Critical Public Health

ISSN: 0958-1596 (Print) 1469-3682 (Online) Journal homepage: https://www.tandfonline.com/loi/ccph20

Who is the fake one now? Questions of quackery,

worldliness and legitimacy

Julia Hornberger

To cite this article: Julia Hornberger (2019) Who is the fake one now? Questions
of quackery, worldliness and legitimacy, Critical Public Health, 29:4, 484-493, DOI:
10.1080/09581596.2019.1602719

To link to this article: https://doi.org/10.1080/09581596.2019.1602719

© 2019 The Author(s). Published by Informa

UK Limited, trading as Taylor & Francis
Group.

Published online: 04 Jun 2019.

Submit your article to this journal

Article views: 5348

View related articles

View Crossmark data

Citing articles: 2 View citing articles

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=ccph20
CRITICAL PUBLIC HEALTH
2019, VOL. 29, NO. 4, 484–493
https://doi.org/10.1080/09581596.2019.1602719

RESEARCH PAPER

Who is the fake one now? Questions of quackery, worldliness

and legitimacy
Julia Hornberger
Anthropology, University of the Witwatersrand, Johannesburg, South Africa

ABSTRACT ARTICLE HISTORY

This paper shows how in the past quackery was seen as a problem of Received 10 January 2019
remoteness and isolation while today it is global connects which provide Accepted 24 March 2019
the nourishing grounds for it. It looks at ‘Dr Elsie’ from rural Bushbuckridge, KEYWORDS
South Africa who uses a Quantum Resonance Magnetic Analysis Machine as Anthropology;
a diagnostic tool to prescribe Chinese supplements. The paper describes entrepreneurship; medical
how the practicing ‘doctor’ draws approval and a sense of legitimate pluralism
professionalism from the economic success of her newly established busi-
ness. Here, pseudo medical business becomes a conduit for social aspira-
tions while she places the ‘burden of proof’ about the legitimacy of what
she does with the very same people who the technology she uses deceives.
The paper is framed by how the author’s own sense of faithfulness as
researcher is challenged by the difficulty to draw a clear line between
authentic and pseudo health care.

Introduction
As part of my ethnographic research on health practice in South Africa, I agreed in July 2016 to
undergo a Quantum Resonance Magnetic (QRM) analysis carried out by Elsie Mathebele1 from
Bushbuckridge, in rural Mpumalanga. For this morning Elsie had set up her mobile practice in the
makeshift barracks of an informal kindergarten. I did so despite considering the analysis a scam, or
at least a medical practice lacking scientific or other legitimacy. I had to hold a thick metal
conductor in my hand that was connected to a little electronic device with some control buttons,
which in turn was connected to a laptop and a special software interface. The computer interface
showed a female body and an electronic mirror image of the control buttons of the machine. And
while I was holding the metal stick in my hand those buttons rotated frantically and various parts
and systems of the body moved into the foreground – circulation, eyes, heart, digestive system,
ovaries – indicating turn-by-turn what was being measured. Within seconds, it, the interface, then
spat out the diagnosis: a multi-layered table, indicating the functioning or otherwise of the various
body parts and systems through some unintelligible numbers on the one side of the table,
translated into a simpler metric of normal, slightly abnormal, highly abnormal. This was then step-
by-step interpreted by Elsie, and followed up with a prescription for a long list of supplements
produced by the Chinese firm Green World, which I should take. I paid R150 rand (10 Euro) for the
consultation, and promised to come back with more money to buy some of the prescribed
supplements when we would meet again.
In this article, I would like to consider two things, which are clearly intertwined. The one
concerns the basis for the public legitimacy and attractiveness of the kind of health intervention
Elsie was practicing, despite it being a form of quackery. After having entered her practice I soon

CONTACT Julia Hornberger julia.hornberger@wits.ac.za

© 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://
creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the
original work is properly cited, and is not altered, transformed, or built upon in any way.
 CRITICAL PUBLIC HEALTH 485

