Culture and tradition / by Fawzia H. Aboo-Baker

Culture and tradition Physical exercise and intellectual effort, a healthy diet and at least adequate living conditions form a balance which some are seeking and others are trying to regain by Dr Fawzia H. Aboo-Baker Technical Adviser to the Regional Director, WHO Regional Office for Africa In this fast-moving world of ours, ways ,!';!![ i:,i'' r:nt:ed d~~ertr:~~~~~ and culture, they tend to come into conflict with the developing processes of our era and with booming scientific progress. Only a judicious blend can help to attain the ideal physical, mental and social well-being of the individual. Different factors become, therefore, prerequisites for our health, while together they reflect our knowledge and heritage. Apart from the spiritual as- pects, three basic items in African life-food, water and environment-taken as ex- amples, help us to understand how these factors affect our balance and well-being. Food Food takes priority even over procreation and protec- tion in ensuring the survival of species. As things stand today, the food situation is highly unbalanced. In the in- dustrial world, more than the necessary 2,000 calories per day are absorbed. Harmful excesses of fats and glucides have, following health education, led to a new market among dietary products : food in tab- lets or dehydrated in bags. On the other hand , the developing countries are still struggling to reach a bare target minimum of 1,000-1 ,500 cal- ories daily. Adult and infants , chroni- cally undernourished, are oscillating W ORLD HEALTH, Aug ./Sept. 1986 between precarious survival and death from famine . What is given as cattle food in the western world would save millions of human lives in Africa. In the aftermath of war, diet has deviated towards an excess of car- bohydrates and fats, while proteins are discredited. Multinationals, leading the ways and tastes of whole conti- nents, have benefited to the detriment of the health of consumers . In Africa, in addition, the colonial powers changed eating habits by introducing excessively fat- or sugar-rich diets . Original drawing by Fawzia Aboo-Baker Proteins have not been neglected, but they were far too expensive for the starving multitude who need them. Fortunately , enough green plants pro- ducing vitamins and mineral salts are consumed. Dietary imbalance and de- ficiencies, apart from the morbidity they bring, are therefore more fatal in Africa than in the western world, where vascular diseases of the heart and brain are the second and third causes of death after cancer. The African's diet is essentially based on root-crops, like manioc, yams and sweet and ordinary potatoes, on bananas, especially plantains , and on cereals like maize, millet, sorghum, rice and (especially in North Africa) wheat. His daily food is pasta, bread, flour, cakes, fried dishes and stews highly seasoned with palm oil. Clearly, although it may be filling, this starchy ·diet is hardly nutri- tious. Marasmus (extreme thinness) and kwashiorkor (caused by a lack of animal protein) are common where manioc and plantains consti- tute the basic foodstuffs for children. These foods may even be poisonous. Unsoaked and unpeeled raw manioc , for instance, can cause neuro- pathies with paralysis of the four limbs, and optic and auditory neuritis with consequent blindness and deafness . Long nerve path- ways of the spinal cord can also be affected , increasing gait dis- turbances and various sensitivity dys- functions . The damage may in some cases be irreversible. While manioc leaves are a good source of vitamin A, they also contain cancer-producing hydrocarbons which can be removed only by thorough washing and pro- longed cooking. Quite clearly, such foodstuffs must 19 be combined with others to ensure a proper balance. It is only through nutritional education that their unde- sirable effects can be avoided by a people who are unaware of the risks and who tend to follow simple and homely traditions. Beverages Blessed or cursed, saviOur or de- stroyer, water is essential to life in Africa. Images of thirst and drought blend with those of lines of women and children bearing water. So much energy and patience is expended on obtaining such a little water; water, moreover , which may prove fatal if those using it do not know that it should be boiled. The effects of con- taminated water are widespread in Africa: skin troubles and diarrhoea , affecting children especially since, all too often, mothers replace the fluids their children lose with the same pol- luted water , thus perpetuating the problem without knowing it. Clean drinking water, though abso- lutely essential, is still hard to find in 20 Africa. The statistics of the WHO's Regional Office for Africa show that , in 38 countries , nine per cent of the rural population and 50 per cent of the town-dwellers had access to drinking water in 1980. In order to provide drinking water for everyone by the year 2000 , supplies will have to be found for 371 million people in coun- try districts and 132 million in the towns. Alcoholic