Calling All Healers

By Stephan Faris/Alenga

When Americans think about the problem of getting modern medical care to the people in Africa who need it most, Anthony Okello is not the solution that comes immediately to mind. He's a medicine man, apprenticed as a teenager to the wandering witch doctor who treated him for a fever that other doctors couldn't cure. When a patient goes to Okello complaining of rashes and diarrhea, as Lucy Ajam did recently, he recognizes the typical symptoms of AIDS for what they are. He immediately sent Ajam to the nearest hospital to start her on antiretroviral drugs (ARVs)--an approach even a traditionalist like Ajam heartily endorses. "For minor cases, I still use local herbs," says Ajam, 51, a roadside bread vendor in Alenga, Uganda, a sprawling settlement overlooking the Nile River. "But it's the ARVs that are keeping me alive."

Like many other African countries battling AIDS, Uganda is struggling to make the most of a sudden influx of dollars from First World donors like the Bill and Melinda Gates Foundation, whose disease-fighting war chest just doubled in size, thanks to a $30 billion endowment from financier Warren Buffett. Uganda is planning to use its money to provide ARVs to every Ugandan who needs them, but the flood of money for medical care is running into a roadblock common in almost every Third World country: an infrastructure incapable of delivering it. In Uganda, for example, there is only one doctor for every 20,000 citizens--and there far fewer doctors in rural areas like Alenga. It's a challenge simply to identify the needy in this country, much less ensure that patients stick to their therapies.

By contrast, there's a practicing medicine man for every 150 Ugandans, which is why traditional healers like Okello are playing an increasingly important role. "Traditional healers are in the neighborhood, and they're open 24 hours," says Dr. Dorothy Balaba, executive director of Traditional and Modern Health Practitioners Together Against AIDS (THETA), an aid group based in Kampala, Uganda's capital. For 80% of the Ugandan population, traditional healers represent the treatment of choice.

But decades of suspicion and mistrust between African and European medicine practitioners aren't so easily overcome, and not every traditional healer is so eager as Okello is to pitch in.

Take, for example, Yahaya Sekagya. Like Okello, his history was shaped by medical trauma. As a teenager he was consigned to a mental hospital for visions he says were calling him to traditional medicine. "It was misdiagnosed and misunderstood by Western medicine," says Sekagya, 43. Although he ended up going to medical school--more out of contrariness than conviction--he also spent six years studying at a medicine man's shrine. Now he's the director of the Ugandan chapter of Prometra, a Senegal-based advocacy group promoting traditional medicine. Sekagya runs an outdoor school in a forest south of Kampala. About 100 students gather weekly under a leafy canopy. Instructors line up herbs on a thin wooden table cut from a single log. Along with the basics of hygiene and anatomy, students learn the identification and uses of local plants. Meanwhile, spiritualists chant, dance and drum to call down spirits and consult them for cures.

While Sekagya concedes that modern medicine is better at blood transfusions, rehydration and aligning compound fractures, he insists that traditional ways should not be dismissed simply because they are not understood. "A Western yardstick is the wrong yardstick to regulate traditional medicine," he says.

He is also worried that expensive modern medicines may be smothering local knowledge, leaving the country dependent on foreign drugs and funding. "ARVs are not curing AIDS. They are improving the quality of life," Sekagya says. "Some traditional practices are doing the same. What attention are we giving to that? And if we come with ARVS and flood the whole system, will we lose those traditions?"

Uganda's medical establishment recognizes that to produce more Okellos they need to listen to the Sekagyas. Thus, the Ministry of Health is drafting a policy to regulate healers, and the Makerere University Medical School in Kampala is teaching students to respect traditional medicine--if only to learn what potions their clients are taking. "They are not going to control the behavior of their patients," says Samuel Luboga, deputy dean of education. "But by being hostile, they can prevent themselves from finding out [what their patients are doing]."

In the Apac district hospital near Alenga, where THETA has encouraged the nurses to accept traditional approaches, it's not uncommon for patients to ask a healer for supplemental herbs or to check themselves out to seek traditional remedies. But even in Apac, the doctors are not so accommodating. Okello carefully fills out referral forms provided by THETA, but they often come back with no comments or diagnosis. "We don't get the feedback," says Okello, who takes it upon himself to make sure patients are following their regimens. "Maybe they feel it time wasting."

Resistance varies from country to country. Nigeria, Mali and Equatorial Guinea, like Uganda, are mainstreaming traditional practitioners. But in South Africa, legislation formalizing the role of healers has met stiff opposition from doctors. "Can you imagine the chaos that would take place in South Africa if traditional healers are allowed to authorize people to receive pensions and disability grants?" says Heinrich Botes of the nonprofit group Doctors for Life International.

The stakes couldn't be higher. With so many sick patients, so few doctors and the ever present risk that misused medicine will spawn resistant strains, promoters of ARVs in Africa can only hope that doctors and traditional healers will learn to get along. "There are so many who said, 'You're crazy to be giving ARVs in Africa,'" says Dr. Michael Rich, the Rwanda director of Partners in Health, an aid group that pioneered community health care. "If we're not successful right now, then in 10 years people are going to say, 'See I told you so, it doesn't work,'" says Rich. "And the money will be gone."

With reporting by Megan Lindow/Cape Town