Into Africa
Kathy Goggin kept the notebook where she could read it out of the corner of her eye. For three days, she’d been practicing the name — Mhlongo, Mhlongo, Mhlongo. Mispronouncing it now would be perceived as a sign of disrespect, and she could forget about doing her research in South Africa. She was sitting in a conference room full of African doctors and traditional healers, all of them waiting for Mhlongo.
His name didn’t roll easily off a Westerner’s tongue. On Goggin’s cheat sheet was a phonetic spelling: mum-thlo-go.
Goggin is an associate professor of psychology at the University of Missouri-Kansas City. She’d been in Tygerber, a northern suburb of Cape Town, South Africa, for almost three months, preparing for a clinical trial of an indigenous plant called sutherlandia. The country’s traditional healers use it to treat cancer and AIDS patients. It was supposed to prevent the rapid loss of muscle mass, but so far no one had subjected the plant to a study under Western research standards. Goggin was working with a team of Western-trained researchers, along with two psychologists from UMKC whose plan was to give the plant to HIV patients and measure any signs of improvement.
Waiting for Mhlongo was a nightmare for Goggin. Because of a learning disability, she can’t distinguish some differences in word pronunciations. She knew that if she couldn’t say Mhlongo’s name right, she would be seen as an arrogant American: someone who is nice until she gets what she wants. Especially doing HIV work in South Africa, where a torrent of grant money — and the prestige that comes with working in the world’s most infection-ravaged region — has drawn a number of scientists looking to make names for themselves.
There are reasons that researchers want to work with traditional healers who attribute most illnesses to the influence of ancestral spirits. In America, they would be called witch doctors. But to South Africans, they are respected and government-accredited. To find cures, they read patterns in animal bones thrown to the ground. Their remedies involve mixtures of herbs and bones, sometimes the sacrifice of a cow.
Because they see more patients, traditional healers know more than university researchers about infection trends and how people deal with illness. Although a visit to the traditional healer in some cases costs twice as much as seeing a doctor trained in Western medicine, most Africans will save their money for the healer’s reading. The ones who do go to a hospital are still likely to consult a healer. The sight of a man carrying candles and a sacrificial chicken is as common in a South African hospital as someone praying over a Bible in a U.S. hospital.
And healers have 2,000 years of the most primitive clinical trials to draw from: Go into the wilderness, find something and feed it to your patient. If it kills him, don’t do it again. If it helps, find more.
Goggin’s work has been much more measured. For 20 years, she has worked in AIDS trials and outreach programs. At UMKC, she heads the HIV/AIDS Research Group and, between teaching classes, studies how patients maintain their quality of life and adapt to chronic and terminal diseases, and how depression and anxiety affect HIV cases and their treatment. Most recently, she has studied ways to help AIDS patients adhere to their often difficult medication regimens.
That’s how, in January, Goggin ended up in a conference room at the University of the Western Cape surrounded by healers willing to be involved in a new study, ready to plead her case for closing the distance between traditional healers and Western scientists. Makhosi Mhlongo was the president of the KwaZulu-Natal traditional healers council. A tall African with graying hair, in Western dress except for a sacrificial animal skin around his wrist, so respected that everyone stood when he entered the room (followed by three bodyguards — two of whom were his sons), Mhlongo had already publicly stated that he was, at best, dubious about Westerners conducting clinical trials on a remedy used by healers. If Mhlongo disapproved after this meeting, healers would refuse to participate in the trials. Goggin would have no chance to study their methods — or get the healers to work with Africa’s Western-trained doctors to manage the AIDS crisis.
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Goggin pronounced her greeting correctly, but that didn’t make the meeting any easier. It didn’t help that some people working on the project had already shown disrespect for the healers by failing to pay them for their help in an earlier phase of the study. Then there was the cultural stigma because she was an American, and in the not-so-distant past her country had supported apartheid. She felt she had a thousand years of history on her back.
