falola 00 fmt auto2 7/26/07 1:48 PM Page i Health Knowledge and Belief Systems in Africa falola 00 fmt auto2 7/26/07 1:48 PM Page ii falola 00 fmt auto2 7/26/07 1:48 PM Page iii Health Knowledge and Belief Systems in Africa Edited by Toyin Falola and Matthew M. Heaton falola 00 fmt auto2 7/26/07 1:48 PM Page iv Copyright © 2008 Toy in Falola Matthew M. Heaton All Rights Reserved Library of Congress Cataloging-in-Publication Data Health knowledge and belief systems in Africa / edited by Toyin Falola and Matthew M. Heaton. p. cm. Includes bibliographical references. ISBN 10: 1-59460-243-3 ISBN 13: 978-1-59460-243-6 1. Medical care--Africa. 2. Traditional medicine--Africa. 3. Social medicine-- Africa. I. Falola, Toyin. II. Heaton, Matthew M. [DNLM: 1. Health Knowledge, Attitudes, Practice--Africa South of the Sahara. 2. Medicine, African Traditional--Africa South of the Sahara. 3. Religion and Medi- cine--Africa South of the Sahara. 4. Health Policy--Africa South of the Sahara. 5. Delivery of Health Care--Africa South of the Sahara. 6. HIV Infections--prevention & control--Africa South of the Sahara. WB 50 HA12 H434 2006] R651.H43 2006 362.1096--dc22 2006018279 Carolina Academic Press 700 Kent Street Durham, North Carolina 27701 Telephone (919) 489-7486 Fax (919) 493-5668 www.cap-press.com Printed in the United States of America falola 00 fmt auto2 7/26/07 1:48 PM Page v To Drs. Vik Bahl and A. B. Assensoh for their humanity falola 00 fmt auto2 7/26/07 1:48 PM Page vi falola 00 fmt auto2 7/26/07 1:48 PM Page vii Contents Tables and Figures xi Notes on Contributors xiii Acknowledgments xix Overview—Investigating Health Knowledge and Beliefs Toyin Falola and Matthew M. Heaton xxi Introduction—Health Knowledge and Belief Systems in Africa Susan Rasmussen 3 Part A Religion and Belief Systems Chapter 1 Examining the Role of Language in Healing: Comparison of Two Therapeutic Interventions for Spirit Possession Christy Schuetze 33 Chapter 2 The Relevance of Worldview Interpretation to Health Care in South Africa J.C. van der Merwe 55 Chapter 3 Fulani Treatment Decisions Andrew J. Gordon and Atoulaye Sall 67 Chapter 4 Weapons of Faith in a World of Illness: Zionist Prophet-Healers and HIV/AIDS in Rural KwaZulu-Natal Fiona Scorgie 83 Chapter 5 The President’s Emergency Plan for AIDS Relief (PEPFAR), the Ethiopian Orthodox Church, and Community Beliefs Kenly Greer Fenio 107 Chapter 6 “Wisdom That Grows and Knowledge That Flies”: Negotiating Translocal Knowledge and Health Development in Senegal Bjørn C. Westgard 137 Chapter 7 Recuperating Traditional Pharmacology and Healing among the Abaluyia of Western Kenya Maurice N. Amutabi 149 vii falola 00 fmt auto2 7/26/07 1:48 PM Page viii viii Contents Chapter 8 The Spiritual Basis of Health and Illness in Africa Felix Augustine Mensah 171 Part B Politics, Policies and Ethics Chapter 9 Commemoration and Narratives of Community Healing: Ten Years after the Rwandan Genocide Kristin C. Doughty 183 Chapter 10 Ethical Issues in Health-Care Practice and Research in Sub-Saharan Africa Ike Anya 205 Chapter 11 Vaccinations in Niger: Perceptions, Beliefs, and Ethical Issues of International Health Initiatives Isabelle Leblanc 213 Chapter 12 Migration, Mortality and Measurements: A Reassessment of the Historiographical Use of “Relocation Costs,” with Attention to the Office du Niger, Soudan Français (Mali), 1925–1945 Brandon County 225 Chapter 13 The Influence of Ideologies on Health Care in South Africa Tania van der Merwe 239 Chapter 14 Total Quality Management (TQM) and the Health-Care Delivery System in Africa John Ngosong Morfaw 249 Chapter 15 “Multiracial Partnership” and African Health Care in the Central African Federation: 1953–1963 B.D. Marsh 261 Chapter 16 Psychology and Orthotics/Prosthetics in South Africa Ilzé Grobler, Gertina J. van Schalkwyk, and Claire Wagner 277 Chapter 17 Rethinking Security Threats in Africa: Changing Patterns of Social Relations and Insecurity Femi N.O. Mimiko 289 Chapter 18 On the Poverty of Health Politics in Africa: Are Governments Doing Enough? Obinna Innocent Ihunna 299 falola 00 fmt auto2 7/26/07 1:48 PM Page ix Contents ix Part C HIV/AIDS Chapter 19 Understanding AIDS in Public Lives: Luambo Makiadi and Sony Labou Tansi David Eaton 315 Chapter 20 The Acute AIDS Abdomen: A Prospective Clinical and Pathological Study S.J.A. Smit and R.S. du Toit 333 Chapter 21 AIDS-Induced Funeral-Culture Changes in Malawi Adam D. Kisˇ 339 Chapter 22 A Holistic Approach in Managing HIV/AIDS Policy in South Africa Ernest Ababio 343 Chapter 23 Indigenous Plants As Complementary Immunomodulators in HIV/AIDS Patients TV Jacobs 355 Chapter 24 Migration and HIV/AIDS in Sub-Saharan Africa Baffour K. Takyi, Gabriel B. Fosu, W. Bediako Lamousé-Smith, and Stephen Obeng-Manu Gyimah 361 Part D Media and Literature Chapter 25 Representations of African Healers in the Popular Print Media: Inquiries into South African Understandings of Health and Popular Culture in the 1970s and 1980s Kirsten Rüther 385 Chapter 26 Trauma, Ngoma, and the Arts: Possibilities for Healing Maureen Fielding 411 Chapter 27 Genocide and HIV/AIDS in Gil Courtemanche’s A Sunday at the Pool in Kigali Lena Khor 425 Chapter 28 “If We Have Something to Tell God, We Tell It to the Wind”: A Linguistic and Discursive Analysis of Akan Therapeutic Discourse Samuel Gyasi Obeng 435 Chapter 29 “No Short Cuts”: Landmines, HIV/Aids and Africa’s New Generation Barbara Harlow 461 falola 00 fmt auto2 7/26/07 1:48 PM Page x x Contents Chapter 30 The Impact of Theater/Drama on HIV/AIDS Education in Southern Africa Patrick J. Ebewo 469 Chapter 31 The Mad Mother and Her Children: A Psychological Reading of Three Films by Jean-Marie Teno Olivier Jean Tchouaffe 481 Part E Information Technology and Health Chapter 32 The Impact of Information Technology on Health Information Access in Sub-Saharan Africa Lenny Rhine 497 Chapter 33 The Use of Geographic Information Systems (GIS) in Supporting and Enriching Health Programs Sandra Dove and Wendy Naudé 509 Index 523 falola 00 fmt auto2 7/26/07 1:48 PM Page xi Tables and Figures Figure 1.1 Ritual Clapping Cadence and Intensity 41 Figure 4.1 Her hands coated in white ash, a Zionist prophet-healer prepares isiwasho during a healing ceremony. Centocow, May 2005 (photograph by the author) 92 Figure 4.2 A group of Zionists summon the healing and divinatory powers of the Holy Spirit by “searching”. Centocow, June 2001 (photograph by the author) 93 Figure 4.3 KwaZulu-Natal, showing the Centocow region in the south of the province. (Map supplied by the School of Life and