2 Geest1991 Marketplace Conversations in Cameroon

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    70 SJAAK VAN DER GEESTwhat they know, we enhance our understanding of such knowledge.

    The issue of the circumstantiality of knowledge is of particular relevance tomedical anthropology. For a long time medical knowledge has been regarded asa more or less firm foundation for the selection of indicated medical interven-tions, a charter for preventive and curative actions. By knowing the charter, itwas believed, one could see the rationality of medical actions. A very sophisti-cated example of this view is Evans-Prichard's classic on Azande witchcraft.

    Recent research and reflection in medical anthropology , however, have calledthis somewhat static and too mechanical picture of medical knowledge intoquestion. Last (1981) has pointed out that indigenous healers among the Hausain Northern Nigeria command no systematic body of medical knowledge. Oneof the most conspicuous characteristics of their practice is not-knowing. Bothhealers and patients share a certain disinterest in medicine. When trying toconstruct a Hausa medical dictionary, Last found that "a large proportion ofmedical words (but especially terms for illnesses) have no standard meaning"(p. 390). He refers to Hausa indigenous medicine as a non-system.

    Tedlock, who did fleldwork among the Maya in the highlands of Guatemala,also challenges the over-systematic bias of most medical anthropologists. Sherefers to the hot-cold dichotomy ascribed to Latin American indigenousmedicine, as 'native etics', i.e., anthropological claims about what the nativesthink. The hot-cold concept, she writes, is "blown up out of proportion in theprocess of answering anthropological questions" (Tedlock 1987:1080). 'Nativeemics' (what the natives really think...) are far more complex and inconsistent.She illustrates her contentions with fragments from interviews in which peoplecontradict themselves continuously and prove extremely opportunistic in whatthey say they think and how then act. When a young Maya was asked why a hotpoultice was used to treat a hot illness, he answered: "Well, it's because itworks! You only think about the hot-cold when you're not sure what to do"(Tedlock 1987:1075).

    Young (1981), who carried out fleldwork in Ethiopia, discusses epistemologi-cal problems in the creation of medical knowledge. He argues that people'smedical knowledge is fragmentary and changes continuously with the changingcircumstances in which they find themselves. What we call knowledge oftenproves - in Western terminology - mere rationalisation. Medical 'knowledge'both precedes and follows therapeutic decisions. 1...An actor's medical knowledge (belief) and his statements are not epistemologicallyhomogeneous. That is, he does not know all of his facts in the same way. This isaccounted for by the fact that his knowledge is recursive and processual, in the sense thathe continually evaluates it against his intentions, expectations, and perceptions of events,and sometimes he compares it with other bits of his knowledge of similar events (Young1981:379).It would be inconsistent for anthropologists not to apply the same analysis to

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    MA RKETP LACE CONVERSATIONS IN CAMEROON 71t h e i r o w n p r o d u c t i o n o f k n o w l e d g e . S e v e r a l a u t h o r s ( s e e, e . g ., M a r c u s a n dC u s h m a n 1 9 8 2; C l i f f o r d a n d M a r c u s 1 9 8 6; G e e r t z 1 9 8 8 ) h a v e d i s c u s s e d h o we t h n o g r a p h i c t e x t s e m e r g e . T h e y e m p h a s i s e t h a t t h e s e t e x t s , l i k e l i t e r a r y o n e s ,a d h e r e t o s t y l i s t i c c o n v e n t i o n s w h i c h c h a n g e f r o m p e r i o d t o p e r i o d . T h es c i e n ti f ic a u t h o r i t y o f a t e x t m a y d e p e n d a g r e a t d e a l o n i ts s t y l is t ic p r e s e n t a ti o n .M a n y a n a n t h r o p o lo g i s t h a s c o m e t o d i s c o v e r th a t th e j o u r n e y f r o m f i e ld w o r k t op u b l i c a t i o n i s l o n g a n d w i n d i n g . A l o n g t h e w a y h e m a y f i l t e r h i s e x p e r i e n c e sa g a i n a n d a g a i n , u n t i l h e f e e l s t h e y d i s p l a y t h e f i g h t c o l o u r s , w h i c h a r e l i k e ly t ob e t h o s e o f t h e l a t e s t f a s h i o n .

    I n t h is p a p e r I h a v e s e t m y s e l f th e t a s k o f d e m o n s t r a t in g h o w m e d i c a l a s w e l la s e t h n o g r a p h i c k n o w l e d g e a r e p r o d u c e d , m o r e o r l e s s s i m u l t a n e o u s l y , i n ac o m m o n e f f o r t . I s h a l l d e s c r i b e h o w p o p u l a r m e d i c a l k n o w l e d g e c o m e s i n t ob e i n g o n a m a r k e t i n E b o l o w a , a p r o v i n c i a l t o w n i n t h e s o u t h o f C a m e r o o n . Iw i l l p r e s e n t t h re e p i e c e s o f c o n v e r s a ti o n b e t w e e n a v e n d o r o f m e d i c i n e s , t w o o fh i s c u s t o m e r s a n d m y s e l f . I h o p e t o c o n v i n c e t h e r e a d e r t h a t t h e m e d i c a lk n o w l e d g e w h i c h t h e t h r e e C a m e r o o n i a n s p r e s e n t i s p r o d u c e d i n , a n d i s p a r t o f ,a s p e c i f i c s o c i a l s e tt in g . I s h a l l in c l u d e s c r u t in y o f m y o w n r o l e i n t h a t p r o d u c -t i o n p r o c e s s , w h i c h w a s m a i n l y o n e o f e l i c i t i n g s t a t e m e n t s . T h e a r t i c l e t h u sa n s w e r s K l e i n m a n ' s ( 1 9 80 ) c a ll f o r m o r e r e s e a r c h i n to p o p u l a r m e d i c a l b e l ie f sa n d p r a c t i c e s , e s p e c i a l l y i n t o p e o p l e ' s e f f o r t s a t s e l f - m e d i c a t i o n . T h e p a p e r ,t r i g g e r e d b y o b s e r v a t i o n o f a p o o r v e n d o r o f o f t e n e x p i r e d d r u g s a n d h i s c l i e n ts ,e x p l o r e s t h e s e p e o p l e ' s s i t u a t i o n a l a n d o p p o r t u n i s t i c e x p l a n a t i o n s o f i l l n e s s a n dt r e a t m e n t .

    RESEARCH SETTING AND CONVERSATIONSI n 1 9 80 I c a r d e d o u t m e d i c a l - a n th r o p o l o g i c a l r e s e a rc h i n t h e N t e m D i v i s i o n o fS o u t h e r n C a m e r o o n . T h e r e s e a r c h w a s n o t o n ' t r a d i t i o n a l m e d i c i n e ' , a s o n em i g h t e x p e c t f r o m a n a n t h r o p o l o g i s t , b u t o n t h e d is t ri b u t io n a n d u s e o f W e s t e r np h a r m a c e u t i c a l s . A t t h a t t i m e c r i t i c s h a d s t a r t e d t o b l a m e t h e i n t e r n a t i o n a lp h a r m a c e u t i c a l i n d u s t r y f o r d u b i o u s m a r k e t i n g p r a c t i c e i n d e v e l o p i n g c o u n t r i e s .I t s t r u c k m e t h a t s u c h a c c u s a t i o n s r a r e l y i n c l u d e d a n y e y e - w i t n e s s a c c o u n t o fw h a t h a p p e n e d t o t h e s e m e d i c i n e s a t t h e l o c a l l e v e l . R e c a l l i n g m y e a r l i e rr e s e a r c h e x p e r i e n c e w i t h th e w i d e s p r e a d i n f o r m a l s a l e o f m e d i c i n e s i n G h a n a , Id e c i d e d t o c o n c e n t r a t e m y f i e l d w o r k o n h o w p h a r m a c e u t i c a l s w e r e d i s t r i b u t e dou t s ide o f f i c i a l channe l s , i . e . , ou t s i de hosp i t a l s , hea l t h cen t r e s and pha rmac i e s .M y i n i t i a l h u n c h p r o v e d a c c u r a t e : p h a r m a c e u t i c a l s , i n c l u d i n g s o - c a l l e dp r e s c r i p t i o n - o n l y d r u g s , w e r e s o l d f r e e l y ( w i t h o u t a p r e s c r i p t i o n ) i n s h o p s ,k i o s k s , m a r k e t b o o t h s a n d e v e n i n th e t o w n ' s p h a r m a c y .

    T h e r e a s o n s f o r th i s s o o n b e c a m e c l e a r t o m e . T h e p u b l i c h e a l t h s e r v i c e s d i dn o t f u n c t i o n a s th e y s h o u l d . T h e y w e r e o f t e n s h o r t o f m e d i c i n e s a n d o t h e r

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    7 2 S JA A K V A N D E R G E E S Tm a t e r i a l s a n d m a n y o f t h e i r n u r s e s a n d d o c t o r s f e l t fr u s t ra t e d a b o u t t h e i r j o b s ;t h e y c o u l d n o t d o t h e i r w o r k d u e t o t h e s e s h o r t a g e s , th e i r l i v i n g c o n d i t io n s w e r eo f t en p o o r a n d t h e ir p a ti e nt s b l a m e d t h e m f o r n o t b e in g a b l e to p r o v i d e p r o p e rc a r e . M e d i c i n e s a n d t r e a t m e n t i n t h e p u b l i c s e r v i c e s w e r e o f f i c i a l l y f r e e o fc h a r g e , b u t o f t e n p a t i e n t s h a d t o p a y s o m e t h i n g i n o r d e r t o g e t h e l p . N o ti n f r e q u e n t l y p a t i e n t s a l s o d i s c o v e r e d t h a t n o m e d i c i n e s w e r e a v a i l a b l e a n d t h e yh a d t o t r a v e l to t h e n e a r e s t s h o p o r p h a r m a c y t o b u y t h e p r e s c r i b e d m e d i c a t i o n s .' N e a r e s t ' c o u l d m e a n u p t o a d a y o f t r a v el , in c l u d i n g t h e t i m e s p e n t w a i t i n g f o rt r a n s p o r t a t i o n . S o m e t i m e s t h e y d i d n o t e v e n f i n d a n y o n e p r e s e n t a t t h e h e a l t hc e n t re . I n a c t u a l p r a c t i c e , t h e r e fo r e , t h e s o - c a l l e d f r e e s e r v i c e o f t e n p r o v e d t o b eq u i t e e x p e n s i v e b e c a u s e i t f o r c e d p e o p l e t o p a y f o r t r a n s p o r t a t i o n a n d t o b u yt h e i r m e d i c i n e s e l s e w h e r e . I t a l s o c o s t th e m c o n s i d e r a b l e t i m e .

