Sheila Bibb and Dr. William C. Olsen, Anthropology

Tuberculosis has long been a scourge throughout the world but in the 1950’s medical developments enabled most countries to bring this insidious air-borne disease under control and it was firmly believed that by the end of the century tuberculosis would be eliminated worldwide. The reality is that since the 1990’s tuberculosis rates have increased dramatically and seem set to continue this upward trend. It has been noted that this upsurge often coincides with an increasing rate of HIV/AIDS. Most of the affected areas occur in sub-Saharan Africa, and I choose to investigate the situation in the Mampong-Ashanti area of Ghana.

My final paper will show that in Mampong there is an increasing rate of both diseases and these will only be countered by a concerted effort on the part of government, local leaders and health care practitioners to not only provide basic information and health care to the public, but also to work with the community to overcome the stigma attached to the disease. This stigma, I argue, is based on the continuing influence of traditional beliefs in the supernatural and the role of the ancestors so that the efficacy of modern treatments is severely undermined and the health and well-being of the community is jeopardized.

The first cases of tuberculosis in Ghana were officially recorded in the early 1900’s, all in the southern coastal area, and the numbers were very low. However, by the mid-1920’s numbers had increased dramatically and the disease had spread far inland. This rapid rise and dispersion has been linked to the mining industry and the use of migrant labor. In practically all cases the outcome was fatal. As modern treatments were introduced numbers declined and outcomes improved, but today, this trend has reversed.

Mampong, in the Ashanti region of Ghana, is a town of some 60,000 residents in both the town itself and the outlying areas. It is rural with most roadways being of dirt, housing being basic with poor sanitation, limited employment opportunities and schooling ceasing at Junior Secondary School level in many cases. The diet consists of fufu, banku or kenkey all served with either soup or stew. Fresh vegetables and fruit are in limited supply and purely seasonal. Most families live at a subsistence level.

I collected statistical information from the local and national Health Authority as well as interviewing groups of people, some directly involved with TB patients either professionally or on a personal level, including pharmacists, and others who were involved in education, as well as one group who had no known connection to TB at all. I spoke with traditional and Christian leaders in the community and additionally had the opportunity to carry out voluntary work in the local hospital, the Children’s Home and a school.

Based on my experiences, the information given during interviews, and numerous conversations with the local people, I found that everyone thought Mampong had a high number of TB and HIV/AIDS cases, but the actual reported figures indicated much less of a problem. However, all those responsible for reporting agreed that the figures represented only an estimated 15% of the actual cases. The under-reporting results from a failure to identify sufferers, itself largely due to the misconceptions held by the public about both the nature of the disease and its treatment. Most agreed that anyone with a cough should attend the hospital, receive a diagnosis and undergo Western medical treatment but in reality, the perceived cost of treatment, together with the inevitable stigma, prevented many from taking this course.

The stigma was manifest firstly as a literal fear of the disease, (known locally as insanmaa waa, the ghost cough), especially when someone died of TB. It was felt that at this stage the disease was at its most contagious since the germs were now actively seeking a new host body. Secondly, some felt that the cause of the disease was not a physical but a supernatural one, brought about by the patient having offended someone—another family member, a friend, a neighbor. That person had then cursed the patient causing TB to develop. An alternative was that when someone died of TB, he or she was displeased with the respect and treatment shown by relatives during the illness and death and as a result was now using their position as an ancestor to ensure that there was always at least one member of the family suffering from tuberculosis. Unless treated by a fetish priest, or a minister, this type of TB would be fatal.

These beliefs frequently occurred in conjunction with a Christian belief as well as a recognition of the need to seek help from the hospital. Consequently, there were many influences at work and the combination, especially of medications, could be counter-productive and sometimes dangerous. Additionally, the effect of TB on the family was far-reaching as there was a general reluctance to marry into a family where they had suffered this disease. Also, it was unlikely that the patient would be able to find work, support or contribute to the welfare of the family, or be involved in any local matters and the family would lose respect within the community.

I conclude that it is essential that the population is educated in basic facts about the disease, the availability of free drugs and treatment, together with an understanding that Western medications will work if a diagnosis is made at an early stage and the treatment followed through completely. Additionally there must be an increased awareness in the importance of a proper diet and sanitation. Most importantly though, all who have an influence on local thought and behavior should strive to change attitudes towards the supernatural forces believed to be at work here and encourage the use of effective medication.

My work showed me that there are many variables and I had to narrow down my research area to just Mampong, as well as adapt my original plan to include an understanding of the supernatural beliefs here as I sought to explain the stigma which is blocking any serious attempt to counter the spread of the disease.