Integrating traditional medicine in the fight against HIV/AIDS

Musawo Musa Takomalirawo, a traditional Ugandan healer, never had any formal schooling, but for the past 40 years he has treated patients for malaria, chronic diarrhoea and nightmares. "I would treat patients for HIV-related ailments like skin rashes, weak immune system and weight loss, but when they kept returning to me in an even worse condition, I assumed it must be witchcraft," he said. Unlike many healers, he has never claimed to have a cure for a condition he knew so little about. Today, in conjunction with the NGO, Traditional and Modern Health Practitioners Together Against AIDS (THETA), Takomalirawo teaches his patients how to avoid contracting HIV, and his services extend beyond simply treating HIV-related infections with herbal remedies. "I teach the community about HIV prevention through the government's 'ABC' [Abstain, Be faithful, use a Condom] approach, and counsel people living with HIV on how to live positively," said the herbal practitioner, who runs a support group that raises awareness about HIV/AIDS issues through music, dance and drama. THETA works to capitalise on the main advantage of traditional healers - their role in local communities. "Traditional healers are reflective of cultural practices; they have a way of mobilising the community and they talk a language the community understands," said Dorothy Balaba, director of THETA. ACCESS TO THE PEOPLE The Ugandan government estimates that up to 80 percent of the country's 26 million people use traditional medicine at some point in their life, with a significant number seeking help from a indigenous healer before visiting their local health unit. According to the UN World Health Organization (WHO), Uganda has a ratio of one healer to 400 people, compared with one doctor for every 20,000 people. Although quack healers and arcane, unhealthy practices have tarnished the reputation of traditional healers, THETA's Balaba is confident that they have an important role to play in the fight against HIV/AIDS. "We don't want traditional healers to say they have a cure for HIV - there simply isn't one - but herbal remedies are able to alleviate HIV-related ailments, and that is what we want and need to encourage," she said. Takomalirawo, who admits he knew little about HIV before starting work with THETA in the 1990s, believes the government is faced with a conundrum: scientifically, doctors are more knowledgeable about HIV/AIDS, but patients continue to turn to traditional practitioners for treatment. WHO says traditional healers will be crucial in promoting behaviour that stops the spread of HIV infections, such as safe birthing practices, the use of condoms and sensitising people to the importance of voluntary testing for the HI virus. It also maintains that indigenous health practitioners could play a key role in preventing HIV infection by discouraging practices such as skin piercing and sexual abuse of women and children. The Ugandan government acknowledges the widespread practice of traditional healing, the influence of healers in the community and the value of herbal remedies in alleviating the suffering of HIV-infected people. MINIMUM STANDARDS NECESSARY Dr Kenya Mugisha, president of the Uganda Medical association (UMA), says there is no doubt that alternative health services provided by traditional healers "are with us, and will remain". However, Mugisha said it was crucial that their integration be carefully carried out to avoid negative consequences. Speaking at a conference on the traditional and complementary medicine policy in April, he warned of the need to establish minimum standards of practice for traditional healers. "If you have to be possessed by spirits before your medicine can work, then you aren't in control of your senses," Mugisha said. "These are things we need to think about." Father Dominic Mwebe, chairman of the St Rahel Herbal Centre and a spiritual healer unhappy with the rapid pace at which government is moving to integrate traditional medicine, echoed his views. "While we all agree on the central role of traditional medicine in our society, it is discouraging that up to now we do not have a standard definition of what traditional medicine constitutes," he observed. The government is in the process of drafting a Traditional Medicine Bill, designed to integrate the traditional healing practices of rural Uganda into the national healthcare system, and create minimum standards of operation for traditional practitioners. "We envisage a health system in which traditional healers and medical practitioners work side by side," said Dr Nelson Musoba, a health programme consultant at the Ministry of Health. He would like a national health service where patients are asked whether they prefer to be seen by a traditional healer or a doctor trained in Western medicine, as is the case in countries such as China. A major concern of traditional healers is the protection of indigenous knowledge and intellectual property, an issue Musoba says the taskforce drafting the bill will take into account. The ministry hopes that merging traditional medicine with the formal health sector will result in a more cohesive campaign to fight HIV/AIDS. It may also save the government money. "It is hard to assess the extent to which traditional medicine reduces HIV/AIDS-related health indicators, but we expect the contribution made by traditional healers to be significant, so it is possible that there could be significant savings to be made by bringing traditional healers into the mainstream," Musoba commented. With its abundance of healing herbs, proponents of traditional medicine believe Uganda is ideally positioned to lead the search for ways of coping with HIV/AIDS outside of the sphere of western pharmaceutical treatments. "It is indigenous knowledge that we have used for centuries, so it is in indigenous knowledge that we will find a cure," Musawo Takomalirawo maintained.