Paper short abstract:

Using ethnographic method this paper explores the role of traditional healers in mycetoma management in a Sudanese village. Contrary to the general believe the study finds traditional healers play a major disease-management role for mycetoma.

Paper long abstract:

Background:

A large sector of the Sudanese population uses traditional medicine to meet their primary health care needs. This article explores Wad Elnimear villager perspective toward mycetoma. The village is in the southeast of Sudan and constitutes one of the largest endemic areas of the regions predominantly affected by mycetoma.

Methodology:

Data was collected through ethnography. This was combined with in-depth individual interviews and focus group discussions to explore participants' perspectives, perceptions and experiences.

Results

Most of the individuals who had mycetoma visit a tradition healer as a first encounter in the management. The majority of the mycetoma patients dealt with traditional healers during one or more stage of the disease, some of those patients visited more than one healer some of them reported visiting a traditional healer even after visiting a clinical doctor. Patients’ decisions to seek care from both traditional healers and from biomedical health facilities was associated with dissatisfaction regarding the outcomes of the specific treatment modalities. Most of these patients reported trying every management modality.

Conclusion

Traditional healers play a major role in managing/treating people who encounter mycetoma. Lack of qualitative data on the use of traditional medicine in mycetoma has led researchers and policymakers to rely on uncertain estimates. This article contributes to filling in this knowledge gap that surrounds the role of traditional healers in mycetoma treatment in Sudan by showing more depth that traditional healers are a major disease-management and treatment option for rural and peri-urban populations.

Paper short abstract:

The abstract presents about a statistically "not significant" study finding which yet disclosed an important fact about stigma and stigma reduction strategies against an Neglected Tropical Disease known as Podoconiosis.

Paper long abstract:

In 2018, I was in Southern Ethiopia to complete my PhD fieldwork. I wrote a PhD dissertation on podoconiosis, a stigmatized and neglected tropical disease that develops when naturally susceptible individuals walk barefoot in a red clay soil. The overall goal of the study was identifying messages to encourage preventive action and reduce stigmatizing attitudes. To this end, we prepared health messages and conducted a pilot test. We administered a posttest comparison evaluation survey to assess the effectiveness of the training. A Mann-Whitney test showed that the pilot intervention was successful. After the training, I was reading one of the indicators meant to measure stigmatizing attitudes to a teenager. The indicator read us “podoconiosis patients are burden to the community” for which he needed to reply “True” or “False”, for which he replied “very true”. The response didn’t affect the finding of the study as it wasn’t “statistically significant”. I later learned that boy has a podoconiosis patient father who is staying at home due to his disability. As a result, he was forced to discharge all the responsibilities a rural father would expect to do: ploughing, look after the family etc. To perform these, the body had to quit schooling. I realized I was trying to change the attitude of the boy that has been developed based on his lived experience. This panel explains the importance of exploring the everyday lived experiences of patients including processes and practices which cause and mitigate social exclusion to design effective interventions.

Paper short abstract:

In critically engaging multiple possibilities for understanding "pathogenic-threat", medical anthropologists often invoke concepts of "layered-meanings". This general term encompasses multiple theoretical standpoints, from "local-biologies" to "cultural competence". Yet, utility of this term varies.

Paper long abstract:

Medical anthropology needs to re-establish some fundamental elements of “layered-meaning” when discussing so-called “pathogenic-threat”. To appropriately engage with “pathogenic-threat” from a medical anthropological perspective, “layered-meanings” cannot be employed only heuristically. Detail is significant (meaningfully-literally). “Layered-meanings” can reference supposedly “multiple” definitions/concepts/beliefs, located within an apparently “single” group/culture/individual-person. E.g., sometimes in rural Sudan, when suffering from the NTD mycetoma, it is fully understood that mycetoma has a “biomedical cause” (bacteria/fungi in soil), but it is equally believed to be caused by God as a consequence of “wrong-doing”.

Yet, relational “layered” local-perspectives on “pathogenic-threat” (sometimes “local-biologies”; e.g. Lock, Nguyen, 2011) can also fragment/diverge when bio-cultural meanings “spread” in similar ways to “pathogenic-threat” itself. E.g.: varying profiles of Influenza-A-H1N1 in Mexico/the United States, named “a mosaic” of divergent “local epidemics within the framework of the broader pandemic.” (Singer, 2018). Demonstrated on an even larger-scale by COVID-19 and its undeniable “global" influence, yet huge amount of “local” diversity. Including: differing levels of regional-infection; differing national-political responses/socio-economic impact(s); degrees of available treatment/care; and more ambiguous examples, incorporating what media calls: “Indian-COVID”, a microbiological-variation of “COVID-19” - intriguingly, otherwise considered a “global-disease”, persistently interpreted as both a “singular” viral-pathogenic-threat and an "all-encompassing" term or concept.

Global-local examples indicate forms of “physicalised-conceptual” layered-meanings and “variations” (verbal-conceptual-microbiological), demanding heightened, more "elastic", considerations of relationality from “new positions” of critical engagement within medical anthropology. Our “layered meanings-definitions-understandings” of "pathogenic-threat" clearly do not “stay in one place”, either literally or metaphorically. Yet they can also facilitate greater clarity to work towards-in-with.

Paper short abstract:

On World Neglected Tropical Disease Day 2022, a network of 'stakeholders' will launch the Kigali Declaration on Neglected Tropical Diseases. This paper explores how such global documents emerge, what work they do, what power they are imagined to have and what practices they produce.

Paper long abstract:

On the 30th January 2022, World Neglected Tropical Disease Day, a network of 'stakeholders' will formally launch the Kigali Declaration on Neglected Tropical Diseases (NTD). This 2000-word document will set out the planned commitments of different categories of stakeholders to reducing the number of people requiring interventions for NTDs by 90%. It is described by its authors as a ‘high level political framework’ with ‘the power to mobilise resources, with peers standing shoulder to shoulder for the collective good’. Such declarations are ways of officially making known commitments, yet carry with them no ways of making them legally binding. This paper asks how those involved in the creation of such documents imagine their policy rhetoric will turn into action and what inspires belief in their efficacy. It explores how such documents emerge, what work they do, what power they are imagined to have and what practices they produce.