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The numbers are staggering. Despite notable progress, sub-Saharan Africa continues to record the highest infant, maternal and neonatal mortality rates in the world. One in eight children dies before the age of 5, twenty times more than the average in developed regions, according to the UN. They are carried away by malnutrition, respiratory infections or even malaria. The danger also hovers over mothers. 57% of maternal deaths worldwide occur on the continent. In 2017, 295,000 women died during pregnancy or childbirth, particularly in Mali, Niger and Mauritania.
While African states committed in 2001 to devote 15% of their budget to health, twenty years later, none of them has achieved this objective. But, if the chronic underinvestment in the health sector largely explains this mortality, certain social behaviors also play a role according to the French anthropologist Yannick Jaffré. The director of research emeritus at the CNRS thus points to the danger represented by so-called traditional medicines. He sees a “political instrumentalization” which weighs on the chances of survival of mothers and children.
Faced with the lack of trained nursing staff, medical structures or quite simply resources, patients and their families generally turn to so-called traditional alternative medicine. Why do you consider these practices dangerous for mothers and children in particular?
In severe cases, they waste valuable time while being ineffective. Have we ever seen a traditional healer cure a child with cancer? A midwife saving a woman victim of a hemorrhage of the deliverance?
The methods employed by the phytotherapist, the imam, the pastor, the diviner do not constitute medicine. These are popular healing practices. They are not subject to a body of observation, criticism or scientific experimentation. Traditional healers certainly have their little recipes, but they are nothing ancestral. Today’s tradition is not yesterday’s. Thirty years ago, some of them claimed to be able to treat HIV with traditional remedies developed fifteen days before!
Not to mention that this “care” is expensive. Parents of a child with a cough due to tuberculosis go to the hospital only after exhausting their resources with a healer. When the doctor asks them to buy medicine, they have no more money. This will weigh on the child’s chances of survival.
However, these alternative practices are financially supported by the World Health Organization (WHO) through programs, research institutes and an African day of traditional medicine. Why do you think this is a “ideological vision” ?
The WHO relies on these practices for lack of conventional alternatives. This vision is reinforced by the political instrumentalization of traditional medicine. During the Covid crisis, in Mali, the leaders claimed the existence of local remedies, in opposition to conventional drugs from abroad. The speech was: “We have our own healers and treatments, let’s go with that. » It was a junk political claim without scientific content. The results were also not conclusive. In Madagascar, where a herbal remedy has been produced, people have suffered the dramatic consequences of Covid. But some countries, such as Benin, have opposed these local treatments.
This is the challenge led by my colleagues on the continent: they are asking that Africans also have access to hospitals. Like everywhere in the world. Why, in the name of so-called local particularities, promoted by the WHO, should they be satisfied with this pseudo-medicine which can lead to tragedies?
According to the UN, 60% of deaths before the age of 5 occur in the first year of life. How practices “traditional” do they fit into the lives of young children?
It is a cohabitation that begins at birth. In several countries in West Africa, once out of the mother’s womb, the baby is placed on a mattress for ten minutes, while the midwife takes care of the parturient. He is naked, exposed to the draft and this is a first risk for his health.
Then, if the child refuses the first feedings, it is customary to let him come back later, when he wishes. Its nutrition is therefore neglected. In representations, a baby is already endowed with decision-making autonomy at birth. Moreover, in the past, when a child died at birth, it was said that he had decided to join his playmates in the afterlife. The following days, to protect him from the evil eye, the infant is bathed in decoctions which he will then swallow. This is another infectious risk.
Older, the child may be faced with dehydration. This pathology which is noticed by a subsidence of the fontanel is called “gounandjigui” in Bambara, which means “the collapsing fontanel”. It is a disease in its own right for the populations. However, the first reflex is often to go to the healer who will spread an ointment on the sagging part. If it persists, the parents will go to the hospital. If the child dies, we will deduce that it was not a disease of White and that the hospital could not treat him. However, without these long courses of care, the child could undoubtedly have been saved.
What about mothers? Apart from the structural causes linked to the lack of infrastructure and resources, what are the other reasons that explain this high exposure to death?
They follow the rule of ” too “. Too high fertility, too many children, too early, too late, too close together. They also die in childbirth following haemorrhage, eclampsia (convulsive seizures), but also because they are not treated in the same way according to their status.
During work in five African capitals, I spent three months in delivery rooms observing how they died. They are too often subjected to violence there. We can see two or three midwives reassuring a parturient in full labor. And, next door, women give birth in the greatest solitude, sometimes to a stillborn child. The rule in the African public hospital is that of relative equity, from which caregivers also suffer: everything is done for some and nothing for others.
To be properly accompanied in a maternity ward, the woman must be someone before D-Day. Prenatal consultations are used to build a bond with the midwives. During these sessions, future mothers offer them 20,000 to 30,000 CFA francs. [30 à 45 euros] to establish a fictional relationship and begin to call them “aunties”. This guarantees them a privatized delivery in a public structure.
The anonymous woman, without money, who arrives without a big boubou, the one who is not the wife of a high official, is often hospitalized in emergency. She will be neglected. This is where all the drifts happen. I saw midwives arguing, hitting women. To justify themselves, they explain “that women must push without complaining because pain makes them women in their own right”.
This violence undeniably contributes to maternal mortality. I remember the case of a woman who had to undergo a caesarean section. As the guard who held the keys to the room where the oxygen bottles were located was at a baptism, the woman could not be re-oxygenated. She narrowly escaped, but not her child. Also, in the event of haemorrhage from delivery due to a lack of blood available in the maternity ward, the husband must have his blood sampled. By the time he goes to a collection service and comes back, it’s often already too late.
In your work, you point out the linguistic gap between caregivers and patients. Why is this an additional risk factor for patients already weakened by the failures of health systems?
In Africa, despite mass schooling, 50 to 60% of the population are illiterate. Added to this picture is the importance of national languages in daily life. However, health professionals are trained in French or English. The medical corpus, the pathologies are not translated into African languages. Once in consultation, communication with patients, whose language they do not always speak, is complicated.
This encourages people to turn to drugs sold individually in the street, which are cheaper than in pharmacies. There is also this immediate complicity that is tied with the itinerant salesman who speaks the language and understands the representation of the pathology. Moreover, on certain boxes of illicit drugs, an illustration will demonstrate the healing power of the product. In Mali, painkillers “leave the stick”, depicts a man walking with a hunched back with a cane. After taking the medicine, he straightens up and walks on his own. The evocative force is absolute for the buyer. He thus avoids the dispensary where the doctor, not very understanding, will give him a prescription written in a foreign language. It is also this landscape that constructs infant mortality.