realized that my dismissive understanding of QRM analysis jarred with the confidence and opti-
mism with which Elsie Mathabele run her small practice and conducted her interaction with me.
What stood out for me was that Elsie was proudly convinced about what she was doing. While we
often think about medical practice as bringing about transformations regarding the patient’s body
or mind, in Elsie’s case it was she who had undergone the transformation when opening her
practice. She told me that she had left behind a dreary job as shop assistant in a cheap clothing
store, how great it was to have one’s own business, and how she was planning to expand it. She
also told me that she planned to buy a pop up gazebo, which would allow her to set up her mobile
consultation room more centrally and more visibly at local marketplaces, instead of behind the
makeshift walls of the daycare facility. Thus, running her practice had helped her to constitute
a sense of confidence and agency, which had an assuring effect on what she was doing.
At the same time, though, when carrying out her analysis, Elsie herself was undergoing or being
subjected to what she was doing. This undergoing seemed especially to be the case when she asked
me to help her get the computer programme running, connecting the digital interface and the
measuring rod. And more so when she praised me with some sense of relief that because of my
literacy I could see for myself in the chart what was wrong with me; and how I could in fact help her
in reading the symptoms rightly. She said that this experience was different for her than with some of
her many old and illiterate clients, who did not understand what they saw on the screen. Here, it was
more the technology than herself which was running things. And our relationship – she as doctor
and me as patient – was primarily constituted and largely guided by the machine. This then also
shifted the focus of questions of legitimacy, away from Elsie towards the shiny machine.
And then again, when I expressed my surprise at the high price of the products which she offered
as treatment – my potential bill had come to R 1300 (90 Euro)2 – she recounted to me, displaying
some surprise herself, how the previous day a woman had bought the whole care packet she had
prescribed to her, at once and in cash. In other words she was telling me that the proof is in the
pudding; namely what she was doing was bringing in money, and that her clients, even often quite
poor, were willing to buy the pricy products prescribed. Here then, she was placing the question of
legitimacy with her patients: if people are willing to pay the price, then it cannot be wrong – and of
course also implying, that I could not go wrong if I were to do the same. And so here the audience
decides in the end about the success of the performance. And the fact that people were consulting
her and buying from her obviously meant that what she did indeed had value.
It thus struck me that the question of the legitimacy of her practice was not necessarily related
to a clear sense of the division of real from fake, authentic from quack, but was distributed across
a range of sources and features. These were both highly socially networked and extremely
contextual in terms of the location in which this practice was embedded and which she was
able to transcend at the same time. This also contributed to the special aura the machine appeared
to possess. In other words, it became clear that to simply link fake medical practice to a lack of
legitimacy would actually prevent me from understanding how the legitimacy of her practice was
being constituted. It also indicated to me that I had to rethink the idea of what a fake medical
practice can do after all.
But to come to my second concern: This disjuncture between legitimacy and fakeness then
made me think how far my efforts as researcher had actually been the fake practice here, coming in
with such rigid presumptions. I had never had any interest in exposing her doings as quakery, or
the people from who she had sourced the machine, and had always treated her with the
confidentiality and respect she deserved as a research subject. Nevertheless, I had been propelled
in my research by a curiosity which had been energized by a sense of scandal about fake medical
treatment. This had been animated by stories which people had been relating to me in the
Bushbuckridge area where I had been carrying out my research. Bushbuckridge is a densely
populated area in the Mpumalanga countryside, without much of a real urban centre close-by
but with a thriving informal market economy due to its vicinity to the Mozambican border.
486 J. HORNBERGER

Spending time at these markets and talking with people about them, for example, I encountered
many stories related to fake medical practice.
A pharmacist had told me one of these stories. Her aunt had had a stroke because instead of
taking blood-pressure reducing tablets she had been swallowing antiretrovirals, which she had
been sold as blood pressure medication at one of the informal markets. Another story came from
a public health official who was working in the area. She had told me that the local hospital was
expanding its preventative primary care and was carrying out free blood pressure tests at these
markets. But apparently some people had started to copycat this practice and now offered
potentially less professional blood pressure tests in return for money. The irony was, so the person
remarked, that people trusted a service more when they had to pay for it. Seemingly obvious, both
stories were told with a great portion of outrage about the illegitimacy of such practices. On the
one hand, then, the division of fakeness from realness seemed a genuine concern, and was used as
indicator to judge the legitimacy of medical practices. And in some way this had primed me in my
expectation of what else I would come across in the course of my research, making me more
judgemental than I had been aware. On the other hand, this was without much analytical traction,
if not outright misleading, when it came to understanding what went on in Elsie’s practice. This
made me wonder – to turn my second concern into a question here – how can we maintain the
authenticity and legitimacy of our researcher practice in a world of health which is both increas-
ingly subjected to suspicious judgments of fake and real, and yet which is able to produce a sense
of legitimacy in the midst of this by drawing on other, substituted criteria.
In the following, then, I would like to read my observations about Elsie’s practice through a set of
arguments which all somehow aim, or which I am putting to work as such, to deconstruct the
concept of fakeness without obliterating it. In fact, as those arguments show, the aim is to disen-
tangle fakeness from judgmental overtones and instead to harness its analytical power in describing
a particularly productive social force. It is here also that this article connects to the special issue of
which it is part, exploring the idea of pseudo global health as acutely diagnostic of the ever-
increasing expansion of medical care across globally highly unequal social and economic relations.

