Episode 1 - “I thought I was bewitched” - Benard’s Story
Meet Bernad, an elderly Yawo man from northern Mozambique who suffers from a mysterious illness. Travel along with him as he searches for answers while navigating the health care system available to him in his rural African context.
Bernad has been having chest pains and trouble urinating. Not knowing whether the problems are from natural causes or witchcraft, he visits a traditional healer, takes home remedies prepared by his wife Abiti Bakali, visits a government hospital, and crosses international borders to be seen at a private clinic. At this last stop, he is told to take medication to alleviate his symptoms, and to go to another facility for further testing. He does neither. Six months later he has passed away, leaving behind his wife and daughter.
In Ciyawo with English subtitles. Updated in 2024. (German, Spanish and Portuguese versions available from the 2016-release version).
Bernad is our main character. He is having trouble eating and doesn't know why.
Abiti Bakadi is Bernad's wife. She is a skilled herbalist who knows which plants and roots to use for medicinal purposes.
Caçiano Abrão is the District Director of Health Services in Mandimba
Austin Salimu is a Malawian Yawo who was instrumental in the story acting as a fixer, translator, and cultural advisor
Note: translation from 2016 version, not yet updated to most recent edit.
Note: translation from 2016 version, not yet updated to most recent edit.
Note: translation from 2016 version, not yet updated to most recent edit.
Viewing Guide
Student Viewing Guide prepared by Arianna Huhn, California State University San Bernardino. Email: ahuhn@csusb.edu
-
Bernad has been having chest pains and trouble urinating. Not knowing whether the problems are from natural causes or witchcraft, he visits a traditional healer, takes home remedies prepared by his wife Abiti Bakali, visits a government hospital, and crosses international borders to be seen at a private clinic.
At this last stop, he is told to take medication to alleviate his symptoms, and to go to another facility for further testing. He does neither. Six months later he has passed away, leaving behind his wife and daughter.
-
Medical Pluralism
Witchcraft
Structural Violence
Traditional Healing
Biomedicine
Vernacular Healer
Global Inequities
Home Remedies
Transnational Medicine
Critical Thinking Questions
Answer alone or in small groups, or use to guide a class discussion.
-
Consider the multiplicity of options within categories (like “biomedical care”), along with the ways in which structural inequalities make some options not available. Consider cultural, linguistic, financial, and logistical barriers to meaningful healthcare.
-
Consider models of separate use, hierarchy of resort, simultaneous use, and syncretism, among other therapeutic pluralities.
-
Consider structural and cultural factors in formulating your response.
-
Include source(s) of miscommunication, but also other possible reasons. Were the instructions on Bernad’s prescriptions adequate?
Debate
Who or what is at fault for Bernad’s death?
Who or what stands in the way of Bernad receiving meaningful healthcare?
Contextual Notes
-
There are over 2000 languages spoken in Africa. Of the seven major indigenous language families, “Niger-Congo” is the largest, which includes the “Bantu” languages spoken across much of central and eastern Africa. It is common for Africans to be multilingual and to encounter more than one language among friends and neighbors. Most African countries retain the language of the colonial-era government (French, English, Portuguese, Arabic) as an official language, some in combination with an indigenous language or languages.
-
Portuguese presence in what is today Mozambique can be traced to the 15th century, when explorers set up commercial posts alongside Swahili traders along Indian Ocean coastal trade routes.
Their occupation intensified with the “scramble for Africa” in the late 1800s, and “Portuguese East Africa” became an official colony (and later province) of Portugal. The colonial era brought forced labor, taxation, and rampant racial discrimination. Demands for equality and independence fueled a guerrilla war led by FRELIMO (Front for the Liberation of Mozambique), fought from 1964 to 1974, and ended only due to political instability in Portugal.
-
The average life expectancy in Mozambique was last calculated at 60.8 years (World Bank, 2019). This represents significant gains — in 2009 the average life expectancy was 51.7, and in 1999 it was only 48.5. Still, 60.8 is among the lowest life expectancies in the world. “Life expectancy” is not the same as “life span” — many Mozambicans live well into their senior years. Life expectancy rates in developing countries are highly impacted by infant mortality, as well as high disease burdens and poor healthcare infrastructure.
