SOME
RECENT COLLABORATIVE STEPS TO GAIN RECOGNITION FOR TRADITIONAL HEALERS
AND ENHANCE PRIMARY HEALTH CARE IN LOCAL COMMUNITIES IN KWAZULU - NATAL
Ann Hutchings,
Department of Botany, University of Zululand
South Africa
In a paper addressing medical problems relating to traditional medicine observed in babies admitted to hospital, Faku (1996) never the less recommends the integration of traditional healers into allopathic health care and their acceptance as co-workers.. This is indicative of a relatively new approach to traditional medicine which has generally been considered more as a threat to health care than as a resource by the state authorities of South Africa. Insight gained from their experience with traditional healers prompted authors such as Ingle (1973) and Holdstock (1979) to advocate some form of collaboration but steps to gain official recognition for healers were only initiated at the end of the last decade (Freeman and Motsei, 1990). Despite various meetings and presentations since then, progress has been slow with few of the expressed problems being resolved. In 1997 discussions were initiated on a proposed National Centre for Traditional Medicine by the Department of Health. A presentation, applying to medicines and not to the conduct of practices of traditional healers, was made to the Minister of Health and is still under review. The issue of possible integration of traditional healers into the restructured health care system was raised in June 1997. Interested parties were invited to make submissions at public hearings held in all provinces of South Africa. Discussions on a proposed council for traditional healers were then initiated but again, the matter is still under review.
The paper will discuss a submission presented at the public hearing held at Ngwelezane Hospital in Empangeni on the 4th June 1997. The submission was drafted by a group comprising several members of the Inyangas National Association (INA), including members of heir executive committee, and two researchers from the University of Zululand (UZ). Subsequent qualifying procedures introduced by the INA and accepted by an interim steering committee are outlined. Recent attempts by a small group of healers, researchers and hospital workers to address local problems and to enhance Primary Health Care (PHC) through collaboration are also described.
Submissions were asked to address the following questions:
1.How can traditional healers organize themselves into one Provincial structure?
2.How will they administer/control their practice?
3.How will they get trained and acquire certificates?
4.Unfit for work certificates - can they issue these and can they safeguard against abuse?
5.Medical Aid and Health Insurance - can they be allowed access to that funding?
6.What is the impact of traditional medicine on nature conservation?
The following summary of points and recommendations made in the submission includes som brief references to previous collaboration by participants.
Organization into one provincial structure
When the submission was presented, the process of organizing traditional healers into one provincial structure in Kwa Zulu - Natal (KZN) had already been initiated and an interim steering committee was formed with representatives from all associations involved in KZN. This steering committee is responsible for drafting a set of guidelines on ethical matters and safety precautions that will be adhered to by all members.
Administration and Control of practice
Within the INA an executive committee has the power to suspend members for unethical practices. The steering committee will adopt the same procedure.
In 1997 meetings were called by the INA at various tribal courts in KZN to explain the need for healers to belong to a professional organization and also to define and discuss ethics. It was recommended that all associations wanting to be recognized by the Provincial structure follow similar pathways.
It was recommended that communication channels should be established between traditional healers and hospitals. This would facilitate the setting up of mechanisms whereby any harmful practices observed by either hospital or healers with respect to traditional medicine could be communicated to all concerned.
Training and certification
At the time of submission the INA was registering members on receipt of fees but had already implemented training sessions and initiated the holding of practical examinations. Candidates would be examined orally only on their knowledge of traditionally used herbs, the mixing of medicines and treatment of disease. From 1998 certificates would be issued only to members who have passed the examination and membership was to be renewed every year. Local licensed and experienced healers approved by the committee would conduct training courses for these examinations.
It was also recommended that training and workshops in PHC and conditions not previously treated traditionally, including AIDS, diabetes and hypertension, be undertaken through local hospitals and other organizations.
Workshops and meetings on various aspects of PHC have previously been conducted at UZ and a set of training videos has been obtained.
