As championed by the United Nations and other NGOs, the international commitment to providing ‘health for all’, universal basic schooling and adequate shelter has long been contradicted by a development approach based upon a market fundamentalism that subordinates human welfare to corporate profits – necessitating an enormous shift in global priorities.
On a not too distant horizon, advances in human biotechnology may enable us to engineer the specific genetic makeup of our children. Only a few months ago, the headlinemaking Italian doctor Severino Antinori claimed to have implanted cloned embryos in several women. We are already at the stage where we can selectively terminate our offspring if certain genetic criteria are not met. Soon it may be possible to discern, and ultimately select for or against, individual traits in our children.
It is widely recognized that diarrheal diseases of infancy and childhood are a leading cause of death in less developed countries. It has also become increasingly recognized that the ultimate control of diarrheal disease depends on a comprehensive understanding of local beliefs and practices that relate positively or negatively to its transmission. Noting the importance of the mother in childhood diarrhea, the World Health Organization recently observed, "There is an urgent need to understand her present attitudes, perceptions, and practices regarding diarrhea as well as those of other community workers." Yet too often mere lip service is paid to cultural factors while actual research funds are allocated to engineering, epidemiology, biomedical research, economics, and other more conventional areas of disease control.
Collaborative health programs involving traditional healers have been advocated by WHO and UNICEF since 1977-8. Pilot collaborative programs that focus on primary health care have been started in Nigeria (1-3), Zambia (4), Ghana (5), Swaziland (6,7), Kenya (8,9), Botswana (10); and Uganda (11), among others. Due to a variety of constraints including opposition to such programs from biomedical interests (12,13), these programs have usually not been replicated on a national scale. Some have faltered or been discontinued. However, in the last few years there has been a rekindling of interest in traditional healers on the part of African governments and donor organizations concerned with HIV/AIDS prevention. Collaborative AIDS programs have already begun in Swaziland (14), Zambia (15), Zimbabwe (16), Mozambique (17), South Africa (18) and no doubt elsewhere.
Bongaarts and his colleagues found a positive statistical correlation between lack of male circumcision and HIV sero-prevalence in the capitals of 37 Africa countries (Bongaarts et al 1989:373-5). Although most geographically localized studies of risk factors have not considered circumcision, a few have and have also discovered positive associations between HIV infection and lack of male circumcision (e.g., Greenblatt et al 1988). It is not known what the causal connection is between these factors but Barton (1989:13) notes that "post-coital abrasions in the foreskin is common in uncircumcised males."
In 1977 the World Health Assembly of the World Health Organization passed a resolution promoting the development of training and research related to traditional medicine. The following year in Alma Ata, WHO and UNICEF issued additional resolutions supporting the use of indigenous health practitioners in government-sponsored health programs. Such programs were initially directed at traditional birth attendants (TBAs) as distinct from traditional healers. The first well-documented collaborative program involving traditional healers in Africa predated the resolutions (having started in 1954) and focused on psychiatric care (1). More recent programs have focused on primary health care, especially on the "appropriate health technologies" of child survival such as oral rehydration therapy (2). Others have been restricted to screening and referral of patients to government clinics (MacCormack 1986:157). However, official, national-level collaborative programs of any sort are still rare in Africa.
As part of an initial phase of a pilot program to develop collaboration between indigenous healers and government health workers, qualitative research was conducted with traditional healers in Manica Province, Mozambique. The purpose of the research was to establish a knowledge base to develop a culturally-appropriate strategy for inter-sectoral communication related to the prevention of infant and child diarrheas. Dehydration as such was not understood, however the outstanding symptom of depressed fontanelle was recognized as a serious condition not necessarily related to diarrhea. Diarrhea and dehydration were nevertheless found to be linked through the concept of nyoka. Nyoka is believed to be a Guardian of Bodily Purity that dwells within all people. When impurities or contaminants enter a body, the nyoka reacts with cramps, diarrhea and a downward "pull" of a child's fontanelle, among other symptoms interpreted as the nyoka's attempts to purify the body through the expulsion of impurities. Nyoka appears to be a symbolic expression of the need to respect the human body. It is a complex concept that bears resemblance to biomedical concept of the immune system. It is linked with fundamental ideas about health and illness that find expression in notions of pollution or contamination that are found elsewhere in Africa