The role of practitioners of traditional medicine in the treatment, care and support of people living with HIV/AIDS
Summerton, Joy Violet
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The ravaging impact of the HIV/AIDS epidemic on societies, especially in developing countries, has evoked a renewed urgency to consolidate all available resources to address the health needs of individuals living with HIV and AIDS. One such resource to the avail of many resource-ridden countries is the traditional healing system. Despite global proclamations and national policies that propagate the inclusion of traditional health practitioners into national health systems and priority programmes in order to address the health care needs of communities, in practice, traditional healing remains shadowed by its western health care counterpart. The South African government has declared traditional health practitioners partners in the national emasculation of the HIV/AIDS epidemic. However, significant results to this effect have not as yet been produced. The lack of effective integration of traditional health practitioners into national health programmes, such as for HIV/AIDS in South Africa, points towards a discrepancy between policies and proclamations propagating the inclusion of traditional health practitioners into the mainstream of health care, and actual integration. It is in the light of this discrepancy that this study proposes the exploration of factors that hinder collaboration between practitioners of the traditional and western health care systems. Key factors to successful collaboration between traditional and western health practitioners are identified from various initiatives in Africa and Asia, and against the backdrop of the WHO suggested integrated health care systems. These success factors are used as a bench mark to analyse collaboration in the study area and propose recommendations towards successful and meaningful collaboration. The study explores the perceived value and weaknesses of the traditional healing system in the treatment and care of people living with HIV/AIDS. This entailed ascertaining impediments to effective collaboration between traditional and western health practitioners for the purpose of informing the two categories of practitioners as well as policy developments aimed at integrating traditional and western health care. A literature study of the traditional healing system, international and national policies relating to HIV/AIDS and traditional healing, and lessons learnt from developed and developing countries on collaboration between the two health care systems informed the development of the research instruments and served as a conceptual framework for interpretation of the findings. The study was conducted in five urban settlements in the Buffalo City Municipality, in the Eastern Cape Province. The Eastern Cape was selected due to the researcher’s affiliation to the culture and vernacular of the research respondents, and due to the venerable nature of traditional health practitioners in many communities in the Eastern Cape. Preliminary investigations in preparation for the research revealed that the organisation and regulation of traditional health practitioners is more problematic in urban than in rural areas, thus the selection of an urban area to conduct the research. Due to the exploratory nature of the research, a qualitative research design was applied whereby indepth semi-structured individual interviews were conducted with 23 western health practitioners, 20 traditional health practitioners and three managers from the Department of Health. The focus of the interviews was to explore the perceived strengths and weaknesses of traditional health practitioners; impediments to collaboration between traditional and western practitioners; the structure and organisation of the traditional healing system; and views about the legalisation and professionalisation of traditional health practitioners. Purposive, snowball and sequential sampling was applied to select respondents. The main findings of the research points towards a dire need for closer collaboration between traditional and western health practitioners. The need for collaboration is based on both the perceived weaknesses and strengths of the traditional healing system. However, the nature of collaboration envisaged differs significantly between the two groups of practitioners. On the one hand, traditional practitioners envisage collaboration as entailing a bilateral (two-way) referral system between traditional and western practitioners, and joint decision making about certain patients and conditions between the two practitioners. On the other, western health practitioners envisage a far more unilateral collaboration which entails a one-way referral system from traditional to western practitioner, traditional practitioners receiving training in western medicine and traditional practitioners sharing information about the contents of proclaimed curative medicines/remedies. Furthermore, the absence of unequivocally delineated guidelines for collaboration is one other major hindrance to effective collaboration between the two traditions of practitioners. In general, the legalisation and professionalisation of traditional health practitioner is welcomed by both genres of practitioners. However, the lack of knowledge about the content and implications of the Traditional Health Practitioners Bill posses major threats to the successful implementation of the proposed Act. Overall, the research indicates that traditional healing has a role to play in the provision of health care to people living with HIV/AIDS. However, the weaknesses of this system of health care, which undermine its value, need to be addressed. Furthermore, clearly delineated policies need to be developed in close collaboration with the major stakeholders, namely traditional and western practitioners, to guide effective collaboration as envisaged by both groups of practitioners. Local government should adopt a more active role in initiating collaboration as well as monitoring its effective and culture-sensitive implementation.