New publication: Environmental and Household-Based Spatial Risks for Tungiasis in an Endemic Area of Coastal Kenya
New publication! I started working on this cool project on tungiasis (jiggers) with colleagues in Kenya and Japan way back in 2014. Today, I am happy to say that after much ado our work has finally seen the light of day, thanks to Nagasaki PhD student (and soon to be Dr.) Ayako Hyuga. It appears today in the journal Tropical Medicine and Infectious Disease (MDPI).
Environmental and Household-Based Spatial Risks for Tungiasis in an Endemic Area of Coastal Kenya
“#Tungiasis is a #cutaneous #parasitosis caused by an embedded female sand flea. The distribution of cases can be spatially heterogeneous even in areas with similar risk profiles. This study assesses household and remotely sensed environmental factors that contribute to the geographic distribution of tungiasis cases in a rural area along the Southern Kenyan Coast. Data on household tungiasis case status, demographic and socioeconomic information, and geographic locations were recorded during regular survey activities of the Health and Demographic Surveillance System, mainly during 2011. Data were joined with other spatial data sources using latitude/longitude coordinates. Generalized additive models were used to predict and visualize spatial risks for tungiasis. The household-level prevalence of tungiasis was 3.4% (272/7925). There was a 1.1% (461/41,135) prevalence of infection among all participants. A significant spatial variability was observed in the unadjusted model (p-value < 0.001). The number of children per household, earthen floor, organic roof, elevation, aluminum content in the soil, and distance to the nearest animal reserve attenuated the odds ratios and partially explained the spatial variation of tungiasis. Spatial heterogeneity in tungiasis risk remained even after a factor adjustment. This suggests that there are possible unmeasured factors associated with the complex ecology of sand fleas that may contribute to the disease’s uneven distribution.” #environmental #kenya #NTD #NeglectedTropicalDisease #parasitology #globalhealth #publichealth
New publication: An urban-to-rural continuum of malaria risk: new analytic approaches characterize patterns in Malawi
12 years in the making! Our new paper from partners at the University of Michigan and the #Malawi College of Medicine on new approaches to defining urban and rural environments in the context of malaria risk is now out in #Malaria Journal.
It was the last chapter in my dissertation to be published (all the rest were published when I was still in grad school.)Short version: malaria is complicated and really local. Malaria transmits poorly in urban and environments and well in rural environments. There’s urban like spaces in “rural” areas and rural-like spaces in “urban” areas, demanding a more nuanced view of what those terms really mean.
We know that malaria is a “rural” problem, but not all “rural” spaces are the same. Even in the country, there are “urban like” spaces and in “rural like” spaces even in the largest cities in Sub-Saharan Africa. Could those spaces impact malaria risk? If so, shouldn’t we redefine what we mean by urban vs. rural to inform intervention strategies to better target resources?
Here, we combine GIS and statistical methods with a house to house malaria survey in Malawi to create and test a new composite index of urbanicity and apply that to create a more nuanced risk map.
The urban–rural designation has been an important risk factor in infectious disease epidemiology. Many studies rely on a politically determined dichotomization of rural versus urban spaces, which fails to capture the complex mosaic of infrastructural, social and environmental factors driving risk. Such evaluation is especially important for Plasmodium transmission and malaria disease. To improve targeting of anti-malarial interventions, a continuous composite measure of urbanicity using spatially-referenced data was developed to evaluate household-level malaria risk from a house-to-house survey of children in Malawi.
Children from 7564 households from 8 districts in Malawi were tested for presence of Plasmodium parasites through finger-prick blood sampling and slide microscopy. A survey questionnaire was administered and latitude and longitude coordinates were recorded for each household. Distances from households to features associated with high and low levels of development (health facilities, roads, rivers, lakes) and population density were used to produce a principal component analysis (PCA)-based composite measure for all centroid locations of a fine geo-spatial grid covering Malawi. Regression methods were used to test associations of the urbanicity measure against Plasmodium infection status and to predict parasitaemia risk for all locations in Malawi.
Infection probability declined with increasing urbanicity. The new urbanicity metric was more predictive than either a governmentally defined rural/urban dichotomous variable or a population density variable. One reason for this was that 23% of cells within politically defined rural areas exhibited lower risk, more like those normally associated with “urban” locations.
Are dogs associated with infections by a skin burrowing flea in Kenya? Masanobu Ono and I with Kensuke Goto, Satoshi Kaneko, mwatasa Changoma just published a paper on #tungiasis in the journal Tropical Medicine and Health.
