by David Lamb
The eighteen-year-old girl who now sat at Satigi’s feet was barren and gripped by constant stomach cramps. Her father stood behind her and explained that the girl’s husband had had her cursed because she had borne him no children. Beetles, he said, now filled her stomach. Satigi listened carefully, questioning the girl about the guilt she felt.
He had the bare-breasted girl put on a white blouse and expose her stomach. She squatted on an upturned urn and watched calmly as Satigi sharpened a small knife on a whetstone. The father pulled a fold of flesh from the girl’s stomach. Satigi made a small incision in it, then cut his own right thigh, just enough to draw blood. He mixed the blood with hers, spat on the wounds, rubbed ashes on her stomach, waved a rhinoceros horn over her head and between her legs, closed his eyes and recited a prayer, and had her walk twice over his toes. “In two days she will be well and will bear her husband many children,” he said, rising and clapping his hands together. The girl stood. She smiled. The cramps, she said, were gone.
During the colonial era the European administrators condemned these centuries-old beliefs and practices as pagan quackery. Traditional medical techniques were banned and traditional therapists were driven underground, although each was—and often still is—the most influential figure after the chief in his village. Many countries today still prohibit the casting of evil spells. In Kenya not long ago, two men went to jail for killing chickens in an attempt to put a hex on an opposing soccer team, and it is common for a candidate seeking office to have a spell cast on his opponent. But at least nineteen African countries have established institutes of traditional medicine for research and treatment. They are not involved with sorcery or quackery, and their techniques are respectably scientific.
“Remember, the African was being treated for his sickness long, long before any European doctor ever set foot on the continent,” said Dr. Adama Kone, the director of Mali’s Institute of Traditional Medicine, which was cleaner and more modern than most hospitals I saw in Africa. “Only fifteen percent of the people in Mali have access to modern health care. The others have to rely entirely on traditional practitioners. In some cases, as with hepatitis, their cures are faster and better than anything offered by modern medicine.”
For hepatitis, the seven-day cure involves grinding the living layer of bark from a gardenia micranthum tree into a fine yellow powder. The first day the patient takes five grams of the powder, which has been mixed with one-quarter liter of fresh milk and allowed to stand for twelve hours. On each of the following six days he takes five grams mixed with water that has stood for thirty minutes.
The leaf of the same tree is used as a laxative, and its chopped root is used to treat diabetes. Asthma is treated with the carbonized nutlike fruit of the tree.
Traditional medicine does not ignore the organic and physical aspects of disease, although its approach stresses social and psychological factors as well. Satigi, for instance, started each diagnosis by taking the patient’s history: Have there been financial or marital problems that would cause stress or other conditions? Have there been hostilities in relations with others? Has an evil spirit intervened? Have there been strains on the family as a unit?
Satigi rose from his mattress. “Now I must sleep,” he said. “I am growing old, but there are so many who want to see me that there is not much time for sleep. You go now and when you write your story, do not write that I carry the forces of evil. It is I who confront the evil with my powers of good.
“Now go. Allah will protect you and love you. Your spirit will never be broken or cut. Your name is good as mother’s milk.”
He bowed and disappeared into a little cubicle off his consulting room to find rest at last. Four days later he died in his sleep.
In colonial times traditional healers like Satigi were often jailed by the authorities. They were considered part of the primitive unchristian past which Europeans thought Africa needed to bury in order to take its place in the modern world. But there has been a dramatic shift in such thinking in recent years, and today the World Health Organization is trying to revolutionize the way health needs are handled in Africa and other parts of the Third World. The organization now defines health as “a complete state of physical, mental and social well-being and not merely the absence of disease and infirmity.” To achieve this, Africa’s primary emphasis must be on primary health care. Clean drinking water, improved sanitation, better birth-control programs, a balanced diet and increased food supplies are more important for Africa today than more drugs and doctors. Medical facilities such as the open-heart surgery unit built in Nairobi in the late 1970s can wait for another decade. Africa can no longer afford to concentrate all its medical services in the cities while ignoring the huge majority of people who live in the country.
