La Maladie

Reflections on HIV/AIDS from Gabon


Koumba had no place to turn. Her natural beauty would save her in this hour—or so she thought. As a young girl growing up in the village of Bongolo in southern Gabon, she had always been told that tonton (a familiar term for “uncle”) would one day be her mari (husband). Even at the age of two, her mother told her, “Voila ton mari, Koumba” (“Here is your husband, Koumba”).

Koumba saw that her uncle had a wife, or at least someone who prepared his meals and kept their house in order. However, he seemed to leave their family compound frequently at night. Nonetheless, Koumba was content to leave the details of tonton and mari to the future. Her life in school, at her mother’s plantation and at home occupied her most of the time.

But when Koumba turned 16, she was no longer considered a child, and she had to find work. Her family was poor. Koumba’s father, a polygamist, lived in Libreville with a second wife, called “the rival.” Koumba’s mother was sick and couldn’t maintain her plantation. Koumba had to find her own means to pay for tuition and books.

Unholy Matrimony

Karim, a local merchant, had recently moved to the nearby town of Lebamba. Whenever Koumba bought something at his store, he would waive the bill or agree to let her family pay at the end of the month when other relatives would give them money.

School was swiftly approaching, and Koumba had no money for tuition. Karim asked her one evening if he could visit. Koumba’s grandmother was delighted when Karim arrived in his new truck. Curious heads peeked from behind mud brick walls, grapefruit and palm trees and piles of firewood or garbage. Koumba was wearing tight-fitting clothes, just like what she had seen on television.

Tonton was forgotten that night. Karim’s request turned into an affair. Soon he provided money to build a cement-block house for Koumba. Her grandmother’s pockets too were filled with extra francs; she would no longer have to labor as hard at the plantation. Koumba was nicely supplementing the family income.

In this way, which is commonly accepted in Gabon, Koumba was able to pay her school fees. Additionally, one of Koumba’s professors, Mr. Toundou, had been very friendly to her. One evening after class, he invited her over. Several conversations extended into all-night visits. Early in the morning, Koumba would make her way home. Neither her mother nor grandmother asked where she had been. New clothes, extra groceries and excellent marks were the reward Koumba and her family gained.

Uncomfortable Questions

For the remainder of the school year, Koumba saw Karim and Mr. Toundou, along with a few other copins (male friends) in succession. One copin was often not aware of the other. When Koumba had an absent menses one month, she went to the local clinic, where the nurse confirmed her first pregnancy. Koumba was afraid. What would Karim think? What would happen to her studies? What would tonton say?

Koumba knew that certain leaves from the forest could provoke a miscarriage. With the advice of a nganga (traditional healer), she took the suggested dose. Pain and bleeding ensued, so her mother took her to the government hospital in Lebamba rather than the nearby Bongolo Hospital, where too many relatives and acquaintances from the local church worked. Koumba was stabilized and sent home.

One month later, she started to bleed and cramp. This time, her family insisted she go to Bongolo, where the midwife confirmed by ultrasound that her baby was alive. The family doctor asked some relevant but uncomfortable questions and proposed an HIV (human immunodeficiency virus) test. Koumba agreed. When the results came back negative, Koumba was relieved.

She left Bongolo a few days later, three months pregnant. The prayer and advice áá she received were seeds of hope, but her false sense of security from being “seronegative” (negative for HIV) would be her worst enemy. The family doctor prayed for Koumba. But only the Holy Spirit could convict her of God’s truth and grace.

Hope for Change

The high road of holiness is a hidden one for most Gabonese. The epidemic of HIV, AIDS (acquired immunodeficiency syndrome) and other sexually transmitted diseases testifies to a lack of godly discernment. Cultural attitudes toward sex and sexuality are driving the epidemic of HIV/AIDS in sub-Saharan Africa. Couples are encouraged to “try things out” before marriage. Even then, a man may choose polygamy or monogamy at his state wedding.

Social status changes according to a family’s prosperity, and sex is seen often as a means to an end. If a man with financial means is interested in a young woman, parents often push her into his arms to reap the benefits. A daughter’s health and well-being is a small price to pay for material success. Young girls have their copin or mari waiting for them to grow up. Grandchildren and children are coveted at the expense of abstinence before marriage.

Menarche (the beginning of a girl’s menstrual cycle) ushers girls into sexual activity. A friend at the C&MA mission station once asked me to pray for her daughter who had just started having her periods. Her nervous tone betrayed her anxiety over her child’s future. One seropositive acquaintance estimated a 60- to 70-percent sexual activity rate for young women before marriage.

Media provides the loudest voices offering sex education, since it is shameful to discuss sexual relations in family quarters. Parents rarely speak to their children about puberty. A grandmother or grandfather may pass down some of the family “secrets” and cultural traditions. Even most Christian parents don’t explain godly sexuality to their children.

One seropositive acquaintance suggested that people in the city might be more promiscuous. City life and diet tend toward a precocious puberty. Hence, young people engage early in sexual relations. They may have various partners in different areas of the city, lending favors and earning financial rewards. Young men too give themselves to older women who reward them materially.

“Youth live in captivity,” a pastor and his wife explained. Pressure and poverty are the driving factors for them to give up their bodies. My friend said that good parental influence from an early age is the main hope for change.

