Pharmacy in Senegal: Gender, Healing, and Entrepreneurship
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Pharmacy in Senegal: Gender, Healing, and Entrepreneurship
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Product Details
| ISBN-13: | 9780253014757 |
|---|---|
| Publisher: | Indiana University Press |
| Publication date: | 01/20/2015 |
| Pages: | 176 |
| Product dimensions: | 6.00(w) x 9.00(h) x (d) |
| Age Range: | 18 Years |
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Pharmacy in Senegal
Gender, Healing, and Entrepreneurship
By Donna A. Patterson
Indiana University Press
Copyright © 2015 Donna A. PattersonAll rights reserved.
ISBN: 978-0-253-01475-7
CHAPTER 1
France's Biomedical Expansion: Creating African Medical Personnel
Science knows no country, because knowledge belongs to humanity, and is the torch which illuminates the world.
—Louis Pasteur
Throughout the twentieth century, Senegal was at the intersection of indigenous, Islamic, and Western medical knowledge. This predominately Muslim, Francophone West African country embodied the notion of science without borders. Furthermore, the establishment of the School of Medicine and Pharmacy in French West Africa early in the century transformed the practice of medicine and ideas about health and healing. This school led to the creation of a new professional class of African medical personnel. This professional class continued to expand during the course of the twentieth century and became an integral part of health care in postcolonial Senegal. In this chapter, I examine the intersections of French colonial expansion and African medical professionalization in French West Africa in the early to mid-twentieth century.
Precolonial Health Systems
In precolonial times, many African societies had complementary healing traditions that utilized herbal medicine in conjunction with different forms of religious intercession. Indigenous healing traditions were often complex practices involving plants, other materials, and rituals. These healing techniques were transmitted from generation to generation through oral traditions and apprenticeship. During this precolonial era, many Africans valued their health and well-being and judged political leaders and healers by their ability to protect their constituents and their community. Indigenous healers or intercessors invoked supernatural aid to ensure bountiful harvests, secure boundaries, and robust communities.
Throughout the globe, humans have always tried to heal illness, pain, injury, and imbalance. The African continent was no exception, and healers were found in communities throughout Africa. Some of the most prominent caregiving figures in traditional medicine were the sangomas in South Africa, Zar intermediaries in Northeast Africa, and a variety of mediums along the Bight of Benin in West Africa. Numerous scholars have documented indigenous West African healing practices, most notably among the Igbo, Yoruba, Wolof, and Tuareg ethnic communities. In many of these sub-Saharan societies, healing was holistically conceptualized as creating harmony between a person's physical and spiritual selves. In addition, healing often meant restoring balance with an ill person's family, community, and perhaps ancestors. Most African healers employed both herbal and ritual methods of healing. Maghan Kéita suggests that "the gris-gris, the talisman, the amulet, had been a source of religious and medical power throughout Africa long before the inception of Islam." Local ideas about healing were transcultural and included multifaceted approaches to the preservation and improvement of health. Indeed, traditional healing included herbs, spirit possession, gris-gris (talismans), and religious intercessions of different origin.
The spread of Islam in the West African subregion brought new ideas about healing and disease. Islam spread in Senegal from the ninth century. Many of its early adherents were clerics, merchants, and members of the ruling class. Large numbers of the masses converted in the eighteenth and nineteenth centuries, and Islamic ideas about religion and healing were often syncretized with existing health care traditions. Responses to disease varied according to whether the disease's origin was considered natural or supernatural. Because African approaches to healing were already polycultural, Muslim therapeutic methods were usually complementary and did not rival biomedical treatments. In addition, both indigenous and Islamic ideas about healing were more holistic and less focused on the treatment of symptoms than were European medical "cures." Treatments for illness varied widely, and included Qur'anic recitations and religious intercessions (such as those performed by Wolof marabouts in Senegal), intercessions that relied on plant and animal products, herbal medicine, and spirit possession. In Senegal, the Serer, Wolof, Lébou, and Fula ethnic groups all employed local healing traditions.