As part of this realization, WHO now endorses the integration of traditional and modern medicine and recommends increased research into herbal as well as magical-religious cures attributed to thousands of practitioners such as Satigi. There is, the organization says, “an absolute need to establish national associations of traditional healers recognized by the authorities, members of which … would gradually come to lealize their strength.”
The health problem, like so many others in Africa, is one of education. Even if Africa can shift its medical emphasis from the cities to the villages, even if it can train the medical assistants willing to work in the rural areas, even if traditional and modern medicine can be integrated, it still will not be easy to convince an African mother that her children should not drink with the cattle from the same polluted waterhole or that dogs and humans should not share the same plate. After all, she will tell you, that’s what her parents did and they lived to be forty or forty-five years old, so what can be wrong with the practices? But until public health becomes the concern of every village, the general standards of health will remain abysmal. Every developed country, including the United States, had to make this same transition.
In 1981, members of WHO meeting in Geneva voted 118-1 to restrict marketing practices of the $2 billion-a-year international baby-formula industry.* WHO estimated that the formula caused as many as ten million serious cases of malnutrition or diarrhea each year in the Third World, and one million deaths. Almost overlooked in the debate was the fact that there is nothing harmful about the formula itself; the danger occurs because illiterate mothers cannot read the instructions for preparing the formula and mix the powder with polluted water in unsterilized bottles.
But the Third World’s suspicion that Western food and drug companies don’t care how their products are used abroad is easy to understand. Foreign drug companies, in fact, have discovered a bonanza in black Africa, which they have turned into a dumping ground for their pills by capitalizing on the absence of consumer-protection laws and of regulations against false advertising.
In movie theaters and on billboards across the continent, Africans are bombarded with messages that various drugs can restore youthful vigor, sexual potency, even mental alertness. Most of the advertisements are outright lies—they never could be published in the United States in the first place—yet Africans in huge numbers turn to these “miracle drugs” to cure everything from ankle sprains to polio. The practice is reminiscent of the quick-tongued salesmen who used to travel the Western frontier a century ago, peddling their cure-all potions from the back of horse-drawn carts; the results, though, are far more lethal in Africa than they ever were in Montana or Wyoming.
The most damning study I found on the role of drug companies in Africa was in a recent report published by Dr. John Yudkin of the London Hospital Medical College. His study dealt with the purchase, use and promotion of drugs in Tanzania, a country where there are 147 drug-company representatives (most of them Tanzanians working for firms with ties abroad) and only 600 doctors. The report said, in part:
Aminopyrine and Ipyrone are analgesics [pain relievers] which may produce agranulocytosis—where, due to an allergenic reaction, the marrow stops producing
white cells—with a mortality rate of about 1 in 200. In Britain and America these drugs have been virtually withdrawn from the market.
They are licensed for use (in the West) only in patients with terminal malignant disease in whom safer fever-relieving drugs have been unsuccessful. In the African Monthly Index Medical Specialities [MIMS, a handbook published by the drug industry] thirty-one preparations containing these drugs are recommended as analgesics for minor conditions.
Anabolic steroids may produce stunting of growth, irreversible virilization—changes of external genitalia and hair growth—in girls, and liver tumors. They are used in Britain to treat renal failure, terminal malignant disease and aplastic anemia. They are not recommended for use by children before puberty. In African MIMS, however, they are promoted as treatment for malnutrition, weight loss, exhaustion, “excessive fatigability” in schoolchildren, and as appetite stimulants.
Methadone is included in African MIMS as a cough repressant.
