The Sunday News
Dr Cherifa Sururu
My family settled in Zimbabwe during the time of Federation of Rhodesia and Nyasaland.
It was normal practice that after retirement; most of our forefathers would go back to their countries of origin mainly Zambia, Mozambique and Malawi. However, most of those who made it to their countries of origin did not survive for long.
Most would die in their first few months or years of arrival. Without any convincing explanations for these “mysterious deaths” many settled for witchcraft as the cause for these premature deaths.
The belief in witchcraft was so strong that with time some of the migrant workers decided to settle in Zimbabwe fearing “attacks” in their rural homes.
Some went on to cut ties with their close relatives as it was believed that witchcraft could only work if one could trace one’s ancestry or roots. I know of a few people who in the present day keep their totems a secret because they are afraid of witchcraft attacks.
As a health care professional who works with evidence-based medicine, and after so many years of deep reflections, I decided to re-establish my connection with my roots and assess the health conditions existing in my own village of origin in Malawi.
It turned out that stories of witchcraft deaths were actually tragic deaths due to super bugs that had evolved over time due to perennial sanitation challenges (cholera, typhoid, and other diarrheal diseases), high burden of HIV/ Aids/ TB and malaria complicated by under-nutrition. There was also extreme poverty.
In primary care, we are taught to be patient centred. Patient centredness makes a patient the centre of attention. It empowers the patient to be appreciated according to the way they live and their understanding of the phenomenon of disease and illness.
We as healthcare practitioners, aspire to treat the person, not the symptoms in our effort to practice holistic medicine.
The true and full human being is therefore, the physical, social, psychological and of course the spiritual being.
Leaving any part of the person not fully addressed, results in unsatisfactory patient and healthcare encounters.
In this week’s article, I look at a peculiar case of Maxwell and try and bring out why his lifestyle and beliefs negatively impacted on his health.
At 48, all seemed to be going well for Maxwell (not his real name). He had a very well-paying job with a parastatal in the city of Bulawayo. He and his wife had a very good marriage. God had blessed them with three beautiful children.
The oldest was sixteen. He had a modest house in a middle density suburb. Like most Zimbabweans who had “made it”, he owned an ex-Japanese vehicle. He was the envy of his neighbours and members of his extended family. Maxwell had strong beliefs in witchcraft. He would consult witchdoctors as he believed his social status attracted so much jealousy and “enemies” especially from his extended family.
Maxwell, just like some patients with Non-Communicable Chronic Diseases (NCDs), had not taken his anti-hypertensive drugs properly for the past five years despite a confirmed diagnosis.
He would drink heavily over the weekends coupled with “braai” binges where he took in excessive salt. At home it was normal practice for him to add some more salt to his food as he believed his wife’s salt measure was not his ideal.
Tomato sauce was also his favourite and he made sure it was part of every month’s grocery list. He did not smoke. He was obese and came complaining of three days of a severe headache associated with right sided facial and body weakness. His speech was noted to be slurred.
His blood pressure was extremely high. Despite the slurred speech and the accompanying wife, he narrated the story of his illness on his own. There were non-verbal cues every time the wife would be asked to add to the history as if she was seeking approval to talk.
She preferred that the husband handle direct questions on his drinking behaviour.
Having worked with most ethnic tribes in Zimbabwe helped me understand that this was a “normal” way of communication that showed that the wife respected her husband.
For the healthcare provider, it seemed a straight forward consultation.
The unmanaged blood pressure had caused the stroke and a Computerised Tomography (CT) Scan had confirmed an intra-cerebral haemorrhage (bleeding) due to rupture of a blood vessel due to too much pressure caused by the extremely high blood pressure. It also seemed easy to explain that Maxwell needed urgent treatment to lower his blood pressure to avoid further worsening of his condition.
However, Maxwell indicated that he was not yet ready to take any medication for life. He thought that once he had started anti-hypertensive medications, any attempt to stop would cause complications.
This came as a shock to the healthcare provider who really needed Maxwell to start treatment immediately, given the seriousness of his health condition.
Maxwell’s reluctance to take medication indicated that he had his own explanation of his illness which was not in sync with that of the healthcare provider.
He explained that he had only come to the hospital on the advice of his sixteen-year-old son. Upon noticing the worsening health condition of the father, the child had pleaded with the father to seek medical treatment.
The son was said to have been afraid to lose his father.
Maxwell, however, strongly believed that he had been bewitched and was exploring spiritual and traditional healing help.
He had only come because he wanted the son, who understood very little about the “actual” cause of his illness, to settle while he was exploring the “true roots” of his illness.
According to Maxwell, the symptoms he was exhibiting were a clear case of “goblin” attack and all he wanted was to establish the culprit behind this jealousy motivated “attack” and the possible “instant” spiritual solution.
It seems most patients would appreciate the care they receive if they would comprehend what will be happening to them. The communication should ideally take into consideration the level of education and background of the patient. The healthcare provider has an obligation to create the communication environment that allows the patient to express themselves.
Healthcare provision should be about the patient. If the patient does not “open up”, no matter whatever care they will get, it will not meet their expectation. This starts a costly movement of the patient from one practitioner to the other in search of healing.
An agreed compromise was made with Maxwell to start treatment immediately. This was a shared treatment plan. The healthcare provider and the patient had both contributed to the treatment plan. He was told that hypertension treatment comprises of lifestyle change and drugs.
The lifestyle change involves decreasing salt intake to less than 3g per day, making sure that he intentionally loses weight towards the ideal body mass index of less than 25 and making sure that he avoids harmful alcohol intake of more than 15 pints per week. He was also told that he should not exceed 3 pints per day.
He also needed to manage his psychosocial life, so that he would spend quality time with his family instead of “drowning” himself in alcohol. He needed also to surround himself with friends and family who were going to make his recovery and maintaining his chosen lifestyle easily.
Take home messages
This article highlights the importance of raising medical literacy in the population. I will therefore talk about hypertension as a disease in forthcoming articles.
Patients should be allowed to express themselves when seeking treatment. The environment should allow truthful and empathetic communication.
It seems most of our patients seek alternative care. We therefore need collaboration by players in the health industry so that the patient does not receive mixed messages about their illness.
With collaboration, we may learn that, alternative health providers may have medical literacy and may be useful in the provision of comprehensive health services.
As healthcare providers we may have to accept that our patients will be seeking answers to their health issues.
We also need to appreciate that only honest and truthful communication that takes a patient as “whole” using the physical, social, psychological and for sure spiritual framework.
Appreciation of how these interact will help address the patient’s issues.
We need to be patient centred as we deal with an avalanche of “attractive” promises of “instant” miraculous healings from alternatives sources versus self-sacrifice, discipline based therapies we advocate.
Until we meet again, may God bless you all.
