This week marks the arrival of Samuel Bewiadzi Akakpo as a visiting PhD student, who will be joining the team at the Making Clinical Sense Project. To kick off his visit, Victoria Lewis, a research assistant at the Making Clinical Sense Project, took the opportunity to interview Mr. Akakpo. In this interview we learn more about Samuel’s research interests, previous work, and unique perspectives on the field.
Samuel Bewiadzi Akakpo is a visiting PhD student at Maastricht University and was awarded a scholarship within the Making Clinical Sense project led by Anna Harris. Samuel has been a researcher in the field of medical anthropology for seven years and primarily focuses on Traditional Bone Setting in indigenous Ghanaian societies (Ewe and Nawuri ethnic groups), medical terminologies of the Ewe, cross-border patient mobility and access to healthcare along the Aflao-Lome Bordeland, and the practice of traditional medicine and indigenous knowledge systems of health and healthcare among the Ewe of Ghana.
Victoria Lewis is a master’s student at Maastricht University studying Globalisation and Development within the Faculty of Arts and Social Sciences. She has a background in anthropology and is currently researching the use of traditional ecological knowledge within conservation policy in the context of Suriname.
Victoria Lewis (VL): Your research focuses on traditional knowledge systems and practice, specifically in Ghana. So why is it important that we are knowledgeable of this in the context of Ghana when we apply it to medical education?
Samuel Bewiadzi Akakpo (SBA): So, you see, the main healthcare systems are very pluralistic, in the sense that we have been exposed to Western models of healthcare, and so a lot of hospitals, clinics and health centers are being constructed across the country, where we’ve been made to understand that Western healthcare models are very reliable. You have very competent healthcare professionals who have been trained in medicine, Nurses and physiotherapists, who have that kind of broad-based knowledge to attend to you in all aspects of your life, especially when health issues are concerned. But we also understand that beyond that, there are indigenous knowledge systems, which also play very critical roles in ensuring stable health in our society. Because prior to the emergence of biomedicine, those who laid the foundation for healthcare were the traditional medicine practitioners. And so once we have the doctors and the nurses in the hospital, in our community, we have people like priests, priestesses, and traditional birth attendants. We have divinests, and every while we have the orthopedic surgeon in the hospital at the community level. And we have traditional bone setters. So practically whatever goes on in the hospital in terms of in healthcare, actually, we have that kind of replication of that in the community. These two practitioners use different models of operating and they have different policies that we may use. Those in the hospital believe in the scientific method, where everything has to be proven, but those at the society or the community level, they understand health, diseases, and illnesses, but they are processing from a different perspective because they look at it from the cultural background. They look at it from the premises that persons and their belief systems are part of their environment. So that also informs their health seeking behavior, and the approaches that they should adopt in seeking healthcare.
The essence is that over 70% of the Ghanaian population live in rural areas. Within these rural areas, some of these orthodox medicine facilities are not there. Like the hospitals, the clinics and the health centers. There are some communities in Ghana that don’t even have a clinic. And so you don’t expect them to go to a clinic when they fall sick. So what you have to do is to depend on their indigenous knowledge systems. Their knowledge in herbs, their knowledge in the use of mineral substances to treat the various ailments and diseases that you may. Fortunately for them, there are a number of times and medicine practitioners who operate within these rural communities without hospitals. So once you don’t have a hospital, you don’t have any other alternative than to go and patronize the services of the traditional medicine practitioner.
The rural people believe in the competence, the efficacy of the health, the medicine and mineral substances that these practitioners use in dealing with their problems. And they also believe that every issue that deals with illness and diseases has a spiritual interpretation. So some of these diviners and priests, while they will provide you with the help to deal with the physical aspects of the ailments, will also go beyond the physical into the spiritual realm to acquire from the spiritual domain as to what the causes are. So if there is the need for some clarification, right, some sacrifices, libations and prayers to be made, to deal with the issues spiritually that has to be done. And it comes from the traditional medicine practitioners who are the gatekeepers of health and healthcare within the rural areas.