Thinking about eclectic markets of health

In trying to understand the question of legitimacy in a practice such as Elsie’s, the first thing
I would like to do is consider the epistemological context in which this is taking place. What
conditions allow for knowing what is real and what is not, what is efficacious and not? How can
people know what works and what does not? In many ways, I would like to argue, Elsie is a player
in a world of great uncertainty around health, medicine and well-being, a world in which people’s
attitude is often one of epistemic eclecticism, aiming to cover all grounds, rather than one of clear
selective and evaluative choice and practice.
Here I follow, Adam Ashforth’s seminal work on witchcraft in Soweto (2000, 2005), where he
describes the spiritual insecurity in which people live through the experiences of poverty, violence,
and ill-health in township life. Ashforth (2000, p. 248) describes how people feel that they have lost
touch with clear traditions – if they have ever had it – in such a way that these can no longer offer
a clear sense of how misfortunes such as illness and death come to be afflicted and can be
prevented. While this means that there is no single truth to be followed in understanding how
things work, it also means that no possible cause, including witchcraft, can be disavowed as
a possible source of misfortune. He suggests then, following Last’s (1992 in Ashforth 2000) work
in Hausaland, that understandings about treatment should be approached from the perspective of
a sociology of ‘not knowing’. This however is not a dead-end road but rather provides the rich
ground for ‘a bustling marketplace of specialists offering to set matters aright’ (Ashforth, 2005,
p. 127). In fact ‘innovation and imagination are the key ingredient today in the struggle against the
ailments wrought of malice and spoken of as witchcraft, just as they are in the struggle for
salvation’ (Ashforth, 2000, p. 248).
 CRITICAL PUBLIC HEALTH 487

While Ashforth mainly looks at the consumers of healing, I would like to argue that a similar
perspective can be applied to the providers of health and healing. Not just as the ones who take
advantage of the world of ‘spiritual insecurity’ but as those who also share this lifeworld of ‘epistemic
anxiety’ and eclecticism. In this world truth or efficacy are not the primary markers of the validity of
these initiatives. What constitutes validity instead is their entrepreneurial and performative success.
Thornton (2010) also embraces the idea of healing as a market. He writes about the kaleido-
scopic variety of health practices which exist side by side in the small town of Barberton, in
Mpumalanga – not far away from Bushbuckridge. However, instead of insecurity about what works
and a certain disconnect from systems of knowledge, he attributes the vibrancy of these markets to
the idea of the ‘elasticity of belief’ (2010): people evaluate their choices in terms of what is most
convincing to believe. In this sense, his argument is even more relativistic. Firstly, efficacy follows
belief. If people believe in a certain idea at certain moments of healing, be it Christian, traditional,
new age or bio-medical, then consulting any of these practices automatically also brings about
healing. He further qualifies that the main aim of consulting any of these healing options is not
primarily to get better but to rather carry out a moral evaluation of one’s life, especially as
afflictions always come from somewhere or rather someone and can be understood as a lack of
protection from unsettled social relations, ancestral or living. Secondly, efficacy in itself is relativis-
tic, as each choice ‘offers options and risks, gains and losses and outcomes are not guaranteed.’
(Thornton, 2010, p. 147).
Thornton makes clear that in Barberton biomedicine itself also does not escape this flexible
assessment, and is treated as one of the many options available to be considered or not. Discussing
a case of a woman who was suffering of HIV/Aids connected TB, and who had sought healing from
a range of options, including local biomedical doctors who prescribed her anything from anti-
biotics to sea salt, he concludes that ‘ we often assume the superiority of bio-medicine but in this
market and in this population, there is often little difference in effectiveness, real or perceived.
Skepticism is an essential skill for shoppers in this market’ (Thornton, 2010, p. 155).
And indeed from what I have seen in Bushbuckridge, Elsie’s stomping ground, biomedical
institutions such as pharmacies and even hospitals are hardly ‘pure’ or exclusive biomedical
institutions. Pharmacies have given in to selling locally produced herbal concoctions, which have
not been tested and approved by the regulatory mechanisms in place. And a therapist who works
in one of the government clinics told me of how she informally treats her patients with self-made
products.
Does this then mean that any description of specific health practices is entirely relativistic, and
that questions of fake or quack have no place here at all? There is an interesting passage in
Thornton’s piece which I would like to bring to the fore here, to make the case that medical
relativism and pluralism does not necessarily mean that questions of ‘the fake’ have no validity.
However, their meaning might less well serve to describe the outright falsity of a practice, but rather
a certain quality of creative mimesis, and the art on playing on certain open-ended ambiguities.

