Epilepsy in the Afghan Village
By M. Miles (m99miles@hotmail.com)
Here is another story from the radio scripts that were translated into Pushto and broadcast to rural Afghanistan some years ago. The aim was to alert families to the idea that their disabled members could find ways of playing a fuller and more interesting part in the life of the community. In the story below, the village headman talks about epilepsy, and how they learnt to manage it. This has been slightly revised and updated.
Interviewer: Today we will talk with Malik Abdul Muhammad about one of the health problems of his village: people who have epilepsy or 'fits'.
Malik Abdul Muhammad: Yes, there are four or five adults and children in our community who have fits badly. There might be some more who have small fits that are not noticed. In earlier times it was thought that all these people had a djinn or spirit. Now the modern idea is that epilepsy is just a physical disease or condition, which usually the health worker can treat with the right sort of drugs.
Int: Which of these views is believed in your village?
MAM: Some think one thing, some think the other, and some believe both! People who have more education or have spent a few years in the city are more likely to hold the modern view. They see fits as a medical condition that can be treated. But still the ordinary people are afraid when they see someone fall down, out of control, jerking and twitching his limbs. Some people say there are two different sorts of fits: one sort is caused by djinns, and nothing can be done about it; the other sort of fit is just a disease, and we know that for every disease Allah in His mercy has provided a remedy. I myself used to think that fits were always caused by a djinn, but that's not my view now.
Int: Something happened that caused you to change your mind?
MAM: I will tell you. My cousin has a daughter who used to have fits. Her fits were not of the worst sort. She used to sit down suddenly and her face became blank for half a minute. Occasionally she would soil her clothes with urine during the fit. At first my cousin was ashamed to have such a child. But the girl seemed to be normal in every other way. So once when he visited the city he took his daughter with him and consulted a doctor. Tests were done at the hospital and some drugs were prescribed.
Int: What effect did the drugs have?
MAM: After the girl had been taking them for a few days, the fits stopped. She had been getting one or two small fits every day. After taking the drugs she had only an occasional fit, perhaps once in two months. So after a few months had passed, my cousin said, "The girl is better. Praise to Allah!"
Int: So was that the end of it?
MAM: No. My cousin thought the problem was finished, so he stopped buying the drugs for the girl. After some weeks, her fits became frequent. He took the girl a second time to the doctor. More tests were done. The doctor said that the girl would be okay, but only if they continued the drug without stopping. He also said to bring the girl every six months for a check-up.
Int: That was good advice. The drug must be taken regularly. The person with fits should be examined again by the doctor after some time. How is your cousin's girl these days?
MAM: She's fine now. The drug treatment began four years ago, and I took careful note of what happened. The drug is still working and the problem is under control. So I thought about this whole matter and I became certain that this sort of fit is a medical problem that can be treated. Now my cousin has arranged for his daughter to catch up with her education.
Int: Good. What about the other people in the village, who have fits?
MAM: I sent word to the heads of their families, that they should get those people treated by the health worker. Some of them have done so, but one or two have given some excuse or delayed it. I have called one of the men who used to have fits. You may ask him any question. He is waiting outside. [Calls] Ijaz, present yourself!
Ijaz: Peace be with you!
MAM & Int: And upon you be peace!
MAM: Ijaz, we wish to know whether you are having any problem now with fits.
Ijaz: Praise to Allah, the problem has stopped since I went to the health worker and began taking the drugs he prescribed. Before that, it used to be very difficult for me to work. In my family we are builders and carpenters, and it happened one time that I was repairing a roof. I suffered a fit and fell off the roof and hurt myself badly. On another occasion I was using an axe to cut wood, when I had a small fit which caused me to lose concentration. As a result I dropped the axe on my foot. In those days my family did not want me to continue working, because they were afraid I would have a serious accident.
Int: It was natural for them to be worried! But what was decided?
Ijaz: At first we visited some holy men and hakims and tried the prayers and treatments, but with no success. My family began to think that I had a kind of epilepsy that could not be treated. I was not willing to continue visiting the local practitioners and going to the shrines, because I did not want too many people to hear about my problem. Some of our neighbours used to make nasty remarks about me. On one occasion when I was younger, I had a fight with a man because he said I was mad. It may be true that I was irritable before having a fit, but I was not mad. He had no right to make such a remark!
