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Concern, cooperation, and coexistence in healing

BMJ 1999; 319 doi: (Published 10 July 1999) Cite this as: BMJ 1999;319:133
  1. R E S Tanner, former chairman
  1. East African Institute of Social Research, Kampala, Uganda

    Consideration for and interest in modern traditional medicine in east Africa by scientific medicine face three barriers; the cultural and social distance between the two professions; institutional restrictions and professional etiquette which limit contacts; and the scientific mentality and training.

    The traditional healers are alert to social changes

    It seems, therefore, that the medical profession holds all the high cards and that any cooperation would have to be on the doctors' terms, but is their position really so superior?

    Most developing countries have Western-style medical systems, which are underfunded, understaffed, underpaid, and deal with rapidly expanding populations. They cannot provide a personal or adequate service because of the shortage of drugs, staff moonlighting, the need to pay for services, and the preference of the senior staff to work in the major towns.

    The ways in which medical services are provided alienate patients, and the cures proposed are not only outside their social comprehension but have no relation to the social and personal conditions, which in their opinion may or may not be the cause of their ills. Furthermore, the previous known successes of medicine in controlling mass diseases have faded into folk memory by the assumed prevalence of untreatable AIDS.

    Many people prefer to go to their quasitraditional healers, and in some towns more people can be found using their services than all the social services agencies together. What is their popularity based on?

    Firstly, their business and reputation depend on the gossip network of a community, which may involve millions of people. Scientific medicine considers that success should be based on clinical success whereas these patients consider success to be based on cures, even partial cures, which are as much social as clinical. They know that misfortune and ill health are more often based on social factors than on epidemiology.

    Secondly, they are found almost everywhere, particularly in the towns, at times and places which are convenient for everyone; they do not have working hours, and are ready to be consulted on Sundays, holidays, and in the evenings.

    Thirdly, the traditional healers have, of course, to be paid, but payment often occurs after rather than before treatment and depends as much on results as on the cost of the consultation. The consultation occurs on a more equal social level than would occur in a hospital between patient and doctor.

    Fourthly, the healers are dealing with the misfortunes of their patients within a shared and understood pattern of action. What the healers suggest to the patients involves no mysteries. In scientific medicine doctors hope that their patients will trust them, just because they are doctors.

    Fifthly, the healers' patients contribute to the diagnosis by providing the social rather than the physical clues which suggest a course of treatment. This treatment will involve suggestions for social behaviour, and probably medicine which would usually be a compound of animal, vegetable, and mineral materials in such small quantities as to parallel homoeopathy. A Sukuma healer might well be able to name, identify, and know the uses of more than 500 plants.

    Finally, the traditional healers are alert to social changes and adapt their solutions to the social conditions surrounding their patients and to the materials which are available locally.

    There seems little doubt that these healers will continue to provide a much more popular service than any less readily available scientific medical service because of its humane aspects; they have time for their patients in less intimidating surroundings and they relate more positively and quickly to their circumstances.

    Scientific doctors deal pragmatically with the problems of their patients, whereas quasitraditional healers view their patients in a much wider perspective that accepts as fact the lethal properties of spirits and personal animosities, which their rivals ignore as primitive ignorance.

    The two systems run parallel courses which can never converge except in their acknowledgment of human suffering. Scientific doctors would never have the time or see the point in accepting their rivals' unhygienic methods, metaphysical hypotheses, and undefinable and unquantifiable materials. The traditional healers contribute a great deal to keeping human suffering within socially, politically, and economically manageable proportions in developing countries.


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