    A p a r t f r o m t h e p u b l i c s e r v i c e s t h e r e w e r e p r i v a t e , m o s t l y c h u r c h - r e l a t e d ,h o s p i t a l s a n d h e a lt h c e n t r e s a n d c o m m e r c i a l p h a r m a c i e s . A l l o f t h e s e f u n c t i o n e dr e l a t i v e l y w e l l . T h e y h a d a r e g u l a r s u p p l y o f d r u g s a n d t h e i r p e r s o n n e l w e r e a tt he i r pos t s .

    F i n a l l y , t h e r e w a s t h e i n f o r m a l p r i v a t e s e c t o r w h e r e m e d i c i n e s w e r e t r a d e d .T h o s e t a k i n g p a r t i n t h i s t r a d e c o n s t i t u t e d a ' h e t e r o g e n e o u s g r o u p . M o s t w e r eo r d i n a r y v e n d o r s w h o s o l d g e n e r a l p r o v i s i o n s , in c l u d in g m e d i c i n e s , i n s h o p s a n dk i o s k s . I n t h e d i v i si o n c a p i ta l E b o l o w a t h e re w e r e a p p r o x i m a t e l y 7 5 s u c h s h o p sa n d k i o s k s w h e r e o n e c o u l d p u r c h a s e a t l e a st o n e o r tw o t y p e s o f m e d i c i n e s . As e c o n d c a t e g o r y c o n s i s t e d o f m a r k e t v e n d o r s w h o s o l d m e d i c i n e s a l o n g s i d eo t h e r p r o d u c t s . A t h i r d g r o u p c o u l d b e s t b e r e f e r r e d t o a s ' h a w k e r s ' . T h e yt r a v e l l e d f r o m v i l l a g e t o v i l l a g e d u r i n g t h e c o c o a h a r v e s t s e a s o n w h e n t h ev i l l a g e r s h a d s o m e e x t r a m o n e y a t t h e i r d i s p o s a l . T h e s e h a w k e r s p r o v i d e d av a r i e t y o f a r t ic l e s in a d d i t io n t o m e d i c i n e s . A f o u r t h c a t e g o r y c o n s i s t e d o ft r a d e r s w h o w e r e s p e c i a l i z e d in th e s a l e o f m e d i c i n e s a n d h a d a m u c h l a r g e ra s s o r t m e n t t h a n t h e p r e v i o u s l y - m e n t i o n e d g r o u p s . I n E b o l o w a I e n c o u n t e r e df o u r s u c h t r a d e r s . T h e y n o t o n l y s o l d m e d i c i n e s b u t a l s o g a v e m e d i c a l a d v i c ew h e n a s k e d . O n e o f t h e m g a v e i n j e c ti o n s a s w e ll . A f i f t h g r o u p c o m p r i s e dm e d i c a l i n s ti tu t io n p e r s o n n e l . S o m e o f t h e m p r i v a t e l y s o ld m e d i c i n e s w h i c hw e r e s u p p o s e d t o b e p r o v i d e d t o t h e p a t ie n t s f r e e o f c h a rg e .

    S e l l er s o f m e d i c i n e s i n th e i n f o r m a l s e c t o r m a i n l y o b t a i n e d t h e i r p r o d u c t sf r o m t h r e e s o u rc e s : m e d i c i n e s w e r e s m u g g l e d i n to C a m e r o o n f r o m n e i g h b o r in gN i g e r i a a n d d i s t ri b u t e d th r o u g h o u t t h e c o u n t r y ; th e y w e r e p u r c h a s e d - w i t h o u tp r e s c r i p t io n s - f r o m l e g a l l y e s ta b l i s h e d p h a r m a c i e s a n d s o l d a t a p r o f it ; t h e yw e r e b o u g h t f r o m m e d i c a l s e r v i c e p e r s o n n e l w h o t h u s t r ie d t o e a r n s o m e e x t r ai n c o m e .

    T h e s e p r i v a t e s e rv i c e s - b o t h f o r m a l a n d i n f o r m a l - a r e li v i n g p r o o f o f th em a l f u n c t i o n i n g o f p u b l i c h e a l th c a r e . T h e y e x i s t b e c a u s e a n d w h e r e t h e p u b l i cs e r v i c e s d o n o t a c h i e v e th e i r o b je c t i v e s . M y e s t i m a t e is t h a t a b o u t o n e - h a l f o f a llm o d e m h e a l t h c a r e d e l i v e r y i n C a m e r o o n o c c u r s o u t s id e t h e p u b l i c s e r v i c e s. T h e

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    MARKETPLACE CONVERSATIONS IN CAMEROON 73informal circuit has acquired a crucial position in daily health care, next to theprivate hospitals and health centres.

    There are at least four reasons why informal drug vendors respond even betterto the needs of poor people than the formal institutions. All four are related toavailability and attainability. First, drugs from vendors are more affordable.Clients can purchase as little or as much as they need for self-treatment at thatmoment. Second, drug vendors are geographically more accessible than othersources. A vendor can always be found within a radius of a few kilometers fromwhere one lives, but a pharmacy or health centre with drugs may be 50 or morekilometers away. Third, most vendors are available day and night. Their shopsonly close when everybody goes to bed; even after 'closing', it is usuallypossible to buy medicines if necessary. This flexibility contrasts sharply with thestrict time schedule to which the formal services adhere. The fourth reason forthe drug vendors' popularity is that the social distance between them and theirclients is much smaller than that in the formal sector. In a shop it is possible tolook around, examine various products and ask questions about how they shouldbe used. Such behaviour is not possible in a hospital or pharmacy.

    There are, however, also disadvantages to buying from a drug vendor. Clientsknow, for example, that the products they buy are often of inferior quality. Thechoice of medicines is limited and vendors are known to have little medicalknowledge. The preference for a drug vendor should be viewed within thecontext of the total range o f therapeutic choices. People with a medical problemwill first try a treatment which costs them little. Only when this fails will other,more costly and more inconvenient, steps be taken (see further Van der Geest1982, 1987, 1988).

    It was in the informal circuit that I came to know Mr. D., an old man who soldWestern medicines in one of the three markets of Ebolowa. The man, a Bulu,had been a cocoa farmer before. Since losing one of his legs after an accident onhis farm, he had tried to eke out an existence by selling medicines. Some fortydifferent Western drugs were usually spread out on a small table in from of him.Of some kinds of medicine, only a small supply appeared available, of othersmuch more was in evidence. Some were in their original packing, others were injars and boxes without a label. I estimate some 75% of his products would fallunder the category of 'prescription-only'.

    The old man's sitation, let me emphasise, was extremely miserable. Owing tohis handicap he could not move. He spent day and night on his comer at the'market', not the real town market but the former lorry station, a place in thecentre of the town. Here many people were always passing by, those whoarrived in town and those who were waiting for a taxi. I noticed that somepeople left their luggage with the old man while they did their shopping. The'market' was a covered place about 10 meters wide and 30 meters long. It heldan estimated ten booths where one could buy snacks, drinks and daily neces-

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    7 4 S J A A K V A N D E R G E E S Ts i ti e s. I n t w o b o o t h s m e d i c i n e s w e r e s o ld . B e t w e e n t h e b o o t h s s t o o d w o o d e nb e n c h e s w h e r e p e o p l e s a t t o e a t o r r e l a x i n t h e s h a d e , w a i t i n g f o r t r a n s p o r t ,c o n v e r s i n g , o r t a k i n g a n a p .

