There are many different approaches which people take to living and working in another culture. For myself submerging myself into the culture and embracing it is important, however what about when cultural practices go against everything we are trying to achieve? What happens when health care and cultural practices clash?
Cultural practices isn't a foreign concept for me, having been brought up in both Pakistan and New Zealand, and for the most part I am open minded. I respect and appreciate the place of spiritual practices in caring for the unwell and a huge number of our pharmaceuticals originated from herbal remedies. However, I do believe that there is a time and a place for traditional interventions and these needs to be weighed carefully for their benefits to the patient.
Here in Uganda it is no different to anywhere else in the world in that there are many cultural beliefs and practices surrounding health and healing. While some of these are harmless, others range in the degree of damage they can cause.
Probably the mildest of cultural remedies is the ingestion of herbs. I'm not sure what these herbal remedies are - the staff themselves aren't sure - but they can be given for any number of reasons. The problems most commonly occur when they are given to newborn babies. Every so often we get a baby in who is very unwell and vomiting green fluid. Bile my medical friends might think and in the past I would have agreed, but here it is just as likely to be the regurgitation of the herbs the infant has been coaxed to ingest. The rationale for giving herbs can be anything from poor feeding, not breathing well, pale, feverish, vomiting or pretty much anything else. Unfortunately, when it comes to vulnerable and already unwell infants, it just adds another complication to the equation as we attempt to bring them back to health.
Prayer for the unwell is common here, we ourselves have a Chaplin who comes into the medical center every few weeks to pray for our patients and with our staff. The problem, however, is not with prayer, it is when a patient is believed to have evils spirits in them or be cursed. While, to my knowledge, no dangerous practices are used in these cases, the risk is that because the family believes it to be a spiritual issue, they do not seek medical help. By the time these cases reach a medical facility they are critically ill and sometimes it's just too late.
Those are the milder issues. If you don't have a strong stomach, I would probably suggest that you do not read the remainder of this.
To my knowledge, there are three more major local practices, though there are likely more that I have not yet come across. While they are all dangerous, the other major problem that arises with all of them is that families don't bring their children to the medical center until much later.
The most recent one which I came across is mostly used on infants. This practice involves applying a hot object to a babies forehead to burn it. I'm not quite sure of the rationale of this one, but with one baby it was possibly done because of a high fever, the other because the baby's sutures of their skull were wide spaced and the fontanelle was wider than usual. As you can imagine, besides the immense pain of being burnt, this practice can also result in infection and severe scaring.
Local tonsillectomy, or tonsil mutilation, is a practice that is more common to Rwanda than Uganda but many of the residents of the district of Kisoro were once Rwandan refugees and so the practice has become very widely spread within the region. For reasons unknown, tonsillitis is the disease of choice here. No matter the symptoms, it could be a stomach ache, head ache or diarrhea, even vomiting up worms, it is locally diagnosed as tonsillitis. The remedy for this is to visit a local practitioner who performs a "tonsillectomy" . This consists of using a sharp object, commonly a sharpened stick, and piercing multiple times first the inside of the nasal passage, then the tonsils and back of the throat. The last patient we had in with this had not even been unwell... she was 2 weeks old, a first child and the mother was worried about feeding problems, so she had a local tonsillectomy done. When she arrived at our medical center she was unconscious, cold and hardly breathing. We fought for four days to keep her alive and, this time, we were lucky. Previously in the medical center children have died from this procedure, either from severe infection it has caused or from blood loss. One of our continual battles is educating regarding this but, unfortunately, most people just don't think that we understand.
The final practice that I am aware of is called false tooth extraction. Again, this is usually preformed on babies or very young children and it involves cutting into the gum and extracting the four eye teeth or canines. The two explanations I have received for this are that these teeth attract evil, or that they cause illness. Similar to the tonsil mutilation, the most common complications of this are infection and blood loss. This practice, however, is more wide-spread across Uganda.
Superstitions are another issue we battle with and come in a myriad of shapes and forms. We had a mother bring in a severely disabled baby recently but she had been told by the women in her village that, because while she was pregnant and out in the field she had seen a mole come above ground, that was the cause for her babys disability. Because of this belief she refused to take her child to the specialist referral hospital for treatment and took him home where he will likely die.
There is no simple solution. This issue requires a change in how people think, in their beliefs and in areas of their culture. In many ways, as a Muzungu (foreigner) this task cannot be accomplished by me because it is not my culture and it is too easy for me to be dismissed as someone who just doesn't understand things here. Thankfully our national staff are passionate on this subject - in fact I would hate to be at the other end of one of their lectures on it! Education is not quick or simple solution, it takes time and effort and the progress can be painfully slow but here, in Kisoro Uganda, the process has begun. I hope and pray for its success in time ahead.
Image: A little village by lake Mutanda. Small villages are often very isolated and so older cultural beliefs are much stronger.
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