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Improving health care in South Africa
By Jacqueline Lampe, Director AMREF Flying Doctors

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COLUMNISTS

Improving health care in South Africa
By Jacqueline Lampe, Director AMREF Flying Doctors

 

By Jacqueline Lampe*

 

At the start of the last World Cup, a Sangoma (traditional healer) from the Zulu culture reached the international news because she predicted the winner of the tournament: Argentina. We know now that this prediction was incorrect, but in South Africa these sangomas are highly respected and have an important role in the sports world and in traditional medicine.

 

Sangomas can bless a soccer team and the pitch for example by offering animal blood, using medicinal plants, praying, singing and dancing. During the World Cup a sangoma was punished by the FIFA because she had dug a hole in the pitch, burned a sacrificial chicken and left it there. This seems unusual, but for soccer players in South Africa it is common to visit a sangoma for potions, balms or talismans to boost their performance or treat injuries.

 

Sangomas

 

In South Africa there are more sangomas than western style doctors and in the country-side over 60 percent of the population seeks health advice and treatment from traditional healers before visiting a medical doctor. Those that do seek formal health care also continue to visit a traditional healer.

 

Most sangomas are female and have other roles besides health care such as: divination, directing rituals, finding lost cattle, protecting warriors, counteracting witches, and narrating the history, cosmology and myths of their tradition. When sangomas want to cure a patient they seek guidance from the ancestors. This is done in three ways: possession by an ancestor, or channelling; throwing bones; and interpreting dreams. In possession state the sangoma works into a trance, through drumming, dancing and chanting, and allows his ego to step aside so an ancestor possesses his body and communicates directly with the patient, providing specific information about his problems.

 

Sangomas give their patients medications of plant and animal origin imbued with spiritual significance (Muti). Muti can be drunk, smoked, inhaled, used for washing, smeared on the body, given as enemas, or rubbed into an incision.

 

Combining western medicine with traditions

 

The shortage of health workers in South Africa, especially in rural areas where 72 per cent of the population live form a big problem. While there have been improvements in health care services, many clinics still lack basic equipment, drugs, tests for HIV and TB and essentials like piped water and electricity. Although most people in rural areas first consult traditional healers when falling ill, the health care system does not fully collaborate yet with these sangomas.

 

One of Africa’s major NGOs started a project to improve this and to include the help of sangomas in the fight against the big illnesses of South Africa: HIV-AIDS, TB and sexual transmitted diseases (STDs). The program started in 2005 and intends to equip traditional healers with counselling skills and a wide range of expertise related to HIV/AIDS, STDs and TB prevention and care, and is integrating indigenous healing systems with western medical approaches. As part of this project, healers are taught how to take a patient history, to recognize signs and symptoms of diseases, home-based care, prevention of mother-to-child transmission, anti-retroviral therapy, and how to counsel and refer patients to the hospital for testing. Patients who test positive are referred back to the healers for immune boosters, other herbal remedies and counselling. The healers are also encouraged to get tested, so that the advice they give to patients is based on their own experience.

 

The sangomas also get technical training, including project management to improve the business of traditional healing, financial management (though they have many clients, many sangomas are poor for lack of suitable payment structures) and leadership.

 

The lack of proper health precautions at the traditional clinics was of great concern. In fact, up to 50 per cent of the sangomas have been infected with HIV through their improper handling of blood and other body fluids. Therefore the department of health supports the project by providing home-based care kits, including gloves, disinfectant, bleach, bandages, sanitary sheets and condoms for their clients. During the training the sangomas learn they have to use a new razor for each patient when cutting the skin, and wear gloves when rubbing in the medication. They are also taught to sterilize the porcupine quills which they use for acupuncture, to prevent cross-infecting their patients.

 

Miriam Tembe, a sangoma

 

Inside a dumba (traditional hut) in a village in KwaZulu Natal, Miriam Tembe sits on the floor, staring at a pile of bones. The dumba is ‘where the ancestors live’, and is Miriam’s consulting room. The walls are hung with a traditional healer’s paraphernalia – gourds, animal skins, and a string of teeth. A wooden cupboard with a glass door is packed to capacity with an assortment of tins, bottles and jars full of powders and liquids – Miriam’s pharmacy. Close by Alfred Nyawo sits on the ground, eyes downcast, waiting for the verdict. After reading the bones, Miriam announces that he is well. Nevertheless, she pulls on a pair of latex gloves and examines him.