An urgent need for discussions to take place with the Department of Health so that traditional Healers can be utilized in the fields such as Tuberculosis management, AIDS counseling and caring, and mental health care, where existing systems within the state are already overburdened was stressed. Proposals for collaborative work should be made and implemented as soon as possible.
Issuing of unfit for work certificates and protection against abuse
It was recommended that such certificates should be issued, once mechanisms for registering healers are in place. Lists of registered healers would be compiled by local committees and submitted to the Provincial structure. These lists would be made available to interested parties such as employers, hospitals and clinics. Appropriate legislature needs to be drafted after discussion with all role players.
Access to Medical Aid and Health Insurance
It was recommended that access to medical aid and health insurance should be implemented after careful investigations of appropriate procedures and protective measures against abuse. Traditional healers usually employ an outcome-based structure of charges, which differs from those on which most medical aid systems are based.
Conservation of medicinal plants
The severe impact of the trade in medicinal plants on the environment was acknowledged. It was recommended that traditional healers should be involved in collaborative farming and gardening projects, including those being initiated by the parks boards and those aimed at improving cultivation and harvesting procedures.
Some members of the INA have made use of the silverglen training facilities in plant cultivation and have passed the knowledge gained to others in their local communities.
ACIVITIES
Training and examinations
Since the above submission was made, the INA has held further introductory and training workshops and also conducted the first set of qualifying examinations in various parts of KZN. Venues for there procedures have included tribal courts, schools and universities. UZ staff members have videotaped procedures at two introductory meetings, a training session and two examination sessions. Lists of members joining the association at these meetings and of candidates who passed the July examinations have been computerized.
A document issued at an annual general meeting of the INA on 25th October 1997 stated that all associations in KZN had met and agreed that all healers should be examined and obtain accredited documents in order to be legally recognized. At the meeting of the associations, an examination committee of five was elected, with Mr. S.J. Mhlongo, president of the INA, being elected as chairman. It was also decided that presidents of all participating associations would, once they themselves had been examined, assist the committee to facilitate the examination process. Candidates for examination would not, however, have to be affiliated to an association. No discrimination would be made between associations, and examinations for all candidates would be held in the same venue.
Records of results are kept by the chairman of the examination committee and submitted to and kept by the Department of Health to enable them issue certificates of accreditation and licenses. The above processes were selected as a means to:
a.Control traditional healing
b.Ensure a proper selection of authentic healers in the proposed Traditional Healers'Council
c.Differentiate skilled and qualified traditional healers from charlatans.
Primary Health Care - Collaboration with Ngwelezane Hospital
The group researchers and healers who drafted the submission presented at Ngwelezane Hospital have also met with the superintendent of the hospital. He approved a proposal to investigate means of combining services of traditional healers and health care workers from the hospital for the good of the community served by the hospital. Three meetings have since been held at the hospital, with the aims of:
* Establishing suitable referral systems between the hospital and local traditional healers.
* Identifying and finding practical solutions to local health problems where possible.
* Implementing workshops and training sessions in primary health care.
* Investigating the feasibility of establishing some form of healing centres and gardens in local communities and rehabilitation facilities for mentally ill patients.
* Obtaining the sanction of the local tribal authorities in order to facilitate local community participation.
Meetings in Tribal Courts
It was decided that obtaining the sanction of the local tribal authorities really needed to be addressed before any community-based projects could be further investigated.
Preliminary meetings to introduce the project to the Amakjhosi and tribal elders were held at four tribal courts in November 1997 attended by a team of three healers from the INA, the clinical psychologist and the AIDS/HIV co-ordinator from the hospital and two researchers from the UZ departments of Botany and Psychology. The proposals were well received and follow-up meetings were arranged so that more members of the communities' involved and traditional healers could be present. Three follow up meetings have since taken place in which members of the newly formed KwaZulu-Natal Nature Conservation Board and community health care workers have taken part. Attendance has, however, been erratic and influenced by the high incidence of violent crime in the area. Recently, one of the healers who played a pivotal role in the group was murdered. The day before the last meeting another expected participant, the co-ordinator of AIDS/HIV projects in KZN had her car hi-jacked and life threatened - for the third time. Fear obviously inhibits local community attendance and opportunities for holding workshops are likely to be severely limited in the near future. Obviously the project will take time and resourcefulness to implement.
