Acronyms and effacement: traditional medical practitioners (TMP) in international health development.

International development draws on a globalized vision of 'traditional medicine' when constructing country-specific programs that use local practitioners to further health objectives. This paper looks at the tension between this mobile notion of 'the traditional' and the local social ground. Categories such as traditional birth attendant (TBA) and traditional medical practitioner (TMP) emerge from a process of translation that links local realities to development in specific ways. Examination of training programs for two kinds of 'indigenous practitioners' in Nepal--birth attendants and shamans--shows that various Nepalese specialists are constructed as TBAs and TMPs in a discursive process that emphasizes some differences while eliding others. The acronyms TBA and TMP encapsulate numerous acts of translation through which diverse local practices are subsumed into an overarching development framework. The many layers of this process include: how 'traditional healers' are understood in international health policy; how, in national planning, these conceptions are made to fit with existing Nepalese healers; and how research on 'local ideas and practices' becomes authoritative knowledge about 'traditions', which then, in turn, form a basis for the planning and implementation of training programs. The conceptual categories evident in development discourse on 'traditional healers' take concrete, practical form in the design and implementation of training programs. At the same time development attempts to create programs tailored to local conditions, it generates frameworks that efface or exclude much of what local people think, believe and do. Although training programs for TBAs and TMPs have been advocated as a way to 'bridge the gap' between the realities of local peoples lives and development institutions' visions, it is important to realize that, at another level, development discourse produces the very problems it aims to solve. The case study of training programs for TMPs and TBAs in Nepal shows how the universalizing principles inherent in development discourse systematically dismantle and decontextualize different socio-cultural realities in the course of taking them into account. Development institutions are thus positioned as authoritative mediators of all local worlds. Translation is a social act that, through the management of the circulation of discourses, reinforces the particular global-local power relations of international development. Relations of power, as well as states of health, are at stake in health development encounters. This paper questions whether health development can achieve its humanitarian goals within the existing conceptual framework.