drinks , however , are easier to obtain. Some are traditional brews, others have been introduced during the period of colonialism. Palm-tree sap is made into a wine containing 8 to 9° of alcohol. Spirits can be distilled from maize , manioc and bananas. They are made by pro- cesses that are far from h,Ygienic and often stored in petrol cans. They therefore contain hydrocarbons and become fiery , corrosive beverages which people drink out of habit , for pleasure or to alleviate depression. Ulcers of the digestive system and oral, oesophageal , gastric and duoden- al cancers are very common, as are cirrhosis of the liver, steatosis (fatty degeneration) and hepatitis-which takes a hold on the undernourished and those with deficient immunity. Alcohol, multiple deficiencies and tox- ins cause epilepsy, optic neuritis with blindness, polyneuritis (symmetrical damage to several nerves) with paraly- sis and Gayet-Wernicke encephalo- pathies (cerebral dysfunctions) , result- ing in irreversible dementia. The consumption of " imported " drinks must not be underestimated. Tropical heat is hardly conducive to abstention from beer and whisky, and their consumption may be five times higher than in the "west" . The fact is, beer is cheaper than water. Man lives in an eco-system which he has gradually adapted to his own needs and leisure activities, but which he has also polluted without inhibi- tion. Although there are many sources of pollution, the greatest effect on the atmosphere stems from big chemical industries and, to a lesser extent, from nuclear power. Africa's environment is polluted in various ways. Firstly, there is human and animal waste. For humans , toilet W oRLD HEALTH, Aug ./Sept. 1986 Culture and tradition Left: Even more than disease prevention, it is food that ensures the survival of the species. Wom- en carrying foodstuffs-and their babies-in Zaire. Right: A Congolese woman stoops over her work as she cooks the family meal. The smoke from the five is a strong atmospheric pollutant which she is likely to breathe all her life. Photos WHO/H. Anenden facilities are few and far between, but bountiful Mother Nature is always pre- sent- fostering all kinds of diseases. Housing is rudimentary where it exists . Frequently there may be no- thing more than a straw hut in which no distinction is made between bed- room, sitting room, dining room, bath- room or kitchen. Food is cooked either in the open or in a corner of the hut. The container stands on three bricks and the fire is fed by a mixture of agricultural waste, coconuts and manure. The smoke it gives off is a fierce atmospheric pollutant which ir- ritates the eyes, nose and mucous membranes all the time, every day. They form fertile ground for infections of the respiratory tract and for nose and lung cancers. Women, and the children they traditionally carry on their backs, are particularly affected. Three hours a day are enough for a child to develop bronchiolitis and pneumonia within a week. Infant mor- tality through repeated pulmonary in- fections is very high. Even worse are the effects on the pregnant woman. This form of pollution is even more W oRLD HEALTH, Aug ./Sept. 1986 poisonous than cigarette smoke, and lies at the origin of many spontaneous abortions, premature births, stillbirths, underdeveloped babies and deaths in childbirth. The only inexpensive remedy for this endemic plague is an awareness campaign, whence the need for in- tersectoral cooperation. And the first of these sectors to be concerned are health, housing, the environment and industry. The way of life Health, in the sense of physical, mental and social well-being, depends absolutely on the way of life. The various features of primary health care like education, a healthy environment, adequate and balanced diet, proper · drinking water, protection for mothers and children and the prevention of disease provide the essential basis for our whole life-span. Primary health care is now only a memory for those who have pro- gressed beyond the stage of needing it. There is safe drinking water on tap, there is a microwave oven in a sterile kitchen, television channels can be changed at the touch of a button by remote-control, and frozen, preserved and pre-cooked foods are available from the supermarket shelf. Life has become dull, sad and sedentary, and boredom finds its outlets in tobacco, alcohol and psychedelic drugs. The realisation of this situation has given rise to the "ecology" movement, jogging and other artificial forms of exercise . Our common sense should show us that we must rebuild a rational and healthy life which does not rely on crazes . A judicious mixture of physical exercise and mental effort, a healthy, balanced and adequate diet and at least reasonably decent living condi- tions can all be obtained through mak- ing people aware and educating them so that they can become self-reliant in matters of health and feel responsible for their own lives . Some are still struggling to attain such a balanced existence, while others, having once attained it, are struggling to regain it. • 21