ON January 8 a court in Malawi convicted three men of inciting violence when they stormed a property in pursuit of 'bloodsuckers'. The event was just one of many which have occurred over recent months thanks to parts of the country being gripped by fear that so-called bloodsuckers at large. These figures are not vampires, but other people capable of using magic to suck the blood from others at a distance. Rumours of their existence triggered vigilante mob violence that led to nine deaths. One epileptic man was killed. Another man was stoned to death and set on fire.

I was in northern Malawi, with Scottish medical charity EMMS International, reporting on some of the health projects they support, when, the stories started to emerge, and parts of the country were gripped by fear. Often doctors, nurses and others in positions of power are suspected of being bloodsuckers and so at risk of violence. Here was proof that in one of the poorest countries in the world it's not just food, security, politics and economics, that hold back people's live but also superstition, culture and tradition.

Last year, the UN announced it was pulling its staff out of two districts in southern Malawi. And not without reason. In a part of the world in which magical thinking and belief in witchcraft is prevalent, rumours of such blood suckers have a powerful impact. This is a country which still has a witchcraft act, inherited from its British colonisers. Such was the fear and violence that Malawi’s Society of Medical Doctors even declared the situation a “mass hysteria”.

At Mulanje Mission Hospital, a hospital supported by EMMS, director Dr Ruth Shakespeare observed that in recent months her staff's ability to deliver a health service was “impacted greatly” by the eruption of terror. “For about six weeks it was difficult to go to villages. We are very well known in the area. But we could only go in very well marked ambulances, and not in any of our other vehicles.”

It’s not only those in power that are targeted as blood suckers. Several of the hospital’s local patients were also caught up in the vigilante violence that went on. “To understand that,” says Shakespeare, “you have to understand how absolutely terrified the population became. People became far too frightened to sleep in their houses. Everybody was sleeping outside or trying to sleep outside at night, for many, many weeks. So if somebody seemed to be a stranger, the level of panic was such that the person would be attacked.”

The bloodsucker-inspired violence in her area has now died down. But the belief in witchcraft still lingers. Mostly, says Shakespeare, the fear comes back in times of food insecurity. “It’s interesting that in Mulanje whenever this has emerged it has been around September time when people are very anxious and no one is very sure whether the rains will come, and if they will be able to harvest crops in the coming year.”

But magical thinking and long-held beliefs have a far wider impact than just the bloodsucker phenomenon. Many Malawians, for instance, still opt to visit a witch-doctor over going to modern health services. Flyposts litter the capital Lilongwe advertising a vast array of witch doctor services, with promises like: “Bring back lost lovers/stolen properties. Stop early ejaculation. Manhood enlargement. Pass exams and interviews. Do U Want A Baby.”

Of course, beliefs have an impact on public health in all countries. It’s not only in Africa that there is magical thinking – Holy Communion with its changing of bread and wine into the body and blood of Jesus Christ fits the bill pretty well – and in many ways witch doctors are not so very different from herbalists and other alternative health providers in the UK. But Malawi is a country in which such belief powerfully courses through almost all aspects of life. Christianity too is part of this texture. There are even some churches who tell their followers that they must not take the treatments offered by clinics and hospitals.

In Mzuzu in the north of Malawi, EMMS International is supporting Livingstonia Synod Aids Programme (LISAP) which delivers HIV education. In a tiny village, a group has gathered in a grain store newly built to help them keep the maize and other harvests safe, giving the community greater food security. As well as helping set up the store, LISAP has been teaching locals how to make their homes more hygienic, and encouraging them to all find out their HIV status. Part of what they do is to educate, and counter superstitious beliefs.

Malawi has made real progress in tackling its HIV epidemic. There are around a million people - in this country with a population 16 million - living with HIV, and in 2016 there were 36,000 new HIV infections and 24,000 AIDS related deaths. This represents progress on the 98,000 new infections in 2005.

Local man Justine Nyangu recalls a time, only a few years ago, when most of the people in his area didn’t know much about AIDS. His own village has been devastated by the disease, and he now looks after four orphans in his own household, children of his sister who died of AIDS. “Since LISAP came in, most of the people are tested. At first people were afraid. They would think if I am tested positive for AIDS people will be laughing at me.” They were, he says, previously too ashamed to seek official medical help. “They would hide. They would go to the witch doctor. Now we don’t go to a witch doctor. We first go to the clinic or the hospital, where they can tell you if your blood is positive or negative.”

At the nearby health centre, a local chief tells a similar story. According to him fewer people are now visiting herbalists and witch doctors, and most now attend the health centre. “But there are challenges that we are still facing,” he says. “There are also churches that do not allow their members to access healthcare from the health centre. They believe that when you get ill you are going to be healed by just praying and that no other medication should be part of that.”

In a village near Livingstonia town, Loveness Mhango talks of how when she felt pain that turned out to be cervical cancer, she went to see the witch doctor, who gave her herbs to boil and instructions to wash her face in a particular way. “I later realised that the witch doctors are no help. I just seek the medical help from the hospital now.”

When it comes to combatting HIV in sub-Saharan Africa, it’s long been believed that one of the big challenges is to combat cultural practices that enable its spread. New HIV infections in Malawi, where early marriage and early sexual activity is common, occur mostly among women and young people, particularly teenage girls. Among 15 to 24 year olds nearly twice the number of women as men are HIV infected.

Magical thinking and cultural traditions also play a role in this. Dr Ruth Shakespeare believes that one of the reasons traditional beliefs are so persistent is because so few girls finish education, many of them not even completing primary school. “Because,” she says, “of the limited opportunities for education for girls there’s a lot of magical beliefs which don’t really help girls to understand family planning, HIV and all those sorts of issues.”

Among those cultural traditions, is the practice, still followed in some communities, of putting adolescent girls through a “cleansing” ritual with “hyena” men, who are employed by parents to have sex with their girls and thereby sexually cleanse them and protect them from HIV. One hyena man, Eric Anviva, had sex with 100 women without revealing that he was HIV positive. He was later convicted of “harmful cultural practice”.

Though such practices are dying, they persist in some places. As Kwezi Gondwe, a nurse working in an EMMS supported project in Livingstonia describes: “They do happen here. Sometimes a girl will have reached puberty and the parents will get someone to have sex with her. They get a big man to have sex with the girl, saying that they hope to clean the girl. It’s very dangerous. The girls are of course quite young.

“Some of the NGOs have tried to change this. But you can’t change it all at once. Even here along the lakeshore they have tried to change things, the chief, the church leaders, the communities, the political leaders. The government wants change, so everyone is aware.”

EMMS international is currently running Every Life Matters, a fundraising campaign backed by the UK Government, which will match donations from the public, pound for pound.

www.emms.org/everylife

MIGHT MODERN FEARS HAVE INSPIRED THE BLOODSUCKER HYSTERIA?

AT the Mulanje Mission Hospital, a hospital supported by EMMS, director Dr Ruth Shakespeare says fears about blood-suckers are not new in Malawi. She knows of outbreaks of hysteria going back 30 years. She suggests the answer to the outbreaks of panic might be down to a sense of insecurity among the very poorest people in the country - with these insecurities expressing themselves as mass panic.

“There have been many previous episodes in Malawi," she says, "but also in Zambia and Mozambique. And bloodsucking is not the same as vampires. To explain it is difficult, but it’s basically a belief that people are being exploited.”

As Shakespeare puts it: “Some say it’s a reaction to post-colonial exploitation. Many believe that it’s an expression of dissatisfaction with the socioeconomic situation that people find themselves in. That’s very much my understanding. We’re in an area where the majority of people are extremely poor, 70% earning less than $1.25 a day. We’re in an area where only 50% of children finish primary school. An area where there are now extreme effects of climate change affecting people’s food security.”

It’s not surprising, therefore, she observes, that people’s feelings of vulnerability and economic powerlessness are expressed in some way, perhaps subconsciously. “There’s been a long-standing belief in the community that when things don’t go well the government is in some way exploiting them. And I really do think that the blood sucking rumours should be seen in that light, and not thought of very literally.”