So, you will see about 60% of Ghanaians who patronize the services of traditional medicine practitioners. I argued earlier that the Ghanaian healthcare system is pluralistic or syncretic, in the sense that people blame the two: Western knowledge as against African indigenous knowledge systems. And so that has been the health domain and environment a lot of people operate in. So it becomes very important for us to expose this type of knowledge to people to understand that the Ghanaian healthcare system is not as skewed to one direction, but rather the multiplicity of practitioners and knowledge systems that can use a lot in dealing with healthcare issues.
VL: There’s this obvious difference between the health care system in Ghana as opposed to a country in the West, where indigenous knowledge is not valued, even though it’s there.
SBA: Exactly, yes, it’s not valued. But in our context, it’s highly valued. Because there are certain diseases that the Orthodox medicine practitioners cannot deal with. And we believe that it’s not every disease that goes to the hospital. Some of them must, no matter what the situation they must be dealt with, at the community level. So sometimes there are certain diseases that want to go for, say you look at the symptoms of the disease and realize, no, this is not the hospital issue. And so you have to look for an alternative medicine, and what we mean by alternative is that for other practitioners who have knowledge in that type of disease that you are suffering from, they will now explore the problem with a diagnosis, and then find a better and lasting therapeutic solution to your problem.
But while this knowledge is not probable in the West because they don’t believe in the spiritual or psychic domain of health and healthcare, for us in our context, here in Ghana, we believe that diseases go beyond the biological and physiological framework into much deeper spiritual dimension, because the causes of disease may either be physical or spiritual. So no matter what the situation, you might want to blend the two.
VL: It’s very interesting. So many people are not aware of this. Especially in the West. With this knowledge, have you found it to be important within your research in development and governance?
SBA: One major challenge confronting this traditional knowledge is that practitioners don’t have that recognition from the government assistance now, even though the government has made some policy documents to regulate the activities, the policies have not been implemented to benefit them. So it’s making their will very very difficult in the sense that they are that they are not legally recognized to operate within the society. And so that has been a very big challenge to that. But with my research into these areas, we are breaking the grounds and a lot of them are getting the recognition and registration that they need in the various administrative districts in the Volta Region.
What I’m doing now is currently in the Volta Region, because I can’t go to other regions because of a lot of constraints. But within the indigenous environment, I’ve started some advocacy work, where we are bringing all these types of medicine practitioners together. And we have started registering them within the various administrative districts so that they can get the legal recognition from the central government to operate within the various communities. So that’s what we’ve done. But on the other side of the research work, it has boosted my morale to continue to research into health and healthcare issues. And it is even to understand the complexities of health seeking behavior in our societies because I’ve met a lot of people who tell me that they’ve gone to the hospital to seek medical care, and by the end of the day they end up in the shrine of a priest to continue to seek, what? Healthcare.
So all along I thought that’s what you foresee, it’s all about the hospital. I’ve come to realize that it’s not only about the hospital, that it goes beyond hospital. People will go to the hospital, but also visit, what? Traditional medicine practitioners. People who go to the hospital, they are given scientific medicine and drugs, but go back to them and you find camps within their various environments. So they explore both models to deal with their problems and it is very, very interesting research into this particular field. So that’s how come I eventually had to settle on traditional bone setting for my PhD work.
VL: What is the lasting impression that you want to leave on people here? On the socio-cultural dynamics of Ghana?
SBA: The last impression I want to leave on people here is to understand our culture, our way of life, how we understand issues of health and healthcare, the importance of culture to our daily survival, because you cannot detach the African people, the Ghanaian people from their culture, because in every aspect of our lives, be it politics, be it social, be it economic, every quarter has a role to play. And so in our music and dancing, now even the language itself, there is a lot of cultural elements even in our contemporary governance. At the state, there are cultural elements in there. So the lasting impression that I want to live on the people of the Netherlands is to showcase the Ghanaian culture extensively in terms of our cultural practices, in terms of the healthcare systems that we have, in terms of the popular health culture and domestic health care practices. How we can blend Ghanaian healthcare systems with the Western healthcare systems, and how the cultural and historical conditions of Ghana shape our medical practices and policies in contemporary times.
Read the full interview here.