PALLIATIVE CARE AND TRADITIONAL HEALERS ZODWA SITHOLE

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Amberly Hill
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1 PALLIATIVE CARE AND TRADITIONAL HEALERS ZODWA SITHOLE

2 ADVOCATING FOR THE INTEGRATION OF PALLIATIVE CARE IN THE CARING OF PATIENTS WITH LIFE THREATENING ILLNESS BY TRADITIONAL HEALERS

3 WHAT IS TRADITIONAL MEDICINE? (TM) It is a body of knowledge that has been developed over thousands of years which is associated with: Examination Diagnosis Therapy Treatment Prevention Promotion Rehabilitation of the physical, mental, spiritual or social wellbeing of humans and animals. ( SA DOH Draft Policy on African Traditional Medicine)

4 INTRODUCTION The WHO classifies the Traditional Health Practitioner (THP) as someone who is recognised by the community as competent to provide health care by using vegetable, animal, and mineral substances and certain other methods based on the social, cultural, and religious background In Africa up to 80% of the population uses TM Approx. 27 million SA depend on TM (Mander, 1998) The TM is accessible and affordable The majority of people living with HIV have consulted both biomedical doctors and THPs

5 INTRODUCTION CONT. Communities prefer THPs because: Long distances to health facilities Long queues Waiting periods to see doctors Fear of surgical procedures Maintain privacy (THPs do not usually keep records) and the belief in an African explanation of illnesses.

6 INTRODUCTION CONT. THPs are not officially recognised by government They operate outside formal health structures Exclusion of THPs from the formal health structures can have serious consequences: 1. Patients may disregard their doctor s advice 2. Take herbal medicines that could have dangerous interactions with modern medical preparations 3. Parents who shuttle between TPHs and modern health facilities may delay diagnosis and treatment 4. Children are also at risk since they rely on their parents to take decisions

7 REASONS FOR VISITING THPs STIs, psychotic diseases, cancer, against witchcraft, prophecies of future events and annual check ups Mothers usually consult different healing resources at the same time starting with THPs and then modern care Children are often sent to THPs with acute diarrhoea, chronic skin rashes, fever, convulsions, loss of appetite and weight loss

9 DIFFERENT CATEGORIES OF THPs IN SOUTH AFRICA

10 THE DIVINERS: ARE PREDOMINANTLY FEMALE AND USE THE GUIDANCE OF ANCESTRAL SPIRITS THROUGH DIVINATION TO DIAGNOSE AN ILLNESS

11 THE HERBALIST: IS USUALLY A MALE WHO HAS KNOWLEDGE OF CURATIVE HERBS AND MEDICINES MADE FROM ANIMAL EXTRACTS

12 FAITH HEALERS: USUALLY BELONG TO ONE OF THE INDEPENDENT CHRISTIAN CHURCHES AND USES THE POWER OF PRAYER AND THE LAYING ON OF HANDS AS WAYS OF HEALING

13 WHAT IS THE DEPARTMENT OF HEALTH (DOH) DOING? Traditional Health Practitioners Act (Act No. 22, 2007) that led to the establishment of a Traditional Health Practitioners Council. The council will be responsible for ensuring the safety of TM and services, and also serve as a regulating body for THPs The DOH has drafted a policy on African TM for South Africa.

14 THE NEED FOR PALLIATIVE CARE IN SOUTH AFRICA In April 2011, the WHO reported on the estimated total deaths by cause for each member state from 2008 statistics SA estimated 667,900 deaths from all causes: There were an estimated 415,000 deaths for predictable causes including HIV 263,000 NCDs 83,700 Cancer 48,800 TB 19,500 So what was the dying experience like for approximately 400,000 South Africans?

15 DID PALLIATIVE CARE REACH THESE PATIENTS? If we match the number of patients who died in hospice against the total deaths in the country for TB, HIV & Cancer, we find that only 10,912 patients died in hospice care in 2008

16 PALLIATIVE CARE TRAINING FOR TRADITIONAL HEALTH PRACTITIONERS

17 PALLIATIVE CARE TRAINING FOR THPs In 2009 meetings were held between Palliative Care practitioners and THPs to establish a relationship The senior THPs and palliative care trained/ experienced staff, who are also THPs outside of their job, attended the meeting to assist in drawing up the curriculum

18 PALLIATIVE CARE TRAINING FOR THPs CONT.. THPs shared their understanding on Palliative Care Palliative care team shared their understanding of traditional HP Both teams discussed what can Traditional Healing teach Palliative Care and what can Palliative Care teach Traditional Healing.

