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International African Institute
L'Etat sorcier: santé publique et société au Cameroun by Bernard HoursReview by: Philip BurnhamAfrica: Journal of the International African Institute, Vol. 58, No. 2 (1988), p. 240Published by: Cambridge University Press on behalf of the International African InstituteStable URL: http://www.jstor.org/stable/1160668 .
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northern Cameroon (especially in the suggestion that Moundang Christianity offers a model for an alternative). Part Four is an extended discussion, with substantial statistical back-up, of the causes and consequences of migration. Here and elsewhere in the book the deleterious effects of abandoning the mountains for plains cultivation or life in the towns are underlined. The final part deals with the principal economic activities, starting with five case studies of diverse agricultural systems then discussing subsistence and cash crops, as well as animal husbandry. After a description of marketing, we finish with urbanisation and the regional communication network.
In conclusion, Boutrais reviews some of the outstanding problems of development, notably the future for mountain agriculture, the limited successes of the paysannat and the dependence upon cotton as a cash crop. As a whole the volume is a tribute to the cumulative effect of supporting individually unspectacular research efforts which build into a regional perspective. While the book is refreshingly unprogrammatic, I feel there may be a moral trying to get out.
RICHARD FARDON
University of St Andrews
BERNARD HOURS, L'Etat sorcier: sante publique et societe au Cameroun. Paris: Editions l'Harmattan, 1985, 165 pp., ISBN 2 85802 569 7.
As the subtitle of this book makes clear, L'Etat sorcier is an analysis of the (Western-style) system of public health in Cameroon, with particular emphasis on the ways in which the everyday participants in the quest for health conceive of the functioning of this system. The author carried out periods of participant observation in four different types of Cameroonian health care institution-a public dispensary in one of the quartiers of Douala, a large public hospital in Douala, a small public maternity clinic in a village near Tiko in southwestern Cameroon, and a small, private, mission-run health centre near Buea. The book has been constructed primarily by stringing together quotations from the patients, nurses, doctors, janitors, pharmacists, etc., whom Bernard Hours interviewed in these settings. The book is thus fashionably written in the 'discourse' mode and, although the Cameroonian voices the author has selected to speak to us certainly ring true in my experience, the total effect is unsatisfyingly impressionistic and anecdotal.
A major theme emerging from Hours's interviews with patients and practitioners alike is the perceived contradiction between the ideal vision of the state as the powerful protector of the public's health and the actual experience of unsatisfactory public health care and empty dispensary pharmacies. Much resentment focuses on the lower echelons of the health service, especially on the nurses, who are often accused by the public of stealing the medicines that should be available, by right, to needy patients. Nurses defend themselves by accusing the state of inadequate support for the health service, which makes health workers like themselves bear the brunt of public dissatisfaction and protest. Hours uses the metaphor of the Cameroonian state as witch doctor to highlight its position in this chain of accusations relating to health and illness, power and powerlessness. While this metaphor captures some aspects of present-day ideologies relating to health in Cameroon, it is not an adequate substitute either for a theoretical analysis or a detailed empirical study of Cameroonian state health policy and practice.
PHILIP BURNHAM
University College, London
northern Cameroon (especially in the suggestion that Moundang Christianity offers a model for an alternative). Part Four is an extended discussion, with substantial statistical back-up, of the causes and consequences of migration. Here and elsewhere in the book the deleterious effects of abandoning the mountains for plains cultivation or life in the towns are underlined. The final part deals with the principal economic activities, starting with five case studies of diverse agricultural systems then discussing subsistence and cash crops, as well as animal husbandry. After a description of marketing, we finish with urbanisation and the regional communication network.
In conclusion, Boutrais reviews some of the outstanding problems of development, notably the future for mountain agriculture, the limited successes of the paysannat and the dependence upon cotton as a cash crop. As a whole the volume is a tribute to the cumulative effect of supporting individually unspectacular research efforts which build into a regional perspective. While the book is refreshingly unprogrammatic, I feel there may be a moral trying to get out.
RICHARD FARDON
University of St Andrews
BERNARD HOURS, L'Etat sorcier: sante publique et societe au Cameroun. Paris: Editions l'Harmattan, 1985, 165 pp., ISBN 2 85802 569 7.
As the subtitle of this book makes clear, L'Etat sorcier is an analysis of the (Western-style) system of public health in Cameroon, with particular emphasis on the ways in which the everyday participants in the quest for health conceive of the functioning of this system. The author carried out periods of participant observation in four different types of Cameroonian health care institution-a public dispensary in one of the quartiers of Douala, a large public hospital in Douala, a small public maternity clinic in a village near Tiko in southwestern Cameroon, and a small, private, mission-run health centre near Buea. The book has been constructed primarily by stringing together quotations from the patients, nurses, doctors, janitors, pharmacists, etc., whom Bernard Hours interviewed in these settings. The book is thus fashionably written in the 'discourse' mode and, although the Cameroonian voices the author has selected to speak to us certainly ring true in my experience, the total effect is unsatisfyingly impressionistic and anecdotal.
A major theme emerging from Hours's interviews with patients and practitioners alike is the perceived contradiction between the ideal vision of the state as the powerful protector of the public's health and the actual experience of unsatisfactory public health care and empty dispensary pharmacies. Much resentment focuses on the lower echelons of the health service, especially on the nurses, who are often accused by the public of stealing the medicines that should be available, by right, to needy patients. Nurses defend themselves by accusing the state of inadequate support for the health service, which makes health workers like themselves bear the brunt of public dissatisfaction and protest. Hours uses the metaphor of the Cameroonian state as witch doctor to highlight its position in this chain of accusations relating to health and illness, power and powerlessness. While this metaphor captures some aspects of present-day ideologies relating to health in Cameroon, it is not an adequate substitute either for a theoretical analysis or a detailed empirical study of Cameroonian state health policy and practice.
PHILIP BURNHAM
University College, London
240 240 REVIEWS REVIEWS
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