Swanson: What is a good working definition of the term health evangelism?
Wangai: The word evangelism simply means the sharing of the good news that you don't have to be what you are. Health denotes the total-life concept. I like a modified form of the World Health Organization's definition of health as the physical, mental, and social well-being of the individual. At its best, health evangelism means passing to others the knowledge that will enable them to enjoy life to the fullest.
Swanson: How do you pass on to others the knowledge that makes it possible to have a happy life?
Wangai: We need to show others life at its fullest so they can be attracted by its beauty and can appreciate the need to realign their lives accordingly. When I was younger, I used to ask God for many things so that I could enjoy life. But God gave me life so that I could enjoy all things. The key is for people to realize that health is what we enjoy while we are on our way to that which God is preparing for us to enjoy.
Swanson: What specific problems have to be met to practice health evangelism in the Third World?
Wangai: First of all, the disparity between the urban and rural settings. By and large the urban people in Third World countries no longer have the cultural restraints they grew up with, yet they are not fully Western. They are in-between. We see problems of all sorts that you see in any developed country— drug abuse, alcoholism, tobacco use, and so on. In the rural setting, the basic pattern of infectious diseases is as common as Western degenerative diseases, but the types of infectious diseases differ from what you see in the Western countries.
Swanson: Give an example of these differences.
Wangai: One of our most common childhood tumors, for instance, is Burkitt's lymphoma, which is associated with a virus that spans the malaria belt. Because we don't have malarial mosquitoes in Western countries, we don't often see Burkitt's lymphoma in the West. The challenges are different in the Third World.
Swanson: From your observations, what kinds of things have been successful in Third World health evangelism!
Wangai: Third World health evangelism must take into account the cross-cultural context. In most developing countries, because of their cultural roots, people have developed an appreciation for, and are quite successful at, detecting cause-and-effect relationships. This in turn enables them to incorporate the concept of powers in their life patterns.
In the developing countries, therefore, for any message to get across, it must appeal to the heart as well as to the mind. Too often the gospel has been addressed to the mind at the expense of the heart, as though Jesus Christ should be conceptualized rather than actualized in terms of power. To the individual in a developing country, if Jesus is not a part of the cause-and-effect relationships that impact upon a person, He remains an interesting but very irrelevant figure. Culture has prepared us Third Worlders to comprehend Jesus Christ, whose name is above every other name.
When we go into an area, for instance, we might meet what you call a witch doctor (we call him a traditional medicine man) and get him on our side. Then he tells his own people, "You know who I am. I'm a traditional medicine man, but these people are talking about a stronger Power. Their message exceeds what I offer." By just that one endorsement we have an entire village willing to listen to the message of Christ.
Swanson: Based on traditional mission stories, the idea of working with a witch doctor seems a bit radical. Is this a new concept!
Wangai: There are two types of traditional medicine men, both of which are called witch doctors. One type of traditional medicine man is basically a curative person. The other is a diviner who supposedly keeps the evil powers at bay and harnesses the good powers. We can work successfully with the former, but not the latter.
Today the medical boards of many countries recognize and certify traditional medicine men. Many countries now recognize that one has to work with traditional medicine men.
For instance, we don't have any proper treatment for asthma. But in many areas in my country particular herbs have been used to produce a complete bronchial dilation. Asthmatics go free of attacks for five, six, or seven years. Even modern Western medicine hasn't been able to do this. So we need to cooperate. We can teach the traditional medicine men of the Third World, and we have something to learn from them. We need to work together.
Swanson: Sanitation is a problem for people from the rural part of the Third World. What kinds of approaches to this problem would be successful?
Wangai: In one area that I visited, some of the people were pushing to build toilets to manage waste, keep off flies, and so forth. They gave incentives for building toilets, and people did build them. Six months later we took stock, and all the toilets were nice and clean. We did a survey to find out how many people were using the toilets, and no one seemed to know where they were. They were totally unused. Again, being aware of the cross-cultural context is not merely desirable—it is mandatory.
Swanson: Was this a matter of giving the people something without showing them how to use it, or was it more a cultural problem?
Wangai: It has to do with showing people why they have to do something. It is a matter of convincing them that it's for their own good, not leaving them with the impression that it's just for the good of the government, the good of the church, the good of the missionaries, or whatever. Within their cultural back ground, people must be able to perceive something as being for their own good.
Swanson: You mentioned cross-cultural approaches. Do you have any other approaches that you think are helpful?
Wangai: We have to start where the people are, start with what they know, and build upon it. Too often we bring in a lot of information and forget that in Third World countries the pattern of problems is different. While human nature is the same and man is the same, the expression of human nature changes from place to place.
We have to build on what people know, and that means working with the people who are there. The time is far gone when the missionary can do the work of 10 people and be a jack-of-all-trades. Today we don't want a person who does the work of 10, but a person who puts 10 local individuals to work among their own people. This is the key to success.
Swanson: When you go into a community that has not had any previous exposure to health evangelism, what should you do first?
Wangai: Find out what those people perceive their needs to be and satisfy them. In one area in North Africa, for example, in a totally Islamic setting, we saw that the people needed to change their lifestyle. But people who had tried to help them before had failed to effect change there.