19 DEVELOPMENT OF TRAINING CURRICULUMS A task team consisting of practitioners from both sectors was set up to develop training curriculums. The first curriculum aims to train THPs The second curriculum aims to sensitive Palliative Care practitioners to the views and practices of Traditional Healers.

20 OBJECTIVES OF THE COURSE Knowledge Skills Attitudes Understand the Identify patients that need key concepts of palliative care. palliative care within the African context. Understand when and where to refer patients for palliative care Have an understanding of common lifethreatening illnesses Communicate effectively with terminally ill patients and their families. Provide appropriate physical care for patients, including those who may be bed bound. Communicate effectively with other health workers involved in care. Sensitize the community about palliative care. Collaborate with biomedical health workers. Be willing to share knowledge with biomedical health workers to enable them to provide culturally sensitive care. Implement hygiene and infection control and teach patients, families and other traditional healers about these, particularly with regard to HIV/AIDS & TB.

21 DESIGN OF THE COURSE The course has been designed to include 2 face-to-face teaching modules with a gap of a month between each to practice what has been learnt. The training outline is as follows: Day 1 What is Palliative Care Day 2 Growing skills around physical care needs Day 3 Whole person care and Mastering referrals 1 month gap to practice Day 4 Addressing challenges Day 5 Pulling it all together

22 PROGRESS A Palliative Care Training Manual has been developed UNISA has agreed to assist in translating the manual into all the African languages at no cost The course have been translated into isizulu, Tshivenda, SiSwati and Sesotho 18 THPs have been trained ( KZB) A total of 11 Traditional Healers have been trained to use this SMS system to communicate with hospices when they need information Train the trainer training was conducted, to run the Palliative Care training course in other provinces. The National DOH (Directorate Traditional Medicine) has supported this goal and the training has been rolled out to the following provinces: Limpopo: 23 Soweto: 24

26 SMS COMPAIGN Communication with the THPs and provision of mentorship has been a problem. With the help of Fellows from Parsons the New School for Design, the Healers have been trained in using an SMS text messaging system that will enable them to ask questions of the experts and receive brief replies The system will also allow periodic delivery of fresh training content, tips and reminders to the traditional healers. This system has been tested with Msunduzi Hospice.

27 SMS COMPAIGN CONT Aim of the project 1. To train, mentor, and provide ongoing support through in-service training, give guidance, develop referral systems between THPs, hospices and the DOH 2. To assist the THPs in their practices when they come across a patient who needs palliative care 3. To link the Healers with the hospices 4. To facilitate referrals

28 SMS COMPAIGN CONT TheSMSsystemwillhelptoprovidethehealerswith weekly short text messages reminding them of aspects of their training as well as updating them with new developments in Palliative Care. The SMS system will also link the healers with expert Palliative Care practitioners by enabling them to send texts asking questions on issues they need help with, and receiving responses from the experts within a short time frame.

29 THE BENEFITS OF THE SMS CAMPAIGN TO THE HEALERS: Improve communication between hospices and THPs Integrate palliative care in the caring of THPs patient Refer patients whose pain and other symptoms cannot be controlled by the THPs The SMS information system will support the THPs by making information available in dealing with palliative care needs.

30 CONCLUSION It is the responsibility of policymakers, public health officials, international donors, and others to recognize that the conventional biomedical health-care system alone has not and will not be in a position to fulfil the ultimate goal of every national HIV/AIDS strategic plan without engaging the help of all relevant stakeholders, including traditional healers.

The Contribution of Traditional Medicine in Treatment and Care in HIV/AIDS- The THETA Experience in Uganda

The Contribution of Traditional Medicine in Treatment and Care in HIV/AIDS- The THETA Experience in Uganda THETA background information THETA is an acronym that stands for: Traditional and modern Health