EDITOR'S PREFACE

The  papers 

in  this  volume  were  all  presented  at  the  workshop  GLOBALIZATION  AND
CHANGES IN  CULTURES  OF  SURVIVAL AND CARE,  jointly  organized  by  the Institute
of  African  Studies  and  scholars  from  Bergen  University,  October  10-12, 2001. They  cover  a
wide  range  of  topics and  issues from  different  disciplinary perspectives.

T^e  first paper,  by  Kari Waerness, is  on the  ethics  of care and  the  social  research  and
political  theory  which  have  been  developed  around  this  subject  in  northern  academia.  She
first  poses  the  basic  question:  what kind  of social  research needs  to be  promoted  in  view
of  the  tremendous  challenges that  problems  of  globalization and  changes  in  the  cultures  of
survival and  care  represent  for all  the world?  She  discusses  this  very important question  in
the  light  of  her  three decades  of  pioneering research  on  the  topic  of  care carried  out  in the
context  of  a  well  developed  Scandinavian  welfare  state.  She  stresses 
to  develop
knowledge which will  be an  influential  tool in  creating  better  care  policies and  practices and
the  potentially  dominant  and  powerfully
which  will  among  other  things  counteract 
influential  market  oriented  discourse  which  stresses  quantifiable  efficiency  and 
carer
productivity.  Of  course,  theoretical  discourse  on  care  takes  us  into  the  heart  of  feminist
scholarship and  gender debates and  of  necessity  into  considerations  of  power. She  reminds
in  empirical
us  of her  concept  of the  rationality  of  caring, which has  been  found  fruitful 
research  on  public  care  systems  and  calls  our  attention  ultimately  to  the  need 
to  reach
consilience among the  major  disciplinary approaches.

the  need 

The second paper, by John Anarfi, clearly  points  to the  link  between the  globalizing  forces
of  international  labour  migration, sexual  vulnerability  and  health  risks  in the  West  African
Sub Region.  He  calls attention quite  graphically  to the consequences  of this  wide scale spatial
mobility  of  populations  both  female  and  male  in terms  of  the  speed  and  directions  of
spread  of  sexually  transmitted  disease  and  death  in  the  region.  The  link  between  labour
movements  and  health  risks  is  illuminated,  a  link  which  was  already  clear  more than  a
decade  ago  but  which 
international  and  national  organizations  chose  to  neglect.  Professor
Anarfi's  message is  very  clear. These linkages and  risks  will  continue  to be ignored at  our
peril.  Moreover  labour,  gender  and  health  issues  are  seen  to  be  inextricably 
linked  and
requiring  multifaceted,  holistic  solutions.

conflicts  caused  and 

The  third  paper by Christine Oppong also  looks at the  impacts  of  globalizing  economic
in  terms  of  their  impacts  on  gender  roles  and  family
and  demographic  transformations, 
systems.  The  disruptions  and 
the  reproductive/productive  squeeze
increasingly  suffered  by  women  in their  child  bearing  years  are viewed  as  impacting  the
quality  of  care  that  mothers  and  other  care  takers  are  giving  to  their  children.  This  is
perceived  as  having  disastrous consequences  for  infants  in  terms  of  under nutrition.  Levels
of  under - nutrition  in  infants  in Africa are  high and  even  rising at the  present  time, even in
countries at  peace not war and  as  yet  not  heavily  affected  by the  scourge  of  HIV/AIDS.
The aim  of the  paper  is  to motivate  more researchers  to  carry  out  the  needed studies  of
carer - infant  interactions and  contexts, which could serve as bases  for  more  effective  policies
and  programs to enhance infant  development.

