White, red and black: colour classification and illness management in Northern Ghana.

Health care facilities in Northern Ghana are not only too few, ill-equipped and under-supplied, they are also underutilized. Health care personnel have often noted the irony in the fact that the sick do not make use of the health care facilities when they most need them. Rural peoples often wait until the illness has become so serious that even with emergency measures there is little hope of survival. The author maintains that the causes of this are not simply the lack of community education, the lack of warmth and friendliness on the part of poorly paid health workers, their perceived inefficiency, the great distances to be travelled and the constant shortages of medication. More constraining than all of these are the conflicting cultures of illness management. In a time of otherwise rapid social and cultural change, peoples of Northern Ghana have not often responded to Western medical systems in ways judged appropriate to such systems and have strongly resisted education or coercion to adapt to them. The author maintains that the classificatory systems controlling illness management among the Anufo of Northern Ghana and among others of that locale are colour-coded. This coding of "white", "red" and "black" is not simply a convenient way to classify types and stages of illness, or other aspects of life, but it orders and prescribes social roles and responsibilities vis-à-vis the sick person and the illness itself. In such systems, illness is thought to progress from a "white" stage to the "red" to the "black" or return to the "white". At the onset of the illness, the white stage of individual action, innovative self-help measures are encouraged. But once the illness becomes serious it enters the red stage and innovative measures cease as the more conservative, traditional machinery for problem-solving takes over. The whole community becomes involved. Their roles and functions are strictly prescribed and stringently adhered to. Deviations are thought to exacerbate the problem. When all of the standard social obligations required in this system of illness management have been fulfilled and the person either becomes better or moribund (i.e. the situation is reclassified to either "white" or "black"), once again there is room for individual experimentation, and other forms can be tried. In Northern Ghana traditional structures of illness management block Western biomedical therapy at the exact moment when innovations would be most effective and encourage the inappropriate use of biomedical drugs and therapy at other times. The author maintains that in Northern Ghana and possibly in other rural areas of Africa an emic understanding of the roles and functions that are rigidly adhered to at the emergency "red" stage can help the Western medical systems to be more flexible in adapting to traditional systems of illness management.