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 Professor John Rwomushana, MD, Uganda AIDS Commission |
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Prof. Rwomushana: There are really three aspects to the special interest and link between the Ugandan AIDS commission and the traditional healer community. First, the commission was established to bring on board all types and groups of the population that could contribute to the prevention and control of HIVAIDS. Secondly, because HIV/AIDS was new then, and still is new, there were aspects that were not very well understood by classical medicine and classical public health sector. We were looking for answers, for strategies that would help, at least in the immediate present, and hopefully in the future. Thirdly, the traditional healers were community people. They are from before until now, and will continue to be because it is where they come from, and it is where they work. We were not reaching the local communities through the traditional strategies, and yet it was the local communities that needed support. Maybe they had answers, given that at least AIDS prevention depended upon awareness and knowledge. In addition, traditional healers are able to give special care, sometimes without modern medical support. So I think these three reasons helped us to work through the approach at the Ugandan AIDS Commission, which is the coordinating body for HIVAIDS, in order to support traditional healers and promote traditional medicine.
Of course, these efforts take people with a special interest, and it so happens I was the medical person at the AIDS commission, I helped to start the AIDS Commission, to conceptualize it, to try to establish, build and develop it as a coordinating agency. It so happened that I was very interested in traditional medicine anyway. It was an opportunity to bring on board the non-classical healthcare and prevention sector, and take advantage of these people who are based in the communities. My interest was not purely medical, it was because I thought there was power in traditional medicine: spiritual power, social power, and the power of herbal medicine. In fact, more so the power of herbal medicine, as not much had come from biomedical sources in alleviating secondary infections and HIV/AIDS. We now know that that some of the viral infections, because of a reduced immunity, are taken care of very well by traditional herbs.
So, from a personal point of view, I happen to be very interested in traditional medicine. I had worked in the local communities in this country and in a few other countries. My training in medicine had been broad, compared to the usual modern medical training, having gone to school in Israel where branches of the human race were coming together at that time with many diverse cultural backgrounds. And then, of course, classical Jewish background is very communal, very traditional. I had spent time in India before I went to medical school, and I think this influenced my understanding and approach to social issues from the spiritual aspect and even from the philosophical aspect. I also happened to be interested in anthropology, but in a superficial way. I think this combination of the role of the AIDS commission, my work as a founding member and maybe health coordinator of this institution, and my interest in traditional medicine combined to highlight traditional medicine as a strategy for HIV/AIDS prevention, care and social awareness in this country as a novel and very dynamic subject. I think that is how it all came altogether.
Now, the AIDS Commission, itself, was the idea of the President of this country. His idea was to bring together everybody, not only the public health workers, to address HIVAIDS. He wanted to include representatives from the local rural communities to address the effects of HIV socially, economically, and culturally and from a health perspective. Therefore, for us working for the president and understanding what he wanted, we could not leave out traditional medicine. While not everyone was particularly interested, I think they were obliged to come on board and support and promote traditional medicine. As the work and function of the AIDS Commission moved on, we were able to devolve these responsibilities to people who were interested and were implementers. In particular, I am referring to the work of Theta. Theta stands for Traditional Healers and Modern Health Practitioners against AIDS. So many very interesting, focused, and able people took over Theta and helped, from the civil society point of view, to assist traditional healers and their work. The Ministry of Health has always wanted to embrace traditional medicine in this country. The approaches, the mindset, the training, the understanding, up to that time, were not sufficient to allow the Ministry to take traditional healers and traditional medicine on board. The best they could have done before AIDS was to integrate traditional medicine with modern medicine, which is not practical. But with understanding from other cultures where traditional healing is taken seriously and has been advanced - for example Japan and India - traditional medicine has been developed along side modern medicine. The two can clearly collaborate; we now understand you cannot completely integrate them because they are different. So, we were able to develop Theta as part of an interactive strand of AIDS care and prevention. That is how Theta grew, supporting and working with and being supported by the government Theta brought in the social, community and cultural aspects of traditional medicine. That is where we are now, and our people collaborate with other organizations in Africa and the international community. I have seen Uganda catch up with, and maybe overtake, other groups with respect to HIVAIDS, and this is largely because of the open and candid attitude in this country towards HIVAIDS. It is inclusive of anybody that can contribute.
