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Nelson R Mandela School of Medicine

Strengthening Collaboration Between Traditional & Allopathic Practitioners in HIV and AIDS. Prof Nceba Gqaleni South African Research Chair: Indigenous Health Care Systems. Nelson R Mandela School of Medicine

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Nelson R Mandela School of Medicine

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  1. Strengthening Collaboration Between Traditional & Allopathic Practitioners in HIV and AIDS Prof Nceba GqaleniSouth African Research Chair: Indigenous Health Care Systems Nelson R Mandela School of Medicine Funded by the Department of Science & TechnologyAdministered by the National Research Foundation

  2. Traditional medicine is a component of a rich heritage African Society The traditional African way of life has been built around a concept of a circle; symbolizing connectedness, balance, and an approach to life in a holistic manner. UBUNTU African Culture African Religion African Philosophy Traditional Medicine African Spirituality Adapted from Letendre (2002): Crossing Boundaries 1(2):78-87

  3. African Healing • It is useful to understand that African traditional healing happens within a totality of experience of a cosmology that has specific elements. • This cosmology often includes objective and subjective elements, which those who believe in it understand to be exactly that Prof Pearl Sithole(UKZN)

  4. Traditional health practice The South African Traditional Health Practitioners Act defines traditional health practice as performance of a function, activity, process, or service based on a traditional philosophy that uses indigenous African techniques and principles that include traditional medicine or practice, including the physical or mental preparation of an individual for puberty, adulthood, pregnancy, childbirth, and death.

  5. Traditional philosophy “indigenous African techniques, principles, theories, ideologies, beliefs, opinions and customs and uses of traditional medicines communicated from ancestors to descendants or from generations to generations, with or without written documentation, whether supported by science or not, and which are generally used in traditional health practice”

  6. Patients health seeking behaviour Patients see no conflict in seeking both allopathic and traditional African healing for their ailments

  7. “People have the right of access to traditional practitioners as part of their cultural heritage and belief system.” Integration into the national health system Source: ANC, A National Health Plan for South Africa (1994), South African Health Review 2007, Chapter 12

  8. Corporate agreements with unions on THPs • Chamber of Mines and NUM • Sun International and NEHAWU • ESKOM • University of Pretoria and NEHAWU

  9. Medical Schemes and THPs • MedScheme has introduced limited benefits for members consulting THPs • Are there more?

  10. Effect of TM on employee wellness • Traditional health practitioners (THPs) are consulted for a number of work related problems like stress, anxiety and depression and have proven to be effective for a number of years in improving such conditions. • When used appropriately it can enhance employee wellness: • Cultural inclusiveness • Cultural sensitiveness • Complementary and supportive • HIV and AIDS support

  11. Who are traditional medicine users? • The traditionalists • who strongly believe in culture and supernatural phenomenon • Practicalist and realist • Will seek whatever they consider will help them • Denialist • in denial about their life

  12. HIV Prevalence Scenario in South Africa Approximately 6million are HIV+, of these: Approximately 1million qualify for ARVs Approximately 5million do not qualify for ARV therapy 70% (4,2m) of HIV+ are co-infected with TB 40million remain uninfected or their HIV status is unknown

  13. PSP for HIV and AIDS, STI, TB • Covers five key priority areas • Prevention • Treatment, care & support • Research • Monitoring and surveillance • Human rights and advocacy

  14. Prevention • Promotion of HCT through referral • Public campaigns including multi-media • Promotion of Medical Male Circumcision • Could THPs conduct HCT?

  15. Spread of myths • Have largely decreased through training of THPs • Provincial Department of Health • NGOs (AIDS Foundation, AMREF, etc) • UKZN

  16. Treatment, care and support (1) • Treatment is the most area that continues to be of concern • Largely due to potential negative impact on ARV adherence and drug interactions • There still needs to be a national consensus on this area

  17. Treatment, care & support (2) • THPs have been trained on provision of palliative care or home based care • Keep patient record and referral forms • Trained on universal precautions and risk of transmission through razors etc. • Promote nutrition and gardening

  18. Traditional healers as tuberculosis treatment supervisors:What do patients think? • 10% of patients had used a healer as the first health provider for their illness • 40% had attended a healer at some time prior to diagnosis. • 84% would consider choosing a healer as a treatment supervisor. D. Wilkinson, L. Gcabashe, M. Lurie, INT J TUBERC LUNG DIS 3(9):838–842

  19. The MRC Hlabisa experience THP DOTS Public Health DOTS 67% (n=157) treatment completion 18% (n=41) mortality 10% (n=23) default 5% (n=12) transfer rate Colvin M et al., Int Conf AIDS. 2002 Jul 7-12; 14: abstract no. hPeB7264. • 89% (n=47) treatment completion (p=0.002) • 6% (n=3) mortality (p=0.04) • 6% (n=3) default • 0% transfer rate

  20. Research (1) • Clinical trials on traditional medicine on patients who do not qualify for ARVs are in progress (largely in KZN public hospitals) • Have been approved by MCC • Outcomes have not been released yet

  21. Research (2) • Laboratory and animal studies on traditional medicines abound • Few have been translated to clinical trials • There are major methodological challenges and MCC guidelines required

  22. Monitoring and surveillance • Less is taking place at this level • There is a greater need for collaboration with the allopathic sector due to lab costs and Health Information Systems • Need to train and educate health care workers • WHO has designed a module to this effect

  23. Advocacy & human rights • Apparent with THPs looking after OVCs • There is need for greater collaboration with PLWHA • THPs have a potential positive role in influencing society

  24. General TM developments and achievements • THPs are now recognized by the Department of Health • UKZN has also taken an initiative of having a designated THP • Ethekwini Municipality has taken strides by having a designated Traditional Medicine Manager • UKZN, Ethekwini Municipality, KZN DoH and KZN THPs are collaborating on HIV & AIDS • Other NGOs like AMREF work with THPs

  25. Employee wellness possibilities • Consultative role on creating a culturally sensitive employee wellness programs can be played by Traditional healers • Collaborated efforts can be formed by the Traditional healers and employers of creating wellness programs • A referral system can be initiated by having a designated database of TH which wellness officers can refer to and employees can consult by choice. Designation of a TH services similar to that of UKZN “This will provide relief on presented sick notes dilemmas”.

  26. Editorial comment • Traditional health practitioners are key to scaling up comprehensive care for HIV/AIDS in sub-Saharan Africa Homsy J, King R, Balaba D and Kabatesi D AIDS 2004, 18:1723–1725

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