    I n 1 9 8 0 th e o l d m a n h a d r e c e i v e d a g r a n t o f 3 0 ,0 0 0 C F A ( a b o u t . 6 0) f r o mt h e l o c a l D e p a r t m e n t o f S o c i a l A f f a ir s t o se t u p h i s s m a l l b u s i n e s s ( a l t h o u g hs t r ic t l y s p e a k i n g i t w a s i l l e g a l ) . T h e r e p o r t o f h i s c a s e , m a d e b y t h e s o c i a lw o r k e r , c o n t a i n e d t h e f o l l o w i n g d e s c r i p t i o n o f h i s c o n d i t io n :M r D . , i n c a p a b l e d e c o n t i n u e r l 'e n t r e t i e n d e s a c a c o y ~ r e , d i m i n u 6 , n ' a y a n t a u c u n m o y e nd e d 6 p l a c e m e n t , v i t e n p l e i n a i r ~ l ' a n c i e n s t a ti o n n e m e n t d e s c a r s o u i l d e m a n d e l ' a i d ejourna l i~ r e aux gens de bo nne v o lon t6 e t sym path i san t s de l a v i l l e d 'E bo low a . I1 fu tm6nac6 pa r son f r~ re qu i ne v ou la i t p lus v iv r e avec lu i , r a i son pou r l aque l l e Mr . D . qu i t t ason v i l l ag e na t a l pour a l l e r v iv r e en v i l l e .M r . D . , d i v o r c 6 p e n d a n t u n b o n t e m p s , c o n f i a s o n f i ls ~ s a m ~ r e q u i d e m e u r e ~ M - E .Ce t t e de rn i~ re , v i e i l l e e t f a t iqu6e , s ' occu pe de l ' en t r e t i en de son pe t i t i l l s , cons ide r6c o m m e o r p h e l i n c o m p l e t . M r . D . e s t p u r e m e n t e t s i m p l e m e n t i n d ig e n t .Co mp te t enu de tou t ce qu i p r6c~de , i l se r a i t souha i t ab le d ' ac cor de r un secour sl ' i n t e r ess6 pou r lu i pe rme t t r e de s ' i n s t a l l e r .T h e o l d m a n h a d m a d e a l i t t le sh o p o u t o f p l y w o o d i n o n e o f t h e h o l lo w p i l l a r st h a t s u p p o r t e d t h e r o o f o f t h e m a r k e t . I n t h e n i g h t h e w i t h d r e w t o t h e b a c k o f h i ss h o p w h e r e h e h a d a b e d a n d s o m e p o s s e s s i o n s , m o s t o f t h e m i n o l d b a g s .E v e r y t h i n g l o o k e d s o r d i d , a nd I n e v e r f u ll y u n d e r s t o o d h o w h e m a n a g e d t o l i v e.W h e n I p a s s e d i n t h e n ig h t , I f o u n d h i s p l a c e c lo s e d . H e w a s a t l o g g e r h e a d s w i t hm o s t o f h is r e l a ti v e s w h o m h e a c c u s e d o f t a k i n g th e p r o f i ts f ro m h i s c o c o a f a r m sw i t h o u t p a y i n g h i m a p e n n y . A n o l d w o m a n s e e m e d t o c o n c e r n h e r s e l f w i t h h i mt o s o m e e x t e n t . I a m n o t s u r e i f s h e w a s r e l a t e d t o h i m , n o r d i d I a s k h i mw h e t h e r h e p a i d h e r f o r h e r h e l p . I h a d t h e i m p r e s s i o n t h a t s h e c a r r i e d o u t h e rc h o r e s w h e n v e r y f e w p e o p l e w e r e a r o u n d . O n c e , v e r y e a r l y i n t h e m o r n i n g Is a w h e r e m p t y i n g h i s c h a m b e r p o t i n th e s t r e et , j u s t b e h i n d h i s s t or e. T h e o t h e rv e n d o r s o n t h e m a r k e d h a d l i tt le c o n t a c t w i th h i m . T h e y f o u n d h i m a p e c u l i a ra n d u n p l e a s a n t p e r s o n . H e o f t e n s h o u t e d a t p e o p l e a n d c h i l d r e n w e r e a f r a i d o fh i m . H e p r o f o u n d l y m i s t ru s t e d p e o p l e . O n c e , w h e n a f te r m y a r r i v a l i n to w n Ih a d s e n t a y o u n g b o y t o b r in g m y b a g t o th e o l d m a n ' s p l a c e , h e r e b u k e d m e f o rg i v i n g th e b a g t o s o m e o n e I d i d n o t k n o w . I s h o u l d " T r u s t n o b o d y " , h e s a i d .

    M y v i s it s t o h i m w e r e a c h a n g e i n h i s d r e a ry a n d s o m b e r r o u ti n e . H e c l e a r l ya p p r e c i a t e d th e a t t e n t io n I p a i d h i m . H e u s e d m y c o n c e r n , I s u s p e c t , a s a p r o o f t oo t h e r s th a t h e w a s s o m e b o d y a f t e r a l l . T h a t ' s h o w i n an y e v e n t i t s e e m e d t ow o r k o u t. P e o p l e s p o k e t o m e a b o u t h i m a n d r e f e r re d to h i m a s m y f r i e n d . T h eo l d m a n c a l le d m e docteur b u t a t t h e s a m e t i m e w e a d d r e s s e d e a c h o t h e r w i t h tu,a d i s t i n c t io n w h i c h i n C a m e r o o n i s o f l e ss s i g n i f i c a n c e th a n i t w o u l d b e i nF r a n c e , h o w e v e r .

    I n o u r r e l a ti o n s h i p w e w e r e d e f i n i t e l y n o t e q u a ls . T h e o l d m a n h o p e d t ob e n e f i t f ro m m e i n s o c ia l a n d m a t e r i a l r e s p ec t s . H e n e v e r , h o w e v e r , m a d e h i sr e q u e s ts i n a s u b m i s s i v e w a y . H e k e p t h i s d i g n it y a n d o f t e n e m p h a s i s e d h i s a g e

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    M A R K E T P L A C E C O N V E R S A T I O N S I N C A M E R O O N 7 5a n d g r e a t e r e x p e r ie n c e w h i l e h e a d v i s e d o r c ri t ic i s ed m e . H e h a d c l e v e r w a y s o fp e r s u a d i n g m e t o d o w h a t h e w a n t e d . O n e r e q u e s t h e m a d e c o n t i n u o u s l y f o re x a m p l e , w a s f o r m e t o b u y m e d i c in e s f o r h i m o n m y t r ip s t o Y a o u n d 6 a n d o t h e rt o w n s . O n e d a y , w h e n I t o l d h i m t h a t I d i d n o t i n t e n d t o s u p p l y h i m w i t hm e d i c i n e s , h e s t a rt e d t o la u g h a n d s a i d: " Y o u ( t u ) a r e m y d e c e a s e d b r o t h e r w h oh a s r e t u m e d t o h e l p m e . " I g u e s s i t m e a n t t h a t I h a d t o d o w h a t h e w i s h e db e c a u s e t h e r e w a s n o o n e e l s e t o h e l p h i m . I g i v e t h i s e x a m p l e t o i l l u s t r a t e t h a tw h i l e h e c e r t a i n ly d e p e n d e d o n m e f o r a n u m b e r o f t h in g s , r a th e r t h a n b e g h ec h o s e t o e x e r t p r e ss u r e o n m e .

    T h e r e w e r e o t h e r i n s t a n c e s , h o w e v e r , w h e r e h i s u t t e r h e l p l e s s n e s s a n dd e p e n d e n c e c o u l d h a r d l y b e c o n c e a l e d . H e t r i e d t o c o n v i n c e m e t h a t I s h o u l db u y a w h e e l c h a i r f o r h im . I d i d n o t b u t a r r a n g e d s o m e t h i n g w h i c h I t h o u g h tw o u l d b e m o r e u s e f u l : I h a d a n a r ti fi c ia l l e g m a d e f o r h i m a t t h e h o s p it a l. H ea g r e e d a n d I t o o k h i m a c o u p l e o f t im e s t o t h e h o s p i ta l t o f it th e p r o s t h e s i s . I h a dh o p e d t h a t i t w o u l d m a k e h i m m o r e i n d e p e n d e n t , b u t w h e n t h e l e g f i n a l l ya r r i v e d h e r e f u s e d t o w e a r i t . I t s t ra i n e d o u r r e l a t io n s h i p t o s o m e e x t e n t .

    I n 1 9 8 3 I r e v i s it e d C a m e r o o n a n d s p e n t t w o w e e k s i n E b o l o w a . D u r i n g o n ew e e k I p a i d d a i l y v is i ts t o t he o l d m a n . I b o u g h t f o o d a t t h e m a r k e t w h i c h w e a t et o g e t h e r a n d w e d i s c u s s e d h i s b u s i n e s s . U s u a l l y I s a t n e x t t o h i m a n d w r o t ed o w n w h i c h m e d i c i n e s h e s o ld . I a sk e d h i m a b o u t t h e u s e O f t h e m e d i c i n e s a n dw h e n e v e r h e h a d c l i e n t s ( b u s i n e s s w a s r a r e l y b r i s k ) , I n o t e d d o w n w h a t I h e a r da n d s a w a n d t r i e d t o t a l k w i t h t h e c l i e n t s a b o u t w h a t t h e y h a d b o u g h t . A t f i r s t If o u n d i t d i f f i c u l t . I f e l t u n e a s y i n t h i s r a t h e r i n f o r m a l s i t u a t i o n a n d f e a r e d t h a t Iw o u l d d i s t u r b t h e o l d m a n ' s t r a d e . H e , h o w e v e r , s a w i t v e r y d i f f e r e n t l y . H e w a sp l e a s e d w i t h m y p r e s e n c e a n d a p p a r e n t l y t h o u g h t t h a t I w o u l d a t t r ac t c u s t o m e r s .A f t e r a f e w d a y s I h a d b e c o m e a f a m i l i a r s i g h t a t t h e m a r k e t . S o m e p a s s e r s - b ya n d o t h e r m a r k e t v e n d o r s jo k i n g l y a s k e d t h e o ld m a n i f h e h a d e m p l o y e d a w h i tes e c r e ta r y ( I w a s a l w a y s w r i t in g ) . S o m e t i m e s t h e c li e n ts a s k e d m y a d v i c e a b o u t ap a r t i c u l a r m e d i c i n e . U s u a l l y I a n s w e r e d , t r u t h f u l ly , t h a t I d i d n o t k n o w a n dr e f e r re d t h e m t o t h e o ld m a n .