-
Bilharzia (also known as schistosomiasis) is an acute, chronic disease that is caused by parasitic flukes (worms) penetrating the skin through contact with infected water. The flukes take up residence in a person’s blood vessels, causing abdominal pain, diarrhea, and blood in the stool. Chronic infection can also lead to anemia and malnutrition in children, as well as enlargement of the liver and spleen, lung damage, and increased risk of bladder cancer. Bilharzia can be safely and effectively treated with Praziquantel, but this is not always available to those infected.
Health and Healing in Africa: An Introduction
Like many developing countries, Mozambique carries the double disease burden of communicable diseases (like malaria, hepatitis, tuberculosis, schistosomiasis, and typhoid), and non-communicable diseases (like cancer and heart disease). The average lifespan in Mozambique is 60.8 years. Pregnancy and childhood are particularly vulnerable statuses: the country’s maternal mortality rate stands at 289 deaths for every 100,000 live births, and 74 out of every one thousand children born in Mozambique do not reach the age of five. Mozambique additionally suffers one of the highest rates of HIV/AIDS in the world (12.6% of the adult population). As is true across much of the African sub-continent, Mozambique’s physician-to-patient ratio is low (3:100,000). This is driven in large part by poor wages prompting trained medical professionals to seek alternative means of employment. Many healthcare systems in Africa receive only minimal government funding, the result of austerity measures tied to structural adjustment loans intending to reduce national spending as a means to stabilize economies through privatization. In Mozambique, the result has been a deluge of NGOs and expatriates funded by foreign aid, and fragmentation of the national health system. In addition to physician shortages, government facilities in Mozambique today face constant paucities in medications, supplies, and trained technicians to repair and replace faulty machinery, along with bureaucratic hurdles that impinge on capacities for attending to patient needs.
Biomedical physicians, clinics, and hospitals in Mozambique exist alongside vernacular healers, sometimes called “traditional healers” (médicos tradicionais) or healers (curandeiros) and in the colonial era referred to as “witchdoctors” (feiticeiros) or simply as “witches” (bruxas) for their management of maladies by combining spiritual and physical interventions. Vernacular healers are heterogeneous in their services. Some are herbalists who procure and administer pharmacopeia (herbs, roots, flora, fauna) in the form of drinks, baths, dermal incisions, ointments, enemas, vaginal infusions, porridges, and amulets. Using the word “medicines” to describe these substances can be deceiving, as many have the capacity to act in a curative and in a destructive manner, dependent on the user’s intentions and on supernatural forces, rather than inherent properties alone. Health depends not only upon such medicinal interventions, but also on balanced and peaceable relations with kin, ancestors, deities, and the environment, which can sometimes be achieved only by determining why a person fell ill (especially in the case of sudden illness, mysterious death, or coincidence of malady with conflict). Diviners are able to cross boundaries between the world of the living and the world of spirits to ascertain causes – which may be natural, but could also include ruptured relations, the breaking of a taboo, vengeful spirits, or witchcraft. Patients participate in co-constructing their diagnosis through dialogue with vernacular healers (unlike the inferiority of patient ignorance in comparison to expert knowledge underlying many biomedical encounters). Spiritists might prescribe a remembrance or healing ceremony, negotiate with supernatural beings, or be possessed by them, as a part of treatment.
Illness, in this manner, is treated in vernacular healing as more than bodily dysfunction; it is an embodiment of social disorder that must be revealed, resolved, and given meaning in order to affect remedy. The focus of biomedicine only on the physiological manifestations of illness is one reason that many persons – purportedly 80% of the African population – visit vernacular healers. There are over 300,000 vernacular healers in Mozambique. In addition to herbalists, diviners, and spiritists there are also birth attendants, circumcisers, faith healers, needle men (individuals who administer injections outside of clinical settings), and practitioners of Quaranic medicine. Many vernacular healers are called to the profession through their survival of a prolonged illness, or through dreams in which ancestors or spirits provide guidance and instruction. Mozambique has an association for vernacular healers (AMETRAMO, Associação de Médicos Tradicionais de Moçambique, Association of Traditional Healers of Mozambique) with approximately 75,000 members. Some Mozambicans see the organization as a validation of vernacular healing, while others see it as a product of problematic marketization in the healing sector.
