Pergamon

Sm. Sci. Med. Vol. 39, No. II, pp. 1587-1588, 1994 Elsevier Science Ltd. Printed in Great Britain

BOOK REVIEWS

Parasitic Diseases in Water Resources Development, by J. M. HUNTER, L. REY, K. Y. CHU, E. 0. ADEKOLU-JOHN and K. E. MOTT. WHO, Geneva, 1993. SW. fr. 35. Price in developing countries: SW. fr. 24.50.

This book can be read on two levels: as a case study in the Anthropology of Development and as a straightforward appeal to ministries of health in developing countries to ensure that they are included in the initial planning and implementation of all water development schemes. Written by five distinguished authors, the book examines the inter- relationship between water resource development and four parasitic diseases; malaria, schistosomiasis, onchocerciasis and filariasis. The book presents a cogent argument for intersectoral collaboration, its integrated health planning, and includes many useful examples of the ecological com- plexity of disease transmission. The book also presents a useful country by country discussion of major water projects with up-to-date references. For these reasons, Parasitic Diseases in Water Resources Development should be found on the book shelf of everyone with a professional concern for water resources and health.

The authors claim that parasitic disease control strategies should be reassessed because of the recent introduction of effective drugs-especially praziquantel for schistosomiasis and ivermectin for onchocerciasis. But control involves more than treatment after disease outbreaks.

The adverse health impacts of large dams have been known for many years. Since the 192Os, planners and researchers have been discussing the actual and potential health impacts of the Aswan Dam and the Gezira irrigation project on schistosomiasis [l, 21. Preconstruction health studies around the Volta Dam in Ghana and the Kainji Dam in Nigeria did not result in the establishment of effective, sustainable control programs after dam con- struction [3,4]. The sorry story continues into the 199Os, as exemplified by the recent explosive outbreak of S. mansoni in the Richard Toll irrigation scheme in Senegal [5,6].

In the light of such evidence, it is not surprising that today many planners and researchers consider that big dams are fundamentally flawed and cannot achieve high and sustain- able levels of agricultural production; in addition to their adverse impact on the health and well-being of the supposed beneficiaries (the local laboring population), they cause serious environmental degradation. However, the authors write as if it is inevitable that large dams will continue to be built, in order to provide for the needs of a population which is expected to double every 34 years. The view of ‘develop- ment’ which is espoused here reflects the views of the principal author, that disease is an unintended side effect of ‘development’ [7]. Critiques of this view identify it as an offspring of modernization theory which takes a macro- rather than micro-view of change processes [8].

In view of the authors’ stated concern for community involvement and primary health care, it is unfortunate that they only provide a brief discussion of small scale village level impoundments which they admit have. in aggregate, a greater impact on health ihan the big dams (p. 62). This lacuna is partly a result of the difficultv of disc&sing a myriad of small, diverse developments -and strategies within a brief book, and of an approach which begins from an international and national perspective. There may, as the authors’ claim (p. 63), be a scarcity of accurate information on the health impacts of local level water developments. However, they point out that many

local health and agricultural workers can provide evi- dence of such impacts (p. 66). There is a vast, but widely scattered, literature on local development projects, and the relationship between local initiatives and the lowest level of government bureaucracies which is relevant to the central theme of this book. What is needed now is the incorporation into the larger picture of local examples focusing on the capabilities, needs and behavior of local people, as well as a deeper understanding of the local level infrastructure, staff and facilities which are needed to implement effective inter- sectoral policies at the grass roots level.

The book’s lack of a local perspective also masks the human dimension of the current health problems associ- ated with water resource ‘development’. While the book satisfies monetarists with a brief mention of the economic cost of disease in terms of labor losses, it misses the opportunity to present a forceful argument for action by portraying the suffering, the poverty and the waste of human potential which are so often associated with such projects. Recent studies of elephantiasis in north- em Ghana (by the first author of this book), and of cur- rent conditions on an irrigated sugar estate in Ethiopia can begin to provide such evidence [7,8]. Such studies often include the beginning of a diagnosis of what went wrong and what might be done to begin to improve the situation.

