Sickle cell anemia is a blood disorder that a patient genetically inherits from parents. Periodic pains and chronic anemia characterize extreme conditions of the disease. This medical complication is brought about by problem in the hemoglobin, which in essence refers to the red blood cells. The hemoglobin molecules take oxygen from the lung to other parts of the body organs and tissues. After the distribution of oxygen, the hemoglobin then takes carbon dioxide back to the lungs for purification. Sickle cell disease affects the normal functioning of hemoglobin in that it clogs together and as a result, give up oxygen. In some instances, the clogging of hemoglobin leads to formation of rod-like structures that stiffen the red blood cells and make them form sickle like shapes. A normal red blood cell is smooth and shaped like a donut. A sickled red blood cell is not able to squeeze and get out of small blood vessels and as a result, form a blockage that in turn cuts supply of oxygen, by oxygen-carrying hemoglobin. This would cause pain occasionally to a person with this implication. Consequently, the blockages can harm body tissues and cause fatal medical problems. This research paper takes an analysis of sickle cell disease in Africa by looking at how African culture either propagates or help in fighting the disease.
At least 10% and an average 20% of the African population living in the tropical regions are carriers of sickle cell trait. In Africa, Akinyangu, (2006) notes that “the homozygous sickle cell disorder (Hb SS) also known as sickle cell anemia is by far the commonest type of sickle cell disorder” (p. 24). Population of the African people in its genetics shows that the elimination of sickle cell trait, (Hb AS) has dilution effect on sickle hemoglobin or the S gene. Mozambique and South Africa lie in the southern sub-Saharan region of Africa that is free from malaria. The prevalence of the S gene is low and this explains why the African population ignores it as a medical problem. On the other hand, the Hb AS prevalence is below 0.3% of the Bantu population but the percentages increase to Bantu regions in the north of Mozambique regions to the north of river Zambezi. According to Akinyangu, (2006), “The 2000-year-old migration of Bantus from western to malaria-free southern Africa is thought to have led to the remarkably low S gene frequency among the South African Bantu” (p. 25). Annually, 200,000 cases of sickle cell disease are reported in Africa (Dapa and Gil, 2002).
Africans are reluctant in accepting that there are high prevalence rate of sickle cell anemia, (SS Hb) following a recent discovery. This belief is because case of SS Hb was first reported in 1910 and since then, many cases of the condition have been reported in America and Europe. Since the SS Hb cases in Africa are rare, Africans downplay the severity of this condition. The low level of SS Hb in Africa was raising curiosity given that the cases were common among African-Americans than native Africans.
African Culture and the Prevalence of Sickle Cell Disease
Despite sickle cell being a fatal disease, the African population does not care about testing for sickle cell anemia because they feel it is not a medical problem. A story by the Atuhaire, (2007) on an uninformed populace finds out that sickle cell test is not a priority for an average person. The author writes that Namara (not real name) did not include test for sickle cell in her routine checkup but out of curiosity, she requested for sickle cell test. “To her shock, she tested positive to sickle cell anemia and negative to all the others. The doctor’s words ring in her mind up to today. “You are a carrier,” he had told her.” (P. 24). Sickle cell disease would still claim many lives in Africa because it is not a priority for the majority. Namara laments about the number of people who could be similar to her and are still not aware of the condition. This lack of general knowledge about the disease is greatest impediment to fighting sickle cell disease in Africa. For a couple in a relationship, the stigma does not end with testing; there is difficulty of revealing bad news to a partner in case one is found to be a carrier. The complexity of the matters lies in the multiplication of problems when one partner fails to tell the other about the disease. Sickle cell is hereditary as mentioned in the above discussion, if genes do not mix well, a couple may give birth o children with higher risks of being sickle cell carriers. “And this neglect and lack of awareness, according to Ndugwa, is the reason many children don’t live through childhood or Namara and many others discover too late and are thrown in a dilemma that would rather have been avoided” (Atuhaire, 2007, p. 24).
