Improving the health status of the rural elderly in Mali.

On the basis of a seven-year study, 1984-1991, in a traditional Bambara community in the Sahel region of the Republic of Mali special problems of health in later life are reported against the background of general ecological conditions. Some quantification of age- and gender-specific features of illness is offered on the basis of parasitological and clinical tests administered. This article starts with the premise that the health of all age groups in traditional African society is assessed by their members in culturally specific ways influenced by their social organization and cosmology and by their "sociocentric" and "cosmocentric" interpretation of health and sickness.Future health measures in Mali should apply and transform some of these views and practices. On account of the seniority principle which underlies Bambara social organization, the demographically small group of elderly traditionally held a somewhat privileged position. Physical weakness in late phases of life were, and to some extent still are, embedded in strictly regulated kinship and community structures. Traditionally, health and sickness are viewed as related to forces outside the individual, emerging from nature or social conflict. But traditions deteriorate as competition, instrumentalism, person-centered social mobility aspirations, and the quest for individual liberties grow as a result of various processes of modernization (which penetrate even into the more isolated regions and villages). The article shows that certain traditional elements of the rural Bambara way of life (e.g., village committees) permit an organization of solidarity to replace the diminishing traditional social organization under the conditions of the appearance and, in part, availability of certain elements of Western medicine.