Two grass - root projects
Two grass root projects have been initiated and documented this year. Progress is briefly detailed below.
Case study
A case study involving a severely stunted marasma child being treated for scabies and malnutrition in one of the healer's homes has been initiated. A combined treatment strategy, involving the use of a traditional medicinal plant with known skin healing effects and the introduction of vitamin supplements and a simply and economically prepared paste to deter flies and the spread of infection has been implemented. Regular monitoring with photographs has taken place. The treatment has been visibly successful and healers have indicated a willingness to have other case studies initiated.
Preliminary visits to Psychiatric Ward
A total of five visits to the female psychiatric wards have been made by two of the healers, in the company of the author and the clinical psychologist employed at the hospital. These visits have been informal and free interaction between patients and healers has taken place. Assessments made by healers have been acute and helpful. A patient who was discharged shortly after the project was initiated, is now undergoing treatment and also preliminary training as a healer at the home of one of the healers involved. Her progress is being documented and the beneficial effects of the treatment are already apparent.
It is hoped that through this exploratory investigation better and more appropriate procedures in group therapy and rehabilitation will be developed.
Constraints
The main constraints that have been experienced in our attempts to enhance Primary Health Care and promote the full recognition of traditional healers may be summarized as:
* Poor communication
* Overburdening of existing resources
* Crime
* Apathy
AIMS OF PROJECT
* Establishing suitable referral systems between the hospital and local traditional healers.
* Identifying and finding practical solutions to local health problems where possible.
* Implementing workshops and training sessions in primary health care.
* Investigating the feasibility of establishing some form of healing centres and gardens in local communities and rehabilitation facilities for mentally ill patients.
* Obtaining the sanction of the local tribal authorities in order to facilitate local community participation.
SUGGESTIONS
* Consulting space provided for traditional healers in hospitals and clinics, with staff being made available for cross consultation and opportunities for meetings facilitated.
* Some funding and expertise be made available for the establishment of small healing centres and gardens, for which the local tribal authorities and communities would be responsible. These would function as venues for health education and meetings of healers.
* A communications network for all such projects be established within a recognizable society. This could take the form of a newsletter.
* A forum for the lobbying of provincial and state authorities should be established. These would be directed at drafting and implementing appropriate and necessary legislation.
The poor communication experienced relates to the lack of adequate services such as telephones and transport and also prejudices evolving from our no-so-distant past. Legal statutes that effectively "outlawed" or limited traditional practice also severely limited communication. It is still apparent that allopathic practitioners do not always recognize traditional healing as a profession with a recognizable code of ethics, and that traditional healers do not always trust the allopathic medical profession. Misconceptions revealed in our recent activities include beliefs that the Ancestors are an evil force that should be done away with and that nurses are administering poisonous medicines. Fortunately, it has been possible to begin to address and resolve these misunderstandings.
The very high prevalence of AIDS, drug resistant TB, malnutrition and psychosocial disorders in KwaZulu-Natal has led to an overburdening of hospital resources. State cuts in university budgets have severely limited funding available for research, as precedence has to be given to teaching. This is often reflected in regulations set for grant applications by outside organizations. Funding is also usually granted for very limited periods and this makes for problems in community projects that take time to become viable. Most of our limited resources are spent on transport of ourselves and healers to meetings and the hospital, and insufficient resources for employing necessary helpers and liaison workers are available.
Violent crime is a serious problem as already indicated. The situation is so bad that the hospital has to face the prospect of closing down some of its services. Three ambulances have been hijacked in the last six months and health educators and community workers cannot be sent to some of the areas where they are most needed.
The above factors all have general demoralizing effects leading to apathy within the institutions involved and among local communities. This is perceptible not only in poor attendance at meetings, but also at management levels and in the high level of institutional theft at both the university and the hospital. Misuse of items such as transport and telephones and theft of computers seriously jeopardizes community health and education projects.
