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.
From left to right: Stacie, a traditional healer, Deshka, and their translator, Eliakimu
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.
Dr. Donald Catino — Investigating the evidence for herbal traditional medicine
I am an an internist and have done a medical literature search 1950 to 2009, gathering nearly 100 articles which give objective evidence of the efficacy of these herbs in a wide variety of diseases: HIV, tuberculosis, malaria, other parasitic diseases, and common bacterial infections, as well as diabetes, asthma, seizures, thrombosis, estrogen deficiency and even dental caries and periodontal disease.
Most of the current evidence is in vitro laboratory testing, but some animal, and a few human studies have been done. I will be presenting this evidence to the Weill Bugando medical staff on Oct. 21. My goal is to begin to convince the medical staff of the value of Herbal Traditional Medicine, and to begin to forge a working relationship between the hospital physicians and the local healers.
Mutual understanding, education and respect, followed by mutual patient consultation, and eventually cooperative clinical research are the long term goals.
Dr Donald Catino and his wife Pamela are visiting again and continuing their interests in Herbal Traditional Medicine in Tanzania. Dr. Catino has been practicing medicine for more than 45 years.
Liz Pavlovich — Switching places: traditional and western medicine
Echinacea, ginger root tea, acupuncture – all considered legitimate treatments by many people nowadays. But on the flip side of things, there can be a tendency to belittle the traditional medicine and traditional healers in non-western countries as reminiscent of the “backwards” lifestyle and health care. In Africa, where up to 80% of the population uses traditional medicine as the primary form of health services and access to western health services is absurdly low, this perception helps no one.
Reconciling where we should stand on traditional medicine is difficult for social and cultural reasons. It can also be frustrating for practical reasons, such the dire need for more doctors, nurses and pharmacists who are trained primarily in western methods to halt the spread of diseases like malaria that can be treated easily with the correct regime of modern medicines. But a symbiotic relationship between the two methods that promotes the best of both worlds is possible.
Local populations are apt to listen to traditional healers – these skilled persons are respected by their communities as a way to treat ailments of a natural or supernatural nature. They will persist as the voice and mind of those they serve. We therefore need to be able to work with traditional healers so that positive change can be realized. This means open exchanges between the two groups to break down stigmas and eliminate some of the conclusively harmful practices. Hope lies in the fact that some organizations and African governments have already created courses to educate traditional healers on prevention and detection of HIV/AIDS. These healers are now agents of positive change to help stop the spread of this pandemic.
My work with the Touch Foundation in Tanzania to support a university that trains doctors and other health workers is not in spite of traditional medicine. Part of our mission to give people greater choice and knowledge, more confidence in health facilities as they become better staffed and equipped, and a much needed improvement to quality of life.
Liz Pavlovich is a Program Officer at the Touch Foundation and is based in Mwanza, Tanzania.
Emily Bell — Traditional vs Western Medicine in Tanzania
Photo courtesy of PBS
The Who Cares? Blog theme for October is traditional versus western medicine.
The vast majority of Tanzanians have never seen a doctor. In part, this is due to the extreme shortage of doctors (one doctor per 30,000 people), transportation challenges and other issues of access. Another important factor is that many Tanzanians – particularly those in rural areas – rely on traditional healers or “witch doctors.”
Why do people turn to traditional healers? It is partly a matter of cultural and religious traditions, but may also be due to lack of alternative medical choices. For some individuals, it is not an “either or” choice. They might consult a traditional healer first and ultimately seek care from a medical clinic when their symptoms do not go away.
The consequences of delaying medical care can be dire. According to a recent article by PBS, “Deaths at Birth Highlight Tanzania’s Healthcare Challenges,” one woman and six infants die each hour due to birth-related complications. Without access to medical care, many women give birth in their homes, relying on traditional healers or health workers with little training. If anything goes wrong, the health consequences can be dire. In response, the government is providing medical training to traditional healers. An article in The New York Times pointed out the importance of respecting cultural traditions when considering how those advocating western medical interventions might collaborate with traditional healers. The article highlighted an effective childbirth program in Peru that respected local traditions.
In a Touch Foundation study on the Tanzanian health systems, focus groups consisting of health workers, traditional healers and patients explored several issues, including traditional health services. Participants noted that skilled health workers should educate traditional birth attendants on prevention of disease and danger signs so that traditional birth attendants know when to refer patients to a medical facility. Simple interventions such as provision of sterilized delivery kits and clean knives for circumcision can also have positive health impact.
While community reliance on traditional healers can result in delayed or poor care, researchers are also studying traditional healing practices to determine which remedies might produce positive outcomes that can be scientifically proven.
For example, in Tanzania, the World Bank is supporting the Tanga AIDS Working Group, which is a partnership between doctors and traditional healers who have developed treatments for AIDS-related opportunistic infection. The group has “treated over 4,000 AIDS patients with herbs prescribed by local healers. The impact has been most significant in alleviating the opportunistic diseases brought on by the AIDS virus. The patients who have responded most positively have lived longer, by up to five years.” UNAIDS described their work as “an outstanding example of how positive results can be achieved in the fight against AIDS by using local, culturally relevant expertise and resources to provide low-cost care and prevention for people living with AIDS.”
Emily Bell is Head of Advocacy and Communications at the Touch Foundation.