ILLNESS AND CURING IN BEREKUM, GHANA KOFI BISMARK EFFAH B.A. (HONS.), UNIVERSITY OF GHANA, LEGON, 1986 THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in the ,Department of SOCIOLOGY AND ANTHROPOLOGY 0 KOFI BISMARK EFFAH 1991 SIMON FRASER UNIVERSITY August 1991 All rights reserved. This work may not be reproduced in whole or in part, by photocopy or other means, without permission of the author. APPROVAL Name: KOFI BISMARK EFFAH Degree: MASTER OF ARTS Title of thesis: ILLNESS AND CURING IN BEREKUM, GHANA Examining Committee: Chair: DR. J. 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Title of Thesis/Project/Extended Essay Illness and Curing in Berekum, Ghana Author: - I ' (s iYgnature) Kofi Bismark Effah (name) July 30, 1991 (date) ABSTRACT The thesis examines the ways in which illness is conceived, explained and confronted in Berekum, Ghana. Starting from the assumption that illness experience is socially and culturally constructed, the explanatory models employed by laypersons and healing practitioners are examined. Patterns of health-seeking behaviour among patients are identified and analysed; and the various treatment procedures common in the community are described in detail. The data upon which the thesis is based were gathered in two main ways; participant observation as a native of Berekum and as a fieldwork researcher in the community for four months in early 1990; and an interview survey of seventy-eight professional healers and laypersons in Berekum carried out during the fieldwork period. Participant observation centred mainly on situational analyses, both current and retrospective, of treatment sessions and illness episodes. Survey interviews elicited information on local conceptions and explanations of illness, as well as on factors underlying informants7 health-seeking behaviour. In general the investigation serves to fill some serious gaps in the current literature on illness in Ghana, which tends to deal mainly with etiological explanations in a normative fashion. More specifically, it documents a preference for naturalistic causal explanations of illness on the part of healers and laypersons in Berekum, despite the recognition given to spiritual causation in some situations. It is found that scientific or western medicine is typically the first choice for those who are ill. This choice is influenced not only by the, type of etiological explanation espoused, but by a number of interacting factors such as the type of illness itself, the quality and cost of treatment and the extent of state intervention in various healing practices. Finally, the thesis suggests ways in which fruitful co-operation might be achieved between indigenous and scientific medicine in Ghanaian communities. DEDICATION To Janet for her support TABLE OF CONTENTS Approval ...............................................................................................................................ii ... ABSTRACT ..........................................................................................................................111 Dedication ............................................................................................................................. / I . INTRODUCTION .........................................................................................................1 RESEARCH PROBLEM ..............................................................................................1 RESEARCH QUESTIONS ..........................................................................................3 REVIEW OF RELEVANT LITERATURE .................................................................5 THEORETICAL ORIENTATIONS ............................................................................17 METHODOLOGY ......................................................................................................21 I1 . THE SOCIO-CULTURAL CONTEXT OF ILLNESS IN BEREKUM .................... 26 INTRODUCTION .......................................................................................................26 SOCIAL ORGANIZATION .......................................................................................27 MARRIAGE ...............................................................................................................28 THE POLITY ...........................................................................................................30 THE ECONOMY ......................................................................................................31 BEREKUM: A TRANSIT CENTRE ........................................................................ 33 RELIGION AND FESTIVALS .................................................................................34 I11 . LAYPERSONS' EXPLANATIONS OF ILLNESS .............. 1.................................... 39 INTRODUCTION ....................................................................................................... 39 EXPLANATIONS OF ILLNESSES IN GENERAL ................................................ 41 EXPLANATIONS OF SPECIFIC ILLNESSES ....................................................... 44 CONSENSUSILACK OF CONSENSUS ABOUT ETIOLOGICAL EXPLANATIONS OF ILLNESS ..................................................................... 55 INFORMANTS' ILLNESS EXPERIENCE ...............................................................56 IV . HEALERS' EXPLANATIONS OF ILLNESS ..........................................................60 INTRODUCTION .......................................................................................................60 EXPLANATIONS OF ILLNESSES IN GENERAL ................................................ 62 EXPLANATIONS OF SPECIFIC ILLNESSES ..................................................... 69 EMPHASIS ON SPIRITUALISTIC/NATURALISTICEXPLANATIONS ................ 69 . CONSENSUSILACK OF CONSENSUS ABOUT ETIOLOGICAL EXPLANATIONS OF ILLNESS ..................................................................... 75 V . TREATMENT OF ILLNESS IN BEREKUM .......................................................... 81 INTRODUCTION .......................................................................................................81 SCIENTIFIC MEDICAL TREATMENT ...................................................................82 HERBAL TREATMENT ...........................................................................................86 ADUTO: TWO CONTRASTING TREATMENT PROCEDURES ............................ 90 FAITH HEALING ..................................................................................................103 FAITH HEALING IN OSSAMADI CHURCH ......................................................105 CHOOSING AND EVALUATING THERAPIES IN BEREKUM ......................... 112 VI . CONFRONTING A NEW ILLNESS: THE CASE OF AIDS ............................. 121 INTRODUCTION .....................................................................................................121 PATIENTS' KNOWLEDGE ABOUT AIDS ........................................................... 123 HEALERS' KNOWLEDGE ABOUT AIDS ....................................1....................... 130 NURSES' KNOWLEDGE ABOUT AIDS .............................................................. 135 OTHER INFORMANTS' KNOWLEDGE ABOUT AIDS ...................................... 137 VII . SUMMARY AND CONCLUSION ..........................................................................141 CONCLUSION .........................................................................................................153 APPENDIX A ..........................................,. ........................................................................ 156 FREQUENCY TABLES ..........................................................................................156 APPENDIX B ..................................................................................................................207 INTERVIEW SCHEDULE ......................................................................................207 vii APPENDIX C ..................................................................................................................22 2 MAP OF GHANA ..................................................................................................222 BIBLIOGRAPHY ..............................................................................................................223 viii CHAPTER I INTRODUCTION RESEARCH PROBLEM The thesis has as its central aim the investigation and explication of the ways in which people conceive, explain and confront illness in Berekum, an interior Ghanaian community of about 25,000 people. Medical sociologists try to understand how Ghanaians respond to afflictions and misfortunes by emphasizing the etiological