The term “traditional healing” can give a false impression that the techniques under discussion are both ancient and unchanging. This is certainly not the case, as vernacular healers have always adapted to new situations and adopted new technologies. Likewise, the term “Indigenous Knowledge” for describing the expertise of vernacular healers sidesteps the fact that many do not attempt to understand or explain the logics through which their techniques operate. This term only works if “knowledge” is considered as a method for discovering and experiencing the world, rather than as fixed data about the world. Regardless, the term “knowledge” is certainly more accurate than “belief,” which implies uncertainty or wrongness, which is why social scientists are reticent to employ the term in relation to vernacular healing. Some criticize that focus by governments and international organizations on the “efficacy” of vernacular healing also problematically fixates on those aspects that are compatible with biomedicine (bioactive substances), while ignoring the broader importance of somatic experience. While much in African pharmacopeia is effective and curative, to simplify vernacular healing to this element is reductive. Likewise, to assume that African individuals making use of biomedical pharmacopeia implies acceptance of biomedical theory or rejection of vernacular healing is false; medical pluralism is common.
The Sick in Africa documentary series concentrates on health and healing in the region along the border between Mozambique and Malawi. Residents here are primarily Yawo-speaking and followers of Islam (mostly Qadiriyya and Sukuti). Most earn their livelihood through small-scale farming and trading, and live in homes built themselves with a combination of natural materials, concrete, and corrugated iron sheeting. In addition to vernacular healers, many receive health care from a local clinic or regional hospital in Mozambique, or cross the border into Malawi to visit private medical institutions or to stealthily access government health services intended for Malawians (this is done in the opposite direction, as well, with Malawians traveling to Mozambique for medical care). In both countries, national healthcare is heavily subsidized by the government, but often requires traveling with your own kitchenware and a companion who will provide for your feeding and other daily care.
Learn More
Recommended resources for additional context:
John Janzen and Edward Green (2008) “Medicine in Africa” in Encyclopaedia of the History of Science, Technology, and Medicine in Non-Western Cultures. Edited by Helaine Selin. Springer. Pages 1493-1508.
Rebekah Lee (2021) Health, Healing, and Illness in African History. Bloomsbury.
Tracy J. Luedke, and Harry G. West (2006) Borders and Healers: Brokering Therapeutic Resources in Southeast Africa. Indiana University Press.
Mkhwanazi, Nolwazi. 2016. “Medical Anthropology in Africa: The Trouble with a Single Story” in Medical Anthropology 35,2: 193-202.
William C. Olsen and Carolyn Cargent, eds. (2017) African Medical Pluralism. Bloomington: Indiana University Press.
Ruth J. Prince and Rebecca Marsland, eds. (2014) Making and Unmaking Public Health in Africa: Ethnographic and Historical Perspectives. Ohio University Press.
Daria Trentini (2021) At Ansha’s: Life in the Spirit Mosque of a Healer in Mozambique. Rutgers University Press.
Claire L. Wendland (2010) A Heart for the Work: Journeys Through an African Medical School. University of Chicago Press.
“Jikajikape jangawuma mbili | Alone, alone, one cannot produce history”
Mike Berry, former HOD Pharmacy DeptCOM Blantyre, Malawi (28 July 2016)
“This is terrific and should be viewed by every medical, pharmacy and laboratory science student training at the College of Medicine in Blantyre… It illustrates so many of the problems health care professionals have to overcome. I could use it here in UK too.”
Joanne Beale, British volunteer in Mozambique (29 July 2016)
“…This story mirrors so many that we encountered in Mozambique and Tim’s film shows so many of the different challenges of health care in Moz from a lack of education, to equipment with instructions in Italian, to the tensions between traditional healers, witchcraft and medicine. If you want to understand more about what we’ve been experiencing over the last couple of years or simply wish to feel more grateful for the NHS (or other health services for non British friends) please have a watch.”
Dr. Alan Thorold, anthropologist (8 Aug 2016)
“Great ethnographic film about health challenges in rural Mozambique.”
Cam Beeck, Massangulo, Mozambique (26 July 2016)
“…you’ve done a brilliant job at capturing the complexities and despair around healthcare out here. Make sure you watch this y’all…”
C.R. Oldham (27 July 2016)
“…What an amazing job. I know I’ve never been to Africa, but something about your camera work and lack of narration (using only subtitles) gave me the feeling of being transported away to a place I’d never visited. Something else funny–when Bernad gets his diagnosis and says essentially ‘I’m just a poor farmer! I knew nobody would try to curse me!’ I had a brief vision of my own grandfather, who would say something very similar. I found it fascinating because in that instant skin color, cultural differences, language barriers just faded away and I was left looking at a man who could have been my grandfather facing the human condition…”
Connie Wragge (August 2016)