Lack of a suitable framework for the incorporation of traditional healers into hospital and community health procedures from the provincial structure impedes progress and results in uncertainty in the nursing hierarchy. Documentation on the first examination results have been submitted but the promised licenses have still not been issued. Although the central government has committed itself to a policy of providing more accessible and affordable health care, issues relating to traditional healing are unlikely to be addressed before the next election.
Conclusion
Events such as this workshop provide an all too rare opportunity to communicate. If we are going to have an official health policy that truly reflects the actual needs - and the resources - of the community, obviously there is a need for much greater channels of communication. I suggest that:
* Consulting space be provided for traditional healers in hospitals and clinics, with staff being made available for cross consultation and opportunities for meetings facilitated.
* Some funding and expertise be made available for the establishment of small healing centres and gardens, for which the local tribal authorities and communities would be responsible. These would function as venues for health education and meetings of healers.
* A communications network for all such projects be established within a recognized society. This could take the form of a newsletter.
* A forum for the lobbying of provincial and state authorities should be established. These would be directed at drafting and implementing appropriate and necessary legislation.
Most of the activities reported in this paper have been undertaken by a very small but dedicated group of people. Much depends on the inspiration of individuals involved. A strong motivator for this group was Mr. Fanenkhosi Mthethwa, the healer who was murdered. It was his dream that traditional healers should become community health leaders and educators. When we started to work in the hospital, he expressed the view that this was like a dream coming true. With persistence, I believe, we can still achieve our aims. I end this paper by paying tribute to him and acknowledging the contribution his vision and participation made to the project.
REFERENCES
Faku, O. 1996. A Perspective of Traditional Medicines. pedmed9,12
Freeman, M. And Motsei, M., 1990. Is there a Role for Traditional Healers in Health Care in South Africa. The Centre for the Study of Health Policy, paper 20, Department of Community Health, University of the Witwatersrand, Johannesburg.
Ingle, R.F. 1973. An Experience of Amaquira. South African Medical Journal 47, 333 - 334
Holdstock, T.L. 1979. Indigenous Healing in South Africa: a neglected potential. South African Journal of Psychology 9, 118 - 124
Ann Hutchings,
Department of Botany, University of Zululand
South Africa
In a paper addressing medical problems relating to traditional medicine observed in babies admitted to hospital, Faku (1996) never the less recommends the integration of traditional healers into allopathic health care and their acceptance as co-workers.. This is indicative of a relatively new approach to traditional medicine which has generally been considered more as a threat to health care than as a resource by the state authorities of South Africa. Insight gained from their experience with traditional healers prompted authors such as Ingle (1973) and Holdstock (1979) to advocate some form of collaboration but steps to gain official recognition for healers were only initiated at the end of the last decade (Freeman and Motsei, 1990). Despite various meetings and presentations since then, progress has been slow with few of the expressed problems being resolved. In 1997 discussions were initiated on a proposed National Centre for Traditional Medicine by the Department of Health. A presentation, applying to medicines and not to the conduct of practices of traditional healers, was made to the Minister of Health and is still under review. The issue of possible integration of traditional healers into the restructured health care system was raised in June 1997. Interested parties were invited to make submissions at public hearings held in all provinces of South Africa. Discussions on a proposed council for traditional healers were then initiated but again, the matter is still under review.
The paper will discuss a submission presented at the public hearing held at Ngwelezane Hospital in Empangeni on the 4th June 1997. The submission was drafted by a group comprising several members of the Inyangas National Association (INA), including members of heir executive committee, and two researchers from the University of Zululand (UZ). Subsequent qualifying procedures introduced by the INA and accepted by an interim steering committee are outlined. Recent attempts by a small group of healers, researchers and hospital workers to address local problems and to enhance Primary Health Care (PHC) through collaboration are also described.
Submissions were asked to address the following questions:
1.How can traditional healers organize themselves into one Provincial structure?
2.How will they administer/control their practice?
3.How will they get trained and acquire certificates?
4.Unfit for work certificates - can they issue these and can they safeguard against abuse?
5.Medical Aid and Health Insurance - can they be allowed access to that funding?
6.What is the impact of traditional medicine on nature conservation?
The following summary of points and recommendations made in the submission includes som brief references to previous collaboration by participants.
Organization into one provincial structure
When the submission was presented, the process of organizing traditional healers into one provincial structure in Kwa Zulu - Natal (KZN) had already been initiated and an interim steering committee was formed with representatives from all associations involved in KZN. This steering committee is responsible for drafting a set of guidelines on ethical matters and safety precautions that will be adhered to by all members.
Administration and Control of practice
Within the INA an executive committee has the power to suspend members for unethical practices. The steering committee will adopt the same procedure.
In 1997 meetings were called by the INA at various tribal courts in KZN to explain the need for healers to belong to a professional organization and also to define and discuss ethics. It was recommended that all associations wanting to be recognized by the Provincial structure follow similar pathways.
It was recommended that communication channels should be established between traditional healers and hospitals. This would facilitate the setting up of mechanisms whereby any harmful practices observed by either hospital or healers with respect to traditional medicine could be communicated to all concerned.
Training and certification
At the time of submission the INA was registering members on receipt of fees but had already implemented training sessions and initiated the holding of practical examinations. Candidates would be examined orally only on their knowledge of traditionally used herbs, the mixing of medicines and treatment of disease. From 1998 certificates would be issued only to members who have passed the examination and membership was to be renewed every year. Local licensed and experienced healers approved by the committee would conduct training courses for these examinations.
It was also recommended that training and workshops in PHC and conditions not previously treated traditionally, including AIDS, diabetes and hypertension, be undertaken through local hospitals and other organizations.
Workshops and meetings on various aspects of PHC have previously been conducted at UZ and a set of training videos has been obtained.
An urgent need for discussions to take place with the Department of Health so that traditional Healers can be utilized in the fields such as Tuberculosis management, AIDS counseling and caring, and mental health care, where existing systems within the state are already overburdened was stressed. Proposals for collaborative work should be made and implemented as soon as possible.
Issuing of unfit for work certificates and protection against abuse
It was recommended that such certificates should be issued, once mechanisms for registering healers are in place. Lists of registered healers would be compiled by local committees and submitted to the Provincial structure. These lists would be made available to interested parties such as employers, hospitals and clinics. Appropriate legislature needs to be drafted after discussion with all role players.
Access to Medical Aid and Health Insurance
It was recommended that access to medical aid and health insurance should be implemented after careful investigations of appropriate procedures and protective measures against abuse. Traditional healers usually employ an outcome-based structure of charges, which differs from those on which most medical aid systems are based.
Conservation of medicinal plants
The severe impact of the trade in medicinal plants on the environment was acknowledged. It was recommended that traditional healers should be involved in collaborative farming and gardening projects, including those being initiated by the parks boards and those aimed at improving cultivation and harvesting procedures.
Some members of the INA have made use of the silverglen training facilities in plant cultivation and have passed the knowledge gained to others in their local communities.
ACIVITIES
Training and examinations
Since the above submission was made, the INA has held further introductory and training workshops and also conducted the first set of qualifying examinations in various parts of KZN. Venues for there procedures have included tribal courts, schools and universities. UZ staff members have videotaped procedures at two introductory meetings, a training session and two examination sessions. Lists of members joining the association at these meetings and of candidates who passed the July examinations have been computerized.
A document issued at an annual general meeting of the INA on 25th October 1997 stated that all associations in KZN had met and agreed that all healers should be examined and obtain accredited documents in order to be legally recognized. At the meeting of the associations, an examination committee of five was elected, with Mr. S.J. Mhlongo, president of the INA, being elected as chairman. It was also decided that presidents of all participating associations would, once they themselves had been examined, assist the committee to facilitate the examination process. Candidates for examination would not, however, have to be affiliated to an association. No discrimination would be made between associations, and examinations for all candidates would be held in the same venue.
