TANGA AIDS WORKING GROUP (TAWG ) Indigenous knowledge Program Presented at the World Bank, Washington DC 11 th July 20

1. TANGA AIDS WORKING GROUP (TAWG)Indigenous knowledge ProgramPresented at the World Bank, Washington DC11th July 2005 • PRESENTER: Dr. S. Mtullu • PROJECT MANAGER • TANGA AIDS WORKING GROUP (TAWG) • P.O. BOX 1374, TANGA-TANZANIA • Tel/Fax : +255-27-2642266 • Email – tawg@kaributanga.com

2. WHY IK PROGRAM ? • This was after observing AIDS patients recovering from bed to work after the use of herbal remedies • No effective cure or vaccine against HIV infection. Prevention & symptomatic treatment are the only alternatives. • Existing Health services are unaffordable by the poor TRM offers opportunist for reaching the poor at a little added costs • TH’s are accepted, respected and usually have credibility in the community • Traditional Healers are always available to the community; Ration of Healer to population is 1:350 while that of medical doctors is 1:20,000 • Collaboration provide opportunities for sharing knowledge in Health Management.

3. OBJECTIVES OF TAWG IK PROGRAM • To provide effective low cost herbal remedies to treat opportunistic infections associated with HIV/AIDS. • To raise awareness among TH’s to safe guard both traditional healers and their clients from being infected during their practices • To build capacity of healers in providing community education and care

4. OBJECTIVES Cont…… • To conduct research on promising herbal remedies in collaboration with TH’s and other scientific institutions • To ensure sustainable supply of medicinal plants in use through conservation and cultivation of the herbal medicinal plants • To build and strengthen bridges to collaboration between traditional and modern health systems

5. CARRIED OUT AND ON GOING ACTIVITIES • Provision of Herbal treatment to treat opportunistic infection in PLHA in collaboration with THP • Training of THP on Basic HIV/AIDS knowledge, Safer working environment, counseling, referral criteria, community mobilization and collaboration and networking. • Organizing continuous knowledge exchange meetings between THP themselves and with TAWG • Ethno botanical studies to identify names of the medicinal plants in use

6. CARRIED OUT AND ON GOING ……. • Mini 0bservational clinical efficacy study for Pyrenacantha Kaurabassana on skin conditions • Clinical observational on the efficacy of three herbal plants in use by TAWG • Community to community knowledge exchange meeting between care providers, TH’s and PLHA • Continuous searching for new medicinal plant remedies to be researched and included in TAWG herbal treatment program

7. BENEFICIARIES • People living with HIV/AIDS attending TAWG services. • Traditional Healers who are trained and those who provides Herbs for Care and Research. • Communities served by trained THP. • Government Hospital who are relieved the burden of Care

8. THE HERBAL TREATMENT PROGRAM • 70% of patients are referred from the Hospitals • Clients are enrolled after Voluntary Counseling & Testing. The enrollment is optional. • Clients use Traditional Herbal medicine collected and prescribed by healer and distributed by TAWG • Patients are treated for Free – we play the healer. • Medicine are given to patients in a powder form to make tea or mix with coconut oil/water for topical applications. • Clients are monitored by professional health workers every two weeks at the clinic. • Initial treatments six months then the patient can be an off treatment every 2-3 months. • Serious patients are followed up at their homes. • The standard treatment is 3 plants medicines, but there are 5 other herbs used for different conditions

9. WHAT DO HERBS HELP • Increase appetite • Gain weight • Stops diarrhea • Reduces Fever • Clears up oral thrush • Resolve skin rashes and fungus • Treats herpes zoster • Heals ulcers.

10. PATIENTS RESULTS • Patient begin showing seeing results/ improvements between one week & 4 weeks after starting treatment. • Patient who survive for 6 months generally live for 2-5 years some patients have 12 years now. • Medicine have not proved very helpful in advanced stage of HIV/AIDS. • Patients uses the herbs for treatment and prevention of OI.

