March
2009
Which Doctor?5
I met the nicest witchdoctor last week. I was spending the day in one of our study villages, supervising village health workers, biking around to points of interest and taking GPS coordinates. It started out as a joke when Steve Schachterle and I agreed to write a paper on “Distance to Witchdoctor” as part of our analysis of relevant variables correlated to different disease categories: Malaria, Acute Respiratory Infections, Diarrheal Disease and Sexually Transmitted Infections. The more I thought about it, however, the more I felt it was actually important to include witchdoctors among our identified local resources, since they justifiably serve as dispensers and repositories of traditional medical knowledge.
First, I suppose I should say something about the term “witchdoctor.” Although not the sort of thing that anyone would self-apply where I come from, Tanzanians often use the English word “witchdoctor” in a completely neutral sense. Like the word “half-caste” for people with mixed race heritage, it sounds much worse to the American ear than to the Tanzanian. As for the far more unfortunate tendency of Tanzanians to use the N-word as a label for black Americans, well, that’s painful to hear for many reasons – not the least of which being a lack of consciousness that anyone would find it offensive. In any case, for the sake of propriety, perhaps I should substitute “traditional healer” for “witchdoctor,” although I am not entirely sure whose sensibilities I would be protecting in this instance. Maybe they have decided to take back the word “witchdoctor.”
Despite the freedom available in English usage, I have found it more important to be careful with my terminology in Kiswahili. In looking around the village for traditional healers, I explicitly used the term Mganga wa Kinyeji (village doctor) or Mganga wa Asili (traditional doctor) in my search. While “witchdoctor” may be a neutral term, Mchawi (witch/wizard/sorcerer) is not. To make matters a bit complicated, Tanzanians generally consider the terms Mganga and Mchawi to be synonymous, the former a nicety disguising the underlying malevolent reality of the latter. “Is it possible to be Mganga without also being Mchawi?” I asked some Tanzanian colleagues. “If an Mganga only helps people,” I was told in the tone of voice suggesting the concession of an unlikelihood, “then he is not Mchawi.”
Medicinal elements of traditional beliefs and practices can be touchy subjects to broach, especially coming from a white American. Among the more harsh criticisms I have heard Tanzanians level at one another is the claim that some tribe/ethnic group (Kabila) is barbarous or unchristian, as evidenced by their traditional religious/magical/spiritual practices. I hear gossipy backbiting about who wears amulets, buries good luck charms, or talks to their dead ancestors along with the typical denunciation that such people are not real Christians. Of course, the longer I stay in Tanzania the more convinced I am that most people have not so much given up traditional beliefs as they have incorporated them into Christianity, Islam or modern science, as the case may be. “I don’t believe in witchcraft since as I Christian I believe all power comes from God,” a primary school teacher friend told me, “therefore God protects me from the witchcraft.” If this quote leaves you a bit confused, trust me, it’s better to just embrace the paradox.
Taking GPS coordinates at the homes of local healers, I made sure to sound a positive note about what I was doing. “I am using this computer to identify important locations in the village so we can make a map,” I explained to the kindly old man, the fourth and final of the villages’ Waganga. “We are marking the village government office, school, churches, water sources, dispensary, drug store, and the homes of the Waganga,” I continued as he looked at me somewhat worried, “places where people can get local medicine” I added in my best nonchalant tone. “We would also like to see some of your medicines,” one of the village health workers added, anticipating my interest.
The old man immediately struck a pleading if defensive note. “All of my medicines come from tree roots,” he insisted, “I am not Mchawi.” I emphasized that his work was important and that I was only interested in knowing where people could get medicine in the village. “People just pay me with food,” he continued, “I only work to help people, not to make money.” In addition to being known for their ability to get rich from their spells, Wachawi also use sinister ingredients in their medicines: blood, bones, hair, skin – often requiring a brutal collection. In my former village, a local man was found dead in the woods with much of his skin missing. Witchcraft was the universal suspect. Albinos are in particular danger on this account, as many Wachawi agree that their skin possesses magical properties. White, European skin, I was assured by everyone, has no magical benefits, though some regard European hair as potent. The old man said he used only tree roots to distance himself from such practices.
