By: Sarika Bansal
An estimated 1,700 doctors practice in Zambia, but fewer than 5 percent of them work in rural areas where 60 percent of the population lives. In a country where two thirds of the people live below the poverty line, transportation to health centers is often prohibitively expensive.
As a result, people usually turn to the vast network of traditional healers in Zambia, who charge a fraction of what many modern doctors do and whom many Zambians, particularly from older generations, also trust over modern doctors. There are more than 20 times as many healers as doctors, and they exist in the most remote villages.
Such a mismatch could well have set the stage for a showdown between modern medicine and traditional healing. But instead of shunning healers, Zambia’s mainstream medical community is trying, in a limited but creative way, to make them into allies and use them to promote healthy behaviors around the country.
One night in the mid-1950s, Rose Mwanza had a dream that she could heal the sick with herbs and roots. Upon waking up, she decided that she had found her life’s calling: she would become a traditional healer in her hometown of Lusaka, Zambia.
Within a few months, Mwanza opened a clinic in her home and began seeing patients, to whom she offered cures for ailments like impotence and the common cold. She developed a love potion out of dove hearts and sheep innards. She found a tree bark that she said could prevent seizures, if grated and mixed in porridge.
When her daughter Beauty was born several years later, Mwanza decided to make healing a family business. Beauty became Rose’s apprentice, and by the age of 21, she had learned enough to run her own shop. Today, 30 years later, Beauty runs a clinic in Lusaka’s bustling marketplace. She sees 30 patients a day and offers them many of the same potions, barks and herbs as her mother.
Unlike her mother, though, Beauty uses latex gloves and sterile blades. And if someone reveals that they have HIV, she does not treat the patient herself; she refers them to a nearby medical clinic. She learned this through an innovative program the Zambian government has pioneered to work with traditional healers.
Beauty is one of an estimated 40,000 traditional healers in Zambia. Healers in Zambia, as in many parts of Africa, treat — or at least claim to treat — most maladies. Some, like Beauty and her mother, are herbalists. Others specialize in helping women give birth. Still others are spiritual or divine healers, who do not offer medicine or medical assistance, but rather help patients with spiritual issues that they believe may be causing illness.
The Traditional Health Practitioners Association of Zambia (THPAZ) organizes healers and fights for them to become a legitimate part of Zambia’s medical system. The organization’s president, Rodwell Vongo, wants healers to become a respected part of mainstream society. “We have a lot to offer each other,” he said, with a voice reminiscent of actor Morgan Freeman. “What I fail at doing, they (Western doctors) do. What they fail at doing, we do.”
Bridging the divide
Vongo regularly meets with entities like the United Nations Development Program, the World Health Organization and the Zambian government. He also represents his constituency on the Country Coordinating Mechanism, a group that sends proposals to the Global Fund regarding HIV/AIDS, tuberculosis and malaria spending priorities.
As a bridge between traditional healers and the modern world, Vongo is conscious of his image. He wears suits to interviews, not traditional garb, and refuses to be photographed near African handicrafts or masks. When asked if he would perform a traditional ceremony for foreign journalists, he sarcastically responded that he was “not a monkey.”
Partially through Vongo’s influence, the Zambian government and international donors have begun to see traditional healers as an important part of Zambia’s health care system. Some groups partner with them, partially in an effort to reduce the scourge of HIV/AIDS in the country.
Approximately one in seven Zambian adults lives with HIV, and the country sees 200 new infections a day. The prevalence of the disease is one of the biggest problems African nations face. As groups like Catholic Relief Services and others have noted, poverty is both a cause and an effect of the disease, which impacts family structure and the ability to make a living.
The pandemic also affects children. Worldwide, an estimated 2.1 million children are HIV positive, many as a result of mother-to-child transmission, according to UNICEF. Even children not affected by the disease are sometimes orphaned in communities overwhelmed by the spread of HIV.
“In essence,” said Steven Novella, regarding the WHO’s partnership with Zambian healers, “the goal is to use an existing infrastructure of trusted primary care providers (traditional healers) to get them to help the HIV/AIDS program, rather than hinder it.”
