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Introduction

Nowadays, technological progress is so obvious that it is hard to imagine a place on Earth where its achievements are rejected. The scientific knowledge in medicine is critical to the diagnosis and treatment of a patient’s disorder that, in turn, will maintain wellness. Nevertheless, all world nations have certain beliefs and behaviors related to the health care system that may diverge from the generally excepted standards. In this paper, the variety of traditional African cultural practices related to the health care system shall be discussed. Specifically, it focuses on the role of cultural practices and their effects on human health, specifically the human immunodeficiency virus (HIV) responses. The purpose of this paper is to examine African cultural views of health, illness, and healers, as well as attitudes toward traditional medical practices amongst African countries. In this respect, it is crucial to investigate harmful traditional practices affecting people’s health and increasing the risk of getting HIV infection. The paper refers to different cultural practices characteristic of peoples of Africa, specifically cleansing rituals, dry sex, removal of the external female genitalia, and male circumcision. Although particular customs are aimed at saving the culture within a community and transfer it to the next generations, all the above-mentioned traditions are a threat to the population. Therefore, while Africans value their culture and customs, certain traditional African cultural practices can be regarded as harmful rituals affecting human health.

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African Cultural Views on Health, Illness, and Healers

The population of African counties has its specific understanding of health and illness, as well as symptoms and treatment of the disorder. This cultural peculiarity has vital implications for medical professionals because customs and beliefs have an essential role in the establishment of attitudes concerning the health care system. In this respect, religion is of crucial importance to peoples of Africa (Eiser & Ellis, 2007: 177). For example, the African populace may be likely to attribute the disorder to destiny or the will of God and, in turn, refer to the healing power of prayer. Therefore, the holistic approach to medicine and the health care system prevails over Western treatment, emphasizing the importance of African social and cultural history (Hyder & Morrow, 2012: 66).

Religion is a source of great spiritual and emotional support for peoples of Africa. In many cases, religious beliefs and customs have a direct relation to health outcomes. The particular phenomenon can be explained by the two historical events that supported the establishment of this cultural tradition. These events include slavery and the civil rights movement, specifically, the crucial role has been played by Christian churches in the African communities (Eiser & Ellis, 2007: 177). In this regard, the church was considered the source of deliverance from sin as well as salvation for both body and soul because usually there were no medical institutions available. Although Christianity together with Islam became major religions in African countries, traditional cultural beliefs and practices related to religion and health care coexist with the two above mentioned faiths (Vaughn & Baker, 2009: 65). Therefore, half or more of the population respect sacrifices to ancestors and spirits and believes that without them they will not be protected from harm (The Pew Forum on Religion & Public Life, 2010: 33).

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According to surveys:

Roughly a quarter or more of the population in 11 countries say they believe in the protective power of juju (charms or amulets), shrines, and other sacred objects. Belief in the power of such objects is highest in Senegal (75%) and lowest in Rwanda (5%) (The Pew Forum on Religion & Public Life, 2010: 33).

Thereby, African peoples believe in sacrifices to ancestors, witchcraft, traditional religious healers, and angered spirits, yet they are also members of Christianity or Islam.

At the same time, people of the African religion believe that there is a supernatural basis for serious illness. According to Ojua & Omono (2012), African peoples think that an angered spirit of ancestors can evoke illness to punish the patient for his or her wrongdoings (as cited in Ojua, Ishor, & Ndom, 2013: 177). People believe that when they upset their ancestors, they promote disruption of the order. As a result, poor deeds produce disharmony and support the development of illnesses (Ojua, Ishor, & Ndom, 2013: 177). According to African religious beliefs and customs, people live in a tight relationship with the gods and spirits. This relationship is attributed to the vital forces of every living being. When a person exists in complete harmony with himself or herself and the environment, he or she remains in a state of health. However, a person’s bad behavior or poor deeds may interrupt this harmony and force the anger of spirits (Hyder & Morrow, 2012: 69). African peoples believe in sacrificial offerings to the spirits of ancestors, specifically their protective power. According to The Pew Forum on Religion & Public Life, “upwards of one-in-five people in every country say they believe in the evil eye, or the ability of certain people to cast malevolent curses or spells” (The Pew Forum on Religion & Public Life, 2010: 33). The particular surveys were conducted in the Democratic Republic of the Congo, Cameroon, Senegal, Tanzania, and Mali where most citizens supported this belief. Additionally, disorders and illnesses are usually interpreted as a spiritual force guided by sorcerers, wizards, angered ancestors, or evil spirits (Vaughn & Baker, 2009: 65). African populace thinks that patients do not suffer from diseases by chance. According to the standpoint of African people, a serious illness is considered a result of a primary supernatural cause, whereas viruses or bacteria are regarded as secondary causes of disorder (Ojua, Ishor, & Ndom, 2013: 178). A particular belief is characteristic of people who practice the traditional African religion.

