Lab 2: Social Networks/Social Support.

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Case Study 1: Mary’s Social Network—Coping With Illness

In early November, Mary experienced an episode of guinea worm. At first, she put a mixture of herbs and oil on the ulcer, but the wound still became hot, sore, and painful. Mary was thus confined to her room for the next six weeks until the painful ulcer healed. One of the older men in the family compound was an expert with herbs and made various preparations for Mary during her illness. Once they heard she was sick, her friends from church would visit in the evenings and offer prayers for her quick recovery.

Mary had a small business selling dried beans, rice, peppers, and cassava meal. On market days, she would set out her wares under a tree in the middle of the village market. On other days, she would have her goods displayed on a small table in front of her house. When Mary was busy behind the house preparing meals for her husband and three children (aged 8 months, 3 years and 7 years), her 15-year-old sister or her husband’s 14-year-old niece would watch the sales table out front. When Mary became sick, she was able to rely on her two helpers until the supply of rice and beans was exhausted. However, because of her helpers’ age and lack of experience, Mary did not entrust them to go to the district headquarters to buy new stocks of these staples when the supply ran out in early December. These helpers also were able to shop and prepare meals for Mary.

Mary’s husband was a lorry driver and spent much of the week away from the house transporting produce from the farms to the state capital, some 80 miles distant. He had a second, younger wife in the capital and tended to spend more time and money on her. The little money he brought back to the village about once a week had to be shared between Mary and he r elderly, widowed mother-in-law. Basically, Mary supported her children and herself through her trade in rice and beans. Once her stock was exhausted, she was worried about where she would get money for her daily needs. In a gesture of good will, the second wife, having learned of Mary’s pain, went to a friend who was a nurse, got some aspirin and antiseptic lotion (to clean the ulcer) for Mary, and sent these to the village through the husband.

Mary belonged to a “contribution club” that met monthly. The twelve members would make a set financial contribution to a central pot and then in rotation, each member would have a turn receiving all the proceeds for that meeting. Mary was due her turn to receive the money in January, and now she worried how she would make her contribution for December. Mary also belonged to the market women’s association. The chairwoman of the association visited Mary and agreed that members would loan her some stock of rice and beans to sell and keep her financially stable until she was well.

Mary also had a cousin who had married someone in the village. She sent word to her cousin, who visited, brought her cooked food on several occasions, and loaned her a small amount to cover the cost of a new school uniform for her oldest child. The cousin, who was a Moslem, also brought Mary a small amulet containing verses from the Koran to help her recover.

Mary’s youngest child was due for a measles immunization. She thought long and hard about whom she could trust to take the child to the cli nic. Her mother-i n-law was having difficulty walking herself, but she also did not believe that vaccinations were necessary for children. A sister-in-law with a child about the same age lived in the compound, but she and Mary had had a falling out over an argument that the mother-in-law favored Mary’s husband more than her own. About that time, the middle child developed a fever and Mary was too weak to carry her to the clinic. Her mother-i n-law was on hand to offer advice about herbs, but Mary decided to send one of her helpers to the nearby medicine shop that was operated by one of the contribution club members. The shop owner allowed Mary to have the drugs on credit.

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Fortunately, Mary was well enough to participate in all the holiday celebrations in the village. During that time, she went to all her friends and colleagues and thanked them for their support during her bout with guinea worm

Case Study 2: Mrs. Opawumi and Her Church

Mrs. Opawumi is a very religious woman, married to the pastor of Christ Apostolic Church on Iwo Road. She suffered a stroke secondary to hypertension that resulted in paralysis of her right side and loss of speech. She is receiving treatment at the University Teaching Hospital’s Physiotherapy Department.

Prior to her illness, Mrs. Opawumi had never known about hypertension or stroke, but she could remember as a child that her mother suffered from an illness which resulted in loss of speech and inability to walk. She had been treated at the same hospital.

Mrs. Opawumi went to school only up to primary class three because her family could not afford to send her further. After dropping out of school, she spent much of her childhood helping her mother in her business as a trader and actually managed the business after her mother’s sick ness. She developed the habit of praying at that time and, because of her prayers, never imagined that she herself could suffer the same problems that her own mother faced.

Her normal daily activities center around the church because she is married to the pastor. She is a leader of the various women’s societies in the church and acts as a midwife for the members. She also contributes to the general ministry. She organizes programs—such as fasting, prayer sessions, and night vigils—for the women’s wing of the church. In addition to all these church responsibilities, she had to raise her own five children.