The partnerships the mainstream medical community is forming are admittedly limited. They are not interested in incorporating traditional beliefs into modern medicine. In fact, few medical professionals give much weight to traditional Zambian drugs, which were not developed as rigorously as, say, acupuncture in China or Ayurveda in India.
“Perhaps 5 percent of medicines that healers offer have any actual medicinal value,” said Alan Haworth, a retired psychiatrist who has been working in Zambia since 1964 and has worked closely with many healers. “Healers tell patients that there are no side effects — but that’s because there are no effects at all.”
Vongo recognizes and teaches healers the limits of their practices. “We don’t have traditional gloves, so we use your (latex) gloves,” he said. “We don’t have traditional condoms or traditional injections. When people need an IV, the best thing to do is to refer them to the clinic.”
To date, most partnerships with healers focus on educating them about HIV/AIDS and hygiene. Vongo trains many healers himself. Though he has not formally studied medicine — like most healers, he learned the art through informal mentors — he can intelligently discuss topics related to HIV and tuberculosis, primarily because of his frequent contact with Zambia’s medical community. Other trainings are done in conjunction with doctors, medical licentiates, nurses and midwives. THPAZ estimates that more than 3,000 healers have been trained to date.
In some cases, trainers try to limit the potential harm healers can cause. Some healers, when drawing blood, will use one razor blade for an entire family — which is especially dangerous if a family member has HIV or another disease transmissible by blood. They also teach the dangers of “blood cupping,” a traditional practice in which healers suck “bad blood” from patients with their mouths.
THPAZ also wants to dispel potentially dangerous myths. When HIV/AIDS was on the rise in Zambia in the 1990s, some healers told patients that it was caused by women having sex during menstruation. Other healers promote defilement and “sexual cleansing” to help cure the disease. Instead, trainers ask healers to supply condoms to patients to prevent HIV.
“If we don’t sensitize healers, we’ll lose a lot of gains in Western medicine,” said Vongo. To that end, he and other trainers emphasize the importance of patients continuing their modern medicines even after visiting healers. He spoke of healers who told patients to stop their DOTS (Directly Observed Treatment, Short-course) therapy for tuberculosis midway. Unfortunately, doing so can result in drug-resistant tuberculosis, which is difficult and expensive to treat.
Working with healers has its challenges. “Collaboration is a difficult task,” said Haworth. “Not every healer will listen to what modern science has to say.” Manyando Silukena, a healer in Zambia’s Central District, said he learned to heal “directly from God” and that doctors could not teach him anything new. “There is no formal training (for healing), just like there wasn’t for the disciples of Jesus,” he said.
Training healers, said Clement Chela, director of the National AIDS Council, requires an immense dose of patience. “If you try and change them outright, you’ll be seen to think you are superior,” he said. Instead, one must work with healers for months, and sometimes years, until they themselves realize that some sicknesses require modern medicine to be cured. It also helps to engage trainers who can both sympathize with healers and speak to them respectfully.
Another challenge is the presence of bogus healers. “We have some quacks,” said Vongo, “and that’s really a shame.” These individuals overcharge clients, deal drugs like cocaine, or falsely claim to possess certain healing abilities. Some have even killed patients with their treatments.
THPAZ has tried to address this problem with its certification process. It offers information on healers who have been practicing for at least two years. If the community deems a healer safe and effective, he or she earns a certificate from THPAZ. Healers that people do not trust are unofficially excommunicated.
Since the advent of modern medicine, healers have largely been cast aside as unsophisticated witch doctors. In recent years, though, several countries — including Zambia, South Africa, Cameroon and islands in the South Pacific — have found value in bringing this population into the primary health care system. A randomized controlled study in northern Zambia, for instance, found that training traditional birth attendants in some modern techniques “significantly reduced neonatal mortality in a rural African setting.” If programs are designed carefully, this group can boost the health of many rural populations — or at least limit the harm they could otherwise cause.
“Healers are doing a big service to the community,” said Vongo. “They’re certainly doing more than the 1,700 Western trained doctors in Zambia.”