The  fourth  paper  by  Albert  Awedoba  is  about  health  seeking  and  coping  strategies  in
onchocerciasis  afflicted  communities 
impacts  of  globalization
include an  eclecticism, an  ingenious  blending  of  diverse approaches  and  traditions  in  health
seeking  behaviour as  people are  influenced  not  only  by  indigenous knowledge but also  new
information  from  various  sources  from  far away as well as  near. Effective  choices are seen
to  be  based  on  knowledge,  perceived  efficacy,  consultations  with  others,  personal

in  Ghana.  He  notes  how 

1

experience, 
facility.

location  of  facility  and  cost  effectiveness  of  seeking  help  from  a  particular

that  a  major 

local  capacity 

The  fifth  paper is about  tree  planting  in the Chiana district in the  Kasena- Nankani area in
the Upper East Region  of Ghana and about care and  use of  trees  which are  of  course  crucial
to  human survival  in  so  many  ways. Kojo Amanor  examines  environmental  discourses and
women's  empowerment.  He  notes 
rhetorical  emphasis  of  post-Rio  global
environmental programs  has  been  on promoting community participation, especially  of women
and  respect  for  indigenous  knowledge and  traditional  institutions,  and  with an  emphasis  on
that  environmental
building 
programs  may  rather  erode  local  capacities 
imposing
programs on them that  do  not  make sense  in  local contexts, eroding  local  knowledge. Local
community  groups  become  clients  of  environmental  coalitions  and rely  on their  inputs Yet
he  maintains there  is  only a  very  minor  trickle  down  of  resources  to  the communities and
community groups. He  finally  urges  the need to recognize  environments as  anthropogenic and
to  understand 
linkages  between  humans  and  their  environments,  making  the  natural
assets,  not  foreign  technologies,  the  basis  for  building  new strategies  on  how  to care for the
environment, integrating  the  production and  livelihood  needs  of  the  local  producers.

to  manage  programs.  In  contrast  he  found 

the  environment  by 

to  manage 

the 

Gro Lie's  paper  is  based  on long  term,  in  depth  work  in East Africa. 

It is about  how
people  talk about  their  experiences  of  the HIV  epidemic and  the  way  metaphors are  used
in  response  to  HIV/AIDS.  It is based  on  a multidisciplinary  qualitative  study.  Metaphors  in
vogue  included  social  engineering  and  war  as well  as  building  and  the  family.  The  paper
comes  to  life  with  a  vivid  description  of  interactions 
in  Lusaka  where  several  women  had
become concerned about  the  care  of  the  growing  number  of AIDS orphans. As they say they
are  planting the  seeds  of  love  in these  children  so  that  they will  grow  up  to  be  caring
persons.  Many eyes  were wet as  Professor Lie  closed her  presentation.

impacts  of  user 

fees  on  potential  patients.  He  remarks  that 

In  the  seventh  paper  Kodjo  Senah  writes  of  globalization  and  health  care  delivery  in
Ghana.  He describes  the  commodification  of  health  care  in Ghana, examining 
historical
developments  from  the  colonial  system  onwards.  As  he  notes,  the  post - colonial  health
status  of the  nation  is  not  encouraging. He recounts  the  inadequate  financing  of the  health
system  and 
the
commodification  of  health  care  has  led  to  the  fetishizing  of  Pharmaceuticals.  Drugs  are
widely  available  and  often  used  without  adequate  supervision,  leading 
to
illness and  death. In conclusion he  emphasizes  that  the raise sense  of security  emanating  from
the  prevalence  of  drugs  has  reduced 
for  promotion  of
environmental  health  and  sanitation. Yet prevention  of  diseases  by  social  improvements  and
environmental  management  is a  more  promising  avenue  for  enhancing  health  than  merely
increasing  expenditure  on  medical 
that  major  determinants  of
health are  likely to  be  nutritional  status and  quality  of the  environment,  but  in  globalizing
the  health  care system  he  notes  that this  seems  to  have  been  forgotten.

technology.  It  is  argued 

in  some  cases 

to  mobilize 

impetus 

the 

their 

In  the 

last  paper,  Misonu  Amu  calls  attention  to  the  potential  of  songs  and  music  as
vehicles  for  important  health  messages  and  underlines  the  potential  of  entertainment  for
education.

Christine Oppong,
Legon, 2002