Decolonisation in health care

Introduction

This paper deals with various topics that are important in conducting research in and about Africa in the context of health. In this paper, I will discuss what debate is going on about decolonization in health care in which it becomes clear how colonial power relations still apply in the distribution of knowledge in health care. For example, the Global North still seems to have a dominant position in the distribution of knowledge in which they are also in a position to decide what is important to do research on, and what is and is not a health crisis. I show this by giving examples in which knowledge from the Global North is seen as superior, with the consequence that this knowledge is indiscriminately adopted in the Global South. This does not always have a positive effect. In addition, I give examples where it becomes clear that knowledge from the Global South is not seen as equivalent or is ignored by the Global North, as seen with the use of Moringa as a medicine. This paper discusses the research on the use of Moringa and Moringa snuff in which I also reflect on my own research. While reflecting on my research, I will delve deeper into the concept of interdisciplinarity and indigenous knowledge. Topics covered in this paper are decolonisation, crisis thinking, interdisciplinarity, globalisation and the distribution of knowledge.

Decolonisation and knowledge production in the medical sector

In the medical sector, there is a debate about decolonisation. As Membe in a video from Duke Franklin Humanities Institute (2017) outlines, there is a horizontal way of learning where some send and have knowledge and others receive. He rightly asks how this is redistributed and contributed. Cousins et al. (2021) makes it clear that not only knowledge but also resources are unfairly distributed, referring to the Covid-19 crisis where vaccinations went mainly to the Global North. This was despite there being a shift from international health to global health in 1990 given that health goes beyond national borders. According to Cousins et al (2021), this shift actually made colonial power positions clearer as technologies were transported from the Global North to the Global South, and it was in the Global North that what was prioritised in terms of health was determined (2021:1-2). According to Adriaanse (2004), the Dutch government shows a good example of this. Non-conventional therapies such as Chinese herbal therapy or natural therapy are not in the basic package of health insurances and diplomas in these types of health care are generally not recognised by the government (2004). Zorginstituut Nederland (2023) indicates that health treatments that do not meet the state of science and practice cannot be reimbursed, which makes it difficult to include knowledge from the Global South given that this does not always meet the scientific requirements set by mainly the Global North. This exposes power dynamics in a sense. 

Bandal (2018) also mentions the epistemological hegemony of the North where the knowledge of the South would be considered subordinate in the context of health care. Ferguson (2006) also talks about how globalisation processes ensure that there are tendrils between states and places in the world where African experiences should be taken more seriously by starting the conversation about social relations of those involved, who has what responsibility and about inequality on a planetary scale (2006:23). In healthcare, according to Bandal (2018) who refers to Freire, there are also power differentials in terms of knowledge. He indicates that ideologies in the health sciences focus on the life of a Western middle class. Also, foreign students in the health sciences are quickly seen as the “native informant” who can lead to exotic knowledge, whereas in a decolonial perspective, it should be to see foreign students from the Global South as partners who contribute to a more equal knowledge system in health. A pluralistic perspective can help to make knowledge in healthcare more dynamic and progressive, while a decolonial approach can provide a renewed focus in research and implementation, according to Bandal (2018) What also causes unequal knowledge relations at a global level are the internships completed by students from the Global North in the Global South. The short-term internships provide rotation in money, goods, students and can also create a dependence on foreign students in hospitals in the Global South, which can actually worsen the power balances, according to Bandal (2018). Indeed, it shows again, in my view, that African countries should be helped in the field of healthcare where a white saviour complex emerges instead of being seen as a valuable internship where equal transfer of knowledge would be at the forefront. 

The hegemony of the Global North over knowledge of health also results in a slow fading of knowledge from the Global South as a result of globalisation, according to Bandal (2018). As Setiloane (2020) outlines, African cultures adopted the practices of the Global North in the context of health because it was seen as better. This was because of the socioeconomic status of Africa and Europe. Europe had a higher socioeconomic status so African countries started to copy European countries as a consequence, according to Setiloane (2020). In reality knowledge from the Global North is not always the best. Setiloane (2020) refers to an example of breastfeeding when the Global North proclaimed that breastfeeding was not modern and there were better ways of breastfeeding. Women from African cultures went along with the “modern” way of breastfeeding from the Global North, which ultimately caused more mortality among babies (2020:5). 

What is striking about the research being done on the plant Moringa is that mainly countries in the Global South have researched the subject a lot compared to the Global North. According to Pareek (2023), three countries that have researched Moringa the most are India, Nigeria and Brazil. There seems to be more interest in using Moringa as a medicine from the Global North. When looking at articles that give advice about the use of Moringa from the Global North, it is striking that too little research has been done to determine that the use of Moringa is not harmful and it is considered therefore not recommended for vulnerable target groups. Despite the fact that there are more than 1,000 studies in India alone on the use of Moringa (Pareek, 2023), articles from the Global North such as Verywell Health written by Clark (2023) say that too little research has been done to determine that it would actually good for someone’s health (2023). 

