Saturday, August 13, 2011

curses and poison (when cultures collide)

There is a subject about living in Congo that was hard for me.  It was the fact that most people believed in witchcraft, or as was more commonly translated, curses and poisoning.  I know there is a long history that I'm sure it is intertwined with cultural traditions, practices, and spiritual beliefs of years past that still remains and is practiced today.  And I'm positive you can find a lot of reading about the history of spiritual beliefs in Congo and learn a lot more about it.  I want to talk about one side of the story that I saw that relates to present day and the lack of quality health care.

First, if you read this post, you will note that there is a very poor functioning health care system in the area where we lived.  You could go see any number of medical people with some sort of training and get prescribed any number of medications.  For example, when my daughters all had very bad diarrhea about 8 months ago, I took E. to a nearby clinic.  I was told she has an infection, they wanted to draw blood, do stool cultures and they also wanted to start 6 medications immediately.  The medications treated everything from malaria to pinworms.  When I asked what they were presumably treating, they said "an infection" (with a sort of, "why are you asking anyway?").  When I asked why they were giving my baby a medication that is not given to babies in the U.S. (except in extreme cases), he said it is because they experiment with children and medications here (yeah, I did have a quick flash of horror of The Constant Gardner for a minute!).   The approach was, you (or your child) is sick, here are all the medicines I can think of that could possibly be somewhat appropriate to a sick person (or child).  If you don't leave with medicine you weren't treated well, the more medicines the better.

Most often you are sick, you go to a clinic, and then you leave with a lot of blood work done and a long list of mediations to take (that you go buy at the local pharmacy).  You aren't told why you are taking the medicine, what it is for, or what they even think you are sick with most often.  Over prescribing antibiotics (and multiple unnecessary medications at the same time) is extremely common.  In pediatrics the problems are even multiplied.

When someone dies, you often don't know why.  They were sick, then they died.  Or they had surgery, then they died.  If you are sick enough to go to the hospital, you often go there to die.  Resuscitation is uncommon.  Supplies few (except in some of the larger hospitals where you might have outside funders giving donations).  Diseases are complicated by extreme poverty.  Read this post.

Most aspiring physicians dream of doing additional training (where they often have to start over) elsewhere, and the fortunate few are able to see their dream realized.  (There are some amazing congolese physicians doing work in eastern Congo, dedicating their lives to relieve suffering.  Check out this doctor and read about this group.  And there are more.  It is inspiring. )

So, given all of this, perhaps it is not surprising that when someone dies or is very sick, there is an underlying belief that the person has been cursed and/or poisoned.  There is a deep paranoia and mistrust that exists within the culture, that translates even up to the middle and higher classes.  You hear stories everyday of someone dying from being poisoned, someone else was cursed, someone went to go get medicine from the local traditional healers or from the "witchcraft" type to treat someone.  You hear fear and mistrust.  You hear stories that don't make sense, that make you wonder.  

From my western training and medical experience, I find it baffling most of the time.  When an older man (who has struggled from diabetes for a long time) dies from complications from diabetes, it is clear to me.  He died because he had diabetes.  Instead, rumors swirl.  He died because he was poisoned.  He was cursed.  Someone poisoned him because he had mzungu (white) friends, and they were jealous.  When I consider the ancient traditions, more recent traditions and the past coupled with the mysterious, nebulous, unknown of western medicine that has been foisted on that same past (the western medicine which doesn't explain anything, and if anything adds to the confusion by its lack of clarity and reason), I can make more sense of it.  

One of my husband's work colleagues once had his leg swell and swell.  There are tropical diseases that could have caused this problem.  I found them in my big textbook I lugged to Africa.  This man was an educated man.  He didn't seek help from the hospital, he said he would die.  He said he had been poisoned and he needed the appropriate antidote.  He went to the local traditional healer.  He got better.  I was interested and did more reading.  In one case I found the sentence, "the medication given for [this disease] can often be given confused with another medication in the developing world hospital setting, and if this one is given erroneously, death is the result".  In the end, the traditional medicine (probably taken in part from a medicinal plant in the tropical jungle) healed him.  In his mind, the antidote to the poison he was given healed him.

One little boy I met, I will never forget, as his story was so heart wrenching.  He was 8 years old (photo below).  He weighed 30ish lbs.  He was part of a local feeding center.  His parents never fed him, so he ate at the center the one meal a day.  He never grew.  His parents didn't feed him because they said he was cursed.  They said they knew he was cursed because he never grew.  He probably did have an underlying disease, maybe a chronic infection that contributed to his severe malnutrition.  But a bigger part was that he was being intentionally starved because he was a "cursed" little boy.  The man I had the joy to be working with at the time was so calm about it, it wasn't surprising to him.  And over the next year, he persistently visited the family to try to help them see that he wasn't cursed, and that feeding him will help him gain weight.  It took a long time, but the family did change and began to feed him.  

It is complicated and heart breaking.  I am very grateful for good quality health care.  I hope I never take it for granted.  And I hope that more and more physicians that maybe train elsewhere go back to Congo to work in the hospitals and clinics and increase the quality of care.  I believe it is a basic human right and deserves attention and resources.

1 comment:

Heather said...

Oh my goodness, Holly, this little boy's story is heartbreaking. Thank you for all the educating you've done and continue to do. There are just some things you can't forget about after being in Congo, and yet I find myself pushing those things to the back of my mind because of the sheer pain of remembering. Thank you for bringing it back to the front of my mind where it should be.