*4.4.1 The care of the sick child*

The traditional healer cares for the sick child's body. The body is thought to be possessed by an "evil spirit," an illness that manifests itself in the patient by chronic anemia and the seizures of pains in the back and feet. These symptoms inform the traditional healer about the extent of possession and persecution of the sick child's body by wizards. In response to this possession/persecution, the traditional healer provides bodily care to the patient.

Jules says that he was wounded on the body. The painful parts of the sick child's body are scarified to allow the therapist to act directly on the evil and to limit the destruction of the body by the wizards. He does this by administering a powder with magical powers, effective against sorcerers. Therefore, the care of the patient has a curative aim of "*freeing*" the patient from this possession and persecution by wizards. Thus, not only is the blood treated here, but also the body too.

#### *4.4.2 Care of the brothers, sisters and the mother*

Jules' mother and his paternal uncle accompanied Paulette to the traditional healer. The brothers and sisters, who were absent from the consultation, received through the uncle the treatment given by the traditional therapist. Jules refers to the fact that his paternal uncle administered on him and his other siblings scarifications and he applied the powder from the traditional healer. Because the father is deceased, the paternal uncle went accompanied his mother and the sick sister to the traditional practitioner. This shows the involvement of the extended family in traditional care and support for the mother in this process apart from acting as an intermediary between the traditional healer and the family. He is also responsible for monitoring the application of the traditional medication.

At the requestion of the traditional healer, his paternal uncle scarified Jules just as he did to his sister. The treatment was administered orally and via scarification of the back. "*Even my mother and my older sister ate the same medicine. After eating it, the remaining was put in the blood*." Thus, Paulette's siblings and her mother who were considered at risk of becoming, and of being persecuted by witches were also subjected to the traditional treatment against sickle cell anemia. The goal of this treatment is to protect them against the ailment.

The traditional practitioner, through these treatments, sought to domesticate the harm represented by the disease. He did not seek to exclude this evil from the family, but to transform it into an entity likely to cohabit in harmony with family members. The "bad" blood of the sick child is thus transformed into "good" blood, into a blood that is no longer a threat to him or to the family members. This therapy does not aim at excluding the "evil" from the family, but to make the ailment an entity of the family and to bring the family members to accept it as such [43].

#### **4.5 The experience of traditional treatment**

With Jules, there is a before and an after of traditional treatment. An "unsecured" pre-treatment period where the threat of contamination by the disease

**47**

*Sickle Cell Anemia, Representations and Care: Experience of a Brother of a Sick Child…*

looms, and a more "secure" post-treatment period when the threat is contained by

Jules thinks of the traditional treatment as a protection against its contamination by the disease. Taking this treatment is associated with a reduction of fear regarding the disease and possible contamination. He says, "*I'm not too scared. Before I was very scared. Now, with the remedy in my body, I'm not as afraid as I was before*." It is interesting to note that although the fear of his sister's death has diminished, it still lingers in his mind. He experiences his body as less vulnerable and more protected against the disease. This indicates that at this point, Jules feels safer with the disease

The receiving of traditional treatment against sickle cell anemia thus helps Jules contain the fear and anguish that arises in him because of his sister's illness. It helps him to contain his feelings of persecution by the wizards and the fear of infection

For Jules, the blood of the patient is a dead blood, a blood possessed by the wizards. In this sense, "a bad blood" attacks the "good blood" transfused into the patient during hospitalizations. According to him, this gives meaning to the chronic

The traditional treatment is thought by Jules to be effective against wizards. It makes the blood of the sick and the non-sick unassailable by wizards. His treatment reduces the feeling of persecution by wizards, even in the event that his sister dies. "*They will not look for me anymore*," he says. The traditional treatment is thus invested as a protection against the attacks of wizards, against the disease and, of

Jules does not associate the death of a patient with the end of the disease as in the case of his mother's youngest daughter, which preceded that of their father. According to him, the disease survives and invests another child or family member. This leads Jules to think of himself as the next potential victim of the disease in the event of Paulette's death. "*If Paulette dies after her little sister, that means we're going to get another person to kill. If she dies, another person will die. That's what scares me*." Jules has a fear of death concerning his sister. He suffers more from this fear of death that he feels threatened by the disease, this "death". He thinks of his sister's imminent death and, therefore, his infection with the disease

The administration of the traditional treatment leads Jules to say this about the wizards, "*it's over for them, everyone ate the cure, everyone is armored*," and specifically, "*when wizards enter the family they do not leave*." In connection with receiving traditional treatment, he says one thing and then contradicts it. He expresses ambivalent feelings of protection against and vulnerability to wizards. This suggests that the sense of security against witchcraft remains feeble, as the feelings of

The drawing was made, after the interview, on the dining table in the living

anemia and the iterative crises of pain that his sick sister experiences.

with the disease even if it does not totally eliminate this fear.

*DOI: http://dx.doi.org/10.5772/intechopen.90995*

*4.5.1 Treatment reduces feelings of insecurity*

*4.5.2 Treatment makes blood bad for wizards*

course, against Paulette's and his own death.

insecurity were never really eliminated.

**4.6 The contribution of the drawing**

receiving traditional treatment.

and with the wizards.

and his own death.

room, lit by sunlight.

*Sickle Cell Anemia, Representations and Care: Experience of a Brother of a Sick Child… DOI: http://dx.doi.org/10.5772/intechopen.90995*

looms, and a more "secure" post-treatment period when the threat is contained by receiving traditional treatment.

#### *4.5.1 Treatment reduces feelings of insecurity*

*Human Blood Group Systems and Haemoglobinopathies*

family.

*4.4.1 The care of the sick child*

provides bodily care to the patient.

*4.4.2 Care of the brothers, sisters and the mother*

**4.4 The traditional healer treats the patient and his family**

The traditional healer cares for the sick child, her siblings, her parents and her extended family because the illness is considered an ailment of the patient and his

The traditional healer cares for the sick child's body. The body is thought to be possessed by an "evil spirit," an illness that manifests itself in the patient by chronic anemia and the seizures of pains in the back and feet. These symptoms inform the traditional healer about the extent of possession and persecution of the sick child's body by wizards. In response to this possession/persecution, the traditional healer

Jules says that he was wounded on the body. The painful parts of the sick child's body are scarified to allow the therapist to act directly on the evil and to limit the destruction of the body by the wizards. He does this by administering a powder with magical powers, effective against sorcerers. Therefore, the care of the patient has a curative aim of "*freeing*" the patient from this possession and persecution by

Jules' mother and his paternal uncle accompanied Paulette to the traditional healer. The brothers and sisters, who were absent from the consultation, received through the uncle the treatment given by the traditional therapist. Jules refers to the fact that his paternal uncle administered on him and his other siblings scarifications and he applied the powder from the traditional healer. Because the father is deceased, the paternal uncle went accompanied his mother and the sick sister to the traditional practitioner. This shows the involvement of the extended family in traditional care and support for the mother in this process apart from acting as an intermediary between the traditional healer and the family. He is also responsible

At the requestion of the traditional healer, his paternal uncle scarified Jules just as he did to his sister. The treatment was administered orally and via scarification of the back. "*Even my mother and my older sister ate the same medicine. After eating it, the remaining was put in the blood*." Thus, Paulette's siblings and her mother who were considered at risk of becoming, and of being persecuted by witches were also subjected to the traditional treatment against sickle cell anemia. The goal of this

The traditional practitioner, through these treatments, sought to domesticate the harm represented by the disease. He did not seek to exclude this evil from the family, but to transform it into an entity likely to cohabit in harmony with family members. The "bad" blood of the sick child is thus transformed into "good" blood, into a blood that is no longer a threat to him or to the family members. This therapy does not aim at excluding the "evil" from the family, but to make the ailment an entity of the family and to bring the family members to accept it as such [43].

With Jules, there is a before and an after of traditional treatment. An "unsecured" pre-treatment period where the threat of contamination by the disease

wizards. Thus, not only is the blood treated here, but also the body too.

for monitoring the application of the traditional medication.

treatment is to protect them against the ailment.

**4.5 The experience of traditional treatment**

**46**

Jules thinks of the traditional treatment as a protection against its contamination by the disease. Taking this treatment is associated with a reduction of fear regarding the disease and possible contamination. He says, "*I'm not too scared. Before I was very scared. Now, with the remedy in my body, I'm not as afraid as I was before*." It is interesting to note that although the fear of his sister's death has diminished, it still lingers in his mind. He experiences his body as less vulnerable and more protected against the disease. This indicates that at this point, Jules feels safer with the disease and with the wizards.

The receiving of traditional treatment against sickle cell anemia thus helps Jules contain the fear and anguish that arises in him because of his sister's illness. It helps him to contain his feelings of persecution by the wizards and the fear of infection with the disease even if it does not totally eliminate this fear.

#### *4.5.2 Treatment makes blood bad for wizards*

For Jules, the blood of the patient is a dead blood, a blood possessed by the wizards. In this sense, "a bad blood" attacks the "good blood" transfused into the patient during hospitalizations. According to him, this gives meaning to the chronic anemia and the iterative crises of pain that his sick sister experiences.

The traditional treatment is thought by Jules to be effective against wizards. It makes the blood of the sick and the non-sick unassailable by wizards. His treatment reduces the feeling of persecution by wizards, even in the event that his sister dies. "*They will not look for me anymore*," he says. The traditional treatment is thus invested as a protection against the attacks of wizards, against the disease and, of course, against Paulette's and his own death.

Jules does not associate the death of a patient with the end of the disease as in the case of his mother's youngest daughter, which preceded that of their father. According to him, the disease survives and invests another child or family member. This leads Jules to think of himself as the next potential victim of the disease in the event of Paulette's death. "*If Paulette dies after her little sister, that means we're going to get another person to kill. If she dies, another person will die. That's what scares me*." Jules has a fear of death concerning his sister. He suffers more from this fear of death that he feels threatened by the disease, this "death". He thinks of his sister's imminent death and, therefore, his infection with the disease and his own death.

The administration of the traditional treatment leads Jules to say this about the wizards, "*it's over for them, everyone ate the cure, everyone is armored*," and specifically, "*when wizards enter the family they do not leave*." In connection with receiving traditional treatment, he says one thing and then contradicts it. He expresses ambivalent feelings of protection against and vulnerability to wizards. This suggests that the sense of security against witchcraft remains feeble, as the feelings of insecurity were never really eliminated.

#### **4.6 The contribution of the drawing**

The drawing was made, after the interview, on the dining table in the living room, lit by sunlight.

#### *4.6.1 The complexity of the instructions*

Following the instruction "*I would like you to draw your family*" Jules says he does not know how to draw human beings. Regarding his family, he thinks he is too tall to be represented on a sheet of paper and he asked for a second drawing sheet. He was told that for this drawing, it is recommended that he use a single sheet.

Jules persisted in his request by asking whether he could draw the other people on the back of the paper. To this question, the answer was negative. Following these requests for clarification of the instructions, he resigned himself to drawing according to the rules. This behavior is informative about the limits of family design in this context where the family is not limited to the father, the mother and the children. It is an extended family leading to the need to (re)think the handover, analysis and interpretation of this drawing in a sub-Saharan African context following [42].

#### *4.6.2 The drawing of the extended family*

The eldest daughter in the family ("grande soeur," on the drawing) is the first character drawn by Jules, followed by his father ("papa" on the drawing) the second character. This can signify in Jules that this sister is the most important person in the family because she provides a home near the hospital and money for medical bills. She took the role of the father. That can be why the father is then drawn second. Mother ("maman" on drawing), older brother ("grand frère Willie" on drawing), cousin ("grand frère Hugo" on drawing), maternal uncle and aunt, mother's aunt, paternal aunt, other maternal uncle, cousin mother ("grande soeur Manuella" on drawing), her maternal cousin ("petit frère" on the drawing) and her maternal grandmother were, respectively, drawn by Jules. All the characters in the drawing are real. There are no fictional characters. The drawing is invested as a projective support on which Jules illustrates what he lives and thinks about his family in connection with the illness of his sister.

That Jules's drawing includes his extended family reflects his sense of belonging to it and the support it brings to his immediate family in the face of his sister's illness and the successive deaths of his father and youngest sister. It is thus a drawing on which is projected the family solidarity surrounding his sister's illness (**Figure 1**).

The characters are not very invested by Jules, who drew them in a very minimalist way. It is possible that he wanted to draw all the members of the extended family, which would have led him to drawing his characters in a minimalist way on the sheet. It may also reflect an inhibition of affects in Jules concerning his family ties.

**49**

of his later father.

*Sickle Cell Anemia, Representations and Care: Experience of a Brother of a Sick Child…*

Moreover, this is the first time that he drew human characters without drawing on a predefined model as he often does at school. However, a large part of the sheet is empty. The drawing is in the "upper central part" high center of the sheet, in a portrait orientation. The drawing location in the upper part of the document can signify the escape of the present, the escape towards the unreal and the distance from oneself according to [41]. It is therefore possible that this drawing signifies Jules' avoidance concerning his family, which is "inhabited" by death and disease.

No character is in contact with others as they do not touch each other. This can be interpreted as lack of family support and the isolation of family members according to [41]. This interpretation is questionable, however, in a cultural context where affection and support do not necessarily manifest themselves through physical contact [26] through touch, caress or hug, for example, thus reflecting the

Jules says he drew "*these people*" in his father's house, at his father's funeral in his village. Of all these characters, the elder sister ("la grande soeur" on the drawing) is designated as the happiest person. This is because, according to Jules, she bought the coffin for the burial of his father. The mother is referred to as the least happy person in the drawing because "*she was crying because she had lost her husband*." The elder sister is invested psychologically and symbolically as the father of the family. She is the one who provided financial support for the funeral. She is designated as the nicest person in the drawing because she looks after her siblings. The fact that Jules first drew his older sister might reflect her emotional over-investment. She is invested as a mother emotionally and symbolically. The least kind person is the paternal aunt (paternal aunt, on the drawing). Jules justifies himself by declaring, "*It is they who caused the village to be fired. They are mean. They said that mom killed her husband*." When asked what role he would like to take within the family dynamic in the drawing, if he had the opportunity, Jules points to his mother saying, "*She is kind. As I go to school, she always buys me lunch*." This reveals the mother's nurturing role in

*DOI: http://dx.doi.org/10.5772/intechopen.90995*

This may justify his lack of drawing.

complexity of this child's life.

*4.6.3 The elder sister, a father figure*

the family and invests her as an identification figure.

therefore thought to be inhabited by death.

*4.6.4 The absence of Jules on the drawing of a mourning scene*

Jules said he had drawn his family members in his father's house during his father's funeral in his village. This tells us that he is still suffering grieving the death of his father. It is possible that Jules represents himself and associates his family with death, due to the past deaths of his father and his youngest sister, along with the imminent and distressing risk of the death of his sick sister. The family is

Jules's absence from the drawing may reflect his avoidance of the family, which he associates with disease and death. With this, he avoids living psychologically in this family dynamic, where he feels insecure about the circumstances. The sick child is also absent from the drawing. This can translate, for Jules, the anguish regarding the potential death of his sister. The sick sister is thus excluded from the family dynamic, thought of as not making/leaving her because of an illness that makes her a "dead" person. It could also be a way of distancing himself from this sister who reminds him of the suffering of the family. This absence contrasts with the presence

The presence of the father in the drawing can explain in Jules the incomplete mourning process of this father who is still invested as alive. He remains present

**Figure 1.** *Jules Family drawing.*

#### *Sickle Cell Anemia, Representations and Care: Experience of a Brother of a Sick Child… DOI: http://dx.doi.org/10.5772/intechopen.90995*

Moreover, this is the first time that he drew human characters without drawing on a predefined model as he often does at school. However, a large part of the sheet is empty. The drawing is in the "upper central part" high center of the sheet, in a portrait orientation. The drawing location in the upper part of the document can signify the escape of the present, the escape towards the unreal and the distance from oneself according to [41]. It is therefore possible that this drawing signifies Jules' avoidance concerning his family, which is "inhabited" by death and disease. This may justify his lack of drawing.

No character is in contact with others as they do not touch each other. This can be interpreted as lack of family support and the isolation of family members according to [41]. This interpretation is questionable, however, in a cultural context where affection and support do not necessarily manifest themselves through physical contact [26] through touch, caress or hug, for example, thus reflecting the complexity of this child's life.

### *4.6.3 The elder sister, a father figure*

*Human Blood Group Systems and Haemoglobinopathies*

Following the instruction "*I would like you to draw your family*" Jules says he does not know how to draw human beings. Regarding his family, he thinks he is too tall to be represented on a sheet of paper and he asked for a second drawing sheet. He was told that for this drawing, it is recommended that he use a single sheet.

Jules persisted in his request by asking whether he could draw the other people on the back of the paper. To this question, the answer was negative. Following these requests for clarification of the instructions, he resigned himself to drawing according to the rules. This behavior is informative about the limits of family design in this context where the family is not limited to the father, the mother and the children. It is an extended family leading to the need to (re)think the handover, analysis and interpretation of this drawing in a sub-Saharan African context following [42].

The eldest daughter in the family ("grande soeur," on the drawing) is the first character drawn by Jules, followed by his father ("papa" on the drawing) the second character. This can signify in Jules that this sister is the most important person in the family because she provides a home near the hospital and money for medical bills. She took the role of the father. That can be why the father is then drawn second. Mother ("maman" on drawing), older brother ("grand frère Willie" on drawing), cousin ("grand frère Hugo" on drawing), maternal uncle and aunt, mother's aunt, paternal aunt, other maternal uncle, cousin mother ("grande soeur Manuella" on drawing), her maternal cousin ("petit frère" on the drawing) and her maternal grandmother were, respectively, drawn by Jules. All the characters in the drawing are real. There are no fictional characters. The drawing is invested as a projective support on which Jules illustrates what he lives and thinks about his family in con-

That Jules's drawing includes his extended family reflects his sense of belonging to it and the support it brings to his immediate family in the face of his sister's illness and the successive deaths of his father and youngest sister. It is thus a drawing on which is projected the family solidarity surrounding his sister's illness (**Figure 1**). The characters are not very invested by Jules, who drew them in a very minimalist way. It is possible that he wanted to draw all the members of the extended family, which would have led him to drawing his characters in a minimalist way on the sheet. It may also reflect an inhibition of affects in Jules concerning his family ties.

*4.6.1 The complexity of the instructions*

*4.6.2 The drawing of the extended family*

nection with the illness of his sister.

**48**

**Figure 1.**

*Jules Family drawing.*

Jules says he drew "*these people*" in his father's house, at his father's funeral in his village. Of all these characters, the elder sister ("la grande soeur" on the drawing) is designated as the happiest person. This is because, according to Jules, she bought the coffin for the burial of his father. The mother is referred to as the least happy person in the drawing because "*she was crying because she had lost her husband*." The elder sister is invested psychologically and symbolically as the father of the family. She is the one who provided financial support for the funeral. She is designated as the nicest person in the drawing because she looks after her siblings. The fact that Jules first drew his older sister might reflect her emotional over-investment. She is invested as a mother emotionally and symbolically. The least kind person is the paternal aunt (paternal aunt, on the drawing). Jules justifies himself by declaring, "*It is they who caused the village to be fired. They are mean. They said that mom killed her husband*."

When asked what role he would like to take within the family dynamic in the drawing, if he had the opportunity, Jules points to his mother saying, "*She is kind. As I go to school, she always buys me lunch*." This reveals the mother's nurturing role in the family and invests her as an identification figure.

#### *4.6.4 The absence of Jules on the drawing of a mourning scene*

Jules said he had drawn his family members in his father's house during his father's funeral in his village. This tells us that he is still suffering grieving the death of his father. It is possible that Jules represents himself and associates his family with death, due to the past deaths of his father and his youngest sister, along with the imminent and distressing risk of the death of his sick sister. The family is therefore thought to be inhabited by death.

Jules's absence from the drawing may reflect his avoidance of the family, which he associates with disease and death. With this, he avoids living psychologically in this family dynamic, where he feels insecure about the circumstances. The sick child is also absent from the drawing. This can translate, for Jules, the anguish regarding the potential death of his sister. The sick sister is thus excluded from the family dynamic, thought of as not making/leaving her because of an illness that makes her a "dead" person. It could also be a way of distancing himself from this sister who reminds him of the suffering of the family. This absence contrasts with the presence of his later father.

The presence of the father in the drawing can explain in Jules the incomplete mourning process of this father who is still invested as alive. He remains present beyond his death; unlike the other daughter who died before him. While the dead father remains present (illustrated on the drawing), the sick sister' s absence from the drawing may signify Jules' avoidance of this sister and therefore, avoidance of the threat of death that accompanies her illness. On a psychological level, Jule's drawing may signify that, the living sister is dead, while the dead father remains alive. This complexity of Jules's experiences is illustrated within his drawing.
