T he A nthropological D imension of a P atient's T reatment: a R esponse to P rof . B ernard U geux

A. Issues raised by Bernard Ugeux Ugeux identifies a number of truths about the relationship of culture, health, ill health and healing: 1. Culture determines how health, ill health and healing are understood in a particular context. It offers explanations and specific therapies depending on a given case. 2. A health care system is the product of a culture. Each culture has a health and management system imprinted with its own vision of the person, his or her relationship to other persons, to the cosmos, the environment and invisible reality. 3. Health and illness have several dimensions that include the individual/physical, social, cosmic and spiritual dimensions. 4. Western biomedicine generally ignores the transcendental/spiritual dimension, unlike indigenous healing systems. 5. Generally, regardless of cultural background, people hold subjective explanations for their experiences of illness, which people interpret from their own culture. 6. Healing implies a reconstruction of one's mental and psychological universe, and the religious and cultural reconstruction of disease. It is a reconstruction of meaning. 7. For effective therapeutic interventions, healers should enter into the patient's explanatory systems, i.e. his/her own coherence. This is because every culture has its own system of meaning, with its own internal coherence. 8. Though Western biomedicine has made tremendous strides in finding cures for complicated illnesses, it raises unrealistic expectations, especially the demand for immediate results. 9. There are three spheres of health care, namely, the popular, traditional and professional sectors. Each sector has well defined approaches on aetiology, remedies, and the definition of healer and patient and their roles. B. My response to Ugeux I agree with the issues raised in Ugeux's presentation, and would like to explore their application and manifestation within the context of the understanding of health, ill health and healing in African Instituted Churches (AICs). These are churches that are inculturated in the African context and seem to operate more from within the "African map of the universe". Africans have reflected on health issues at various stages of their encounter with Christianity, especially since the 19th and 20th centuries. Included in these inculturated churches are what have been labelled as "Spiritual/Zionist" AICs and charismatic churches. Although the former churches are said to be declining due to the challenges posed by charismatic churches, they still persist in the rural and urban areas, and often draw their clientele from the older and poorer populations, as, for example, happens in Kenya. In some countries like Nigeria and South Africa the churches have large memberships, and some have reinvented themselves to cope with modern globalizing changes and the aforementioned challenges. One major characteristic of these churches that is at the core of their appeal is their concern with healing. They understand, interpret and mediate health and healing from an African cultural and biblical perspective. Ill health is also understood from within the churches' worldview. Dynamic African cultures today are a mixture of traditional value systems, beliefs and practices, and of new value systems imbibed from foreign cultures. In African understanding, health is a state that entails mental, physical, spiritual, social and cosmic (environmental) harmony. Having health implies equilibrium in all these dimensions. Health is associated with all that is positively valued in life. It is also a sign of a correct relationship between people and their environment, with one another and with God. Illness is viewed not just as a physical condition, but a religious matter as well. As Pobee argues "A traditional African assumes a metaphysical aspect to health and its absence and healing. …