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Caitlin Koury

Caitlin Koury is a junior in the NHS, studying Health Care Management and Policy with a certificate in International Health and a minor in History. She is originally from the Jersey Shore area, in a small town known as Red Bank. Currently, Caitlin is spending her fall semester studying Developmental Studies at the University of Ghana. While studying in Ghana is a completely different from attending to school in D.C., it has been an incredible experience enhanced by Caitlin’s internship at the International Health Care Center, a clinic devoted to HIV/AIDS patients. She works directly with the medical staff on developing community health programs and interacts with patients daily. These patients have served as an inspiration to participate in JYAN in order to share their stories related to health, religion, and the developing world.

The Struggle between Religion and HIV/AIDS in West Africa

November 7, 2011 | 2 COMMENTS

“When we talk about religion, it’s very interesting because it goes with established, historical religions and then supernatural beliefs. It’s one of the constraints that we face in managing some of our patients.”
- Dr. Naa Ashiley Vanderpuye, medical director of the International Health Care Center (IHCC) Haatso, Ghana

My internship with the IHCC and my several months in Ghana have proven this country a deeply religious one. People cling to a strong belief in God and rely on Him even when faced with financial crises, eviction and job loss. “Leave everything to God” is a common phrase that brings them peace.

The IHCC specializes in care for HIV patients. When Ghanaians are diagnosed with HIV, they treat it the same way, believing it is “all in God’s plan.” They believe that through spiritual healing, and “divine intervention,” God will cure them.

Other patients prefer African Indigenous Religions to traditional western ones. These religions believe in super natural powers, fetishes, and cults. People believe that herbal remedies and potions made of various animal parts and plants can cure HIV and other presiding ailments.

While there are differences in the traditional and indigenous religions of Ghana, both groups present difficulties when treating HIV. For instance, an HIV positive woman came in to the IHCC for follow up visits while her husband defaulted. When Dr. Naa asked the woman about her husband’s absence she explained that their family had taken him to their village. He had a swollen leg that they believed was caused by a spiritual power.

One morning she found a small animal inside one of their water collection pots. When her husband went to see what was lurking inside the pot, he swiftly kicked away the creature inside. The family believed that this action angered the spirits who consequently caused his leg to swell. While the wife knew that the swelling wasn’t directly linked to HIV, she sought the advice of a spiritual healer to cure her husband’s bad karma

Health and religion are uniquely connected in Ghana. When an HIV patient begins treatment, he is considered lucky if he starts to improve right away. Sometimes, the medication has negative side effects like nausea, headaches, and body pains that deter patients from continuing their antiretroviral therapy. “At some point patients say the orthodox medicine isn’t working so they disappear. They tell us they don’t believe in modern medicine and wind up dying,” says Dr. Naa.

Pastors commonly preach that they have a cure for HIV. There are ever-present signs for church events and conferences focused on faith based healing and deliverance from evil. They advertise HIV as a spiritual disease that only faith can cure. The pastors tell people that prayer will save them over medication. Some people stop, some fast, and the church leaders perform “healing” rituals for them.

Soon after they come to the IHCC asking to be tested again wanting to know if they’re still positive. “Of course they are,” says Dr. Naa. Belief in God is so strong that people believe God will relieve them of illness. Dr. Naa notes, “I never try to discourage them, but insist they have to do it with their medications,” Dr. Naa is a proponent in the ability of psychological strength. Unwavering belief in God can help improve patients’ conditions, but not without medication.

Unfortunately, many choose only spiritual healing because they hear rumors of people who were treated by their pastors with holy water and afterwards, produced a negative test result. “I’m open to the idea that spirituality can heal if it can be proven,” says Dr. Naa. But it has yet to show any concrete evidence.

Traditional medicine is the same way; healers claim to have a cure and produce their own concoctions. These healers claim to have a vision on how to prepare such a concoction, but refuse to explain what it is composed of or disclose whom they have cured. Dr. Naa asks her patients to supply proof of the spiritual healing of others who have been “cured,” which they often fail to provide. Still, she accepts their beliefs as long as they do not default on their medication.

Religion presents a double edge sword to health in Ghana. While health care workers recognize the healing power of faith and its ability to strengthen the body, they must also deter patients’ beliefs that they will get better based on prayer, herbal remedies, and spirituality alone. When pastors and traditional medicine specialists emphasize prayer and herbal remedies over ARV treatment, it undermines the medical system. Medical personnel must develop tactics to incorporate spiritual belief into modern treatment in order to effectively cater to the needs of religious individuals.

