This article summarizes my take-home messages from an article recently published in BMJ Global Health that I co-authored, titled, “Who are the real community health workers in Tshopo Province, Democratic Republic of Congo (DRC)?”
“So, how was you time in DRC?” was the question I dreaded hearing when a paper I co-authored was published in BMJ Global Health. Most people didn’t even know that I ventured to DRC to do global health work. That’s because… I didn’t.
I’m ashamed to admit that I was the only author of the paper who didn’t have the privilege to visit this country of destitute poverty. In fact, when I interviewed to be a qualitative research consultant for this project, I was in a hostel in Myanmar. I completed the bulk of the work for this project – analyzing 127 interviews and eight focus groups with guidance from a senior consultant – out of coffee shops in Vienna and Boston, and even in an overnight bus ride through Mexico. What authority do I have as a white girl from Southern Illinois who has just once stepped foot on the continent of Africa to claim any knowledge on the subject of Tshopo Province’s healthcare system?
Yet something in my heart makes me feel as though I know the emotions and the shared experience of humanity in reading the words of the health workers and the farm-working families of the land. I was all at once touched, shocked, and captivated by this country as I swam through the French-language qualitative data. What was this “white man’s medicine” that continued to pepper the text? Does this term denote that the legacy of colonialism still persists? Why do the medical structures left in the colonial legacy fail so poorly in serving the people of Tshopo Province?
Between the lack of medical supplies in health clinics, clinics’ limited hours of operation, clinics’ distance from places of work and living, the lack of training provided to community health workers, and the out-of-pocket expenses for health amidst the destitute poverty of the region, it’s easy to see that modern medicine is inadequate in Tshopo Province.
Amidst the rubble of colonial medicine, it was clear from families’ stories that traditional healers are often the foremost primary providers of health. As a Bengamisa-based father of one child states:
“In the case (when the child has a cough and fast breathing), we recognize that the hospital isn’t competent to treat this kind of problem, so we turn directly to traditional medicine.”
Moreover, a Yaleko-based father of explains the necessity of traditional medicine due to the widespread, pervasive poverty of his farming district:
“Last month, we didn’t have enough money in hand to go to the hospital. Since the money wasn’t there yet, we said first we’ll buy traditional medicines.”
Given traditional healers’ paramount role in health, why was their profession being stigmatized by modern medical providers? And why were they being excluded from further investment in their skills and expertise? Although traditional healers frequently referred patients to modern medical clinics when their conditions were beyond the scope of their practice, modern medical doctors and community health workers rarely did more than warn families to avoid traditional healers, whose practice was informal and illegitimate, according to the tenets of colonial medicine.
Several traditional healers who were interviewed did practice their trade informally, as the high cost of formal certification was altogether inaccessible. One healer in particular expressed repeated concerns – verging on paranoia – of the interviewer being a government spy sent to shut down his practice:
“We’re afraid of the agents of the state… I don’t have any state documents… They make us pay. Right now, I’m afraid of you (the interviewer) because you arrived today (to question me).”
It seems that "white man's medicine" has worked well on paper – establishing health clinics and certification procedures for health professionals. Yet, in practice, Western medicine has led to division and exclusion – failing to fill health clinics with supplies needed to heal, creating financial barriers to becoming “legitimate”, and attempting to convince locals that their native forms of medicine are no more than quackery.
The simple yet poignant words of the families, the healers, and the physicians fuel me with great desire to express the stories of poverty and inequality that color the land. But – the eternal question – how far can my impact reach behind the lens of my computer? I’m still awaiting an opportunity to explore the “heart of darkness” that this country continues to be, in the meantime, the stories will stay vivid in my mind, and they will continue to inspire my commitment to global health.