Dr. Mary Kay Smith draws a flow chart in her Medical College of Ohio office explaining traditional African belief systems. Her collaborations with Zambians have helped to develop anti-AIDS programs that fit the culture.
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Shortly after Dr. Mary Kay Smith arrived at Kafakumba Pastors' School in Ndola, Zambia, in the summer of 2001, she was told that classes would be shut down for a few days while she taught the students about AIDS and HIV.
Dr. Smith, a psychiatrist at the Medical College of Ohio, had made her first trip to Zambia with a short-term missionary group from Toledo's Epworth United Methodist Church, and was ready to lecture and to provide medical help for the natives, called Baluba.
But she was not expecting to lecture a group of 90 male students from five African nations about AIDS.
"I'm 5-feet tall. A woman. Caucasian. Blue eyes. My hair is mostly blonde. How are we going to connect?" she asked herself.
It became clear, however, that although Dr. Smith was an American woman who didn't speak their language, she and the students at the ministry school had something in common: Christianity.
That spiritual link proved to be the key, Dr. Smith said in an interview this week in her office at MCO.
As the world struggles to find ways to combat the AIDS pandemic in Sub-Saharan Africa, where an estimated 25 million people are living with HIV, the diminutive Toledo psychiatrist said she learned through collaborating with the Baluba that understanding their spirituality is essential to stopping the spread of the disease.
Dr. Smith, director of public and community psychiatry at MCO, earned an interdepartmental bachelor's degree in psychology, chemistry, and biology from the University of Toledo in 1986, and a medical degree from the Medical College of Ohio in 1991.
But when she arrived in Africa, her intention was not just to share her medical and scientific training by teaching and providing medical and psychological care, she also came to listen and learn.
"We have to go where the people are, to learn about their lives," Dr. Smith said. "Then we can come together and find a solution."
While the pastoral students at Kafakumba are Christians, the influence of ancient traditions handed down through the generations remains strong, she said.
In her office at MCO, Dr. Smith enthusiastically drew a flow chart on a whiteboard depicting the traditional African view of life and spirituality.
While the chart, originally created by the Rev. Kasongo Munza, director of Kafakumba Pastors' School, is specifically about the Baluba, it is representative of most traditional African religions, Dr. Smith said.
Differences between African and Western world views are significant, she added, and Americans and other Westerners cannot expect their programs to succeed in Africa unless they are adapted to fit local customs and connect across the cultural divide.
In Dr. Smith's African flow chart, the spiritual world is at the top, with God at the apex. Below God are angels, then spirits.
Spirits are divided into two categories: the good, which Africans consider to be their "benevolent ancestors," and the evil, or demons.
In the physical world, human "diviners" provide a link to good spirits, while sorcerers, or witch doctors, serve as contacts for evil spirits.
Africans traditionally believe that illnesses, including AIDS, can be caused by a number of factors besides natural biological reasons.
Many believe, for example, that AIDS is caused by a sorcerer's curse, or that the disease resulted from a person disturbing their "benevolent ancestors," a critical concern among Africans.
When the Baluba become ill, they usually seek help from diviners first. If that fails, they will go to sorcerers to conjure evil spirits.
A widespread - and deadly - fallacy among many Africans is that AIDS can be cured by having sex with a virgin, Dr. Smith said. Such ignorance only worsens the crisis.
By teaching the scientific and biological factors of AIDS and HIV to students at Kafakumba, Dr. Smith and others have helped erase many harmful myths and superstitions.
"By the end of my classes, I would put any of the Kafakumba students up against any medical student here [at MCO], as far as understanding infectious disease," Dr. Smith said.
When the pastoral students leave Kafakumba, they take their knowledge back to their homelands and to their congregations.
Many conduct informational clinics at their churches based on what they were taught by "Mama Kay," as she is fondly known by the Baluba.
In African society, pastors are the equivalent of "diviners," the humans who are in touch with the good spirits, Dr. Smith said. Since the diviners or pastors are the first ones Africans contact for help, educating them about AIDS can have far-reaching consequences.
But there are many other social, biological, psychological, spiritual, and natural forces that contribute to the pandemic. Attempts to stop the spread of the disease in sub-Saharan Africa must address issues on multiple levels, Dr. Smith said.
For example, she said, one foundational belief among African tribes is that procreation is the most important purpose in life.
When Western groups send condoms to Africa, they typically are unaware of how much importance Africans place on fostering life. The cultural emphasis on procreation is so important that it usually precludes Africans from using condoms.
Many Africans also are resistant to change, fearing any changes that might disturb their benevolent ancestors.
According to Reverend Munza, the preservation of ancestral heritage - land, power, and traditions - is "not negotiable."
By making an effort to learn the intricacies of African spirituality and culture, and adapting her plans accordingly, Dr. Smith is making inroads into developing programs that can
have an impact on the effort to halt the spread of AIDS.
She and several groups from Epworth United Methodist Church are planning short-term mission trips to Kafakumba Pastors' School this summer.
"There is nothing magical about psychiatry," Dr. Smith said. "But we look at the biological, psychological, and social approach. How else would you go about this?"
She shakes her head and smiles.
"I would never have come up with this on my own. That's the beauty of this. This is when you stand back and say, 'Let God do his thing.'●"
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