Sjaak van der Geest

Respect and reciprocity: Care of elderly people in rural Ghana

This article deals with ideas and practices ofcare of elderly people in a rural Kwahucommunity of Ghana. It is part of a largerproject on social and cultural meanings ofgrowing old. Four questions are addressed: Whatkind of care do old people receive? Whoprovides that care? On what basis do peoplecare for the old or do they feel obliged to doso? And finally, what are the changes takingplace in the field of care for old people?Concepts of respect and reciprocity take acentral position in accounts of care and lackof care. The article is based onanthropological fieldwork, mainly conversationswith 35 elderly people and observations intheir daily lives.This article deals with ideas and practices ofcare of elderly people in a rural Kwahucommunity of Ghana. It is part of a largerproject on social and cultural meanings ofgrowing old. Four questions are addressed: Whatkind of care do old people receive? Whoprovides that care? On what basis do peoplecare for the old or do they feel obliged to doso? And finally, what are the changes takingplace in the field of care for old people?Concepts of respect and reciprocity take acentral position in accounts of care and lackof care. The article is based onanthropological fieldwork, mainly conversationswith 35 elderly people and observations intheir daily lives.

Is there a role for traditional medicine in basic health services in Africa ? A plea for a community perspective

Traditional medicine in Africa is contrasted with biomedicine. Most traditional medical theories have a social and religious character and emphasize prevention and holistic features. Traditional medical practices are usually characterized by the healers personal involvement, by secrecy and a reward system. Biomedical theory and practice show an almost opposite picture: asocial, irreligious, curative and organ‐directed; professional deatchment, public knowledge and ‐ until recently ‐ ‘free of charge’. It is suggested that local communities do not expect that basic health care will improve when traditional healers become integrated into the service. They ask instead for improvement of basic health care itself: more services with better access, more dedication and respect from doctors and nurses, more medicines and personnel. Fieldwork needs to be done at the community level to arrive at a better understanding and assessment of the communitys opinion concerning a possible role of traditional medicine in basic health care.

The fake patient: a research experiment in a Ghanaian hospital.

The authors report on a research experiment involving the admission of one of them as a pseudo-patient in a rural Ghanaian hospital. The experiment was meant to assess the feasibility of carrying out unobtrusive participant observation in a hospital setting. Practical, methodological and ethical implications are discussed.

Pharmaceuticals in the Third World: The local perspective

This introduction is a plea in favour of social field research into the local context of the distribution and use of pharmaceuticals in developing countries. This local perspective is conspicuously absent in studies and policy recommendations concerning drug use in the Third World.

Marketplace conversations in Cameroon: How and why popular medical knowledge comes into being

The author argues that buyers and sellers of Western pharmaceuticals at a local marketplace in Cameroon construct their ideas about illness and medicines in reaction to two kinds of situations in which they find themselves. The market situation induces people to adjust their medical beliefs to the economic transaction. Sellers are likely to inflate the efficacy of medicines and customers adjust their medical concepts to fit their limited financial means. In that way they rationalise their inability to buy all the drugs they would have liked to buy. The interview situation leads informants to produce rather specific and assured answers on topics about which they may know very little. Reasons include the inequality between interviewer and informant and the latters wish to avoid making an ignorant impression on the interviewer. Three conversations held during fieldwork in 1983 are discussed.

Fracture treatment by bonesetters in Central-Ghana: Patients explain their choices and experiences

Objective  To understand factors influencing patients’ decisions to choose either fracture treatment by a bonesetter or in the hospital and to explore patients’ experiences with bonesetter treatment.

The articulation of formal and informal medicine distribution in South Cameroon

The context of medicine distribution in South Cameroon is more complex than I had foreseen when I set out to do anthropological fieldwork in 1980.1 Perhaps naively, I had expected to find one fairly survey able field of formal services and another small and rather chaotic one of informal activities where medicines were transacted, purchased and consumed outside professional medical control. This chapter is about my discovery that there are not two fields, but only one in which formal and informal activities are closely interwoven. In a sense one could say that the chaos is not restricted to a delimited informal sector but is found everywhere. But one could equally well hold that there is no chaos at all. What appears chaotic and formless (in-formal) at first sight proves fairly structured when one looks more closely and starts to understand the commercial logic of the whole. That is another discovery on which I shall report in this paper.

I want to go! How elderly people in Ghana look forward to death

Older people in a rural Ghanaian community indicated that they look forward to death. Traditional ideas of ancestorhood, reincarnation and modern Christian beliefs about life after death had little influence on their resignation. Images of a possible ‘hereafter’ hardly existed. Agnosticism – in a religious guise – prevailed. They saw death foremost as a welcome rest after a long and strenuous life. Their readiness for death did not, however, include an acceptance of euthanasia. Both the young and the old held the view that life and death are and should remain in Gods hands. This article is based on anthropological fieldwork in the rural town of Kwahu-Tafo in southern Ghana.

Social and cultural efficacies of medicines: complications for antiretroviral therapy.

Using ethnographic examples of medicine use, prescription, distribution and production, the authors argue that social and cultural effects of pharmaceuticals should be taken into account. Non-medical effects deeply influence the medical outcome of medicine use. Complications around the advent of anti-AIDS medicines in poor countries are taken as a point in case. The authors are medical anthropologists specialised in the social and cultural analysis of pharmaceuticals.

Opanyin: The ideal of elder in the Akan Culture of Ghana

ResumeLes proverbes ont ete utilises comme des catalyseurs pour permettre de sonder le concept ?panyin (les anciens) dans la culture Akan du Ghana. L’opanyin apparait comme une personne ideale “parfaitement adulte,” un gentleman/une dame honorables, d’un âge certain, pleins de sagesse qui offrent leurs conseille aux autres, bien eleves, pleins de tact, patients et genereux et qui consacrent les dernieres annees de leurs vies au bien-etre de la abusua (famille). Cet article interprete la glorification des anciens, pratiquee essentiellement par les anciens eux-memes: c’est la une strategie pour faire face a leur tragique perte de prestige et de pouvoir a notre epoque. Rares sont les anciens, exception faite pour ceux dont les vies ont ete un succes sur les plans social et materiel, qui sont dignes des ideaux des Ωpanyin. Pour les autres, l’idee reste un reve, une sorte de refuge pour se proteger d’une vie difficile et douloureuse. La recherche anthropologique de terrain pour cet article a consiste en conver...