Medical systems in Ghana: A study in medical sociology

Medical systems in Ghana: A study in medical sociology

II\ no help in idrntif>ing pre\rnti\-e strategies (the third subtitle of the lvork,. ignores disabilities Lvhich creep up on workers over a period of ...

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II\ no help in idrntif>ing pre\rnti\-e strategies (the third subtitle of the lvork,. ignores disabilities Lvhich creep up on workers over a period of years. and hence provides \rr> little help for redesigning of our workers’ compensation systems or identifying their

present lveaknesses Iems.

in handling

other important bilCHOL.AS

Crute~ for PO/iC~~ 4ltrrmltir~rs. .\ltrssLdlusetts Imtit1rte of’

.hIfFORD

1’

Medical Systems .in Ghana: A study in Medical Accra-T&~ 1975. 146 pp. N.o4.50.‘

Sociology.

This book is “devoted

ing. they are somewhat disappointing. The generalizations of the first raise so many questions that they point to the urgent need for systematic studies. Many interesting urban phenomena. for instance “healing” as a part of religious activities, and the growth of self-medication and city herbalists, are not mentioned. The second of these two sections shows the inadequacq of the foundations laid. More benefits are claimed for health and medical services than is usual on the part of professionals. Attention is drawn to the “high dependence ratio” of Ghana as an “unintended consequence of health and medical services”. But the problems involved in grafting family-planning services into health services. when Ghana had a noteworthy record in this field. are not discussed. Instead generalizations concerning systems of medical care in developing countries are followed, somewhat incongruously. by some useful suggestions explaining the persistence of traditional medical practice. Then we leap into a brief discussion of the capacity of China to “fuse.. indigenous and foreign medical systems to suit their cultural needs”. Again. events have overtaken Dr. Twumasi and his sources-1969 and earIier---shave largely been replaced by much more detailed recent studies. It may help to give the flavor of the book if the three conclusions drawn from the penultimate section arc given verbatim:

to the investigation of a common phenomena in developing countries, i.e. the copresence of scientific and traditional medical systcmr... to explicate the nature of the interrelationship”. It is. unfortunately, not satisfactory in a numhcr of respects. but may, in a few years. be seen as significant. The author seems to have worked for 2 >r uith the Ghana Ministry of Health as a supervisory ofticcr. His academic experience seems to have hern \‘cry largely at the University of Alberta and at McGill. and the book is based almost entirely on published material. My feeling is that far from being ahlc to undrrtake any field work, which would have made the book of greater value since Dr. Twumasi ia thorough and systematic. the author did not manage to get back to Ghana to tap the best sources of relevant information amongst people working in hsalth and medical services. For example Ghana has ;Lnumber of well known traditional practitioners who 5pecialiTc in problems of infertility. In his study. Dr. Twumasi concentrates upon Askanti. As a nonGhanaian and speaking no Twi. I nevertheless managed without too much effort to learn something about one of the practitioners working in a village about 20 milts from Kumasi. Although this is known to be a lucrative speciality, Dr. Twumasi makes no mention of healers or shrines concerned with infertility as a special problem. The sign5 of the hook’s origin as a thesis are. per-

P. A.

TdlJ7o/or/

.A.

prob-

TWUMASI.

Ghana

Publishing.

h;q’~ too prominent. A section on theory. somewhat loo amhitiouz for the material that follows. but also I’br too supcrlici;d to grapple with the ambiguities and

prohlcm\

inhcrcnl

in terms

like “supernatural”

and

“magic rcli,giou~“, is followed by another on the Ashanti ~Asmk) social \yztcm, on which thorc is alrcxiy ;I

siibstanlixl

and readily

available

p. ;Irc

:~llocatcd to ;m ~count

cinc”

Thcrc

dlgh1ly

secondary

chanpcs

than 111

the

ones

political

~hc

utilized.

and social

have hecn \trongcr

Only

sourccz.

Ices casilq avariuhlc, that arc

formattvc would

AI-C’ xomc

literature.

of “Traditional

had

far

The

I7

Mcdithough more

in-

section

on

system

of Ghana

it been concentrated

on Adianti;

that on the background to scientific mcdicinc in <;h;ma is analytic rather than descriptive. Rapid

change

health

\crvicc\ mix

ncctlcd To the

updating

xctionx. Social

~rcprc~nt

in

rhc structure :mothcr

bcforc

“The

Sq\lcm”

manning

of

the

The material

puhlicalion.

l:Ili.cts

;111d

and dilemma.

01’ “The

the core of ~hc hook.

