Nelson R Mandela School of MedicineNelson R Mandela School of Medicine

Funded by the Department of Science & TechnologyFunded by the Department of Science & TechnologyAdministered by the National Research FoundationAdministered by the National Research Foundation

Prof Nceba GqaleniProf Nceba GqaleniSouth African Research Chair: South African Research Chair:

Indigenous Health Care SystemsIndigenous Health Care Systems

Strengthening Collaboration Between Traditional Strengthening Collaboration Between Traditional & Allopathic Practitioners in HIV and AIDS & Allopathic Practitioners in HIV and AIDS

Traditional medicine is a component of a rich heritage

The traditional African way of The traditional African way of life has been built around life has been built around a concept of a circle; a concept of a circle; symbolizing symbolizing connectedness, balance, connectedness, balance, and an approach to life in and an approach to life in a holistic manner. a holistic manner.

UBUNTUUBUNTU

African Philosophy

African Religion

African Culture

Traditional Medicine

African Spirituality

African Society

Adapted from Letendre (2002): Crossing Boundaries 1(2):78-87Adapted from Letendre (2002): Crossing Boundaries 1(2):78-87

African Healing

• It is useful to understand that African It is useful to understand that African traditional healing happens within a totality traditional healing happens within a totality of experience of a of experience of a cosmologycosmology that has that has specific elements.specific elements.

• This cosmology often includes This cosmology often includes objectiveobjective and and subjectivesubjective elements, which those who elements, which those who believe in it understand to be exactly thatbelieve in it understand to be exactly that

Prof Pearl Sithole (UKZN)Prof Pearl Sithole (UKZN)

Traditional health practice

The South African Traditional Health The South African Traditional Health Practitioners Act defines traditional health Practitioners Act defines traditional health practice as performance of a function, practice as performance of a function, activity, process, or service based on a activity, process, or service based on a traditional philosophy that uses indigenous traditional philosophy that uses indigenous African techniques and principles that African techniques and principles that include traditional medicine or practice, include traditional medicine or practice, including the physical or mental preparation including the physical or mental preparation of an individual for puberty, adulthood, of an individual for puberty, adulthood, pregnancy, childbirth, and death.pregnancy, childbirth, and death.

Traditional philosophy

““indigenous African techniques, principles, indigenous African techniques, principles, theories, ideologies, beliefs, opinions and theories, ideologies, beliefs, opinions and customs and uses of traditional medicines customs and uses of traditional medicines communicated from ancestors to communicated from ancestors to descendants or from generations to descendants or from generations to generations, with or without written generations, with or without written documentation, whether supported by documentation, whether supported by science or not, and which are generally science or not, and which are generally used in traditional health practice”used in traditional health practice”

Patients health seeking behaviour

Patients see no conflict in Patients see no conflict in seeking both allopathic and seeking both allopathic and traditional African healing for traditional African healing for their ailmentstheir ailments

Integration into the national health system

Source: ANC, A National Health Plan for South Africa (1994), South African Health Review 2007, Chapter 12

Corporate agreements with unions on THPs

• Chamber of Mines and NUMChamber of Mines and NUM

• Sun International and NEHAWUSun International and NEHAWU

• ESKOMESKOM

• University of Pretoria and NEHAWUUniversity of Pretoria and NEHAWU

Medical Schemes and THPs

• MedScheme has introduced limited MedScheme has introduced limited benefits for members consulting benefits for members consulting THPsTHPs

• Are there more?Are there more?

Effect of TM on employee wellness

• Traditional health practitioners (THPs) are Traditional health practitioners (THPs) are consulted for a number of work related problems consulted for a number of work related problems like stress, anxiety and depression and have like stress, anxiety and depression and have proven to be effective for a number of years in proven to be effective for a number of years in improving such conditions. improving such conditions.

• When used appropriately it can enhance When used appropriately it can enhance employee wellness:employee wellness:

Cultural inclusivenessCultural inclusivenessCultural sensitiveness Cultural sensitiveness Complementary and supportive Complementary and supportive HIV and AIDS supportHIV and AIDS support

Who are traditional medicine users?

The traditionalistsThe traditionalistswho strongly believe in culture and supernatural who strongly believe in culture and supernatural

phenomenonphenomenon

Practicalist and realist Practicalist and realist Will seek whatever they consider will help themWill seek whatever they consider will help them

DenialistDenialistin denial about their life in denial about their life

HIV Prevalence Scenario in South Africa

Approximately 6million are HIV+, of these:Approximately 6million are HIV+, of these:

Approximately 1million qualify for ARVsApproximately 1million qualify for ARVs

Approximately 5million do not qualify for ARV Approximately 5million do not qualify for ARV therapytherapy

70% (4,2m) of HIV+ are co-infected with TB70% (4,2m) of HIV+ are co-infected with TB

40million remain uninfected or their HIV status is 40million remain uninfected or their HIV status is unknownunknown

PSP for HIV and AIDS, STI, TB

• Covers five key priority areasCovers five key priority areas

1.1. PreventionPrevention

2.2. Treatment, care & supportTreatment, care & support

3.3. ResearchResearch

4.4. Monitoring and surveillanceMonitoring and surveillance

5.5. Human rights and advocacyHuman rights and advocacy

Prevention

• Promotion of HCT through referral Promotion of HCT through referral

• Public campaigns including multi-Public campaigns including multi-mediamedia

• Promotion of Medical Male Promotion of Medical Male CircumcisionCircumcision

• Could THPs conduct HCT?Could THPs conduct HCT?