In Western Europe, hospitals and universities began to flourish in the twelfth and thirteenth centuries. Formal medical training was instituted at universities in Paris and Montpellier beginning in 1220. As in Africa, medical knowledge in Europe was influenced by that of other regions. As Europeans gained greater knowledge of the globe through exchange, exploration, and conquest, they developed a broad body of medical knowledge. Plant-based materia medica was imported from the Americas, Southeast Asia, and Africa. As many of the biomedically trained pharmacists interviewed for this project pointed out, a high percentage of biomedical drugs were derived from plants. Apothecaries in the thirteenth century worked in tandem with doctors to provide drugs to patients. Senegal, influenced by both Islamic healing traditions and European biomedicine, was at the intersection of healing modalities. Both traditions would remain important through the colonial era.
The introduction of European biomedical practices to colonial Africa fundamentally changed indigenous approaches to healing. In Europe, medical personnel were increasingly trained in hospitals and universities, and these institutions incorporated medical experimentation, extensive research, and publication. European biomedical knowledge expanded exponentially in the seventeenth, eighteenth, and nineteenth centuries with new developments in germ theory, pharmaceuticals, and responses to epidemics. European physicians and other medical personnel believed their interventions were far superior to indigenous and Muslim practices, partly because they were more logical. Although practitioners of the biomedical approach competed with African health care practitioners, complementary health systems continued to exist in tandem with these imported healing traditions. Steven Feierman explores the diverse factors that contribute to diagnosis, healing, and medicine in Africa and argues that "in most African communities several types of healers work side by side: physicians or medical assistants, specialists in sorcery or spirit possession, Christian or Muslim religious healers, and others." In Senegal, over time, patients became impressed with the results of biomedical approaches. Many of them conferred with both biomedical and religious healers, sometimes simultaneously for the same illness. In the colonial era, health care providers and pharmacists were aware of this practice and considered these factors in their interactions with clients. As a result, these two healing approaches are not mutually exclusive and often influence each other.
Indeed, the multiple Senegalese medical systems, some of indigenous origin and others imported from the West, are often more complementary than competing. For example, when I asked informants about indigenous and biomedical pharmacopeias, most discussed the influence of plant-based remedies on biomedical pills, tinctures, and the like. One pharmacist, Aïssatou Moreau, spoke to the historical connections of traditional healing: "Yes, I think that we should further develop pharmacopeia because our grandparents did not take medicine [biomedical drugs]. They healed themselves well for years with roots and plants. In my opinion, I would like more collaboration between pharmacists and people who practice pharmacopeia. However, this is rare here. At the university, there is a branch that considers these linkages." Some pharmacists sold herbal medicines, and others agreed with Madame Moreau that biomedical and traditional health care practitioners should collaborate. The majority of my respondents supported a policy of marketing proven herbal remedies and creating a network of reputable traditional health practitioners. Like most of the world, Senegal has no system for certifying and regulating either herbal drugs or traditional healers.
Questions about the intentions of French and, later, black African doctors grew in parallel with French colonial health policy. France's attempts to curb epidemics and promote urban development, often by further subjugating African populations, were skeptically received. French authorities devalued African-owned property, black bodies, and African traditions, and disregarded traditional non-European ideas about health and sanitation in favor of their own theories of contagion. Some of the colonial health policies helped reduce the transmission of disease, but others promoted racial segregation and fostered illness.
Expansion of French Colonial Medicine
During the seventeenth century, France continued building medical facilities, but it also began laying the foundation for policy concerning the health of nonwhites. As early as 1685, France created a public health force to help prevent disease transmission within and between black and white communities in Martinique. From the eighteenth to the early twentieth centuries, the French colonial authorities promoted biomedical techniques and constructed medical establishments as part of France's global imperial colonizing mission. These medical establishments were established primarily to provide health care for European patients; auxiliary clinics and "native" hospitals were built to meet the needs of indigenous populations. The growth of France's overseas biomedical colonial mission connected its disparate colonies. Many of the architects of this mission spent time as colonial bureaucrats, leading to the cross-fertilization of policy connecting the Americas, Africa, Asia, and the Pacific.
