Development of health systems
Mediation at the heart of medical pluralism
Protection of biodiversity (pharmacopoeias)
International aid programmes often face social and cultural obstacles which highlight the incomprehension, often unintentional and poorly identified, between the implementers of the projects and the populations amongst whom they are implemented. These difficulties, which have deep implications, can be lessened to some extent by taking a cross-disciplinary approach to developmental interventions and by encouraging long-term collaboration between social science specialists, development actors and concerned members of those communities for whom the interventions are intended. It was in this spirit that the organisation Nomad RSI (Research and International Aid) was created in 1997.
Nomad RSI works in the domain of international health and encourages therapeutic diversity and the protection of the environment. Its projects are principally conducted in the South and largely involve disadvantaged, minority communities. In addition, Nomad RSI supports and conducts various activities in Europe, such as publishing books and organising debates, seminars and festivals. These events bring global (and local) health and environmental issues into the spotlight.
To be as effective as possible, Nomad RSI concentrates its efforts on coordinating a small number of projects at any one time. Most projects aim to address the social inequalities shaping healthcare access and to support local medical systems. It is committed to the sustainable utilisation of therapeutic natural resources, particularly medicinal plants, and supports a development of these resources that is favourable to local medical systems, and which brings equitable social and economic benefits.
There is much evidence from recent decades to indicate that narrow approaches to social and environmental problems lead to inappropriate and ineffective actions. The organisation insists that broad cultural and biological diversity is vital for the sustainability and equity of life on this planet, and thus resists monocultures of any kind. This double condition appears in the very existence of therapeutic diversity, that is to say, in the existence of various cultural forms and rich natural resources, from which arise myriads ways to understand the body, its afflictions and the means to deal with them.
Illness does not only concern disorders of the (biological) body and health is not solely defined by the absence of disease. With this in mind, Nomad RSI tries to approach health problems in their multiple biological, social, environmental, economic and symbolic dimensions. The organisation thus supports a range of therapeutic forms, each of which brings a different response and a different remedy for people who are, or who feel themselves to be, suffering. Some medicines cure and their effectiveness is certainly remarkable. Many therapeutic forms also help taking care of people while changing the way patients perceive their afflictions. In other words, to favour therapeutic diversity allows a better consideration of both disease-as-object and the body-as-subject. From this realisation, the idea of a reasoned medical pluralism is born, in which medical systems of many kinds, including biomedicine, can independently find their place.
Nomad RSI bases its programmes upon long-term collaboration between local teams, international development workers and academic researchers. The cross-fertilization of these forms of knowledge is fundamental to the vision and operation of the organisation, and the Research Unit of Nomad RSI (NRU) is of vital importance in these efforts. Through it, independent research is conducted, with the aim of better understanding the social dynamics and transformations under way in the regions where project work takes place. The Research Unit is multidisciplinary (anthropology, development studies, political science, ecology, ethnobotany, agronomy etc.) and covers a broad constellation of issues orbiting questions of global health. Studies are conducted by researchers working independently of the project teams, although enquiries often directly concern Nomad RSI’s fields of implementation. Other work within the Research Unit examines different dimensions of the reconfiguration of therapeutic space in society. Such studies provide contextual orientation for project activities and contribute to a better understanding of health systems through book series, publications, conferences and meetings.
The Development Unit is responsible for implementing all Nomad RSI’s projects. It comprises team members from the project areas and a small number of international staff. Most national team members are retained over long periods on the basis of their skills and personal commitment. Thus the considerable amount of field experience and knowledge generated through in-project research and implementation, which the local teams engage with continually, remains in the team and feeds back into the ongoing programmes. Expatriate staff members work with the local teams, learning from them while helping them to improve their skills in project design, fundraising and management. The local teams are in the process of gradually increasing their operational independence, in preparation for eventual autonomy. Staff members are also essential actors in the process of articulating research and action, working to build the connections between the teams, the commissioning and facilitation of research, and the application of its findings. In this way, local knowledge and field experience are in constant interaction with inputs from the direction team and from the Nomad Research Unit. The results of these interactions become Nomad RSI’s projects. Where possible, independent evaluations of projects are conducted via the Nomad Research Unit and the outcomes fed back into the process.
It is essential to recognise, however, that the translation of research into action is complex and imperfect, reflecting the inherent complexity of social life. Research findings cannot always be transformed into valid project activities. In any case, the activities themselves generate new social outcomes, which must also be understood. An iterative process between independent research – as distinct from ‘expertise’ – and action is fundamental to the design, implementation and evaluation of Nomad RSI’s projects.
The organisation works to bridge gaps between knowledge forms, to engender positive and close working relationships between all its partners and to implement project activities which are carefully adapted to the social and cultural context. Yet, it is as much through the tensions and difficulties inherent to this process as through the many instances of harmony and congruence that the organisation has progressed. Nomad RSI continues to struggle for genuine collaboration between South and North, research and action; while reaching for inclusive healthcare and continued therapeutic diversity.
Nomad RSI is a non-profit organisation, recognised under the French law of 1901. The organisation was registered in the Official Journal of the French Republic (no. 745, June 1997).