Belief and health - a view from Africa
A few weeks ago, a taxi drew up to the hospital entrance and a crowd quickly gathered around some agitated relatives who emerged and called for a stretcher. Out of the taxi was bundled an emaciated lady, and on our first inspection it was hard to decide if we were dealing with a patient or a corpse. The on-duty nurses rushed with us to the emergency room where we recognised some signs of life - a few gasping respirations and an agonal heart beat. It was quickly apparent that we were in a hopeless situation. Her body gave off a faint smell of smoke and a hugely swollen and discoloured leg had patches of large - possibly deliberate - burns. Her abdomen was swollen with ascites (fluid), and there was an ugly carpet of fresh chatta marks cut into her leg and abdomen. Her blood pressure was unrecordably low and her pupils already fixed and dilated. She had been unwell for 2 months, we heard, but Chitokoloki was clearly a last resort, some time after the family had wasted money and treatment opportunities on 'traditional healers' (witch doctors). We undertook a round of resuscitation but abandoned efforts shortly afterwards; it was clear that battling for her survival was futile and our role was merely to confirm death.
A few months ago, a dog in the nearby town became suddenly agitated, hyper-aggressive and bit a large number of other dogs and people before he was finally caught and killed. Jess spent multiple mornings with screaming children, mass-vaccinating those affected to try and prevent disease. Some days later, a young boy arrived with his uncle. He too had been bitten, but his parents had taken him to the local witch doctor. Clearly, some family disagreement had occurred and as the boy became sick his young uncle insisted on taking him for hospital care. He was a sweet little boy, but anxious, foaming at the mouth, and when offered a glass of water he went into full-blown panic and spasms. This is the classic presentation of rabies - so-called 'hydrophobia' and anxiety, progressing inexorably to increasing mental derangement and death. Over the coming days, we watched him deteriorate, and were powerless to arrest his slow descent into terror-filled madness. Once established, rabies is universally fatal and all we could do was try and fog his consciousness with sedatives and opiates.
A few months ago, a dog in the nearby town became suddenly agitated, hyper-aggressive and bit a large number of other dogs and people before he was finally caught and killed. Jess spent multiple mornings with screaming children, mass-vaccinating those affected to try and prevent disease. Some days later, a young boy arrived with his uncle. He too had been bitten, but his parents had taken him to the local witch doctor. Clearly, some family disagreement had occurred and as the boy became sick his young uncle insisted on taking him for hospital care. He was a sweet little boy, but anxious, foaming at the mouth, and when offered a glass of water he went into full-blown panic and spasms. This is the classic presentation of rabies - so-called 'hydrophobia' and anxiety, progressing inexorably to increasing mental derangement and death. Over the coming days, we watched him deteriorate, and were powerless to arrest his slow descent into terror-filled madness. Once established, rabies is universally fatal and all we could do was try and fog his consciousness with sedatives and opiates.
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| Photo credit: https://commons.wikimedia.org/wiki/File:Rabies_in_dogs.png |
False beliefs can have tragic and fatal consequences. Although Zambia is ostensibly a Christian nation, many people remain tied to the tenents and practices of traditional animistic belief. In the area around Chitokoloki, river-users are regularly lost to crocodile attacks. Perhaps surprisingly, the response of the villagers is not to modify their bathing behaviour, but to mount a witch hunt for the local who must have turned into a magic crocodile. Even those who profess a Christian faith, there is great fear around the world of spirits and curses. It has been clear to us on many occasions that loving the people around Chitokoloki means not only addressing their physical health problems, but addressing maladies of the heart, mind and soul.
Each time an operation is undertaken, we try to use the Surgical Safety Checklist - a tool designed by the World Health Organization as a prompt for surgical teams to process key safety steps before and after surgery. The WHO encouraged local adaptations and ours is pictured below:
Each time an operation is undertaken, we try to use the Surgical Safety Checklist - a tool designed by the World Health Organization as a prompt for surgical teams to process key safety steps before and after surgery. The WHO encouraged local adaptations and ours is pictured below:
This prompt to pray for our patients at 'time out' is a reminder that in this institution, our focus and motivation is subtly different. We make enormous efforts to deliver the best healthcare possible, but it is the beliefs and ethos underpinning this effort that is key to our success. The mission station at Chitokoloki was founded over 100 years ago with the earnest desire to see this small part of Africa transformed by the love of Christ. Something of this motivation is captured in our conversation with our missionary nurse colleague, Julie-Rachel Elwood.
