Accra, Ghana, March 14 -18 2006
HDN Key Correspondent Conference ReportThis short report is in three sections: an overview of the conference, its aims and objectives; a consideration of the various interventions that were presented; and a broader discussion around how the approach to traditional medicines contrasts with the allopathic (orthodox medicine).
This paper does not claim to be a full report of the event, but rather aims to highlight the key issues and - more importantly - ensure that traditional medicines in HIV care receive due consideration.
1. WHAT WAS THE CONFERENCE HOPING TO ACHIEVE?80% of Africans utilise traditional healers (TH) dispensing traditional medicines (TM). Stated by Dr Richard Fru of Cameroon during the opening presentation of this important conference, held in the Ghana Institute of Management and Public Administration, Accra, Ghana, this stark fact set the scene for the rest of the week.
Though allopathic medicine has achieved almost global hegemony; it is local, community-driven and culturally relevant interventions that are the primary source of treatment for millions of people - their first point of contact. The 'ancient', or indigenous knowledge that informs traditional medicine was often contrasted here in Ghana with the relatively recent, and therefore more youthful allopathic interventions.
The purpose of this summit - opened by an enthusiastic Health Minister of Ghana, the Hon Courage Quarshigah - was to remedy the imbalance between allopathic and traditional medicine, and at the same time promote a paradigm of care allowing the two approaches to co-exist. Presenters at the summit hailed from African nations, and beyond, including: Zambia, Tanzania, Ghana, Cameroon, Belgium, Malawi, Canada, Hong Kong, the United States and the United Kingdom.
In spite of the geographical variety, there did seem to be for the majority of delegates a united and unifying desire to emphasise alternative approaches to the care and treatment of PLWHA rooted in local knowledge, drawing on a long cultural heritage that in many instances predates modern interventions by centuries, perhaps millennia. Given most people attending the conference were from Africa, many of the topics focused on herbal and plant-based interventions.
Non-African interventions included traditional Chinese medicine (TCM), and the use of acupuncture for HIV/AIDS symptom relief in northern Thailand, by Dr Laura Louie - the Mae On Project. Promoting acupuncture as a cost-effective intervention which does not interact with ARVs, is cost effective and improves quality of life, Dr Louie's presentation confirmed that 'ancient' treatments still have a role to play in the management of 'modern' disease', a notion confirmed throughout this event.
2. TRADITIONAL MEDICINE AND ITS BENEFITSSo, what are the benefits of traditional medicines? Primarily, is the fact it uses a holistic approach, taking into account the physical, mental, emotional and spiritual aspects of an individual, which are invaluable for healing/health and often overlooked by allopathic medicine.
Treatments were not the only focus of the summit - many of the presentations and discussions also considered issues around equity, the need for mutual respect between TM and allopathic practitioners, and intellectual property rights. Some presentations described methods used by empirical science to evaluate the application of TM in HIV treatments - including a paper by Dr L Pieters of the University of Antwerp in Belgium, describing the development of research studies to evaluate the effectiveness of herbal remedies, and the specific modes of action of particular herbs.
Another paper, by Dr Mary Richardson of the National Foundation for Alternative Medicine, Washington, highlighted the continuing need to regulate traditional medicines, to maximise safety and efficacy - especially around contamination. The urgency in developing research paradigms and appropriate independent verification would, she suggested, lead to more effective low cost medication.
These and similar papers did reveal an especially difficult facet in the evaluation of TM - consistency of the product. If one herb being used for a treatment is to be evaluated for example, when in the lifecycle of the plant is the medication to be extracted? From where?
These and similar questions pose serious challenges for traditional African medicine, but one common feature reiterated throughout the week here in Ghana is the relative affordability, low toxicity, and ease of manufacture of TM. Their effectiveness against the 'monster' of HIV/AIDS - as suggested by one of the first speakers - is also a feature that many at the summit felt significant.
It is the strong cultural relevance of TM, derived from knowledge within the local community that is perhaps their most potent characteristic. They are - literally - owned by the populace. Indeed, Dr Rokia Sanago of the University of Mali suggests that because TH live in the 'same reality' as their community, their impact is especially powerful: subtly suggesting perhaps that practitioners of allopathic medicine are less adept at engaging with their clients.
Clearly, TM has resonance with the local community. However, issues of regulation of practitioners remain important, a fact highlighted by Dr Dabra VI during his description of a local project in which TH were provided with additional information about HIV in a bid to ensure that their practice was safe. The results of the project - a marked increase in knowledge and understanding of HIV/AIDS - demonstrated that TH could also play a vital part in the community for HIV prevention, because they are often the most trusted practitioners.
A similar project, in Mali, also suggested that, in the right circumstances, TH were willing to engage with education programmes designed to ensure that TM was practiced safely - in a way that would not diminish its uniqueness or relevance, but also to ensure risk of HIV transmission was minimised (e.g. during circumcision rituals). Dr Rokia Sanago of the University of Mali described a study in which 249 TH took part.
Following culturally sensitive education, 97% altered their practice to minimise HIV transmission. Other examples - for example, ensuring the TH are aware of interactions between anti-retroviral (ARV) medication and TM, suggest it is possible to integrate traditional and 'modern' knowledge in meaningful and beneficial ways, as has been often demonstrated in the context of western naturopathic medicine.
3. WHAT IS INDIGENOUS KNOWLEDGE?TM is founded upon indigenous knowledge, and is therefore local and immediate. People seeking treatment are already part of the 'world' of the TH, whose approach is also shaped by the cultural history of the region, or predicated on the need for close and meaningful interactions between the healer and the patient.