Most people haven’t heard of tungiasis, an ectopic skin disease caused by the skin burrowing parasite, T. pentrans. It causes itching, pain, is associated with serious secondary bacterial infections, gangrene, social exclusion and debilitation. It primarily afflicts the very young and very old and is found almost exclusively in the poorest parts of the poorest parts of the world. It fits the classic definition of a neglected tropical disease.
We explored associations of wildlife and domesticated animals with household level tungiasis in Kenya using a two stage complex sampling based survey in an area adjacent to a wildlife preserve.
Tungiasis is a ectopic skin disease caused by some species of fleas in the Tunga genus, most notably T. penetrans. The disease afflicts poor and marginalized communities in developing countries. Transmission of tungiasis comprises a complex web of factors including domesticated animals and wildlife. This research explores animal and environmental risk factors for tungiasis in an area adjacent to a wildlife reserve in Kwale, Kenya.
A two-stage complex sampling strategy was used. Households were selected from three areas in and around Kwale Town, Kenya, an area close to the Kenyan Coast. Households were listed as positive if at least one member had tungiasis. Each household was administered a questionnaire regarding tungiasis behaviors, domesticated animal assets, and wild animal species that frequent the peridomiciliary area. Associations of household tungiasis were tests with household and environmental variables using regression methods.
The study included 319 households. Of these, 41 (12.85%) were found to have at least one person who had signs of tungiasis. There were 295 (92.48%) households that possessed at least one species of domesticated animal. It was reported that wildlife regularly come into the vicinity of the home 90.59% of households. Presence of dogs around the home (OR 3.85; 95% CI 1.84; 8.11) and proximity to the park were associated with increased risk for tungiasis infestation in humans in a multivariate regression model.
Human tungiasis is a complex disease associated with domesticated and wild animals. Canines in particular appear to be important determinants of household level risk.
There really isn’t much out there. I found 15 papers on PubMed and Web of Science. I am looking for more.
(Davidson, 1970; Erulu, Okumu, Ochola, & Gikunju, 2018)
I found two case reports. The first was from 1970 documenting a case of a white woman being bitten in Voi when a black-necked spitting cobra (Naja nigricollis) entered her bed at night. She received prompt care of polyvalent antivenom, travelled to Mombasa the next day, received treatment again and was relatively mobile within a week. It too three months for a hole in her foot to finally heal and for normal sensation to return to her toes.
The second documented a bite from a black mamba (Dendroaspis polylepis) in Watamu. A 13-year-old boy presented to Watamu Hospital with labored breathing, frothing at the mouth, severe ptosis, pupils non-responsive with unreadable blood pressure and elevated heat rate. He was administered the SAVP polyvalent antivenom and the boy recovered.
Hospital based surveillance and clinician surveys
(Coombs et al., 1997; Ochola, Okumu, Muchemi, Mbaria, & Gikunju, 2018; M. Okumu et al., 2018; M. O. Okumu et al., 2019; Ooms et al., 2020)
Coombs, et al gathered data from four areas of Kenya using Ministry of Health records. It was found that bite cases varied by region. Documented deaths are rare. The incidence rate of snakebites varied by region, with Kakamega being low and areas like Samburu and Baringo being high. Documentation of snake bites was often incomplete. Many bites were recorded as “Other” in hospital records. Though environmental factors and habitats account for some variation in bite incidence rates, a lack of coordination of health facilities and inconsistent record keeping might also be a factor. Authors conclude that surveillance capacity needs to improve and that community should be educated to identify bites and provide appropriate treatment (i.e. only using tourniquets for neurotoxic bites from snakes like mambas.) Transport and proximity are noted as barriers to treatment.
Ochola, et al. Study on snakebites from four hospitals including Kakamega Provincial, Makueni District and two others. Two year retrospective study of hospital records form 2007-2009. 176 total bites, 91 in 2009. Bites peaked at 1-15 years of age, 132/176 bites occurred on the lower extremities. 49/176 were given antivenom. Most bites occurred in the dry season, in the bush and in the evening. Mortality was 2.27%. Authors found that antivenom was often not available, and use was inconsistent. Patients presented to hospitals 2 to 6 hours after the bite, mostly due to travel distance. 75% if clinicians believe that patients saw traditional healers before arriving at the hospital. Manual laborers at highest risk.