Moreover, the influence of African religious beliefs and cultural traditions is also evident in people’s choices of treatment. Therefore, “in 14 of the 19 countries surveyed, more than three-in-ten people say they sometimes consult traditional healers when someone in their household is sick. This includes five countries: Cameroon, Chad, Guinea Bissau, Mali and Senegal” (The Pew Forum on Religion & Public Life, 2010: 33). At the same time, the choice of African citizens can be explained not only by cultural beliefs and traditions but also by economic reasons as well as the absence of necessary health care institutions. Referring to traditional healers, the African populace believes in the efficacy of this approach. According to traditional African religious beliefs, diviners and healers are regarded as health care specialists aimed at distinguishing between infractions that cause misfortune and illness (Vaughn & Baker, 2009: 65). Healers also prescribe appropriate traditional medicines or conduct specific rituals in order to heal the patient from evil spirits (The Pew Forum on Religion & Public Life, 2010: 6). Furthermore, while African traditions are disposed to personify evil, people usually blame witches for their illnesses and weakening of their life force. In this respect, African citizens seek to protect themselves with traditional rituals or sacred objects (Vaughn & Baker, 2009: 66). What is more interesting, African slaves carried particular religious beliefs and traditional customs to the Americas, specifically Haiti and Cuba, where they transformed into religions known as Voodoo and Santeria, respectfully (The Pew Forum on Religion & Public Life, 2010: 6).

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The Role of Traditional Medical Practices Amongst African Countries

While traditional African cultural practices and beliefs prevail in most African countries, the populace is more hostile to Western medicine. Moreover, the latter is usually expensive, and thus Africans are forced to refer to their traditions and customs. Yet, modern Western medicine has a lot in common with ancient traditions of healing, and some of these customs are still widely used in contemporary medical practices. For example, phytotherapy can be regarded as a variant of traditional medicines (Truter, 2007: 57). Fundamentally, the African population believes in the efficacy of traditional African medicine and the power of traditional healers associating them with the herbs and rituals. Shizha & Charema state that “in Malawi, Lesotho, South Africa, Swaziland, Zimbabwe, and Zambia most people associate traditional medicine with the herbs, remedies (Mishonga), and advice imparted by Sangomas or Inyangas, and with strong spiritual components” (Shizha & Charema, 2011: 168). At the same time, traditional African medicine bases on a belief in the relation between the spiritual and physical health of a person. In fact, traditional healers refer to a holistic approach concerning health care and treatment of an illness. Consequently, the healer treats the physical, psychological, and spiritual manifestations of a disorder. In this respect, healers do not divide a person’s natural form from physical or spiritual (Truter, 2007: 57). Therefore, traditional healers possess great power in Africa as well as are the main health manpower resource for the country.

In many African countries, specifically those which are situated in the southern part of the continent, indigenous healing practices and healers are a major source of health services for most citizens in rural areas (Shizha & Charema, 2011: 169). In many cases, Africans prefer to visit a traditional healer than a medical professional in the hospital. According to WHO (2002), “it is estimated that between 80 and 85% of the population of sub-Saharan Africa receives its health education and health care from practitioners of traditional medicine” (as cited in Shizha & Charema, 2011: 169). At the same time, while the disease may be evoked by different environmental factors and spiritual influences, the healing process has to target rather a community or society than the disorder itself. In this respect, it is crucial to explore the stages of the traditional healing process. In fact, the traditional African healing process consists of two stages. The first stage is diagnosing the cause of the disorder or identification of the force, either spiritual or environmental, through rituals and supernatural divination. The second stage includes the process of healing depending on the cause of the disorder. Therefore, if the illness is evoked by the sorcerer or wizard, the healer removes the hostile source. In case when the reason for the disorder is angered spirits or ancestors, the patient has to seek forgiveness, making necessary sacrifices and rituals to please them and appease their anger (Truter, 2007: 57). For this reason, the healing process is impossible without the participation of family members, both alive and dead.

Furthermore, there are different types of healers in traditional African culture. Each of the traditional healers has their own field of expertise as well as their own methods of symptoms diagnosis and treatment of the disorder. In this respect, traditional African healers can be subdivided into sangoma, inyanga, umthandaz, and a traditional midwife (Truter, 2007: 57). A sangoma or ‘diviner’ can be regarded as the most ancient kind of healers in African tradition. Sangoma is a person who diagnoses a disorder and then defines the circumstances under which the disease has been obtained. Sangoma may not know about medicinal herbs because he or she acts as a medium between the material world and the spiritual side (Truter, 2007: 57). The healer identifies the illness in the cultural context, specifically in spiritual. In most cases, diviners are women, but a particular practice may include people of any gender (Truter, 2007: 57). Additionally, diviners are highly appreciated in their community for their specific mystical powers. An inyanga is a healer who has knowledge in the use of herbs and other traditional African medicines (Truter, 2007: 58). Most inyangas are males who do not inherit this skill like sangomas but chose to become a healer. The treatment by inyangas includes rituals and symbols for luck (Truter, 2007: 58). Another type of African healer is umthandaz, a person who belongs to a Christian African independent church. Truter notes that “umthandaz heals mostly through prayer, laying hands on patients, or providing holy water and ash” (Truter, 2007: 58). The healers believe that their healing power comes from God. In addition, traditional birth attendants are responsible for pregnancy problems and help pregnant women during childbirth. They also perform traditional African circumcision practice (Truter, 2007: 58).