Mhlongo understood English, but his questions and Goggin’s answers still went through a translator so that everything was in Zulu, just so everyone knew who was in charge. Mhlongo asked how they proposed to go about the study. He asked about intellectual property rights if it turned out that sutherlandia really worked. He asked about what rights the healers would have to the plant if someone decided to market it. Goggin knew she couldn’t guarantee anything. After Mhlongo asked a question, he’d look away from her when she responded.
She looked around at her African colleagues. All of them were looking at the floor.
“I can’t promise everything will be perfect because I’m not totally in control,” Goggin said. “But I can promise I will never ask for anything from the traditional healers that I cannot personally give back.”
Mhlongo asked a few more questions, considered her answers, and then, for the first time, looked her in the eyes. He nodded. Goggin looked at the others and saw that their heads were raised.
With that, Mhlongo seemed satisfied. In Zulu, he said, “We should have food now.”
A healer’s ancestors come to him in his youth. One day he’ll have a stomach pain, a headache, maybe hallucinations. This is the call to become a healer. The sickness will last a long time. It’s a rite of passage.
A healer must do more than just survive the initiation before he can function as one of South Africa’s primary caregivers. A prospective healer must undergo a long period of training. He must learn humility before the ancestors, wash in the blood of sacrificial animals, learn to mix his own potions. At the end, he sacrifices a goat or a cow and is immersed in a river as a sort of baptism.
Powders, called muti, are the healers’ most powerful tools. Healers can go into the wild to pick the ingredients themselves, but most buy plants in open-air markets. That’s where Bill Folk, a silver-haired biochemistry professor from the University of Missouri-Columbia, first saw sutherlandia — a long, thin plant that looked like the kind of thing that grew in ditches back home.
Folk studies the effectiveness of natural remedies and is co-chairman of the Columbia-based International Center for Indigenous Phytotherapy Studies. He went to the markets in 2004 to find the plant that he’d heard was the go-to treatment when a healer dealt with a terminal patient or with any other serious illness.
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In the markets, Folk found hundreds of healers bartering and selling plants among the vendors’ stalls, separated by makeshift walls or stacks of plants and jars. People were grinding muti and eating plants. Some stood with hacksaws in front of dried animal limbs hanging on display.
“It was in virtually every stall,” Folk says of sutherlandia.
To study whether the plant worked, Folk needed a doctor who could measure psychological responses and translate the South African concept of quality of life into American terms. Aside from the differences in their preferred health care, Africans are still dealing with the cultural shifts after the end of apartheid in the early ’90s. The country’s already fragile infrastructure has further deteriorated as people have migrated from rural to urban areas. And though there are institutions comparable to those in the United States, such as universities and hospitals, they’re surrounded by poverty and disease.
Folk sent out a call to Missouri’s universities when he first considered studying the plant in 2002.
“Kathy surfaced as the person who had the expertise and had the interest,” Folk says. “She knew AIDS. She’s been working on it her entire career and she’s done it everywhere.”
Folk’s open call was the first time that Goggin had heard of sutherlandia. She started visiting South Africa soon after and now travels there at least three times a year.
Folk and Goggin wrote a grant proposal, and the National Institutes of Health awarded the University of Missouri-Columbia $4.4 million to conduct research with the University of the Western Cape. Most of the work would be with a hospital, Edendale, one of the few in South Africa where healers and Western-trained doctors coexist. The hospital was also home to a tuberculosis ward, a large, open room where the majority of patients were HIV-positive. It wasn’t unusual to see healers there.
Goggin learned one lesson early: Western doctors are afraid of healers.
After all, a South African healer knows what’s wrong with a sick person before ever meeting the patient. After lighting incense to clear the examination room, the healer tosses animal bones on the ground to get a message from the ancestors. When the healer appears before the patient, dressed in the right colors to honor the spirits, the patient doesn’t speak. The healer tells the patient what the trouble is — the patient may be tormented by an evil witch or might have neglected to pay proper respect to the ancestors. Most times, the healer prescribes a muti, ingested or inhaled, though enemas are common, too. Sometimes the healer must cut the patient and rub the muti into the bloodstream. In more extreme cases, the healer will channel spirits while dancing and pounding drums and speaking in tongues.
