WHITE, RED AND BLACK - COLOR CLASSIFICATION AND ILLNESS MANAGEMENT INNORTHERN GHANA

Health care facilities in Northern Ghana are not only too few, ill-equ ipped and under-supplied, they are also underutilized. Health care per sonnel have often noted the irony in the fact that the sick do,not mak e use of the health care facilities when they most need them. Rural pe oples often wait until the illness has become so serious that even wit h emergency measures there is little hope of survival. The author main tains that the causes of this are not simply the lack of community edu cation, 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 constraini ng than all of these are the conflicting cultures of illness managemen t. 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 ed ucation or coercion to adapt to them. The author maintains that the cl assificatory 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-a -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 w hite stage of individual action, innovative self-help measures are enc ouraged. But once the illness becomes serious it enters the red stage and innovative measures cease as the more conservative, traditional ma chinery for problem-solving takes over. The whole community becomes in volved. Their roles and functions are strictly prescribed and stringen tly adhered to. Deviations are thought to exacerbate the problem. When all of the standard social obligations required in this system of ill ness management have been fulfilled and the person either becomes bett er or moribund (i.e. the situation is reclassified to either ''white'' or ''black''), once again there is room for individual experimentatio n, and other forms can be tried. In Northern Ghana traditional structu res of illness management block Western biomedical therapy at the exac t moment when innovations would be most effective and encourage the in appropriate use of biomedical drugs and therapy at other times. The au thor maintains that in Northern Ghana and possibly in other rural area s 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 system s of illness management. Copyright (C) 1997 Published by Elsevier Scie nce Ltd