His thoughtful, measured analysis of ITC and its implications for public health arrives as a long-awaited and crucial response to the all-too-frequent dismissal of -- if not downright opposition to -- indigenous healing practices and belief systems on the part of foreign aid workers, development "experts" and often even by Western-educated nationals of African and other developing regions. Green's creative ideas for integrating ITC with biomedicine are of paramount and timely importance towards addressing a number of today's health plagues, from AIDS to TB, malaria and a host of other contagious scourges. As he reasons, "We do no injustice to science and medicine, and certainly not to public health, if we build on - rather than ignore or confront - indigenous contagion beliefs in our attempts to mitigate the ravages of infectious diseases" (p. 18).
The author clearly strives to avoid either/or polarizations in his analysis of ITC's potential - and above all fundamentally down-to-earth -- contributions to efficacious public health prevention and patient care. As one cogent example:
"Critics of the approach of this book might argue that it is impossible to separate ethnomedical beliefs that are traditional from those that have been influenced - perhaps heavily so - by Western biomedical ideas and education. My response is that African ethnomedicine, like African religion, seems always to have been an open, changing, adaptive system that incorporates new ideas and beliefs even if it reworks them to suit existing beliefs. And, from a practical viewpoint, it does not matter how much biomedical ideas about, for example, microbes has influenced indigenous "germ" theories of unseen insects. What is important is the nature and content of the present belief system, however blended and syncretistic it might be. The fact that some Swazi bogobela - master healers who train initiates - teach that bilharzia [Schistosomiasis] is caused by snail-contaminated water only proves that new, foreign ideas have been adapted and adopted into the present etiological system by its most conservative and influential participants. It is the present belief system - not an imagined pure system of the past - that needs to be understood by those in public health who would influence popular health beliefs and practices in ways deemed compatible with public health (p. 202)."
Anthropologists and other readers interested in the evolutionary and other bio-socio-cultural (pre)historical underpinnings to ITC will find the book's theoretical reflections, summarized in the final chapter, especially thought-provoking. Green argues for a more visible place at the table for his and similarly adaptive anthropological perspectives concerning the complex interface between environment, disease and population in human societies. His conclusion is that "Undue focus on witchcraft beliefs and practices by anthropologists and others has not contributed to the incorporation of ethnomedical findings in public health programs - something many anthropologists bemoan as a serious oversight. However, we are more likely to see health programs informed by ethnomedical research if we place more emphasis where it deserves to be: not on witchcraft beliefs - which is probably the area of least compatibility between indigenous medicine and Western public health - but instead on naturalistic understandings of contagious illnesses" (p. 269-70).
My only criticism of this consistently high-caliber work concerns a reference in Green's book to the frequently cited notion of "super-strains" or unusually virulent subtypes of HIV (p. 181). Max Essex, chair of the Harvard AIDS Institute, and some other researchers have speculated that certain strains, or "clades," of HIV may be more prevalent and hence more infectious among heterosexual populations - thereby explaining, at least in part, the striking discrepancies in HIV rates apparent between different world regions. However, the current consensus among most epidemiologists and virologists is that Essex's initial speculation was incorrect. Melissa Pope of Rockefeller University and Essex himself have tried and failed to reproduce his preliminary results in the laboratory. In Haiti and some other Caribbean and Latin American countries, there are heterosexual epidemics with predominately the same "clade B" virus found in the U.S. and Western Europe, and the Philippines and some other low-HIV countries have exposure to those clade C and E "superstrains" ravaging through such high-HIV areas as Thailand and the "AIDS Belt" of Eastern/Central and Southern Africa. Inspired by Green's own manner of thinking, should we not look primarily to different social environments and cultural-behavioral practices to account for such epidemiological phenomena?
This minor point aside, few readers will be disappointed by Edward's Green's latest and most incisive contribution to the evolving exploration into the multiplicity of human cultures and their rich and complex array of traditional (and modern) healing systems.