Ooms et al. study of health care workers in three countries including Kenya. HCWs reported that there was no gender disparity in snakebite victims, that most victims are between 21 and 30 and that most people are bitten when conducting farm related activities or walking. Only 12% of HCWs received training in snakebite management. Only 20% claimed that medicines were available. Snakebite incidence occurred in both urban and rural areas of all countries. Half of all respondents claimed that people seek traditional treatments before coming to formal facilities.
Okumu et al Paper on general poisonings. Snakebites are only one part of the paper but make up 33% of all cases that appeared at Jaramogi Oginga Odinga Teaching and Referral Hospital. Antivenom used in 58% of all snakebite case. “Black snakes” accounted for 37% of bites. Victims were not able to identify snake species in 38.6% of bites.
Okumu, 2019 Paper on cost of snakebite treatment. 127 snakebite victims attending JOOOTRH between January 2011 and Dec 2016. Most victims were 13024 years of age, 64 were female, 94 were from rural areas, 92 were bitten on the lower limbs. 49 bitten at night, 43 attempted to self-treat, median time to the hospital was 4.5 hours. Outcomes included cellulitis, compartment syndrome, gangrenous foot, psychiatric disorder and death. 1-5 days in the hospital. Median cost $26. Authors call for public health programs to educate the public on how to identify and treat snakebites.
(Snow et al., 1994)
Retrospective study of 4,712 households. Most bites were not from venomous snakes. Most people identified both venomous and non-venomous snakes as being potentially venomous. 68% of people sought treatment from traditional healers. Authors suggest that traditional healers be integrated int primary health care and hospital-based systems. Household heads were approached and administered a questionnaire in Kilifi and ask to retrospectively report bites. Out of 4,712 visits there were 121 case of snake bite reported, 57% were male. Most were Giriama. 55% were bitten at night. A73% on the foot. 94% bitten outdoors. Only 39% could reliably describe the snake. No deaths were recorded. 79% performed some kind of first aid immediately after the bite. 88% sought treatment, with 78% visiting the healer. Only 29% visited a hospital. There was evidence to suggest clustering of bites.
(Anne-Sophie, Neil, & Aida, 2017; Eucabeth & Augustine, 2017; Omara, 2020; B. O. Owuor & Kisangau, 2006; Bethwell O. Owuor, Mulemi, & Kokwaro, 2005)
(Benson, Mohamed, Soliman, Hassan, & Abou Mandour, 2017; Harrison et al., 2017; Omara, 2020)
Anne-Sophie, D., Neil, D. B., & Aida, C.-S. (2017). Medicinal Plant Trade in Northern Kenya: Economic Importance, Uses, and Origin^sup 1. Economic Botany, 71(1), 13.
Benson, R. A., Mohamed, N. M. A., Soliman, M., Hassan, M., & Abou Mandour, M. A. (2017). Application of k 0-INAA for the determination of essential and toxic elements in medicinal plants from West Pokot County, Kenya. Journal of Radioanalytical and Nuclear Chemistry, 314(1), 23. Retrieved from https://link.springer.com/content/pdf/10.1007%2Fs10967-017-5370-3.pdf
Coombs, M. D., Dunachie, S. J., Brooker, S., Haynes, J., Church, J., & Warrell, D. A. (1997). Snake bites in Kenya: a preliminary survey of four areas. Transactions of the Royal Society of Tropical Medicine and Hygiene, 91(3), 319-321. doi:10.1016/s0035-9203(97)90091-2
Davidson, R. A. (1970). Case of African cobra bite. British medical journal, 4(5736), 660-660. doi:10.1136/bmj.4.5736.660
Erulu, V., Okumu, M., Ochola, F., & Gikunju, J. (2018). Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the Literature. Tropical medicine and infectious disease, 3(3), 104. doi:10.3390/tropicalmed3030104
Eucabeth, O. a.-M. a., & Augustine, A. (2017). Identity Construction in Three AbaGusii Bewitchment Narratives. International Journal of Society, Culture & Language, 5(1), 29.