Dr. Dorothy Balaba, MD, Executive Director of Theta
Dr. Dorothy Balaba: Professor, you told us how Theta was started, how the Ugandan AIDS Commission was interested in traditional medicine from the beginning, and how Theta took on this work. It is now about fourteen years later. Do you feel Theta has made a contribution?
D: There has been a lot of contribution by Theta in the battle against HIV/AIDS. Effectively, Theta works on behalf of the AIDS Commission in so far as it coordinates traditional healers, advocates for traditional medicine, and it helps us to mobilize both traditional medicine and traditional healers socially. Certainly, Theta has contributed from the implementation point of view and has helped traditional healers to contribute to the fight against HIV/AIDS. They have worked with traditional healers to improve treatment, to understand better the needs and resources available for patient care, and to modernize, to some extent, their approaches. Theta has guided traditional healers in social research, operational research, and even basic social research on the effectiveness of some of the herbs, and this has been successful.
I have my own quarrel with Theta. I wish they could be much bigger. I wish they could do much more for this country. I do not see another institution in this country - private or public - that can continue to help us any better than Theta in fighting HIV/AIDS. That is my only quarrel with Theta; otherwise, I think they have done very well.
They could collaborate more closely with the AIDS Commission as we now continue to decentralize the roles, functions, and tasks of coordination by giving them to constituencies such as the government sector, the private sector, the youth effort, the faith based organizations, and so on. We have helped to align and support these constituencies so they can do some of the tasks that we cannot do at the level of centralized government. If Theta can work more closely with this national partnership, I can achieve my dream of Theta being a bigger, more confident, leader with greater scope and coverage. This would assist the public health sector lead by Ministry of Health, and the Ministry of Education, as well, that leads in health and prevention.
Dorothy, can you respond to that challenge, taking on a larger role and being more involved? Can you imagine that?
Dr. Balaba: Yes, the professor’s quarrel with Theta is actually a reality. The communities are seeing Theta as taking more of a leadership role, especially evolving and building this partnership between the traditional medical system and the biomedical health workers. We are getting loads and loads of demands, both nationally and internationally. People want us to expand beyond Uganda. This is something we are considering, although expansion is something you should take with a lot of caution. We are looking at our capacity. How do we maintain the quality of our work? When you bring two systems together, it involves attitudinal changes, it involves changing mindsets, and this is something that takes quite some time. The work that Theta does is quite intensive; if you look at expansion and yet maintaining the quality of work, it is a big challenge. We have come up with different strategies as we look at how we train trainers. At the national level, we now have many trained traditional healers, trained health workers, and trained community persons, who can train other traditional healers, health workers, and community persons to believe in this philosophy. At the same time at the regional level, we started courses through the regional AIDS training network where we are training program implementers and traditional medicine and health leaders, and empowering them to initiate programs with traditional healers. We believe we will get there.
Prof: We still need to formalize this process of explaining the potentialities and possibilities of traditional medicine. There has been an effort to develop a statute for guiding and supporting traditional medicine in this country; I don’t know how far it has gone. These are some of the things I would like to see Theta take a lead in, but they take their time, you need to formalize these efforts.
Dr. Balaba: We need to formalize them.
Caitlin: Can you give an example of how you might go about formalizing them?
Dr. Balaba: We are trying to develop a policy for the regulation of traditional medicine. It is the mandate of the Ministry of Health to do this, and we support them. We have done a study on the role of traditional medicine in health care, and we do much advocating bringing to the attention of the stakeholders in policy making the need to speed up this policy. Theta is doing a lot of informing; we realize there is a significant lack of knowledge among the main stakeholders, the policy makers. There is a knowledge gap, and this has stalled the process of making the policy. We want to increase our efforts in lobbying to be sure that the right information gets to the right stakeholders at the right time so that the process is speeded up.
Prof: So I think Dorothy has answered the question regarding strategies to ensure that these efforts to formalize the policy and program guidelines for regulation and support of traditional medicine are implemented.
The Ministry of Health leads this sector, but the sector has both a public and a private domain, and both are equally important in the eyes of our governance. This policy will not be just a document, but the process of developing policy guidelines in a new area. I think that the implementing of this policy would require contact between the different levels, and the different actors would take the relevant components of the guidelines into their own areas of work.