Berkley Center

"In the last month, has he had a fever? A cough? Chills? Diarrhea?"

The response was "Yes" to all. The little boy's nose was running as he stared up at the group of foreigners wielding clipboards. Our translator kept firing questions at the boy's mother: "Has he had a headache? Did you take him to the clinic? Do you think he had malaria?"

We were conducting a malaria survey in a village four hours away from the capital. My group reached 30 children, all under the age of ten, and of those 30, 29 suffered from at least one symptom of illness within the last month. At the compound of one family, every child had bloody urine, an indicator of intestinal worms; at others, the children had sores on their heads or rashes on their backs.

There was a dispensaire, or a clinic, in that same village, and malaria treatment was free (or at least, free according to the law). Treatment for other diseases ranged from being free to a few dollars, the price someone would pay for a new pair of shoes. Yet of the 30 children, only seven had gone to the clinic that past month. Perhaps more tellingly, nine children had been taken to a guérisseur, a traditional healer.

Our survey was far from comprehensive, but it did provide insight into the crucial role that traditional beliefs play in sectors such as public health in Senegal. Although Senegal is 95 percent Muslim, traditional beliefs and customs from before the introduction of Islam still have a strong influence in the country. Though that influence is less evident in urban centers such as Dakar, many people still believe, for instance, in the power of spirits. Evil spirits are often thought to cause illnesses and deaths, and children often have gris-gris, or protective amulets, tied around their waists to ward off these evil spirits. Meanwhile, people frequently turn to traditional remedies before they turn to clinics and modern medicine.

In the three months I've spent in Senegal so far, I have been struck by the degree to which religion and tradition permeate life here, and the health sector is certainly not exempt. As with so much in Senegal, the role of religious or traditional beliefs in health is marked by paradoxes.

On one hand, certain traditions can be a difficult force to overcome in efforts to improve community health. Beyond the reliance on traditional healers, female genital mutilation (FGM) or cutting is still widely practiced in certain regions of the country. Although the Qur'an makes no reference to female genital cutting, and it certainly doesn't suggest it, many people believe that the practice is justified by Islam. In fact, the "Demographic and Health Survey of 2005" found that, despite its illegality, more than a quarter of women are affected by FGM.

On the other hand, religion can play a crucial role in the improvement of Senegal's public health. Senegal's HIV rate, for instance, remains below 1 percent (compared to DC's rate of at least 3 percent). The influence of Islam is a crucial reason behind this relatively low rate. Not only does Senegal have comparatively conservative social norms, but religious leaders also have a key voice in the fight against the spread of HIV. Muslim leaders, for instance, preach about HIV in mosques and include AIDS education in religious teaching programs, and both Christian and Muslim organizations preach tolerance and provide support for those affected.

Unfortunately, improving Senegal's public health depends on a lot more than garnering support from religious leaders. In a country where the average person can expect to live into his or her fifties, the health situation is intimately linked to the economic situation. The average yearly per capita income is below $1,000 a year, so a medical treatment of a few dollars is often beyond the means of a family. As we were leaving one of the village compounds during our malaria survey, one of the older men called out to us in Serer. The man was smiling, but we were struck by his words, "Can you cure me of my sickness of not having any money?"