Msoka, E. F., Bunn, C. , Msoka, P., Yongolo, N., Laurie, E. , Wyke, S. , McIntosh, E. and Mmbaga, B. T. (2024) A rapid ethnographic appraisal of community concepts of and responses to joint pain in Kilimanjaro, Tanzania. BMJ Global Health, 9, e013245. (doi: 10.1136/bmjgh-2023-013245)
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Abstract
Introduction: Musculoskeletal disorders, experienced as joint pain, are a significant global health problem, but little is known about how joint pain is categorised and understood in Tanzania. Understanding existing conceptualisations of and responses to joint pain is important to ensure both research and interventions are equitable and avoid biomedical imposition. Methods: Rapid ethnographic appraisal was conducted in a peri-urban and rural community in Kilimanjaro, documenting language used to describe joint pain, ideas about causes, understandings of who experiences such pain, the impacts pain has and how people respond to it. We conducted 66 interviews with: community leaders, traditional healers, community members, pharmacists. Photographs were taken and included in fieldnotes notes to supplement the interview data and develop thick descriptions. Data were analysed by constant comparison using QDA Miner software. Results: Across the sample, dominant concepts of joint pain were named as ugonjwa wa baridi - cold disease; ugonjwa wa uzee – old age disease; rimatizim – disease of the joints; and gauti – gout. Causes mentioned included exposure to the cold, old age, alcohol and red meat consumption, witchcraft, demons, and injuries/falls. Age, gender and occupation were seen as important factors for developing joint pain. Perceived impacts of joint pain included loss of mobility, economic and family problems, developing new health conditions, death, reduction in sexual functioning, and negative self-perceptions. Responses to joint pain blended biomedical treatments, herbal remedies, consultations with traditional healers and religious ritual. Conclusions: Conceptualizations of and responses to joint pain in the two communities were syncretic, mixing folk and biomedical practices. Narratives about who is affected by joint pain mirror emerging epidemiological findings, suggesting a strong ‘lay epidemiology’ in these communities. Anthropological methods can support the decolonisation of global health by de-centering the imposition of English-language biomedicine and pursuing synthetic, dignified languages of care.
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