Harrison, R. A., Oluoch, G. O., Ainsworth, S., Alsolaiss, J., Bolton, F., Arias, A. S., . . . Casewell, N. R. (2017). Preclinical antivenom-efficacy testing reveals potentially disturbing deficiencies of snakebite treatment capability in East Africa. PLoS Negl Trop Dis, 11(10), e0005969. doi:10.1371/journal.pntd.0005969
Ochola, F. O., Okumu, M. O., Muchemi, G. M., Mbaria, J. M., & Gikunju, J. K. (2018). Epidemiology of snake bites in selected areas of Kenya. Pan Afr Med J, 29, 217. doi:10.11604/pamj.2018.29.217.15366
Okumu, M., Patel, M., Bhogayata, F., Olweny, I., Ochola, F., & Onono, J. (2018). Acute Poisonings at a Regional Referral Hospital in Western Kenya. Tropical medicine and infectious disease, 3(3), 96. doi:10.3390/tropicalmed3030096
Okumu, M. O., Patel, M. N., Bhogayata, F. R., Ochola, F. O., Olweny, I. A., Onono, J. O., & Gikunju, J. K. (2019). Management and cost of snakebite injuries at a teaching and referral hospital in Western Kenya. F1000Res, 8, 1588. doi:10.12688/f1000research.20268.1
Omara, T. (2020). Plants Used in Antivenom Therapy in Rural Kenya: Ethnobotany and Future Perspectives. J Toxicol, 2020, 1828521. doi:10.1155/2020/1828521
Ooms, G. I., Van Oirschot, J., Waldmann, B., Von Bernus, S., Van Den Ham, H. A., Mantel-Teeuwisse, A. K., & Reed, T. (2020). The Current State of Snakebite Care in Kenya, Uganda, and Zambia: Healthcare Workers’ Perspectives and Knowledge, and Health Facilities’ Treatment Capacity. The American Journal of Tropical Medicine and Hygiene. doi:10.4269/ajtmh.20-1078
Owuor, B. O., & Kisangau, D. P. (2006). Kenyan medicinal plants used as antivenin: a comparison of plant usage. J Ethnobiol Ethnomed, 2(1), 7. doi:10.1186/1746-4269-2-7
Owuor, B. O., Mulemi, B. A., & Kokwaro, J. O. (2005). Indigenous Snake Bite Remedies of the Luo of Western Kenya. Journal of Ethnobiology, 25(1), 129-141. doi:10.2993/0278-0771(2005)25[129:Isbrot]2.0.Co;2
Snow, R. W., Bronzan, R., Roques, T., Nyamawi, C., Murphy, S., & Marsh, K. (1994). The prevalence and morbidity of snake bite and treatment-seeking behavior among a rural Kenyan population. Annals of Tropical Medicine and Parasitology, 88.
Ancestor worship is a common theme in African lore, particulary in the traditional arts. So while people are singing the praises of their dead relatives, I always wanted to ask what to do if my ancestors were horrible people?
I was recently speaking with some people whose parents were refugees from Romania, ostensibly people who were fleeing life under the dictator Nicolae Ceaușescu, a forgotten piece of Stalinist work who made the lives of Romanians miserable for decades. While Ceaușescu and his government were vile, the people who came to the US were refugees and likely middle class families decended from peasants back home.
The contrast with my and many Americans’ heritage is stark. I am decended from a family of Mitchells, a distinguished Scottish family of wealthy means who decided to take a gamble and invest in agricultural ventures in the Southern United States. The first to come was a man named Thomas Mitchell, my maternal great x 10 grandfather, who arrived in US, fought in the Revolutionary War and set subsequently set up shop for the family business in Georgia.
Thomas, like many Scots who came to the Southern United States, came to profit not only off land and agricultural products that could be exported to Europe, but also off the promise of cheap, forced labor from Africa. Thomas Mitchell was a slaver.
From slave based agriculature, the Mitchell family became extremely wealthy in the South, producing numerous politicians, lawyers, administrators and academics. There is still a county named for the Mitchell family in Georgia.
In 1836, the Mitchell family expanded their land holdings by assembling a militia of 75 men and committing a genocide against the Native American residents of their land “in which all the Indians except five were killed, their arms, campage, etc. falling into the hands of the whites.”
There are others, but the point is, does it make sense to venerate one’s ancestors when they were clearly committing crimes against humanity? The Romanians I spoke with probably have terrible members of their family, but likely have not had their lives shaped by a horrible past.
I am not unique. Just about any white person in the South whose family was their during the 18th and 19th centuries was involved in the buying, selling and use of humans. If they have money now, it is a direct result of slavery and the ethnic cleansing of Native Americans in the South. We should never forget, because that’s how we got here, the past that shapes our present. Our current lives were made possible by terrible people doing reprehensible things to other people.
So no, not going to sing any praise songs to my ancestors any time soon. Maybe I’ll do the opposite instead.