As the Mganga took me and the other village health workers to his shaded treatment area, he continued to plea his case. “If my medicine doesn’t work,” he continued, “I tell people to go to the dispensary. If that doesn’t work, then they need to go to the hospital in Kongwa or even Dodoma.” I was impressed. By the far the biggest problem with local healers is their potential opposition to western medicines. Especially given much of the widespread skepticism regarding AIDS and the western powers (“Americans put HIV into condoms,” I have heard from suspicious Tanzanians on more than one occasion), there are plenty of Waganga who implore their HIV+ patients to take traditional medicines in lieu of Antiretroviral medications. Obviously this Mganga was concerned with the health of his patients, not his medical market share.
“I only have one medicine right now to show you,” the old man apologized. I assured him I was happy to see whatever was on hand as I took the proffered gourd-bottle. “What does this medicine treat?” I asked. “It is a topical oil,” he explained, “for injuries, pain, malaria,” he gave as examples. I had to admit that I was hoping for a slightly less grandiose claim, given how circumspect he had been up until this point. Nevertheless, I understood him to be sincere and thanked him for his work. I am not inherently opposed to placebos, especially when accompanied by the appropriate referral for serious cases.
Undoubtedly much of the magical approach to illness stems from an inherent sense of powerlessness in the face of disease and uncertainty. When a patient comes to you clearly suffering, it feels like doing something, anything, has to be better than admitting defeat. There is little consolation in telling someone to just get bed rest and let nature run its course. I can relate to the witchdoctor’s woes, as I get asked for medical advice on a regular basis these days. I am not a medial doctor, nor do I have at my disposal any diagnostic tools other than a rapid malaria test kit, a thermometer, and the knowledge gained from countless, paranoid hours spent reading my Peace Corps issued copy of Where There is No Doctor, analyzing my mysterious skin inflammations and unpredictable digestive cycle.
During the course of our current study, our village health workers are dispensing Coartem and Quinine for malaria, Amoxacillin for acute respiratory, ear and some skin infections, oral rehydration salts for diarrhea, Azithromycin for chlamydia, Ciproflaxin for gonorrhea, Paracetamol for non-malaria fevers and cough syrup for coughs without rapid breathing. Naturally the villagers have come to expect us to have a medicine for every illness and have expressed feeling neglected or cheated if we cannot provide them with such. It is in fact the reason we are giving out limited amounts of cough syrup. Our initial treatment regimen called only for treating coughs accompanied by rapid breathing. Mothers were getting annoyed at reporting their child’s persistent coughs during the health workers’ twice weekly visits without getting anything for it.
As I continue to talk with villagers about their symptoms, I find it is often the case that the best treatments are simple, common and throroughly unexciting. In this arid environment with limited access to clean water, most people are not drinking enough. Even for those with better than average access to water, this still seems to be a common problem. I have had several people tell me about muscle soreness and headaches at the end of the day. These same people are reporting that they often drink less than a half liter of water per day. Additionally, the local diet is dominated by starches and other carbohydrates with limited fresh vegetables. Telling people to drink more water and get more vitamins in their diet feels a bit like a brush off – to me and to them. It would be nice if I had my own tree root oil to dispense.
The most common requests of Waganga/Wachawi in this area appear to be exorcising demons and producing rain. Being bothered by demons seems to be a common complaint and one for which the local solutions are viewed as rather reliable. The bad news for my work is that the first requirement for the demon-afflicted is cutting out all western medicines. Apparently they are contra-indicated for the local stuff. A trip out into the wilderness for up to a week commonly comes next. Finally, local medicines, prayers, drumming and dancing generally finishes things off. As for rainmaking, and I swear I’m not making this up, the local spiritual and meteorological practitioner climbs up onto the roof of a house with a mud-baked roof, takes off his clothes and moons the sky. I guess I shouldn’t knock it until I’ve tried it.
Further reading:
Newspaper article on witchcraft and the law in Tanzania
Insightful commentary on witchcraft in Tanzania by a public health worker