As we surveyed the area, we found that the perceived need of the people was for a meetinghouse where the men could chat and socialize and just have a nice time. The only way we could have a successful program was to begin by building a house. After that, the people were willing to listen to anything else.
Their perceived need was not our goal, but when we satisfied their perceived need they were really open to what we had to tell them. Then we were able to change their lifestyle in terms of sanitation, environmental health, personal health, infectious diseases, malnutrition, respiratory illness, and these sorts of things.
Swanson: What impact does the provision of such services have on people?
Wangai: They see that you have their best interest at heart and that you're not just trying to change them and make them who you are—if you are Eastern, Western, or whoever you are. They want you to keep their best interest at heart.
Swanson: Is there a great deal of suspicion about representatives from the developed countries?
Wangai: For a long, long time many people in the developing countries have been used as guinea pigs, as pawns in a chess game played by the superpowers.
Now they are asserting themselves. They are saying, "We're somebody, and we want to be treated with respect and dignity. People need to respect us as such." This underlies the rise of nationalism in South America, Inter-America, Africa, and Asia. People want to be recognized and accepted. They're saying, "Hey, we belong to the brotherhood of man."
Swanson: What impact have lifestyle practices of developed countries had on those of Third World countries?
Wangai: In 1958 the medical journal of my country reported that there was not a single documented indigenous case of appendicitis or diabetes in the country. All of those who had these diseases in my country were expatriates. As a matter of fact, we thought we had genetic protection against the Western degenerative diseases.
Today throughout the continent we have several million diabetics. Appendicitis is one of our most common abdominal emergencies. People have patterned their lives after the Western model. They think, "Anything White is right," and "If you're Black, get back." Rather than going for the natural foods, many are now going to McDonald's, just like Americans. Even in the remotest areas of Africa, people are turning toward Western habits because they think they are right. Tobacco use, for instance, is at an all-time high. This, I think, is a tragedy.
Swanson: There seems to be a trend toward .strong advertising of tobacco in the Third World countries. What can be done about this?
Wangai: In my country, Kenya, the government has done a beautiful thing. It has banned tobacco advertising and mandated that warning labels be put on cigarette packages. In developing countries cigarettes contain at least twice the nicotine and tars that an identical brand in the Western world contains. A cigarette purchased in Nairobi contains at least twice the nicotine and tars as one of the same brand bought in Tokyo, London, or New York.
In these areas, information on the dangers of tobacco use is not as available to the community as it is in North America. We must educate through the media—through television, but especially through radio. (Radio is popular because it is regarded as a status symbol.) The message must also be communicated through magazines—in both English and the local languages—and through health education materials, such as audiovisuals.
Swanson: How do you communicate to Third World people that smoking now may affect their health 20 years from now?
Wangai: This same problem exists all over the world. Everybody values a life free from hurt, free from hunger, and free of inconveniences. Oftentimes people in the developing countries have experienced a lot of hurt and trauma in one way or another. But scare tactics have not worked well. Fear is short-lived.
Most people in the developing coun =tries believe in God in one form or another. They are very open to spiritual things. They are very open to supernatural and external influences in their lives. You must convince the people that extra power is available to them to overcome life-destroying habits and that health is in a continuum to eternity.
Swanson: In urban settings in the Third World there seems to be a trend toward returning to the old ways. Give us a little background on this.
Wangai: When people become educated and Westernized, they tend to reject their traditional practices. The trend in the eighties has been to get back to our roots, to where we came from. This includes trying to go back to our traditional foods, customs, culture, and modes of dress.
Swanson: Is this trend supportive or antagonistic to health evangelism?
Wangai: I think it is very supportive. Most of the lifestyle trends that we consider undesirable the traditional culture also considers undesirable. Among Hindus the arrival of Christianity and Westerners has resulted in drug abuse, alcohol use, and pornography. But in the traditional cultural setting such things are taboo. So in such a setting, the push to go back to one's roots means to go back to a lifestyle that in many ways is consistent with proper health.
Swanson: You suggested that in establishing health evangelism in a village, taking into account the people's psychology and culture works better than attempting to address immediately and directly their physical needs. Can you expand on that?
Wangai: A lot has been done in the area of the physical, but not in the psychological. In most cases the untouched area of emphasis is man's psyche. People are starving in most underdeveloped countries of the world, and Western countries have been so gracious as to come out in full support and send a lot of grain and assistance. As a token that we all belong to the brotherhood of man, this has been very good. But meeting physical needs is not all that counts.
One village I know of received a lot of grain. In this village, by tradition, yellow corn is thought to cause infertility. Their reasoning goes something like this: "In America the average family has three children. In our village the average family has at least eight children. The reason Americans have few children is that they eat yellow corn. Now America is sending us this yellow corn as a form of contraception." So the yellow corn goes to feed the hens. The chickens are fat and fluffy, but the people are starving and dying daily. The question is not one of the grain, because the yellow com is much more nutritious than the white. If we can break through the psychological barrier that has been erected, we can succeed; that's the approach we need today.
Swanson: How quickly can a person expect to see such changes in people's attitudes?
Wangai: It takes time and a lot of patience. But it will take less time if we will use people who are there and who know the cultural setting. They can break through the psychological perceptions more easily. Healthful behavior and attitude changes are not "instant pudding."
