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 "Within the African region, Theta is the one organization that is always cited as having shown that African solutions to African problems are a major way of responding to problems in Africa. Often people look for answers elsewhere, but this organization has shown that HIV/AIDS is a very big problem in Africa, and solutions will not only come from elsewhere, but internally using what we already have as Africans. " Dr. Donna Kabatesi |
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As early as that time, we approached traditional healers who we had heard from patients were providing them with care. Most that we approached were very excited to work with us, and to find solutions to HIV/AIDS-related problems.
From the beginning, we wanted to document what worked, and the approaches the traditional healers use to reach out to their patients. We organized a clinical observation study. We wanted to observe a group of patients who obtained their medicines and care from traditional healers and a similar group who were able to obtain treatment from the modern clinics that TASO was running.
I was asked to join the team as a clinician who would conduct patient examinations and record my observations of what was happening with patients. As an individual, my interest has always been public health, finding a health solution for as many people as possible. We knew we didn’t have much experience with AIDS, and many patients were dying in pain with symptoms that could be alleviated. Dyerial problems were one major cause of death, and skin diseases. In the hospital where I worked, we didn’t have any major medications that would alleviate these symptoms very easily. We had a lot of hope in what traditional herbs would offer, as well as psychosocial support that traditional healers were able to provide. That, for me, as an individual, was the drive. Let’s go out there. If traditional medicine is helping patients, lets find the traditional healers, lets work together to provide patients with comprehensive good quality care. And, indeed, a year later we were actually able to show that some herbal medications were useful for patients. In fact, there were working as well as what we had in the hospital and even, sometimes, better. That’s really the beginning of Theta.
Dr. Donna at her desk at the CDC, Kampala
We were also intrigued and excited to learn that traditional healers had a way of communicating and relating to patients that offered them hope and that they found comfortable to deal with. As early as 1993, we began to recognize the special counseling skills that traditional healers had, particularly working with female clients. Together, we designed a package of HIVAIDS information. Then, using their skills and their usual way of communicating with their patients, they were able to disseminate these HIV/AIDS related messages. Until today, that training program has evolved, but it came out of our realization that traditional healers were superior communicators and counselors for their patients.
Now In our medical school, the curriculum addresses these community resource people, and Theta has played a large role in helping the doctors and nurses curriculum to include some material on how the traditional healers fit into the system. But, at the time I went to school, nobody talked about it. What we knew was based on what we had seen at home. Those of us who grew up in the villages, your grandmother, your mother, they know that certain herbs work. And when you are sick, they go to an older person in the village to seek advice. So those of us who grew up in villages already had these rudimentary pieces of appreciation of traditional medicine. Otherwise, I was indifferent at the time, I was just curious to learn a little more about this and to see how it can be applied.
C. What is your sense of what Theta needs to do now?
D: Theta needs to learn from the past 14-year experience and begin to be responsive to the new problems we have. Some are related to HIV, but also there are other issues. Engaging traditional medicine has grown bigger than Theta, and it is important to begin to identify what areas Theta, as an organization, is uniquely experienced in, and develop them. I am thinking, for example, Theta does not need to do a lot of advocacy work locally, here in Uganda. But there is a lot of cooperation and networking in the African region that can happen. That area needs to be strengthened so that this whole activity initiative moves to another level.
I think locally there is lot Theta can do to make sure more traditional healers are reached. This is not just by Theta, but working with other groups and organizations, and encouraging them to work with traditional healers through training trainers. Working with the Ministry of Health as well, to make this a regular intervention that is in national and district plans.
At the technical patient level, I would like to see Theta move to respond to the new challenges we have identified. For example, we now have so many people being tested for HIV in the communities. But do those people have the counseling support networks to help them deal with whatever issues are related to HIV testing? I do see a traditional healer in his village, in his community, being prepared to take on these roles of support, being part of the supportive network for people who test HIV positive but have not entered into the system of ARV treatment, for example. Even when they are in the treatment program, they have issues and concerns, and have no one in the community who is paying attention to this. People who go back to their villages really have no one. Doctors and nurses are just too few and so far removed from the person’s situation. My hope would be that Theta would pick up on these gaps in patient care and patient support and begin to work with their network of traditional healers to work with this new need.
Then there is this whole issue of widows and children who have been orphaned by AIDS. Traditional healers are well placed and Theta has had some experience with some of the traditional healers in how they can respond to this new need. I feel this can be expanded too.
I think Theta has a unique place in terms of bringing these two systems - traditional healers and biomedical - together and actually documenting how these two health systems can work together. I serve on the African region World Health Organization traditional healing expert committee. What I have learned in interacting with people on the committee and in WHO, is that there aren’t that many organizations and institutions in the African region that have as much experience as Theta, and that have been focused for a period of time on HIV issues and working with African traditional medicine. Those unique experiences can be brought to bear through, for example, documenting better what has worked, and what hasn’t worked, and truly disseminating this. Theta is being called upon to participate on certain issues and provide leadership for certain issues, and Theta doesn’t have much capacity right now to deal with all these demands and requests. I do feel those are the areas that can be strengthened.
C: Theta has the experience but it needs to be documented and communicated in a way that will inform the international community?