There is more to a Western-trained doctor’s apprehension than professional embarrassment. South African emergency rooms are filled with patients dying from problems that a healer has failed to treat. All those anally inserted mutis — some reports say Zulu children have up to three enemas per week — have caused gastrointestinal problems so common that South African doctors recognize a condition called ritual-enema-induced colitis. And healers bear some responsibility for transmitting HIV: When they cut a patient to administer the muti, it’s usually with a knife that hasn’t been cleaned.
Healers don’t trust Western medicine, either. Researchers have come looking at their methods before, and healers have seen the herbs they’ve discovered and prescribed to patients for thousands of years show up as supplements in health stores. Rarely do they see any of the profits. And though they’re accredited by the South African government, they still sometimes feel that they are seen as inferior to the doctors in white coats — mainly because there is still no degree program to recognize them. (Healers like Mhlongo are trying to have one established.)
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“Traditional healers didn’t want to mix with doctors because they believe doctors will steal their knowledge of medicinal plants,” says Elliot Makhathini, a liaison between healers and doctors at Edendale. “And there was a prejudice due to history. Healers were stigmatized, I think, for political and economic reasons,” he tells the Pitch by phone from South Africa.
For Folk’s project, patients needed to be more willing to work with the Western-trained researchers administering the tests, and healers needed to be more forthcoming about how they used sutherlandia and what responses they saw in AIDS patients.
“We don’t need them to change. We need them to meet each other,” Goggin says. “Most Africans will never make it to Western medicine without traditional healers, and we will lose the benefits of traditional healing if we don’t make the two worlds talk.”
Africans need Western medicine. The rate of HIV infection in Africa is the highest in the world. Some Africans believe they can cure themselves by having sex with a virgin. The president of one West African country, Gambia, has held press conferences to claim that he can cure AIDS by massaging an herbal paste into sick people and ordering them to eat bananas.
Goggin’s first meeting with traditional healers was at one of their clinics. Each woman wore a colorful head wrap to signify her station. Goggin questioned them on how they measured quality of life. Did it mean anything if a patient wasn’t sleeping well? What was a happy life? Did they recognize depression as a disorder? If they did, did they treat it? How?
Without understanding how they measured happiness, it would be impossible to understand how sutherlandia was affecting the depression that accompanies HIV infections. And without the healers backing the study and approving its methods, South Africans would never accept its findings.
For nine hours, the healers tried to translate the African concept of quality of life for Goggin.
“In Zulu, the first three words of a sentence modify the next word, which can be changed by the last three. So when you ask a question, it can be a nightmare,” Goggin says. “And when you’re asking questions like ‘Is this a little? Is this not at all?’ those are very hard things for them to qualify.”
At the beginning, the healers had been proper and professional with Goggin. But toward the end of the session, the two women raised their voices. Though they were still speaking in Zulu, Goggin recognized the tension. She realized they were arguing over how to measure depression. It was a relief.
“I knew I was in,” she says. “In this culture, you don’t argue in front of someone if they’re an outsider.”
That you can get rid of AIDS by taking a virgin wasn’t the first bizarre idea that Goggin had heard. She was 16 years old, living in Southern California in 1983, when newspapers started covering a strange new virus. Back then, some leaders wanted to quarantine all the cases on a small Hawaiian island.
The Goggins were a middle-class family. By the sixth grade, she was almost 6 feet tall, a good basketball player without many friends.
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“I felt like a freak,” she says. “I was taller than every teacher but one and the janitor. That janitor and I spent a lot of quality time together.”
Her father liked a good argument, and the family talked about news at the dinner table. AIDS was a big topic of conversation on those evenings when Goggin was in high school. She noticed one story about a hospice in Long Beach where infected men were receiving care.
She went looking for the place and found it in an upscale neighborhood, populated mostly by gay men. It was a small house, with five bedrooms, a kitchen and a living area, run by a Franciscan monk who wore the same brown polyester suit most days. From the outside, nothing about the house revealed who was staying there. Men heard about it at homeless shelters.