New chapter from myself in a Springer volume: “Access to Health Care in Sub-Saharan Africa: Challenges in a Changing Health Landscape in a Context of Development”
I wrote a chapter for “Health in Ecological Perspectives in the Anthropocene” edited by Watanabe Toru and Watanabe Chiho. I have no idea if they are related. Either way, my chapter “Access to Health Care in Sub-Saharan Africa: Challenges in a Changing Health Landscape in a Context of Development” occupies pages 95-106 in the volume.
Check it out, you can buy the book through Amazon for a cool $109, or just my chapter through the Springer site for $29 or you can simply write me and I’ll give you a synopsis.
Here’s the abstract for the book:
This book focuses on the emerging health issues due to climate change, particularly emphasizing the situation in developing countries. Thanks to recent development in the areas of remote sensing, GIS technology, and downscale modeling of climate, it has now become possible to depict and predict the relationship between environmental factors and health-related event data with a meaningful spatial and temporal scale. The chapters address new aspects of environment-health relationship relevant to this smaller scale analyses, including how considering people’s mobility changes the exposure profile to certain environmental factors, how considering behavioral characteristics is important in predicting diarrhea risks after urban flood, and how small-scale land use patterns will affect the risk of infection by certain parasites, and subtle topography of the land profile. Through the combination of reviews and case studies, the reader would be able to learn how the issues of health and climate/social changes can be addressed using available technology and datasets.
The post-2015 UN agenda has just put forward, and tremendous efforts have been started to develop and establish appropriate indicators to achieve the SDG goals. This book will also serve as a useful guide for creating such an indicator associated with health and planning, in line with the Ecohealth concept, the major tone of this book. With the increasing and pressing needs for adaptation to climate change, as well as societal change, this would be a very timely publication in this trans-disciplinary field.
I am always looking for free alternatives to ArcGIS for making pretty maps. R is great for graphics and the new-to-me ggmap package is no exception.
I’m working with some data from Botswana for a contract and needed to plot maps for several years of count based data, where the GPS coordinates for facilities were known. ArcGIS is unwieldy for creating multiple maps of the same type of data based on time points, so R is an ideal choice…. the trouble is the maps I can easily make don’t look all that good (though with tweaking can be made to look better.)
ggmap offered me an easy solution. It downloads a topographic base map from Google and I can easily overlay proportionally sized points represent counts at various geo-located points. This is just a map of Botswanan health facilities (downloaded from Humanitarian Data Exchange) with the square of counts chosen from a normal distribution. The results are rather nice.
#read in grographic extent and boundary for bots
btw <- admin<-readOGR(“GIS Layers/Admin”,”BWA_adm2″) #from DIVA-GIS
# fortify bots boundary for ggplot
btw_df <- fortify(btw)
# get a basemap
btw_basemap <- get_map(location = “botswana”, zoom = 6)
# get the hf data
# create random counts
# Plot this dog
geom_polygon(data=btw_df, aes(x=long, y=lat, group=group), fill=”red”, alpha=0.1) +
geom_point(data=HFs.open.street.map, aes(x=X, y=Y, size=Counts, fill=Counts), shape=21, alpha=0.8) +
scale_size_continuous(range = c(2, 12), breaks=pretty_breaks(5)) +
scale_fill_distiller(breaks = pretty_breaks(5))
Currently, I’m doing a research project on snakebites and found this gem in the literature, of which there is little:
“Snake bites are common in many regions of the world. Snake envenomation is relatively uncommon in Egypt; such unfortunate events usually attract much publicity. Snake bite is almost only accidental, occurring in urban areas and desert. Few cases were reported to commit suicide by snake. Homicidal snake poisoning is so rare. It was known in ancient world by executing capital punishment by throwing the victim into a pit full of snakes. Another way was to ask the victim to put his hand inside a small basket harboring a deadly snake. Killing a victim by direct snake bite is so rare. There was one reported case where an old couple was killed by snake bite. Here is the first reported case of killing three children by snake bite. It appeared that the diagnosis of such cases is so difficult and depended mainly on the circumstantial evidences.”
When does a person “ask” someone to “put his hand inside a small basket harboring a deadly snake?” Does that ever happen? Apparently so.
Apparently a man killed his three children using a snake.
It gets better:
“In deep police office investigations, it was found that the father disliked these three children as they were girls. He married another woman and had a male baby. The father decided to get rid of his girl children. To achieve his plan, he trained to become snake charmer and bought a snake (Egyptian cobra). The father forced the snake to bite the three children several times and left them to die. At last, he burned the snake.”