She and her husband live on the church premises. After her mother died, she transferred her small business to a shop close to the church, where she still maintains the trade in provisions. Her youngest daughter, who is in high school, helps at the shop in the evenings after school. The older children live in other cities.

Mr. Opawumi not only finished high school but obtained a diploma from the polytechnic in business studies and another diploma from a bible college. He is also busy with daily church activities and is especially renowned for his healing sessions. He was shocked at his wife’s stroke and was actually embarrassed that he apparently could not protect his own wife’s health.

Mrs. Opawumi’s stroke happened during a special church convention that his parish was hosting. It occurred during an evening revival session that was being held after a long day of prayer meetings and bible study sessions. While Mr. Opawumi was in the pulpit calling for those who had a sickness to come forward, he noticed that a woman seemed to have fainted and was being carried out of the church. He couldn’t leave the service but instructed his assistants to find out what was wrong and help the woman. Little did he know it was his wife.

The assistants carried her to the house and began a prayer vigil. A few women from the church societies stayed with her and encouraged her to rest and tried to get her to eat. That was when Mrs. Opawumi realized that she could not lift her hand or speak. She started trembling in fear and fainted. At this point, people knew that Mr. Opawumi had to be notified.

Mr. Opawumi and the church elders rushed in and started praying. They said that this must be the work of the devil and his enemies trying to disturb the convention and revival. A nurse, who was a church member, was asked for advice. She injected Mrs. Opawumi with some sedatives. They all agreed that Mrs. Opawumi should rest quietly at home.

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In the meantime, the news of Mrs. Opawumi’s collapse spread throughout the congregation. People became afraid that demons were attacking and, since they did not know who might be the next victim, ran from the premises. The elders of the church maintained a vigil beside Mrs. Opawumi all night.

The next day saw no improvement in Mrs. Opawumi’s condition. Her husband and the church elders took her to a nearby private hospital. The church members contributed about $600 that morning to ensure she received proper treatment.

Over the next two months, a considerable amount of more money was spent, but Mrs. Opawumi’s condition did not improve. Many church members visited Mrs. Opawumi daily and prayed by her bed. They suggested that the private hospital was not a proper holy environment to ensure adequate recovery from the work that the devil had supposedly done on Mrs. Opawumi. She was brought home, and while she continued taking the medicine the doctors prescribed, she was the center of continuous prayer vigils, day and night, for two weeks. She became even weaker.

It turned out that her own relatives had not heard about the catastrophe. Finally, her cousin visited and was shocked. She suggested that Mrs. Opawumi be taken immediately to the University Hospital. She explained that the University Hospital would be cheaper than a private clinic and had better facilities and up-to-date equipment that could even focus on rehabilitation. The family realized that they had tried almost everything except indigenous medicine, which Pastor Opawumi said was “the devil’s work,” so they agreed to send Mrs. Opawumi to the University Hospital. The church elders agreed, too, and promised to find money and transport to help pay for treatment and drugs and ensure that Mr. Opawumi could visit every day.

Once at the University Hospital, Mrs. Opawumi’s blood pressure was brought under control. Her dizziness and anxiety were reduced. She began to regain her speech and started exercises in the physiotherapy unit. At the PT Unit, Mrs. Opawumi met other patients with similar histories. She met one Mrs. Adeyemi who had been exercising for several months. Mrs. Adeyemi explained that she could not even move her leg and arm at all when she first arrived, but with the regular exercises, she had improved greatly. This gave Mrs. Opawumi encouragement that she, too, could regain her strength and mobility.

At discharge, the physiotherapist and doctor explained to Mr. and Mrs. Opawumi the need to continue taking the hypertension medicine. They requested that she attend the physiotherapy unit for twice-weekly appointments.

The church members welcomed Mrs. Opawumi home. Everyone brought food. They asked what help they could offer. A schedule was worked out for the two members with cars to take Mrs. Opawumi to the PT sessions. One of the women’s societies agreed that its members would come around daily to remind Mrs. Opawumi to take her medicines and see if she needed help in preparing her special salt-free diet. A special collection was taken up to help pay for the regular PT sessions.