However, defining this indigenous knowledge is difficult, for at best it is a nebulous concept - still not well-understood even by the 'custodians of this knowledge themselves', according to Dr Luis Sambo, Director of the regional office of the WHO in the Democratic Republic of Congo. As a result, it is imperative there is a legal framework, national plan and a need to protect the intellectual property rights (IPR) of TH: and this was a leitmotif of the event - the nature and ownership of knowledge.
Dr Esther Kibuka-Sebitosi of the University of South Africa discussed the meaning of indigenous knowledge, and - perhaps most significantly - the ways that the knowledge held by traditional healers can be protected from unscrupulous or excessively acquisitive organisations and companies.
Based on a survey carried out in the region, traditional healers, she suggested, are afraid of exploitation, and wary that they would not get fair recompense from the passing of knowledge to 'outside' organisations. She raised interesting additional points that resonated with others during the conference - the very nature of traditional healing and indigenous knowledge is that it is, by definition, local and rooted in the immediate culture.
From a legal and ethical perspective, therefore, trying to define what actually needs protecting is difficult - names of plants and interventions will vary between regions; taxonomies will inevitably be different. She therefore highlighted the urgent need to develop appropriate mechanisms to protect the interests of traditional healers, avoid bio-piracy and develop radical frameworks to preserve the intellectual property rights of those in possession of 'indigenous knowledge
4. A CLASH OF CULTURES?Throughout the event, the unifying factor underpinning all activities was a firm belief in community, and the power derived from approaches to illness and treatment rooted within the local social and cultural system. A fear of losing this ancient knowledge was reiterated many times - Health Minister Courage Quarshigah suggested people had unfortunately 'decided to disconnect [themselves] from indigenous knowledge' - partly, he suggested, because scientists have 'no use' for it at all.
He declared his ardent support for TM - perhaps a sign that in Ghana at least, there will be additional prominence given to policies that protect and encourage traditional medicine.
The essential contrast between allopathic and traditional medicine was illustrated well by one particular presenter, a practising allopathic doctor - Wisconsin-based Dr Richard Nagler. He was incisive in his critique of the inflexibilities in western medicine, with its 'different goals and different approaches to the use of knowledge', and which often sees alternative approaches as competition.
Nagler's argument is clearly central to the whole question of validity and acceptability of TM, and close to the view of anthropologist Arthur Kleinman writing in the 1980s, who argues that all approaches to illness are essentially relative, and equally valid. What is perceived as the 'orthodox' approach is simply just another approach, and from the perspective of culture, no more or less valid than any other - it is simply a matter of point of view.
Nagler concluded with a call for all governments and organisations to have as their goal the 'support and respect' of TM. Dr Richard Atleo Hereditary Chief of the Ahousaht in British Columbia, Canada also confirmed the contrasts between knowledge generated by traditional science - through research; and that from traditional medicine - based on outcome.
To western ears, this may sound like heresy, and indeed, when evaluating the efficacy of TM, orthodox western driven research paradigms may not be the best approach.
Clearly, what is important is the need for a model of treatment and care drawing on the best of both paradigms - the scientific approach of western medicine (valuable for many medical emergencies) and traditional medicine rooted in indigenous knowledge and often best suited to chronic conditions unresponsive to western interventions.
As this conference confirmed, whilst this may seem a perfectly rational way of dealing with contrasting paradigms, in many instances the allopathic, 'scientific' approach usurps the traditional, with the result that interventions offered to patients received are founded entirely upon an alien paradigm.
On the final day of the conference, Dr. Godfrey Swai proposed a self-sustaining integrated medical clinic featuring allopathic medicine, traditional Africa medicine, acupuncture, nutrition and health maintenance programs, as an example of a useful model for development. He described how over the centuries, the rise and fall of colonialism and slavery was inversely related to the dominance of traditional medicines in African cultures, and he feels now is the time for truly holistic interventions in the relief of HIV/AIDS symptoms, especially as the provision of ARVs and associated treatments were falling short of expectations - and promises.
The summit here in Ghana was driven by a desire to encourage mutual trust and respect between traditional and allopathic medicine. Both have value, and the search for a holistic and integrated approach between these two types of medicine, was clearly the intention of this conference. Dr Rodwell Vongo, President of the Traditional Health Practitioners Association of Zambia perhaps provided the most revealing statement: 'do western doctors believe in demons or ghosts? Do TH believe in psychosocial issues?'
At other times this week, words not normally heard at events dealing with 'treatments' were heard: dreams; visions; myths; stories, and whilst Vongo was clearly encouraging the development of TH in mainstream treatments, he also went on to comment on the lack of progress on both sides for not expanding their understanding of other approaches and paradigms - but he was also clearly aware of the stigmatisation of TH, and proposed that allopathic and traditional healers 'join forces', and achieve a level of synergy that is currently lacking.
5. CONCLUDING POINTSAs HIV/AIDS continues to ravage many parts of the developing world, and the roll out of ARV lags far behind the targets set by international agencies, traditional medicine offers an accessible alternative, especially when allied with allopathic treatments that are already well established, such as treatments for TB. The campaign AIDS-Care Watch is one initiative that wishes to highlight the value of TM, especially in areas starved of ARV but with access to other allopathic treatment.
TM is not dependent on external and often culturally novel treatments that for many are too expensive or simply unavailable. They provide - in this case - a resolutely African solution for an African problem, and as argued throughout this summit, when grafted on to other forms of treatment, result in an overall package of care with an impact far beyond that of individual components.
Following the conference, the declaration included these words - summing up the spirit of the event and challenging governments and agencies to act:
'...We urge State parties, governments and multilateral organizations to respect the customary laws and practices that define access and availability of indigenous cultural knowledge, and to ensure adequate and mutually acceptable exchanges.'
The full declaration can be found here:
www.africa-first.com/gsaidstmik2006/declaration.htmMore information about AIDS-Care Watch can be found here:
www.aidscarewatch.orgSource: AF-AIDS eForum