Under the Influence

The hospital’s chaplain, Pastor Pascal, is attuned to spiritual and cultural influences on our patients. In the past, some believed HIV/AIDS was inflicted on Africa by les blancs (the white people). Many deny HIV/AIDS exists. Because Gabonese suspect an evil source for every illness, some think local ngangas cast spells to cause la maladie (the sickness, referring to AIDS). “It’s bad luck,” others have said passively. Irresponsible sexual behavior as a potential culprit is often denied.

As patients seek medical care on the one hand, they often will also grasp at the witch doctor’s straws with the other. Animism has strong roots. A positive HIV test drives many people to the initiation ceremonies of these gods. The people wear special clothes, dance ritualistically and drink a toxic substance that allows them to live “outside of reality.” As one young Christian seropositive woman told me, the origin of these ceremonies is the enemy, and “[it is the] demons, who are destroying the world.”

In the 1980s, the Gabonese population began to acknowledge the HIV/AIDS problem. However, authorities did not make a deliberate response until the 1990s. Current statistics on seropositivity in Gabon are difficult to obtain, but estimates range from 8 to 12 percent of adults. The government response to the crisis has been positive, but slow to get off the ground. An ambulatory treatment program that distributes antiretroviral medications (ARVs) is functioning in Libreville and four other cities around the country. The United Nations, French Red Cross and some other nongovernmental organizations (NGOs) have made ARVs available to some Gabonese for a moderate fee.

Gabonese citizens living in rural areas, however, cannot afford the cost of trips to the city every few months for treatment, or the consultation and lab fees required. For those who live in the two poorest provinces in southwest Gabon, a trip to the capital city costs half of a month’s salary. Unless a patient knows someone who has influence or money, it can take up to a month to be seen and treated. The disparity between rich and poor is stark, and most patients’ resources are exhausted within weeks. “With their millions, the rich don’t see you,” a pastor’s wife confirmed, regarding how the well-to-do ignore the poor.

Nevertheless, it is shame that hinders the average seropositive person from receiving the necessary care more than the paucity of resources.

Silence Kills

The Church’s response has likewise been limited and slow to get off the ground. One national pastor lamented, “The Church is doing nothing.” Like the average Christian home, the average Christian church is afraid to speak openly about sex.

There are a few, especially among young people, who are fighting well. Virginity is rare, but a “secondary” virginity through abstinence is a reality for some. For the most part, as one pastor declared, “We stay too far away from practical things.” He congratulates a Christian leader in Libreville who actively campaigns for abstinence among youth, attempting to stem the tide of HIV/AIDS. The Minister of Health apparently supports his work, as do external agencies.

It is not just fear of AIDS, however, that should motivate a godly generation to preserve its virginity. Christians must desire to live for the holiness of God, a God who in His goodness and grace chose to wash us for our sin. When Gabonese Christians see life—including sexuality—as a treasure, they will pour theirs out at Jesus’ feet rather than waste it on the world. Christians have a crucial role to play in preserving godly sexuality—the single, the celibate and the married.

In Gabon, the crisis of HIV/AIDS looms. Christians in North America may help stem the tide by supporting the national church and by helping Bongolo Hospital establish its own HIV/AIDS clinic, complete with a well-trained and loving staff, modern laboratory tests and ARV treatment for even the poorest of patients.

Pastor Pascal envisions starting a committee of people who have a burden for families, youth and seropositive individuals. Money, however, is scarce. Christians who can fund training programs for Gabonese chaplains and pastors will in turn impact this church, community and country. Praying that God will enable the church of Gabon to shine into the lives of HIV/AIDS patients the bright hope of God’s love, forgiveness and redemption through Christ may be the key to a major breakthrough.

Koumba does not realize yet that the “most excellent of men” is waiting. Until she is willing to hear His call, she will continue on her self-destructive course. Meanwhile, the angels’ tears mingle with the Lord’s as He looks on this corner of the jungle called Bongolo. Are there any who will understand, any who will seek Him?

Deadly Diagnosis

Generational sexual behaviours have paved the way for the spread of HIV/AIDS in Gabon. Although most of our patients at Bongolo Hospital are diagnosed between 20 and 50 years of age, the disease spans all ages.

Many patients have the test done elsewhere but want to see if Bongolo Hospital will confirm the result. Many even refuse to donate blood, afraid that their preliminary exam will be positive. Declaring the truth about individual HIV status is the greatest barrier to healing.

To be diagnosed with “la maladie” is a death knell for many patients, some of whom are traumatized, rejected, abandoned by their families and treated as lepers. Many Africans still believe that living in the same house or touching someone even by a handshake may transmit the infection. This further isolates these lonely people.

Children are especially vulnerable. Unless a compassionate relative decides to care for them, family members may leave a child to die. Some parents refuse to “waste” the little resources they have on a sick child. People withdraw from them “little by little,” a pastor’s wife said.

During one of my first attempts to disclose a positive test result, the woman collapsed onto the floor, wailing. I ended up running to get African colleagues for help! That visit, traumatic for both patient and doctor, triggered a more comprehensive team approach involving a nurse consultant and our Gabonese chaplain.

We tell outpatients of test results as soon as possible, usually during their hospitalization and as they are recovering under treatment from opportunistic infections. We wait to notify parents of seropositive children until we begin to see clinical improvement. If we state the diagnosis prematurely, patients or parents may flee, not giving us a chance to intervene at a medical or spiritual level.

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