Thornton (2010, p. 154) recounts the following event:

“A sangoma had been discussing with me what many traditional healers, along with the general public, often
suspect or declare: ‘healing is fake’. She believed that only ‘the mind’, as she put it in English, could heal the
body. ‘(Biomedical) Doctors have a lot to fear from us, and that is why they do not like us,’ she said. She had up
to this point been engaged in a diatribe against both traditional healers and medical doctors. I asked her what
she meant. How could traditional healers be a threat to doctors when she was telling me that most of them were
‘fakes’? ‘Because most of them are no better than we (sangomas) are,’ she concluded. ‘Haven’t you noticed?’”

Turning it around, what this conversation brings out is that fakery is perceived to be very much
part of every health business. It describes a certain creative quality of performance, of making one’s
practice convincing in the very light of uncertainty and relativism.
488 J. HORNBERGER

The analytics of fake health practice and quackery

From here on I would like to explore the enunciative and analytical force of the idea of the fake, as in
potentially dubious health practices and quackery. I start by considering how quackery has been discussed
in the past in South Africa. When reading about the early history of the medical profession in South Africa
(i.e. Didgby, 2006), one gets the impression that quackery was mainly an issue of remoteness and isolation.
While in the colonial centers like Cape Town and Grahamstown the formal profession was able to
consolidate an exclusive legitimacy through a process of oversight and regulation, it was in the remote
towns and countryside that quackery flourished. Consider this account by Digby (2006, pp. 148/9):

“Private practice of unlicensed practitioners flourished, and the Select Committee of 1890 heard of an Indian
practitioner who ‘had great repute as an eye doctor‘, and of Mrs Goosens, who had long practised as a “cancer
curer.‘ Medical journals reported on successful legal cases against those posing as registered doctors. Early
twentieth-century doctors considered that the Cape Parliament was reluctant to legislate against such
‘quakery‘ because the dominant rural farming interest among its members was favourable to it. So, despite
the expansion and consolidation of the medical profession quacks and ‘wonder doeners‘ [wonder workers]
continued. As late as 1952, for example, a Queenstown man was found guilty on five counts of practicing as
a doctor without a license, although his patients testified in court that they ‘felt very much better‘ after his
treatment. This man diagnosed by looking at the eye and, on being challenged by the Prosecutor for
a diagnosis, got the response that ‘your back is not as it should be ‘, ‘it worries you so much you think you
have kidney trouble, but there is no need to worry.‘ The light sentence – a suspended fine of five pounds –
suggested that these diagnostic skills impressed a gullible court.”

Here, professional standards were more of a distant sound and only one of many considerations that
made for a good doctor. They had to compete against other factors such as inventiveness, charisma,
popular beliefs and probably also scepticism towards the city elites and their ways of doing things.
However, can we really describe Bushbuckridge as a remote area in this way, and is the distance
from regulation really what compels the proliferation of contemporary quackery? Not only is
Bushbuckridge a busy border area connecting South Africa to Mozambique, but also infrastructure
here is so good that people go back and forth to Johannesburg in one day to, for example, stock up on
their goods – which are anything from locally produced to global brands. Pseudo doctors, not formally
registered but with thriving practices, are still a major issue in South Africa. But remoteness and
unconsolidated regulatory standards alone no longer seem to be driving this. Rather, or so I would
like to argue, it is global connections, and access to global alternative medical ideas/technology/
medicine, which seem to be the rich nourishing ground of the current iteration of so-called quackery, or
what can quickly be dismissed as illegitimate. And Elsie’s Quantum Resonance Magnetic analysis is
exactly that – it is a global technology. She has bought the machine and been trained in its use in South
Africa’s major city, Johannesburg. She keeps on getting her supply of prescription supplements from
Johannesburg. And Green World, the company which has sold it to her, is a transnational operation
with its headquarters in China. It can be easily found not just in business directories in Johannesburg
but on the internet, where it openly and confidently presents the various branches of its venture. And
so does the shiny machine, connected to a laptop and its interface with spinning images and numbers,
quickly shed any notion of bricolage and make-do that is often associated with African localism. Instead,
it radiates high-tech-worldliness, even or especially when set up in the unlikely place of the barracks of
the makeshift kindergarten. In fact then, it indexes the globality of the most contemporary conditions,
where instead of the traditional northern capital making its predatory impact on the South, setting
hierarchical standards of validity, it is the perpendicularly swelling flows of import-export, investment
and extraction from South-to-South, which are entangling and indebting Africa in new ways, bringing
with them substitute hierarchies of rationality and normativity as well.
At the same time, this South-South worldliness is not without its underbelly, and by virtue of
being from China, the specter of the fake returns with a vengeance. As Pang confirms, ‘China is the
chief pirate nation’ (2008, p. 120), known so by the world, but also self-critically and anxiously, with
Chinese people admitting to themselves their concerns about lack of originality and participation
in the world on equal par (2008, p. 121).
 CRITICAL PUBLIC HEALTH 489

