In Africa, the spiritual world is as real as the material world, if not more real. Spiritual forces are not ethereal and metaphysical, but everyday factors to deal with. Three patients brought this truth home to me this week.

We had been trying for weeks to find out what was wrong with Amina (not her real name). She was fifteen months old and looked bright, but kept having fevers and anemia. Her brother had died at the same age. Finally we discovered that she had HIV. About the same time, she began having fevers again. Unfortunately, she quickly deteriorated and died despite treatment. She started breathing rapidly one morning, was in clear respiratory distress hours later even on oxygen, and died within twenty-four hours.

One of our hardest tasks is telling parents that their child has HIV. Clearly the implications stretch far beyond the simple fact of a terminal illness in the child; HIV is different from, say, cancer. We did confer with the parents and were faced with their different perspective, especially the father's.

The dad, a businessman and a Roman Catholic by upbringing, strongly resisted the idea that an ordinary illness killed Amina. To him, the cause was deeper and more sinister. His family has an ancestral spirit-power, which can give protection and good fortune when it pleases, but can also cause destruction and death. A shrine on the family compound houses the spirit, and rituals keep it satisfied. The father "knows" that it is this spirit that has for some reason been bringing death, though he had his wife move to a far city to escape it. He is not alone, as the villagers also see the hand of the spirit in the sickness afflicting the two babies.

Deborah is only 10 days old and has tetanus. This is her third day in our intensive care unit. Her parents live here in Jos but like most people here they a village somewhere to be their home. After Deborah was born at home, her umbilicus was "cleaned" with oil and rat droppings. Many traditional cultures use some such measures for care. (Remember, it was only 100 years ago that doctors in now-developed countries used harmful folk remedies like bleeding and purgatives).

The result is that Deborah has the dread disease of newborns, one that caused her first to refuse feeds, then to have repeated severe spasms of the whole body. Today she is on oxygen, intravenous fluids, and sedation to try to control the spasms. Yet the family has announced that they intend to take her home to the village, because this kind of illness can't be helped in hospitals. (There is some truth to that, since most babies with tetanus do die here.)

Our acting medical director, Dr. Ushie, the ICU staff, and I were discussing the problem of the planned removal of the child. Dr. Ushie said that one cultural side of the situation is that a relative may have put a curse on the child as a sacrifice to some spirit power. Then the relative would not want the child so far from home, and in a Christian hospital, where the curse might not work. In fact, it is widely understood that many people offer sacrifices of this sort to obtain what they want from the spirit world, whether wealth, or political power, or something else.

A related practice is for the power-seeker to secretly induce the victim to eat human flesh. For example, we were warned in church that some secret society members were giving local school children "sweets" which were actually human fingers. If the unsuspecting victim eats the meat, his soul then becomes the property of the spirit, which may eventually kill him in a kind of reciprocity.

The point is not that some fringe secret society members have these beliefs and practices, but that they are to some extent part of the general belief system, whatever his religion or educational level. The animistic view runs very deep.

The final example of the week was a happier one. Baby Joshua had a fairly serious case of pneumonia. On morning rounds we noted that he was having a harder time breathing though he was already on oxygen. We adjusted his antibiotics and gave a dose of diuretic to try to clear some fluid from his lungs.

An hour later we checked on him and found him even a bit worse, breathing fast and grunting. We agreed we should transfer him to the ICU. The mom, who had been anxiously holding the boy, began wailing and implored us to "do something, please do something for my baby!" With my western, secular bias I told her that we were indeed worried, but that there was really nothing more we could do but pray; we were already doing everything possible.

"Pray for my baby, pray for him right now!" the mother demanded. What a humbling picture of the different world views! I, the "missionary" doctor, was seeing prayer as the last resort when our powers failed, while the mother saw it as the first source of power. I'm sure our failure to pray seemed to her like forgetting to give antibiotics. What a challenge to me to ask whether I really believe what I claim to believe. Is God really in control? Then why am I anxious? Does he hear our prayers? Then why do I pray so little? Are the deeper realities and values really spiritual, as Jesus said? Then why do I pay so little attention to them and so much to the material world? By God's grace I will learn to see a little more clearly with the eyes of the spirit in the weeks to come.

--Mike Blyth, Feb. '97