AFRICAN TRIBAL CULTURES INFLUENCE THE FORMULATION OF TECHNIQUES TO ERADICATE HIV/AIDS IN AFRICA

Tata Thaddeus Agwo

1-2-3-4-5. That is how long it takes for another victim of HIV/AIDS to die in Africa. By the time you finish reading this article, about a hundred more have died and a hundred more infected. Before you read how African tribal cultures influence the formulation of techniques to eradicate HIV/AIDS in Africa, let’s enter the mindset of a western reporter, Gedeon Levy about lady G.

"G. lies in bed. The yellowish liquid flowing into her vein from an infusion does nothing to ease her agony. Every bone shows through her shriveled, sallow, sore-pocked skin. She stares into nothingness, breathing heavily. She is about 40, but these are death rattles. By the time these lines are published, she will no longer be among us. If G. had been a white woman from the West, her life would be longer. But she is a black woman from Africa, one of 560,000 AIDS victims in her country this year, and her fate was sealed. Last week she still lay in the outpatient clinic at Yaounde's central hospital. There was no one to pay for full hospitalization. There is 'no health insurance in Cameroon', and the 1,259 CFA francs (the local currency) - about NIS 10 a day in a 10-bed ward - was beyond her means. G. was about to be sent home to die, but how could she be moved in her condition? It's hard to imagine. She was accepted at the outpatient clinic only when her symptoms became so serious it became clear she was dying. There was no one to pay for her treatment beforehand - that's the way it is for most AIDS patients in Cameroon. In the room next to G., A. was in somewhat better shape. He is a 21-year-old student who had casual sex, never thinking anything could happen to him, and became infected. He had come to the hospital complaining of weight loss and diarrhea, convinced he had contracted malaria, another common malady in Cameroon, but was diagnosed with AIDS. His family is relatively prosperous and he is among the few patients getting the effective treatment known in the West as the AIDS cocktail.
But A.'s family can only afford the costly cocktail for another few months. When the money runs out, he will be left to die. Meanwhile, he is taking fewer pills a day than the recommended dose, also common in Cameroon, in the hope that he will be able to prolong treatment. The cost of the cocktail is finally going down in Africa. Until a short time ago an AIDS patient had to pay about $800 a month, an astronomical sum in local terms. Now it has gone down to $50, which is about half the average monthly salary, for medications imported from Australia and Brazil, not including the frequent tests.
The problem is this price too is beyond the means of most AIDS patients. Yaounde's central hospital, with 500 beds, is one of two major hospitals in the capital with a population of about a million. The outside of the hospital, built in colonial French days, is attractively landscaped. But patients' relatives spend their nights sleeping on the ground here, doorless toilets are located in the corners of the wards, and medical equipment is limited. In this entire huge country, with a population of 16 million, no heart bypass surgery is ever performed, for example. Ambulances are a rare through the major economic center of Douala with a huge bag of medications balanced on their heads are called "ambulances" here. The hands of the hospital's medical director, Prof. Magloire Biwole Sida, are tied. A gastroenterologist who got his medical degree in Cameroon and did his residency in Marseilles, Sida is a large, welcoming man. He remembers fondly two ophthalmologists from Beilinson Hospital who operated there last year.
Sida's hospital only cares for about 9,000 of the city's AIDS patients, and only 2,000 of these are being treated with the cocktail, out of city with 200,000 people who are HIV-positive. With an average rate of 12 percent of its population HIV-positive, Cameroon ranks 12th out of 28 African countries in this respect. In the 19 years since the first AIDS patient was diagnosed in Cameroon, the situation has worsened steadily. In 2001 there were 530,000 AIDS patients, this year there are 560,000. The number of those dying of AIDS is going up too - 49,000 Cameroonians will die this year as against 41,000 in 2001. A whole generation of Africans is growing up without parents. In Cameroon there are already 240,000 AIDS orphans. Public relations campaigns, obvious on billboards, and cheap condoms, the equivalent of eight cents each, have had no impact. The small amount of help from abroad doesn't always reach its destination. The Cameroon daily Herald this week asked on its front page how 213 million CFA francs ($400 million) was spent on just 323 AIDS patients in Douala. Where did the money go? Money, says Prof. Sida, is actually a risk - when there is money, one can pay a prostitute. He pulls out an envelope at random from a box containing numerous test results. Envelope number 2,199. Positive. The patient doesn't know yet - a psychologist and a social worker will tell him. The wealthy world turns its face away and doesn't lift a finger. The Belgian flight attendant sprays the plane lavatory with disinfectant before takeoff, right after the doors close, hoping to leave everything behind. But a six-hour plane ride from Europe, thousands of people are dying for no reason - day after day, and only because they are Africans. Nothing can be left behind forever, even if the doors are closed and the air is well fumigated”  

