The CIHA Blog is very pleased to post this piece by Dr. Estelle Koukam Magne, in which she discusses the contributions of tradpractitioner medicine in Cameroon, and its continued subalternization despite its contributions during the COVID-19 pandemic. In her post, Dr. Koukam Magne details the complexities within calls for medical pluralism in both international and national discourse.
Estelle KOUOKAM MAGNE is a Cameroonian anthropologist and full professor at the Faculty of Social Sciences and Management of the Catholic University of Central Africa in Yaoundé, Cameroon. Her fields of research are health, religions, food, humanitarianism, gender, and politics. Please find a list of her latest publications near the end of the post.
Estelle KOUOKAM MAGNE est une anthropologue camerounaise et professeure titulaire à la Faculté de Sciences Sociales et de Gestion de l’Université Catholique d’Afrique Centrale à Yaoundé, au Cameroun. Ses domaines de recherche sont la santé, les religions, l’alimentation, l’humanitaire, le genre et le politique.
Sources: crtv, june 08th 2020
At the start of the COVID-19 pandemic, the World Health Organization called on Africa to “prepare for the worst.” In the months that followed, herbal therapies were offered by researchers to the Cameroonian population from various African countries (Madagascar, Benin, Togo, Ghana, etc.). In Cameroon, after several debates and controversies, the herbal medicine of the Archbishop of Douala, Samuel Kléda, and the cardiologist Euloge Yiagnigni Mfopou, were officially authorized as adjuvants in the treatment of COVID-19 by the Ministry of Public Health. As adjuvants, they are supposed to be used as complement treatment of the protocols used in the hospitals.
These events raise several questions. How do institutional practices, particularly those of institutions holding the power to legalize therapies offered during the COVID-19 pandemic, hinder the decolonization of medical knowledge? How does the status of “adjuvant” given to therapeutic medicines show the ambiguity of political institutions in the face of the process of decolonization of local knowledge? How is the management of the COVID-19 pandemic an issue of recognizing the other in their difference? These questions are even more important given the politics of subjugation of “traditional” medicine since the colonial period, when the colonial administration joined with Christian religious organizations to denigrate African modes of healing. Daniel Noni Lantum has used the term “heretical” to describe how the colonizers thought of “traditional” medicine. This attitude has prevailed even while the biomedical treatments used during major endemics have iatrogenic effects.
After decolonization in 1978, the Alma Ata conference on primary health care recognized traditional doctors but subordinated them to biomedical professionnals, reducing them to the status of community agents. In 2002, the WHO conference in Kazakhstan reiterated the need to “integrate” these medicines into health systems. This continued subalternization results in a lack of systematic research at the institutional level on the therapeutic value of African medicine, perpetuating an institutional discourse that attempts to mediate the tension between self-esteem and dependence.
1. Tradpractitioner subaltnerization
Archbishop Samuel Kleda presenting its medicines
Source: Cameroon Tribune, June 08 th, 2020
Africa has resources to fight the COVID-19 pandemic. It also has the “memory resources” to respond to this health emergency. This term refers to how governing structures undertake actions inspired by the memory of fights against both earlier and ongoing endemics. For example, we have witnessed the implementation of turnkey solutions. They are inspired, on the one hand, by an old and more recent memories of the management of epidemics in Africa, in particular the fight against the Ebola virus and the fight against cholera, which generally requires the application of measures aimed at preventing the transmission of the disease, usually called “barrier measures” in the context of the fight against COVID-19.
Another turnkey solution inspired by recent experience in the fight against HIV/AIDS was, from the outset, the mobilization and training of community relay agents who were to become major agents in sensitizing the population to respect barrier measures. This initiative has had the merit of popularizing the discourse on barrier measures even if social conditions often made them impractical. For instance, wearing a mask has remained a marginally observed barrier measure; confinement and physical distancing have remained ineffective due to an extremely precarious economic and socio-political context.
The final turnkey solution was that of the local and industrial manufacture of chloroquine, inspired by Didier Raoult’s chloroquine + azithromycin therapeutic protocol and proposed by the Cameroon’s Ministry of Scientific Research and Innovation. These different political choices at the start of the epidemic showed disdain for traditional therapists. On the other hand, we are also witnessing the awakening of a medical Pan-Africanism which advocates recourse to sources of herbal medicine.
Indeed, in April 2020, Samuel Kléda, Archbishop of Douala and a traditional therapist, announced that he had found the drugs/therapies that work against COVID-19. He did so with strong conviction. An association of consumers from civil society even awarded him a prize. But Kléda has been very cautious — he says he treats people having any or all the symptoms of COVID-19, and they recover once they have taken the medication he prescribes. He is clear that as a traditional therapist, he considers them cured when the symptoms disappear. From his point of view, it is up to “scientists” to judge whether his claims are valid according to their criteria.