D: Now that I am out of the day-to-day organizational activities of Theta, I can see that the place of Theta is clearly defined. There is an assumption among staff to know that this is obvious. People know about it, they have seen it at work. But they need to articulate these experiences at the various national and international conferences in a very clear and consistent way. Right now Theta does not have a lot of capacity to deal with that. For example, if they had a person committed to continually articulating their experiences very clearly. Often the senior staff is torn in a 1000 different directions, and that doesn’t work very well in having a consistent communication strategy of what you do and what you have learned.
C: What have been some of the important contributions of Theta?
D: The one that comes to me very quickly is to help Uganda understand that out there, in the community, there are people who are a major resource. They are willing to do something about HIVAIDS in their communities. They just need a little bit of input and training and they rise to the occasion. That is one major contribution of Theta’s.
Now, more than ever, people are conscious there are other ways of dealing with disease, and are interested in herbs. In the past, there was a tendency to neglect this area of medicine. They didn’t trust that it worked, that it was important and useful. I think Theta has really shown the community in Uganda that certain herbal medicines are useful. They are important, communities use them, and we can do some research and document them better.
And perhaps the other area that Theta has made a contribution, I don’t know if this is understood by people outside the organization, is that if you want to work with people in the community, there are people by the nature of what they are already doing are willing to spend some time, to volunteer their time. They might want to come and respond to a problem. But, because they are not necessarily placed in that role and responsibility in the community, there are problems sustaining their interest. You have problems sustaining their voluntary spirit. On the other hand, we have seen that traditional healers will continue to participate in an issue as long as they feel it fits in with their life, and they see patient care and supporting people in their communities as part of their mission. Other individuals such as local government people get tired and loose interest. So, for me, these are three main areas that have been brought out.
Within the African region, Theta is the one organization that is always cited as having shown that African solutions to African problems are a major way of responding to problems in Africa. Often people look for answers elsewhere, but this organization has shown that HIV/AIDS is a very big problem in Africa and solutions will not only come from elsewhere, but internally using what we already have as Africans.
Until you have lived an experience, it doesn’t really make a lot of sense to you. Sometimes staff expresses frustration, why can’t we raise money to run our program. And I say, you have to continue driving these pieces of information because it is not so obvious to people who have not lived this experience that what you are doing is important. It is very tough to see there is real value here. For us to articulate this for those who haven’t had the opportunity to work with traditional healers is important. Theta needs to bring people to visit, to experience, to work with them for a couple of weeks or a month, to be able to say ‘wait a minute, this is really valuable stuff’!
C: They have to go to the field.
D: People need to have the patience to see different experiences and Theta can play a role to make that happen.
My work at CDC, we have many visitors from the US. The only time they have gone back believing that a program is making a difference is when they have been able to go to the field, and they have been able to interact with patients and people in the community. It doesn’t matter how many PowerPoint presentations you make. Things don’t make sense for people who haven’t lived them. The interaction with people in the field does make a huge difference. It takes a lot of organizing, but people always love to do this. Spend less time doing presentations, let them go out there and see for themselves. It is a very powerful tool.
C: Would it be possible to funnel some of these people from international organizations to Theta where they can get out into the field?
D: Yes, for example, people do visit TASO clinics. What they see is the numbers waiting for treatment, but they don’t have a lot of experience going to people’s homes. It is a different kind of setting. TASO has helped patients to tell their stories.
C: What are you working on now?
D: We are doing some research. I have a team of twelve, we are working with several organizations to provide treatment and care for people with HIV. We are also working to provide counseling and testing to as many people as possible through the existing health structure, but also through community and other innovative approaches. So there are a number of HIV programs we are supporting.
C: Is there the funding so those who are on anti-retroviral drugs (ARVs) can continue indefinitely?
D: This is part of the President Bush initiative. We know the funding is there up to 2008. After George Bush, I don’t know, but there is that bipartisan commitment. There are some issues. They don’t say what you can talk about, but in subtle ways, they let you know this is what you can spend this money on and what you may not spend the money on.
Dr Samuel Kalibala is a Medical Doctor specialized in Sexually Transmitted Disease and HIV Counseling. He is currently employed as the Regional Representative of the International AIDS Vaccine Initiative (IAVI) in East and Southern Africa based in Nairobi, Kenya. In the period January 1998 to July 2003, he was the Team Leader for the Horizons project in the Population Council’s regional office based in Nairobi. Within Horizons, Dr Kalibala focused on VCT, Mother to Child Transmission (MTCT) and Antiretroviral (ARV) intervention studies in Kenya, South Africa, Uganda, Zambia and Zimbabwe. Prior to joining Horizons he had worked with UNAIDS and WHO in Geneva where he provided technical assistance and carried out research on HIV/AIDS Care and Counseling in African, Caribbean, Latin American, Asian and Eastern European countries. Before joining WHO in 1992 he had worked as the Deputy Coordinator of the National STD control program and as a Medical Officer and Counselor Trainer for The AIDS Support Organization (TASO) in Uganda.
Dr. Kihumuro Apuuli, the Uganda AIDS Commission chief, said: “We are not going to manage this epidemic if we are not focusing on where the problem is.” Prevalence could easily rise unless prevention activities are urgently focused on adults.