Facilitating collaboration between traditional healers and western health practitioners in the management of chronic illnesses in Swaziland.

Abstract

The purpose of the study was to analyze the process of facilitating collaboration between traditional healers and western trained health care workers in the management of chronic illnesses, hypertension and diabetes. This process was facilitated through qualitative participatory action research which utilized the principles of Action Science Enquiry. This was a qualitative research. Two phases were as followed: phase one was the analysis of the problem of collaboration while phase two was the implementation of strategy one and two. Strategy one was the development of the constitution of traditional healers towards the establishment of the Swaziland traditional Healers' Council and a traditional healers' department within the Ministry of Health and Social Welfare. Strategy two was a small comparative survey into the safety and efficacy of traditional medicine. The survey compared clients who utilized only traditional medicines and those who utilized only western medicines to control their hypertension. Data was collected through interviews, meetings, observations and clinical measurements. Audio-taped and field notes were transcribed, carefully studied and analyzed. The editing analysis described by Crabtree and Williams (1992) was utilized in the analysis of data. The results of phase one was a descriptive profile of traditional healers and the way hypertension and diabetes were managed by the traditional healers and the western trained health care workers, with the aim of finding out how they could collaborate. A number of barriers for collaboration were identified such as the lack of a legal body of traditional healers, negative attitudes of western trained health care workers towards clients and traditional healers, ethical issues, perceptions of illnesses and payments as well as the lack of transparency. Enhancers for collaboration were also identified. Consequences of a successful collaborative process were established by the participants. Strategies to solving the problems of collaboration were identified and two of the strategies were implemented. A traditional collaborative model was identified and compared to an existing modem collaborative model. Phase two, strategy one, the legalizing of traditional healers in Swaziland, was decided upon during one of the meetings held between traditional healers, clients and western trained health care workers. Barriers to successfully organize this strategy were also identified, such as organization and exclusion, leadership style, traditional and cultural structures, lack of resources, poor communication and different traditional healers' categories. Action plans to solve those problems were developed and progress was made. The end result was that a draft of the traditional healers' constitution content was developed. Stakeholders who would be part of the development of the constitution were contacted. The stakeholders included the Ministry of Health and Social Welfare, the Ministry of Natural Resources and Agriculture, the Swaziland World Health Organization, the Ministry of Justice and the University of Swaziland. The traditional healers managed to form an interim committee called the Traditional Healers' Constitution Development Committee. This committee was still in a process of involving all traditional healers in Swaziland to furnish their views and opinions to the committee concerning the constitution. The target date for the constitution to be completed was set to be around April, 2001. The researcher will still be working with the committee until the legalizing process is completed. This would take another one year to complete. Phase two : strategy two, establishing the efficacy of traditional healers' medicines to control hypertension was established to enhance trust between the traditional healers and the western trained health care personnel. From the small sample, it would seem that fluctuations of blood pressure levels were similar between the two groups. This showed that traditional healers medicines to control hypertension in Swaziland is effective. Though it was difficult to establish the safety of those clients who utilized only the traditional medicines, there were no abnormalities discovered to be associated with the use of the traditional medicines.