Impact of Swaziland Culture and the Provision of Health Care

The Kingdom of Swaziland (SZ) is country situated in the sub-Saharan part of the African continent. According to the information released by the World Health Organization (WHO), this nation has a size of approximate 17,000km² as well as a population of more than 1.2 million individuals. However, the SZ is predominantly occupied by young citizens since the persons aged 60 years and above constitute of about 5.3% of all inhabitants. Evidently, SZ has experienced a dramatic rise in early deaths as well as an increase in the level of various diseases.^4’1 In connection with the above statement, the life expectancy for SZ citizens is in between 52-55 years. One of the ailment that has affected this nation in a greater manner is HIV since 39% of expectant ladies between 15-24 years as well as 27.5% of grownups ranging between 15-49 years are infected with this disease. In a like manner, the majority of people from SZ also have various complications such as opportunistic tuberculosis, and problems linked with AIDS among other infectious health issues. In consideration of women health, the researchers have identified that the maternal mortality has increased at a higher rate. Still, the cervical cancer is confirmed to be the 17^th factor leading to women death.² Indeed, there are numerous health barriers and risks as well as cultural biases contributing to the depletion of health status in Swaziland. 

Health Risks and Barriers

There are several health barriers and risks that have depleted the wellbeing of SZ civilians. The first factor that has worsened healthiness is low rates of employment and education. To illustrate, the employment and educations challenges in Swaziland are systemic and large-scale issues that might be analyzed at a nationwide level. In this case, the SZ has failed to invest their capital in tertiary training lopsided to secondary learning, a thing that increases the number of undereducated individuals.¹ For instance, it is only 21% of males and 18% of females with 12-years have attained the basic education. On the other hand, the persons that do not have secondary education only the opportunity of securing jobs in agricultural and manufacturing areas as well as on dwindling industries.^3,4 As a matter of fact, the above elements have contributed to an ending cycle of internal oppression and poverty. 

Moreover, the existence of a poor family structure has also depleted the health status in a greater manner. Conversely, SZ family structure has changed from a multifamily and extended family support network to a single and individual parent household has contributed to a greater implication on the women’ lives. Furthermore, the early deaths in this nation emanate from various aspects such as tuberculosis, HIV/AIDS, accidents, and illness.^5,3 On the same point, middle-years ladies are not bothering to care for the grandmothers, children and also the great-grandmothers, hence, ending a great number of kids needing to be raised. 

Furthermore, the SZ’s administration does not have effective public health interventions. Undoubtedly, the SZ’s health sectors have failed to put lots of emphasis on issues affecting ladies including child assistance, food, education, access to all health care services, and safe housing.³ In connection to the above information, it is noted that the medical sector has not come up with an effective outreach program at the major location, thereby, failing to work together with community partners such as school and church.¹ Still, the government does not collaborate with ladies with leadership capabilities in order to be able to handle their needs in an effective manner. 

Poverty is another factor hindering provision of health care services in an effective manner. To illustrate, scarceness is the strongest force inspiring the SZ’s citizens to act in a certain manner that increases their risk of contracting HIV, particularly while exchange sex for money. The study reveals that in Swaziland many young girls and men have indulged into sex commercial works in order to get financial support to cater for their daily living, school fees, foods, and clothing as well as for the desire of expensive gifts and luxurious lives.³ Conversely, the aspect of being involved in such activities has made them contract HIV/AIDS, a malady that has robbed the nation the most skilled, professional and productive citizens. Due to increased deaths of energetic persons, the old persons have the responsibility of feeding and supporting the rest community members.⁴ As a result, the aged people are unable to access the quality life and observe diet, hence, the community members are prone to various diseases. 

