Collaboration between Medical practitioners and Traditional healers: Views of a Cameroonian Health Educator.
Before the beginning of the 19th century, medicine consisted of exclusively of what is considered today as traditional medicine. Traditional medicine is generally the old healthcare practices linked to a culture. It had been practised in different forms by all cultures and so we can talk of African medicine, Asian or Chinese medicine. Traditional healers consider health as the intimate association of the physical, mental, social, moral and spiritual wellbeing. In traditional medicine, emphasis is on the moral and spiritual aspect of existence and this gives a new dimension to healthcare and permits man to maintain good health.
When the Whiteman introduced western medical science, the tendency was to condemn all native beliefs and practices as backward and unacceptable. In so doing, traditional practices were largely driven underground and a valuable opportunity to learn their good points – such as community approaches to handle diseases and the role of the family in the care of the individual- were all lost. However, some gains were made since practices such as cannibalism and human sacrifice to appease gods were eradicated.
Western science brought with it the concept of strictly organic or materialistic causation of disease, i.e. the germ theory, deficiency disease and diseases of excess. This, however, cannot explain to Africans and Cameroonians alike issues of health and diseases that they are confronted with daily. The whole area of mental health and illnesses cannot be explained away; nor is it possible to explain why two people faced with the same organic disease react differently. Why should lightning strike one of two people walking in the rain?
The theme of the 4th Edition of the African Traditional Medicine Day which was: “Reinforce collaboration between modern medicine practitioners and traditional healers”, demanded that to resolve some of this rationally, health policy makers need to research more intensely the issues raised by the intersection of western science and traditional beliefs and practices.
In practice there is hardly any question of real collaboration and exchange between modern and traditional medicine in the framework of Primary Health Care.
As far as Cameroon is concerned, traditional healers and traditional medicine are facing the problems of illegality, charlatanism and the non-ratification of the law on traditional medicine in parliament.
Critical observers have shown division of opinion on the plea for reassessment of traditional healers and traditional medicine. Some have criticized their practice as being romantic and unscientific and a questionable way of economizing. Again, others are of the opinion that the WHO’s guidelines are only a beginning and are still characterized by ethnocentrism and scientism. They take the view that policy-makers still make too extensive use of the biomedical yardstick when evaluating traditional medicine.
All said and done, is there any great need for medical practitioners and traditional healers to collaborate?
One time WHO Director General, Dr. Halfdan Mahler, had this to say concerning “The Health for all by the Year 2000” slogan. “WHO member states are actually defining and applying strategies so that all their inhabitants attain a level of health permitting them to live a socially and economically productive life…
To realize this, it will be necessary to make use of all the useful means and mobilize all the possible resources. Amongst these means and resources are diverse types of indigenous practices and practitioners and traditional birth attendants”.
This concept was approved by the International Conference on Primary Health Care that took place in 1978 in Alma Ata. In that document [5, p33], collaboration with traditional healers is recommended in the following terms:” Traditional medical practitioners and birth attendants are found in most societies. They are often part of the local community, culture and traditions and continue to have high social standing in many places, exerting considerable influence on local health practices. With the support of the formal health system, these indigenous practitioners can become important allies in organizing efforts to improve the health of the community. It is worthwhile exploring the possibilities of engaging them in primary health care and training programmes accordingly”.
In addition, WHO has devoted a report to the integration of western and traditional medicine. Although some skepticism still exists, the idea seems to prevail internationally that additional training and involvement of traditional practitioners can make up the great shortage of personnel in the health system or ease it.
Another advantage is that they will be less inclined to leave the community than specially trained modern health workers who will want to seek for further career opportunities elsewhere after training. Their close relationship with their fellow villagers is yet another advantage.
The Alma Ata Declaration in its description of PHC, stressed on the need of bringing together all those involved in health care, if need be, traditional healers, prepare them technically and socially to work as a team and to respond to the health needs of their locality.
In certain developing countries some health administrators have recommended the association to PHC of traditional healers who understand the socio- cultural context of the local population, who are well respected and who must have acquired a considerable experience. Economic consideration, the distances to be covered in certain countries, including Cameroon, to get to a health facility, the influence of traditional beliefs, the lack of health professionals particularly in rural areas are some of the factors that contributed to this recommendation.