Goggin thought the house looked cute. But when she went inside, the smells hit her. The tenants were in the advanced stages of the virus; most stayed in bed. They look like skeletons, Goggin thought.
Goggin visited for two months. She spent her time cooking meals and cleaning. Basketball was her way into the men’s heads. She sat on their beds and watched games with them. She remembers one Lakers fan she liked to antagonize by rooting for the Boston Celtics. Eventually, they started telling her their stories. Few had any family. She got the impression that most of them weren’t gay men, like the ones she’d read about in the newspaper, but intravenous drug users. Sometimes she knew they wouldn’t be there the next day.
While Goggin was learning about AIDS firsthand, bad ideas about the virus were spreading. People didn’t understand how it was transmitted, and they were scared. One day, Goggin came home to find her father arguing with a conservative friend. She remembers how her father ended the conversation: “You try to stop her from going there, then!”
Nobody did. She spent more time with the Franciscan, often complaining that no one was helping the patients — particularly the churches and the government.
Then the Franciscan took her aside and told her, very calmly, that the Catholic Church had paid for the hospice and given it to him. Church leaders wouldn’t be sending any more help, though, and they didn’t want anyone to know they’d been involved.
The news that the church had funded the hospice just made her more angry.
“I got pissed. I’m still pissed.”
Goggin went to California State University and studied psychology. After graduation, she went on to work in clinical trials because she thought that was where she could help HIV-AIDS patients most directly and see the most concrete results. On the side, she helped set up AIDS awareness programs and did what she could to educate people about prevention.
She earned a Ph.D. in clinical psychology in 1994 and went on to work as a researcher at New York Hospital in New York City. Though AIDS infection rates at the time were holding steady among gay men, they were rising in the general population of blacks. There, working on AIDS-prevention projects, she’d seen how churches were the centers of the black community, but church leaders had trouble finding ways to educate people about the virus. She wrote health surveys as a way to open the door to talking about AIDS, which was on the rise among black youth but was an uncomfortable thing to talk about, given its connection to premarital sex, drug use and homosexuality.
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(Today, Kansas City health officials who work with AIDS patients say infection rates are rising across all demographics, including blacks and certain groups of gay men who regard the disease as an infection that can be lived with. In the metro, new HIV diagnoses rose from 193 cases in 2002 to 273 cases in 2006, a 41 percent increase.)
Goggin took a job as an assistant professor at UMKC and moved to Kansas City in 1997. She lives in Lee’s Summit with her husband, Delwyn Catley, also an associate professor of psychology at UMKC, who researches how people quit smoking. They have a 2-year-old daughter.
Almost immediately after arriving here, Goggin started working in territory unfamiliar to her — though not as far away as Africa.
The Rev. Eric Williams met Goggin almost a decade ago, at a week of prayer events focusing on AIDS in black churches. She was at a meeting of church pastors, all of whom were discussing ways to talk about the disease with their congregations.
Williams believes in getting things out in the open, and here was this 6-foot-2 redheaded white woman talking almost manically about AIDS outreach in the black community.
“All right, let’s just get this out of the way right now,” he said. “Does anyone have a problem with Kathy doing this because she’s white?”
No one did.
Williams had some experience being the outsider, too. He has been the pastor of the Calvary Temple Baptist Church at 29th Street and Holmes for 17 years. A bald man with flecks of white in his goatee and a gold cross around his neck, he places his hands together as if he’s saying a prayer when he speaks and he answers most questions with stories. He was one of the first black pastors in Kansas City to perform services for people who had died of AIDS, starting 15 years ago, when he received a call from a mortuary attendant.
A young man, very active in his church, had died of AIDS. Williams won’t name names now but says the pastor of the man’s church had refused the service. It wasn’t an uncommon thing. Williams admits to making a few Adam and Steve jokes in his younger days, too. Or, even worse, figuring that God might be using the virus to punish gays for their sins.