11. PATIENT RESULTS Cont…. • Patients on treatment throughout remain health though in some cases the immunity status may be down. This type of patients normally dies of a short illness and are not bed ridden. • Patients who leaves treatment for a longtime after a period of recovery won’t benefit from the same herbs in the second episode of OI. • Our goal is effective treatment, we provide any treatment traditional or conventional that contributes to the patients well being. • Note: Patients improvements has priority over research.

12. HEALER’S PREVENTION PROGRM • Identification is conducted through the community members, TH’s associations and physical visits • A series of sensitization meetings between Local Government, District PHC Committee, Village health committees, and Traditional Healers themselves. • Adult Learning participatory approach was used to train healers in HIV/AIDS knowledge, counseling, - danger signs and symptoms and referral criteria - community mobilization and sensitization, - safer working environment, - provision of home care services - and IEC materials distribution including condoms.

13. PREVENTION CONT…. • A simple appropriate manual was prepared. • Initial Workshop were for 5 days and were followed by refresher knowledge exchange meetings after every three months • Monitoring guide was developed and TH’s were followed up at their sites to monitor their improvements.

14. ACHIEVEMENTS • TAWG has so far treated 4,500 AIDS patients with opportunistic infection using herbal medicines. • Currently we have 1,300 patients from six treatment centers. • Build capacity of healers to assess patients progress. • The quality of life of PLHA using TAWG herbs have been improved – stigma reduction • TH’s are now powerful community educators and strong partners in IEC distribution • Two clinical observational studies have been conducted so far

15. Achievements Cont…….. • 329 healers have been trained including 87 traditional birth attendants • 468 people have been referred from TH to health facilities for HIV testing and care • 1,648 educational sessions were conducted by TH’s reaching 38,720 people • 9 TH’s initiative are in place (4 orphan care and 5 community theatre groups • TH’s are potential outlet for IEC materials distribution and condoms.

16. OUTCOME OF TAWG TREATMENT PROGRAM • Keeping more people alive have automatically maintained the workforce hence reducing the newly orphaned children. • Through this program we have managed to help the Government in respective districts to: - Reduce the cost of patient treatment - Reduce resources spent on Care - Reduce the patient load to hospitals.

17. CHALLENGES • Increasing number of clients seeking services from TAWG leading to strain on the available resource. • Defaulters - mostly due to failure to cope with increasing appetite • Lack of cooperation between the traditional health system and modern health system. • Bulkiness of the herbs • Environmental destruction. • Inadequate coverage of training healers (<10%)due to inadequate resources

18. WAY FORWARD • Continue providing low cost herbal treatment to PLWA • Conservation - sourcing the forest for the project - Integrating local healers in joint forestry management and re-vegetation projects - Training on medicinal plant propagation for home gardens - Training and education on HIV/AIDS prevention and care for all local healers who live in proximity to the forest project - Education for forestry workers on HIV/AIDS prevention and care i.e. truck drivers and workers who spend extended time away from home

19. WAY FORWARD Cont….. 3. Research - Process validation of the herbs we are currently using. This will involve standardization and packaging thus easing the portability and reduce stigma - Design and conduct two more observational clinical studies on promising herbal plants 4. Strengthening TAWG’s approach in collaborating with traditional healers by establishing a comprehensive community based training program including TH’s trainer of trainers. 5. To establish a sustainable partnership between TH’s and formal health system (BHW) through education programs targeting both groups 6. Developing an educational booklet on local medicinal plants for home health care.

20. EXPECTED OUTCOME • Renewal of hope among the poor HIV infected patients through access to low cost treatment • Evidence based validation of the herbs will benefit users and THs. • Sustainable supply of the medicinal plants will be enhanced • Improved treatment knowledge of TH’s and BHW’s to better serve the community • Forged links between TH’S and BHW’s • Replication of effective best practices within the country and region

21. CONCLUSION • Enable us sustain our Indigenous Knowledge initiatives to continue caring for people living with HIV/AIDS THANK YOU