It is then with special focus on the fake as global but also as particularly Chinese that I want to
further hone in on trying to understand better what is at stake in setting up a practice of Quantum
Resonance Magnetic analysis in the peri-urban area of Bushbuckridge. As we will see, at stake are
the creativity of faking, the possibility of healing radiated by the flair of alternative medicine, and
Elsie’s aspiration to transcend the dire local realities of working in retail through energetic and
successful entrepreneurialism. It is in these features that the legitimacy of her practice is rooted.

The creativity of faking

Several arguments try to make sense of what it means, in the contemporary world of competing
capitalist planes, to call something fake and how the fake challenges our understanding of creativity
and originality. To continue here with Pang (2008), while it is notoriously difficult to spell out what
creativity is, huge effort has been going into classifying and criminalizing legally practices of fakery
(2008, p. 124). He makes this observation acutely in his pursuit to unearth the semiotics of the
counterfeit. His point is well represented through the endless range of categories that exists within
Intellectual Property Rights legislation such as forgery, fakery, patent theft, counterfeiting, piracy,
copyright theft, etc.. This, so Pang (2008) says, happens to ‘legitimize negatively the values of
creativity’ (2008, p. 118) and diverts the threat which the fake poses to the notion of creativity and
its centrality to assumptions about modernity. And indeed, the fake has the power to challenge ‘the
original’ in many ways – especially when ‘the original’ is a mechanically produced commodity. Here
two aspects come to the fore which highlight the affinity of the fake and the original, and undermine
the idea that they are at opposite ends of a spectrum of creativity. Firstly the original commodity, just
as the fake, is mass-produced and based on an endless mechanical or digital process of copying.
Secondly, even the aura of the brand, which is supposed to bring back the sense of singularity and
originality, does not attach itself to the commodity as a quality as such but needs to be constantly
performed to mimic and meet the desire of its target market (Pang, 2008, p. 127) – with advertisement
of course being one of the stages for the performative mimesis. This creates an element of
performative mimesis, where the original commodity has a share in the nature of the fake, whose
entire nature is one of mimesis. Because of this affinity, the fake can to some extent stand in for the
original, without contradicting the idea of modernity.
In fact, as Abbas (2008) points out, the fake offers a short-cut to modernity. It only introduces
a different temporality, one of development now and here – ‘we can have this commodity or this
technology right away’ – without being hold hostage any longer to the teleological temporality of
modernistic development and, especially for non-Western countries, its constantly deferred pro-
mise of the not yet – ‘you will get there one day but not quite yet’.
While however Abbas has little time for thinking of the fake as a form of creativity in itself, Pang
points out that traditionally, in Chinese artistic practice, copying is highly valued. Similarly, in Ingold’s
(2014) work on ‘the creativity of undergoing’ a notion of creativity is considered which rehabilitates
copying and mimicking, rather than the emphasis on invention that underlies the modern idea of
creativity and originality. For example, by over and over replaying and copying a masterpiece of
music, one brings the masterpiece into the world, but not by inventing it but by inhabiting it. On
a more everyday basis, this means that ‘behind the contingencies of what people do, and the
miscellany of products or created goods, to which these doings give rise, is the ‘creative good‘ that is
intrinsic to human life itself, in its capacity to generate persons in relationships’ (Ingold, 2014, p. 166).
In other words, to work with and pay attention to what is there already gives rise to “a process in
which human beings do not create society, [but] living socially, create themselves and one another “
(ibid). Both of these notions – the fake as short-cut to modernity, as well as this much more
embedded and social notion of creativity, where humans are undergoing society and by doing so
yet give rise to society/mobilizing what is available to them and shaping themselves in it in relation
to others – are what also at play in Elsie’s performance of diagnosis and advice.
490 J. HORNBERGER

