Last week I was placed in OPD, however, I came down with a bad case of gastroenteritis so I was only able to manage one day in the department!
My day began in a flurry of activity, with a man being rushed in on a stretcher. He was emancipated, barely consciousness, and close to death. Taking his blood pressure, I measured 60/30 and it was rapidly tanking. We performed multiple medical interventions, but it was apparent that they were not going to save him. At his realization, the nurse I was working with began singing to him in Slozi, a song that I knew, and so I joined in. This man crossed over while we were singing to him, making our last intervention not medical, but spiritual.
Since arriving in Zambia, I have heard about and witnessed evidence of traditional practices of medicine. I have heard about witchcraft. I have seen amulets around children's necks, meant to ward off demons and curses. I have also witnessed the delicate lines of scars across different areas of the body. These scars are present on many patients I have seen here in Zambia, especially during my outreach nursing experience in Maikilipwe. Sometimes the cuts are fresh, and either infected or stuffed with herbs or pastes. The doctor we were working with in Makilipwe explained that these scars were made by traditional healers and/or witch doctors. She explained that many people in Zambia, especially in rural areas, believe in witchcraft and that their health is closely intertwined with spirituality, traditional beliefs, and culture.
I have a scientific approach to health care, but do agree that healing is a complicated physical, psychological and spiritual process. In university, we are trained as nurses to "treat the whole person", acting holistically. We are taught to not only treat the disease, but to also treat a person's spirit. We take many classes on relational practice, and are taught to inquire about our patient's personal health practices, even their religious beliefs. As a nurse I have worked with priests, pastors, and traditional First Nations healers on multiple occasions. Comparing those past experiences to the work I have been doing in Zambia, I have come to the realization that never before has the weight of personal beliefs affected me so heavily. Having to find a balance between respecting a patient’s traditional beliefs, while attempting to provide them the most appropriate intervention for their ailment can often be a frustrating endeavour.
The World Health Organization (WHO) defines traditional medicine as “the sum total of knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve, or treat physical and mental illnesses”.
I was told that many traditional healers have a vast knowledge of flora and fauna, often using parts of plants, birds, insects, snakes, and fish for healing. Like modern medicine, they use their techniques to deal with a wide range of medical and psychological problems. Some of these remedies have a direct effect on the body, others seem to work solely because people believe in them. The healing power of this belief can be very strong, commonly known as the placebo effect in modern medicine. However many of these traditional practices carry the risk of being more harmful to patients. For example, they believe that you can cure a poisonous snakebite by either biting the snake, or by smearing the snake’s bile on the wound. We know that the only cure for a poisonous snakebite is the appropriate anti-venom specific to the species of snake, meaning these traditional methods will ultimately prove to be un-effective and done in vain. During our medical outreach we also learned of various other traditional remedies that are similar such as using parts of scorpions to heal scorpion stings, or using parts of a tree with lumps on its trunk to treat patients with mumps. The benefits for these traditional remedies are limited, but for less serious ailments they can prove effective in other ways than directly treating the condition, such as bringing a sense of calm to patients.
In Zambia, traditional medicine is the main source of primarily health care. The ratio of western medical practitioners to the population is approximately 1:11000, while the ratio of traditional healers to the population is as low as 1:200 in some areas (WHO). Traditional medicine is the most accessible form, sometimes the only form, of health care in many areas as hospitals and clinics are difficult for many to access. Western medicine also removes native Africans from their culture, and forces them into a system they are not comfortable with, removing them from their family and traditions.
However, if unregulated, traditional healer's and witch doctor's services can create more harm in the patients they are attempting to treat. During my research I learned of the "Traditional Health Practicitoner Association of Zambia (THPAZ)." Currently there is a large divide between traditional and modern health care systems, where collaboration has the potential to be extremely beneficial. WHO acknowledges this divide, and is working to ensure the use of safe and effective practices of traditional healers through upgrading their skills and knowledge. THPAZ has partnered with WHO and the Zambian Ministry of Health to facilitate effective health education and training in refferal practices. Through this education, and collaboration there is the potential for improving medical care for patients in rural, and urban areas.