The Holy Spirit in the Household: Pentecostalism, Gender, and Neoliberalism in Mozambique

Concrete violence, indifference and future-making in Mozambique

In the Mozambican suburb of Inhapossa, piles of fresh concrete blocks vividly convey a sense of the momentous transformation under way in a place where building is now described as being ‘in fashion’. Exuding promises of a better future, this fresh concrete is emerging amidst the ruins of a not so distant violent past, in a country where the built environment has been scarred by decades of war, economic decline, neglect and vegetalization. If ruins are reminders of what once was or of what could have been, what do they become in a context of growing prosperity? The contrast between fresh and rotting concrete seemed to beg for anthropological attention, to call for an approach that would simultaneously capture the poetics and politics of concrete throughout its life and even longer afterlife. What my ethnography revealed, however, was that unlike the fresh concrete, which inspired songs and made people fall in love, the decaying concrete scattered across the suburb often inspired little more than indifference. By examining how Mozambicans remember the past and project themselves into the future through their engagement with the built environment, I propose to approach indifference neither as refusal to engage, nor simply as silence, and certainly not as political illiteracy, but rather as an affective experience in its own right that speaks of a particular orientation towards the future.

Exploring the knowledge, explanatory models of illness, and patterns of healthcare-seeking behaviour of Fang culture-bound syndromes in Equatorial Guinea

In 1994, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) included "culture-bound syndromes" in its classification of psychiatric disorders and associated them with disease processes that manifest in behavioural or thought disorders that develop within a given cultural context. This study examines the definitions, explanatory models, signs and symptoms, and healthcare-seeking behaviours common to Fang culture-bound syndromes (i.e., kong, eluma, witchcraft, mibili, mikug, and nsamadalu). The Fang ethnic group is the majority ethnic group in Equatorial Guinea. From September 2012 to January 2013, 45 key Fang informants were selected, including community leaders, tribal elders, healthcare workers, traditional healers, and non-Catholic pastors in 39 of 724 Fang tribal villages in 6 of 13 districts in the mainland region of Equatorial Guinea. An ethnographic approach with an emic-etic perspective was employed. Data were collected using semi-structured interviews, participant observation and a questionnaire that included DHS6 key indicators. Interviews were designed based on the Cultural Formulation form in the DSM-5 and explored the definition of Fang cultural syndromes, symptoms, cultural perceptions of cause, and current help-seeking. Participants defined "Fang culture-bound syndromes" as those diseases that cannot be cured, treated, or diagnosed by science. Such syndromes present with the same signs and symptoms as diseases identified by Western medicine. However, they arise because of the actions of enemies, because of the actions of spirits or ancestors, as punishments for disregarding the law of God, because of the violation of sexual or dietary taboos, or because of the violation of a Fang rite of passage, the dzas, which is celebrated at birth. Six Fang culture-bound syndromes were included in the study: 1) Eluma, a disease that is targeted at the victim out of envy and starts out with sharp, intense, focussed pain and aggressiveness; 2) Witchcraft, characterized by isolation from the outside, socially maladaptive behaviour, and the use of hallucinogenic substances; 3) Kong, which is common among the wealthy class and manifests as a disconnection from the environment and a lack of vital energy; 4) Mibili, a possession by evil spirits that manifests through visual and auditory hallucinations; 5) Mikug, which appears after a person has had contact with human bones in a ritual; and 6) Nsamadalu, which emerges after a traumatic process caused by violating traditions through having sexual relations with one's sister or brother. The therapeutic resources of choice for addressing Fang culture-bound syndromes were traditional Fang medicine and the religious practices of the Bethany and Pentecostal churches, among others. Among African ethnic groups, symbolism, the weight of tradition, and the principle of chance in health and disease are underlying factors in the presentation of certain diseases, which in ethno-psychiatry are now referred to as culture-bound syndromes. In this study, traditional healers, elders, healthcare professionals, religious figures, and leaders of the Fang community in Equatorial Guinea referred to six such cultural syndromes: eluma, witchcraft, kong, mibili, mikug, and nsamadalu. In the absence of a multidisciplinary approach to mental illness in the country, the Fang ethnic group seeks healthcare for culture-bound syndromes from traditional healing and religious rites in the Evangelical faiths.