Besides, the mistrust of healthcare givers is another element depleting the provision of health care services. The researchers have identified that ladies have a tendency of misbelieving fosters. In relation to the above statement, the patients hold that the nurses are not competent enough to offer the necessary services. Indeed, women have pointed out that some nurses normally show aggressive behaviors toward ladies who are in active labor.¹ In a like manner, the same attitude towards healthcare givers in SZ have increased at a higher rate where the citizens consider that the majority of nurses does not have the necessary qualification for handling their issues.⁵ Undoubtedly, the above instances have affected the provision of medical services in a negative manner. 

In addition. The lack of enough resources and supports is depleting the provision of healthcare services. To be specific, the negative enables worsening health maintenance are lack of money, inadequate nourishment, poor housing security as well as limited employment opportunities.⁵ Irrespective of SZ citizens having good experiences in the workstations, the government have failed to come up with effectual method or roadmap to attain certain forms of public health goals that are considered to be the most essential to community members.¹ Still, it occurs that the community does not have appropriate methods of supporting underprivileged individuals within society. 

Also, the traditional practices such as female genital mutilation (FGM) is a factor challenging the healthcare services. The FGM entails a surgical removal of the entire or part of the most sensitive ladies genital organs. In several cases, this practice is done for the purpose of injuring the female genital parts or for nontherapeutic or cultural reasons. However, there are numerous negative effects associated with the FGM.^3,4 For instance, the long-term and immediate health implications of the above exercise are a shock, severe pain, urine retention, hemorrhage, damage to the adjacent parts and formation of ulcers on the injured part. It is noted that the FGM is paving a way for several infections and diseases, hence, hindering proper control of diseases in SZ. For instance, FGM is considered to be among the leading factors contributing to rise of vaginal lesions and tearing, which, in turn, lead to a rise in cases of HIV transmission among ladies residing in SZ.³ In relation to the above information, the rise in HIV transmission faced by girls and women since the involved caregivers normally use unsterilized instruments to cut off unwanted part. 

Cultural Biases

The cultural biases in SZ have also challenged the process of handling healthcare-based issues in an effective manner. To illustrate various SZ cultural groups have different belief systems relating to healing and health and this programs are closely connected with the western biomedical medicine theory.² Certainly, the above belief systems may entail varied disease models, illness/wellness paradigms, the culturally-specific diseases and disorders, the use of indigenous and traditional health care approaches and practices.⁵ To add, the people from Swaziland have a tendency of seeking healthcare services that are westernized and laying lots of emphasis on healthcare providers’ feelings.  

For instance, SZ shows cultural prejudice by relying on personalistic disease theory that denotes that intervention to a certain ailment should be carried out by agents such as sorcerers, witches, humans, supernatural and non-human forces. Based on the above framework, these individuals hold that illness emanates from strong emotional states such as fright, grief, shame, jealousy, and intense anger. Correspondingly, the personality theory is applicable to patients who are aware of and have faith in medical practices and beliefs from their individual cultures.⁴ Indeed, these health beliefs and attributions are vitally different among varied cultures, hence, making it hard for the healthcare givers to come up with a common way of offering medical attention to all patients.¹ On the same point, there are other persons who have strong beliefs that the majority illnesses emanates from ghosts and spirits, hence, ending up failing to make use of any provided medical intervention. 

Furthermore, the naturalistic disease theories applied by some SZ members have depleted the provision of quality care services. This theory offers the description of the ailment in scientific terms, objective and it also operates in the assumptions that the disease can attack people when their bodies are out of balance. Owing to the above framework, the disease is believed to affect the body because of an identifiable, specific medical factor of pathogens such as bacteria and virus. In consideration of the biomedical framework, the pathogens should be eradicated to ascertain that the affected persons are considered healthy.² Similar to the above theory, the naturalistic disease theory is another notion indicating that the body has four elements that determine body healthiness and they includes phlegm, blood, black bile, and yellow bile. When the above components are not balanced, the human being is considered unhealthy. With regard to naturalistic theory, it is said that healing can emanate from the restoration of the suitable balance of humor via the removal of starvation and bleeding as well as the replacement of medicine and special diets that contribute to a given deficiency.⁵ As a matter of fact, the above aspect makes some individuals from SZ to disregard the professional healthcare givers since they have they own ways of dealing with medical issues. 

