and should be avoided because it can jeopardize an individual’s physical, spiritual, or mental health.
Many East Africans make assessments of their physical health based on the general quality of their blood. Blood can be weak, strong, run quickly or slowly, and be sick or healthy.75 People are born with either weak or strong blood, and those with weak blood are more likely to become sick and less likely to make a full recovery after being ill. For example, on the Tanzanian coast, many mothers explained their children’s frequent illnesses by saying that the children “did not have enough blood in their body [damu hana or damu imepungua].” The mothers explained this lack of blood by citing numbers they were told at the local clinic, that a child had “only 40 percent” or “.5.” These figures referred to the hemoglobin levels that nurses and doctors had mentioned during consultation with the mothers.76 In explaining their children’s poor health, the mothers drew upon existing ideas of the relationship between the quality of blood and health, but also integrated biomedical information into their explanation, since the 40 percent and 0.5 indicated, to them, an actual lack of blood in the body.
As the above example implies, current conceptions of blood are neither static nor uninfluenced by biomedical ideas. Prior to the introduction of biomedicine in the late 1800s, it was common practice for East Africans to utilize a variety of healers including diviners, herbalists, and those specializing in Islamic medicine. As Europeans arrived, the search for effective treatment and persuasive explanations for diseases broadened again to include missionaries, who were considered just another set of “immigrants and traders.”77 Even outside the cosmopolitan Swahili Coast, there was a strong tradition of accepting foreign specialists, treatments, and explanatory systems. Among the Iraqw of Northern Tanzania, “the incorporation of an alien way of looking at and acting on illness” was not at all new.78 In Uganda, as Susan Reynolds Whyte argues, there is “reason to believe that the exotic has always played a part in Nyole and other East African medical systems.”79 In interviews with modern residents of Dar es Salaam, elders said that the “traditional,” or widely accepted, therapies for some diseases had significantly changed over the years—a change they attributed to “the greater presence of biomedicine in their lives.”80
Although we might be tempted to perceive here a replacement of one (traditional) system of thought with a biomedical (modern) one, that would not be accurate. It would be more precise to see ideas around health, disease, and healing that now exist in East Africa as syncretic.81 To discuss anything as “syncretic” is to imagine two or more distinct systems coming together to form something new—a third system—that borrows bit and pieces from each. This new, syncretic set of ideas concerning health is a patched-together mosaic of medical technologies, systems, and concepts. It is a product of a long history of medical pluralism that has involved centuries of contact with Ayurvedic and Islamic medicine in addition to biomedicine. It incorporates local ideas of witchcraft and sorcery, political and societal health being manifest though individual bodies, and a broad conception of “normal” health and appearance linked to day-to-day functionality.
There are clear examples of East African understandings of blood assuming syncretic forms. “Anemia” is translated in Swahili as upungufu wa damu, which is, literally, “deficiency of blood.”82 Traditional remedies dating back to the 1890s focus on “building” or “strengthening” the blood by eating “hot” foods such as beans, leafy greens, and raisins, which biomedicine identifies as being iron-rich.83 Thus, well before the first vitamin was identified in 1910, and before chemical analysis showed that these particular foods were iron-rich, it was enough to have a category of hot foods that would “strengthen the blood” through the production of the blood humor.84 Yet, biomedical understandings of blood are still constantly rubbing up against preexisting ideas, and that friction creates new explanatory models. When a boy died on the Kenyan Coast in the 1980s, people explained that he had “no blood in his body” and opined that the boy should have eaten “hot” foods. Still, in discussing his death with a foreign anthropologist, they were adamant that either hot foods or vitamins would have cured the boy, since both strengthened the blood.85
This system of medical syncretism forces biomedicine to exist with other, potentially contradictory beliefs. A clear example is many people’s understanding of malaria. From a biomedical perspective, malaria is spread by female anopheles mosquitoes, which carry a parasite from infected person to uninfected person. Every malaria infection can be classified into one of four types, produces a particular (and predictable) set of symptoms, and can be successfully treated with a number of different drugs. Yet, although there is widespread awareness of these biomedical expectations about malaria, they are not the only—or the dominant—local understandings of the disease. Multiple public health projects have found that most Tanzanians know that mosquitoes spread malaria.86 But the knowledge is not exclusive. Medical anthropologists have shown that, while people agree that mosquitoes cause malaria, there are also other well-known and widely accepted causes. As Susan Beckerleg reports, “the view that mosquitoes cause malaria by introducing wadudu [bugs/parasites] into the blood stream is not well accepted. . . . And even where accepted, the theory has to coexist with apparently contradictory causes such as changes in the wind.”87 In central Tanzania, people recognized mosquitoes as causing malaria, but also felt that exposure to “hot sun” and “hard work” could lead to malaria.88 In Ifakara, Tanzania (in the southeast), anthropologists found that people’s explanations for malaria often wove together notions of witchcraft with “knowledge of the biomedical cause of malaria.” They found that in addition to noting mosquito bites as a cause of malaria, other modes of transmission included drinking or wading through dirty water and/or being exposed to hot sun.89
One disagreement between biomedicine and indigenous health concepts centers on blood regeneration. From a biomedical perspective, blood regeneration occurs naturally: the body produces new blood in the same way that the heart beats or the lungs take in oxygen—without conscious thought on the part of the person. Thus, in this framework, the loss of small amounts of blood for donations or medical tests is not considered dangerous, and in most medical research projects blood taking is labeled as “no” or “low” risk. However, for many East African groups, blood regeneration is considered difficult if not impossible, and occurs only through conscious changes in diet or avoidance of certain behaviors. As it has been described among the Haya of western Tanzania, certain foods increase the blood (meat, green leafy vegetables, and fish) while others decrease it (coffee and citrus). Additionally, “hot” activities such as working in the sun or excessive sex can cause “illness such as feverish chills, which are characterized by a lack of blood.”90 In general, women and children are thought to have weaker blood and to be more at risk during procedures like blood donation or surgery because of the difficulty of blood regeneration.91
Disagreement about the ability or inability to regenerate blood means that East Africans and biomedical researchers are likely to come to radically different assessments of the risk of giving blood. This is partly linked to physical health: whether one will have enough blood in the body to be healthy and strong. A second concern regards the risk of having blood move through unknown hands in unknown places, opening oneself to the risk of witchcraft.92 The general feeling is that there are only a few acceptable occasions when blood can circulate outside the body, such as during marriage ceremonies or rituals to mark blood brotherhood or blood friendship. Moreover, even while blood is shared at such times, these are fraught exchanges. It is the very risk involved in sharing blood that emphasizes the depth of relationship with the person the blood is being shared with. By contrast, when the prospect of giving blood to an unknown foreign medical researcher is raised, an East African is likely to come to a very different assessment of the risk involved in such an encounter.
Stories about blood theft and medicines made from human blood have a long history. For at least the last 130 years, one frequently mentioned nefarious use for blood is as an ingredient for mumiani.93 The word mumiani is often translated today as a person, someone who is