    I s ha l l n o w r e p o r t t h r e e c o n v e r s a t io n s w h i c h t o o k p l a c e a t t h e o l d m a n ' s s h o p ,t h e f i r s t t w o a b o u t g o n o r r h o e a , t h e t h i r d a b o u t " f i l a i r e s ' . A l l w e r e o r i g i n a l l yc o n d u c t e d i n F r e n c h . T h e c o n v e r s a t i o n s a r e h a r d ly m o r e t h a n a n e c d o t e s w h i c hw i l l s e r v e a s a s t a rt i n g - p o i n t f o r a d i s c u s s i o n . T h e y g a v e d i r e c t i o n t o m yt h o u g h t s , b u t t h e y d i d n o t p r o v i d e a n y t h i n g l i k e ' d a t a ' o n w h i c h I h a v e b a s e d m yi n t e r p re t a t i o n . I t is r a t h e r t h e o t h e r w a y r o u n d : t h e c o n v e r s a t i o n s p o s e d q u e s t i o n sw h i c h I c a n o n l y h o p e t o a n s w e r b y v i e w i n g t h e m i n t h e t o t a l c o n t e x t o fp e o p l e ' s ( s e l l e r s ' a n d c u s t o m e r s ' ) d a i l y s t r u g g l e t o s u r v i v e , w h i c h w a s t h e r e a lt o p i c o f m y r e s e ar c h .

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    7 6 S J A A K V A N D E R G E E S TConver sa t i on I

    A y o u n g m a n , l o o k i n g t h r o u g h t h e v i a l s o f in j e c ta b l e a n t i b io t ic s o n t h e o l dm a n ' s t a b l e , f i n d s A l m o p e n . H e n o t i c e s i ts d a t e o f e x p i r a ti o n - 1 9 7 8 ( f i v e y e a r sa g o ) - a n d f i n a l ly c h o o s e s Pdn ext i l l ine . 2 W h e n I a sk w h y h e n e e d s i t, h i s a n s w e ri s el u s i v e . " I t i s a n a n t i b io t i c , y o u c a n u s e i f f o r a l l k i n d s o f t h i n g s , r h e u m a t i s mf o r e x a m p l e . " " B u t f o r w h a t w i ll y o u u s e i t ? " I i n s i s t . " I t i s n o t f o r m y s e l f , i t i sf o r m y b r o th e r , I d o n ' t k n o w w h y h e n e e d s i t. " I a s k : " I s it f o r ' c h a u d e p i s s e '( g o n o r r h o e a ) . " H e l a u g h s : " P e r h a p s y e s , b e c a u s e h e i s a b a c h e l o r . " " B u t w h ya r e y o u b u y i n g i t h e r e ? I s n ' t t h e r e a d i s p e n s a r y i n y o u r v i l l a g e ? . . . . U n d e rc o n s t r u c t i o n , " h e a d v i s e s m e . " M o r e o v e r , " h e a d d s s o m e w h a t c o n t r a d i c t o r i l y ," t h e n u r s e i s h a r d l y e v e r a t h i s p o s t . "

    I a s k h i m , " I s t h e A l m o p e n n o g o o d b e c a u s e t h e da t e h as e x p i r e d ? " " Y o u c a n ' tu s e i t a n y m o r e f o r a n i n j e c t i o n , " h e a n s w e r s , " b u t i t i s st il l g o o d f o r s p r i n k l i n go n t o a w o u n d . " W h e n I d i s c u s s t h i s c o n v e r s a t i o n l a t e r o n w i t h o t h e r s , a p h a r -m a c o l o g i s t c o m m e n t s t h a t t h e s p r i n kl i n g i s n o t a b a d i de a . O t h e r r e m a r k s b y t h ey o u n g m a n a r e c r it i c i se d , h o w e v e r . I t is n o t t r u e t h a t P~next i l l ine c a n b e u s e da g a i n s t r h e u m a t i s m . N o r i s o n e v i a l o f Pdnext i l l ine s u f f ic i e n t f o r th e t r e a t m e n t o fg o n o r r h o e a , f r o m w h i c h h e i s m o r e l i k e ly t o s u f fe r th a n ' h i s b r o t h e r ' .

    Conver sa t i on 2A y o u n g m a n p i c k s u p a v i a l w i t h P r o c a i n . T h e o l d m a n s a y s ; " I t h a s e x p i r e d . "A f t e r s o m e d e l i b e r a t i o n t h e c u s t o m e r s b u y s t w o Pen i c i l l i n t a b l e t s ( e a c h 5 0 0 , 0 0 0u n it s) . I a s k w h y h e n e e d s t h e m . H e i s a p r i s o n e r ( s o m e p r i s o n e rs m o v e f r e e l y int o w n a n d c a n b e h i r e d f o r w o r k b y t h e t o w n ' s n o t ab l es f o r v e r y l o w w a g e s ) .Y e s t e r d a y h e v i si t e d a w o m a n a n d t h i s m o m i n g , w h e n h e u r i n a te d , h e f e l t p a i n .S o h e t h i n k s h e h a s c a u g h t ' c h a u d e p i s s e '. I a s k h i m i f t w o Pen i c i l l i n t a b l e t s a r es u f fi c ie n t . H i s a n s w e r i s n o , b u t h e h a s n ' t a n y m o r e m o n e y . I n a n y e v e n t, t w oa r e b e tt e r t h a n n o n e . H e a s k s i f I c a n h e l p h i m . I g i v e h i m 2 0 0 f r a nc s . H e b u y sa n o t h e r t w o t a b le t s. H e w i l l ta k e t w o t o n i g h t, t w o t o m o r r o w m o r n i n g .

    W h e n I d i s c u s s t h i s c o n v e r s a t i o n w i t h a d o c t o r , h e r e m a r k s t h a t n o v e n e r e a ld i s e a se s y m p t o m s c o u l d a p p e a r s o q u i c k ly . F u r t h e r m o r e a d o s e o f f o u r s u c ht a b l e t s i s n o t s u f f i c i e n t f o r t re a t i n g g o n o r r h o e a . T h e t a b l e ts , h e a d d s , a r e n o t w e l la b s o r b e d i n t h e b o d y . T h e c o n v e r s a t i o n f u r t h e r s h o w s h o w e c o n o m i c c o n s t r a i n t sm a y l e a d t o t h e w r o n g u s e o f m e d i c i n e s a n d t o s u b s e q u e n t r a t i o n a li s a ti o n s( " T w o a r e b e t te r t h a n n o n e " ) .

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    7 8 S JA A K V A N D E R G E E S Tb i o m e d i c a l k n o w l e d g e a t a l l . A n t h r o p o l o g i s t s h a v e f r e q u e n t l y s t u d i e d t h e i d e a sand p r ac t i c e s o f tr ad i t i ona l m ed i c a l spec i a l i s t s , wh i l e l a J 'ge ly neg l e c t i ng t hew o r l d o f p o p u l a r m e d i c a l k n o w l e d g e . M e d i c a l n o t i o n s c u r r e n t i n th e l a y s e c to r ,h o w e v e r , a r e l i k e l y t o h a v e a f a r g r e a t e r i m p a c t o n h e a l t h c a r e p r a c t i c e s th a n t h es p e c i a l is t k n o w l e d g e o f m e d i c a l d o c t o r s , h e r b a l i st s a n d p r i e s t- h e a l e rs .

    D r a w i n g f r o m c o n v e r s a t i o n s a s r e p o r t e d a b o v e I h o p e t o s u g g e s t h o w l a ye x p l a n a t i o n s o f i l l n e s s a n d p h a r m a c e u t i c a l e f f i c a c y c o m e i n t o b e i n g . T w oc o n t e x t s s e e m p a r t i c u l a rl y i m p o r t a n t f o r u n d e r s ta n d i n g t h e g e n e r a t io n o f p o p u l a rm e d i c a l k n o w l e d g e : t h e b a s i c m a r k e t s i t u a t i o n o f s e l l i n g a n d b u y i n g , a n d t h ei n t e r v i e w s i t u a t io n w i t h i ts q u e s t i o n s a n d a n s w e r s .

    T H E M A R K E T S IT U A T I O NM e d i c i n e s a r e c o m m o d i t ie s . C l i en t s p a y f o r th e m , s e l le r s m a k e m o n e y f r o mt h e m . B o t h p a r t i e s a d a p t t h e i r id e a s a b o u t m e d i c i n e s t o t h e i r r e s p e c t i v e p o s i t i o ni n t h e t r a n s a c t i o n . I n v e r y s i m p l e t e r m s , t h e s e l l e r w i l l b e i n c l i n e d t o p r e s e n t' h i s ' m e d i c i n e s a s c a p a b l e o f c u r in g a l a r g e n u m b e r o f c o m p l a i n t s a n d t o i g n o r ep o s s i b l e s i d e - e f f e c t s , c o n t r a - i n d i c a t i o n s o r o t h e r p r o b l e m s . H e h o p e s t o s t i m u -l a t e s a l e s . Ye t , i n p r a i s i ng h i s wa re s , t he s e l l e r may a l so ac tua l l y be l i eve i n t he i rp o t e n c y .

    M u c h h a s b e e n w r i t t e n l a t e l y a b o u t t h e o v e r - o p t i m i s t i c p i c t u r e o f t h e e f f e c t so f m e d i c in e s p r o p a g a t e d b y p h a r m a c e u t i c a l c o m p a n i e s . I t h a s b e e n p o i n t e d o u tt h a t in s e r ts i n d r u g s s o l d in t h e T h i r d W o r l d m e n t i o n m o r e i n d i c a t io n s a n d f e w e rs ide - e f f ec t s and coun t e r - i nd i ca t i ons t han i n se r t s i n t he Wes t ( s ee , e . g . , S i l ve rmane t a l. 1982 ) . S t i ll , I wou ld be su rp r i s ed i f t he peop l e wr i t i ng t hose p ro m ot iv et e x t s d i d n o t i n d e e d b e l i e v e i n t h e i r p o s i t i v e m e s s a g e s , a t le a s t t o a c o n s i d e r a b l eex t en t .