The Food Culture of the Africans
African health professionals have established that “many intricate biochemical processes that govern the body can be influenced by the presence of certain vitamins, minerals, or nutrients” (African Traditional Herbal Research Clinic, 2008, p. 17). As a result, the diseases that Africans suffer from result from improper dieting and lifestyle. Whereas the African biochemistry is founded on melanin molecule, the West nations base their study on white body chemistry. These two types of disease analysis are incompatible; hence, should not be used interchangeably. Nitrilosides are found in a range of vegetables, which according to African traditional Herbal Research Clinic, (2008) there are 14 nitrilosides that are well distributed in at least 1,200 plant species. The distribution of plants that contain nitrilosides is even in all corners of the world. In addition, beta-cyanogenetic glucosides are available in 13% of the plant family and out of this percentage, 46% of the plants are found in tropical regions.
Beta-cyanogenetic glucoside compound is hydrolyzed by an enzyme called beta-glycosidase into hydrogen cyanide, benzaldehyde, and sugar. The human food culture is hostile to cyanide and as a result, the Western food technology has tried to do away with derivable cyanide from food processed for human consumption. As much as it is true that nitrilosides contain poisonous cyanide, table salt is another substance that is poisonous because it is a compound made up of chlorine and sodium. Chlorine is also poisonous. However, the two elements are tightly bonded in the two compounds and this negates any danger of licking out. By chewing cyanogenic foods, hydrolyzes great proportion of cyanide as nitrilosides mixes with the b-glucosidase enzyme. Cooking is also an important process in neutralizing and stabilizing the nitrilosides.
Nitrilosides-rich plants include most cereals like sorghum, maize, and millet, field, lima, and kidney beans, and vegetables. Other plants that contain cyanogenetic glycosides are cassava, sweet potatoes, and apples among others. The fact that these foods are consumed across different cultures in the world negates the concerns of poisoning. The African food culture follows traditional dieting that contains nitriloside foods and as such, “Nitriloside-rich plants and foods are a vital part of an amazing biochemical process in the African body type. For centuries, nitriloside-rich plants were used by Africans as a food and medicinal agent without manifesting any side effects” (African traditional Herbal Research Clinic, 2008, p. 17).
Maize, sorghum, millet, and cassava are among staple foods in the African continent and while the Western food culture removed them from their diet, the African biochemistry has been decided by this diet. The consumption of traditional African food is helpful in the control of sickle cell anemia due to the connection between traditional African diet and nitrilosides-rich plants. People with African descent develop sickle cell disease because of a developed natural immunity to malaria. Because of this, the transportation of Africans to other parts of the world through slavery led to development of sickle cell trait that with heavy reliance on nitrilosidic chemical composition of their original native diets. The relocation of the Africans to other places meant that they became deficient of the necessary components that inhibit cell sickling in their blood streams. Study by Robert Huston as quoted by the African traditional Herbal Research Clinic, (2008) found out that “sickle cell anemia could be controlled by cyanate tablets that is also produced by nitriloside plants acting within the body, and it seems logical to assume that this is the way nature intended it to be taken” (p. 18).
Barbra Dixson’s study quoted in African traditional Herbal Research Clinic, (2008) also found out that African prevalence rate of people with sickle cell trait stand at 25% of the entire population yet it is rare to find cases of the sickle cell disease. In the Caribbean regions, the sickle cell disease is also rare given that the populace’s staple food is cassava and yams. Persons with sickle cell conditions live until old age, except for few cases of serious sickle cell implications. The Jamaican diet; for example, is rich in thiocyanate that helps in controlling the disease. Africans are genetically predisposed to sickle cell disease due to the diet composition of the African food culture. The finding of Dixson’s research offer real solution to addressing the sickle cell pandemic, which lies in the nutrition filed instead of the conventional use of drugs, blood transfusion and blood thinning.
Sorghum and millet are staple foods in arid and semi arid areas in the tropical Africa. The foods are still main source of energy, protein and other vital nutrients for the body for the majority disadvantaged groups in the society. The crops grow in harsh climatic conditions without use of fertilizers. Despite the ability of the crops to do well in the tropical regions, Africans shy away from agricultural production of the crops because they are associated with ‘poor people’. They are referred to as coarse grains that are never graded in both local and international markets. As such, there is no guaranteed market in case of over production by local farmers. Other than the negligence of mass production of the crops, the African society seems unperturbed by medicinal value of the plants in the prevention of sickle cell anemia.
