The medical pluralism well established in Africa has changed from being seen as an obstacle to be proposed as an opportunity by the development agencies, from WHO to UNESCO. This change is beginning to have some effects in the African Health Systems, especially in the cases where it coincides with a previous national or local strategy. Anyway, the first approaches have been generally very instrumentals, either searching to transform traditional and local therapists in something similar to the Chinese "barefoot doctors" or to extract biological principles of customary recipes. Advances are promising, but they announce big problems if the diverse logical implied are not taken into account. The paper analyses the consequent epistemological challenges focusing in some Malagasy cases, contrasted with other well known African examples.

In the last three decades the status of traditional pharmaceuticals has changed. Following for many extents a pattern already experienced in some Asian countries (e. g. China, India), in diverse African countries the traditional pharmaceuticals have gained a new room.

Due to the politics of legitimation of traditional medicine, mainly in the '80s and '90s, and also to the attempts to re-create African identities grounded on a new usages of traditional cultural elements, their circulation is not limited anymore to a simple exchange between healers and clients. Traditional pharmaceuticals are now available on the markets and even in the drug-shops and pharmacies. New factories have been established to process traditional pharmaceuticals in a quasi-industrial way. Their forms and packagings recall those of biomedical drugs. As other spheres of traditional culture, pharmaceuticals are now something marketable. This implies new social dynamics that must be analyzed.

At the same time traditional medicine has become part of the cultural heritage. As such, it founds a room in museums and exhibitions. It is part of a larger cultural heritage and identitarian claim project. When it is stored and exhibited in museums it becomes also a specific cultural commodity, whose meanings need to be investigated .

The paper intends to explore the two new dimensions of the traditional pharmaceuticals outlined above.

The assumption that "because it worked there, then it must work here" is to a large extent responsible for the exacerbation of the HIV scourge in Sub-Saharan Africa. We show this in two separate studies from Zambia. 1) In the 1st study, we demonstrate that the application of the Human Rights approach as a one-size-fits all concept in Zambia is at odds with local realities and in some instance responsible for the rise in risky sexual behavior 2) In a 2nd study we showed that the act of outlawing Traditional Birth Attendants (TBAs) in Zambia purely on the advice of 'scientific evidence' obliterated the only option available to HIV+ pregnant women in poor rural areas, thereby worsening the situation.

Conclusion

These two studies render the question of "what works" obsolete and irrelevant. Like other scholars have observed recently, the question should no longer be about "what works?" but rather "what are we committed to making work in the given context?". The later question accepts the fact that reality is complex and cannot be summarized in a "cook-book" to be used by many. It is reflective, decentralized, and less authoritative. It allows for use of local practical wisdom; and at the same time, prioritizes processes that give room to local responsiveness, and careful judgement of what might work and how, given the context (rather than following mechanical solutions anchored on 'evidence').

Traditional African traumatology constitutes a therapeutic resource present in all communities and enjoys a better access, geographic and economic, than traumatology and physiotherapy of a biomedical nature. However, this discipline is still largely unknown even by African governments themselves and international health cooperation agencies. This study is the result of the field work carried out over some years in West Africa, mainly in Gambia and Mali, consisting of participant observation and the collection of clinical data referring to the practice of traditional "physiotherapy" or "traumatology" by one side, and Western physiotherapy, based on the biomedical paradigm, on the other. It is evident, through the use of qualitative and quantitative research tools, the great effectiveness of the techniques and treatment protocols used by professionals called "traumatoleg traditionel" or "setter bone". An analysis of the physical, social and symbolic effectiveness of these practices is carried out, through a comparative study between the same ones and those used by the biomedical system and, on the other hand, making possible a legitimation, from the scientific point of view, of the themselves.