## Illustrations
FIGURES 1. Inhabitants per medical doctor in several countries. 29 2. Western medical personnel and facilities per inhabitants in Luozi Territory and Zaire Nationally. 30 3. Kinship relations in Luzayadio's case. 70 4. Structure of confession and accusation in Luzayadio's case. 71 5. Close kin marriage types in matrilineal context. 74 6. Kinship relations in case of Axel and Cécile. 78 7. Kinship relations of Nsundi and Kinkanga-Kituma clans. 94 8. Partial genealogy in cases of Lwezi and Mbumba. 115 9. Formation of therapy managing group in case studies. 132-133 10. Social components constituting therapy managing group. 140 11. Correlation of social context of decision and therapy choice. 149 12. Co-occurrence of therapies and specialist's (or group therapist's) roles in case studies. 152-153 13. Correlation of distance travelled by clients with cost and role of therapist consulted. 154 14. Diagrams of the body. 159 15. Correlation of therapy actions and problems handled by banganga 204 viii / Illustrations 16. Correlation of therapy actions and problems handled by kinship therapy and bangunza 210-211 17. The course of therapy summarized 220 PLATES (Between pages 106 and 107) MAPS 1. Lower Zaire. 10 2. Territory of Luozi, Manianga. 14 3. Manselele, near Mbanza Mwembe: Nzoamambu's garden village. 164-165 scheme. This survey is underway as I write these lines, financed in part by the Canadian International Research and Development Corporation. Zaire is not alone in this venture. A recent World Health Organization regional conference in Brazzaville brought together numerous representatives of other African nations to compare strategies for the incorporation of traditional healers and health methods in a coordinated health system with modern medicine. These endeavors suggest that what has changed is not so much the de facto relationship of Western or modern medicine to techniques and roles derived from traditional medicine, but the manner in which officials see that relationship.
This book presents an "on the ground" ethnographic account of how medical clients of one region of Lower Zaire diagnose illness, select therapies, and evalute treatments, a process we call "therapy management." The book is intended to clarify a phenomenon of which central African clients have long been cognizant, namely that medical systems are used in combination. Our study is aimed primarily at readers interested in the practical issues of medical decision-making in an African country, the cultural content of symptoms, and the dynamics of medical pluralism, that is, the existence in a single society of differently designed and conceived medical systems.
In the course of preparing this book, a number of theoretical issues in social science and medicine emerged, and are developed to some extent. Our key analytical idea pertaining to therapy management came to us in the field as we dealt with kinsmen and other escorts of the afflicted. The idea took firmer shape in seminars at McGill University, as the nature of decision-making, transactions, and resource evaluation was studied in therapy management groups that effectively mediated between sufferer and healing specialist. We are indebted to Professor Don Bates of the Department of History of Medicine at McGill and the students in our seminars for their contribution to the analysis.
Once the nature of the therapy managing group had come into focus, subsidiary themes were worked out. One of these was the idea of a therapeutic or medical system consisting of practices, Preface / xxi Nzoamambu, his wives and his son Tezulwa, graciously hosted us for a week during which time we learned his medical world view and observed his practice as master nganga. Without his lessons we would not have been able to include Chapter 10 on the ideas behind Kongo customary medicine, ideas which made much of our other data intelligible.
We must also acknowledge the contributions by Drs. N sonde and Bazinga who took time to share their views on the role of modern medicine in Zairian society, and in relation to the work of traditionalists named above. Along with these members of the new generation of medical doctors we mention Sister Emily of Mangembo Hospital; the medical staff at Sundi-Lutete, Karen, Kayuma, and Batumunitu; the staff at Kibunzi, Barbro and Tata Nsinga. All were helpful and understanding.
Governmental officials in Zaire assisted our project, granting the necessary permits so we could conduct our work peaceably. For this we are grateful to them. The Social Science Research Council of New York provided the original grant, recognizing the importance of a joint team of a medical doctor and an anthropologist. Without their funds, the project could not have happened. Supplemental small grants were made by McGill University and the University of Kansas.
Once our work was in manuscript form, it benefitted from the criticism of most capable readers. Dr. Glen Tuttle encouraged us after reading a rough early draft. The late Dr. Kurt Kauenhoven, Dr. Don Bates, and Professors Allan Young, Wyatt MacGaffey, Brooke Schoepf, and several anonymous readers are acknowledged for their varied and helpful comments. Professor Charles Leslie was our most thorough critic. He wanted this book to reach completion as much as we did.
The book's coverage of matters medical would not have been possible without the collaboration of Dr. William Arkinstall, cofieldworker, participant in the McGill siminars, and colleague in several later work sessions. Bill and his wife Karen shared in the whole experience of this project; their presence is acknowledged in the content of the book as well as matters of style and logic. Their friendship has been inestimable.
Reinhild, my wife, alone knows the true cost of this book. Her xxii / Preface poignant criticism of all aspects of the work has been excelled only by her encouragement when needed. Bernd, Gesine, and Marike have generously given of their father so that this might happen.
A cup (mbungu) to all who were involved! Heubuden
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