In the wake of structural adjustment programs in the 1980s and health reforms in the 1990s, the majority of sub-Saharan African governments spend less than ten dollars per capita on health annually, and many Africans have limited access to basic medical care. Using a community-level approach, anthropologist Ellen E. Foley analyzes the implementation of global health policies and how they become intertwined with existing social and political inequalities in Senegal. Your Pocket Is What Cures You examines qualitative shifts in health and healing spurred by these reforms, and analyzes the dilemmas they create for health professionals and patients alike. It also explores how cultural frameworks, particularly those stemming from Islam and Wolof ethnomedicine, are central to understanding how people manage vulnerability to ill health.While offering a critique of neoliberal health policies, Your Pocket Is What Cures You remains grounded in ethnography to highlight the struggles of men and women who are precariously balanced on twin precipices of crumbling health systems and economic decline. Their stories demonstrate what happens when market-based health reforms collide with material, political, and social realities in African societies.
Author(s): Ellen E. Foley
Series: Studies in Medical Anthropology
Publisher: Rutgers University Press
Year: 2009
Language: English
Pages: 216
Cover
......Page 1
Your Pocket Is What
Cures You......Page 4
Copyright......Page 5
Contents......Page 8
Acknowledgments......Page 10
1. A Different African Health Story......Page 16
The Research Setting......Page 19
Culture, Power, and Practice......Page 22
Critical Medical Anthropology (CMA) and the Practice of Health......Page 24
Methods......Page 26
The Production of Anthropological Knowledge......Page 29
Organization of the Book......Page 32
2. A Brief History of Senegal......Page 35
Early History, Islam, and the Dawn of Colonization (1659–1854)......Page 36
Saint Louis as a Base for Commerce and Conquest......Page 37
The Civilizing Mission (1854–1960)......Page 40
Independence and Beyond: From a Single-Party Stateto a Stable Democracy (1960–2000)......Page 44
Alternance and Beyond: Senegal in the Twenty-first century......Page 49
3. Urban and Rural Dilemmas......Page 52
Saint Louis: From Colonial Glory to “Dry City”......Page 55
Postindependence Decline......Page 56
Pikine: Bidonville par Excellence?......Page 58
Living in Development’s Shadow: Changing Economies in Ganjool......Page 60
Daru-Mumbaay......Page 61
Changing Economies: From Farming to Fishing......Page 62
The Rhythm of Daily Life: Work and Play......Page 67
Urban and Rural Dilemmas Compared......Page 70
4. Glocal Health Reform in Saint Louis......Page 73
From Health for All to User Fees: Shifts in Global Health Policy......Page 74
A Look at the Numbers: Senegal’s Epidemiological Profile......Page 78
The Saint Louis Medical District: People and Places......Page 83
Decentralization, Community Management,and User Fees in Saint Louis......Page 84
Decentralization and City Politics in Saint Louis......Page 85
The Perils of Participatory Management......Page 88
User Fees and Quality of Care......Page 93
Tallying the Balance Sheet: Decentralization and Health Reform......Page 95
5. Market-Based Medicine and Shantytown Politics in Pikine......Page 99
“If you get sick in Pikine, you won’t getwell in Pikine.”—Mamadu Seck......Page 101
“Our health post is sick.”—Daba Joob......Page 104
“There are a lot of politics here.”—Abdu Joob......Page 105
Pikine as a Reflection of Tensions in the Medical District......Page 108
6. Knowledge Encounters: Biomedicine, Islam, and Wolof Medicine......Page 111
Conceptualizing Medical Pluralism andSenegalese Healing Traditions......Page 112
Therapeutic Landscapes and Health Practice
in the Saint Louis Region......Page 117
God Is the Medicine for Everything......Page 124
Waiting for God......Page 126
7. Gender, Social Hierarchy, and Health Practice......Page 130
The Politics of Gender and Household......Page 131
Household Composition and Child Health......Page 139
8. Domestic Disputes and Generational Struggles over Household Health......Page 145
9. Encountering Development in Ganjool......Page 158
Nutritional Surveillance and Health Talks......Page 160
Conflicts with Plan International......Page 164
Let’s Give Birth at the Health Hut......Page 167
The Pattern of Development Failures......Page 169
10. Believe in God, but Plow Your Field......Page 173
Notes......Page 180
Glossary......Page 184
References......Page 188
Index......Page 196