In addition, some persons in SZ normally focus on both mental and physical limits of cultural health. For instance, the notion of being plump and stout is connected with prosperity and good health. In a like manner, some cultural groups in Swaziland have a tendency of celebrating more voluptuous ladies who are fit and thin.⁴ Indeed, the above factor has contributed to instances where some ladies fail to be concerned about their healthiness, but they instead focus on factors that will make them more attractive to men.¹ Precisely, this behavior has made ladies forget to observe body mass index (BMI), hence, ending up being weak and risking to have varied infections and diseases. 

Still, the notion of having discriminative perception over varied individuals is also worsening healthiness in SZ. For instance, some people from Swaziland holds that immigrants are the ones who have certain infectious ailments.⁴ In this case, the foreign is assumed to be prone to many diseases because of their disrupted social and family networks, prejudice and financial challenges that hinder them from maintaining their healthy lifestyle. Similarly, the victims of discrimination do not also have the opportunity of securing highly paying jobs, a thing that made them less mindful of healthcare concerns.² conversely, the above aspect is acting as a barrier to the provision of quality care.

To conclude, despite Swaziland having a population of 1.2 million people, the government have not managed to offer the suitable care to its citizens, hence, leading increase of early deaths. Some of the factors that hinder the effectual progress of SZ’s healthcare sector include cultural biases as well as health risks and barriers.  To be specific, the health risks and barriers affecting SZ’ s medical sector include negative attitude toward nurses, poverty, low education level, underemployment, poverty and poor health interventions among others. On the other hand, the prejudice towards some cultural groups is making is also challenging the effectiveness of SZ’s healthcare sector. Indeed, the Swaziland government should establish suitable ways of dealing with healthcare issues.

References

1. Murray BA., Social and cultural factors in women’s health in rural Africa. 2017: 17-23.
2. Vaughn LM, Jacquez F, Bakar RC. Cultural health attributions, beliefs, and practices: Effects on health care and medical education. The Open Medical Education Journal. 2009: 22; 2; 1.
3. Ziyane IS. Factors which deter Swazi women from using family planning services (Doctoral dissertation). 2009: 1-227
4. Morris JL, Short S, Robson L, Andriatsihosena MS. Maternal health practices, beliefs and traditions in southeast Madagascar. African journal of reproductive health. 2014; 18; 3:101-17.
5. Nxumalo KN, Okeke CI, Mammen KJ. Cultural Beliefs and Practices towards HIV/AIDS amongst High School Learners in Swaziland. Studies on Ethno-Medicine. 2014 1; 8; 2:135-46.

Appendix

There are numerous health risks and barriers that have weakened the SZ’s healthcare sectors and they are as follows: ³

• The family structure has changed, hence, subjecting the elderly people to a burden of catering for their youngsters
• The government does not have effective health interventions to promote citizens’ wellbeing
• The poverty is also increasing the risk of people of Swaziland to contract diseases and infections
• Failure to believe the health care providers is depleting effectual interaction between physicians and patients, hence, depleting medical services
• Swaziland government does not have enough support and resources for enhancing healthiness for its citizens.
• FGM also put women at higher risk of contracting diseases, infections, and viruses, thereby, depleting the provision of healthcare services. 

On the other hand, the cultural biases are also affecting the healthcare sector in a negative manner. as it is shown below: ¹

• The Swaziland community has failed to offer equal opportunities to all inhabitants, hence, subjecting the foreigner’s hardships such as lack of employment, a thing that, in turn, contribute to rise of the level of diseases. 
• Moreover, people in this nation use a theoretical approach to handle their health issues, thereby, demeaning the professional caregivers.
• Still, some members of the Swaziland community also link diseases with eating habits, hence, being unable to identify some diseases.