The Africans (50 page)

“Ah yes, but how about the things that are frightening you? Let me explain how the mind controls and causes pain. When I was a small boy tending goats in Uganda, sometimes I would cut my leg running through the thickets. I would feel no pain because I was so intent on keeping the goats together. Then when I got home and my mother saw the blood and asked me what happened, the pain would start.”

Muhangi glanced at the case file again and scribbled out a prescription for a tranquilizer. “I know your pain is real,” he said, “but can you see that the pain is in your mind, not your body?”

“That may be so,” Phillip answered in a soft voice, “but have you not some pill that will help my cholera?”

Phillip shuffled out the door. A young girl named Theresa entered with her mother. Theresa was fifteen years old, less than three feet tall and the brightest student in her class. The headaches, cramps and sleepless nights began about the time she learned that she was a midget. Her headmaster refused to advance her to the next class because she was so small, and a Kenyan physician she had seen tried to put her on display in a ward so medical students could see what a midget looked like.

“This headmaster, he is no use, a stupid man,” Muhangi muttered
as he prescribed an antidepressant and wrote the headmaster saying Theresa should be graduated with her class.

“She is a smart girl,” Muhangi said to the mother. Theresa sat nearby, teary-eyed. “If she cannot do some things, at least she should be buying Mercedes-Benzes and writing books someday. After all, people who stammer also become orators. Theresa can still have a full, happy life. Do you understand, Mom?”

The mother said nothing and her face reflected no emotion. She waited for several more moments, but there was little else the doctor could say. She turned as she reached the door and said, “How can Theresa write books if she is so small?”

Muhangi’s weekly clinic represents a modest beginning in the treatment of the mentally ill. Yet throughout all of sub-Sahara Africa (excluding South Africa) there are only and estimated 100 psychiatrists serving 342 million people, and in most countries treatment is primitive or nonexistent. Generally only those who act totally made are considered in need of psychiatric help.

In parts of the Sudan, the insane are manacled and beaten twice a day in mental institutions. In at least ten countries there are no mental health specialists and no mental health facilities. Uganda once had the most advanced psychiatric care in black Africa, with twelve European-trained psychiatrists, outpatient clinics in a dozen rural towns, and a modern inpatient hospital at Makerere University in Kampala. President Amin’s rule of terror reversed that progress and by the time he was overthrown in 1979, all of Uganda’s psychaiatrists were dead or in exile and the mental health facilities were closed.

Kenya has only one in-patient mental health facility, Mathare Hospital. It was built to hold 1,000 patients but has twice that many, and one third of the patients are there on criminal charges. One ward has forty beds and 150 patients, and many patients never see a doctor; they are merely drugged for a few weeks and then released as sort of walking zombies. The admission ward, where all patients spend their first few days or weeks, is similar to a cage in a zoo. It has a cement floor littered with banana peels and human waste, towering bars and no roof. Inside are sixty or seventy patients, glassy-eyed, half-naked, trapped like animals.

Given such conditions, it is not surprising that the primary source of health care for Africans remains, as it has for generations, the practitioner of traditional medicine. Often called a witch doctor or sorcerer, he casts spells, removes curses, treats mental and physical
ailments. Anyone who doubts his powers needs only to meet Satigi Soumaouro, as I did one morning in the sleepy West African city of Bamako, capital of Mali.

For three days and three nights Satigi had treated a steady stream of patients, so by the time I appeared at the door of his dark little room at the end of a dirt alleyway, he was weary. He sat barefoot on his mattress, rubbing sleep from his eyes. This was his operating theater and his consultation room, and on the cement floor were his instruments: gourds, rattles, springbok horns, chicken beaks, potions of herbs, several cattle hoofs and a jar of shiny brown beetles.

Satigi was seventy-nine years old. The face beneath his blue fez was lined and drawn, but in his very presence—in the strong, steady gaze, in the soft, melodic voice—there was an aura of power that transcended both his exhaustion and my doubt.

