Bridging the gap between traditional healers and modern healthcare
Alfonsé is a traditional healer who serves the communities that live on the fringes of Uganda’s Bwindi Impenetrable National Park, home to half of the world’s remaining mountain gorillas. Having fled unrest in his native Congo, Alfonsé and his family have now set up residence in Mukono parish on the edge of the forest.
On his small plot of land, Alfonsé grows a wide range of medicinal herbs and plants, which he harvests for use in his daily practice. All of these were originally derived from the neighbouring forest, which contains over 400 species of flora. Armed with a large wooden pestle and mortar and some water, he grinds up the leaves, shoots and roots of these plants, transforming them into different healing potions. Next, he uses a sieve made of dried reeds to separate out the plant matter, leaving just the liquid behind. The potion is then decanted into a dried and hollowed-out pumpkin husk that serves as a drinking vessel. Lines etched into the side of the cup are used as a guide for measuring out dosages according to the patient and nature of their condition.
Upon presenting with an ailment, patients undergo a brief consultation before being administered an appropriate treatment. In most cases, the portion is either drunk or rubbed onto the affected parts of the body. Some of the more serious ailments Alfonsé has been known to treat include malaria, tuberculosis and dysentery. However, his know-how also extends to a range of other social and health related conditions such as women’s health, impotence, social problems and of course evil spirits. For many of the marginalised people that live around Bwindi, traditional healers like Alfonsé are the first and last line of defence for a number of contagious and debilitating diseases. There are several reasons why they are so popular. Firstly, they often outnumber other health workers in rural areas, being more accessible and more affordable then their Western-trained counterparts. Secondly, and perhaps more importantly, it is because they are embedded, extensively and firmly, within Ugandan culture; they are highly respected and widely consulted members of the communities. Despite their prominence Ugandan society, there are several fundamental concerns with traditional healers. Firstly, many of them have had little or no contact with modern medical doctors. Secondly, the majority of their treatments lack a credible evidence base, often being prescribed without any scientific proof that they are safe or effective. Some are actually known to interfere with the effectiveness of modern treatments, such as anti-HIV drugs. Thirdly, traditional healers are known to spread myths and misconceptions on important health and social issues that can then spread malpractice in the communities.
The good news is that African governments are increasingly beginning to recognise traditional healers as an integral part of their health systems. They have realised that by excluding them, they can actually cause more harm then good. They also acknowledge that, through education programs, traditional healers’ unique first-point-of-contact position can be leveraged to improve access to modern healthcare services. By training them on how to implement a science-based program of counseling and basic healthcare, they can be used to refer patients with serious conditions to hospitals for proper treatment. Conservation Through Public Health strongly advocates the view that traditional healers, like Alfonsé, should not be left on the sidelines. In fact, they play a key role in CTPH’s integrated conservation community health programs that ultimately aim to allow gorillas, humans and their livestock to coexist through improving primary healthcare. CTPH has held training workshops with traditional healers of Bwindi with support from THETA (Traditional and Modern Healers Against HIV/AIDS). As earlier mentioned, one of the biggest challenges faced by the poor communities living around protected areas is the lack of access to proper health services. To address this, CTPH helped create a network of Village Health and Conservation Teams (VHCTs) around Bwindi and other protected areas. VHCTs are made up of community volunteers that make health services more accessible in rural communities through household visits, making referrals and providing education on healthcare issues. They also give coaching on the importance of conservation and its inextricable linkages to healthcare, hence the ‘C’ in VHCT.
Essentially, VHCTs act as the bridge between the local communities and health centres. This explains why one of their key responsibilities is to unite forces and engage with the traditional healers. Alfonsé, whose very own wife, Miriam Bifumbo, is a VHCT volunteer, is a key role model in this effort. Without losing the traditional essence of his practice, he now attends monthly VHCT meetings, has been trained on when to refer suspected TB, HIV and malaria patients to the community hospital and also encourages modern family planning practices. Ultimately, thanks to the combined efforts of CTPH, the VHCTs, and the traditional healers, a greater number of people are receiving proper healthcare in the protected areas around Bwindi Impenetrable National Park. With more perseverance, others will follow suit.