To begin with, and reflecting Abbas’ insight, by introducing the glistening Chinese technology
of Quantum Magnetic Resonance therapy, Elsie can bypass this sense of arrested development, and
instead introduce a sense of progress and inclusion into the world. The machine appears as a rather
sublime object of technology, and its range of nicely packaged supplements throw a bright light
into a world which people often experience as messy and backward. From there, an embedded and
social notion of creativity kicks in as she puts the machine to work and makes it amenable to the
people who come to consult her. So, while she runs the tests on people, presenting to them the
seemingly scientific numbers and images, she converses with them, helps them to evaluate their
lives in terms of fertility and sexuality, and pain and agility. Even in my case, it was this to which she
paid most attention, identifying me as a married woman with a potential desire to pleasing my
husband and having more children. She searches for leads as she speaks: Do you have pain here, or
there, what is bothering you, then she looks at the images confirms and qualifies, makes it
scientifically specific, and then broadens it out regarding one’s social desires.
But also, as I highlighted in the beginning, she does not simply manipulate the machine, but the
machine and how it works is also what stirs her. She thus undergoes it as much as she subjects to it
the people who come to her. But by doing so and co-performing with her machine she brings into
the world a set of new relationships, of giving advice and being a patient, and at the same time
tries to attune the process to what the ‘target market wants’. Fakeness then makes way here to
creatively inhabiting this interactive process of creating some form of transcendence of local
conditions, stabilized by new social constellations of caring, listening and advising.

Redeeming fake science

But there is an additional way in which the accusation of quackery simply as fake medical practice does
not hold up, and where instead the Chinese origin of the machine becomes a source of meaning
related to as-yet untapped possibilities of healing. This source of meaning lies in the association of the
science of QMR therapy with Traditional Chinese Medicine (TCM) as a source of biomedical advance.
This association brings into view that,in medical history, there might always have been cases where
a certain medical practice and or technology were discredited as proper medicine, and yet much later
were redeemed as the source of great discovery. The QMR therapy can draw validity from this narrative.
I am drawing here from work by Hsu (2009) on how TCM has been shaped in the context of
Chinese trading and healing in East Africa. She shows how Chinese proprietary medicines
developed from TCM are either considered as non-efficacious folk medicine, or simply get
absorbed into the category of modern bio-medicine. Such polarization has hollowed out the
middle ground of TCM and with that the possibility of constituting an alternative modernity. For
the purpose of this chapter, the article also brings up the case of artemisinin. The story of the
discovery of artemisinin represents powerfully how an alternative medical system that lacked
legitimacy in the light and methods of western medicine nonetheless brought about a far-
reaching intervention regarding contemporary malaria treatment. In fact, artemisinin is currently
providing the gold standard of malaria treatment as recommended by the World Health
Organisation. The search for artemisinin started in the context of the Vietnam War, where
Chinese troops which were originally superior in strength suffered great losses because of
malaria. The search for artemisinin thus literally was supposed to be a weapon helping to
counter the hegemony of the West. The source of the discovery were traditional writings of
Chinese Medicine. They not only pointed the scientist towards the plant, but also towards the
way to extract the substance. And Tu Youyou, the scientist who made the discovery, has even
been awarded – many years later though – the Nobel Prize.3 East African Chinese traders, as
much as other defenders of TCM and other alternative medical systems, use this iconic case of
artemisinin discovery to market and imbue with value far less tested and efficacious Chinese
proprietary medicines (Hsu, 2009), p. 113). In a similar vein then, the Quantum Magnetic
Resonance therapy, by declaring itself part of TCM, can occupy a claim to scientificness and
 CRITICAL PUBLIC HEALTH 491

effectiveness. The pseudo-scientific thus clearly produces a space of possibility, as the thrust of
this book also brings out, thriving on its ambiguity and possible doubt about the validity of its
science, rather than closing down its value. This space of possibility is fully embraced by Elsie
and the way she understands the process of diagnosis. For example, the Green World webpage
states the ‘human body has electro-magnetic signals that it emits every second. The magnetic
signals are found in the body’s blood cells and they represent a specific condition of the human
body such as human health, sub health and disease.’ This reasoning reverberates in Elsie’s
words, with which she explained to me the working of the machine and the three categories
into which she translated the complicated decimal numbers and with which she determined my
condition between healthy, not quite so healthy and really sick.