Both in its conceptualization and in its finished form, Parasitic Diseases in Water Resources Development can be seen as an interim report on the progress made in relating health to ‘development’ since 1915, when the Rockefeller funded International Health Commission with its concern for labor-efficiency, extended its world-wide program to include a campaign against malaria. If this 1993 report is anything to go by, it would Seem that those who have done well from water resource ‘development’ are members of what the authors call “the international civil engineering community” (p. 118), the manufacturers of heavy earth- moving equipment which are now used to create many unsupervised village impoundments, and the national, regional, and supernational bureaucracies which are called into being by such ‘development’.

REFERENCES

1. Scott J. A. The incidence and distribution of the human schistosomes in Egypt. Am. J. Hyg. 25,56&614, 1937.

2. Humphreys R. M. Vesical schistosomiasis in the Gezira irrigated area of the Sudan. Trans. R. sot. trop. med. Hyg. 26, 241-252, 1932.

3. Edungbola L. D., Asaolu S. 0. and Watts S. J. The status-of human onchocerciasis in the Kainji reservoir basin area 20 years after the impoundment of the lake. Trop. geog. Med. 38, 226232, 1986. Scott D., Senker K. and England E. C. Epidemiology of human Schistosoma haematobium infection around Volta Lake, Ghana, 1973-75. Bull. Wld Hlth Org. 60, 89-100, 1982. Chaine J-P. and Malek E. A. Urinary schistosomiasis in the Sahelian region of the Senegal River Basin. Trop. geog. Med. 35, 249-256, 1983. Diaw 0. T., Vassiliades G., Seye M. and Sarr Y. Epidemiologic de la bilharziose intestinale g Schisto- soma mansoni B Richard-Toll (Delta du fleuve S&gal) ttude malacologique. Bull. sot. path. &or. 84, 174-183, 1991.

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7. Hughes C. C. and Hunter J. M. Disease and “develop- Wonja Sugar Estate, Ethiopia. E. Afr. med. J. 67, ment” in tropical Africa. Sot. sci. Med. 3, 443-493, 532-538, 1990. 1970. IO. Hunter J. M. Elephantiasis: a disease of develop-

8. Stock R. “Disease and development” or the “under- ment in northeast Ghana. Sot. sci. Med. 35, 62749, development of health”: a critical review of geographi- 1992. cal perspectives on African health problems. Sot. sci. Med. 23, 689-700, 1986. Social Research Center SUSAN WATTS

9. Simonsen P. E., Nega A. and Furu P. Intestinal The American University in Cairo schistosomiasis among children in a labour village of Cairo, Egypt

Religious Medicine: The History and Evolution of Indian Medicine, by KENNETH G. ZY&. Transaction Publishers, New Brunswick (U.S.A.) and London (U.K.), 1993,311 pp. U.S.$49.95.

Rgveda and Atharvaveda medicinal systems between 120&200 B.C. have been examined by Zysk within an evolutionary framework. The book is divided into three sections: (i) elaboration of internal and external diseases with the relevant hymns to cure and drive the evil spirits which bring them; (ii) discussion of medicines which are considered universally beneficial in the Indian medicinal system; (iii) textural annotations of relevant verses to which Zysk referred in his discussion of diseases and their method of cure by the traditional healers.

The analysis of the first two sections is based on the interpretation of particular hymns which were recited by the healer and/or the patient to drive away the demons or evil spirits which bestowed these diseases on the individual. The hymns provide information on eradication of related afflic- tions of the vedic peoples as well as a guide to development of appropriate medicinal remedies to prevent and cure diseases in the classical Ayurveda system. The second section on medicines provides individual hymns which indicate the medicinal properties of water and relevant plants which are the cornerstones of Ayurevedic medicine. The appendix section provides the Sanskrit names of plants with their botanical equivalents and helps in providing the reader with an insight about the level of botanical knowl- edge of the Ayurvedic healers.