MAM: That was all a long time ago. People don't say anything about you now. You are a respected builder in this village.
Int: So when did you get some treatment that worked?
Ijaz: After a lot of discussion with the family, my father and my uncle said that I must not work with them in building and carpentry unless some effective treatment could be found. So then I knew that I must see the health worker. First of all the health worker gave me some drugs which stopped the fits, but those drugs made me sleepy, which was a problem when I was trying to work. I went again and asked for some other drug. The health worker told me that I should take the same drug, but less often. He said to take two of these pills instead of three. When I tried this number, the fits stopped, and I did not feel sleepy. So that was the best.
Int: This is important. Each person is a little different from every other person. So the health worker has to balance the number of drugs, to stop the fits without causing any other problem like sleepiness.
MAM: Ijaz, do you know of any other person who has fits?
Ijaz: I know of a boy on the far side of the village who has very strong fits. He is also mentally retarded. The family are hiding him. Even the neighbours did not know that he was there. I came to know about him because the family called me to build an extra room at their house. They had tied up this unfortunate boy in the women's quarters, but he got himself loose and came into the men's side and was shouting nonsense. Then they had to tell me about him, although they were ashamed and wished to hide him. His head was bruised because he often fell down when he had a fit.
Int: What did you say to them?
Ijaz: Well, of course I could understand their feelings, but I told them that there was no reason to hide the boy. They should not be ashamed of him. They must take him to the health worker for some drugs to control his fits. The boy actually fell down in a fit when I was there, and the family stood there and did nothing. I showed them how to loosen any tight clothing he was wearing, and to roll him onto his side and place some cloth so that he would not bang his head on the floor. They said to me, "Are you a builder, or a doctor?" But
I told them that these are simple and sensible actions that any person can do. By explaining it I convinced them.
Int: You did well, Ijaz. Every person should have this knowledge and take these simple actions. Then the problem of fits will be properly managed and the ordinary people will no longer fear the djinns or make nasty comments. The belief in djinns is a traditional part of our religion, and nobody will argue with that. But we know for sure that Allah in His Mercy has provided the knowledge to make these drugs to control fits. It is therefore our duty to use this knowledge for everyone's benefit.
It is true that some children who have fits are mentally retarded, but there are many people who have fits and are perfectly normal every other way. In either case, treatment should be started without delay. In the case of the child who damages his head when he falls, it is possible for him to wear a little turban or helmet made of cloth or leather, to protect the head. But in general the child who has fits should be treated normally, and should go to school and live a normal life. It is not possible for one person to catch fits from another person. There is no reason to keep people out of the normal life of the community, simply because they sometimes have a fit.
Historical-Medical Note (not broadcast) Belief in two different sorts of epilepsy is a strong tradition in many Muslim countries, being traced back to the 'Prophetic Medicine', i.e. collections of sayings and incidents attributed to the prophet Muhammad, concerned with medicine and religion. For example, the renowned teacher Ibn Qayyim al-Jawziyya (CE 1292-1350) produced such a compilation, recently translated and introduced by Penelope Johnstone (1998) "Medicine of the Prophet", Cambridge: Islamic Texts Society. In Chapter 9, "Treatment of Epilepsy (sar`)", al-Jawziyya stated that there are two sorts of epilepsy: "(1) epilepsy from evil, earthly spirits; and (2) epilepsy from bad humours. The second is that of whose cause and treatment the physicians speak." (p.46) Concerning the first sort, al-Jawziyya said that the best physicians can recognise it, but they cannot cure it.
In the context of health education and service in rural areas of a strongly Muslim country such as Afghanistan (or indeed any other country), the task of the rural health worker is not to get into arguments about religious beliefs and traditions, but to offer assistance politely and with a strong basis of experimental evidence. He or she should certainly know what are the principal local beliefs about each illness or condition, and should try to discern which parts of those beliefs can be built upon with a scientifically tested medicine, therapy or technique. In the case above, the belief that one sort of epilepsy can be cured while the other sort cannot be cured, is not necessarily problematic. The tradition concedes that the sort believed to be "incurable" is not easily recognised. This leaves it open for modern anti-epileptic drugs to be tried, even if there is no guarantee of success.
|
