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Taboo Health Issues Around the World

Yellow hazmat suits against a green background. | Thomson Reuters Foundation

Many treatable health issues are plagued with taboos that prevent people from seeking treatment. While an ailment could be stigmatized in one country, it could be “the norm” in another.

Below we look at five common health issues and learn about the taboos that surround them, plus some culturally sensitive approaches that could help increase treatment rates.

Mental Illness

Prescribing 15 minutes of television a day may not be the most orthodox method of curing depression, but for Vrunda, a recent widow in Goa, India, who endured months of panic attacks, lack of sleep and loss of appetite, it was a life-saver. "At first I didn't even have the desire to turn it on," she explains, but after a few weeks of regular sessions she became interested in programs, and in turn, in her life. Her counselor, Subhash Pednekar, was working at a call center in the region famed for its palm-fringed beaches when he saw an ad posted by a local organisation seeking graduates interested in becoming mental health counselors. He was one of 40 chosen to take part in the program, and from that group, one of 12 selected to work as a counselor in an innovative project using lay people to treat patients with depression. According to a 2011 study by the World Health Organisation (WHO), India has highest rate of depression in the world, with 36 percent percent of the population reporting a major depressive episode. Symptoms are a combination of depressed mood, loss of interest, insomnia, fatigue, feelings of worthlessness and suicidal thoughts among others. Despite the severity of the problem, India only has around 3,500 trained psychiatrists — one for every 200,00-300,00 people. This is what is referred to in the language of mental health as a ""treatment gap"". To deal with this, Dr. Vikram Patel, of the London School of Hygiene & Tropical Medicine, co-founded Sangath – a Goa-based NGO that trains anyone with a high-school degree to recognize symptoms of depression and administer counselling treatment. They operate out of a local health clinic. People who are clearly suffering are sent to mental health workers. They are then screened for depression and offered two months of home-based counselling. Sangath is part of a global movement towards community mental healthcare as an answer to the developing world treatment gap. With depression on track to be the second leading cause of disability worldwide by 2020, according to the WHO, interest and investment in such programs is increasing. Patel believes that developed world practitioners could take lessons from such programs as well. This short film introduces the Sangath approach through the experiences of Vrunda and her counselor, Subhash.
Counselors on Motor Bikes Fight Depression in Goa

Mental illness covers a wide spectrum of conditions and treatment is a complicated issue. Depression is the leading cause of ill health and disability, according to a recent study by the World Health Organization (WHO), with more than 300 million people living with this disorder worldwide.

Some regions are more accepting of mental health in mainstream conversation, such as some areas of Europe and Scandinavia, where citizens are more open about taking psychopharmacological drugs and visiting a mental health practitioner.

India, on the other hand, is deemed one of the most depressed countries in the world. The WHO found 36 percent of India’s population has reported a major depressive episode. Mental health practitioners, such as a group of counselors on motor bikes, are starting to break the taboo around the topic by adopting talk therapy as a way of working out problems. However, there are not enough psychotherapists to service the number of people who need the help in low-income countries, where the average amount of therapists is one psychiatrist per every 1-2 million people.

Chen Wei was a successful businessman until he was diagnosed with bipolar disorder in 2003. Not happy with the services available, he founded China’s first support group for people suffering from depression. In a country with widespread stigma around mental illness, it was a difficult move. His parents feared for his future. But the needs are great: some 6 percent of China’s population of 1.2 billion people suffer from depression. “I think that maybe in 30 years, the public will be well educated about mental illness. They will know how to deal with it just like they do with a cold”, he said."
Shanghai Tulip: Breaking China's Mental Health Taboo

People in China, also view mental health issues as something shameful. Businessman Chen Wei decided to form his own support group after seeing the lack of resources available for the more than 1.2 billion people suffer from depression in the country.

The U.S., ranked the third most depressed country in the world, doesn’t fall too far behind India or China. Many employers restrict employees from using sick time for “mental health days” and tend to deem an employee as being unfit to work after a stay in an institutionalized mental facility. (See why this boss's response to a woman's mental health day transparency went viral.)

Globally, we are beginning to recognize that mental health should be addressed, rather than stigmatized. The World Health Organization’s recent year-long campaign was themed “Depression: Let’s Talk” to create awareness around mental illness worldwide — and the need for treatment.

Female Genital Circumcision

Female genital circumcision, cutting, or female genital mutilation, is the practice of ritualistic cutting to remove all or a portion of a woman’s outer genitalia. There are different types of cutting and different reasons for it, including rite of passage, group identity, and preservation of virginity. The reasons depend on varying cultural, and even tribal factors specific to that ethnic or cultural group.

The circumcision is said to be very painful and often performed without anesthesia or proper medical care. Women who have been cut face increased risk of infection and pain during childbirth or intercourse, and it can even affect the prenatal health of a baby and the delivery process.

The practice (typically performed by elderly women) is taboo in Western culture but supporters view cutting as the masculine counterpart of the male circumcision. People who approve say it is a purifying and sacred initiation practice into womanhood, linking a wife to her husband and his family. Cutting is practiced among various religions and is more common in numerous Northern and Central African countries, as well as parts of the Middle East and Asia. A survey in 2015 from the Population Reference Bureau claims 80 percent of Egyptian female teenagers still conduct female circumcision.

FGC is facing a growing opposition and the members of communities who traditionally practiced cutting are beginning to speak out against it. As older generations who fervently believe in FGC begin aging out, this number may to decrease as younger generations become more independent and less tradition-oriented. Policymakers are taking a stand against the practice as well, as 43 countries have banned cutting.

