BookReview8 79
no easy answers. Why is child welfare not such a topical issue in today's world? PoliticillIlll, economists
and social scientists spend their time discussing nuclear weapons, the Third World debt and AIDS.
Granted that these are all important issues in hlD1lan existence, it is hard to understand why
disproportionately little international effort is being directed towards alleviating the living conditions
of the majority of children across the globe.
MacPherson's book lays bare some startling facts about child welfare in the Third World. It
examines a broad spectrum of the main negative socioeconomic factors which are at play in the life of
the average child in the developing world, without pretending that there are easy solutions. The book .
relies mainly on empirical ewenences indeveloping countries in Asia and Latin America to put forward
its case, with minimal refelkmce to the African experience.
Traditional approaches to child welfare are strongly challenged. They are generally seen as alien
and western, urban-biased, expensive and therefore unable to provide a realistic answer in the cashstarved
societies of the developing world. Strategies which seek to build on what communities already
know and have have a greater chance to succeed, he argues.
MacPherson's book, while undoubtedly depressing, shows that itis possible, even in poorcountrles,
to improve the living conditions of the poorest. Tanzania, regarded as one of the world's poorest
countries, has been able to achieve what no other African nation has done in terms of bringing social
services to its population, thanks to government policy. But Tanzania is now experiencing its worst
economic crisis in history, resulting in the loss of some social gains. It is not clear whether there is any
relationship between the deteriorating economic conditions and the egalitarian policies of the past.
It is a pity that MacPherson does not attempt to look at the political and military context in which
some Third World children live. This is particularly relevant in Southern Africa where apartheid has
devastating consequences on the lives of millions of children, especially over the last decade. Coming
at a time when common sense seems to be h'eaking out throughout the world, this book raises issues
which deserve to be put in the forefront, on the agenda, of a more peaceful world. MacPherson's book
need not be another voice in the wilderness.
Laypeople, academics, child welfare activists, and all people interested in advancing one of the most
legitimate causes of the twentieth century will find this book both refreshing and stimulating.
Reviewed by Allan Masomere, Harare.
Development Psychiatry: Mental Health and Primary Health Care in Botswana, David Ben-
Tovim, Tavistock, London, 1987 (233W, £12.95 pbk).
This book can be seen as a milestone in the literature of mental health in Africa, describing, with
considerable empathy, skill and conciseness, the results of the author's experience in the integration of
primary health care and psychiatric services inrural areas, and as a lone psychiatrist with the Botswana
Ministry of Health. Until the late 19708 Botswana's only psychiatric facility was an isolated mental
hospital, which had become grossly overcrowded. After collaborative work with the WHO and other
international agencies, Botswana embarked on a programme of integration of psychiatric care with
existing primary health care services. Development Psychiatry places this bold experiment in a clear
perspective in a national, African and international context. •
It should, however, be said at the outset that although the work describes how a psychiatric system
can move from a curative and institutional health service to a wider service that incorporates primary
hellI.th care, it does so from an overt commitment to the physical diseasemode1 of mental dismders. "It
is my view that none [of the models] have been found to have a wider range of awlicability than the
[physical] disease model", and, Ben-Tovim goes on to say, that "treating psychiatric disorders II!
80 Book Revillws
diseases entities, if not completely secure, is at least a widely recognised working hypothesis, and it is
one that will be adopted here" (p9). Unfortunately it becomes clear later in the book that the disease
model is not really a working hypothesis to be proved effective or otherwise by the author, but rather
the model is assumed effective and this assumption remains unchallenged throughoutthe book. Notonly
is the physical disease model the preferred theory, but drug therapy seems the preferred practice: "Once
a depressive disorder had been identified by whatever means, our standard treatment was the
prescription of the tricyclic anti-depressant Amitriptyline in the dose 125-175 mg daily. Treatrnentoften
seemed effective (sic)" (1987:134).
Ben-Tovim offers a taxonomy of psychiatric conditions that are echoed in his chapter titles:
emergencies and alcohol; epilepsy, schizophrenia and depression; and what he calls "headaches and
heartaches", the symptoms relating to "non-psychotic distress". Although he admits that "nonpsychiatric
distress" is the one most amenable to non-drug therapy it proved difficult for the author to
offer non-medical treatment or help. Infact rarely do interventions described in the book refer to helpers
other than nurses or doctors. Social workers are mentioned in passing four times and psychologists
twice, and even then without any description of an interventive role.
With the caveat, then, that this book is a fairly explicit description of a purely medical approach to
diagnoses and treatments, it is a valuable pioneer work in a field that badly needs indigenous literature.
Reviewed by Joe Hampson SJ, Harare.
Sex Roles, Population and Development InWest Africa, ChristineOppong (ed), Heinemann, London
1987 (242pp,£25hbk).
This book is a collection of thirteen diverse and highly informative studies of women in development
The common theme focuses on the crucial roles women play in both the informal and formal sectors,
and the contributions emphasise that, for effective development planning in general, women's existing
roles, their needs and their potential must be central considerations.
The papers are presented under four headings: Women' s Work (two studies, ofMuslirn women in
Nigeria, and women in Bamaka, capital of Mali); Fertility, Parenthood and Development: Yoruba
Experiences (five papers on the Yoruba in Nigeria); Population Policies, Family Planning and Family
Life Education: Ghanaian Lessons (three studies); and Government Plans and Development Policies
(three papers, examining policy in Sierra Leone, Nigeria and Ghana).
It can be seen that although the book purports to cover West Africa, in reality it examines only four
of the eighteen countries that might have been included. Of the thirteen papers, seven concern Nigeria,
with the major focus on the Yoruba. Thus the book in no way attempts to give a balanced over view of
the whole region, but presents selected, detailed studies whose orientation and conclusions have amuch
a wider geographical relevance. Indeed, their relevance is in many senses global, and not restricted to
West Africa as a region.
The various papers reflect different academic disciplines and research methodologies. The latter
include household surveys, individual and group studies through participant observation and structured
interviews, and the use of census data and other official statistics, policy documents, and other existing
material. These are presented Within the framework of international developments, such as UN, IW
and OAU initiatives, for example the Lagos Plan of Action 1981.
The studies are all of countries with a significant incidence of extreme poverty, and many common
problems of development. These include socioeconomic flux as traditional ways and values compete
with modemisation; the disruption of the family; illiteracy; and a young population structure andrapid
population growth, despite continuing high mortality (at 139, the infant mortality rate of the region is
the highest recorded in the world). Fertility is, predictably, extremely high.