African Political Culture
In the wake of new findings concerning prevalence rate of sickle cell disease in Africa, designing and implementing policies to curb the inheritance of sickle cell disease problem. Policymaking requires effective planning and investment in research to address the problem associated with sickle cell disease in the sub-Saharan Africa. “A frequently canvassed quick-fix ‘solution’ has been mass Hb genotype screening of the population and prohibition or discouragement of marriage between couples who both carry the sickle cell trait” (Akinyangu, (2006, p. 27). Adopting quick fix solutions to grave issues in Africa in is the norm, however costly they turn out to be in the long run. This can be explained in that there is lack of adequate financing of research that is critical in designing effective policies. This can be demonstrated by the banning marriages for partners who are both carriers of sickle cell genes. The Military Administrator of Oyo State in Nigeria banned such marriages back in 1995. The prohibition was thwarted since it offended basic human right under the UN charter in which Nigeria is a signatory. Even though the Nigerian authority had strong opinion, that prohibition was the best way of curbing child complication sired by sickle cell carriers, Akinyangu, (2006) observes that no adequate research was carried to substantiate the claim. In addition, nowhere in the world has there been an establishment that selective making is a solution to evading inheritance of medical disorders.
The claim that selective mating as a strategy to resolve the sickle cell pandemic is still wanting because Africans do not understand the complexity of the matter. In addition, skills and resources required to substantiate development of such policies are unaffordable to most governments. Less attention is paid to public sensitization to make the population aware of pre-testing model for efficacy and acceptability in society. However, “A common misconception is that genetic counseling means marriage counseling aimed at directing carriers of the trait not to marry each other choices” (Akinyangu, 2006, p. 28). Political dispensation that aims at addressing the sickle cell disease prevalence in Africa must be relevant. The African nation ought to advance policymaking by engaging relevant stakeholders like health educators. In addition, adequate resource allocation will also be fundamental in preplanning and rolling out effective and tested programs.
The political system in Africa is bewildered with poor resource management, lack of effective prioritization, and conflict of political interests. This makes it difficult to initiate recommendations made by other international bodies like the World Health Organization, (WHO). Report by WHO indicates that African nations through their Health Ministers do not respond to calls by the body to address the effects of sickle cell disease as a public health concern. More attention is given to HIV/AIDS, tuberculosis, and malaria at the expense of sickle cell disease. “Not surprisingly, all international aid is now targeted at these infections and not at sickle cell disorder. Superior professional advocacy is needed to sensitize African governments and the international aid agencies to the need of addressing sickle cell disorder” (Akinyangu, 2006, p. 28).
Lack of political will has lead to emergence of strategic option in the fight against sickle cell disease like the formation of non-governmental organizations. In Nigeria, there is the Federation of Sickle Cell Clubs of Nigeria, (FESCCON) that liaised with other international organizations in Africa to form Federation des Associations de Lutte Contre la Drepanocytose en Afrique. Most of the members of the organization hail from French speaking nations hence the adoption of the name but in English, it translates to Federation of Associations Combating Sickle Cell Disorder in Africa, (FALDA). This approach has immense potential in addressing the sickle cell disease in Africa.
The Culture of Traditional Medicine
Humanity has practiced the use of traditional medicine since the existence of human race. In the modern world, there is growth and sophistication of human experience essential to consider herbal medicine as alternative to appease the populace without being sensitive to their cultural affiliation. Practice of herbal medicine is not considered as mainstream practice by conventional Western and orthodox medicine. However, as Okpuzor, et al., (2008) note “Two-third of the world population (mainly in the developing countries) rely entirely on such traditional medical therapies as their primary form of health care” (p. 47). Treatment of a number of medical conditions in the African perspective takes social, economical and cultural connotations. Africans believe that nature is God’s gift to humankind and that plants should be the main source of healing. As such, they develop crude methods of extraction of plant medicines to cure diseases. Sickle cell disease is among other conditions that have benefited from traditional African medicine, a culture that has helped in keeping the disease at bay.
Low economic power by most developing African countries coupled by the cultural belief on traditional medicine forms good foundation for developing herbal medicine in treatment of sickle cell disease. In addition, most peasant farmers who carry the sickle cell genes cannot afford high cost of treatment of sickle cell disease. Okpuzor, et al., (2008) opine:
In Nigeria and most parts of developing countries, medicinal plants have been used in the treatment of painful crises associated with sickle cell disease (SCD) especially among the lower socio-economic class who cannot afford the high cost of western medicine as well as traditionalists who simply believe in their efficacy.