Environmental Sciences, University of KwaZulu-Natal) 94 Table 5.1 Anonymous Surveys of Focus Groups 123 Table 5.2 Surveys-Respondent Receives Information on HIV/AIDS from the Clergy 125 Table 5.3 Surveys-Religion (EOC and non-EOC) 125 Table 5.4 Frequencies for Survey Respondents (EOC vs. non-EOC) 132 Table 7.1 Medicinal Plants Found among the Abaluyia 165 Figure 9.1 Local Trials of Genocide Perpetrators in Zivu, Rwanda 188 Figure 9.2 Rwandan Genocide Memorial, Ntarama 194 Figure 13.1 Flowchart of (Simplified) Process of Domination 241 Figure 13.2 Model of Ideology Theory 242 Figure 13.3 Relation between Ideology, South African History, and South African Health Care 244 Figure 16.1 Diploma of Special Knowledge 285 Table 17.1 Debt Undercuts Aid to Africa (US$bn) 296 Figure 19.1 Luambo Makiadi 317 Figure 19.2 Memorial to Makiadi 322 Figure 19.3 Flyer of Sony Labou Tansi 325 Table 20.1 Acute AIDS Abdomen Patient Classifications 335 Table 20.2 Outcomes of Surgeries 336 Figure 22.1 HIV Infections Growth in South Africa, 1990–2000 347 Table 22.1 Estimated HIV Infection Rates As % of Race/Age Groups in South Africa, 2000 347 Figure 24.1 Description and Coding of Variables Used in the Analysis 372 xi falola 00 fmt auto2 7/26/07 1:48 PM Page xii xii Table and Figures Figure 24.2 Summary Characteristics of the Respondents Used in the Analyses: Men Aged 15–59, Ghana and Kenya DHS 373 Figure 24.3 Perception of Risk Status by Migration Status: Ghana & Kenya Men Aged 15–59, l998 374 Table 24.4 Distribution of Specific Behavioral Changes by Migration Status among Those Who Know about AIDS: Men Aged 15–59, Ghana and Kenya DHS, 1998 375 Figure 24.5 Odd Ratios Predicting Use of Condoms, the Avoidance of Multiple Partners, and Abstinence by Migration Status and Selected Characterstics among Male Respondents Who Know about AIDS: Ghana and Kenya, 1998 376 Table 24.6 Odd Ratios Predicting Use of Condoms, the Avoidance of Multiple Partners, and Abstinence by Migration Status and Selected Characteristics among Men Aged 15–59: Ghana and Kenya, 1998 377 Figure 33.1 Location of The Valley Trust, KwaZulu-Natal, South Africa 510 Figure 33.2 Location of Clinics around The Valley Trust (Clinics from which monthly statistics are collected by TVT marked with a green triangle) 511 Figure 33.3 Distribution of CHWs in KwaZulu-Natal 512 Figure 33.4 Percentage of Households Visited by CHWs in uGu District, KwaZulu-Natal 513 Figure 33.5 Distance of Clients from The Valley Trust (0–5km = 99) (5–10km = 115) (10–15km = 121) (15–20km = 116) 515 Figure 33.6 Distance to Referral Hospitals from The Valley Trust 515 Figure 33.7 Schools Currently Receiving Support from The Valley Trust in Terms of OVC Identification 516 Figure 33.8 Access to Birth Certificates 517 Figure 33.9 Other OVC Indicators within the KwaXimba Survey 517 Figure 33.10 Location of Clinics and Sample Primary Schools in the Umlazi Birth Registration Project 519 Figure 33.11 Household Resources 520 Figure 33.12 Household Farmers, Showing Those Households with No Income (including no grants) 521 falola 00 fmt auto2 7/26/07 1:48 PM Page xiii Notes on Contributors Ernest Ababio is an Associate Professor and Head of Department of Public Manage- ment and Political Science at North-West University, Vaal Triangle Campus in South Africa.