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Harmful Traditional Practices Affecting HIV Responses

Although most Africans value their traditions and customs related to the health care system, refer to healers, and transfer religious rituals from one generation to another since not all traditional practices are good for the well-being of the nation. To be precise, there are a number of harmful traditional African practices that bring severe health problems rather than heal. While sacrifices to spirits and ancestors as well as the wearing of amulets can hardly damage the patient’s health, there are some ingenious African traditions that openly ruin one’s health. In this respect, cleansing can be regarded as one of such traditional African practices. This is an ancient traditional ritual that includes a sexual act during which the recipient is purified through the semen (Day & Maleche, 2011: 3). The particular practice is widely used among widows who believed to be unclean after the marriage with her late husband. For the cleansing practice, the elders of the community identify a man who the widow has to have intercourse with. Therefore, both women and men engaged in this practice are at risk of getting venereal diseases, specifically HIV infection, because the recipients have had many sexual partners during the ritual (Day & Maleche, 2011: 3). Day & Maleche note that “this is further aggravated by the fact that sexual cleansing calls for unprotected sex. Culturally, it is strongly believed that condoms cannot be used to effectively cleanse a person because it is semen that does the cleansing” (Day & Maleche, 2011: 3). A cleansing ritual is widely used in a number of African countries, specifically Zambia, Kenya, Botswana, and Malawi.

Furthermore, dry sex can be regarded as another traditional African practice that raises the risk of receiving HIV infection. This ritual includes vaginal penetrative sex without the use of a condom. During dry sex, lubrication is greatly reduced by different means: herbs, dry cloth, or chemicals. It is believed that in such a way, men can obtain heightened sexual pleasure (Day & Maleche, 2011: 3). On the contrary, during this intercourse, women suffer from micro-lacerations, inflammation, and numerous infections. This practice is common for Sub-Saharan Africa where women who do not follow the ritual are considered dirty and unfaithful. Day & Maleche state that “in one study, eighty-six percent of women in Zambia and 93% of women in Zimbabwe reported having practiced dry sex, and similar practices have been described in Malawi, Botswana, and South Africa” (Day & Maleche, 2011: 5). The practice of dry sex does not only cause physical harm and pain to women, but it also violates female rights. Another African tradition related to health care is known as the removal of the external genitalia in women. Female genital mutilation is a custom that has no health benefits, and what is more important, it causes intense pain and promotes the development of disorders, including HIV infection (Day & Maleche, 2011: 8). In order to perform such procedures, one uses the unsterilized instruments, including knives, pieces of glass, or razor blades. In some cases, the above-mentioned instruments can be used on several people (Day & Maleche, 2011: 8). Although about 21 countries in Africa have banned this practice, it is still used among the peoples.

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At the same time, male circumcision is one more ingenious African tradition that is made because of cultural and religious reasons. Day & Maleche note that “according to WHO, male circumcision is the surgical removal of all or part of the foreskin of the penis” (Day & Maleche, 2011: 14). Moreover, the healing process takes around one week if the practice has been made for a baby. In African families, circumcision is usually performed because of cultural traditions meaning a ritual of passage (Day & Maleche, 2011: 14). This ritual is usually made by a specific healer who uses an unsterilized knife shared among other boys. When the procedure is done in unhygienic conditions, it increases the risk of getting infections, including HIV (Day & Maleche, 2011: 14). Furthermore, according to a survey conducted in South Africa, a particular practice does not protect men from HIV transmission (Day & Maleche, 2011: 15). Nevertheless, the practice of male circumcision remains a traditional and widely used ritual among African peoples.

Conclusion

The purpose of this paper was to examine the relation of African cultural practices to the health care system. It discussed the diversity of traditional African customs and beliefs, the role of traditional medical practices amongst African countries, and their effects on human health. Based on the research findings, it could be concluded that not all traditional African cultural practices are beneficial to the populace. Therefore, there are a number of rituals and traditions practiced by Africans that harm human health, specifically cause the development of diseases and transmission of HIV infection. Moreover, some of the traditional practices, such as dry sex, cleansing, and female genital mutilation, do not only increase female chances of getting a severe infection but also violate human rights. Although indigenous African cultural practices are based on religious beliefs and the spiritual nature of living beings, harmful traditional rituals may lead to irreparable consequences. In this respect, it is crucial to review certain traditional African rituals and even ban some of them in order to protect African peoples from severe illnesses.