 a : Maladie simple…………………………………………………………………………….191 b : Maladie complexe………………………………………………………………………..192 5 : Concordance et divergences des catégorisations ordinaires, traditionnelles et des professionnels de santé………………………………………………………………………197 6 : Méconnaissance et exclusion des espaces de soins……………………………………...199 TROISIEME PARTIE : Modèles Thérapeutiques pour le traitement des maladies des enfants chez les Nzèbi…………………………………………………………….…..…….203 Chapitre I : Mode de reconnaissance de la maladie ou Diagnostic………………………….204 a : Les facteurs de reconnaissance de la maladie par les parents…………………………....204 b : Etape du diagnostic biomédical………………………………………………...………..206 c : Etape de reconnaissance de la maladie par les tradipraticiens…………………………...210 d : Regard des professionnels de santé sur les parents………………………………………212 Chapitre II : Itinéraires thérapeutiques des maladies infantiles…………………………….216 A : Les soins domestiques en automédication………………………………………….…...217 a : Situation observables en automédication ……………………………………..................224 b : À l’aide des plantes, des plantes et des animaux………………………………...............231 c : À l’aide d’autres éléments……………………………………………………………….232 d : Usage des produits pharmaceutiques utilisés en automédication………………………..233 B : L’itinéraire emprunté en cas d’échec des soins domestiques…………………………....236 Chapitre III : Intervenants thérapeutiques ou guérisseurs……………………………….…..238 a : Transmissions des savoirs thérapeutiques populaires…………………………………...241 b : Savoirs biomédicaux ordinaires………………………………………………………….248 QUATRIEME PARTIE : Les différents traitements………………………………..…...250 Chapitre 1 : La représentation de la guérison chez les Nzèbi…………………………..…....251
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