Persuading Africans To Take Their Herbs With Some Antivirals [WSJ]
U.S.-Backed Program Pushes Doctors, Healers to Treat AIDS Patients Together
By MICHAEL M. PHILLIPS
May 5, 2006; Page A1
DURBAN, South Africa -- Nokusho Bhengu was 35 years old when, she says, her dead father appeared to her in the form of a mustachioed snake and told her to leave her children and study to become a medium and healer.
"If you resist," Mrs. Bhengu says the snake warned her, "it will go badly for you." She did as she was told.
Now, 39 years later, when the sick arrive at her doorstep, she puts on a headdress made of desiccated goat gall bladders, burns incense, communes with the ancestors and then prescribes home-brewed remedies made from leaves, grasses, roots and sticks. Among other things, she says, the ancestral concoctions help alleviate the symptoms of AIDS, including weight loss and skin lesions.
Word of Mrs. Bhengu's skill has spread far and wide, from her home village of KwaNgcolosi , throughout the Valley of a Thousand Hills, into the nearby port city of Durban and, most recently, to Washington, where the Bush administration has enlisted her in its multibillion-dollar fight against AIDS.
Some 80% of South Africans go to traditional healers when they get sick, especially if they have AIDS, a disease that Western medicine can treat but not cure. In part, healers remain so popular because they offer something the country's overburdened physicians often cannot: personalized, low-cost care that's in keeping with the widespread practice of ancestor worship.
The Bush administration's health experts have decided that AIDS-plagued Durban is an ideal setting to test whether a network of 10,000 herbalists, mediums and faith healers can be integrated with a city's clinics and hospitals. That requires somehow reconciling two groups of health practitioners with radically different views of what causes disease and what cures it.
With $700,000 in initial U.S. funding, the Nelson R. Mandela School of Medicine at the University of KwaZulu-Natal, the local health department, and the local Traditional Health Practitioners Councils in March launched a project aimed at training 375 healers to test their patients for HIV, keep records of their progress, and refer them to AIDS clinics where they can get the latest antiretroviral drugs. At the same time, the project directors are hoping they can persuade medical doctors to refer patients back to traditional healers for palliative care and house-call attention.
"I have a lot of respect for what do," says F. Gray Handley, health attaché at the U.S. Embassy in Pretoria. "It makes good sense to figure out if there's a way to incorporate them into effective therapeutic programs."
At first, the healer training will focus on inner-city Durban, where about 40% of the adult population is believed to carry the AIDS virus, according to data from surveys of pregnant women. Of the 130,000 Durban residents whose HIV infections warrant antiretroviral therapy, just 10,000 are getting the drugs from government clinics, according to research conducted at the University of the Witwatersrand.
The U.S hopes Durban will ultimately serve as a model for the rest of South Africa and for other sub-Saharan nations where people rely heavily on traditional medicine. "When things are good, they go to church," says the Rev. Linus Mwenda, senior pastor at Deliverance Church in Meru, Kenya. "When times are tough, they tend to go back to traditional ways -- witch doctors, ancestor worship and diviners."
But the effort requires bridging a doctor-healer divide that reflects vastly different medical cultures.
Physicians are often deeply suspicious of healers and their remedies, complaining that the hospitals sometimes end up having to treat patients poisoned by traditional potions. Some South African healers have reportedly encouraged their patients to take herbal mixtures instead of life-extending antiretroviral drugs. In addition, "some of them still do promote this idea that if you sleep with a virgin you'll rid yourself of AIDS," says Suzanne Leclerc-Madlala, head of the anthropology department at the University of KwaZulu-Natal.
Doctors see diseases caused by bacteria and viruses that can be transmitted from one person to another. Healers traditionally don't believe in contagion. "Most diseases are caused by witchcraft," says Queen Ntuli, a 45-year-old medium and herbalist who is helping set up the U.S.-financed project as secretary-general of the Traditional Health Practitioners Council in KwaZulu-Natal, the province that includes Durban.
Healers believe that people who violate social norms can bring disease upon themselves, as well. "If you do the wrong thing, the ancestors will abandon you," says 57-year-old Bongi Nkomo-Gwala. She became a healing medium as a child when, she says, she fell into a trance and walked alone from South Africa about 200 miles to the home of a senior healer in neighboring Swaziland. Now she charges $3 for a consultation. Those who can't pay that much give her a chicken or some corn instead.