The symbolic efficacy of medicinal plants: practices, knowledge, and religious beliefs amongst the Nalu healers of Guinea-Bissau

BACKGROUND

In attempting to understand how the use of medicinal plants is symbolically valued and transformed according to specific cosmologies, we gain valuable insight into the ethnopharmacologial practices, in terms of the major role played by healers, as custodians of local ethnobotanical knowledge, but also as ritual masters. Thus, the goal of this paper is to understand how medicinal plants are used differently depending on a combination between the healers' field of expertise and personal history on the one hand, and the diversified religious and symbolical frameworks on the other.

METHODS

This essay is based on intense ethnographical research carried out amongst the Nalu people of Guinea-Bissau. Methods included participant observation and semi-directed interviews with six locally-renown healers (four men and two women). The progress of their work and the changes operated within the sets of beliefs associated with ethnopharmacological practices were registered by means of repeated field visits.

RESULTS

A total of 98 species and 147 uses are accounted for, as well as a description of the plant parts that were used, as well as the methods of preparation and application according to the different healers' specialized practices. At the same time, this research describes those processes based on pre-Islamic and Muslim cosmologies through which medicinal plants are accorded their value, and treatments are granted their symbolic efficiency.

CONCLUSIONS

Medicinal plants are valued differently in the pre-Islamic medicine and in the medicine practiced by Islamic masters. The increasing relevance of Islam within this context has affected the symbolic framework of ethnopharmacological practices. Nevertheless, the endurance of those processes by which symbolic efficiency is attributed to local treatments based on plants is explained not only by the syncretic nature of African Islam, but also by the fact that patients adopt different therapeutic pathways simultaneously.

Neoliberalism

Neoliberalism has been a popular concept within anthropological scholarship over the past decade; this very popularity has also elicited a fair share of criticism. This review examines current anthropological engagements with neoliberalism and explains why the concept has been so attractive for anthropologists since the millennium. It briefly outlines the history of neoliberal thought and explains how neoliberalism is different from late capitalism. Although neoliberalism is a polysemic concept with multiple referents, anthropologists have most commonly understood neoliberalism in two main ways: as a structural force that affects people's life-chances and as an ideology of governance that shapes subjectivities. Neoliberalism frequently functions as an index of the global political-economic order and allows for a vast array of ethnographic sites and topics to be contained within the same frame. However, as an analytical framework, neoliberalism can also obscure ethnographic particularities and foreclose certain avenues of inquiry.

Becoming and remaining community health workers: perspectives from Ethiopia and Mozambique

Many global health practitioners are currently reaffirming the importance of recruiting and retaining effective community health workers (CHWs) in order to achieve major public health goals. This raises policy-relevant questions about why people become and remain CHWs. This paper addresses these questions, drawing on ethnographic work in Addis Ababa, the capital of Ethiopia, between 2006 and 2009, and in Chimoio, a provincial town in central Mozambique, between 2003 and 2010. Participant observation and in-depth interviews were used to understand the life histories that lead people to become CHWs, their relationships with intended beneficiaries after becoming CHWs, and their social and economic aspirations. People in Ethiopia and Mozambique have faced similar political and economic challenges in the last few decades, involving war, structural adjustment, and food price inflation. Results suggest that these challenges, as well as the socio-moral values that people come to uphold through the example of parents and religious communities, influence why and how men and women become CHWs. Relationships with intended beneficiaries strongly influence why people remain CHWs, and why some may come to experience frustration and distress. There are complex reasons why CHWs come to seek greater compensation, including desires to escape poverty and to materially support families and other community members, a sense of deservingness given the emotional and social work involved in maintaining relationships with beneficiaries, and inequity vis-à-vis higher-salaried elites. Ethnographic work is needed to engage CHWs in the policy process, help shape new standards for CHW programs based on rooting out social and economic inequities, and develop appropriate solutions to complex CHW policy problems.