Interdisciplinarity in my own research

According to Schipper et al (2021), it is important to apply interdisciplinarity to problems and research. Interdisciplinarity involves striving to interconnect natural science with social and human science. This works to avoid getting stuck in reductionism and reduce the chances of misunderstanding information because a problem or research is viewed from multiple perspectives. There are some pitfalls with interdisciplinarity though where it is mainly about communication. For interdisciplinarity to work, the disciplines should be able to write in their own terms as this will preserve the value of a piece. What often happens is that the terms are nuanced so that it remains understandable to the wider audience which causes the meanings to lose their value (2021:3-6). In the research I will do, I will focus on the psychosocial aspects of Moringa snuff use among young people in Tamale, Ghana, but keep in mind other disciplines. For instance, the historical and demographic perspectives have already been researched which I will involve when I do my research. Furthermore, there has been no writing specifically about Ghana in relation to the use of Moringa snuff. In other countries, this has been written about, often examining the biological perspective by, for example, looking at what substances are in Moringa snuff. What strikes me about these reports from a biological perspective is that there is little focus on other perspectives. This was reflected in studies by Addo et al (2007) and Owusu-Asante et al (2021), among others. The only other perspective that emerges in their articles is a medical perspective in which they describe the risks to health when snuff is used. Another study by Logo et al (2021) took more account of different disciplines. This study looked at adolescents in Ghana who use tobacco. Spatial factors and the socio-economic status a child lives in were considered. In addition, this study also takes behaviour into account (2021). What I personally noticed while reading these different articles is that Logo et al (2021) was clearer in language. This may be so because the concepts are a bit more in my own field, but I also have enough knowledge of health to read well through Owusu-Asante’s (2021) article. Still, there is a difference in clarity due to the interdisciplinarity applied in these articles in that Logo et al. (2021) clearly explained the disciplinary terms used in the article where this was somewhat less the case in Owusu-Asante et al. (2021), but also in Addo et al. (2007). 

Furthermore, indigenous knowledge can help solve a problem because indigenous peoples know better the local context according to the IPCC. Instead of embracing this knowledge, they often look at what would be more valuable and particularly prefer scientific knowledge because it would be more testable and fit into models (2021:3-6). According to Schipper et al. (2021), what would be a better option is to juxtapose different disciplinary formulations so that researchers have to think differently about how disciplines can come together. Ultimately, the goal is to be able to actually make change or solve something rather than something that is feasible to test with models, according to Schipper et al. (2021:6-7). In the research I will do in Tamale, I want to take into account the local context and have people from Tamale tell me what they think about the use of Moringa snuff among young people. The research on Moringa snuff from a historical perspective was done by Samuel Abokyi, who is from Tamale. 

Conclusion

Topics discussed in this paper include decolonisation, crisis thinking, interdisciplinarity, globalisation and the distribution of knowledge. Mbembe (2017) made it clear that knowledge is distributed in a horizontal way in which one sends and the other receives. Cousins et al. (2021) indicated with his example of Covid-19 that the Global North is the transmitter for this. He also shows that it is not only about the distribution of knowledge, but also of goods and technology (2021:1-2). Conversely, it also seems as if the knowledge of the Global South is taken less seriously by the Global North, which can be seen, for example, in which treatments are reimbursed, in this case by the Dutch government (2023), but also in the example of the studies that have been done on the use of Moringa as a medicine in which the Global North writes in recommendations that too little research has been done on Moringa to determine that it is not harmful, for example by Verywell Health (2023). According to Bandal (2018), a pluralistic perspective would help to get this unequal distribution of knowledge more equal by making it more dynamic and progressive. He also gives the example that internships within the healthcare sector can be improved by this approach. At the moment, it seems that students from the Global North can help in the hospitals in the Global South while students coming from the Global South are seen in the Global North as informers of the “exotic knowledge”, This could be made more equal by a pluralistic approach whereby the transfer of knowledge becomes more equivalent in the sense that students from the Global North can learn from their internships in the Global South. Finally, I reflected on my own research in the context of interdisciplinarity. For my research, I have to take into account multidisciplinarity, taking into account the historical and demographic context in my research in which I investigate the psychosocial context of the use of Moringa snuff among young people. I want to involve the knowledge and skills of the young people from Tamale in my research because their knowledge is of equal value to my knowledge, and they may even have more expertise in this subject. 

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