Module 4: Traditional Medicine

In many cultures, traditional healers are regarded as highly respected community leaders, and their beliefs and judgments are significantly valued.  Traditional healers are generally compassionate and thoughtful individuals, and some of them are extremely effective in counseling psychological issues, while others can be detrimental to a patient's health.  The fundamental idea of traditional medicine is that “disease is a supernatural phenomenon governed by a hierarchy of vital powers beginning with a most powerful deity followed by lesser spiritual entities, ancestral spirits, living persons, animals, plants, and other objects.”(1)  These greater forces act together with one another and can either diminish or improve an individual’s power.  A lack of harmony leads to disease, and natural elements extracted from plants and animals can help cure the illness.

In South Africa, approximately 200,000 traditional healers are currently practicing, compared to only 25,000 medical doctors, and roughly 80% of the black population uses the services of traditional healers.  Different types of South African healers exist; for example, the “inyangas” are herbalists, usually male, and experts with plants; the “isangomas” are psychic spiritualists, and usually female. Isangomas are required to be be specifically summoned by the ancestors and then thoroughly trained. “Mmthandazi” are Christian healers who are affiliated with one of the African churches.(2) 

Today, there are a variety of different views about traditional healers.  In South Africa, the Health Act of 1971 officially banned traditional healers, but many organizations still have them registered, such as the Southern African Traditional Healers Council, the Association of Traditional Healers of Southern Africa, the Congress of Traditional Healers of South Africa, the African Dingaka Association, or the African Skilled Herbalists Association.  Medical schools generally see traditional healing as a somewhat primitive approach to medicine practice.  Some, however, observe the different approaches that traditional healers employ and then adopt some of their methods if their own are not sufficiently working.  Government health services directors are realizing that they must work together with traditional healers instead of simply ignoring them.  This is a difficult process, however. While they are certainly not medically qualified or comparable to fully trained and educated doctors, they can be helpful in tackling critical problems at a local level .  Though some countries do recognize traditional healers, the integration in most countries has proved to be a difficult task.  An established dialogue between traditional healers and medical doctors is important since a traditional healer’s ideas are highly influential in the community. However, receiving treatment from a traditional healer can delay medically necessary and important diagnosis and treatment.(3)

Traditional healers can often be helpful in delivering successful medical interventions.  For example, in the Central African Republic, AIDS training was delivered to traditional healers, who then disseminated this information to village members who might not otherwise be educated about these serious health issues.  Ninety six traditional healers received the 17-36 hour training, which included education sessions about the prevention of HIV transmission and sexually transmitted diseases in general, condom use, counseling for those diagnosed, and fostering a positive appearance for traditional healers.  The program was assessed through interviews, and it was determined that information and outlooks on the AIDS epidemic were improved by the traditional healers’ training.(4)

In Hlabisa, South Africa, a study was conducted to determine the potential for traditional healers to assist in the treatment of tuberculosis.  In the study, 63% of the healers (15 out of 24 total) differentiated between actual tuberculosis (the infectious disease requiring modern medical attention) and “idliso”, which is the toxic poisoning of spirits, believed to be best healed by a traditional healer.  Most of the healers described that they had sent patients who were potentially TB infected to the hospital before, and that they were definitely willing to cooperate with other health providers in treating the patients.  The possibility of a productive collaboration between traditional healers and tuberculosis treatment seems to be highly beneficial.  While suspicion and doubt have historically existed between traditional healers and doctors, a novel approach with a common sense of respect and admiration towards one another provides potential for a partnership.(5)

In Malawi, there is an extremely high GUD, STI, and HIV prevalence.  Due to these realities, there is an immediate need to incorporate the traditional healers in control activities to advocate safe sex and encourage condom use.  In a 2002 study, 90% of those who had not used condoms lived in villages and had received treatment exclusively from traditional healers.  In Malawi, traditional healers are believed to be more empathetic and approachable than medical doctors, and community members therefore have greater confidence and trust in the traditional healers. It can therefore be very beneficial to incorporate them into the HIV control activities and utilize their sites for activities such as condom distribution. Currently,, the national tuberculosis control program in Malawi provides training to traditional healers and promotes the referral of tuberculosis patients to other medical treatments.  It would be beneficial to similarly connect STI and HIV training and referrals to this pre-existing enterprise.(6)

In Cameroon, a study was performed to compare traditional healers and medical professionals based on their personal traits and communication methods.  At one facility, the interaction styles were compared between seven traditional healers and eight medical providers.  The traditional healers interacted differently with the patients, striving to find common ground through communication – a style that probably accounts for the high regard and respect for traditional healers in Cameroon.  Socioeconomically, patients of traditional healers were similar to patients of western providers.  However, traditional healers differ in that they were found to be more “patient centered,” concentrating not only on medical questions but also on daily life issues and the patient’s personal thoughts and feelings.  This type of interaction was identified by the patient as higher quality and therefore the traditional healers inspired them to travel far distances and to pay high fees and costs associated with the care.  The study outcomes may help promote policy makers, program managers, and health care workers to integrate a similar approach of patient-centered communication to standard medical treatment.(7)

A study in Zambia explored the role that traditional healers play in treating individuals with epilepsy.  It was found that the traditional healers acquire thorough histories of their patients, and may refer patients to a hospital if the seizures seem serious or out of their control.  However, it was also recognized that an even stronger collaborative relationship between medical professionals and traditional healers must be fostered in order to improve treatments.(8)

In conclusion, studies across various countries and cultures have demonstrated the importance of partnerships with traditional healers and the valuable assets that they offer.  Traditional healers tend to interact with their patients on a personal and compassionate level, allowing the patient to feel psychologically at ease.  However, the reality remains that traditional healing by itself is usually not enough to cure a disease. Medical practitioners and traditional healers must communicate with one another and work together in order to treat patients in a way that is both scientifically effective and personally sensitive.

Footnotes

(1) Kale, Rejendra.  “South Africa’s Health: Traditional Healers in South Africa: A parallel health care system,”  BMJ, 310:1182-1185, (6 May 1995). 

(2) Ibid.

(3) Ibid.

(4) Somse et. al., “Evaluation of an AIDS training program for traditional healers in the Central African Republic,” AIDS Education and Prevention.  Vol. 10, Iss. 6; pg. 558, (Dec 1998). 

(5) Wilkonson, D.  “Traditional healers as tuberculosis treatment supervisors: precedent and potential (planning and practice).”  The International Journal of Tuberculosis and Lung disease, vol. 9 no. 9, pp 838-842(5), (Sept. 1999).  

(6) Zarchariah et. al.  “Health seeking and sexual behavior in patients with sexually transmitted infections: The importance of traditional healers in Thyolo, Malawi,” Sex Transm Infect, 78:127-129, (24 Jan 2002).

(7) Labhardt et. al., “Bridging the gap: how traditional healers interact with their patients.  A comparative study in Cameroon.” Tropical Medicine and International Health (9 Jun 2010).

(8) Baskind, R.  “Epilepsy Care in Zambia: A Study of Traditional Healers,”  Epilepsia, Vol. 46. No. 7, pp. 1121 – 1126, (2005).