La lutte communautaire contre une endémie tropicale: Croyances surnaturelles et pièges à tsétsé au Congo

Résumé Il est généralement admis que la promotion de la participation communautaire ne peut réussir que si le dialogue avec les populations repose sur des structures sociales efficientes, réseau générateur de l'auto-développement. Dans la lutte contre la maladie du sommeil ou trypanosomiase, l'action antivectorielle est devenue hautement souhaitable pour compléter l'action sur les malades. Le piégeage des glossines (ou mouches tsétsé) est une méthode ingénieuse et efficace, qui a été testée dans 55 villages congolais. Ces essais ont montré la faisabilité d'une prise en charge des pièges par les communautés, tout en révelant certains obstacles. En effet l'efficacité de cette méthode repose sur une optimisation du piégeage rendue possible par la récolte périodique des glossines (recherche des points de capture stratégiques) qui implique un entretien des pièges: réparation des déchirures, contrôle du sac de capture, désherbage de la place.... Or, ces activités, apparemment à la portée des communautés, ne sont pas toujours réalisées en permanence, d'où une rentabilité insuffisante des pièges et finalement la réinvasion par les tsétsé de l'aire traitée. Cette étude présente des éléments de la dynamique socio-culturalle congolaise actuelle, caractérisée par la revitalisation du mysticisme traditionnel bantou et des cultes religieux. Elle tente une interprétation des conduites villageoises à partir de situations types rencontrées au cours de deux années de prise en charge communautaire. En Afrique centrale, les maladies sont le plus souvent appréhendées comme des manifestations de forces surnaturelles. Au Congo, où animisme, christianisme et marxisme sont étroitement mêlés, la connaissance de la représentation contemporaine de la trypanosomiase, est indispensable aux intervenants. Une telle approche suggère que ces intervenants reconnaissent la place accrue faite actuellement au surnaturel par les populations, car un projet d'innovation réussit lorsqu'il est adopté, c'est à dire adapté aux croyances et aux mentalités. Des enquêtes psychosociologiques sont proposées pour aider à leur compréhension. La découverte des structures d'appui pour une action communautaire à long terme se fera alors au détour des chemins, selon les régions, les ethnies, les villages. Community participation in the control of tropical diseases is of major importance nowadays, particularly for sleeping sickness (Gambian trypanosomiasis). Indeed, the authoritarian measures used with success to control this disease during the colonial period are difficult to apply now. Moreover, in the Congo, cultural and financial restrictions are such that patients sometimes refuse treatment. Thus, it has become highly desirable for vector control to be carried out at the same time as the treatment of patients. Trapping tsetse flies (or Glossina) is an ingenious and effective anti-vectorial method which has been tested in 55 villages of the Congo. The blue-black pyramid trap used does not require insecticide impregnation, and is hung in the branches by means of a capture-bag containing diesel oil. These trials, conducted in the sleeping sickness focus of the Niari river, have demonstrated the feasibility of local communities taking over the responsibility for the traps, while at the same time revealing certain obstacles. Indeed, the efficacy of this method depends on the optimization of trapping. This involves the determination of strategic capture sites by periodically harvesting the flies and moving the traps in order to catch the maximum number of flies. It also involves regular maintenance of the traps (i.e. repairs, checking the capture bag, clearing vegetation...). However, although these activities would appear to be feasible at community level, they are not always carried out satisfactorily. This results in the insufficient viability of the traps and finally to the reinvasion of the treated area by the tsetse. This study presents aspects of the present-day Congolese socio-cultural environment characterized by the revitalization of traditional Bantou mysticism and religious worship. The possessors of the 'Vital Force' or Kundu (sorcerers and healers) are confronted at night in an 'over-reality' consisting of the visible reality together with innumerable beings and objects existing specifically in the invisible state. This nocturnal confrontation may modify the local balance of power and relationships, and is also thought to cause certain symptoms of sleeping sickness and other diseases. During the colonial period, Kundu was prohibited. Under the influence of the Christian church, and because of the progress of modern medicine, the power of the sorcerers and healers gradually decreased. Then, in the 1960s, the eruption of Marxism as an anti-religious theory, modified the balance of power once more. For the population, these successive changes have lead to an ambivalent attitude of resignation towards the veracity and recognized achievements of Kundu, and the search for protection in the churches and prayer meetings. It is significant that by opposing each other, Kundu and Christianity are mutually reinforced. Kundu adapts to modern life and continues to assert its authority in the collective subconscious like a force which is essential for sacred activities. Simultaneously, the lack of drugs, equipment and personnel in health centres have led to an influx of villages to the healers. Today, the revitalization of worship is given impulse by the younger generation whereas the power of the elders tends to decline. The Congolese government is currently concerned about the proliferation of religious sects, 77 of which have been officially recorded. The trapping technique is often extremely ritualized among African people. The 'capture force' of a trap is considered in a complex manner as being both in the visible and invisible world. This study attempts to interpret the villager's behavior encountered over the 2 years during which the communities were responsible for the traps. In some cases the tsetse trapping is considered as involving witchcraft. It is thus not seen as achieving therapeutic ends but as being harmful, destructive, and used for persecuting and informing on the population. Destruction of the traps by youths might be also due to refusal of their request for payment. In other cases, the villagers lose interest in trapping simply because the flies decrease in number. In the Congo, where Animism, Christianity and Marxism are closely intermingled, knowledge of the current attitude towards trypanosomiasis is essential for all those engaged in control projects. A community participation approach requires a dialogue between the project teams and the rural populations. To ensure that this dialogue results in self-development, it must be based on an effective local social structure. Such an approach suggest that the project teams must recognize that considerable emphasis is being placed on the supernatural by the local population. Projects involving innovations succeed when they are accepted, that is, adapted to local beliefs and mentalities. The villagers usually accept or reject--partially or totally--an innovation according to the risk they believe to incur with regard to their material resources. To limit this risk, they attempt to break up the innovation. In the case of diseases and trapping, the risk is perceived in its mystical dimension, like an exposure to a supernatural danger. The attempt to limit the risk results in incomplete participation, and eventually in less effective trapping. The sequence of self-development is first the technical adaptation of the innovation, then the psychosocial adaptation (local beliefs and mentalities), adoption, mastership, and finally the extensive application in the natural environment. To help in the understanding of these beliefs and mentalities, we are proposing psychosociological surveys. Support structures for long-term community action will thus be determined according to the region, the ethnic group and village. Tropical disease control teams have too often been completely ignorant of the original perceptions of the participants. Good results will only be achieved if the participants perceive endemic control as being both the source of welfare and a sacred cause.