 

Miriam is a sangoma and Nyawo is her patient. True to Miriam’s pronouncement, Nyawo is not unwell; in fact, he is feeling much better today than he was a month ago, when he had come to see her complaining of persistent muscle pains in his shoulders and legs, and frequent headaches. Today he has come back to pay her, and to thank her because he is no longer in pain.

 

Nyawo is clearly in awe of Miriam; when he arrived, he stood quietly at the entrance of her dumba, waiting respectfully for permission to enter. When allowed, he entered on his knees, clapped his hands in greeting (a sangoma’s hand is never shaken) and went to sit quietly opposite her.

 

“I prefer to come here because I am able to talk to her about anything that is bothering me. She speaks to me very nicely, and she is kind. And any time I come to see her, I never have to wait long before she attends to me,” says Nyawo. “It is very different at the government health clinic”, he says.

 

The last time he went to a hospital was a year ago, when he had the flu. “They are not very friendly there. I cannot speak to them freely. Besides, there are always many people, so you have to wait a long time for your turn. I prefer to come here. I have a lot of confidence in her.”

 

“Go to the clinic”

 

Nyawo’s wife is pregnant and has been having frequent headaches. Miriam advises him to tell his wife not to take any medicine, considering her condition, but go the health clinic for a check-up instead. Then she pulls a box of condoms out of her medicine cabinet and gives it to him, advising to use one every time he has sex. This is the second box of condoms Nyawo is receiving from Miriam. He had never used any before she gave him the first lot. He had heard about condoms, but no one at the hospital had ever talked to him about them during his few visits there, and he had never bothered to ask. “I trust Mama. I always follow her instructions when she treats me, and I always get better. So if she gives me condoms and tells me to use them, I obey.”

 

A happy Nyawo bows and claps his hands to say goodbye, then leaves the dumba the same way he came in – on his knees, this time with a box of condoms tucked safely under his arm.

 

Miriam is one of eighty sangomas in KwaZulu Natal, taking part in the program of AMREF. She sees about eleven patients every week, mostly adults with chest problems, painful feet and joints, STD’s and headaches.

“Before I joined AMREF's programme for traditional healers, I did not know much about HIV/AIDS. I had heard talk about such a disease, but I did not know what it was. Many of my patients would fall very sick, but even after reading the bones, I could not tell what the problem was”, Miriam says. She explains the training was very useful to her: “The information that we get about the western approach to medicine has helped me to deal with diseases like HIV and AIDS, STIs and TB. For example a lot of my patients come to me with persistent coughs and fever. Before I would give them medication and send them home, but some of them got very ill and died. Now I know the symptoms of TB, and that it can kill if it is not treated, so whenever I see such signs, I send them straight to the Monzi Health Centre so that they can be tested and put on treatment.”

She continues: “I get a lot of women coming to see me because they want me to help them keep their husbands home. I give them herbs to rub on their tummies and the pubic area, and this guarantees that their men will never stray. Now I also encourage the women to go for HIV testing and I tell them about female condoms to protect themselves.” She also hands out condoms to all her male customers and explains them why it is important to use them.

 

Training and learning

 

“The training has made a very big difference to the way I run my practice. Before, I depended totally on the bones to tell me what was wrong with my patients. But now, apart from throwing the bones, I also examine the patient, and ask questions like how long he has been coughing, and whether he has been to the clinic. If he says he has been to the clinic, I ask what he was told. Some people go to the clinic, but if the medicine does not work fast, they abandon it and come to me. I tell them that they must continue taking the medicine. If they have not been to the clinic, I send them there. Many of those that I send to the clinic come back to thank me because they got better, and they ask me to give them some of my medicine as well.”

 

Miriam also learned how to protect herself, her patients and her family against infections. She used to treat the patients with bare hands and explains that often she or her children would clean up blood, vomit or spit with bare hands. “I did not know the danger that we were exposing ourselves to. Now I do not let my children do that kind of work and I always wear gloves when I am handling patients”.

 

Now Miriam has her own students who she trains to become sangomas. “I teach them about traditional medicine, but now I am also teaching them all the new things that I am learning. I tell them that when they refer people to the health clinic for cases of HIV and TB, their patients will have greater confidence in them when they get better, and will keep coming back to them, and their practices will flourish.”

  

*Jacqueline Lampe is director of AMREF Flying Doctors in the Netherlands.











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