On the fence just down the street from the hospital where I work in Kenya, there is a sign for a “Dr. Musa” promising treatments for everything from “business” to “male strength”. Sometimes as I walk through town, I will see that someone has set up a tent or is driving a van through with advertisements for herbal medicines that will treat diabetes, high blood pressure, and many other ailments. Patients often come in saying that they had tried herbal medications for their wounds or other symptoms before coming to our hospital, and in one very sad case I was not able to resuscitate a newborn whose grandmother had attempted to feed it a mixture of herbs — only for these herbs to go into the child’s airway, not his esophagus.
Still, I’m optimistic about some possibilities for integrating traditional healers into the medical treatment system (particularly when it comes to obstetrics), and Patrick Gathara explains why:
The effort to eliminate maternal mortality spearheaded by the First Lady’s Beyond Zero campaign follows the same pattern. The focus of the campaign has been to ensure all deliveries are made at a health facility and has provided a fully-equipped mobile clinic to each of the 47 counties. However, there are few attempts to engage the traditional midwives who deliver two-thirds of the babies born to pastoral communities. Even where health facilities are available, women may prefer to go to a traditional birth attendant due to bad experiences in health facilities or a lack of transport, especially when the onset of labour is during the night.
WHO has recommended that the government work with traditional midwives and offer them training and support to ease the nursing shortage, but so far there has been little willingness to do so. Instead, the Beyond Zero campaign prefers to denigrate them as “unskilled” and as a hinderance to “equity in provision of health services”. This attitude reflects not just the colonial and Western derision of traditional health practices but also a preference for high profile external interventions designed to capture the media spotlight rather than the less prominent and perhaps more effective interventions that take advantage of resources within the community.
Personally, I think that when it comes to “male strength” and diabetes, conventional medicine has traditional medicine beat. (Insulin here is cheap and often necessary when the primary staples are carbohydrate-heavy, and you can buy a month’s supply of generic Viagra, which I prescribe quite often for patients with pulmonary hypertension, for less than $10.) But as far as obstetrics goes? Patients should be able to quickly access a quality hospital with emergency services for c-sections and infant resuscitation. But for many mothers and most children (especially in rural areas), traditional midwives that are integrated into the health system and properly trained could do a lot of good.
We had one such woman on staff at our hospital in South Sudan and she was an invaluable resource. For those who are interested in how to get these skills to those who could implement them, Helping Babies Breathe is a fantastic course and you can buy reuseable training materials.