These arrangements worked well for about three months. Unfortunately, one of the people with a car was transferred to another town. The other tried to make up the difference, but her work at the Ministry made it difficult to take time off very often. Economic times were getting harder, and the Opawumis realized that they could not burden their parishioners too often for donations. Mrs. Opawumi began to fret that she should open up her small shop again to bring in money, but Mr. Opawumi said that might increase her stress and blood pressure. Mr. Opawumi had joined a Credit and Thrift Cooperative (started by Pastors of several churches in the neighborhood) and was able to get a small loan to cover some of the taxi expenses on the days when a free ride was not available. The loan was also used to pay for her medical and medication bills. But at times, she missed her clinic appointments and went without her drugs.

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At clinic one day, Mrs. Opawumi asked Mrs. Adeyemi how she had managed all the expenses and inconveniences of maintaining her regimen. Mrs. Adeyemi explained that she belonged to several different social groups. There was a cooperative society among staff at her workplace. She also belonged to a union of secretarial and administrative staff that looked after the benefit of their members. And even though the provisions shop she maintained in the garage of her house was small, she had still joined the women traders’ association in her neighborhood, and those members were able to help each other with loans in times of stress or watch each other’s shops. Members of her Muslim women’s association would help her watch her grandchildren (who lived with her) whenever she had to go to clinic.

A Pregnant Teen on the Navajo Reservation This case study was adapted from experiences of the Family Spirit family life education program of the Center for American Indian Health, The Johns Hopkins University

Sharon turned 17 in late November, but her birthday was not happy. She had just learned that she was pregnant. Tommy, her boyfriend, was home in Tuba City from the university in Flagstaff for the Thanksgiving Holiday. When he heard, his face turned ashen. “My parents will have a fit. They really value a college education, but they also hold family honor high. If they learn you are pregnant, they will make me marry you and get a job.” Sharon was distraught and said, “Let’s not tell anyone. I can leave school at the end of the semester. I will go live with my grandmother until the baby is born. I’ll return to school in September next year and just tell people that granny needed help because she is old.

Just before Christmas Sharon called

Aunt Sally in Tonalea and said, “I am thinking about visiting granny for the holidays. When next you are in Tuba to buy supplies for your farm, can you pick me up and take me to granny’s?” Aunt Sally asked where her sister, Sharon’s mother, would be going too. “Oh no. She’s at the shop during this period. They won’t give her time off. In fact, Sharon rarely saw her mother, and her father was working construction with her brothers in Texas. She actually started to look forward to spending some time with granny.

The ride to granny’s Hogan was only 20

miles, but on the unpaved, winding and rutted mountain roads it took Aunt Sally almost an hour to get to the settlement. Granny was so happy to see Sharon, and was not even upset when Sharon confided in her about the pregnancy. “Don’t worry. We have our traditional ways, and the Medicine

Man can even come and do a Blessing Way Ceremony for you to ensure a safe pregnancy and birth.”

Granny’s traditional ways included waking up at dawn to face the sun and then working throughout the day to keep the body strong. Granny had a sheep farm, and her son, Uncle Jasper, came over daily to help feed the sheep and run the pump that filled all the tanks and reservoirs for the sheep and the house. Jasper also brought foodstuffs from town once a week and would not let granny pay for these. Sharon

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worked with her uncle every day and also helped granny prepare the daily meals of fry bread, which were meager compared to what Sharon ate at the burger places in Tuba. Sharon had thought she might keep up with her schoolwork, but after working with the sheep all day, the prospect of reading by lantern light at night discouraged her. Instead she listened to granny’s stories of how Spider Woman and other matriarchs took care of their children.

It was not until a month after school

resumed that Sharon’s mother came to find out what Sharon was doing. “Why didn’t you tell me you were dropping out of school? Everybody has been asking of you.” This made Sharon think of her friends at school and church, and she started to cry. She realized that she could not lie to her mother and told her the reason for her temporary exile. “I’ll be able to go back to school in September after the baby is born. There’s day care in the town. I’ll catch up and nobody will know. Just tell people granny needed my help.”

Her mother said, “How can you live out

here without light, phone and adequate food? I don’t have much money, but Tommy’s folks are well to do. His father has an important position with the town and his mother serves on all these committees. They have connections. I am sure they would take care of you.” “You don’t understand. They won’t approve,” said Sharon. “They will make Tommy drop out of school and marry me. All his dreams will be lost, and we will have no future, if he has no education.” Mama laughed. “Don’t trust those boys. He probably has three girlfriends in Flagstaff.” Sharon broke down and would not talk o her mother again, so Mama left.

