It was a clear, hot day in September, and in spite of the relentless sun my friend Faatu decided she wanted to visit Amadu, a well-known healer in a neighboring village known for his skill atmocc. After taking our bucket baths and getting dressed, we set out trudging along the sandy road to themocckat’s house. We walked a few kilometers and arrived in the neighboring village and then found Amadu’s house. His wives and several children were sitting outside in the courtyard. “Are you here for mocc?” asked one of his wives. Faatu nodded and the woman told...

This chapter offers an overview of Senegal’s past and examines its seeming inability to overcome its present economic and political dilemmas. Over the course of its history, Senegalese society has been marked by profound social inequalities that have deep roots in the precolonial social order, the colonial experience, and the rise of political and religious elites before and after independence. Social inequalities were institutionalized in the precolonial era in aristocratic societies that were highly stratified by social order and caste. The era of French conquest and occupation, which coincided with the rise of dynamic Sufi organizations and a near-complete Islamization...

Much like the country as a whole, for the past several decades urban and rural residents of the Saint Louis region have confronted increasingly difficult economic conditions. While global capital and state development plans have skipped over this region, finding it unusable, many people have been left behind who are struggling to make do under worsening conditions (Ferguson 2006). They are caught between the empty promises of the state and various donors, and the neoliberal imperative for a privatized, downsized, decentralized government. Pikine residents have been waiting for neighborhood zoning since the early 1980s; meanwhile, the city government insists that...

When I moved to Saint Louis in the fall of 1998, I found that most technical personnel working in neighborhood health posts, and the majority of people seeking health care at government health clinics, had little idea what decentralization and the “new health codes” were all about. New financing systems were in place, as were new modes of management at local clinics, yet only the senior administrators in the medical district seemed to have a sense of how the reformed health system was supposed to function. The buzzwords of the reforms included “community management,” “participation,” and “state-citizen partnerships for health.”...

My first trip to the Pikine health post gave me a good sense of how difficult it is for Pikine residents to seek care there. My research assistant and I set out from the main road on the sandy footpaths that wind their way through the congested neighborhood toward the Senegal River. Even for a lifelong Pikine resident it is easy to become disoriented in the heart of Pikine as small paths can suddenly dead-end on someone’s doorstep, or the path you have chosen becomes so narrow and twisted that you can’t tell if there will be a sudden turn...

Health sector reform in Senegal created new social spaces for the management and delivery of biomedical care, as well as new kinds of relationships between medical professionals and community members. To date there have been tremendous discrepancies between the envisioned benefits of decentralization and community management of health facilities and the contentious arena within which different social actors maneuver to control resources and accrue social capital. A similar disjuncture exists between the expectations of biomedical professionals and the actual health strategies of Saint Louis and Ganjool residents.

The most obvious collision between health-seeking practices and the assumptions of biomedical providers...

This chapter moves from a discussion of knowledge frameworks that inform health action to the daily health dilemmas confronting families in Ganjool. My insight into the lived realities of staying well and responding to disease in rural Senegal emerged during the eight months that I lived in Daru-Mumbaay in 1999. I had been a frequent visitor there since my debut in the village in 1993 as one of the first tubaabs (westerners) to spend any time living, socializing, and conducting research in the village, as opposed to the frequent sightings of white tourists passing back and forth on land and...

Throughout my field research I noticed that there were very few occasions to observe men’s health practice or their strategies for dealing with illness. Day-to-day management of household illness falls largely within the realm of child care performed by mothers and older siblings, and women and children were the majority of patients at the health hut in Mumbaay and at the health posts in town. Not only are men absent from the largely female spaces of health clinic waiting areas, they are missing from most of the public health and development discourse as well.¹ The majority of education campaigns, particularly...

One scalding hot day in the middle of November, I went to the health hut with Khadi to chat and observe her patient consultations. She would often go there in the midmorning and keep the health hut open until it was time for the main meal of the day around 2 p.m. Many mornings were quiet as almost everyone in the village was out watering onions. Business at the health hut would pick up around noon when women came in from the onion fields to do their marketing and prepare lunch. On this particular day, a crowd of women, infants,...

When I returned to Senegal in 2002, two and a half years after I finished the bulk of the research for this project, many colleagues and acquaintances in Saint Louis and Ganjool wondered why I had come back. The marriage that brought me to Pikine and Mumbaay had ended, my graduate school years had come to a close, and I was moving on to a new chapter in my professional life. More than a few times I myself wondered what I was doing there. Was I an anthropologist returning to the field, a friend stepping back into the lives of...