20 World Health • 50th Year, No. 2, Morch-Aprill997
Africa: in search of solutions
Karen L. Ebey· Tessendorf & Peter W. Cunningham
The African solution to the problem of providing primary health care for a lilies in a fusion of modern and traditional health care.
Evidence of this fusion in South Africa and elsewhere is the existence of many African professional nurses who are also traditional healers.
T
he health systems of many African nations are in a state of . crisis. Preventive and curative services are severely under-resourced, and there are wide dispari- ties between urban and rural areas.
In sub-Saharan Africa, where one child in 10 will die before its first birthday, one area where more re- sources are desperately needed is reproductive health. Even basic services like antenatal care for preg- nant women are practically non- existent in many areas. What can be done to save Africa's children?
Sub-Saharan African countries must look for innovative ways of solving this health care crisis, and this means searching for an African solution. Increasing evidence shows that reliance on scientific medicine will not solve all the problems. The region must evaluate what health resources are available, including modern medical practitioners (pri- marily doctors and nurses) and com- plementary or alternative medical practitioners (traditional healers, chiropractors, homoeopaths and so on). In a continent ravaged by con- flict, drought, and economic and political instability, all resources
A village midwife examines a pregnant woman in Ghana. Photo Still Pictures/M Edwards ©.
must be used to the maximum to give Africa's children, born and unborn, a chance to live beyond their first birthday.
In 1977, WHO called on its Member States to use their tradi- tional systems of medicine. After the 1978 Alma-Ata Conference on Primary Health Care, WHO recom- mended that governments use tradi- tional healers and traditional birth attendants as part of the strategy for providing primary health care for all.
Many sub-Saharan African countries have made attempts to integrate traditional medicine into their health systems. One of the major difficul- ties in doing this is that the modern
and traditional medical practitioners look at health in very different ways.
Traditional medicine in Africa relies on knowledge handed down from ancestors (dead or alive) and defines health in psychosocial terms.
Modern medicine, on the other hand, defines health in physiological, scientific terms. The African solu- tion lies in a fusion of modern and traditional health care.
A dual role
Evidence of this fusion in South Africa and elsewhere is the existence of many African professional nurses
World Health • 50th Year, No. 2, Morch-Aprill997
who are also traditional healers. In post-apartheid South Africa, there is an open debate about the future role of traditional healers in the national health care system. African profes- sional nurses who are also traditional healers are becoming more vocal about their dual role. Their numbers are considerable-it is estimated that almost 1% of African nurses also practise as traditional healers.
These women usually, though not always, train to be nurses first. Later in their careers they are "called by the ancestors" to become traditional healers. They undergo a lengthy period of training under the guidance of an experienced traditional healer before they qualify as traditional healers. These nurses/traditional healers are in the unique position of understanding both modern medicine and traditional medicine. They work in hospitals or clinics as professional nurses and they practise as traditional healers out of their homes.
Many of these women are in- volved in the antenatal care of preg- nant women as traditional healers, but their role is limited since they are not recognized by medical practition- ers. They report that it is not uncom- mon for them to treat women who are having problems with pregnancy.
They diagnose through "fortuning"
and by physically examining the patient, and they treat the aches and pains of pregnancy by giving herbal medicines or by massaging the preg- nant woman. They treat women not only physically but also socially and psychologically. For example, one nurse/traditional healer said she was treating a woman who was pregnant with her third child but was not happy about having another baby.
The healer prays with her and mas- sages her for the pains that she has been having; at the same time the healer also takes the woman's psy- chological and emotional conditions into account in the treatment.
These combined healers make use of their clinical nursing training. If they see that a woman has a problem that requires medical attention, for instance, they refer her to a clinic or hospital. In this way, they are able to serve as the first point of contact of
the health care system with the preg- nant woman. They care for their patients until delivery, but they also make sure that the women attend the antenatal clinic.
One such healer reports that her ancestors' spirits help her to diag- nose pregnancy. She says that she can sense when a woman is pregnant.
She states that she has diagnosed the pregnancies of some of her fellow nurses at work even before they themselves suspected that they were pregnant. Later their pregnancies were confirmed by standard tests.
Key resources
These women are key resources for underserved areas of sub-Saharan Africa because they act as a bridge beween modern health care and traditional medicine. Unfortunately, their potential role as a bridge is not always recognized by modern medi- cine. While they are functioning as nurses in hospitals or clinics, they may be hesitant to admit to others that they are also traditional healers because many doctors and nurses have negative views of this. The healers say they are afraid that they will be seen as "backyard doctors" or
A midwife displays her equipment in Burkina Faso.
Photo Still Pictures/M. Edwards ©.
21
"witch doctors". While in hospital, they stay within their role of profes-
sional nurse. However, they admit
to feeling frustrated when they encounter a patient in hospital who they feel could be better taken care of by a traditional healer.
While functioning as traditional healers, the fact that they are also nurses gives them increased status with their clients. Their nursing training makes them aware of the need to ensure sterile techniques and good hygiene. They often refer patients to clinics, hospitals or pri- vate physicians if they feel that they cannot adequately treat the patient themselves.
Nurses who are also traditional healers are a key resource- but an underutilized resource. The future of Africa ultimately depends on how well it can protect the health of its children. All resources, including nurse/traditional healers, must be used to the maximum if all of Africa's children are to reap the benefits of progress in new approaches to antenatal care. •
M.s Karen L. Ebey-Tessendarf and Professor Peter W. Cunningham are in the Department of Sociology, University of Port Elizabeth, P 0. Box 1600, Port Elizabeth 6000, Republic of South Africa.