2. Why taking local medicinal knowledge seriously in the pandemic matters
Medical pluralism has become a norm in some circles, especially given the increasing recognition of the precarious nature of public health measures taken during pandemics. As Foghap and Noubiap (2020) argue, “It is important for Africans to seek local solutions to their health problems, including the current pandemic. To do so, it is crucial that traditional healers and university researchers work together to provide traditional pharmacopoeia drugs against COVID-19, after having proven, through well-conducted clinical studies, their efficacy and safety.” Despite these conclusions, however, there has been very little in the way of projects aimed at better collaboration between practitioners of different kinds of medicine. In addition, from a legal point of view, laws governing biomedical vs. traditional medicine are unjust and inequitable. As Yawaga (2020) points out, “The solutions of Cameroonian law seem contrary to public freedoms, since they constitute, under the guise of the protection of public health, a diversion of criminal law to the benefit of the interests of doctors. This solution seems dangerous since it does not consider the health interests of the populations.” These are issues that concern both sustainable development and cognitive justice.
The COVID-19 pandemic gave the opportunity to African leaders to demonstrate their ability to respond and propose social therapeutic solutions instead of simply imposing guidelines that can be disastrous to communities. For instance, physical distancing would have been disastrous for the daily lives of most Cameroonian households, given how people live and work day-to-day. Moreover, such mandates could have worsened the political instability that already affects the country, given the ongoing Anglophone crisis. Examples of South-South humanitarian action during COVID-19 did occur. One example was put in place by the gift of Covid-organics from Madagascar to other countries of the continent, including Tanzania. Another example arising during my fieldwork was when some informants from the African diaspora in Europe requested Samuel Kléda’s therapeutic treatment to cure themselves.
The images of African leaders reflecting on the solutions to tackle the pandemic through zoom meetings reinforces African self-esteem, in contrast to the constant images of a continent always asking for help and international expertise. The issues raised by vaccinal apartheid stress again the importance of equity in global health; they also add to the importance of including epistemologies of traditional medicines as part of such equity.
3. Access to health care, epistemic justice, and social justice
Euloge Yiagnigni Mfopou, cardiologist and inventor of corocur
sources: “le jour”, June 25th 2021
The erratic management of COVID-19 in Cameroon shows that the continued subalternization of traditional medicines is an issue of epistemic justice, social justice, and access to care. Indeed, national as well as transnational political institutions have been silent regarding implementing trials aimed at a better understanding of tradpractitioner therapies. These institutions were only interested in whether such therapies were harmful, instead of assessing their therapeutic efficacy. This political refusal of knowledge and the institutional silence reduces the population’s recourse to care. Tradipractitioner knowledge then becomes a form of “symbolic efficiency” and not an equitable consideration of the benefits of different sources of knowledge.
Pan-Africanist actions must be initiated both from above, including in meetings by videoconference between certain Heads of State in Africa, as well as from below, through the popularization and institutionalization of various tradipractitioner therapeutic solutions. Without both forms of support, the enthusiasm of the people for plant-based therapies will lack the necessary support to provide effective care.
Dernières publications
Estelle Kouokam Magne, 2021, L’engagement civique des femmes au sein des forces de sécurité́ au Cameroun, CODESRIA, Dakar.
Estelle Kouokam Magne, 2020, « La nourriture de la marmite ». Alimentation et socialisation de l’enfant dans deux villes camerounaises », in Nicolas Bricas et al. (dir.) Manger en ville, Regards socio-anthropologiques d’Afrique, d’Amérique latine et d’Asie, Quae Éditions,
Estelle Kouokam et Laurent Vidal, 2020. «L’observance thérapeutique chez les PVVIH au défi des ruptures d’approvisionnement en antirétroviraux dans les structures de soins au Cameroun.», Face à face [En ligne], 16 | 2020, mis en ligne le 11 octobre 2020, consulté le 04 mars 2021. URL : http://journals.openedition.org/faceaface/1722.
Latest publications
Estelle Kouokam Magne, 2021, L’engagement civique des femmes au sein des forces de sécurité́ au Cameroun, CODESRIA, Dakar.
Estelle Kouokam Magne, 2020, « La nourriture de la marmite ». Alimentation et socialisation de l’enfant dans deux villes camerounaises », in Nicolas Bricas et al. (dir.) Manger en ville, Regards socio-anthropologiques d’Afrique, d’Amérique latine et d’Asie, Quae Éditions,
Estelle Kouokam et Laurent Vidal, 2020. «L’observance thérapeutique chez les PVVIH au défi des ruptures d’approvisionnement en antirétroviraux dans les structures de soins au Cameroun.», Face à face [En ligne], 16 | 2020, mis en ligne le 11 octobre 2020, consulté le 04 mars 2021. URL : http://journals.openedition.org/faceaface/1722.