This report dates 2002. The doors are no longer closing but… As AIDS undoes many African communities, Western efforts to intervene are impeded by inadequate understandings of African culture. For example, polygamy is still practiced in many parts of Africa and condom use remains taboo in some regions.  Thousands of different cultures comprise Africa and unique assemblies of beliefs constitute each village. Professor Wali F. T. Muna, in a foreword to my book noted that we are prone to generalize so as to disguise our limitations in differentiating. I believe the cultural differences in Africa confound HIV/AIDS interventions. Thus, we need a strategy that is based on the lifestyles of the indigenes to prevent and treat the disease.
I spent fours years working as the Financial and Administrative Director of a private hospital in Africa, where I wrote a guideline on patient care management strategies in Africa. Some of the recommendations that I made helped one of the world's major USA oil companies to design patient care management procedures covering employees of the Chad-Cameroon oil pipeline project.  My experiences in Africa and in healthcare systems in the United States push me to realize new ways to treat and prevent the spread of HIV/AIDS in Africa. Years of colonization by Europeans have confounded the formation of working relationships between western healthcare professionals and indigenous Africans. Memories of manipulation and exploitation deter trust. For example, during French rule in Cameroon, the country was partitioned for profit and extraction of natural resources. French rule in Africa, especially in Cameroon, was designed to assimilate indigenes so that they too would feel that they were French people. The economy was designed to serve the interest of France.  For example, it was tuned to produce raw materials, mostly cash crops, to satisfy French industries. As France successfully established administrative units in Cameroon to support their mission, why is it then difficult to convert those same administrative units to serve the indigenes in treating HIV/AIDS? Perhaps resentment impedes this conversion: if we can revive the cultures that were deconstructed by France and other western countries, rather than operating through structures which engender inveterate resentment and distrust, it might ease the indigenes’ acceptance of changes in their lifestyles. Additionally, it might be easier for healthcare professionals who come from the indigenous cultures to communicate and work with the indigenes on formulating culture-specific techniques to prevent the further spread of HIV/AIDS. These three elements must coalesce: western healthcare professionals, indigenous healthcare professionals, and the indigenes. However, resurrecting cultures is problematic. Aspects of African’s cultures have been lost through years of colonization. This confounds attempts to understand the mindsets and lifestyles of the indigenes so as to construct effective methods of preventing the spread of HIV/AIDS.  One man’s story of HIV/AIDS resonates in me: I met John after returning from the United States to work for the Government of Cameroon. John was one of those who left his village after graduation from high school for Yaounde.  Cameroon is a small country in West Africa that borders Nigeria to the west, Chad to the north, the Central African Republic to the east, and Congo and Gabon to the south. Cameroon has thousands of tiny cultures with massive migration to large cities such as Douala, the economic capital, and Yaounde, the administrative capital. For someone moving from a village into a city, it seems a whole new world. People with disparate lifestyles crowd the streets. John was an attorney’s assistant in a law firm.  He consorted with a lot of girls, many of them street girls. We talked about HIV/AIDS and he denied that the disease existed.
“It is a ploy by the Whites to have access to our resources,” he told me.  John and many others of his age had the same mentality. I realized then that HIV/AIDS information was seriously lacking at the village level.. Shortly after moving to Douala to work for a private hospital, John fell ill and came to the hospital for a consult.
“I have frequent malaria and typhoid,” he told me.  Lab results confirmed that he had malaria.  He returned to Yaounde after treatment.  Two weeks later, John came back to the hospital with typhoid and was treated again.  When he returned the next night, the treating doctor requested an HIV/AIDS test.  John reluctantly signed a consent form and soon learned that he had contracted HIV/AIDS.  John’s response was one of indirect denial. “I did not sign a consent form for the test to be done!” he raged. Incrementally, John finally realized that HIV/AIDS was real, but it was too late for him.  He was hospitalized and died a few weeks later.  Culture is a powerful communication tool and can be used to reduce the spread of HIV/AIDS in Africa. In the United States, healthcare professionals, sociologists, politicians, psychologists, philosophers and pedagogic advisors are integrating hip-hop culture into teaching techniques. Last year, a Harvard professor of philosophy, Alison Wesley, was feuding with Harvard’s president, Lawrence Summers. Wesley had started a new pedagogical approach, which incorporated hip-hop. Summers prevented the application of hip-hop, but rather than attempting to stop the inevitable, hip-hop can be used to reduce the spread of HIV/AIDS, teen pregnancy, and substance abuse. Summers argued that the composition of class demographics made it impossible to effectively apply hip-hop-teaching techniques, while Wesley knew that hip-hop, like other cultural transformations, advances opposed or unopposed. Although it seems an oxymoron, change is immutable.  Wesley resigned from Harvard, but not before arguing his position on C-SPAN. Like American hip-hop culture and its poignant possibilities for serving change, Africa’s cultures, once resuscitated, honored and comprehended, can be used to combat HIV/AIDS. Distributing packages of condoms to indigenes isn’t where the work is.  Change must begin the minds of Africans and those minds can be swayed via the cultures that connect them.

In my recently published book, “The Mysterious Virtues of Paul Abanda”, featuring an introduction by Beth Israel Deaconess Medical Center's Senior Vice President of Network Integration, Stanley Lewis, M.D., I examine how indigenous African tribal cultures influence the formulation of techniques to eradicate HIV/AIDS in Africa. By purchasing a copy, you help fund HIV/AIDS education, prevention, research, and treatment. The Funds will go to: