During my first weeks here in Mbarara, Uganda, I spent much of my time at the hospital. In talking with doctors, nurses, and researchers on the hospital campus, I kept hearing that patients often only come to seek biomedical care when it’s too late. Many locals only think of the hospital as a place of despair – it’s where people go to die. This cycle is a self-fulfilling prophecy: people come to the hospital too late for treatment to be effective, and then rumors of the hospital’s failure circulate, discouraging others from trusting in biomedical care or seeking care until it’s too late for them too. Of course, this isn’t the case for every patient, but the bleak story holds true for far too many.
I began to wonder — if the sick don’t seek care from the hospital, where else are they seeking care? What are they doing in pursuit of wellness? These questions led me beyond the hospital gates and into Mbarara Town to the various herbalists, healers, and Christian churches that provide various types of healing services. These various kinds of practitioners are all part of what “healing” means for the people of Mbarara. And in all of these spheres, healing is not only taken as a matter of physical health, but rather, a more holistic kind of health that entails social relationships and financial needs as well. This way of thinking about healing defies the Cartesian dualism (separation of body and mind) that characterizes so much of Western medicine. I’m not trying to say that Ugandan perceptions of illness/wellness are any more or less legitimate than classic biomedical views – but I am noticing a significant difference.
For many patients here, a biomedical diagnosis answers the question of what is wrong, but it does not address why this sickness is afflicting this person right now. While the search for causes may find some biomedical explanation, it does not go so far as to get at the “underlying” reasons. I’m still working on understanding how these explanations of underlying causes work. From what I can tell thus far, not every sickness requires an explanation at this level, but there are some sicknesses that are “spiritual” in nature and can only be adequately understood/cured by figuring out the reasons behind the affliction – this can be done through seeking Christian healing (there are healing and deliverance services at various churches around town throughout the week, every single week!) or consulting a spirit medium.
As for herbalists, they seem to occupy a space that is neither biomedicine nor “spiritual” in nature, although many herbalists profess religion alongside their herbs. To me they are the most interesting, because they don’t fit neatly into my categories – they’re not squarely “scientific” or “religious”. And they are immensely popular. I haven’t met a Ugandan yet who has not sought the help of an herbalist, or used herbs they themselves have gathered and prepared. And this is true of the most “modern” Ugandans too, the ones running NGOs and collaborations with American medical charities. There are some governmental regulations on herbalists’ practice, and many of the herbalists are involved in “research” trying to develop products for sale on a large(r) scale. And patients’ interactions with herbalists take a variety of forms, depending on which herbalist, and which patient.
As I move forward with my research on patients’ ideas of healing here in Mbarara, I’m so interested to learn more about how all of these various options come together for patients as they navigate health and healing in this lively and quickly growing city.