Zysk sets out to examine and establish the classical roots of Indian medicine and provides scientific explanations based on analysis of phenomena described in the hymns. His explanations have their inception in the mysticism and magic and are shown to evolve into the empirically-based healing system of Ayurveda-the classical healing system of India. According to Zysk, each hymn refers to an intrinsic understanding of the ancient healers of the relationship one’s body has with their physical environment. Zysk also identifies two phases in the evolution of classical Indian medicine. The first is vedic medicine, where beliefs consisted within the framework of a whole host of benevolent and malevolent deities and spirits causing good and bad effects in the human realm. Control of these entities was the ultimate goal of this healing system. The second is Ayurveda medicine, where, as the healers gained more knowledge through their practices (Zysk shows through his interpret- ation of hymns that sometime after the second millennium B.C. Ayurveda system of medicine developed) and devel- oped a basic empirical understanding of the interrelation- ships between humans and their environment. This Ayurveda medicinal system based its belief on the fact that diseases occurred because the equilibrium between humans and nature had been disturbed and it was the goal of the healer in such cases to restore the fundamental balance of one’s body.

The book deals very comprehensively with vedic medi- tine-vedic toxicology and pharmacopoeia. Zysk traces the evolution of: (i) vedic medicine to classical Ayurveda; and (ii) the macro-religious beliefs and practices of a system of

medicine based on empirico-rational principles and prac- tices. However, the inadequacies of the work cannot be overlooked. Zysk is well aware of the fact that often exact or actual meanings of the words in the verses are not known, and only assumptions can be made. This inhibits the interpretation as it allows one to guess only in reference to context. The second inadequacy of the work relates to evolution of Ayurveda in modem India. Zysk has not made an effort to develop in this direction. Today in India, Ayurveda has evolved into a comprehensive medicinal system based on natural plants, minerals, rocks and salts. Physicians specializing in Ayurveda practice their medicine side by side with physicians educated in modern western medicine-Allopathy. Besides two other medicinal systems Homeopathy and a Greek-Arab based system called Unani are also operational in India. The Indian government has recognized Ayurveda formally as an important medicinal system and endorsed medical colleges which teach Ayurvedic medicine. Further research as to how Ayurveda evolved in the context of development of medicine in India should be of interest for further research. Although Zysk’s contribution cannot be minimized it provides us with the first step in understanding the evolution of Indian medicine from its vedic roots.

Zysk, while providing the translations of the hymns, isolated the empirical healing traditions intermixed in these rituals and identified their properties while constantly draw- ing parallels with other similar healing systems. These include, for example, references to spells recited by ancient healers in Germany to heal broken legs of horses. Further- more, Zysk’s evaluations and discussions of the ancient vedic healing system becomes more valid as he entrenches them within the critical schools of interpretation. He pro- vides unbiased arguments as he gives interpretations of two or more schools of thought and then he logically provides the most logical interpretation given the level of knowledge about the healing system at our disposal. At no time however, does he make any definitive statement beyond which it could in effect be a product of personal bias. His definitive statements are bound within the scientific par- ameters of investigation and anything beyond that he provides as suggestions to the reader. From this perspective the book not only serves the historian in gathering an analytical basis of religious medicine in ancient India but draws one into the rich literature full of mystical empirico- based healing system that prevailed so long ago as folk medicine. Overall the book provides a comprehensive back- ground in historical basis of the origins of classical Ayurvedic medicine prevalent in India today.

The book is definitely recommended as an asset to anybody interested in ancient Indian medicinal systems and their evolution. Scholars in fields of history, religion and folk medicine will find this an in-depth treatise which has been well researched and comprehensively analyzed. Libraries are absolutely recommended to obtain copies of this book as it is a pioneer analysis of Indian medicinal system.

The University of Akron ANUPA MUKHOPADHYAY

Akron, OH 443255005, U.S.A.