Paulis, M. G. and Faheem, A. L. (2016), Homicidal Snake Bite in Children. J Forensic Sci, 61: 559–561. doi:10.1111/1556-4029.12997
Humans have had to deal with the threat of snakebites as long as humans have existed. While deaths from snakebites are rare, the outcomes are so severe and the nature of the animal so mysterious, that humans have developed all sorts of ways of dealing with them.
Witchdoctors, or Mganga as they are known in East Africa, are the first line for snakebite treatment here. The Waganga are fairly useless for treating many serious health issues, but they have carved out a niche for themselves for a few public health problems.
Our survey in Western Kenya confirms that nearly 100% of people who have been bitten by a snake visit the Mganga, regardless of whether they visit a formal health facility or not.
I went and sat down with an established Mganga here in Kwale and he was gracious enough to answer all of my questions openly and (mostly) honestly.
Hello, thank you for taking the time to speak with me today. Is English OK?
No, my English is not very good. Can we do this through a translator?
Of course. So, what happens when a patient comes in for treatment for a snakebite?
When the patient comes in, I first apply the “njiwe na njoka” (lit: snake stone). The stone sucks all the poison out of the wound. When you put it on the bite, it will stick. When the stone has absorbed all the poison, it will fall off.
What do you mean? Like it just sticks to the flesh without tying it?
Yes, if there is poison, the stone will stick to the body. When all the poison is gone, the stone will fall off. After it is done, I take the stone and wash it with milk several times and then use it again for the next patient.
What is the snake stone? Is it like a rock? I’ve seen people use charcoal in the villages. They tie it to the wound, it doesn’t appear to stick on its own.
No, this is different. This is a stone from the snake. The stone is in the skull of the snake, like that of a fish.
(Note: I did not know this, but some species of snakes have otoliths, like most fish. Snakes (and fish) are deaf in the traditional sense. The otolith is a piece of calcium which grows as the animal ages and sit on top of a bed of nerves. When there are vibrations, the otolith vibrates, stimulating the nerve bed so that the animal can “hear” motion around it. Not all snakes have otoliths but some species of burrowing snakes do.)
Where do you get the stone? Can you just buy it in the market?
The snake stones come from the Maasai, from big snakes in Maasai land. My teacher travels to Maasai land to get them and brings them back.
If the wound is fresh, I apply the stone. However, if it has been two or three days since the bite, I can’t use the stone anymore. Then I have to use a special medicine made from herbs and crushed snake heads. I mix it all together, then crush it into a powder and keep in a gourd.
When the patient comes in, I use a new razor blade to make small scratches on the wound. Then I rub the powder in it and bandage the wound. The wound will try to heal over time, so you have to make the scratches to be able to apply the powder.
Do you use the razor blade again?
No, I always use a new blade. (He was emphatic on this point.)
What is the powder made from?
Snakeheads. When we kill a snake, we keep the heads to make the powder. We mix it with roots, bark and leaves from special plants from deep in the forest. My teacher is a security guard in one of the forests and can get them when he can find them.
Wait, so your teacher is a forest ranger? Can’t he get by being an Mganga?
Yes. He is a forest ranger.
So he took the job so that he can get the plants from the forest whenever he needs them.
OK, so how many bites do you see per month?
It depends, some months I get more than others but mostly one every three months or so.
Do you refer them to the health facility for formal treatment?
Yes, I do. I treat them, then they go to the facility, then they come back to me. (I’m suspicious on this point, though the Mganga in question appears more together than most.)
Is there a religious component to this?
Well, there are two kinds of bites, those where the snake just bites and there is no witchcraft and those where someone has used magic to send the snake to bite you.
How do you know the difference?
If the bite heals quickly, there is no witchcraft. But if the bite is treated and does not improve then there is definitely witchcraft involved. At that time, I have to use powerful magic to get rid of the curse.
What do you do?
I send the snake back to the person who applied the curse. When we hear that someone nearby has been bitten, we know who applied the curse.
(Note: this is not uncommon. Witchcraft is often associated with hatred and revenge but the person applying the curse risks becoming cursed themselves. It is possible that snakebites are seen as a never ending battle of malevolent spiritual forces. What this does is sow distrust among people, even families and the Mganga is seen as the only cure. The result is that the Mganga are never without work.)
How did you learn this craft?
I was sick for a long time with stomach and head problems. I went to the hospital and it never got better so then I went to an Mganga. I improved. The Mganga suggested that I become on and I started training under him.
Thank you very much for your time.