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Abstract:
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This paper examines how risk is perceived by lay populations in response to two aetiologically connected but conceptually divided diseases – malaria and nzoka . Using case study data from an ethnographic study of risk perceptions in north-western Tanzania, we explore the relevance of risk as a concept within a community exposed to traditional and modern value systems, a pluralistic health care system and syncretic treatment-seeking behaviour. We found that the concept of risk was a useful heuristic device, but that what was categorised as risk reflected different social circumstances. The findings reinforce the evidence for risk and risk perception as cultural products. Using empirical examples of experiences with malaria and nzoka , we highlight difficulties in illness recognition, particularly with common symptoms such as high fevers and convulsions in this case. We show how risky decisions over appropriate treatment-seeking were informed by processes of categorisation and re-categorisation as the patient and their family negotiate a solution to illness. We show how this process of risk re-categorisation is framed by social context, hinges on peer and professional advice and responses to treatment, and how this process often continues after treatment ends through recovery or death. We conclude by emphasising the way in which awareness of categorisation as a risky practice in illness management increases the salience of treatment-seeking considered as risk, exacerbating the ‘actual’ risks of experiencing illness.
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