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The role of pharmacists and traditional healers in TB Care in Phnom Penh, Cambodia

The role of pharmacists and traditional healers in TB Care in Phnom Penh, Cambodia. Jan de Lind van Wijngaarden and Gill Fletcher, FHI/Cambodia June 2001. Results of qualitative research conducted by FHI/IMPACT and Action/IEC as part of the FHI/Gorgas TB/ERA Project. Introduction.

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The role of pharmacists and traditional healers in TB Care in Phnom Penh, Cambodia

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  1. The role of pharmacists and traditional healers in TB Care in Phnom Penh, Cambodia Jan de Lind van Wijngaarden and Gill Fletcher, FHI/Cambodia June 2001

  2. Results of qualitative research conducted by FHI/IMPACT and Action/IEC as part of the FHI/Gorgas TB/ERA Project Introduction • This research was carried out to meet two of the TB/ERA project objectives: Assessment of TB burden in vulnerable populations; and the design and production of IEC materials • This presentation will focus on: • Interviews with pharmacists and traditional healers • Pharmacists’ and traditional healers’ attitudes and perceptions regarding TB

  3. Research informants • 7 pharmacists – selected at random • 7 traditional healers – selected using lists from the Cambodian National Traditional Healers’ Association

  4. Methodology • Individual interviews held at the pharmacies / work environments of traditional healers • Cambodian researchers • Tape recorders were used

  5. Possible pitfalls • Interviews at working environment – informants may not have put in maximum time and attention • Researchers new to the subject of TB – not always sufficient probing • Data analysis conducted in English – some info may have been lost • Pharmacist/drug sellers selection was perhaps biased

  6. Why patients go to pharmacists • Pharmacy is near the home • Flexible remedies – quality and quantity of medicines depend on what the patient can pay • Low trust in public hospitals / fear of hidden costs • Hospital staff not always friendly, especially towards poor patients • Feel less stigmatized

  7. But pharmacists… • Have limited knowledge of TB • Only 1 out of 7 interviewed had a pharmaceutical degree; 2 were doctors and 4 had no medical qualification

  8. Pharmacists and TB • All pharmacists say they immediately refer patients to the NTP as soon as they suspect TB, however: • Their diagnostic skills are limited • Many forms of coughs were mentioned for which treatment is provided • Pharmacists only recognized TB in its later (serious) stage

  9. Misconceptions • TB is transmitted by sharing plates / food / eating together • TB can be caused by working too hard • Drinking too much alcohol can bring on TB • TB can be caused by lack of sanitation • TB is a hereditary disease

  10. Good advice given • Cover mouth while speaking • Eat nutritious food • Stop smoking • Sleep / rest • Go to see a doctor

  11. Bad advice given • Eat using separate eating utensils • Stay away from healthy people • Don’t eat fish sauce

  12. Why patients go to traditional healers • Some patients don’t want to go to hospital, for reasons mentioned earlier (too expensive, too far, not friendly) • Patients seek relief from the side effects of modern TB drugs. Often they combine the two kinds • Some healers said patients come to them if modern TB medicines are ‘ineffective’

  13. Traditional healers and TB • None of the traditional healers claimed to be able to cure TB – only to relieve side effects • Traditional healers do however, say they can treat various forms of cough which they do not recognize as TB • Most see cough with sputum as a sign of TB – some only if the sputum is blue • Traditional healers say they refer cases of suspected TB for other treatment

  14. Misconceptions • Sharing dishes and eating together can transmit TB • TB caused by alcohol • Hereditary disease / being weak as a child causes TB • Hard work can cause TB • Sleeping in the same mosquito net can transmit TB • Having sex can transmit TB

  15. Good advice • Cover mouth while speaking • Keep clean / set high hygienic standards • Do exercises • “Don’t worry, be happy”

  16. Bad advice • Abstain from eating certain foods • Stop going outside / becoming tired / working • Eat with separate eating utensils • Stay away from children • Don’t have sex

  17. Modern medicine? • All traditional healers believed modern medicines should be used to treat / cure TB • They see a role for themselves in treating side effects of the drugs • Mixing traditional and modern medicines not seen as problematic

  18. Recommendations • Pharmacists have an important role to play in referring TB cases and providing education to the community • They could even become involved in DOTS for outpatients in communities that are far away from health centers / Cenat • Pharmacists and traditional healers need education on TB issues • Both groups are keen to play a role in distributing / using IEC materials

  19. Thank you for your attention And thanks to NTP, NCHADS, KHANA, Servants, JICA, MSF-F and the Cambodian National Traditional Healers’ Associationfor their inputs and support

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