Fake professionalism or simply entrepreneurialism

But Green World, as its webpage says, does not only sell health; it also sells wealth.4 And this brings
me to the final part of my chapter, in which I want to interrogate the seeming fakeness of what
Elsie does. To what extent does Elsie assert the identity of a healer or a doctor, in the common
sense of a profession with an independent code of conduct, which at least creates the myth that
the rules of professionalism trump the incentive of gain? Or has she not from the beginning very
openly embraced and displayed the identity of an entrepreneur in health, where it is rather the
financial success of the business that determines the validity of that business. Remember when she
told me how surprised she was herself when someone bought from her all the supplements she
had prescribed, amounting to a bill of R 1300 (90 Euro).
There could be a suspicion that the Green World model works very much on the basis of a pyramid
scheme. Especially if we consider that a considerable investment is required to buy the QRM machines
themselves. A basic set costs at least R 20 000 (Euro 1700) Rand. At the same time, the company offers
fantastic possibilities to multiply this investment through a nearly open-ended scale of rising from
a one star consultant to an eight star consultant, running his or her own distribution networks for the
machines and the supplements. The conclusion on the webpage is that ‘You don’t have any reason to
complain of financial lack anymore. The only reason why you would remain poor is because of Laziness
and Lack of ACTION.’5 All this of course is based on making the patients believe that the diagnosis of the
machine is a true reflection of their bodies’ health and of the efficacy of the supplements prescribed to
deal with the weakness and failures, all of which they might have not known about. I, for example, had
no idea that there was something wrong with my ovaries before I had spoken to Elsie, but left her with
a potentially new concern to which I needed to attend through living healthier and consuming some of
the supplements she offered to me. This would imply that Elsie is recasting herself as an entrepreneur,
but the highly-risk taking and scheming type, more akin to a gambler or ruthless stock market broker
(of the lowlands) who is highly invested in holding up and producing the belief of the people who are
consulting her.
Instead, however, the way that Elsie comports herself and presents herself as an entrepreneur
seems to follow a much more gentle but similarly well-known figure: namely that of the Avon lady,
the classic direct sales woman, only that this is now taking place in the informal markets of
Bushbuckridge instead of the suburban household of North America.
Wilson (1999) has written a fascinating account of how under post-Fordist neoliberalism Avon’s
direct sales practices have been extended and keenly taken up in the Global South, including
Thailand. Direct sales is a form of capitalist populism, where distribution is decentralized and
personal social networks are mobilized to advance its reach. Yet as much as it converts personal
social relations into corporate strategy, Wilson shows “as [direct sales] recasts selling into an
acceptable entrepreneurial role, direct sales can serve to articulate goals and desires and narrate
the possibilities for self-refashioning” (1999, p. 403). It is a form of entrepreneurship which is
particularly attractive to women, as they can convert their access to personal networks into
a business advantage.
492 J. HORNBERGER

Wilson then also tells the story of a woman whose main income was based on employment as
the tea lady in a big company. Dissatisfied with the sense of a dead-end road, which came with
serving tea without ever being much noticed as part of the company, she took on the opportunity
of direct sales. Wilson recounts how she thrived on the idea that now it was up to her to determine
the success of what she was doing. Finally, instead of being held back by self-reproducing
structures of poverty and lack of privilege, she could inhabit a world which promised to give
shape and reward her aspirations and effort. With the extra income coming in, she felt confirmed
and encouraged to dream her own dreams, to one day have her own business back home in her
rural area and to provide for her aging parents. Direct sales, rooted in cosmopolitan consumerism,
not only offered her the cloak of being connected to the wider world, but ultimately promised an
opportunity of self-actualization within this world (Wilson, 1999, p. 414).
This directly speaks to Elsie’s account of herself. Running her own health business brings out
into the world and makes productive her respect for herself, her ability to aspire, her ability to
perform and to inspire confidence – something which would have otherwise been buried in a dire
job in which she would have never done more than to sell bad quality clothes for a set minimum
salary. Neatly dressed, tastefully groomed, proud of what she is achieving, pouring in all her effort
in the building of her health-care business – this is how I met and experienced Elsie.
So indeed, bio-medical professionalism, in the classic sense of being based on education, training,
and often gender, remains a closed door for Elsie and for other poor people like her. If at all, it could
only be accessed through faking it. Entrepreneurism, on the other hand, is open to anyone who feels
an aspiration for it. Green World provides the basic tools, such as good-looking commodities,
a corporate identity, reflected, for example, in the bright green T-shirt which Elsie is wearing and
which bears the Green World logo on it. It accepts a broad range of initial investment, and provides
some training in the sales vocabulary. This both induces yet gives form to such aspirations. In this
sense, there is nothing fake about it, or at least fakeness here means something entirely different.

