Kendall Burr and Dr. Willis Fails, Spanish and Portuguese
Mozambicans only partially understand the nature of malaria, AIDS, and cholera, and I attempted to identify the major misconceptions they have regarding these three diseases. Their perceptions of how they are contracted, avoided, and treated are critically important to health awareness educators in the growing effort to combat these diseases. I found as my project progressed that my hypothesis—that there are several major misconceptions prevalent in Mozambique about these sicknesses—was not as significant a factor as a general ignorance and complete lack of understanding. The problem is not that they have incorrect perceptions of how to avoid and identify these diseases, but that they often have no such perceptions at all.
The aforementioned illnesses pose a serious threat in this part of the world. Malaria is especially common; although only about 1% of all cases are fatal, thousands die because they do not know how to identify it before it is too late. AIDS has become a terrifying reality in Sub-Saharan Africa; about 18% of all Mozambicans aged 15-40 are HIV positive, but most do not understand it at all. Cholera is perhaps the most frightening in the provinces flooded in March 2000, especially due to the fact that since hospitals are few, so getting a victim to an IV is difficult.
I went to Mozambique for two months with the BYU Volunteers program in the summer of 2001. I interviewed Mozambicans to find out how much they know on the subject. I asked questions in four areas to find out what they believe—where each disease comes from, what its symptoms are, how to prevent it, and how to treat it once contracted. The questions were openended, posed in such a way as to avoid any “expected response” errors and to get to the heart of what they actually believe. All communication was in the Portuguese language, and since it is a second language both for interviewer and interviewees, my advisor assisted me as questions arose. A significant concern had to do with correctly phrasing the question differently for diverse levels of education and fluency in the language; for example, few Mozambicans had a correct understanding of the word sintomas (“symptoms”), and it was difficult to select a uniform way of phrasing this concept in terms simple enough to be understood by all.
Transportation difficulties were also difficult. One of the demographic categories I intended to study involved proximity to the city. I had resolved to interview 50 people in the urban center of Maputo, 50 people in the surrounding suburbs, and 50 people in rural areas. However, I quickly learned that transportation out to the rural areas was very time-consuming; also, once I got out there I was obliged to walk much greater distances between their huts, and since most of them worked in the fields they were often not home. I discovered I was able to conduct about 5 interviews per hour in the urban areas, about 2 or 3 in the suburbs, but often less than one per hour out in the rural areas. As time became scarce I often considered doing less interviews in the rural areas, but I was able to organize my activities to be able to allot sufficient time to complete the number I had originally planned.
Another consideration had to do with the ability of those interviewed to speak Portuguese. Over half of all Mozambicans do not speak the language, and most of these are among the older age groups. Since I was in the province closest to Maputo, I dealt with a slightly more educated sample of Mozambicans; however, most of the elderly Mozambicans that I approached had little or no proficiency in the language. I attempted several times to have someone interpret for me— most of the people in the Maputo province are born speaking Changana—but although all parties were generally willing to participate, I seriously doubted how accurate the translated responses were, and decided to limit my research to only Portuguese-speaking interviewees. Since my attempt is to make a generalized analysis of all Mozambicans, it is correctly assumed that the health awareness among non-Portuguese-speakers is significantly less than those interviewed; however, the degree to which this is true can only be speculated. This factor also significantly affects the accuracy of the health awareness data for the highest age bracket; since those interviewed over the age of 45 represented only those who knew Portuguese, and represent only the few most educated within this category.
A final concern dealt with how to analyze the data. All responses were qualitative, and to conduct a comparative analysis it became necessary to convert these responses to a quantitative scale. I knew this would be problematic from the beginning, since I was not sure what to expect beforehand and could not develop a quantitative system before interviewing. I resolved to simply take extensive notes from the interviews, so as to accurately represent all responses as communicated by the interviewee. After all interviews were completed, I had a better understanding of how I wanted to quantify their responses, and was able to do it all at once. I decided to give twice as much credit to correct responses to the question regarding how to avoid the disease than to the other three questions, since I believe it to be the most important. Most responses merited partial credit. I then calculated a percentile score for each disease, for each person, and then for each demographic group. The three categories were gender, community (urban, suburban, and rural, as explained above), and age group, which I divided into five categories (9-15, 16-25, 26-35, 36-45, and over 46). I understand that my system for quantifying the responses introduces much error into the data, due to the arbitrary nature of the system and the significant possibility for lack of uniformity in the designation of points allotted. However, I am confident that I conducted the process as accurately and uniformly as possible, and feel that the system I chose was the best option to pursue.
Upon synthesis of the data, my results did not show many common misunderstandings as I had expected. They revealed instead that they simply either knew or did not know about the diseases. There were also interesting results for the demographic groups. I had expected a large discrepancy between the genders, due to the severity of the patriarchal society there (women have far less educational and career opportunities), but I found no such difference in their health awareness; women often knew much more than men. Age differences were also less than expected, but one must remember the importance of the language barrier in this category, as previously discussed. By far the most significant factor was their community; those in urban areas averaged a score of 70 (meaning they correctly answered about 70% of the questions, according to my conversion scale), those in suburban areas scored around 50, and those in rural areas about 25. Since about 80% of all Mozambicans live in rural communities, the significance of this difference is obvious. In all, my research concludes that health awareness education in Mozambique would most improve by focusing on rural communities.