The West has poured billions of dollars into Africa in the past twenty years, attempting to elevate living standards. Most of the money has been wasted and many of the projects have been counterproductive. First, Africa cannot possibly afford the Western-style medical technology that has been forced on it by foreign governments and private donor agencies. (The health budgets of most African countries range from $1 to $10 per person; the United States spends about $800 per person.) Second, many of the development projects actually have lowered health standards instead of increasing them. For example, irrigation schemes and dams are intended to improve food production, but what they usually end up increasing is snail fever, the parasitic disease that drains the energy of 200 million people in the Third World.
Fortunately almost everyone now agrees that Africa must get back to basics in health care. Efforts to make Africa economically stable will fail until attempts to make Africa tolerably healthy succeed. There is no middle ground. In many ways the problem is more educational than medical and its genesis is at the lowest grass-roots level. Increasingly Africa itself recognizes this and is taking steps to change the emphasis of health care.
Nigeria plans to build 285 rural health clinics and has boosted its national health expenditures over a five-year period from $350 million to $2 billion. Mozambique inoculated more than half of its 10 million people against cholera and smallpox in one impressive nine-month campaign. Liberia has installed clean, piped water in six of its cities and now has ten hospitals and 220 clinics operating through the Ohio-sized country. In Kenya alone, more than 700 young Africans are studying medicine at the university level.
But Africa cannot do the job alone. The foreign powers which enslaved Africa, which colonized it and sent countries such as Chad and Guinea-Bissau reeling into independence without a single indigenous doctor, which exploit its minerals today and supply guns for its wars—all of them have a moral obligation to provide the personnel and monetary assistance the continent needs to escape the bondage of medieval health conditions. I remember touring a hospital in rural Zaire one day. Two and three patients shared the same bed. There was no air conditioning and most lay perspiring heavily, too weak to brush away the buzzing flies. Entire families camped around the bed of their sickly relatives. What, I thought, if the West never built another airport for an African government, never bought another gun, never underwrote another foolish project to pad the personal coffers of some soldier-president? What if the West—and even the East—concentrated instead on waging war on the conditions that cripple the bodies and spirits of Africa. A naively idealistic thought perhaps, but how exciting the results could be!
* The United States cast the lone dissenting vote, contending that WHO should not act as an international Federal Trade Commission. Lobbyists for the baby-food industry pointed out that the formula was better for babies than the homemade concoctions many Third World mothers brew: paps, gruels, sugar water or herbal teas.
SYLIS AND CEDIS
If we are to remain free, if we are to enjoy the full benefits of Africa’s enormous wealth, we must unite to plan for the full exploitation of our human and material resources, in the interest of all our people.
—KWAME NKRUMAIJ,
president of Ghana (1957–1966)
THE CHARTERED CARGO JET from London arrived in the dead of night, taxiing past the deserted passenger terminal and whining to a stop at the far end of Ghana’s Kotoka International Airport. A platoon of heavily armed soldiers moved quickly to take up their positions around the Boeing 707. Within seconds, word of the plane’s arrival was flashed to a command post in nearby Accra, the capital, and the government broadcast an urgent message over the state radio station: the airport, all seaports and the international borders were closed until further notice.
Was this another coup d’état? Was the head of state returning from some secret mission or an unannounced vacation at his European estate? Not at all. In this hush-hush operation in 1979, Ghana was changing money, not governments. Its currency—the cedi—had been battered beyond value and would in the days ahead be banned, bundled and burned. In the plane was $690 million worth of new, redesigned cedis to replace the old money.
The Ghanaian cedi is among the frailest of Africa’s currencies, but it has lots of company in the financial sick bay. From the birr of Ethiopia to the kwanza of Angola, currencies in black Africa are under siege, the victims of inflation, mismanagement, rising import costs and unsteady export prices. Most are as worthless as yesterday’s newspaper and are neither accepted in neighboring countries nor exchanged for convertible currency at any foreign bank in the world. Just imagine that the dollars you used in California were useless in Nevada, New York and Washington, D.C., and converting California dollars to, say, Nevada dollars was a process that required several levels of governmental approval. You probably would not trade with Nevada, you would not travel to Nevada, you might not even communicate with Nevada. That is precisely what has happened in Africa where Monopoly-money currencies isolate countries economically and socially as surely as a border strewn with land mines.