COMMENT FROM ERIC MOORING - NOVEMBER 22, 2011

Thank you, Caitlin, for this thoughtful piece. Botswana (where I am studying) is a very religious country, too. While I am rather wary of making generalizations about a continent of more than 1 billion people and dozens of countries, it is probably fair to say that there is a great deal of religiosity across Africa. That is also the view of the 2005 Commission for Africa (the landmark commission led by Prime Minister Tony Blair that outlined a path forward for development in Sub-Saharan Africa).

Botswana has an extraordinarily high HIV prevalence rate, and I think that there are some similar concerns here. My study abroad program visited a small group of traditional healers just outside the capital city and one of the topics we addressed was HIV/AIDS. These people argued that they could cure HIV, but only in its early stages. They said that there was little they could do for a patient presenting with AIDS in its later states.

One of the things that I found interesting was that they encourage their patients to go to clinics for diagnostic testing. One traditional healer explicitly mentioned that he wanted to know patients’ CD4 counts (the most prominent diagnostic measure of the strength of the immune system of an HIV-positive patient).

In the case of Ghana, I would be interested to know what the role of religions is in terms of HIV education and prevention. The traditional healers I met here had advice that would not have been very controversial from a biomedical point of view; they encouraged abstinence and, with less enthusiasm, condom use. I know that in Botswana, traditional healers have formed an association and have some interactions with government health officials. I wonder how common that is elsewhere in Africa and, moreover, what are the outcomes of such interactions. Does it lead to more respect among traditional healers for biomedical doctors and vice versa? Are there ways that traditional medicine and biomedicine can work together?

COMMENT FROM CAITLIN KOURY - NOVEMBER 29, 2011

Thanks for your comment, Eric. It must be fascinating to study in Botswana and I’m glad that you have also experienced traditional medicine. It’s interesting that you were able to discuss with them their viewpoints on HIV/AIDS in the context of prevention with a biomedical perspective.

In Ghana, from what I have observed and experienced, HIV education and prevention is a looming issue that has been neglected. The ABC method is most broadly advertised here: Abstain, Be Faithful, use Condoms. But as for actual sex education, it remains miniscule. The clinic I work in does outreach initiatives as school to combat disparities in impoverished regions, which are the most susceptible to the virus.

In terms of religion’s role, it impedes much of the education and outreach because of traditional Islamic and Christian schools that will only teach abstinence, if anything. Typically, the entire topic is ignored by the school system and only addressed in international schools or by community outreaches performed by local clinics and NGOs.

In regard to traditional healers, there is a visible divide in the medical field, especially when it comes to HIV/AIDS. Unfortunately, I have not had the opportunity to directly interview a traditional healer, but I have been able to speak with believers in fetish and followers of African indigenous religions, which utilize traditional healing methods.

From what I have gathered, it appears that believers are much more apt to taking herbal remedies over prescribed medications, which leads to dispute in the biomedical community. I am unaware of any association in Ghana that mirrors Botswana’s coalition. I think this is because traditional religion is a taboo subject in Ghana, while it is more openly accepted in other West African countries, such as Togo and especially Benin.

The next paper I’m submitting focuses on how traditional medicine and biomedicine can intersect. I believe it is imperative to constructing a better healthcare system and many religious scholars also agree that traditional medicine needs to be integrated to provide holistic healthcare. The clinic often allows patients to continue taking any herbal remedies as long as they adhere to their regular medication. As I discuss in my next paper, herbal remedies and traditional methods can often boost the immune system but do not provide a cure – which causes disputes.

In addition, I think the biggest clash between religion and health is really centered on monotheistic religions because they preach cures and often, spiritual camps for healing. The director of my clinic typically encourages people to keep a strong faith in whatever they believe in, but also finds preachers undermine the medical system by encouraging prayer over medication.