This offers a chance for the development of African medicine, which is a show of the positive side of African culture in the fight of sickle cell disease. Healers of traditional medicine do not have any scientific knowledge in medicine but they use the power of Mother Nature and traditional skills to address critical health problems in the society. As a result, a lot of research into traditional medicine or herbal medicine has flooded a number of health studies.
Sickle Cell Disease in other Parts of the World
Sickle cell disease does not only affect the African population. From the above discussion, the disease was first noted in Europe and America in 1910. In addition, slave trade that caused transportation of Africans to other parts of the world from Africa spread sickle cell disease. Selective mating was also introduced in Cyprus in an attempt to control thalassaemia but the policy did not work effectively because of stigmatization. According to Godsen and Reid as quoted by Akinyangu, (2006) “This in turn led to widespread denial and falsification of hemoglobin genotype results among the carriers” (p. 28).
Due to the failure of this initial strategy, unlike Nigeria, the Cyprus administration adopted screening and optimal treatment for thalassaemia trait carriers. This treatment involved even healthy carriers through public education sensitization program that involved professional health practitioners. The campaign also involved counseling and prenatal disease diagnosis. The success of the new strategy was able to convince the Church in Cyprus to quit their demand that couples show their health records before joining them in matrimony. Today, they only require a proof that a couple has been screened and counseled for thalassaemia. In this way, the fight against sickle cell disease has succeeded in creating national awareness about the thalassaemia trait. Akinyangu, (2006) observes that “It has been so successful that only 2 of the 71 unborn children diagnosed as having thalassaemia major were born in 1984” (p. 28).
The success of the second strategy in Cyprus can be explained in two main parameters. First, the fight against high prevalence rate of thalassaemia need persistence and continuous application of screening and optimal treatment. On the other hand, the success of the strategy in Cyprus can also be attributed to the small population of the country. Unlike the over 800 million population of Africans, Cyprus has a population size of just 670,000 people. This population is manageable given that the country has well developed infrastructure, citizens have access to essential social amenities like hospital care services and good education. The populace is highly literate if compared to the low literacy level in Africa. All these factors contribute to the success of the screening and optimal treatment of the disease carriers.
In the United States, Reuters reported that patients suffering from severe sickle cell disease could be treated through blood transfusion to limit chances of getting stroke. This optimism was thwarted by the reappearance of stroke risks that was found in New England Journal of Medicine. According to Reuters, (2005) “About 1 in 650 African-Americans and up to 1 in 1,000 Latinos in the United States have some form of sickle cell disease” (p. 13). At least 70,000 Americans are carriers of sickle cell and this places the condition as the most common genetic medical condition in America. The most prevalent types of the disease in America are Akira, SS Hb, and sickle cell anemia. Of the three types, Akira is the most serious, (Reuters, 2005). The failure to contain the disease in America through blood transfusion confirms the power of traditional medicine in the fight of sickle cell disease, which has its footage in Africa.
Culture plays part in the prevalence and fight of sickle cell disease in Africa. There are primitive beliefs that Africans need to drop in order to fight the disease. The importance of cassava, sorghum, and millet among other foods in the fight against sickle cell disease are neglected because of the notion that they are food of the poor. Nonetheless, the foods have been found to have medicinal value in the treatment of not only sickle cell disease but also other diseases. On the contrary, the positive belief by Africans on the power of herbal medicine is a boost to the fight against sickle cell in world. This culture and belief in traditional medicine offers alternative medical solution to the conventional ways of curbing sickle cell disease.
Adoption of Western methods in the treatment of sickle cell disease is not a perfect guaranteed to treatment of the disease because of side effects that they have. Since more scholar in the health profession are waking up to that call of taking research on herbal medicine to the next level, real solution would be found to curb sickle cell disease. However, the critical factors in these endeavors would require the sickle cell disease be studied in isolation. This is because there are different manifestation s of the disease with regions having specific type of sickle cell as the most prevalent or most fatal. The case of sickle cell disease in Africa varies with that in Europe and this explains why different forms of treating the disease have been in use in parts of the globe.
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