Some healers say that because AIDS is a new affliction, the ancestors aren't familiar with it. Mrs. Bhengu says she informed her ancestors about the disease in a ceremony in which she slaughtered a chicken and told the dead what she had learned from Western medicine about how the disease is transmitted and treated. "Is this acceptable to you?" she says she asked them. The ancestors, she says, give her remedies to help treat the symptoms of AIDS, but cannot cure it.
"One of the things we notice is nutrition is critical," says Mrs. Bhengu. "We encourage people to grow food organically. People are eating Kentucky and all this fast food, and they forget about what's growing around them."
Some healers do claim they have cured AIDS. One is Mrs. Nkomo-Gwala, who works closely with James Hartzell, a 47-year-old Long Islander with a Ph.D. in Sanskrit who is running the U.S.-funded project. Over lunch recently, Mrs. Nkomo-Gwala told Mr. Hartzell that she had succeeded with remedies prescribed by ancestors who appeared to her in dreams.
Mr. Hartzell, who studied traditional health systems in China and India, thought perhaps it was a translation problem. "In Western medicine, 'cure' means make the disease go away forever," he told her gently.
Mrs. Nkomo-Gwala explained that she has patients who at first tested positive for HIV, took her herbal medicines and then tested virus-free. "That's why we say 'cure,' " she said.
Mr. Hartzell said he doubted the test results. "The question is what happens after three or four or five or 10 years."
Mrs. Nkomo-Gwala was unhappy to hear that. "OK," she responded glumly.
Mr. Hartzell believes that patients will benefit the most if they have access both to the Western doctors who provide advanced drugs, and to the traditional healers who provide personalized care and comfort in a way that makes sense in a world of belief in spirits and curses. Besides, he says, while the scientific research isn't conclusive, anecdotal evidence suggests that some traditional compounds do help alleviate the symptoms of AIDS and other illnesses.
On a recent day he and Mrs. Nkomo-Gwala wandered through a Durban marketplace piled high with donkey bones, black mamba skins, dead owls, dried monkey hands and innumerable herbs. She pointed out some sticks useful for protecting against curses. He bargained over wild ginger, a rare medicinal plant he is trying to cultivate.
If Western doctors are suspicious of traditional healers, the feeling is mutual. Healers believe pharmaceutical companies, which often use plants to develop new drugs, want to steal their secret recipes, which can contain 50 or more plants boiled in water and sold in old liquor bottles.
Healers have their own way of dealing with intellectual property rights. For instance, if Mrs. Ntuli wanted to buy another healer's recipe, she says she would have to pay the seller a cow. Mrs. Ntuli and the seller would then sacrifice goats and burn incense to persuade their ancestors to bless the transfer. The seller would take Mrs. Ntuli into the forest and show her the key plant. She would sniff it and chew a bit to familiarize her ancestors with it.
"We have certain rules given to us by our ancestors," explains Mrs. Ntuli.
Mr. Hartzell and biochemist Nceba Gqaleni, deputy dean of the Mandela medical school, focus on ways to build trust between the healers and the doctors. They train healers to use simple HIV tests that give reliable results in less than 15 minutes, and to refer those who test positive to clinics. Healers will receive plastic file boxes and forms to use in recording information about their patients' health. Periodically, health officials will collect the information in order to generate more accurate data about the progression of AIDS.
The medical school is also providing a list of guidelines to help healers recognize AIDS cases. But even that simple document exposed the cultural divide when the doctors tested it out with a few of the healers. First came a long debate over how to translate English medical terms into the Zulu language: "presenting symptoms," "vomiting" and "memory loss."
Then, Mrs. Ntuli objected to the very nature of the guidelines. Many healers, she said, don't ask patients to describe their symptoms. Instead, they burn incense and ask the ancestors what to prescribe. If the problem is serious, the patient might move into the healer's home for days or even weeks. The guidelines, she argued, should include those steps.
"Our job is not the same as the Western doctors' " job, Mrs. Nkomo-Gwala explained later.
In the end, Mr. Hartzell and his colleagues decided to leave the ancestors out of the clinical guidelines, reasoning that all spiritual mediums know about their role already. |