    T h e o l d m a n s e ll in g m e d i c i n e s o n t h e m a r k e t d o e s m u c h t h e s a m e th i ng . H er e c o m m e n d s h i s p ro d u c t s f o r a w i d e r a n g e o f c o m p l a i n ts a n d s h o u l d a c u s t o m e rm a k e a w r o n g c h o i c e , h e w i l l r a r e l y c o r r e c t h i m . W h a t m a t t e r s f o r h i m i s t h es a le . H i s o p t i m i s m a b o u t t h e e f f i c a c y o f h i s p r o d u c t s i s f a c i li t a te d b y h i s l i m i t e dk n o w l e d g e o f b i o m e d i c i n e a n d p h a r m a c e u t ic s .

    B u t w e a l s o h a v e s e e n t h a t t h e o l d m a n w i l l d r a w a c l i e n t ' s a t t e n t i o n t o a ne x p i r a t i o n d a te . T h i s o b s e r v a t i o n d o e s n o t c o n t r a d i c t w h a t I h a v e j u s t s a i d . T h ee x p i r a t i o n o f t h e d a t e w o u l d e v e n t u a l l y b e d i s c o v e r e d b y t h e c u s t o m e r . P o i n t i n gi t o u t t o h i m a t o n c e p r e v e n t s d i ff i c u lt i es l a t e r a n d e n h a n c e s t h e o l d m a n ' s i m a g ea s a n u p r i g h t t ra d e s m a n .

    I n C a m e r o o n b u y e r s o f m e d i c a t i o n f i n d t h e m s e l v e s i n t h e o p p o s i te p o s i ti o n .A l t h o u g h p o o r , t h e y s ti ll m u s t p a y f o r m e d i c i n e s . T h e r e m e d y p r e s c r i b e d b y ab i o m e d i c a l d o c t o r f o r a p a r t i c u l a r i n f e c t i o n m a y r e q u i r e m o r e m e d i c i n e t h a n t h ec u s t o m e r c a n a f f o r d . H e h a s t o c o n t e n t h i m s e l f w i t h a s m a l l e r d o s e . I t i s l i k e l y

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    MARKETPLACE CONVERSATIONS IN CAMEROON 79t h a t s u c h a f i n a n c i a l c o n s t r a i n t w i l l b e r a t i o n a l i s e d i n m e d i c a l t e r m s . T a k i n go n l y t w o o r f o u r ta b l e t s i n s te a d o f t e n o r t w e n t y i s m a d e r i g h t b y ta lking andthinking i t s o . P e o p l e c u t t h e i r c o a t o f m e d i c a l k n o w l e d g e a c c o r d i n g t o t h e i rc lo th .

    P a r t i c u l a rl y i n th e f i e l d o f m e d i c i n e t h e r e i s a m p l e r o o m f o r s e l f - j u s ti f y i n gra t i ona l i s a t i ons . I t i s d i f f i cu l t t o p rove t ha t a spec i f i c med i ca l i n t e rven t i on ha sh a d a s p e c i f i c e f fe c t . B o t h i ll n e ss a n d r e c o v e r y a l l o w f o r m u l t i p l e i n t e rp r e t a t io n sa n d e x p l a n a t i o n s . I t i s w e l l k n o w n , m o r e o v e r , t h a t e x p l a n a t i o n s ' g e n e r a t e t h e i ro w n e f f i c a c y ' . E s t i m a t e s o f t h e i n fl u e n ce o f th e p l a c e b o e f f e c t o n t he o u t c o m e o fm e d i c a l t r e a t m e n t v a r y f r o m 2 0 % t o 8 0 % . O n e m i g h t s a y t h a t m e d i c a lk n o w l e d g e , w h e t h e r p r o f e s s i o n a l o r ' p o p u l a r ' , c a u s e s h e a l t h e f f e c t s a m o n g i t sb e l ie v e r s. W h e t h e r s u c h k n o w l e d g e i s ' t r u e ' i n b io l o g i ca l o r c h e m i c a l t e rm s m a yw e l l b e o f s e c o n d a r y i m p o r t a n c e . A s i n r e li g i o n , th e m a i n t h i n g i s t h a t th e t h e o r yo r a s s u m p t i o n i s s a t i s f a c t o r y . A p l a u s i b l e e x p l a n a t i o n c a n b e a p o w e r f u lm e d i c i n e , a n d p l a u s i b i l i t y , a s w e k n o w , h a s b o t h a ' s u b j e c t i v e ' a n d a n' o b j e c t i v e ' d i m e n s i o n .

    A p p l y i n g t h e s e c o n s i d e r a t i o n s t o t h e m a r k e t s i t u a ti o n i n E b o l o w a I s u g g e s tt h a t b u y e r s o f m e d i c i n e s a r e l ik e l y t o a d j u s t t h e i r t h e r a p e u t ic b e l i e f s t o f i t t h e i rm e a n s . M o r e w e l l - t o - d o c u s t o m e r s , f o r e x a m p l e , w o r r y a b o u t t h e e f f i c a c y o fd r u g s a v a i l a b l e a t t h e m a r k e t , c e r t a i n l y t h e c h e a p e r o n e s . T h e y r e q u i r e t h e b e s ta n d p r e f e r c o s t l y m e d i c i n e s f r o m p r i v a t e p h a r m a c i e s . S u c h c u s t o m e r s l i v em a i n l y i n t h e c i t i e s o f Y a o u n d 6 a n d D o u a l a . I n d e e d t h i s a f f l u e n t c a t e g o r y i sk n o w n t o o p p o s e a n y b l a n k e t i m p l e m e n t a t i o n o f a n e s s e n ti a l d r u g s p o li c y , w h i c hw o u l d m e a n t h a t o n l y a b o u t tw o h u n d r e d , m a i n l y i n e x p e n s i v e m e d i c i n e s w o u l db e a v a i l a b l e t h r o u g h o u t t h e c o u n t r y . T h e r i c h a p p e a r c o n v i n c e d t h a t t h e s e t w oh u n d r e d e s s e n t i a l d r u g s w o u l d n o t i n c l u d e t h e m e d i c i n e s b e s t a b l e t o c u r e theirm e d i c a l c o m p l a i n t s .

    I t is u n d e r s t a n d a b l e t h a t m o s t p h a r m a c i s t s , p r i v a t e p h y s i c i a n s a n d o t h e r s w h om a k e a p r o f i t f r o m m e d i c i n e s a l s o r e s i s t t h e e s s e n t i a l d r u g s p l a n . F o r t h e m ,c o n g r u e n c e o f t h e ir th e r a p e u t i c b e l i e f s a n d f i n a n c ia l i n t e re s t s i m p l i e s p e s s i m i s ma b o u t t h e q u a l it y o f m a n y s o - c a l l e d ' e s s e n t i a l d r u g s ' a n d d o u b t t h a t t h e p r o p o s e dp a c k a g e i s s u f fi c i e n t to t r e a t e x i s ti n g h e a l t h p r o b l e m s .

    W e l l - to - d o p e o p l e , h o w e v e r , d o n o t v is i t th e E b o l o w a m e d i c i n e m a r k e t . T h a ti s c l e a r l y a p o o r m a n ' s a l t e r n a t i v e . S i c k p e o p l e w h o c a n n o t a f f o r d t o b u y aw h o l e p a c k a g e o f a g i v e n m e d i c i n e , a s t h ey a r e o b l i g e d t o d o i n t h e t o w n ' sp h a r m a c y , c o m e t o t h e m a r k e t t o b u y j u s t t h e a m o u n t t h e y c a n p a y f o r ( a n d th i n ki s s u ff i ci e n t f o r th e m o m e n t ) . 3 Y o u n g m e n s u f fe r in g f r o m g o n o r r h e a s la p d o w nm o n e y f o r a f e w T e t r a c y c li n c a p su l e s a n d c o m e b a c k t h e n e x t d a y f o r m o r e i ft h e y t h i n k t h e y n e e d t o c o n t i n u e t r e a t m e n t ( a n d h a v e t h e m o n e y ) . 4 T h a t t h ey o u n g m a n i n C o n v e r s a t i o n 1 s e l e c t e d a n i n s u ff i c ie n t q u a n t i ty o f a n ti b i o ti c s , c a np r o b a b l y b e a t t r ib u t e d t o h is p u r c h a s i n g p o w e r a t th e t i m e . I n C o n v e r s a t i o n 2 t h er o v i n g p r i s o n e r w a s i n m u c h t h e s a m e s i t u a t i o n . H e r a t i o n a l i s e s h i s b u y i n g o n l y

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    80 SJAAK VAN DER GEESTtwo penicillin tablets by remarking that two are better than none at all.

    The instant production of popular medical knowledge during market transac-tions comes close to what more than thirty years ago Festinger called 'reductionof cognitive dissonance'. From such a perspective knowledge can be viewed asa cultural device to assuage or avoid the pain of any discrepancy between whatis and what ought to be. The Ebolowa market shows us in miniature how culture'works' all the time, smoothing over, alleviating irreconcilable differences. Forthe poor customer this means he manages to believe in the efficacy of the fewmedicines he can buy. For him Douglas and Isherwood's (1980:127) remark,that "it is part of rationality to fix aspirations at some feasible level," clearlyobtains.

