The incorporation of indigenous healers in the fight against HIV/AIDS : an exploratory case study of the collaboration between Izangomas and the formal health system operating through the Valley Trust.
The purpose of this study was to get a better sense of what collaborative efforts between the allopathic and indigenous health systems to address HIV/ AIDS look like 'on the ground' with the hope that revealed successes and failures could inform other initiatives. The pilot investigation took the form of a small case study of the Community Health and HIV/AIDS project at the Valley Trust in KwaZulu Natal's Valley of a Thousand Hills where HIV/AIDS collaboration with traditional healers has taken primarily three forms: 1) incorporation in the formal primary health care system as CHWs (TH/CHWs); 2) formal short-term HIV/AIDS training (Trained); and 3) informal second-hand HIV/AIDS training or information sharing (Untrained). The investigation focused primarily on how the indigenous healers' involvement in the Valley Trust's varying training programs affected their knowledge ofthe disease, their engagement in HIV/ AIDS awareness and prevention efforts, their treatment of HIV/AIDS patients, and their perception and relationship with the formal medical system. The findings show that collaboration between traditional and formal health services, in the form of the Valley Trust's training, results in 'better' HIV/AIDS work by participating traditional healers through enhanced performance on HIV/AIDS knowledge tests. As indicated by their superior performance on correlating knowledge indices, TH/CHWs engaged in the most effectual community prevention activities of the three groups. Additionally, the TH/CHW group appeared to have the most confidence and experience in treating patients with HIV/AIDS. Additionally as compared to the other two groups, their treatment methods were more varied, induding psycho-spiritual ceremonies, diet, traditional medicinal herbs, and support of biomedical efforts. Given the comparative success of TH/CHWs, it was ironic that only the healers' themselves indicated wanting more izangomas to serve as Community Health Workers. As leaders among participating healers, TH/CHWs were critical to the success of the Valley Trust's collaborative project. The findings of this case study suggest that the nature of the varying trainings offered by the Valley Trust accounted for the primary difference in the effectiveness of the healers' subsequent HIV/AIDS work. The study implies that both the skills-based nature and long-term supervision of the CHW training were instrumental in their superior performance. These findings point to the fact that indigenous healers can not function effectively as extension services without investment in infrastructure development and ongoing support. In terms of the collaboration between biomedical and indigenous health systems operating at the Valley Trust, the primary point of contention between the participating parties was the collaboration's unidirectional referral system (healers would refer patients to the clinic and not vice versa). Discrepancies in the collaborative partners' perceptions of one another, which were revealed in the study, point to the need for greater dialogue and formal linkages between participating groups. A referral system of some content and magnitude appears to be the most critical and pressing issue the new structure needs to address.