By Carolyn Baylies (University of Leeds)
Kampala Women Getting By: Wellbeing In The Time Of Aids. By Sandra Wallman et al London: James Currey, 1996, pp. 288 + illus., Jib £35, pb £14.95.
Kampala Women Getting By, produced by Sandra Wallman and her research colleagues, contains a rich combination of detailed field data and incisive analysis. It reports the findings of an ODA funded study of the informal economy of health in one neighbourhood in Kampala, which examined ideas about health and wellbeing and explored the ways women make health care decisions and seek treatment in respect of their young children’s episodes of acute illness and their own experience of STDs. Its focus on women follows from (and elaborates upon) an appreciation that women are frequently disadvantaged relative to men in access to economic resources and the exercise of authority within both the family and the community, that women assume primary responsibility for the health care of their families and that, while moresusceptible than men to STDs, including AIDS, ironically bear the brunt of the blame for the spread of HIV. This is not a book exclusively about AIDS, but necessarily takes account of the seriousness of AIDS in Uganda and the way it figures in people’s worries and can so often claim the lives of mothers and young children.
Kampala Women Getting By is of interest from a methodological point view as well as with respect to the detail presented and conclusions drawn. Wallman and her colleagues used a range of methodologies in the course of their interdisciplinary research, were attuned to the variable suitability of different data collection techniques for different purposes and incorporate data taking a variety of forms – from the graphical representation of census and tables summarising survey results to sketches of houses and excerpts from field notes. The structure of the book is described as reflecting the staging of the research, in moving from broad and shallow to narrow and deep modes of enquiry, the latter making particular use of observation, group discussion and the collection of case studies. While the case notes and records of observation are fascinating die strength of the overall analysis might have been enhanced had somewhat more processing of material been carried out and more commentary provided on the potentially contradictory interpretations which emerge from different methodological approaches, and, indeed, how research which takes up only broad and shallow modes of enquiry may result in only partial illumination and in some cases misinterpretation. Further discussion of problems of verification associated with the different approaches might also have been of value.
The guiding theme of the book is the notion of wellbeing the importance of which is acknowledged from the outset: the vernacular of the population studied does not distinguish between health and wellbeing Moreover, wellbeing is understood as referring to the welfare of the household in a broad sense, not just its physical state. Wellbeing can relate to the way in which income permits welfare to be attained and sustained, and thus can incorporate poverty or relative access to resources, as well as to the health status of household members. The case studies, selected in accord with differential economic position and social acceptability, reveal the range of avenues which women travel to seek health care, depending in part on their access to resources and the networks of which they may be a part. Relative isolation or limited knowledge may figure significantly alongside such factors as level of income in determining the range of diagnostic and treatment alternatives available to women. The experiences of the women studied also indicates the significance of the informal health sector, and suggests the scope of misconceptions about health seeking behaviour which would result from exclusive attention being given to formal sector facilities and provision. It is through asking women what they did – who they talked to and the factors affecting their decisions about what must be done – during the last bout of illness which they or their children experienced, that the significance of their own networks and of informal sector practitioners and providers of advice and medication is revealed.
This book is an important contribution to our understanding of the experience of health and health care, of the tendency for women so frequently to attend to the health of others before taking account of their own health needs, of the desperation of women in seeking care for their suffering children and of the resourcefulness they demonstrate in the process. It is revealing of the way in which health, while the responsibility of individual women, is understood and treatment pursued via a complex network of contacts, often involving relations of reciprocity. Perhaps the most crucial implication for policy relatingto strategies of protection and treatment of HIV/AIDS is the study’s emphasis on the need for such initiatives to incorporate the informal health care sector, given the frequency to which it is turned to by women seeking diagnosis and treatment. But the book also has value for its anthropological approach, ensuring that experience studied is always located within its appropriate context, and the author’s insistence that context must in turn become the object of careful analysis.
[Published in Leeds African Studies Bulletin, 61 (1996), pp. 64-66]