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| The Chitokoloki Airstrip and settlement |
Chitokoloki is part of the Churches Health Association of Zambia (CHAZ), representing 16 Catholic and Protestant denominations, who together administer 34 hospitals, 77 health centres annd 31 community-based organisations. CHAZ facilities provide over 50% of formal healthcare in rural Zambia and 35% of healthcare nationally.
Religious institutions have long been associated with the development of healthcare services. Vicky Lavy highlighted some of this history in her 2013 article for the Christian Medical Fellowhip, 'Faith-based organisations and global health' (accessible here). Dr Lavy highlighted that as far back as AD 259, the Christian community in Alexandria was known for its care of plague victims, often with fatal consequences for the care-givers. The high-profile medical journal The Lancet published a series of articles on 'Faith-based health-care' in 2015, and highlighted that while many challenges exist for faith-based healthcare providers (see for example this comprehensive review funded by the Gates Foundation), in many surveys of sub-Saharan African countries, faith-based institutions enjoy higher satisfaction rates than both public and private counterparts, and probably retain an important role in serving the poorest of the poor (link here).
But the contribution of faith-based organisations goes well beyond that of simply delivering healthcare capacity. Some time back, the British journalist Matthew Parris wrote a surprisingly frank article for The Times entitled, 'As an atheist, I truly believe Africa needs God' (link here). The article is worth reading in full, but it concludes,
From our African experience, now coming to an end, we second this conclusion. But we affirm it from the perspective of ones who have been personally transformed by this belief system. Our Christianity has not given us any pretensions of moral superiority, and we know and love many colleagues of other faiths and none who serve healthcare needs with equal or greater distinction. But the true flourishing of mankind cannot occur simply by attending to biological needs and faults. The church father Augustine of Hippo put it this way as he mused before God:
Religious institutions have long been associated with the development of healthcare services. Vicky Lavy highlighted some of this history in her 2013 article for the Christian Medical Fellowhip, 'Faith-based organisations and global health' (accessible here). Dr Lavy highlighted that as far back as AD 259, the Christian community in Alexandria was known for its care of plague victims, often with fatal consequences for the care-givers. The high-profile medical journal The Lancet published a series of articles on 'Faith-based health-care' in 2015, and highlighted that while many challenges exist for faith-based healthcare providers (see for example this comprehensive review funded by the Gates Foundation), in many surveys of sub-Saharan African countries, faith-based institutions enjoy higher satisfaction rates than both public and private counterparts, and probably retain an important role in serving the poorest of the poor (link here).
But the contribution of faith-based organisations goes well beyond that of simply delivering healthcare capacity. Some time back, the British journalist Matthew Parris wrote a surprisingly frank article for The Times entitled, 'As an atheist, I truly believe Africa needs God' (link here). The article is worth reading in full, but it concludes,
"Those who want Africa to walk tall amid 21st-century global competition must not kid themselves that providing the material means or even the knowhow that accompanies what we call development will make the change. A whole belief system must first be supplanted.
And I'm afraid it has to be supplanted by another. Removing Christian evangelism from the African equation may leave the continent at the mercy of a malign fusion of Nike, the witch doctor, the mobile phone and the machete."
From our African experience, now coming to an end, we second this conclusion. But we affirm it from the perspective of ones who have been personally transformed by this belief system. Our Christianity has not given us any pretensions of moral superiority, and we know and love many colleagues of other faiths and none who serve healthcare needs with equal or greater distinction. But the true flourishing of mankind cannot occur simply by attending to biological needs and faults. The church father Augustine of Hippo put it this way as he mused before God:
"You have made us for Yourself, and our hearts are restless till they find their rest in Thee."
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