    Considering these processes of dissonance prevention and reduction from ananthropological point of view, we should stress that all human knowledge is tosome extent self-fulfilling prophecy, as Lakoff and Johnson (1980:156) havepointed out with regard to the use o f metaphors. For them the truth of metaphoris merely a matter of perception, however:The acceptance of the metaphor, which forces us to focus only on those aspects of ourexperience that it highlights, leads us to view the entailments of the metaphor as beingtrue. Such 'truths' may be true, of course, only relative to the reality defined by themetaphor (pp. 157-158).In the case of medical metaphors the achievement of establishing ' tru th' is morespectacular. The sick body responds to the metaphor and, for that matter, tomedical knowledge in general. 5 We may cautiously suggest, therefore, thatpopular medical knowledge should not be seen merely as 'e rron eous ', leading to'irrational drug use' which will aggravate the complaint in question. It shouldnot be ruled out that 'de fect ive' use of medicines may indeed bring relief. AboveI compared medical knowledge to religion, pointing out the therapeutic potentialof a satisfactory explanation. We might stretch that comparison further, applyingit to the poor customer at Ebolowa market who has little choice other than toadapt his 'knowledge' to his means. His case looks like that of the biblical poorwidow whose two copper coins proved more effective than all the money paidby the rich (Luke 21:2).

    Caution nonetheless remains necessary. We should not take utterances at themarket too seriously. What is offered as knowledge may be hardly more than acover-up for ignorance and doubt. Later on we shall discuss this aspect ofknowledge production in more detail. Here it suffices to emphasise that aconsiderable amount of not-knowing may be camouflaged as assurance and thuspartly nullify the placebo effect. Conversation 2 illustrates this point, for theprisoner's comment, "Two are better than none," also expresses a measure ofdoubt about the rationality of his transaction. His subsequent actiondemonstrates this clearly: the presence of an interested European prompts him toask for money to buy more medicines.

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    MARKETPLACE CONVERSATIONS IN CAMEROON 81Yet another aspect of the market situation contributes to the production of

    popular knowledge: the availability or non-availability of medicines. We see thisto be true in the first conversa tion. Not only limited finances may restrict thechoice of medicines, but also a limited supply of the medicines themselves. Atthe market, although not exclusively there, such shortages are common. For acustomer who fails to locate the right medicine, the most sensible course ofaction would seem to be to look for it elsewhere. Another solution is to revisehis request according to what is on hand. This second strategy is of courseindicated if he knows that the availability of medicines is limited elsewhere aswell. The young man in Conversation 1 contents himself with Pdnextill ine, oneof the few injectable antibiotics on the old man's table. What also is interestingto us is that his pharmaceutical knowledge leaves room for expired antibioticswhich, according to biomedical rules, should no longer be used. The powder insuch capsules can still be sprinkled on wounds. This penny-wise knowledge iswidespread in Africa. Such adjustment of knowledge to accomodate the hardfacts of reality is closely related to the production of knowledge to reducecognitive dissonance that might arise from financial constraints.

    THE INTERVIEW SITUATION

    Last (1981) has argued that anthropologists seldom accept an informant'sinability to answer a question. They have learnt that "I don't know" is not ananswer, but an excuse. They have been taught to repeat the same question, inslightly different words, until they receive a 'real' response. Last remarkshowever that in the end "I don 't know" may be the honest answer, and anythingelse an attempt to placate and get rid of the anthropologist. Anyone who hasever tried putting the questions that he asks his informants to himself may wellconcede Las t's point.

    Last, however, fails to mention that informants may also have reasons foravoiding an "I don't know" answer. They may want not to appear ignorant. Itstrikes me as likely that the interview situation tends to elicit an exaggeratedlyclear and coherent picture of what people think and feel on all kinds of topics,including medical knowledge. Last suggests that local medical knowledge willusually feature more blank areas and anarchy than anthropologists care for us tobelieve. This suggestion is confirmed by my conversation with the old medicinevendor. As our conversation unfortunately began to approximate an interroga-tion, 6 it became increasingly clear that the old man did not want to make anignorant impression. To reveal that he did not know how to use the medicines hesold would be very embarassing indeed. Understanding the dynamics of theinterview situation we should probably consider it first and foremost as anoccasion for staging a performance. The informant finds himself in an extraordi-

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    82 SJAAK VAN DER GEESTnary situation. A strong risk o f embarrassment is inherent. He may not haveconvenient routine answers at his disposal. The interviewer, who is very'knowledgeable' yet ignorant at one and the same time, asks unusual questions.The informant may have no idea what or how to answer. He may even notunderstand the question. To admit this, however, might be too embarrassing.The interview situation may be experienced as one of high psychologicalpressure in which the informant is more concerned about not losing face, thanabout giving accurate or honest answers. In short, the interview situation seemsto demand a performance which corroborates the informant's respectability.. 7

    Psychological pressure will be acute as long as the relationship betweeninterviewer and informant remains uneasy, if either one feels insecure in theother's presence. Feelings of insecurity are likely to be directly proportional todegree of felt inequality. This was certainly tree about relations between me andthe old man, as I have indicated earlier. He was infirm, dependent on others.During the period of my fieldwork, he was keen to benefit from my interest inhim, so it was important to him not to disappoint me in any way. Probably my'interrogation' about " f i l a i r e s ' created considerable anxiety for him fearing thatunsatisfactory answers on his part might endanger the continuation of our goodrelations. His 'per formance ' should be seen in that light. 8 He constructed a moreor less coherent account which, I suspect, was mainly improvised, built fromseveral fragments of information that he had at his disposal. His main concernwas that I would not lose interest in him. Not only was his respectability at stakebut also his future ability to lay claim to my help. My help in the future, hebelieved, depended on my continuing to consider him an interesting andknowledgeable informant. Twice in Conversation 3 the old man answered 'yes'to a (perhaps too) suggestive question. That concise affirmative, too, may havebeen an indication of his desire to comply with m y expectations.

    My discussions with the old man's customers were not loaded with suchspecific psychological pressure. I did not have a personal relationship with them.They did not expect any rewards. Nonetheless some awareness of our inequality

    - and an accompanying feeling of being 'inter rogated' - was definitely present.When I asked about the use of medicines, especially those they had purchased,they, too, seemed disinclined to answer "I don't know." They, too, found itimportant to appear knowledgeable and rational and to avoid the embarrassmentinherent in admitting that they did n't fully know what they were doing.

    CULTURAL REINTERPRETATIONA short while ago I suggested that the old man constructed his story about' f i l a i r e s " on the spot, forging it from fragments of knowledge that he had at hisdisposal. Indeed people don't create medical knowledge out of nothing, but

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    M A R K E T P L A C E C O N V ER S A TI ON S I N C A M E R O O N 8 3r a t h e r m a k e g r a t e f u l u s e o f b u i l d i n g m a t e r i a l s t h e y f i n d l y i n g a r o u n d i n th e i ro w n c u l t u re .

    H e r e L 6 v i - S t r a u s s ' ( 1 9 7 2 ) c o n c e p t o f "bricolage" c o m e s t o m i n d . H e c o n t ra s t sth e "bricoleur" w i t h t h e ' e n g i n e e r ' o r ' s c i e n t i s t ' . T h e l a t t e r , h e s a y s , c o n s t r u c t sh i s t h e o r i e s b y t r y i n g t o g o b e y o n d t h e c o n s t r a i n ts o f h is o w n c u l t u r e , q u e s t i o n -i n g h i s o w n u n i v e r s e , w h i l e t h e bricoleur t i nke r s w i th in h i s cu l t u r e . He i s , onec o u l d s a y , a ' p r i m i t i v e ' s c ie n t is t , i m p r i s o n e d w i t h in t h e c o n f i n e s o f h i s ( p o p u l a r )e v e r y d a y k n o w l e d g e . T o b u i l d m e a n i n g f o r h i m s e l f he u s e s c u l tu r a l f r ag m e n t s ,' s e c o n d h a n d m a t e r i a l s' t h a t a r e fa m i l i a r t o h i m . T h e bricoleur i s p r ac t i c a l byb e n t . T h e s c i e n t i s t , o n t h e o t h e r h a n d , t r a n s c e n d s w h a t i s t a k e n f o r g r a n t e d i nd a i l y e x p e r i e n c e a n d p e r s i s t e n t l y s e e k s t o c h a l l e n g e e s t a b l i s h e d t r u t h s w i t ha l t e rna t i ve exp l an a t i ons . 9

    A bricoleur i s i n a n a w k w a r d s i t u a t i o n a s s o o n a s h e h a s t o ' m a k e s e n s e ' o u to f c o n c e p t s o r o b j e c t s t h a t a re n o t i n d i g e n o u s t o h i s w o r l d . S u c h a s i tu a t io n ,h o w e v e r , i s n o t a t a l l r a r e . P u t s o m e w h a t p a r a d o x i c a l l y : m e e t i n g t h e e x t r a -o r d i n a r y h a s b e c o m e a n o r d i n a r y e x p e r i e n c e f o r p e o p l e e v e r y w h e r e .A n t h r o p o l o g i s t s , t h e r e f o r e , h a v e s p e n t c o n s i d e r a b l e e n e r g y s t u d y i n g t h ep r o c e s s e s o f a c c u l t u r a ti o n a n d e n c u l t u r a t io n . H o w p e o p l e r e c o n c i le t h e f o r e i g na n d t h e f a m i l i a r i n t o n e w , m e a n i n g f u l , o f t e n s y n c r e t i c , c o n c e p t s h a s b e c o m e am a i n t o p i c i n p r e s e n t - d a y a n t h r o p o l o g y .

