Source: HCJB Global
"He didn't follow the instructions correctly," a Malawian said of his dead uncle. "And because of this, he contracted a disease in which his body swelled up and he went mad."

The African was not describing mishandling prescription drugs, but instead the charm his uncle had purchased to become wealthy.

"It was his own fault that he died out of his greed to get rich," was what an Ecuadorian family practice resident Dr. Marco Pesántez, was told.

Pesántez and Dr. José Luis Vivanco each served a one-month rotation at the PIH clinic as part of their family practice residencies at Hospital Vozandes- Quito. "From a Western perspective, one would make a list of possible causes of death and determine what evidence there is to support one diagnosis over another," said Dr. Richard Douce, after helping at the clinic for more than two months.

Douce listed possibilities such as liver cirrhosis or a parasitic infection called shistosomiasis which is common in Malawi. Possibly the man was an alcoholic, but to the nephew, greed and misapplying the charm took his uncle´s life.

"Westerners will ask what caused an illness while an African will ask who caused an illness," said PIH chaplain Lester Chikoya as he underlined fundamental differences in how Africans view health and the HIV/AIDS epidemic. To a person raised within the traditions of many rural African cultures, most things have a spiritual explanation.

Douce led a Bible study in Malawi on the cost of discipleship. While discussing Luke 12:51-54, a PIH counselor told about a friend whose brother had died, requiring the living brother to sleep with the widow in front of the dead man's cadaver in order to let the man's spirit go in peace. Despite pressure from peers and family members, the man refused, not wanting to participate in something based on demonic beliefs.

Many cultural practices in central Malawi's rural cultures attempt to placate ancestor spirits. Some of the taboos prohibit sexual relations in married couples for long periods of time, making sex outside of marriage more attractive, contributing to the spread of HIV in a country that is 80-percent Christian.