Health intervention in an African cultural context
The authors propose an interactionist approach (Babbie, 1995) to address the health and social issues of these children with albinism. Interaction focuses on small-scale intervention rather than on the society as a whole and base intervention on the meaning a person attaches to his/her condition. To be successful there must be compatibility between the objectives of these interventions and the values and beliefs about disease of the population for which they are designed, in this case Sotho children. African cultures often embrace supernatural rather than scientific or medical explanations for the onset of disease and are more concerned with cures than preventative measures. The children in this study are clearly well aware of the short-term consequences of sun exposure but may be less informed about the long-term risks of developing skin cancer. Given the fatalistic attitude within their culture to disease, an intervention strategy focusing on these future risks may not prove effective. An approach that stresses the immediate benefits of sun avoidance and protection may have more impact on behaviour. Short-term monitoring (diary recordings of sun exposure and subsequent episodes of painful sunburn or skin sores) and goals (reducing the number of burns, lesions or trips to the nurse for treatment of skin lesions) may be more appropriate. The children themselves must be convinced that staying out of the sun is a sensible and worthwhile choice. An intervention programme for these African children with albinism is thus likely to differ considerably from one designed for European children, based on their different levels of knowledge and beliefs.
Given the strong and supportive group dynamics at this school, peer group discussion sessions leading to shared and agreed objectives on ways of managing their condition are likely to reinforce positive behaviour and lead to sustainable behavioural change. This will make the children active participants in the intervention, rather than passive listeners. Training in personal coping skills is also important if pupils in this relatively sheltered environment are to integrate into mainstream schools at secondary level and cope with adult life in the community.