Records of results are kept by the chairman of the examination committee and submitted to and kept by the Department of Health to enable them issue certificates of accreditation and licenses. The above processes were selected as a means to:
a.Control traditional healing
b.Ensure a proper selection of authentic healers in the proposed Traditional Healers'Council
c.Differentiate skilled and qualified traditional healers from charlatans.
Primary Health Care - Collaboration with Ngwelezane Hospital
The group researchers and healers who drafted the submission presented at Ngwelezane Hospital have also met with the superintendent of the hospital. He approved a proposal to investigate means of combining services of traditional healers and health care workers from the hospital for the good of the community served by the hospital. Three meetings have since been held at the hospital, with the aims of:
* Establishing suitable referral systems between the hospital and local traditional healers.
* Identifying and finding practical solutions to local health problems where possible.
* Implementing workshops and training sessions in primary health care.
* Investigating the feasibility of establishing some form of healing centres and gardens in local communities and rehabilitation facilities for mentally ill patients.
* Obtaining the sanction of the local tribal authorities in order to facilitate local community participation.
Meetings in Tribal Courts
It was decided that obtaining the sanction of the local tribal authorities really needed to be addressed before any community-based projects could be further investigated.
Preliminary meetings to introduce the project to the Amakjhosi and tribal elders were held at four tribal courts in November 1997 attended by a team of three healers from the INA, the clinical psychologist and the AIDS/HIV co-ordinator from the hospital and two researchers from the UZ departments of Botany and Psychology. The proposals were well received and follow-up meetings were arranged so that more members of the communities' involved and traditional healers could be present. Three follow up meetings have since taken place in which members of the newly formed KwaZulu-Natal Nature Conservation Board and community health care workers have taken part. Attendance has, however, been erratic and influenced by the high incidence of violent crime in the area. Recently, one of the healers who played a pivotal role in the group was murdered. The day before the last meeting another expected participant, the co-ordinator of AIDS/HIV projects in KZN had her car hi-jacked and life threatened - for the third time. Fear obviously inhibits local community attendance and opportunities for holding workshops are likely to be severely limited in the near future. Obviously the project will take time and resourcefulness to implement.
Two grass - root projects
Two grass root projects have been initiated and documented this year. Progress is briefly detailed below.
Case study
A case study involving a severely stunted marasma child being treated for scabies and malnutrition in one of the healer's homes has been initiated. A combined treatment strategy, involving the use of a traditional medicinal plant with known skin healing effects and the introduction of vitamin supplements and a simply and economically prepared paste to deter flies and the spread of infection has been implemented. Regular monitoring with photographs has taken place. The treatment has been visibly successful and healers have indicated a willingness to have other case studies initiated.
Preliminary visits to Psychiatric Ward
A total of five visits to the female psychiatric wards have been made by two of the healers, in the company of the author and the clinical psychologist employed at the hospital. These visits have been informal and free interaction between patients and healers has taken place. Assessments made by healers have been acute and helpful. A patient who was discharged shortly after the project was initiated, is now undergoing treatment and also preliminary training as a healer at the home of one of the healers involved. Her progress is being documented and the beneficial effects of the treatment are already apparent.
It is hoped that through this exploratory investigation better and more appropriate procedures in group therapy and rehabilitation will be developed.
Constraints
The main constraints that have been experienced in our attempts to enhance Primary Health Care and promote the full recognition of traditional healers may be summarized as:
* Poor communication
* Overburdening of existing resources
* Crime
* Apathy
AIMS OF PROJECT
* Establishing suitable referral systems between the hospital and local traditional healers.
* Identifying and finding practical solutions to local health problems where possible.
* Implementing workshops and training sessions in primary health care.
* Investigating the feasibility of establishing some form of healing centres and gardens in local communities and rehabilitation facilities for mentally ill patients.
* Obtaining the sanction of the local tribal authorities in order to facilitate local community participation.
SUGGESTIONS
* Consulting space provided for traditional healers in hospitals and clinics, with staff being made available for cross consultation and opportunities for meetings facilitated.
* Some funding and expertise be made available for the establishment of small healing centres and gardens, for which the local tribal authorities and communities would be responsible. These would function as venues for health education and meetings of healers.