Spread of myths

• Have largely decreased through Have largely decreased through training of THPstraining of THPs

• Provincial Department of HealthProvincial Department of Health

• NGOs (AIDS Foundation, AMREF, NGOs (AIDS Foundation, AMREF, etc)etc)

• UKZNUKZN

Treatment, care and support (1)

• Treatment is the most area that continues Treatment is the most area that continues to be of concernto be of concern

• Largely due to potential negative impact Largely due to potential negative impact on ARV adherence and drug interactionson ARV adherence and drug interactions

• There still needs to be a national There still needs to be a national consensus on this areaconsensus on this area

Treatment, care & support (2)

• THPs have been trained on provision THPs have been trained on provision of palliative care or home based careof palliative care or home based care

• Keep patient record and referral formsKeep patient record and referral forms

• Trained on universal precautions and Trained on universal precautions and risk of transmission through razors risk of transmission through razors etc.etc.

• Promote nutrition and gardeningPromote nutrition and gardening

Traditional healers as tuberculosis treatment supervisors:What do patients think?

• 10% of patients had used a healer as the 10% of patients had used a healer as the first health provider for their illnessfirst health provider for their illness

• 40% had attended a healer at some time 40% had attended a healer at some time prior to diagnosis. prior to diagnosis.

• 84% would consider choosing a healer as 84% would consider choosing a healer as a treatment supervisor.a treatment supervisor.

D. Wilkinson, L. Gcabashe, M. Lurie,D. Wilkinson, L. Gcabashe, M. Lurie,

INT J TUBERC LUNG DIS 3(9):838–842INT J TUBERC LUNG DIS 3(9):838–842

The MRC Hlabisa experience

THP DOTSTHP DOTS

• 89% (n=47) treatment 89% (n=47) treatment completion (p=0.002) completion (p=0.002)

• 6% (n=3) mortality 6% (n=3) mortality (p=0.04) (p=0.04)

• 6% (n=3) default 6% (n=3) default

• 0% transfer rate0% transfer rate

Public Health DOTSPublic Health DOTS

• 67% (n=157) treatment 67% (n=157) treatment completioncompletion

• 18% (n=41) mortality18% (n=41) mortality

• 10% (n=23) default 10% (n=23) default

• 5% (n=12) transfer rate5% (n=12) transfer rate

• Colvin M et al., Colvin M et al., Int Conf Int Conf AIDS.AIDS. 2002 Jul 7-12; 14: 2002 Jul 7-12; 14: abstract no. hPeB7264. abstract no. hPeB7264.

Research (1)

• Clinical trials on traditional medicine Clinical trials on traditional medicine on patients who do not qualify for on patients who do not qualify for ARVs are in progress (largely in KZN ARVs are in progress (largely in KZN public hospitals)public hospitals)

• Have been approved by MCCHave been approved by MCC

• Outcomes have not been released Outcomes have not been released yet yet

Research (2)

• Laboratory and animal studies on Laboratory and animal studies on traditional medicines aboundtraditional medicines abound

• Few have been translated to clinical Few have been translated to clinical trialstrials

• There are major methodological There are major methodological challenges and MCC guidelines challenges and MCC guidelines requiredrequired

Monitoring and surveillance

• Less is taking place at this levelLess is taking place at this level

• There is a greater need for collaboration There is a greater need for collaboration with the allopathic sector due to lab with the allopathic sector due to lab costs and Health Information Systemscosts and Health Information Systems

• Need to train and educate health care Need to train and educate health care workersworkers

• WHO has designed a module to this WHO has designed a module to this effecteffect

Advocacy & human rights

• Apparent with THPs looking after OVCsApparent with THPs looking after OVCs

• There is need for greater collaboration There is need for greater collaboration with PLWHAwith PLWHA

• THPs have a potential positive role in THPs have a potential positive role in influencing societyinfluencing society

General TM developments and achievements

• THPs are now recognized by the THPs are now recognized by the Department of Health Department of Health

• UKZN has also taken an initiative of having UKZN has also taken an initiative of having a designated THP a designated THP

• Ethekwini Municipality has taken strides by Ethekwini Municipality has taken strides by having a designated Traditional Medicine having a designated Traditional Medicine ManagerManager

• UKZN, Ethekwini Municipality, KZN DoH and UKZN, Ethekwini Municipality, KZN DoH and KZN THPs are collaborating on HIV & AIDSKZN THPs are collaborating on HIV & AIDS

• Other NGOs like AMREF work with THPs Other NGOs like AMREF work with THPs

Employee wellness possibilities

• Consultative role on creating a culturally sensitive Consultative role on creating a culturally sensitive employee wellness programs can be played by employee wellness programs can be played by Traditional healersTraditional healers

• Collaborated efforts can be formed by the Collaborated efforts can be formed by the Traditional healers and employers of creating Traditional healers and employers of creating wellness programswellness programs

• A referral system can be initiated by having a A referral system can be initiated by having a designated database of TH which wellness officers designated database of TH which wellness officers can refer to and employees can consult by choice. can refer to and employees can consult by choice. Designation of a TH services similar to that of UKZN Designation of a TH services similar to that of UKZN

““This will provide relief on presented sick notes This will provide relief on presented sick notes dilemmas”.dilemmas”.

Editorial comment

• Traditional health practitioners are Traditional health practitioners are key to scaling up comprehensive key to scaling up comprehensive care for HIV/AIDS in sub-Saharan care for HIV/AIDS in sub-Saharan Africa Africa

Homsy J, King R, Balaba D and Kabatesi DHomsy J, King R, Balaba D and Kabatesi D

AIDS 2004, 18:1723–1725AIDS 2004, 18:1723–1725