    F o r u n d e r s t a n d i n g t h e o l d m a n ' s bricolage t h e c o n c e p t o f ' c u l t u r a l r e i n -t e r p r e t a t i o n ' , c o i n e d b y H e r s k o v i t s a s e a r l y a s 1 9 4 8 a n d r e c e n t l y u s e d a g a i n b yB l e d s o e a n d G o u b a u d ( 1 9 8 5 ) , s e e m s a u s e f u l t o o l . H e r s k o v i t s ( 1 9 5 5 : 4 9 2 )d e f i n e d c u l t u r a l r e i n t e r p r e t a t i o n a s f o l l o w s : " I t i s t h e p r o c e s s b y w h i c h o l dm e a n i n g s a r e a s c ri b e d to n e w e l e m e n t s o r b y w h i c h n e w v a l u e s c h a n g e t hec u l t u r a l s i g n i f i c a n c e o f o l d f o r m s . I t o p e r a t e s i n t e r n a l l y , f r o m g e n e r a t i o n t og e n e r a t i o n , n o l e s s t h a n i n i n t e g r a t i n g a b o r r o w e d e l e m e n t i n t o a r e c e i v i n gc u l t u r e " ( H e r s k o v i t s 1 9 5 5 : 4 9 2 ) . H e r s k o v i t s u s e d t h e c o n c e p t t o c o m e t o g r i p sw i t h p r o c es s e s o f cu l tu r e c h a n g e : " W h y d o . . . p e o p l e t a k e o v e r o n e n e w i d e a o rt h i n g p r e s e n t e d t o t h e m a n d r e j e c t a n o t h e r ? " ( H e r s k o v i t s 1 9 5 5 : 4 9 5 ).

    T h i s a n a l y t i c a l c o n c e p t h a s a l s o p r o v e d u s e f u l in t h e s tu d y o f t h e d e v e l o p m e n to f c u l tu r a l i d e a s r e g a r d in g h e a l t h a n d i ll n e ss . T h e i m p a c t o f b i o m e d i c i n e o n n o n -W e s t e r n c u l t u r e s h a s b e e n e n o r m o u s . M o d e m h o s p i t a l s , h e a l t h c e n t r e s a n d o t h e rs e r v i c e s h a v e c r o p p e d u p t h e w h o l e w o r l d o v e r . W e s t e r n - t r a i n e d m e d i c a ld o c t o r s a n d o t h e r h e a l t h w o r k e r s h a v e e x t e n d e d t h e i r p r a c t i c e s i n t o t h e m o s to u t l y in g c o m m u n i t ie s o f d e v e l o p in g c o u n t ri e s. A l m o s t e v e r y w h e r e p e o p l e a r er e p o r t e d t o b e m a k i n g u s e o f th e s e o p p o r t u n i t i e s o n a l a r g e s c a le . A t t h e s a m et i m e i t h a s b e e n c o g e n t l y o b s e r v e d t h a t using b i o m e d i c i n e d o e s n o t y e t m e a nthinking it. A g r e a t n u m b e r o f r e se a r c h e rs h a v e p o i n t e d o u t h o w p e o p l e m a y' a p p r o p r i a t e ' b i o m e d i c i n e o n t h e i r o w n c u l t u r a l t e r m s . T h e i r i d e a s a b o u t h o wW e s t e r n m e d i c i n e s a n d o t h e r i n t e r v e n t i o n s w o r k m a y b e w i d e l y d i v o r c e d f r o mt h e v i e w s h e l d b y t h e m e d i c a l p e r s o n n e l w h o t r ea t th e m .

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    8 4 S JA A K V A N D E R G E E S TT h e c o n c e p t o f ' c u l t u r a l r e i n te r p r e t a t i o n ' e n a b l e s u s t o b e t t e r c o m p r e h e n d t h a t

    p r o c e s s o f a p p r o p ri a ti o n . B l e d s o e a n d G o u b a u d ( 1 98 5 ) a p p l i e d H e r s k o v i t s 'c o n c e p t i n t h e i r r e s e a r c h a b o u t t h e u s e a n d p e r c e p t i o n o f W e s t e r n p h a r m a c e u t i -c a l s a m o n g M e n d e i n f o r m a n t s i n S i e r r a L e o n e . T h e y a r g u e d t h a t i n d i g e n o u sm e d i c a l i d e a s ( e .g . , a b o u t t h e c o l o u r a n d t a s t e o f m e d i c i n e s ) p r o v i d e a n e x -p l a n a t o r y f r a m e w o r k f o r i n t e r p r e t i n g W e s t e m p h a r m a c e u t i c a l s . O t h e r m e d i c a la n t h r o p o l o g i s t s h a v e p o i n t e d t o a n a l o g o u s p r o c e s s e s o f s y n c r e t ic c h a n g e i np e o p l e ' s p e r c e p t io n a n d a c c e p t a n c e o f W e s t e r n m e d i c i n e ( e .g ., L o g a n 1 97 3 ;McCla in 1977 ; N ich t e r 1980 ; Why te 1988 ; E tk in e t a l . 1990 ) .

    I n a n a r t i c l e a b o u t t h e w a y i n w h i c h i n d i g e n o u s m e d i c a l p r a c t i t i o n e r s a d a p tt h e i r r o l e u n d e r th e i m p a c t o f b i o m e d i c i n e , L a n d y ( 1 9 7 7 : 4 7 7 ) a d v a n c e s t h ec o n c e p t o f ' c u l tu r a l r e s y n t h e s i s ' t o d e s c r i b e a s i m i l a r p h e n o m e n o n : h e a l e r s u s en e w , b i o m e d i c a l , e l e m e n t s i n t h e i r t ra d i ti o n a l p r a c t i c e s ( f o r e x a m p l e : a n t i b io t i c sa d m i n i s t e r e d b y A y u r v e d i c p r a c ti t io n e r s ; s e e B u r g h a r t 1 9 8 8 a n d W o l f f e r s 1 9 8 8 ).I n L a n d y ' s a r t i c l e t h e e m p h a s i s l i e s o n b e h a v i o u r , w h e r e a s H e r s k o v i t s ' t e r ma p p l i e s t o c o g n i t i o n . I n b o t h c o n c e p t s i t i s a s s u m e d t h a t c h a n g e s t a k e o ns y n c r e t i c f e a t u r e s , t h a t p e o p l e ' s n e w i d e a s a n d p r a c t i c e s a r e t h e r e s u l t o f t h ef i s s io n o f fa m i l i a r o n e s . A s H e r k o v i t s s u g g e s t s , a n y i n n o v a t i o n t h a t h a s n o t h i n gi n c o m m o n w i t h p r e c e d i n g p a t t e r n s o f c u l t u r e i s l i k e l y t o b e r e j e c t e d , u n l e s s o ru n t il i t c a n b e r e d e f i n e d a n d t r a n s f o r m e d i n t o s o m e t h i n g t h a t s e e m s s u f f ic i e n t lyf a m i l i a r t o b e a c c e p t a b l e .

    M y c o n v e r s a t i o n w i t h t h e o l d m a n i n E b o l o w a c a n b e a n a l y s e d i n t h a t l i g h t .H e e n d o w s t h e d i s ea s e t e r m ' f l l a i r e ' , w h i c h h e f i n d s p r in t e d o n t h e w r a p p i n g s o fh i s m e d i c i n e s a n d i n t h e i r i n s e r t s , w i t h a n e w m e a n i n g , o n e w h i c h i n c l u d e sa s p e c t s o f t h e t r a d i ti o n a l B u l u c o n c e p t o f t h e i ll n es s N s o n ( ' w o r m s ' ) . T h e B u lum a i n t a i n t h a t a g re a t m a n y d i f f er e n t c o m p l a i n t s d e r iv e f r o m w o r m s . T h e w o r m sl i v e a n d d e v e l o p i n t h e h u m a n b o d y . T h e y e a t t h e o r g a n s o f th e b o d y a n d c a nthus be a s soc i a t ed w i th pa in and d i s comfo r t i n t he hea r t , t he l i ve r , t he i n t e s t i ne s ,t h e g e n i t a l o r g a n s , t h e b l o o d , e t c . I t m a y b e t h a t t h e w o r m s e n t e r s o m e o n e' n a t u r a l l y ' , b u t i t i s al s o b e l i e v e d th a t t h e y c a n b e ' t h r o w n ' i n t o a b o d y b y as o r c e r e r . T h e t r a d i t i o n a l c o n c e p t o f n s o n a d m i t s b o t h a n a t u r a l i s i n g a n d ap e r s o n a l i s i n g e x p l a n a t i o n f o r i ll n e ss . 1 T h e o l d m a n ' s t h e o r i e s a b o u t t h e' f i l a i r e s " b o r e a g r e a t r e s e m b l a n c e t o o d d b i t s I h a d e a r l i e r h e a r d a b o u t n s o n . H ise x p l a n a ti o n s i l lu s tr a te h o w n e w p o p u l a r k n o w l e d g e m a s q u e r a d i n g a s ' s c i e n t i f ic 'm a y b e c o n s tr u c te d u n d e r p r e s s u r e f r o m a v a i la b l e i n d ig e n o u s c o n c e p ts .