Public counselling: Brazilian Pentecostal intimate performances among urban women in Mozambique

Analysing the public character of Brazilian Pentecostal counselling sessions in urban Mozambique, this paper aims to examine the configurations of exposure through which counselling acquires and produces sociocultural forms of intimacy. During 'therapy of love' sessions held by the Brazilian Universal Church of the Kingdom of God, strict bodily acts need to be performed publicly to authorise love. Drawing on the notion of religious habitus, the paper focuses on how the performativity of Brazilian Pentecostal counselling practices responds to and shapes a public culture of love and intimacy among upwardly mobile women in urban Mozambique, and how the performative scripts converts carry out during therapy result in ambiguous relationships.

Pentecostalism and AIDS treatment in Mozambique: creating new approaches to HIV prevention through anti-retroviral therapy

Pentecostal fervor has rapidly spread throughout central and southern Mozambique since the end of its protracted civil war in the early 1990s. In the peri-urban bairros and septic fringes of Mozambican cities African Independent Churches (AICs) with Pentecostal roots and mainstream Pentecostals can now claim over half the population as adherents. Over this same period another important phenomenon has coincided with this church expansion: the AIDS epidemic. Pentecostalism and HIV have travelled along similar vectors and been propelled by deepening inequality. Recognising this relationship has important implications for HIV/AIDS prevention and treatment strategies. The striking overlap between high HIV prevalence in peri-urban populations and high Pentecostal participation suggests that creative strategies, to include these movements in HIV/AIDS programming, may influence the long-term success of HIV care and the scale-up of anti-retroviral treatment (ART) across the region. The provision of ART has opened up new possibilities for engaging with local communities, especially Pentecostals and AICS, who are witnessing the immediate benefits of ARV therapy. Expanded treatment may be the key to successful prevention as advocates of a comprehensive approach to the epidemic have long argued.

Traditional healers and laypeople: a qualitative and quantitative approach to local knowledge on medicinal plants in Muda (Mozambique)

ETHNOPHARMACOLOGICAL RELEVANCE

Through this study, relevant information was gathered on the knowledge about medicinal remedies in some rural communities of Muda (central Mozambique). The use of 198 different medicinal plants has been recorded and a significant number of medicinal species and uses new for Africa and particularly for Mozambique has been detected. Our investigation appears to be the first comparing knowledge about medicinal plants between laypeople and traditional healers and also between the two kinds of healers (curandeiros and profetas).

MATERIALS AND METHODS

Ethnobotanical data were gathered through semi-structured interviews with 67 informants: 9 curandeiros (traditional healers believed to be guided by spirits), 12 profetas (independent Pentecostal churches "prophets" healing both souls and bodies) and 46 untrained lay villagers. Data were entered in a data base and processed, also by means of suitable quantitative indexes.

RESULTS

A total of 546 citations were recorded for 198 different ethnospecies (i.e. basic ethno-taxonomical units). The species with the highest cultural value (estimated with Cultural Importance index) resulted to be Ximenia caffra (CI=0.224), Zanha golungensis (CI=0.194) Vernonia colorata (CI=0.149) and Ozoroa reticulata and Holarrhena pubescens (both with CI=0.134). Eight out of the 162 identified plants mentioned by the informants were not previously recorded as medicinal plants in Africa: Cissus bathyrhakodes, Clematis viridiflora, Combretum goetzei, Dioscorea cochleari-apiculata, Grewia pachycalyx, Indigofera antunesiana, Ipomoea consimilis, Tricliceras longipedunculatum. More than half of the species reported by our informants and already known as medicinal in Africa resulted to be newly documented for Mozambique. Comparing the mean number of species known by each informant group, statistically significant differences were observed both between curandeiros and laypeople and between profetas and laypeople. No significant differences emerged instead between curandeiros and profetas. Yet, even laypeople proved to hold quite a good knowledge about medicinal remedies; women in particular use several different plants to heal common diseases of the whole family, mostly for children and female health problems.