“My mother had these powers too,” Satigi said. “From her milk they were passed to me. My knowledge was born with me.”

This knowledge had made Satigi one of the most sought-after traditional healers in West Africa. His patients came from as far away as Europe, and many had first gone to Western doctors to seek cures for their illnesses. But in the end they placed their fate in the hands of Satigi, partaking of his herbs, his incantations and rites, his knowledge of the universe’s intangible forces.

“There are some things that Western doctors cannot cure,” Satigi said, covering his feet with the long red robe that flowed from his shoulders. “There are things that will always be treated best by traditional medicine,” And for the time being at least, a major portion of the African medical community agrees with him. In fact, traditional medicine is undergoing a revival of respectability in Africa and is viewed by many competent medical authorities as an important adjunct to Western-style health care.

The traditional practitioners’ strength lies in the belief that man is more than a physical entity. His well-being is largely controlled by gods and spirits, and disease is a punishment for wrongdoing. Misfortune is the result of a curse, often uttered in the name of an enemy or a displeased ancestor. Some practitioners will cast evil spells. Others, like Satigi, operate only as the harbingers of good forces; they will remove but not cast evil spells. Both types of practitioners believe that spirits, both good and evil, emanate from one’s ancestors and that a precise balance between those conflicting forces guarantees an individual’s good health.

The eighteen-year-old girl who now sat at Satigi’s feet was barren
and gripped by constant stomach cramps. Her father stood behind her and explained that the girl’s husband had had her cursed because she had borne him no children. Beetles, he said, now filled her stomach. Satigi listened carefully, questioning the girl about the guilt she felt.

He had the bare-breasted girl put on a white blouse and expose her stomach. She squatted on an upturned urn and watched calmly as Satigi sharpened a small knife on a whetstone. The father pulled a fold of flesh from the girl’s stomach. Satigi made a small incision in it, then cut his own right thigh, just enough to draw blood. He mixed the blood with hers, spat on the wounds, rubbed ashes on her stomach, waved a rhinoceros horn over her head and between her legs, closed his eyes and recited a prayer, and had her walk twice over his toes. “In two days she will be well and will bear her husband many children,” he said, rising and clapping his hands together. The girl stood. She smiled. The cramps, she said, were gone.

During the colonial era the European administrators condemned these centuries-old beliefs and practices as pagan quackery. Traditional medical techniques were banned and traditional therapists were driven underground, although each was—and often still is—the most influential figure after the chief in his village. Many countries today still prohibit the casting of evil spells. In Kenya not long ago, two men went to jail for killing chickens in an attempt to put a hex on an opposing soccer team, and it is common for a candidate seeking office to have a spell cast on his opponent. But at least nineteen African countries have established institutes of traditional medicine for research and treatment. They are not involved with sorcery or quackery, and their techniques are respectably scientific.

“Remember, the African was being treated for his sickness long, long before any European doctor ever set foot on the continent,” said Dr. Adama Kone, the director of Mali’s Institute of Traditional Medicine, which was cleaner and more modern than most hospitals I saw in Africa. “Only fifteen percent of the people in Mali have access to modern health care. The others have to rely entirely on traditional practitioners. In some cases, as with hepatitis, their cures are faster and better than anything offered by modern medicine.”

For hepatitis, the seven-day cure involves grinding the living layer of bark from a gardenia micranthum tree into a fine yellow powder.
The first day the patient takes five grams of the powder, which has been mixed with one-quarter liter of fresh milk and allowed to stand for twelve hours. On each of the following
six
days he takes five grams mixed with water that has stood for thirty minutes.

The leaf of the same tree is used as a laxative, and its chopped root is used to treat diabetes. Asthma is treated with the carbonized nutlike fruit of the tree.

Traditional medicine does not ignore the organic and physical aspects of disease, although its approach stresses social and psychological factors as well. Satigi, for instance, started each diagnosis by taking the patient’s history: Have there been financial or marital problems that would cause stress or other conditions? Have there been hostilities in relations with others? Has an evil spirit intervened? Have there been strains on the family as a unit?

