Deshka Foster & Stacie Vilendrer — Traditional Healers and Malaria

We had the fortunate experience to conduct research involving traditional healers in Tanzania during the summer of 2007 for our senior honors thesis. We had both been to the country before as HIV/AIDS educators, but conducting research was an entirely different experience – we dealt with strict government research clearance policies, a complicated data-collection protocol, roach-infested rooms, and grueling schedules. Our goal was to explore why caregivers in the Tanga District of Tanzania pursue a particular course of action to deal with malaria in their children. We interviewed female caregivers with children under the age of five, medical professionals, and traditional healers, or waganga wakienyeji as they are called in Swahili.

Malaria has plagued much of the world for thousands of years and remains one of the most prominent global health challenges of our day. In Tanzania, malaria is everywhere: the tearful wails of babies in their mothers’ arms awaiting treatment at hospitals, the rush of Andopheles mosquitoes attacking bare skin in the evenings when the sun begins to set, and poster advertisements for malaria drugs plastered to the walls in every health facility in town. While some children receive malaria medications from biomedical facilities as the World Health Organization recommends, others receive treatment from family members, traditional healers, or do not receive treatment at all.

Studying malaria treatment at the local level in Africa would be incomplete without considering the role of traditional healers, as they represent the first line of care for over 70 percent of the population in Tanzania. A traditional healer may prescribe an array of treatments for a child with malaria including herbal remedies, such as prepared plants or roots, or spiritual remedies, such as exorcism.

We uncovered several interest findings. Malaria has remained a public health challenge in part because the disease is often difficult to diagnose. Symptoms range from fever, headache, malaise, diarrhoea and vomiting in uncomplicated (simple) malaria to convulsions in complicated (severe) malaria. While about half of the caregiver sample (N=37/61) identified convulsions as a symptom of severe malaria in children, the others reported that convulsions signify a separate disease, distinct from malaria, with its origins in the spiritual world. We gathered a set of Swahili words used to describe convulsions and their associated illness: dege dege, mchango, uchawi, upepo, and zongo. Dege dege and mchango, in particular, had a variety of definitions that reflected spiritual affliction.

Around half of the traditional healers (N=8/18) reinforced a non-biomedical understanding of malarial convulsions:

I know that fever is caused by [a] virus. But when I think it is malaria, I tell the people to go to the hospital… Other times when it is not caused by malaria, it can be caused by demons. When it is demons, I can treat them…I have some drugs that I am using to treat those demons. I call them to talk with them. (Traditional Healer #7)

Remedies described by caregivers ranged from boiled herbs consumed as a tea or used to bathe, to the use of elephant dung, indigenous hens, and spiritual and religious rituals:

For mchango, traditional healers take garlic peels and they mix with elephant waste and they heat the garlic peels. Then they take a piece of kanga [cloth] and cover the baby so that the smoke can spread it in the body of the baby. If you use the first treatment and it fails, there are other traditional treatments that you can use like the leaves of the plant over there [she points to a bush across the yard]. We scratch the leaves and mix with water and then we wash the baby in the water of the leaves from the plant from over there. (Caregiver #17)

Despite these seemingly archaic forms of treatment that some caregivers and traditional healers reported, traditional healers also reported a notable commitment to working alongside the biomedical community. Thirteen of the 18 traditional healers interviewed reported sending patients to biomedical facilities for malaria testing, even if they ultimately intended to treat them with traditional remedies:

Many come here first. I can treat the symptoms, but I send them to the hospital to test first and then I treat them. It is most important that people go and get tested early enough. (Traditional healer #15)

A lack of education about the disease and its full range of symptoms may be a primary reason that caregivers may choose traditional healing over a biomedical facility. A significant public health challenge is to incorporate information connecting malaria and convulsions (rather than simply high fever) into malaria media campaigns to promote behavior change. Shortages in doctors, nurses, and other health workers exacerbate the problem, as caregivers often have no other option than to turn to traditional methods for treating malaria.

Traditional healers play an important role in their communities and may provide certain health benefits to their patients. However, it seems that misunderstanding about malaria, emphasized by some traditional healers, is contributing to deaths. In this study, an alarming 8 percent of the caregivers interviewed had a child die from malaria. In addition, traditional healers are in a unique position to dispense not only treatment but also education to their immediate communities. As traditional healers adapt to new roles in a changing healthcare structure, they may become an important resource for malaria information. The Tanga AIDS Working Group based in Tanga, Tanzania has achieved this type of collaboration for HIV/AIDS educating hundreds of traditional healers on the biology of the disease as well as prevention and treatment options.

We are encouraged to see interest in these issues and welcome questions and comments.