France's biomedical policy in Africa was an integral part of its larger colonial policy. As many scholars have illustrated, France attempted to control disease through urban planning, segregation, quarantine, and preventive medicine. Saint-Domingue received special treatment in an imperial ordinance of 1763 that required a series of investments in the colony, mandating the establishment of "a chief of colonies, three doctors, [and] a pharmacist," as well as other health care initiatives. During the next few decades (including after the Haitian revolution), France continued to promote improvements in Saint Domingue's public health system. In Senegal, sustained expansion of biomedicine began in the eighteenth and nineteenth centuries. As early as 1770, authorities planned to establish a surgeon at Saint-Louis and Gorée to provide medical assistance to French workers. In 1787, in response to growing epidemics, plans were developed to create a new hospital to care for the infirm. The hospital was constructed in Saint-Louis between 1820 and 1829.
Between 1850 and 1900, Senegal had two military hospitals, a colonial hospital, a service to import and distribute pharmaceuticals, and a growing contingent of French medical personnel. The first pharmacy was established in Senegal in 1882. This date is significant. The pharmacy profession was expanding in the Western world, and many cities were starting to cultivate pharmacists. During this period, France also began informally training African workers to assist in medical affairs. In addition, Africans who came from the four communes of Saint-Louis, Gorée Island, Dakar, and Rufisque were allowed access to French public health services.
Colonial Medical Personnel
From 1890 to the end of the colonial period, a small contingent of colonial pharmacists managed pharmacy in France's overseas territories. The remaining colonial pharmacists worked in tropical medicine laboratories in France. They helped to develop breakthroughs in germ theory, vaccination, and biomedical drug preparation, which in turn helped promote public health both overseas and at home. Their training included courses in chemistry, biology, and toxicology at the School of Health Services for Colonial Troops (Pharo) in Marseille and at the School of Medicine and Pharmacy in Bordeaux. Pharmacists finished their training with an internship at the Michel-Lévy hospital in Marseille. Physicians were trained in Bordeaux at the School of Naval Health as well as at Pharo. Once trained, they were prepared to provide a variety of services in their colonial posts.
Colonial pharmacists, like their postcolonial counterparts, engaged in a variety of professional functions. They worked as administrators in colonial hospitals, in pharmacies, and in laboratories. Many also taught African auxiliaries and other students at the medical school. A select few served as pharmacy inspectors, a coveted role in the colonial medical service. In addition, their biomedical training in chemistry and other sciences was especially important. The French government firmly regulated who could practice pharmacy in the colony; in French West Africa, a pharmacist had to have a French diploma and pass an examination. Where there were no pharmacies, doctors were authorized to sell medicine.
Pharmacists provided diagnoses, prepared syrups and serums, measured dosages, supervised African personnel, and managed inventory. This latter duty was very important, because they were often stationed in hot, humid climates with unreliable electricity and limited equipment. Supplies were often ordered months in advance, but because of the distance between the metropole and the colony, they sometimes never arrived or arrived in unusable condition. Medical personnel occasionally had to make do with what they had. For example, a prominent colonial medical doctor, Albert Calmette, substituted Asian water buffalo for pigs in tests for the Pasteur Instituted. Substitutions were used in preparing insulin serums, and penicillin was recuperated from urine to be used again. In addition, shea, mango, and other local seed butters were used in place of pomades.
Jean-François Le Blanc worked as a doctor and professor of surgery in France and Cameroon. He served in rural Cameroon in the 1950s, where he ran the only clinic in a five-hundred-kilometer radius. Because of the huge demand for medical care and the limited staff and supplies, he functioned as both specialist and generalist. Like his colonial compatriots in other parts of the global South, he resorted to creativity and innovation to manage his clinic. When supplies ran low, for instance, he had his secretary buy thread in the market to use in surgeries. Innovation at both public and private levels was critical to the growth of medical practice and research in France's empire.