* A communications network for all such projects be established within a recognizable society. This could take the form of a newsletter.
* A forum for the lobbying of provincial and state authorities should be established. These would be directed at drafting and implementing appropriate and necessary legislation.
The poor communication experienced relates to the lack of adequate services such as telephones and transport and also prejudices evolving from our no-so-distant past. Legal statutes that effectively "outlawed" or limited traditional practice also severely limited communication. It is still apparent that allopathic practitioners do not always recognize traditional healing as a profession with a recognizable code of ethics, and that traditional healers do not always trust the allopathic medical profession. Misconceptions revealed in our recent activities include beliefs that the Ancestors are an evil force that should be done away with and that nurses are administering poisonous medicines. Fortunately, it has been possible to begin to address and resolve these misunderstandings.
The very high prevalence of AIDS, drug resistant TB, malnutrition and psychosocial disorders in KwaZulu-Natal has led to an overburdening of hospital resources. State cuts in university budgets have severely limited funding available for research, as precedence has to be given to teaching. This is often reflected in regulations set for grant applications by outside organizations. Funding is also usually granted for very limited periods and this makes for problems in community projects that take time to become viable. Most of our limited resources are spent on transport of ourselves and healers to meetings and the hospital, and insufficient resources for employing necessary helpers and liaison workers are available.
Violent crime is a serious problem as already indicated. The situation is so bad that the hospital has to face the prospect of closing down some of its services. Three ambulances have been hijacked in the last six months and health educators and community workers cannot be sent to some of the areas where they are most needed.
The above factors all have general demoralizing effects leading to apathy within the institutions involved and among local communities. This is perceptible not only in poor attendance at meetings, but also at management levels and in the high level of institutional theft at both the university and the hospital. Misuse of items such as transport and telephones and theft of computers seriously jeopardizes community health and education projects.
Lack of a suitable framework for the incorporation of traditional healers into hospital and community health procedures from the provincial structure impedes progress and results in uncertainty in the nursing hierarchy. Documentation on the first examination results have been submitted but the promised licenses have still not been issued. Although the central government has committed itself to a policy of providing more accessible and affordable health care, issues relating to traditional healing are unlikely to be addressed before the next election.
Conclusion
Events such as this workshop provide an all too rare opportunity to communicate. If we are going to have an official health policy that truly reflects the actual needs - and the resources - of the community, obviously there is a need for much greater channels of communication. I suggest that:
* Consulting space be provided for traditional healers in hospitals and clinics, with staff being made available for cross consultation and opportunities for meetings facilitated.
* Some funding and expertise be made available for the establishment of small healing centres and gardens, for which the local tribal authorities and communities would be responsible. These would function as venues for health education and meetings of healers.
* A communications network for all such projects be established within a recognized society. This could take the form of a newsletter.
* A forum for the lobbying of provincial and state authorities should be established. These would be directed at drafting and implementing appropriate and necessary legislation.
Most of the activities reported in this paper have been undertaken by a very small but dedicated group of people. Much depends on the inspiration of individuals involved. A strong motivator for this group was Mr. Fanenkhosi Mthethwa, the healer who was murdered. It was his dream that traditional healers should become community health leaders and educators. When we started to work in the hospital, he expressed the view that this was like a dream coming true. With persistence, I believe, we can still achieve our aims. I end this paper by paying tribute to him and acknowledging the contribution his vision and participation made to the project.
REFERENCES
Faku, O. 1996. A Perspective of Traditional Medicines. pedmed9,12
Freeman, M. And Motsei, M., 1990. Is there a Role for Traditional Healers in Health Care in South Africa. The Centre for the Study of Health Policy, paper 20, Department of Community Health, University of the Witwatersrand, Johannesburg.
Ingle, R.F. 1973. An Experience of Amaquira. South African Medical Journal 47, 333 - 334
Holdstock, T.L. 1979. Indigenous Healing in South Africa: a neglected potential. South African Journal of Psychology 9, 118 - 124
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