On 2 February 2022, Phethelo Fakude logged onto his Twitter profile (@JagIsOffline) and shared that he’d undergone a vasectomy. Within minutes, the tweet had gone viral. Now, while nothing is shocking about a young man choosing to take responsibility for his sexual health, especially in a country where almost 60% of South African children have absent fathers, the reaction to his post revealed something much deeper.
“I didn’t anticipate a strong reaction to the tweet. I tweeted about the procedure as a way to update my friends that I’d gone through with the procedure, as I’d made them aware that I’d booked it,” explains Fakude, who is an admitted attorney. “So, I thought only a handful of people in my circles would react to it. What I got, instead, was far more than I could have imagined.”
The tweet, which garnered over 3 million impressions, 5 000 retweets, and 1 020 replies, also received a lot of responses that Fakude wasn’t prepared for. One theme that stood out was that Fakude was accused of not just being less of a man, but also of attempting to absolve himself of his identity and, more so, his culture.
“There were several responses where people spoke of this being a disservice to my ancestors, and that it was insulting to so abruptly bring an end to my bloodline. Other people argued that a man must make children and preserve the family name. Many people saw this as an ungrateful act against all the work that had been done to bring me into this world and make my family.”
Going out into the world and creating a family of your own is a common doctrine that is passed down from generation to generation, with many cultures having practices that enforce ideology. However, in recent years, many individuals have opted against it, with some even going Fakude’s route and using medicine to cement their choices. Fakude’s actions, and the subsequent response to them, raise the question of where health and culture collide.
Cultural healthcare
The idea that a set of rules can dictate how we approach the world and those around us may seem absurd, but the truth isn’t as simple as that.
“Cultural beliefs have a stronghold on us because we’re biological and cultural beings,” explains Dr. Nokwanda Yoliswa Nzuza, Ph.D., a lecturer in Anthropology at the University of KwaZulu-Natal.
While Nzuza acknowledges that our beliefs are culturally influenced notions that we hold to be true, she also admits that these beliefs aren’t necessarily inflexible. She adds that they’re constantly changing as each generation contributes to its experience of the world and may reject or modify beliefs that are no longer useful.
“It’s through cultural lenses that we make sense of the world; they inform our worldview. They fundamentally shape how we live in the world,” she says.
Is healthcare too Westernized?
With some sets of beliefs traced back to pre-colonial times, it’s easy to understand why some individuals would approach certain aspects of their lives guided by these beliefs. Yet, with so many advancements in healthcare in recent years, there’s often a pushback, with the embracing of modern forms of healthcare.
“I think there is a general distrust, especially among black African men and women who consider themselves ‘traditional’,” says Nzuza.
“With men, it’s mostly associated with their cultural understanding of masculinity. Men still see visiting a Western doctor as a sign of weakness, regardless of their medical condition. It’s easier for men to visit traditional healers, as they’re associated with strength, and their treatment regime comprises activities that require stamina and tolerance, for example using an enema, inducing vomit, steaming, and scarification. On the contrary, Western medicine is considered weak.”
She suggests that the recent increase in the number of female Western medical practitioners has also contributed to distrust and discomfort. It appears that some men still prefer to be treated by fellow male healers, as they don’t want to be seen by women in their weak and vulnerable state.
Men seeking healthcare
Dr. Tania Samantha Reddy-Naidu, a general practitioner based in Germiston, says of the notable difference in the ratio of male-to-female patients seeking healthcare services:
“This could stem from the fact that some men view themselves as being sole providers for their families and feel pressured to fulfill societal obligations; hence, they aren’t able to comply with appointments with their healthcare providers. The pressures and strain resulting from fulfilling these obligations would undoubtedly make men less likely to engage in health-promoting behavior.”
Ironically, it seems that men aren’t averse to trusting Western medicine and healthcare practitioners for women’s-health conditions. Dr. Nzuza reveals that women are likely more appreciative of Western medicine, especially when it comes to their sexual and reproductive health, and their partners are visibly supportive, as they’re often seen accompanying them in healthcare facilities.