Traditional healers have long played an important role in Cameroon and Africa in general as far as health care is concerned. They have long term bonds of trust with their communities. They serve at least some of the health and education needs of 80-85% of the population of sub-Saharan Africa giving them wider influence and reach than modern health practitioners with more training. It is clear that traditional healers like religious leaders should be involved in African strategies for the prevention and treatment of HIV/AIDS. Anti retroviral treatment alone will not be able to prevent or solve the multiple aspects of this disease.
The donor community has recently become keen to harness the positive influences of religion and tradition for, particularly in the delivery of health messages. As far as traditional networks are concerned, traditional healers will have to be at the forefront as links in the communities.
When looking at how services can be delivered through these networks, it will be important to see them as complements to and partners with rather than substitutes for state systems of delivery.
Traditional healers are part and parcel of our cultural heritage.
The inattention to culture in health policy making by planners, decision makers and many donors goes some way to explain the failure of so many health and development initiatives. Culture is about relationships between ideas and perspectives, about self respect and a sense of security, about how individuals socialize and values are formed and transmitted. Culture is about shared patterns of identity, symbolic meaning, aspiration and about the relationship between individuals and groups within a society. Culture is both dynamic and reactive. A people’s attitudes and the choices they make. Culture is how the past interacts with the future. As Stephen Ellis and Gerrie ter Haar have put it, “No more than anyone else do Africa and Africans have an authentic, unchanging culture that is transmitted from one generation to another, or ought to be.” What is at issue in contemporary Africa therefore is not a clash between “tradition and modernity” but between different paths and different conception of modernity. This also applies to the relationship between medical practitioners and traditional healers. It is not convincing to try to make a stark distinction between tradition and modernity.
Furthermore, history shows tremendous interactive and evolving nature of African cultures. They have been able to absorb a wide range of outside influences and impositions and have found ways to survive often difficult natural, environmental, and social conditions including conflict and disease. Traditional healers form an integral part of these cultures and medical practitioners cannot successfully work with the local population on health issues without using them as a bridge to attain their goal.
It is well known that the scourge of AIDS will not be combated in Cameroon and Africa by the use of modern medicine alone. Modern medicine prescribed by medical practitioners is essential, but will not be sufficient. What is necessary is the outstanding view that, alongside medical or biological explanations of a disease, many Cameroonians and Africans will also look for an explanation that is spiritually or culturally related. The traditional healers are often consulted for an answer. Much in reducing the transmission of HIV/AIDS turns on cultural attitudes. Learning this will be a two way process as was exemplified by a workshop run by UNESCO in Angola with youths from a variety of ethnic backgrounds.
The purpose was to discuss traditional norms regarding sexuality, social reactions to people living with HIV and AIDS, existing knowledge about transmission and prevention and cultural practices that might contribute to the spread of HIV. But in the process, those running the workshop obtained new understandings of cultural practices, such as initiation rights, scar-tattooing, blood brother practices, circumcision, means of breaking the umbilical cord, polygamy and traditional marriage and healing practices. HIV/AIDS has a narrow link with most of the issues mentioned above. Participants spent time discussing cultural values and practices associated around virginity, condom use, monogamy and the like. Discussions like this help to explain to outsiders amongst whom are medical practitioners, who had designed the education and awareness programmes why these had not resulted in lowered prevalence rates or higher use of condoms. It became clear that the education methods had been distorted by local cultural norms and values regarding sexuality that had previously been overlooked and underestimated by health strategies.
The overall lesson is that outside prescriptions succeed only where they work with the grain of local views. They fail where they ignore or do not understand the cultural supposition of the people they seek to address. Policy- makers and modern health practitioners should recognize the need for greater efforts to understand the values, norms, and allegiance of the cultures of Cameroon and in their health policy making display a greater flexibility, open-mind willingness to learn and humility. Such an approach will pay respect to traditional healers and pave the way for full collaboration between medical practitioners and traditional healers who must be partners in health care. It will also be more likely to produce the results that policy makers want to see in the fight against HIV/AIDS in particular and the burden of disease in Cameroon in general.
NB:The above paper was presented by Mofor Samuel,a health Education Specialist,at a Buea-Cameroon workshop on: Indigenous Knowledge and HIV/AIDS Management: the case of Traditional Medicine ,which held from 23rd-24th Oct, 2009 orgainiseed by AFRICAphonie
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