If you sell your sickness, you get a cure

The Chronicity Care Africa Blog features articles on various aspects of chronic illness experiences and care in African communities. In this piece Naomi Haile reflects on discussions she had with her father Haile and mother Emebet, about a popular African proverb and the insights it reveals about illness disclosure and social support in African contexts.

“If you sell your sickness, you get a cure”

“He who conceals his disease, cannot expect to be cured”

These proverbs are well known and commonly used across African communities.

In Amharic (the national language of Ethiopia) it reads “Beshitawen yedebeke medhanit aygegniletim – በሽታውን የደበቀ መድሀኒት አይገኝለትም”. In Ghana’s Akan and Ga communities a similar proverb goes ‘if you sell your sickness, you get a cure’. “wo ton wo yareε a na wonya n’ano aduro” (Akan); “ke ohoo ohela, onaa ehe tsofa” (Ga).

I spoke to my parents about the use of the proverb in the Ethiopian culture, and found out from my dad that despite its direct meaning, the saying is often used to address “general non-health related issues”.

He gave an example saying:

“Someone who has money problems, but doesn’t speak up about their situation, will never get the help they need. So, in our culture, the proverb isn’t restricted to health-related problems, instead, it’s often used to address general life situations. It’s like a metaphor meaning – If you don’t speak up about your problems, you’ll never find a solution”

But this brings up the question, how is health defined across different African cultures and communities?

Is there such a thing as a general non-health related situation?

Take for example the person with money problems: will their situation impact their quality of life (especially if they’re not reaching out for help)? Yes it will.

And if their quality of life is impacted, won’t this put a strain on both their mental and physical health? Once again, the answer is yes, yes it will.

This is a clear example of a “general life situation” becoming a health situation.

To all the students reading this, if your face has ever broken out into a thousand spots due to a deadline or an exam, raise your hand… (I too am raising my hand).

According to Mind’s 2020 Coronavirus survey, “73% of students said that their mental health declined during lockdown”^[1].

If a student who is experiencing mental health problems doesn’t speak out and submit an extenuating circumstance report, firstly their grade will take a hit, then their mental health will take an even greater hit – and more often than not, behind a wave of mental health issues, comes a wave of physical health issues.

This is another example of a “general life situation” becoming a health situation.

The World Health Organisation (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”^[2]

I’m not sure about you, but reading this made me ask myself, am I healthy? Yes, I don’t have an obvious or visible disease, but am I healthy?

We, humans, are affected by everything we come into contact with. Everything we encounter has an impact on us, whether it’s consciously or subconsciously. We register and form opinions on things without even realising. It’s how adverts work, and how ‘nudging’ in public health works^[3].  

The problem is, a lot of us don’t realise how much the things in our lives are affecting us. Perhaps if we did realise, then many of us would be living a lot differently.

Why? Because deep down, everyone treasures their wellbeing.

When I spoke to my mum, I asked her:

“Do you think He who conceals his disease, cannot expect to be cured is a proverb that people in Ethiopia consider to be effective?“

she responded saying:

“Yes, if there was a poster that had the proverb written on it, put up in a public area, no one would walk past without saying – this is the truth [ewinet new]”

So, if so many people believe this saying to be true, why is no one speaking up?

I believe one possible reason is stigma.

It is human nature to want to be accepted. A great deal of our behaviour is centred around the need for acceptance, and the desire to avoid rejection. How can we keep urging people to open up about their problems, if there’s a high chance that their community will reject them?

In many African cultures, it’s common for individuals or families to hide problems they may be going through. I asked my mum why she thinks this is the case in Ethiopia, and she said:

“They’re ashamed, they don’t want to look weak, and they don’t want to be avoided. If we look at divorce for example – divorce may not be a big deal in some Western countries, but in our culture, it’s pain… especially for women. These women are made to feel like it’s their fault their marriage didn’t work out, and that’s heartache. I know many women who have tried to hide their divorce, they lie and say that their husbands are at work when friends come around. This is to protect themselves from judgement and isolation. But in the end, they end up affecting their health – maybe they’re experiencing high anxiety, depression, headaches, insomnia, weight loss or gain, so many things can come from the stress of hiding. And it’s like a domino effect, one thing affects the next thing, if they have kids, they will be affected. These women may even end up having suicidal thoughts… because of society.”

I then asked her:

“do you think these women acknowledge the fact that their health is being impacted?”

And she said:

“The women in our culture don’t think divorce causes illness – they feel like they’ve done something bad, they don’t think about their mental health and wellbeing – if they did realise that hiding a divorce can cause illness, I am sure they would do whatever it takes to improve their wellbeing.”

A friend of mine recently reminded me of another saying: “closed mouths don’t get fed”.

There’s a lot of truth to that saying. But after listening to what my mum had to say, I started to think about it differently. It’s easy to say to people “Closed mouths don’t get fed”, but if they open their mouths, what will we feed them?

We often don’t think about that.

Nathan Dewall, a psychologist at the University of Kentucky wrote, “People who feel isolated, lonely and excluded tend to have poor physical health”

So are we as a society asking people to open up about problems in their life, just so that they can be rejected or isolated, to the point that their health further deteriorates?

I think a part of us creating supportive environments for health, is simply to acknowledge health in everything.

Research shows that the social determinants of health – such as working conditions, financial status, education, housing, and access to healthcare – have a greater impact on health quality, than health care or lifestyle choices .

Maintenance of health is not limited to health professionals, and health is not limited to a medical box. It’s important that our social environments yell “health and well-being for all”, just as loud as our mouths do.

Let’s make it so that whoever reveals their disease can expect to be cured.

[1] Mind UK, 2020. The mental health emergency How has the coronavirus pandemic impacted our mental health?. p.12.

[2] Who.int. 2021. Constitution. [online] Available at: <https://www.who.int/about/who-we-are/constitution>

[3] Marteau, T., Ogilvie, D., Roland, M., Suhrcke, M. and Kelly, M., 2011. Judging nudging: can nudging improve population health?. BMJ, 342(jan25 3), pp.d228-d228.

[4] DeWall, C. and Bushman, B., 2011. Social Acceptance and Rejection. Current Directions in Psychological Science, 20(4), pp.256-260.

[5] Who.int. 2021. Social determinants of health. [online] Available at: <https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1>