Focus on traditional medicine

While there is a strong cultural acceptance of traditional medicine in Zambia, resistance continues within the "orthodox" medical fraternity towards its use in the fight against HIV/AIDS. Zambians spend almost double the amount on traditional healers compared with conventional medicine. According to research by the University of Zambia, over 80 percent of the spending goes towards treatment for HIV-related illnesses. University researcher Musa Mabandlha explained that traditional medicine continues to play an important role in the provision of health services because it has proved reliable in the treatment of certain diseases, and the management of some psychosomatic cases. Mabhandla noted that people opt for traditional healers because they are generally receptive to their clients and have good counselling skills. That is something rarely provided by conventional medicine. In addition, most healers are accessible as they live in the same community as patients, speak a common language, and their diagnostic procedures are not as bureaucratic as in conventional medicine. "In short, they are convenient." "Furthermore, in remote areas of Zambia where conventional medicine is difficult to access, traditional medicine has tended to be a very reliable substitute for health provision. For this reason alone - forget the argument of an HIV cure - it should be accepted as part of the medical system," he told PlusNews. Traditional healers include herbalists, spiritualists, bone-setters and traditional birth attendants. According to a study by the Kara Trust, they far outnumber formal health workers. The Traditional Health Practitioners Association of Zambia (THPAZ) has around 40,000 members, compared with 850 "orthodox" doctors, 4,000 nurses and 4,000 clinical officers and paramedic staff. The Kara Trust study noted, however, that traditional healers have only a limited formal knowledge of HIV/AIDS. Only five percent of 39 healers polled knew that HIV caused AIDS. More than half of them believed that HIV could be cured. The ministry of health has attempted to co-opt traditional medicine to "reign in" herbalists making dubious healing claims and, on paper, to find a way in which modern and ancient medicine can work together. THPAZ was formed to establish such a dialogue. It not only has an office at the ministry of health with a full time coordinator, it has representation on the country's central board of health. The ministry has also recently allowed herbalist Godfrey Shilalukey to operate from the largest hospital in Zambia, the University Teaching Hospital (UTH), as an "alternative healer" for HIV/AIDS. On the face of it, it would appear that there exists a good working relationship, but the reality on the ground suggests otherwise. "This (policy) is all just up in the air," suggested Andrew Banda head of management information systems at the National AIDS/TB/STD Council. "Traditional healers work in isolation of standard scientific procedure. There is no practical cooperation or coexistence between the two." He is irked that herbalists have continued to treat people with HIV/AIDS unlike medical practitioners who are not allowed to prescribe or administer untested drugs. He said that until their claims are validated, or before they can begin to work with conventional medical doctors, they should first agree to operate in the "accepted scientific manner" of validating drugs and proving efficacy. Head of the virology laboratory at UTH, Dr Francis Kasolo, shares those concerns. He denies being against traditional healers per se. All he wants is to have the medicines go through the standard scientific procedure. "I want to know what components of their medicine neutralises or deals with the virus. I want to see laboratory tests, I want to see patients histories, prognosis, diagnosis, treatment, everything that is needed to validate a treatment." But according to Goings Nhkula, a herbalist: "What proof? The proof of the efficacy of traditional medicine is in the numbers of people with HIV who swarm traditional healers clinics. What further testimony do you need than numbers flocking to your clinic? If we were quacks then people would have stopped coming to us a long time ago," he told PlusNews. It all about professional competition suggested Betty Hewitt, a US-trained herbalist running a natural remedy hospital for the Zambian Defence Forces. She explained that while the army top brass are supportive of her work, this attitude has not filtered down to the people who could have been colleagues - the medical experts. "They are still not convinced that my herbal therapy which uses home grown food works. I invite them to my clinic to see how I work and still there is suspicion and derision," she said. But the respect healers hold in the community remains. Hope Kaunda is an HIV counsellor said she did not believe in herbalists until her cousin, bedridden with an "AIDS-related complex", started using one. "I saw her viral load decreasing, her T-cells increasing and she is in fantastic health now." She said although she now gives her clients the option of using a traditional healer, orthodox medical practice does not encourage this. Neither is herbal medicine, or holistic and culturally-appropriate approaches, discussed as an option for therapy and treatment in counselling training. Zambia is one of the poorest countries in the southern African region and cost is an important factor in choosing treatment. Traditional healers have few overheads and can afford to charge token fees for their knowledge. They usually accept payment in kind or instalments. A course of treatment for an illness like tuberculosis, which would more than likely only be found in the urban areas, would cost about US $75, as opposed to less than US $5 traditional healers would charge. Mabandhla believes the government is missing out a vital link in the provision of health services. Because traditional healers are spread across the country, they can be used as vehicles for health service delivery to a large number of people. Once trained, they could also be enlisted to work on preventative AIDS programmes, distributing condoms, and sensitatisation on sexually transmitted diseases. However, Mabandhla said that although there a number of positive aspects about traditional medicine, problems of lack of standards and regulation have proved harmful. THPAZ should work towards a code of practice to monitor ethical standards to shield the sector from quacks and false claims, he said. "It is not policy or just massaging the issue that will resolve this impasse, common sense and necessity will have to prevail so that both these sectors begin to work with each other rather than against," he added.