“We’re used to hearing ‘If the son’s gay, kick ’em out,'” Williams says. “Heaven forbid you bring AIDS into this house. So you see fathers abandoning gay sons. This family, they showed this kid so much love and acceptance even in death. It really sparked something in me and let me know we had to do something.”
For a while after that, many pastors wouldn’t talk to Williams. He’d hear them calling him “the AIDS man.” At meetings among pastors, others would leave the table when he sat down.
Williams had also been contacting UMKC doctors and other medical professors in the metro to try to get some advice about educating his parishioners on HIV and what resources were available to them. He wasn’t having much luck.
“People always talk about the church being silent on AIDS, but the truth is, the academic community can be just as bad. There were a lot of unreturned phone calls,” Williams says. “Kathy provided a bridge there.”
Goggin already knew that if you were going to work in any community, you needed to find the important decision makers, and she considered churches the biggest social and political structures in the black community. When churchgoers arrive on Sundays, they come to be lifted up. Dealing with AIDS isn’t an uplifting topic.
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“A lot of churches took a stance saying, ‘This is not us.’ But it is,” Goggin says. “I know I’m a white chick from Southern California. I don’t know anything about this community. But what I am good at is helping people change behavior.” If a church wanted to help people change, she knew what to do.
Goggin helped write a survey of health issues that pastors could distribute; HIV and AIDS were only two of the topics. That way, when pastors stood up to tell their congregations the results, they wouldn’t just be talking about AIDS.
With Williams, she also worked on a three-year study on how to reduce risky sexual behaviors among black youth. She talked with kids about why they drank, had sex or did drugs.
“These kids would say, ‘If you were going to a party you shouldn’t be going to and you missed your bus, that would be God giving you a sign,'” she says. “Kids talked about personal control and God control.”
Their answers weren’t that far from what she would hear, years later, about the role of healers in Africa.
In South Africa, one of Goggin’s main tasks has been translating all the study’s materials and measures into Zulu. If she’s done her job, the healers will know more about AIDS prevention, and the Western-trained doctors will know more about how South Africans react to infections.
In February, about six weeks after Goggin last left South Africa, Bill Folk arrived again. It was the middle of the rainy season, when the air felt like July in the Midwest. The country was green, the rivers and reservoirs high.
Folk and another doctor, an American biologist who spoke Zulu, had come to make sure things were on track when the clinical trials started. Now the healers were saying they wanted to work with more Western physicians, and some were participating in a separate National Institutes of Health program to learn how HIV was transmitted and what safety measures the healers could prescribe.
Makhathini, the liaison at Edendale, agrees that more healers are interested in learning about Western medicine so they can screen for specific conditions other than HIV and AIDS, such as hypertension and diabetes. And he sees more Western-trained doctors willing to meet with healers.
“They are learning about conditions treated by traditional healers — conditions which may be due to witchcraft,” Makhathini says. “There are such conditions whereby a person can come and complain of sharp pains in the chest, and the doctor may do all the investigations, only to find there’s no evidence of pathology. And the doctors have learned there are other conditions.”
He thinks there are several reasons for the change, including a government that’s more supportive of the healers than in recent years. But work like Goggin’s helps, too.
“She didn’t impose her own ideas, but she tried to learn from the insider perspective,” he says.
Shortly before returning to America, Folk spent a day at a healer’s clinic translating concepts. He looked around at the clinic walls, lined with dried herbs and jars of handmade compounds. Between the shelves, he saw a lone 5-inch-by-7-inch framed picture.
It was a picture of Goggin and the clinic’s healer standing side by side, smiling.
When the meeting ended, Folk offered to drive the healers, who lived in the country, back home before dark — otherwise, it was a long trip by public transit on roads clogged with wandering cattle and erratic drivers.
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They squeezed in next to each other in the small car. Folk was pressed up against the door in the back seat. As they headed out of the city, the healers all took out cell phones to call their families. They all spoke in English.
As they left the paved roads, Folk thought, I think we’re in good shape now.
