Which Doctor?

The title ‘Doctor’ implies expert knowledge in medicine. I use the term imply because not all persons acknowledged as doctors are experts in medicine. I am not for a moment thinking of all those persons awarded graduate degrees. These are far removed from the reality of my focus. In the village dispensary anyone in uniform is politely referred to as ‘Doctor’. She could be a nurse or cleaner but the fact she works in hospital qualifies her to be a doctor. In the village proper, the cleaner with a medicine chest is revered and given all the honours of due to a Bachelor of Medicine and Surgery. In times of distress he is often the first point of call.

Actually I am not even interested in the health worker. Naturally these will be knowledgeable in matters medicine even if merely by association as is the case of the cleaner. In a community where more than half the adults never completed Grade Eight, even the hospital cleaner has more knowledge on medicine than a host of his fellow illiterates. However, his opinion is often overshadowed by that of the ‘witchdoctor’. Actually, the term ‘witchdoctor ’is a gross misrepresentation. In Kiswahili the word for doctor is ‘Mganga’.  However to distinguish between the medical doctor and the traditional healer a new term entered the language. The medical doctor is referred to by a corruption of his English title. He becomes ‘Daktari’.

The clever 'witchdoctor'will hide behind traditional symbols to advance his career

The term ‘mganga’; refers to traditional healers of different stripes. These include the exorcist who casts away evil spirits or the ‘witchdoctor’, the herbalist using roots and herbs and the seer who can prophesy. Depending on the ailment, the villager will choose the right ‘mganga’. Ordinarily, the choice will be made on the strength of referrals by trusted friends and relatives. The genuine healers will have their knowledge handed down through generations. However, there are many who claim to be possessed by the spirit of healing. These just get the knowledge from ‘nowhere’. Many of the latter will become witchdoctors or seers casting away spirits. These are the easier of the disciplines. You can always conjure up a story to suit the circumstance.

There is the other type of healer usually not defined as a doctor. This is the faith healer- or more appropriately evangelical healer- popularized by the evangelical churches. Anointed by the ‘Holy Spirit’ these healers not only exorcise demons but also claim powers to heal incurable conditions like diabetes, cancer or even HIV/Aids. Originally, they operated along the charitable lines of the church but increasingly appear motivated by the ‘thanksgiving ‘of the potential patient. There will be an envelope of cash stashed with the equivalent of a believer’s thankfulness to the Lord for the healing they will surely receive.

They too, just like the witchdoctor, apply oil and healing touches. The difference is; they call on the angels and biblical prophets to purge the ill of sickness. Of particular interest is their claim to heal by ‘might of their own faith’ and not merely that of the patient. Their knowledge of the spirit world often rivals or even surpasses that of the ‘witchdoctor’. They can be quite as dramatic as the witchdoctor. The Kiswahili saying summarises the witchdoctor’s theatrics this way- Ganga ganga za mganga ni nafuu kwa muwele, ni muwele kupona (A witchdoctor’s theatrics are relief to the patient, they are the patient’s healing). That they are a relatively new entrant in the healing of tropical diseases is usually made up for by a litany of scriptures and fire-spitting theatrics. The evangelical healer wears a veneer of respectability by fact of his better grooming and schooling but that is all.

If you asked me, I will say of the evangelical healer (notice I do not refer to him as a faith healer) - they too are witchdoctors. Period

The traditional birth attendant will also know a thing or two on medicine. In particular, they are conversant with childhood conditions. However, they are not referred to as ‘doctors’. They are just knowledgeable in those matters and are highly revered. The old Kiswahili adage states, ‘Msitukane wakunga hali uzazi ungalipo’.  That is, ‘Do not abuse the midwives while women still give birth’. The implication is we are at the mercy of the midwives.

Which doctor? The poor villager, short of knowledge and money is often at the mercy of all these ‘doctors’. Her first point of call is where her money can reach. Since hospitals never give credit to the poor, it is possible she will stop at witchdoctor’s first. If there is a ‘health worker’ hawking medicines she might consider him first. The ‘he’and ‘she’is deliberate here. For the most part those working in hospitals in our corner of the world are male. This presents problems for women attending ante natal clinics or during childbirth. Only a few rural women are comfortable with male midwives for that sacred moment of childbirth. Instead, they will opt for the unsafe attention of the traditional midwife.

If, as is wont to happen, the local health facility lacks equipment to detect or treat a condition she will rush back to the traditional healer. There are rarely any funds for medical treatment in the village. The health insurance system is the family and the  network of local healers or 'doctors' who can accept to treat the poor on credit. Otherwise it is the evangelical healer who will settle for a brown envelope who is called.

The austere and patronizing system that is our public health system is often too intimidating for the poor. For one, the poor are almost always to blame for their illness. They have to endure stern lectures to get the right medicine. If a child misses a milestone it is the mother to blame. Fathers, who cannot endure such humiliation, will leave it to the mother to trek to the hospital. The pay-per-service system where there is a separate charge for each test only made matters worse. So the hospital could be right next but the sick go past in search of cure from a bush doctor.

Which doctor? The compassionate doctor…..