However, government restrictions do not mean FGC will be stopping anytime soon. Cutting also occurs behind closed doors in the Western world, with more than 500,000 women in the U.S. determined to survivors or at risk every year. In the U.S., California has the highest rate of women at risk of being cut.

The World Health Organization has called for the immediate eradication of FGC urging all citizens of the World to stop this practice.

Menstruation & Childbirth

This film chronicles the story of Somali woman Farhiya, who after giving birth at the age of 17 developed a painful, life-threatening and embarrassing condition called fistula common among many women giving birth in developing countries without strong medical support. The condition affects 2 million women around the world, mostly in Africa, according to the World Health Organization. Fistula was virtually eradicated in developed countries in the 19th century, following the discovery of Cesarean section. Women like Farhiya are ostracized in their communities and forced to live a life in hiding and in pain which could be changed by a simple surgery but are often not financially stable to afford the surgery or don't know such a surgery exists. Farhiya was able to get the surgery in a refugee camp hospital and now lives a happy, empowered life. She also tells viewers of how she gave birth while fleeing her home hearing machine gunfire overhead. Her husband later divorced her for having fistula claiming he could not have a relationship with her. Farhiya now lives in Kenya in Dabaab, which at the time this film was made is the world's largest refugee camp with her two young children.
Farhiya's Story: Free From the Shame of Fistula

There are cultural stigmas around other aspects of women’s health as well, such as the use of birth control. Another aspect of women’s health that remains taboo is menstruation, which forces women into quarantine in some countries. Women in countries including Nepal are not allowed to carry out in their day-to-day activities, such as attending school or working, because they do not have access to menstrual health products. The Nepalese menstrual hut, or chhaupadi, came under scrutiny in 2016 because a woman died due to smoke inhalation from a fire burning inside the hut. Another woman died from a snake bite inside a menstrual hut in July. Although the practice of menstrual huts was banned in Nepal in 2005, new enforcement practices have been put into place by Nepal’s government to criminalize the banishment of women during menstruation. As of August 2018, anyone who forces a woman into a menstrual hut will be sentenced to prison or fined $30.

Childbirth-related injuries are also taboo in many countries. Shame forces many women to endure painful and debilitating conditions, such as bladder incontinence, post-partum depression and psychosis, and fistula, a condition that was virtually eradicated in the 19th century but still plagues women in rural regions. This “Trust Docs” documentary follows a woman who was exiled by her community but found refuge in a program that offers shelter and treatment.

Viral Infections

Sorie and Sewa are from the same village, Kebala, in Sierra Leone, they and Yokie are best friends. The three young men came to Freetown together to study as student nurses. When the Ebola epidemic began, they were given the option to work in the “red zone” – the Ebola isolation unit at Connaught Hospital – and agreed, despite the danger. Their family and friends disowned them and they were thrown out of their lodgings but were able to share a small room at the hospital. Trained to wear the full PPE protection suit, they set to work treating very sick and infectious Ebola patients. They worked the night shift and often lost 5 or 6 patients a night. Sorie describes many patients gripping him tightly until the moment they died. One night, Sorie had an accident that affected all three of them. This video, filmed on the day Sierra Leone was declared Ebola-free, tells the story of the three nurses who survived Ebola.
Three Best Friends Fought and Survived Ebola in Sierra Leone

Viral infections, which range from a common cold to the potentially deadly HIV/AIDS, are surrounded by taboos, especially when knowledge about causes or treatments is vague. The region of a viral infection’s origin can be perceived as being unclean or dangerous for a long time after authorities deem them safe.

The Ebola outbreak in West Africa is an example of the stigma that formed around a virus and region in the developing world. Though the local community lacked access to funds for prevention measures and sterile health facilities, those on the frontlines faced it head on. A “Trust Docs” short documentary tells the story of three young men who decided to help by working as nurses at an Ebola clinic. Although they all contracted the virus themselves, they all survived and stayed committed to helping those infected despite the discrimination they endured.

Aging

Caring for the Elderly

As the world’s life expectancy rate increases, it is important to take a deep look at how the elderly fit into different cultures and societies. By 2020, the number of people aged 60 years and older will outnumber children younger than 5 years old. By 2050, the world’s aging population will double in size. 

The need for assisted living programs is growing as the world changes. Western societies are reporting higher rates of people entering palliative care as the population of elderly people rises, families are having less children, and people are moving farther away from each other for work purposes. Japan, which has a strong tradition of older parents living with children, is the only country where the proportion of the population aged 60 years or older exceeds 30 percent. But even here, the number of multigenerational living arrangements is changing, according to a world report on aging.

The face of deadly disease is changing as well, as the rate of people dying from long-term, chronic disease is growing over the rate of people dying from sudden, acute illnesses. Cultures need to prepare to care for these continuing diseases more effectively in medical facilities, nursing homes and private residences, advises the WHO, and warns, “The preconceived notions and arguably disconnection we as societal participants conduct could be putting us at a loss to truly connect with the elderly.”

Learning more about other cultures provides us a richer backdrop to form educated opinions about how we and other cultures address health issues.

If you are inspired to take action, you can support programs that address health issues around the world with cultural sensitivity, such as Afripads. The program provides menstrual supplies to those who need it. Femme International also accepts donations for kits for women and girls in East Africa who need menstrual care.

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