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[pronut-hiv] Traditional healers being integrated into HIV care and treatment


  • From: "ProNut-HIV" <pronut-hiv@healthnet.org>
  • Date: Mon, 13 Jun 2005 18:11:33 -0400

>From Aidsmap
----------------

Traditional healers being integrated into HIV care and treatment in
Kwazulu-Natal

Efforts to improve the care and treatment of South Africans with
HIV/AIDS are often hampered by misunderstandings and poor relations
between Western healthcare workers, and the community-based African
traditional healers (or sangomas) that many people first turn to when
they have a medical complaint. However, a new project launched in the
Nelson R. Mandela School of Medicine/University of KwaZulu-Natal (UKZN)
in Durban is trying to build bridges and improve collaboration with
traditional healers caring for people with HIV/AIDS.

African health care Systems
It has been estimated that 80% of South Africans see traditional
healers or `sangomas` on a regular basis and that there are around
200,000 sangomas in the country, but efforts to test and treat people
with antiretroviral therapy often leave the community sangoma `out of
the loop.` This can have disastrous consequences, leading patients to
disregard their doctor's advice, or take `muthi` (herbal remedies)
that sometime have dangerous interactions with pharmaceuticals they are
taking. However, working closely with traditional healers could reduce
workload, improve patient care, and give the treatment programme key
stategic allies and counsellors who live within the patient's own
community.

Speaking at a satellite conference prior the 2nd South African AIDS
Conference, Dr. James Hartzell, an adjunct lecturer at the school of
medicine said: "The medical school has long had a strategy to develop
a focus on complementary systems of medicine including African Health
Care Systems (AHCS), Indian Systems of Medicine (such as Ayurvedic),
Chinese Systems of Medicine (Traditional Chinese Medicine, Japanese,
etc.), and other traditional, complementary and alternative systems."
The Department of Family Medicine has lectures on complementary systems
of medicine for undergraduate and graduate medical students, and has a
number of research initiatives under development.

One of the first to be approved by the faculty is the African Health
Care Systems (AHCS) Research Network. In October 2003, a MOU was signed
between the school and the KZN Traditional Healers' Council (including
the Ethekwini (Durban) Traditional Healers' Council), Mwelela
Kweliphesheya, and the Umgogodla Wesizwe Trust. An HIV/AIDS task team
was established from KwaZulu Natal's eleven health districts; and the
US State Department funded two workshops to discuss future directions
for collaboration.

These discussions generated the first major AHCS proposal: The Saving
Lives: Biomedical and Traditional Healing Collaboration on HIV/AIDS,
which received funding last year from the US Presidents Emergency Plan
For AIDS Research (see link).

The Project is in the process of training 350 traditional healers (in
five one-week long trainings) on HIV/AIDS awareness, voluntary
counselling and testing, home-based care and antiretroviral therapy
awareness.

"This is a select group, we don't just take anybody from off the
street. Each participant has to be registered with one of the
councils," said Dr Hartzell.

Project components

Guidelines development: The project is also working to develop joint
HIV/AIDS clinical guidelines using Family Medicine guidelines (which Dr.
Hartzell says has lots of similarities with the traditional healer
approach), the Ethekwini health guidelines, KwaZulu Natal's Department
of Health guidelines as well as traditional healer guidelines that ACHS
has been helping to formalize (based upon informal, unwritten guidelines
that already exist).

Two-way referral system development: To an extent an informal system of
referral already exists between sangomas and health care facilities.
But, said Dr. Hartzell, "Traditional healers complain that it is
largely in one-direction (from the sangomas to the clinics)."

Frequently, patients move back and forth from the sangoma to the
clinic, especially when they want to hear an `alternative` diagnosis
after testing positive for HIV, but the traditional healers don`t know
what is happening at the clinic. "Traditional healers already send
referral letters to clinics and are just asking for at least basic
information back from the biomedical team (which is often hostile to
them) such as what were patients given in terms of treatment", said
Dr. Hartzell.

Forming better two-way communication could be vital to a patient's
health. Dr. Hartzell suggests that "traditional healers can make big
impact on patient compliance and OI management with good collaboration
from the biomedical team."

However, confidentiality issues must be clarified before doctors will
feel free to share patient information with the traditional healers. and
the project is working with the Department of Health on these issues.

Medical kit supply: Most traditional healers work in
resource-constrained settings, seeing an average of five HIV-positive
patients a day, and yet most of them don't even have rubber gloves.
The project is working to supply them with a modified version of KZN DOH
Home-based Care Kit.

Introduction of record keeping systems: "This underlines the success
of the entire project", said Dr. Hartzell, "but is a brand new
concept to most traditional healers." Even so, it has already been
agreed to and advocated by the traditional healer councils.

However, this is one of the project's greatest challenges because of
the issue of illiteracy, which means systems have to use pictograms and
check boxes. Dr Hartzell said they may experiment with tape recordings
as well.

If succesful, these systems, according to Dr Hartzell, should deeply
and broadly improve our understanding of traditional healer practices,
and should dramatically improve the chances of success for the long-term
collaboration between practitioners of the two systems.

Voluntary Counselling and Testing (VCT) strategy development:
Traditional healers are expert counsellors, and are already involved in
pre- and post-test counselling, but they are not currently allowed to
legally test in South Africa. Many other African countries, though,
allow healers to perform the test. Giving sangomas this right could
greatly increase access and acceptance of HIV testing in the
communities.

Development of more effective prevention messages and behavioural
counselling: According to Dr Hartzell, "Patients listen well to what
healers tell them. Healers affirm that they can work together with us to
develop more effective behavior change strategies, and healers are
available 24 hours a day like real old style family and community
doctors."

Healers care for patients while they are on the waiting list for ART:
Dr Hartzell noted that healers can advise patients on good nutrition and
positive living, and encourage behavioural changes. There are many good
herbal remedies for strengthening the immune system, increasing
appetite, treating oral thrush, skin rashes, sexually-transmitted
infections and diarrhoea. According to Dr. Hartzell: "Traditional
healers are already doing a lot of these things, providing a lot of
these services within the community. We're just helping them formalise
it."