Vehicles of Hope for HIV Patients

December 7, 2011 | 3 COMMENTS

I step onto a blue tro tro crowded with men on their way to work, women with fruit to sell, and babies swaddled across mothers backs. While these tro tro vehicles serve as the common mode of transportation in Ghana, they also carry messages of faith. Sprawled across the back of their windows are messages of God’s love and Allah’s wisdom

This tro tro reads “God Above All” in bold, orange block letters across the back window. There is also a sticker with “God Bless You” across the upper portion of the front window, complimented by a Jesus sticker in the right hand corner. The tro tro towers over the passing taxis, whose windows are also adorned with faith based writings. As I gaze outside I see signs for the “Believe in Allah Specialty Shop”, “God is Good Barbershop” and “ Grace Anointed Food” that line the road on the way to my internship at the International Health Care Center (IHCC).

Although the tro ro ride may have been filled with religious messages, religion extends into daily encounters, especially at the clinic. The IHCC serves as an outpatient clinic for mainly HIV/AIDS patients. Religion is a pervading factor at the IHCC, but it is often complicated by patients’ enthusiasm for an unrealistic miracle from God. They maintain faith in God despite their condition and are unwavering in their belief that prayer will heal them.

After the tro tro ride, I shadowed Dr. Naa while she spoke with an HIV positive couple looking to conceive. The couple was facing challenges other than their status; the wife had been battling chronic liver and gallbladder infections, but was doing well at the time of the visit. Her husband insisted that she was experiencing a “divine intervention” because she was in good health and the gallbladder stones were no longer affecting her.

The woman agreed with a hint of laughter, which immediately disappeared when her husband moved on to ask about HIV. He first asked if there has ever been a cure and eventually concluded, with the explanation of Dr. Naa, that HIV was a disease far worse than cancer, because it could not be cured. He then asked, “Is AIDS the devils work? Is it a punishment for disobeying God?”

How could Dr. Naa and I explain that God didn’t intend such a disease for anyone? We attempted to explain that HIV is a virus that impacts all types of people, not just sinners. I struggled to relate it back to God but could not find make a strong connection. This man was a pastor soon to embark on a pilgrimage to Israel, it was only natural he believed HIV was linked to an act of God, and we needed to work with him and his wife in that respect.

What if Ghanaian beliefs inhibit healing? Does strong faith serve as a prevention of full potential? While sitting in the back corner of the tro tro, a young man stood up and began to quote verses from the bible. I couldn’t help but remember my encounter with a Bible Seller on the streets of Brooklyn this past summer. He preached eternal salvation and claimed the devil was arriving soon, promising punishment to all those who did not seek the Lord.

The man on the tro tro was preaching a similar message, asking the riders if they wanted to be saved. I looked around and saw people sitting with blank expression, gazing out the window. I was bewildered; here was a society that had signs on every corner praising God, but there was no emotion evident on any of their faces. I asked the woman sitting next to me, “Do you like this?” to which she answered, “Yes very much. We like it when people preach.” And then she turned back to staring out the window.

I turned my attention back to the preacher, who was now concluding with a blessing. At the end of the prayer, the entire tro tro exclaimed in unison, "Amen." The seemingly apathetic woman next to me turned and told me I should have said “Amen.” “We’re now blessed, it gives us hope.”

Immediately, my thoughts connected my two encounters: the pastor’s questions on HIV and the tro tro sermon. Both the pastor and the tro tro riders wanted something to believe in, to give them hope despite HIV, poverty, or unemployment.

Faith is a mechanism for battling the developmental challenges facing Ghana, as well as individual’s battles with physical ailments. The HIV couple needed faith to substantiate that they could still conceive. The people on the tro tro needed their blessing because it enabled them to believe in something bigger than themselves, to give reason to their struggles. Here, religion boils down to hope: hope for a cure, hope for a safe journey, and hope for a better future.

COMMENT FROM CHLOE CHEN - DECEMBER 14, 2011

Caitlin,

Reading about your experience with religion in Ghana sparked thoughts of both similar notions concerning religion held by Ecuadorians and some very stark differences. Like your ride on the tro tro, my daily trip to school on the public bus system is filled with religious imagery adorning the driver’s personal space. These decorations, many bordering on the kitschy side, have similar slogans too – one being translated to “If this should be my last trip, I have no fear, for You are at my side.” While these used to make me laugh, they have come to bring me comfort on those days when the road is slick from a fresh rainstorm and the bus driver decides to race the other buses on the windy, mountain road from school.