Sc~cnl~lic Mccliclnc on (‘ompcting hut.

though

Systems” intcrcst-

that I find this a disappointing book. find the author’s conclusions either compelling or explicatory. The subtle relationships between village midwives with orthodox training, what W.H.O. has called “traditional birth attendants” and between the staffs of Health Centres and their patients, who frequently spend more time and usually far more money consulting traditional practitioners, need careful investigation if the book is to meet its goals. Dr. Twumasi’s book may prove significant for the inlluence it is likely to have. It may confirm the I

I

have said

do not

Review articles assumption made? presumably in the Department of Sociology at Alberta, that it is perfectly satisfactory for a talented African, or Asian, etc. to leave his native country and work in a distant Western-oriented country on library study in a field where there is regrettable lack of material from field research, and

201

be given a Ph.D. for his efforts. On the other hand. it may help to clarify the responsibilities to the developing world of those university departments genuinely interested in global development. Lecturer in Sociology London.

A History of Public Health in New York City 1866-1966,

NORMANSCOTNEY

by John Duffy. Russell Sage Founda-

tion, New York, 1974. 690 pp. $20.00. During the past hundred years, the definition and scope of public health practice has changed remarkably. Once led by physicians and sanitarians concerned primarily with sewerage, epidemic disease transmission and other aspects of environmental control. public health has evolved into a highly diverse and elastic profession concerned with a wide range of environmental, medical and social issues. Today. the public health worker participates in the organization of medical care services, control of air and noise pollution, mental hygiene programs and rehabilitation projects as well as the more traditional areas. The conquest of epidemic diseases and the technological ability to provide pure water and to dispose of sewage has allowed public health professionals to broaden their areas of interest. John Duffy’s second volume on the history of public health in New York City, outlines these changes through a review of the admnnstrative and political decisions made by the city’s Department of Health from the years 1866 to 1966. Professor Duffy discusses the broad scope of the Department’s history. The Metropolitan Board of Health, the forerunner of the Department of Health, was organized in 1866 in response to an expected epidemic of cholera. In 1870 the Department of Health replaced the board and, with the guidance of such luminaries as Drs. Stephen Smith and Elisha Harris (founding members of the American Public Health Association in’ 1872), the modem history of the Department of Health began. During the ensuing years. significant administrative and scientific advances were made by a Department which was a major innovator in health practice. In the 1870s the Department opened a laboratory to produce smallpox vaccine and organized, according to Duffy, the first vaccination program. In 1894, departmental laboratories began producing diphtheria anti-toxin and. under the direction of Hermann Biggs, tests of the anti-toxin were begun. Also in the 1880s and 90s Biggs and T. Mitchell Prudden established a bacttriological laboratory for the routine dia_aosis of then prevalent diseases. As the years passed, programs in school. maternal and child health, tenement inspection and industrial and immigrant health were started or expanded. Under the direction of senators Goldwater and Haven Emerson, the modern concept of the health district was developed as the basic unit of departmental organization. Significantly, as seemingly ~~i:unt garde programs of the Department became widely accepted governmental activities they

became functions of independent departments. Hence, in New York, independent departments assumed responsibility for the collection of garbage and the provision of pure water. While Professor Duffy has produced a compendium of numerous changes and innovations which have occurred within the department during the last hundred years, a number of problems with the author’s organization and conceptualization limit the book’s usefulness. The book, which was originally intended as an official history of the Department, lacks a central thesis (a point the author readily acknowledges in his concluding chapter). This leads to the inclusion of material whose significance is unclear or vague. Even when data are clearly central to a history of health in New York, it is often inadequately analyzed. For example the sections on hospitals and dispensaries in nineteen century New York are too short and superficial to interest even the most casual reader. In an attempt to be inclusive the work loses focus. The absence of an interpretive framework leads to analyses which sometimes lack depth and subtlety. Duffy attributes the successes of the Department to the vision of one or a few individuals and the Department’s failures are too often explained away as a product of “corrupt” Tammany Hall politicians catering to or manipulating illiterate immigrants. The use of such adjectives as “corrupt”, “dishonest” and “illiterate” demands closer definition and evaluation in light of recent social histories of nineteenth century urban politics. In the nineteenth century at least. corruption may well have been essential to the administration of a sprawling city like New York. Furthermore, immigrants, illiterate or not, may well have recognized what was in their own self-interest. Although the book lacks an analytic framework, it provides much useful information and is valuable as a reference work. An appendix providing a chronology of important dates would have been valuable. In addition, the data presented in the book raise some questions which further studies of public health departments should attempt to answer. First, what are the relationships between actions of a Department of Public Health and the general health status of the community? Duffy points out that modern public health administrators. such as Leona Baumgartner. see health closely linked to the economic conditions of particular population groups. This fact alone raises interesting questions about how effective past public health projects were in decreasing morbidity and