    CONCLUSIONU n t i l r e c e n t l y , i n m o s t a n t h r o p o l o g i c a l a c c o u n t s l o c a l m e d i c a l k n o w l e d g ea p p e a r e d a s s t a t i c a n d i n c o n f l i c t w i t h W e s t e r n m e d i c a l t h i n k i n g .A n t h r o p o l o g i s t s n o w t e n d t o v i e w l o c a l i d e a s a s v e r s a t i l e a n d a d a p t i v e . W e l s c h

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    M A R K E T P L A C E C O N V ER S A TIO N S I N C A M E R O O N 8 5( 1 9 83 ) , w h o d i d r e s e a rc h a m o n g t h e N i n g e r u m o f P a p u a N e w G u i n e a , h a sd e s c r i b e d t h e i r f l e x i b l e a n d s y n c r e t i c i d e a s a b o u t h e a l t h a n d m e d i c i n e . T h eN i n g e r u m h a d i n f a c t i n t e g r a t e d W e s t e r n m e d i c a l c o n c e p t s a n d p r a c t i c e s i n t ot h e i r o w n c u l t u re i n s u c h a w a y t h a t th e y d i d n o t p e r c e i v e a n y r e a l d i s c o n t i n u it yo r c o n t r a d i c t i o n b e t w e e n t h e i r o w n m e d i c a l v i e w s a n d t h o s e h e l d b y W e s t e r n -t r a in e d a i d p o s t o r d e rl i es . T h e e x i s t e n c e o f s u c h a ' l i b e r a l ' t h e o r e ti c a l f r a m e w o r ke x p l a in s w h y t h e N i n g e r u m f o u n d n o d i f f ic u l ty f o r e x a m p l e i n c o m b i n i n gd i v i n a t i o n w i t h a i d p o s t m e d i c a t i o n s . T e d l o c k ( 1 9 8 7 ) d e s c r i b e s a s i m i l a rs i t u a t i o n a m o n g t h e M a y a i n G u a t e m a l a , w h e r e b o t h f o l k h e a l e r s a n d l a yi n f o r m a n t s b o r r o w a n d a m a l g a m a t e e l e m e n t s f r o m v a r i o u s t r a d i t i o n s f r e e l yw h e n a s k e d t o e x p l a i n t h e ir m e d i c a l t h o u g h t s a n d p r a c t ic e s .

    T h e N i n g e r u m a n d M a y a , I m a i n t a i n , a r e n o e x c e p t i o n s i n t h e i r s y n c r e t i cp r o d u c t io n o f n e w m e d i c a l k n o w l e d g e . R e p o r t s o f a h i g h f r e q u e n c y o ft h e ra p e u t ic s h o p p i n g b e t w e e n W e s t e r n a n d i n d i g e n o u s s y s t e m s c o n t in u e t oa r r i v e f r o m a l l o v e r t h e w o r l d . N o w w e a r e s t a r ti n g t o f il l in t h e c o g n i t i v ep r o c e s s e s a c c o m p a n y i n g t h e s e p r a c t ic e s . I n th i s p a p e r I h a v e p r e s e n t e d f r a g -m e n t s f r o m t h r e e c o n v e r s a t i o n s I h a d w i t h t w o b u y e r s a n d o n e s e l l e r o fm e d i c i n e s a t a m a r k e t i n th e S o u t h o f C a m e r o o n . I n t h e s e c o n v e r sa t io n s p o p u l a rm e d i c a l k n o w l e d g e w a s p r o d u c e d t o s e r v e v e r y p r a c t i c a l e n d s : t o r a t i o n a l i s ec o n c r e t e a c t i o n s ( b u y i n g o r s e l l i n g m e d i c i n e s ) , t o a v o i d e m b a r r a s s m e n t , t os a t i s f y a n i n q u i s i t i v e a n t h r o p o l o g i s t a n d t o s a f e g u a r d a p r o f i t a b l e r e l a t i o n s h i p .T w o c o n t e x t s s e e m e d p a r t i c u l a r l y c o n d u c i v e t o t h e g e n e r a t i o n o f s u c h o p p o r -t u n i st i c m e d i c a l k n o w l e d g e . T h e f i r st w a s t h e c o n t e x t o f t h e m a r k e t p l a c e , w h e r ec o s t s a n d p r o f i t s h a v e t o b e a c c o u n t e d f o r i n m e d i c a l - r a t i o n a l t e r m s b y t h o s ei n v o l v e d i n th e t r a n s ac t io n . T h e s e c o n d w a s t h e c o n t e x t o f t h e i n t e r v i e w d u r i n gw h i c h b o t h r e s e a r c h e r a n d i n f o r m a n t h a v e m o t i v e s o f t h ei r o w n t o d o t h e ir b e s tt o c o m e u p w i t h w h a t a t l e a s t m a y p a s s f o r c o h e r e n t m e d i c a l e x p l a n a t i o n s .C o n c e p t s a l r e a d y o n h a n d f o r m t h e b u i l d i n g m a t e r i a l f o r t h e i n f o r m a n t ' sp r o d u c t io n o f k n o w l e d g e .Anthropological-Sociological CentreUniversity of AmsterdamOudezijds Achterburgwa11851012 DK Amsterdam, The Netherlands

    ACKNOWLEDGEMENTSI a m g r a t e f u l t o D o n a l d B l o c h , M a r i o B r a a k r n a n , P a m e l a F e l d m a n - S a v e l s b e r g ,K a r i n d e G r a a f , H i l b r a n d H a a k , R o b e r t P o o l , P i e t V e r b e e k , S u s a n W h y t e a n dL o u i s e S t r o o s n i j d e r w h o h e l p e d i n th e p r o d u c t i o n o f t h is p a p e r . E a r l i e r v e r s io n sw e r e p r e s e n t e d a n d c o m m e n t e d u p o n a t t h e I n t e r n a t i o n a l C o n f e r e n c e o n

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    86 SJAAK VAN DER GEESTEthnomedical Systems in Sub-Saharan Africa in Leiden (June 1988) and at theColloquium 'Anthropologies of Medicine: West European and North AmericanPerspectives' in Hamb urg (December 1988).

    My research was financed by the Netherlands Foundation for the Advance-ment of Tropical Research (WOTRO) and by the University of Amsterdam.Research permission (Authorisation No. 288) was granted by the Camer oongovernment. Research assistance was provided by Kosso Frli x-Fayard.

    NOTES1 Many anthropologists have provided case studies which show how people continuouslyadjust their diagnosis and therapeutic decisions to new bits of information, e.g., Janzen1978; Van Binsbergen 1979a; Fetdman-Savelsberg 1988.2 Prnextilline: Benzylprnicil line sodique (800,000 units) and Benzathine-benzylprni-cilline (200,000 units).3 Official regulat ion prohibits the opening of medicine packages by the pharmacist, soclients can buy only whole packages. Pharmacists stick to this rule as it is not in theirinterest to sell small quantities of medicines. Poor people, who cannot afford to buywhole packages, have to go to the informal vendors who do not object to sellingmedicines per piece.4 Simoni and Ball (1975:179), who studied the selling of medicines on Mexican markets,make a similar remark:There is evidence that the poor are predisposed to strategies which tend to minimizerisks rather than to those which tend to maximize gains, especially under conditions ofanxiety. To get less than what might be preferred, but at low cost, is usually moreappealing than to pay much more than one can begin to afford for the best of treatment

    - especially when there is no complete guarantee that it will succeed either.Similar problems occur when patients receive a doctor's prescription which they cannotafford to have filled completely at the pharmacy. Selecting jus t one or two of theprescribed medications may be the only practical solution, but that solution needs to berationalized in medical terms to ward off feelings of not being treated well ..For somereferences to physicians ' lack of concern for their patients ' financial problems in theirwriting out prescriptions and to the subsequent 'f aulty' follow-up of their prescriptions,see: Fabricant and Hirschhorn 1987; Hardon 1987; Kapil 1988; Melrose 1982;Shatrughna n.d.5 Awareness of the placebo effect has now become part of popular medical knowledge inWestern societies. While writing this article I heard on the BBC World Service about anexperiment carried out in a British hospital, where women undergoing a total hysterec-tomy under anesthesia 'listen to' a tape with a reassuring text telling them that they cantrust the doctor and that everything will be O.K. Patients who - subconsciously - 'heard 'the tape were ready to leave the hospital one day earlier than others... "Mind over matteron the operation table," the BBC reporter concluded.6 The term 'interrogation' also appears in an article by Rosaldo pointing out the contextof domination which gave birth to two famous ethnographies, Le Roy Ladurie 's"Montaillou" and Evans-Pritchard's "Nuer". The former work is based on confessionsextracted from 14th century peasants by an inquisitor. The fieldwork for the latter studytook place in a period when British colonial troops were raiding the camps of theseAfrican herdsmen. Rosaldo speaks of an 'unequal dialogue' (the term is from Le RoyLadurie) and emphasises that the instruments through which such data was 'collected'cannot be separated from the final ethnographic product. Power and knowledge are

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    MARKETPLACE CONVERSATIONS IN CAMEROON 87closely linked. It seems likely that some features of the 14th century inquisi tor alsoinform the bearing of many present-day anthropological fieldworkers.7 For striking examples of informants considering their own respectability to be moreimportant than giving correct answers to interview questions, see Bleek's (1987) reportabout "lying informants" during Family Planning research in Ghana,s But a fieldworker can also suffer considerable anxiety in interview situations (seeHenry and Saberwal 1969). He may establish personal relationships with informants whoare so poor that his own possessions become a burden and embarrassment for him. Thesituation may prompt him to a performance to avoid informants; envy and to allay hisown uneasiness. Four scenarios for such a performance are provided by Foster (1972) inhis "Anatomy of Envy": concealing your riches, denying that they are yours, giving theother a token ('sop') to buy off his envy, and true sharing. All scenarios are enervating,however (see also Bleek 1979; van Binsbergen 1979b).9 This is not the place to criticise L6vi-Strauss' idealised and de-culturalised image of thescientist. The work of, among others, Polanyi (t958), Kuhn (1970) and Latour andWoolgar (1977) suggests that (Western) science is more bound to its cultural premisesand situational contexts than is usually assumed or admitted. In L6vi-Strauss' terms, thereseems to be a lot of bricolage going on in science.10 Preoccupation with 'worms ' and 'throwers-of-worms' has been described by MaltartGuimera (1977 and 1981) for the Evuzok, the Bulu 's neighbours in Southern Cameroon.

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