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Training shopkeepers and schoolchildren in medicine use: experiments in applied medical anthropology in east Africa.

A five-day workshop, "People and Medicines," was held in November 1998 in Mbale, Eastern Uganda, which brought together researchers from different disciplines working in Uganda, Kenya, and Tanzania in the field of medicines. The aim was not only to generate new research questions and methodologies, but also to discuss possible interventions to improve medicine use. In 1980 when I started anthropological research on the use and distribution of Pharmaceuticals in an African country, this was a relatively new topic. Anthropologists traditionally have studied indigenous medicines, including the use of herbal concoctions and magic objects. In 1980 aspirin, chloroquine, and tetracycline were considered unusual things to study—too ordinary. But when anthropologists started to publish their research findings on pharmaceuticals, they revealed that these familiar tablets and capsules had turned into exotic substances. Pharmaceuticals were being used outside the controlled domain of medical doctors, in ways that were far remote from the biomedical rules (van der Geest 1981). Herskovits's term cultural r^interpretation was resuscitated to describe the different perception and taking of Western medicines in non-Western cultures (Bledsoe and Goubaud 1988). Others spoke of the "indigenisation of pharmaceuticals" (Haak and Hardon 1988). Now, almost twenty years later, the ethnography of pharmaceuticals is well established (see van der Geest et al. 1996). It is generally known, for example, that prescription-only medicines are freely available in unlicensed drugstores and general stores and on open markets in most countries of the world. It also is well known that these medicines are sometimes used in highly imaginative ways, or, to put it more bluntly and from a biomedical point of view, wrongly—that is, for the wrong purpose, in a wrong manner, and in a wrong dosage. The cultural differences in medicine use have placed the anthropologist in a difficult position. On the one hand, he or she respects a particular people's point of view with regard to medicines and argues for its rationality. On the other hand, he or she cannot deny the harmful consequences of "inappropriate" drug use. Medicine taking has proven to be an awkward test case for the anthropological virtue of cultural relativity.