Satigi rose from his mattress. “Now I must sleep,” he said. “I am growing old, but there are so many who want to see me that there is not much time for sleep. You go now and when you write your story, do not write that I carry the forces of evil. It is I who confront the evil with my powers of good.

“Now go. Allah will protect you and love you. Your spirit will never be broken or cut. Your name is good as mother’s milk.”

He bowed and disappeared into a little cubicle off his consulting room to find rest at last. Four days later he died in his sleep.

In colonial times traditional healers like Satigi were often jailed by the authorities. They were considered part of the primitive unchristian past which Europeans thought Africa needed to bury in order to take its place in the modern world. But there has been a dramatic shift in such thinking in recent years, and today the World Health Organization is trying to revolutionize the way health needs are handled in Africa and other parts of the Third World. The organization now defines health as “a complete state of physical, mental and social well-being and not merely the absence of disease and infirmity.” To achieve this, Africa’s primary emphasis must be on primary health care. Clean drinking water, improved sanitation, better birth-control programs, a balanced diet and increased food supplies are more important for Africa today than more drugs and doctors. Medical facilities such as the open-heart surgery unit built in Nairobi in the late 1970s can wait for another decade. Africa can no longer afford to concentrate all its medical services in the cities
while ignoring the huge majority of people who live in the country.

As part of this realization, WHO now endorses the integration of traditional and modern medicine and recommends increased research into herbal as well as magical-religious cures attributed to thousands of practitioners such as Satigi. There is, the organization says, “an absolute need to establish national associations of traditional healers recognized by the authorities, members of which … would gradually come to lealize their strength.”

The health problem, like so many others in Africa, is one of education. Even if Africa can shift its medical emphasis from the cities to the villages, even if it can train the medical assistants willing to work in the rural areas, even if traditional and modern medicine can be integrated, it still will not be easy to convince an African mother that her children should not drink with the cattle from the same polluted waterhole or that dogs and humans should not share the same plate. After all, she will tell you, that’s what her parents did and they lived to be forty or forty-five years old, so what can be wrong with the practices? But until public health becomes the concern of every village, the general standards of health will remain abysmal. Every developed country, including the United States, had to make this same transition.

In 1981, members of WHO meeting in Geneva voted 118-1 to restrict marketing practices of the $2 billion-a-year international baby-formula industry.
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WHO estimated that the formula caused as many as ten million serious cases of malnutrition or diarrhea each year in the Third World, and one million deaths. Almost overlooked in the debate was the fact that there is nothing harmful about the formula itself; the danger occurs because illiterate mothers cannot read the instructions for preparing the formula and mix the powder with polluted water in unsterilized bottles.

But the Third World’s suspicion that Western food and drug companies don’t care how their products are used abroad is easy to understand. Foreign drug companies, in fact, have discovered a bonanza in black Africa, which they have turned into a dumping ground for their pills by capitalizing on the absence of consumer-protection laws and of regulations against false advertising.

In movie theaters and on billboards across the continent, Africans are bombarded with messages that various drugs can restore youthful vigor, sexual potency, even mental alertness. Most of the advertisements are outright lies—they never could be published in the United States in the first place—yet Africans in huge numbers turn to these “miracle drugs” to cure everything from ankle sprains to polio. The practice is reminiscent of the quick-tongued salesmen who used to travel the Western frontier a century ago, peddling their cure-all potions from the back of horse-drawn carts; the results, though, are far more lethal in Africa than they ever were in Montana or Wyoming.

The most damning study I found on the role of drug companies in Africa was in a recent report published by Dr. John Yudkin of the London Hospital Medical College. His study dealt with the purchase, use and promotion of drugs in Tanzania, a country where there are 147 drug-company representatives (most of them Tanzanians working for firms with ties abroad) and only 600 doctors. The report said, in part: