www.canadianhealthcarenetwork.ca
April 7, 2011
By: Salima Pirani
Consult Thembi Nxumalo on diabetes treatment and she will likely recommend a mix of natto root and caju bark. Show up with an ulcer and you will be given balsam pear tonic.
Nxumalo is a Sangoma, a traditional healer from South Africa’s eastern KwaZulu-Natal province.
Whether or not these traditional remedies work remains with the spirits, she says.
Many MDs may be sceptical but in KwaZulu-Natal up to 80 per cent of people visit a Sangoma when falling ill instead of a physician.
Simply put, they are the most trusted and respected health authorities in their communities.
Through an innovative training program the African Medical and Research Foundation (AMREF) is leveraging the communities’ trust for traditional healers to strengthen the province’s referral systems, improve the quality of health services, address women's and children's health and tackle South Africa’s massive disease burdens of tuberculosis (TB) and HIV.
Using Traditional Medicine to Battle HIV
The most urgent health crisis in South Africa is the AIDS epidemic. Accounting for 1,000 deaths every day, AIDS is the country’s leading cause of mortality. South Africa has more people living with HIV than any other country, and of its nine provinces, KwaZulu-Natal is home to the highest infection rate at 39 per cent.
These staggering statistics signal the urgency to improve HIV prevention using every possible avenue.
Since the early 1990s the World Health Organization (WHO) has advocated for the inclusion of traditional healers in national AIDS programmes. In 2004 the South African Parliament passed the Traditional Health Practitioners Bill, affirming the importance of traditional medicine as part of its overall health systems.
Outnumbering doctors in Africa 100 to one, THPs represent an accessible and affordable human resource pool especially in the most rural and poor areas.
"The main reason AMREF began working with traditional healers was to address HIV/AIDS," says Penina Ochola, AMREF's South African county director, and HIV/AIDS expert. "The success of prevention care and treatment greatly depends on the participation of the patients, families and communities, including traditional healers".
Training Traditional Healers to Treat and Teach
AMREF launched the initial phase of the project in KwaZulu-Natal's Umkhanyakude District in 2005, training 80 of the district's 882 healers. Due to its overwhelming success the Canadian International Development Agency (CIDA) recently approved funding to scale up the program, with the goal of training an additional 800 Sangomas over the next three years.
The two-month course teaches healers about the use of DOTS for TB treatment, voluntary counselling and testing for HIV and prevention of mother to child transmission of HIV/AIDS.
The impact was undeniable - safe hygiene and sanitation practices increased dramatically. Healers started using rubber gloves during consultations as a standard practice. They were taught how to properly sterilize and dispose of razor blades between patients as well as distribute condoms and teach people about their safe use. They have also been taught to recognize symptoms of TB and HIV and to quickly refer these patients to health centres.
If a patient tests positive the Sangomas ensure they take their medication regularly.
Tightening the bond between formal and informal health systems
Through the program, a closer relationship has been formed between traditional healers and the South African Department of Health. Healers are increasingly accepted as an important entry point into the formal health system. The department has even started providing them with home-based care kits.
``This project is of great value because we are now able to give better care to people in the communities,`` says Sebenzile Hlabisa, the HIV/AIDS coordinator at the Sub-District Health Centre. “The traditional healers help us to reach people whom we may otherwise never have been able to. Two of the healers referred 800 patients to us for testing and treatment within a year.``
Spreading the Tradition
The success of the project is not only through the eyes of the formal health system. The community itself is expressing its gratitude for the improved skills and knowledge of the traditional healers as well as the increased coordination between these community health care providers and health centres.
Amos Mkambi, who could no longer stand the increasingly sharp pains in his chest and back, came to consult Thembi Nxumalo. She encouraged him to go for an HIV test, but he admits he was reluctant.
"Eventually I agreed," recalls Mkambi, "and Thembi went with me to the AMREF centre where I tested positive. They told me I had to start taking ARVs and come back for counselling. Since taking the treatment I feel much better. I am very happy that I came to see Thembi. She gave me good advice by encouraging me to go for a check up and that is why I am still alive."
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