Africa’s general response to the weakening of its overvalued currencies has been to print more money. Nigeria increased its money supply between 1975 and 1977 by 180 percent. Ghana increased its supply 80 percent in 1976 alone and in one fourteen-year period (1965–1979) devalued its cedi seven times. And when the Ugandan finance minister told President Idi Amin that his treasury was out of money, Amin replied, “Well, print more.”
With more money suddenly chasing fewer available goods, the annual inflation rate soars—it is regularly over 100 percent in countries such as Zaire and Uganda—and a dizzying rise in the cost of living destroys any sensible relationship between wages and prices; the poor became even poorer. The price of food in Ghana increased twenty-three-fold between 1963 and 1977, and in 1981 a single car tire cost the equivalent of $360, a tube of toothpaste $6.50. In Zaire a copy of Time magazine sells for $10, a loaf of bread for $2. In Zambia a laborer must spend seven days’ wages to buy a crude cooking pot. Ghanaian laborers earn an average of $1.50 a day, but according to one Western study, it costs them $11 to buy a decent meal for a family of four.
“How do people survive?” asks Yaw Saffu, a University of Ghana professor, who served me a glass of water in his home, apologizing that he could not afford coffee. “With difficulty. They cut back to one meal a day. They get a second job. Their children get milk less often. They go to the countryside on weekends and pick bananas. Some go back to a barter economy. They buy nothing but absolute essentials in the stores.
“Of course, there’s almost nothing available in the stores, anyway. And when something does show up—say a luxury, like a can of dried fish—it’s so expensive you can’t afford it. These cedis in my pocket don’t mean anything, because they can’t buy anything.”
One survival technique is a lack of wastefulness; the African puts everything to use. Discarded wax-coated milk containers make far better starters for a charcoal fire than the fl
uids American supermarkets sell for $2 a can. Plastic sandwich bags brought to Africa by expatriates are washed over and over and seem to last forever. Old rubber tires are turned into sandals. Empty whiskey bottles are sold for a penny and filled with kerosene. Newspapers are recycled. Clothes are stitched again and again. Kitchen sponges are used until they disintegrate. Tin cans become patches for car fenders. Human waste is collected to fertilize the garden. Cardboard boxes become the walls of shanty homes. In many countries you cannot buy a beer to take out of a grocery store unless you first turn in an empty bottle.
The strength of any currency, in the developed or underdeveloped world, is dependent on the power of the local economy to produce goods and services. Thus South Africa’s rand remains strong because that country’s economy is bullish. And Liberia has a built-in cushion because it uses U.S. paper notes as its official currency. But in most African countries, production is declining at the same time that the money supply is increasing, and in twenty of them, according to the World Bank, the per capita income actually decreased during the decade of the 1970s. So with nothing to back the face value of its currencies—such as gold reserves, an accepted international currency, or the ability to produce goods and services—Africa’s money has no more buying power than a barrel of penny postage stamps. When Pan American World Airways ended its service to Zaire in 1978, it had $3 million in local currency in its Zairian bank accounts. Pan Am could no nothing with the money other than pay a few bills in Kinshasa.
At independence, most African countries inherited a monetary system based on the English pound, the French franc, the Portuguese escudo or the Belgain franc. Nationalistic pride, however, got in the way of financial practicalities, and one country after another cut itself adrift from the backing of European currencies and began turning out a mind-boggling array of nonconvertible local currencies: the pula in Botswana, the dalasi in Gambia, the ekuele in Equatorial Guinea, the lilangeni in Swaziland, the naira in Nigeria, the ouguiya in Mauritania, the zaire in Zaire. If nothing else, the new presidents got a chance to put their picture on a paper bill, but most were overthrown before long and the notes had to be redesigned with a portrait of some other head of state.