Several prominent pharmacists emerged from France's overseas colonial ranks, and most of them spent time working in French West Africa. Beginning in 1936, Eugène Le Floch worked in Guinea, Chad, and Cameroon, as well as at posts in Indochina. Félix Busson completed his degree at Pharo after working in the military during World War II. Busson was a major figure in colonial French West Africa and spent considerable time in Senegal, where he served as head pharmacist for Dakar's Dantec Hospital from 1950 to 1953. He continued his career with several posts in Asia and Africa. Another prominent pharmacist was Gauthier Pille, who worked in Madagascar and Chad before moving to Dakar. In the 1950s and 1960s, Pille held a variety of positions in Dakar, working as head pharmacist at Dantec Hospital, holding a university professorship, and codirecting a food science laboratory.
Entry and Growth of African Health Care Officials
France's colonial expansion between 1870 and 1918 brought many challenges; one was how to manage overseas medical expansion. In response, France consolidated its overseas medical facilities and personnel. In 1890, an overseas branch of the Pasteur Institute opened in Saigon, followed by others in Madagascar (1901), Congo (1910), and Senegal (1913). Several microbiology and chemistry labs, scientific missions, hospitals, and other facilities were established during this period as well. Pharmacies also spread in the French colonies during the nineteenth century, and one was established in Senegal by the 1880s. This consolidation and expansion of medical facilities was part of a larger development effort (mise en valeur), and significant investment was made in medical facilities and training in French West Africa. Despite habitual siphoning of funds for other projects, major cities in French West Africa became some of the leading providers of health care in sub-Saharan Africa. If they had been allowed to flourish to their full potential, their legacy might be better known today.
In the late nineteenth and early twentieth centuries, France faced a series of disease epidemics in its colonies. Senegal endured a major outbreak of yellow fever in Saint-Louis in 1878 and suffered bubonic plague outbreaks beginning in 1914. Smallpox, influenza, and meningitis were also common during this period. These recurring epidemics were critical to France's approach to medical planning in French West Africa. In July 1914, at a conference of the Local Hygiene Committee, William Ponty, governor general of French West Africa, and other French administrators agreed to demolish buildings and enforce residential segregation in an attempt to reduce transmission of the bubonic plague. These efforts led to the creation of Medina, a segregated African ghetto near the center of Dakar. By August, approximately three thousand people were living there.
At the same time, elections were being held for the French Chamber of Deputies. Blaise Diagne, the Senegalese candidate, was the first African elected to the French assembly. In the next few years, Diagne became an important intermediary between France and Africa on medical policy.
Nascent medical infrastructure coupled with developments in politics and health care helped to ensure the final stages of France's "medical penetration" of French West Africa. French military medical personnel in the colonies were strained, because of their limited numbers. In 1912, forty-two medical doctors were stationed in French West Africa, an increase of only nine since the last decade of the nineteenth century. In 1905, Ernest Roume, then governor general of French West Africa, established the Indigenous Medical Assistance (Assistance médicale indigène, AMI), and this was followed by the appointment of African medical assistants and the founding of a hospital for African patients in 1913.
(Continues...)
Excerpted from Pharmacy in Senegal by Donna A. Patterson. Copyright © 2015 Donna A. Patterson. Excerpted by permission of Indiana University Press.
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Table of Contents
Acknowledgments Introduction 1. France's Biomedical Expansion: Creating African Medical Personnel 2. Practicing Pharmacy 3. Women Own Pharmacies Too: Financing Private Pharmacies 4. House and Street: Negotiating Professional and Private Lives 5. Pharmaceutical Trafficking in Colonial and Postcolonial Senegal Conclusion Notes Selected Bibliography IndexWhat People are Saying About This
Suggests a new interpretation of the role of pharmacists where, far from being minor participants and supporting actors, they instead become key players in health care delivery.
Pharmacy in Senegal demonstrates the ways in which African state intervention—through education, formal loans, and regulation—helped empower a professional class of women and provided the public with greater access to biomedicine.
Tells a very important story about African access to pharmaceuticals and the development of professions, businesses, and commerce related to that access—which is not always legal.
Cutting across the endless association of Africa with pandemic and global intervention, Donna A. Patterson offers a compelling account of robust, home-grown health professions that shows that the continent is firmly a part of the international medical industrial complex. What is more, women have played a major role in this development. This timely book has a great deal to teach us-not least, about innovative approaches to extending care and securing community health.