Reimagining Social Medicine From the South

Book Title: Reimagining Social Medicine From the South

Author: Abigail H. Neely

Publication Information: Durham and London; Duke University Press; 2021; 169 pp.; $14.72, e-book; $24.95, paperback; $94.95, hardcover

In an era when artificial intelligence increasingly champions personalized medicine, and amid a global pandemic that challenges the health care system every day for efficient and effective delivery, the title Reimagining Social Medicine from the South is bound to intrigue any family physician. This book by Abigail H. Nealy, an assistant professor of geography at Dartmouth College, explores the social, economic, and political determinants of health, as she delves into the medical anthropological and ethnographic constructs of health care delivery to highlight its ontological multiplicity. The author explores the prospects and constraints of the Pholela model and has put forth an argument that it can foster transformations in the oft protracted and complex transition of health care delivery paradigms.

Set in the locales of the Pholela Community Health Center (PCHC) of rural KwaZulu-Natal province of South Africa in the 1940s, the first two chapters offer an account of the evolution and concepts of social medicine, especially of the apartheid era. It underscores the intertwined role of clinical care and a social anthropological approach. Merging clinical care with social aspects including water resources, nutrients, and interpersonal relationships, Neely recounts the evolution of what began as a movement for equality in global health care and culminated in the seminal work of Sydney and Emily Kark and their colleagues.1 The methodologies and conceptual framework established by these pioneers have come to be the central tenets of the now well-recognized practice of community-oriented primary health care (COPC). The novel data-driven approach of the Pholela model of health care delivery also laid the foundation for South Africa’s national health policy formation. The PCHC model has inspired many progressive health initiatives across several countries around the globe and has been replicated successfully in developing as well as industrialized countries.

Written in an expository style, the book presents the perspective of a nonmedical investigator. The author has reflected upon her fieldwork for facts, statistics, anecdotes, and ethnographical and archival records to discuss health care in South Africa. The evidential support has been meticulously documented and annotated throughout the book, replete with field notes, a glossary for the Zulu language, cross-references and citations, an index, and a comprehensive bibliography. Neely has researched and diligently documented fieldwork, interviews, archival reviews, and experiences to explore the “social” in social medicine.

The book goes on to explain the mechanics of the PCHC model that laid emphasis on nutrition, health education, regular health examination, early disease detection, treatment, and follow-up. These measures and social environmental factors made significant contributions to reduce the incidence of malnutrition, crude mortality including infant mortality, as well as preventable communicable diseases such as syphilis and tuberculosis.

The third chapter describes the effectiveness of the “Grow and eat more vegetables” campaign against malnutrition and ill health, the focus of the nutrition program on the macronutrient protein, and augmented livelihood intervention practices. The fourth chapter explores the most unlikely impediment for successful implementation of a social medicine program—witchcraft. Cultural determinism that prioritizes cultural beliefs over biological, evidence-based medical practices can jeopardize understanding of health and illness practices. Neely has deftly underscored these intertwined beliefs, taboos, and health entanglements.

Abigail H. Neely has successfully highlighted the conceptual framework of the practice of social medicine in South Africa, its uniqueness, the strengths of the PCHC model, and its weaknesses. She has emphasized the importance of social elements in the practice of social medicine. Her personal narrative makes the book an easy read, more humane and appealing.

The PCHC model was instrumental in reshaping the delivery of social medicine in South Africa, and that PCHC model can be mapped to present day practice of medicine. Even though we have come a long way in the delivery of health care and made advances with the development of new drugs, there is always an underlying element of social and cultural beliefs that will determine the outcomes of medical care.