The name is absent

emphasis on the connection between spiritual and bodily issues, and to somewhat greater
recognition of their patients as individuals (Vaughan, 1991; Good, 1991). These differences
appear to have lead to a slightly less P/C and more COOP approach. A more voluntary
approach was adopted, e.g. to the use of child-birth and welfare facilities, and demand for
Missionary medical facilities generally greatly exceeded supply. However, over time
distinctions between Missionary and official facilities diminished with the Missionary ones
becoming “more impersonal” (Vaughan, 1991, p 74). Nonetheless, a common perception
remained that “African populations everywhere almost invariably seem to believe that health
workers employed in the Church-related health services provide care that is superior to their
Ministry of Health counterparts because they are trained to understand the connection
between body and soul and to show greater compassion for human suffering” (Good, p2; and
see the evidence in Tibandebage and Mackintosh). The price of this more compassionate
attitude was that Missionary medicine was more culturally intrusive and regarded traditional
healers as enemies (though there were exceptions to this - see Vaughan,1991).

Colonial medicine thus exhibited strong P/C features: COOP elements were small, though
they were present in the treatment of Europeans in the official medical service, and more
comprehensively in Missionary hospitals. Those performing medical services did, of course,
receive financial rewards, but these were related to a person’s hierarchical position and
colour, not to performance (Patton).

Traditional healing practices continued alongside the activities of European medicine. These
covered a wide range of activities including well structured associations, diviners and lay
healers. In India, for example, there were two parallel, complex and sophisticated systems, the
Ayurvedic and Unani. Mainly these systems adopted a more holistic approach than Colonial
medicine, attributing some cases of sickness to spirits, some to sorcery and some to
physiological problems (Feierman; Vaughan, 1994; Curto de Casas). In most parts of the
world, the role of traditional healers continued into the post-colonial era, for example the
curanderos in Latin America. It is not possible to be confident about the mode of operation of
these systems without more research, but from limited reading it seems that they combined
elements of each of the three modes; while in many cases hierarchy and control was a major

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