I think that like in Ghana, the hope that religion brings the Ecuadorian people is its mainstay in their lives. Though from my experience, Ecuadorian faith is something they keep more to themselves – there are no public preachers on these buses – it plays the same role as it does for Ghanaians. When I learned that my host mother’s cousin recently passed away and her brother remains battling cancer in a hospital, her way of consoling my fears for her family was to tell me that they are in God’s hands. She never seemed to lose her faith that whatever may happen, it is part of God’s will.

I believe that religion undoubtedly gives us hope and reprieve from our anxieties no matter what part of the world it may be in, though it is infinitely fascinating to see the different manners in which this manifests. For example, I find that your anecdote of the contradiction between your fellow passenger’s seemingly-apathetic reaction and strong testimony regarding her enjoyment of the sermon aptly shows the highly nuanced roles that religions can play. While any Ecuadorian I might ask about religion may shrug about the role it plays in their life, I know that it nevertheless runs through the lifeblood of their culture as a constant yet sometimes impalpable force.

I think what might be the most interesting aspect of all this is how we both seemed to encounter religion in a most unusual forum – the public transport system. But then again, I guess what better way could there be to reach people with the hook of religion than buses filled with the world-weary, on their literal and spiritual journeys throughout life.

COMMENT FROM ALEXIS THOMAS - DECEMBER 29, 2011

Caitlyn,

Your essay is intriguing and very enjoyable. I find your point of view interesting and it sparked many questions for me. However, any discussion regarding religious belief will be a tricky topic regardless of the culture. For some, religion is a mere habit or an extension of daily practice while for others it is a source of spiritual fulfillment.

It appears to me that the Ghanaians have a deep religious faith that has been strongly integrated within their culture. Similar to your public transportation experience in Ghana, I also noticed while I was in the Dominican Republic that the Dominican guagas, which can be likened to the Ghanian tro tro, displayed several religious slogans such as "When God is with me, I have nothing to fear." Some guagas even played loud religious music, with their drivers joyfully singing along.

I think that the concept of such an outward display of religion is something hard for Western society, especially Americans to grasp. Our country is grounded in the principle of separation of church and state. Unlike the public transportation system of Ghana or even of the Dominican Republic, the public transportation system of the United States is not a place where one would find such open displays to be common. In the United States, religion is not discussed in our public schools and almost every biological mechanism is given a specific scientific explanation.

This is not the case in many developing countries. When describing the IHCC, you stated that "Religion is a pervading factor…but it is often complicated by an unrealistic miracle from God. They maintain faith in God despite their condition and are unwavering in their belief that prayer will heal them." I think that as Western outsiders, this concept is extremely difficult to grasp.

Ghanaians, however, with a lack of education and awareness, often possess no other recourse other than their faith in God. Perhaps we shouldn’t view this hope as utterly useless, but instead with admiration. I do believe that initiatives should indeed be taken to facilitate their education in other areas, specifically in HIV prevention. Education in combination with prevention strategies can inhibit transmission, while religion can be used as a coping mechanism.

COMMENT FROM LAUREN BOAS HAYES - DECEMBER 28, 2011

While I was studying in Thailand we studied the effects of HIV/AIDS in rural Thailand. We learned from an NGO called TNP+ that works as a network of HIV/AIDS individuals who provide support and guidance for each other. We went to the home of a woman, Meh, who has been struggling against AIDS for years and she told us her story. Although she was well informed about her illness most of her community knew nothing factual about her condition. She said that people would say things that sound similar to what you, Caitlin, were asked while working in Ghana. However, Thailand is a Buddhist country so there is little invocation of God and much more discussion of karma.

In Thailand, I commonly heard people accept their problems and attribute them to some karmic response. Meh said that members of her community believe that she must have been a terrible person in a previous life to have this horror brought upon her. She also explained that many individuals who live with HIV/AIDS feel that they deserve their illness because it is part of their karmic cycle.

In response to both Caitlin and Chloe, I am a bit more critical of the role of religion in development and daily life. Through the many visits to Wats that my host families and friends brought me on, I can tell that the Buddhist tradition is very important to many Thais. This comment will certainly not do adequate justice to the complicated relationship between religion and development; however, I witnessed religion-creating apathy. The apathy that Caitlin mentioned seems to have been set aside in order to discuss religion; however, I witnessed religion creating that apathy through dulling the importance of daily realities. If people, in Thailand, Ghana, Ecuador, or elsewhere are focusing on other-worldly salvation, is this diluting the ability to respond to daily injustices and challenges?