CONCLUSIONS

The high number of plants and uses recorded demonstrates that in the study area ethnobotanical knowledge is still quite rich and alive. The finding of many medicinal plants and uses new for Mozambique or even Africa shows the importance of recording this knowledge before it vanishes, also as a basis for further investigations on possible pharmacological properties of local plants. The lack of health infrastructures in Muda results in the need for lay villagers of acquiring and developing a rather high degree of knowledge about plants remedies; in a different interaction between healers and lay villagers, compared to urban areas; ultimately, in a different distribution and wider spread of traditional knowledge on medicinal plants.

Influence of religious affiliation and education on HIV knowledge and HIV-related sexual behaviors among unmarried youth in rural central Mozambique

The interactions between religious affiliation, education, HIV knowledge, and HIV-related sexual behaviors among African church youth are poorly understood. In this socio-demographic study, 522 unmarried youth 12-28 years old in rural central Mozambique were surveyed with a structured questionnaire. Using binary logistic regression analysis, we used religious affiliation and education to measure influence on (1) HIV transmission and prevention knowledge and attitudes and (2) HIV-related sexual behaviors among youth. Religiously affiliated males were more likely than non-religious males to know when a condom should be used, respond correctly to HIV transmission questions and respond with less stigma to HIV-related scenarios. Increased levels of education among males corresponded significantly to increased knowledge of condom usage and HIV prevention strategies and less likelihood to respond with stigma. Only education levels influenced young female responses. Religious affiliation and education had minimal effects on sexual activity, condom usage, and multiple partnerships. African Independent Church/Zionist males were 1.6 times more likely to be sexually inexperienced than non-religious males but were also significantly less likely to use condoms (0.23, p=0.024). Non-religious youth were most likely to have visited sex workers and did not use condoms. These results suggest that religious affiliation, possibly as the result of educational opportunities afforded by religious-affiliated schools, is contributing to increased HIV transmission and prevention knowledge among youth in rural Central Mozambique but not influencing HIV-related sexual behavior. The need exists to strengthen the capacity of religious congregations to teach about HIV/AIDS and target non-religious youth with HIV transmission and prevention information.

"All I eat is ARVs": the paradox of AIDS treatment interventions in central Mozambique

The number of people on antiretroviral treatment in Mozambique has increased by over 1,500 percent since it first became free and publicly available in 2004. The rising count of "lives saved" seems to portray a success story of high-tech treatment being provided in one of the poorest contexts in the world, as people with AIDS experience dramatic recoveries and live longer. The "scale-up" has had significant social effects, however, as it unfolds in a region with a complicated history and persistent problems related to poverty. Hunger is the principal complaint of people on antiretroviral treatment. The inability of current interventions to adequately address this issue leads to intense competition among people living with HIV/AIDS for the scarce resources available, undermining social solidarity and the potential for further community action around HIV/AIDS issues. Discourses of hunger serve as a critique of these shortcomings, and of the wider political economy underlying the HIV/AIDS epidemic.

Anthropological Perspectives on Structural Adjustment and Public Health

Thirty years since its first public use in 1980, the phrase structural adjustment remains obscure for many anthropologists and public health workers. However, structural adjustment programs (SAPs) are the practical tools used by international financial institutions (IFIs) such as the International Monetary Fund (IMF) and the World Bank to promote the market fundamentalism that constitutes the core of neoliberalism. A robust debate continues on the impact of SAPs on national economies and public health. But the stories that anthropologists tell from the field overwhelmingly speak to a new intensity of immiseration produced by adjustment programs that have undermined public sector services for the poor. This review provides a brief history of structural adjustment, and then presents anthropological analyses of adjustment and public health. The first section reviews studies of health services and the second section examines literature that assesses broader social determinants of health influenced by adjustment.