Men’s Health
One of the easiest ways to assess how cultural notions can influence healthcare is by looking at the idea of reproduction. Dr. Nzuza believes the strong reaction to Phethelo Fakude’s tweet about his vasectomy boils down to a lack of understanding of the dynamism of culture.
“Culturally, men are expected to exhibit biological and social features which are characteristic of their manhood – manhood that is largely believed to be exhibited through virility,” she says.
“I believe the backlash was due to people not understanding that manhood shouldn’t be limited to one’s fertility, but, rather, one’s ability to make decisions that are beneficial to their future. The backlash that was received by the young man is similar to that which is still received by women when they choose not to have children.”
As medical director of a health center, Dr. Reddy has picked up on the reluctance of men to engage in conversations about who should take on the responsibility of family planning.
“Reasons vary from male patients not quite understanding what a vasectomy is, to them having a (mis)conception that this impacts on their masculinity. …Some male patients have previously believed that vasectomy was synonymous with castration. Upon providing clarity about the procedure and the compelling reasons to consider it, the relief that they expressed was palpable. In short, gaps in knowledge on the procedure have contributed to the taboo,” Reddy says.
The misconception about healthcare
It’s clear that our preconceived beliefs and cultural views have given rise to misconceptions, and these misconceptions are affecting our approach to healthcare. Clinical psychologist Teboho Monyamane adds that in addition to not having all the accurate information and being misinformed, having to reconcile new information with what you’ve been taught can be challenging.
“When something is ego-dystonic, or contradicts one’s beliefs about oneself, it can be difficult to accept it. For instance, if you believe that mental illness is a weakness (which we know it isn’t), and you regard yourself as a strong person, you may find it difficult to acknowledge that you have a mental illness, and delay in seeking help.”
She adds that we still have a long way to go in challenging the stigma associated with poor mental health.
“Depression and anxiety, for instance, are so common, and yet there is still a lot of stigma and shame associated with them. People sometimes believe that they just need to ‘snap out of it’ and think positive thoughts, that they just need to be stronger.”
Witchcraft or cognitive impairment?
It’s not only reproductive and mental health that is plagued by misconceptions due to cultural beliefs. In recent years, it appears that even cases of cognitive decline aren’t safe from the preconceived notions that people hold. According to a report from the Lancet Public Health, there were 241 937 cases of dementia recorded in South Africa in 2019, and this number is expected to grow to 680 045 by 2050.
Yet, despite the high numbers, it seems many of these individuals aren’t accessing the necessary treatment for the condition. Dementia SA social worker Phazisa Mbilini says the condition is highly stigmatized. There is the belief that the condition proves that one has been exposed by the Almighty, or that their ancestors had been practicing witchcraft.
“Most of these women (victims) are accused of witchcraft by their abusers after being presented with dementia symptoms,” says Mamatsie M. Mokhosi, a Ph.D. candidate in Public Policy at the University of KwaZulu-Natal. Her Master’s thesis dealt with raising awareness and understanding of dementia, especially in rural areas.
Not only does this cause individuals to be ignored or ostracized by their communities, but in some cases, they’ve even been murdered.
The bottom line
We’re comfortable with the familiar, and, often, we seek out the familiarity that is linked to shared views and beliefs, many of which can be traced back to how we were raised. Thus, as Dr. Nzuza points out, our cultural beliefs are usually the first and core reference that we have in trying to make sense of the world.
However, as much as our culture is something to embrace and be proud of, it’s not a monolithic entity. It’s an ever-evolving system that allows room for change.
We exist in a melting pot, and it’s imperative that we respect and better understand one another’s beliefs, she says, even if it means having open, and often uncomfortable, conversations. It’s also our responsibility to create avenues in which these beliefs can be navigated, to the point where we’re able to better protect our health and ensure our longevity.