Conclusion
Elsie thus inhabits openly the role of the health entrepreneur, rather than pretending to be
a professional doctor or healer. In addition, the commodity which she is selling, instead of being
simply a mirror of deception, carries some legitimacy with it, in terms of being scientifically grounded.
Drawing on TCM more generally and some of its famous discoveries, Quantum Resonance Magnetic
can claim a space of ambiguity in which history might very well prove the value of the analysis one day.
And while exactly the high-tech appearance of her diagnostic technology serves as a shortcut to
modernity, she still has to adapt the practice of diagnosis to her patients – or shall I better say clients –
and this requires a form of creativity – rather than simple appropriation – paying attention to what she
knows about her clients and how she reads the obscure numbers of the computer into their appear-
ances and lives. Such assessment of her pseudo health practice shows more and more how Elsie’s
activity runs by its very own logic, which through its personal investment, and in its vibrancy and
particularity, fails to simply fit into the category of the fake or scam.
So where does this leave me and my research practice? Having been curious and yet
convinced of the fakeness of Elsie’s practice in a more judgemental way than I actually realized
it left me feeling like the fake one out. What it showed me is that by having listened to people’s
stories, but also having spent a lot of time with the police (in previous research) and having
read many legal and policy papers on the seemingly clear line dividing the fake from the non-
fake, I had become somehow complicit in the thinking which upholds this line as a clear one,
and automatically links it to a lack of legitimacy. While I always insisted that I took a critical and
analytical distance to the term of the fake, what I had not really done and seen yet is what it
means to really live in the shadow of the fake: How on the one hand the fake can dissolve
under close scrutiny when one takes as the starting point less the ubiquitous external discri-
minating categories, but engages the world from the perspective of those for whom mimicry is
 CRITICAL PUBLIC HEALTH 493

only the starting point of a process of undergoing and embedded creativity. And how, on the
other hand, it is exactly the accusation of the fake and the not quite proper and real which
drives our understanding that this is a practice which opens up doors slightly more successful
and with more opportunity than other attempts to transcend local circumstance. It is then this
field of tension, between accusation of fakery and efforts to deconstruct them, which opens up
interesting analytical possibilities, which allow us to capture the efforts to manipulate the very
same practices which hold people to the ground, in order to hope and possibly thrive against
the odds.

Notes
1. Names and identifying details have been changed to protect the privacy of individuals.
2. According to https://wazimap.co.za/profiles/municipality-MP325-bushbuckridge/, the average household
income in the Bushbuckridge area is R1,400,000.
3. https://www.theguardian.com/science/2015/oct/05/youyou-tu-how-maos-challenge-to-malaria-pioneer-led-to-
nobel-prize.
4. https://www.greenworldbusiness.co.za/pages/green-world-opportunity-presentation.
5. https://www.greenworldbusiness.co.za/pages/green-world-opportunity-presentation.

Disclosure statement
No potential conflict of interest was reported by the author.

Funding
This work was supported by the Deutsche Forschungsgemeinschaft [HO 4464/2-1].

ORCID
Julia Hornberger http://orcid.org/0000-0003-4396-8516

References
Abbas, A. (2008). Faking globalization. In A. Huyssen (Ed.), Other cities, other worlds: Urban imaginaries in a globalizing
age (pp. 243–264). Durham: Duke University Press.
Ashforth, A. (2000). Madumo. A man bewitched. Chicago: Chicago University Press.
Ashforth, A. (2005). Witchcraft, violence, and democracy in South Africa. Chicago: Chicago University Press.
Digby, A. 2006. Diversity and Divisions in Medicine. Health Care in South Africa from the 1800s. Vol. 5. Studies in the
History of Medicine. Oxford: Peter Lang.
Hsu, E. (2009). “Chinese propriety medicines: An ‘alternative modernity?’ The case of the anti-malarial substance
artemisinin in East Africa. ” Medical Anthropology, 28(2), 111–40. doi: 10.1080/01459740902848303
Ingold, T. (2014). The creativity of undergoing. Pragmatics & Cognition, 22(1), 124–139.
Pang, L. (2008). ‘China who makes and fakes’: A semiotics of the counterfeit. Theory, Culture & Society, 25(6), 117.
Thornton, R. (2010). The market for healing and elasticity of belief. Medical pluralism in Mpumalanga, South Africa. In
M. Dekker, and R. A. van Dijk Market of well-being. Navigating health and healing in Africa (Vol. 9). African Dynamics.
Leiden: Centre for African Studies.
Wilson, A. (1999). The empire of direct sales and the making of Thai entrepreneurs. Critique of Anthropology, 19(4),
401–422.