Culture and Public Health

Last night I was at a dinner with a whole bunch of UN junior staffers....from a handful of countries around the world. My mind started wandering on this question that has been bugging me for the last couple of weeks.

Every time I go to a meeting for one of the research projects that I am doing, I can guarantee that the issue of culture is going to come up. People always say, we have to think about culture. It is really important. What about the traditional healers? What about the traditional birth attendants? What about practices like initiation?

To some extent, I do believe these things are important. But, actually, over the last year and a half, they seem less and less important to me. Last year, I focused solely on looking at traditional birth attendants, in policy and practice. I thought that they were so integral to maternal health care. But, after a while, I started thinking, ah, they aren't really. What matters more is just training more nurses. But, thats not fast, so you just have to devise an interim strategy for the in between times.

Well, that is sort of how I came into the experience here in Mozambique. But, people love to talk about culture here. It is strange. During the post-independence government's reign before the end of the war, traditional practices were banned, to unify and make everyone speak portuguese and be alike in order to build the nation. Well, so after, as you can imagine, there was a surge in the traditional sector. Because of this, there are lots of groups working directly with the traditional practitioners or curandeiros.

So, but how are governments supposed to think about these issues? Yes, the sector is important for most rural, even some urban populations. But, most people agree that if the health systems were strengthened and people had appropriate information they wouldn't go anymore.

It is complex. Obviously it has to do with education and people's belief systems. For example, my grandmother believes that you should put cotton in your ears so that cold air does not enter and make you sick. My parents certainly don't believe this because they have had the benefit of education to no longer believe this. So maybe, in this way, the focus of the effort, should really be on valuing people's cultures, but also urging them to question it.

It is sometimes easier to say that things are hard to change because of culture. But sometimes it is also an excuse. Culture is fluid right? It changes? And it is normal that there should be a "natural selection" in the beneficial and non-beneficial practices. So, how can this start being part of the debate???

Working on this question over my cup of morning ginger tea (cutting down on the coffee sadly....)