Mama did recognize her own limitations,

but she did care about Sharon. When she got

back to Tuba she went immediately to see Helen Yazzie, the leader of the women’s society at church. Helen spun into action. She was known for working with the youth, and she mobilized the women in the church group to put together a special package for Sharon that consisted of a homemade blanket, baby clothes and even some foodstuffs to tide her over. She delivered these to granny’s homestead in late March to joy of both granny and Sharon.

As spring came around, both Aunt Sally

and her sister Thelma came to help granny prepare the cornfield. Granny reminded Sharon, “This is what feeds us, so you better help. So Sharon and her two aunts worked the corn from spring through summer. Sometimes the aunts would bring Sharon’s cousins who went to high school in Tonalea. The cousins would tell her what was happening in town and ask her all kinds of questions about the expected baby. Sharon was happy for their visits but from the occasional sideways glance between the cousins, Sharon could tell that they disapproved of her getting pregnant and dropping out of school.

Mrs. Helen visited again in May with

Sarah Begay who said, “You’re all skin and bones Sharon!” “Well,” retorted Sharon, “Granny says I should work and keep active to be healthy, and that’s what I am doing. I even helped Uncle Jasper shear the sheep last week.” Sarah said, “Sharon, you know a pregnant women needs to build her body to support that baby. There’s a government program called WIC that gives supplemental food for women, infants and children, and you should be attending prenatal clinic at least once a month. I’m going to send that public health nurse out to see you and get you signed up.” Granny overheard this and said, “I don’t want any of these Anglo government workers spying around my

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farm. If Sharon needs help, her Aunts will take her into town.”

So it was settled, and Aunt Thelma

agreed to drive Sharon into Tuba City. Sharon signed up at the prenatal clinic and went to the WIC office to get her food vouchers. She had wished that there were a functioning prenatal clinics in Tonalea where few people knew her, but at least she could use the WIC vouchers in Tonalea. As if responding to her worries, whom should she see when she walked out of the WIC office but Sam, a member of the agriculture club she belonged to at school.

“Hi. We haven’t seen you around.

Everybody’s worried. You’re mother’s never at home when we call,” said Sam. Sharon was embarrassed at first, but she said, “You know Sam, I am staying with my grandmother this semester to help her with farm work. She is old and needs all the help she can get. I’ll be back in school in September.” Sam was happy with the explanation. “I wish you had told the school authorities, they are worried, we even overhead them talking about sending for the police. If you want, I will let them know what is happening, but you will need to write to them officially, or your whole year, even the first semester you finished, will be lost.”

Sharon promised to write, and Sam said

he would come out to the farm on the weekend to collect the letter. In fact, when Sam came, he brought three of Sharon’s other friends from the club, and they had a fun Saturday sharing gossip. One of the girls said, “This farm life is really agreeing with you. You’re really gaining weight.” Sharon blushed, but then granny, overhearing everything, said, “I have to feed my granddaughter well.”

Finally, it was time to plan a Blessing Way ceremony for Sharon and the baby. This has been the tradition of her forefathers since the beginning of time. With the profits from the wool, she and Uncle Jasper consulted the Medicine Man and arranged a fine ceremony. All the relatives from around Tonalea came, but they were careful not to let too many people in Tuba know. All the relatives brought food. There was enough to feed the celebrants and for Granny and Sharon to use for some weeks. The celebrants sang and prayed for the well being of the baby. All the aunts and cousins gave advice and encouragement. Several noted how strong Sharon looked and praised granny’s oversight in keeping her active.

Sharon was surprised and a bit

frightened to see Sam, Rhoda and Cheryl from school at the ceremony. “We had to come, and we won’t tell anybody. We were worried about you’re missing school. We agreed to come out every weekend and help you review the courses we are taking this semester.”

The school friends kept their promise

most weekends, and Aunt Thelma and Aunt Sally took turns taking Sharon to prenatal clinic and the WIC office until the time she gave birth. The Aunts even volunteered to help take care of the baby so Sharon could return to school. In fact they suggested that she enroll with her cousins in Tonalea so everyone could watch after her and the baby. As Sharon sat in her hospital bed with the new baby, she felt both relief and hope.