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September 2002

Feature

 


The Ancient and Modern Worlds Unite to Fight HIV/AIDS in Tanga, Tanzania

By David Scheinman

For centuries, traditional healers have been the main providers of primary health care to most Africans. Today healers in Africa, but especially in Tanga, Tanzania, still play crucial roles since -- in addition to their roles as primary health care providers -- they carry the burden of care for treating people with HIV/AIDS. In Tanga, the Tanga AIDS Working Group (TAWG) -- situated in historic Cliff Block of Bombo Hospital -- has been successfully collaborating with traditional healers since 1990. This is the story of a promising partnership between the ancient and modern worlds to combat HIV/AIDS.


Medicinal Plants

Plants have been used as primary sources of medicine for thousands of years and were our very first medicines. Over 4,000 years ago, the Red Emperor of China published a list of 4,000 medicinal plants. Literature about Babylonian medicinal plants was compiled in 1770 BC. The ancient Egyptians even placed medicinal plants in Pyramids to treat their Pharaohs after death. The pharaohs were mummified using plants, herbs, spices, and minerals.

Up until 100 years ago, the sciences of botany and medicine were nearly the same. It was only in the beginning of the twentieth century that pharmacology began focusing on identifying, synthesizing, and patenting bioactive compounds and started moving away from using herbal treatments. Soon herbal medicine, which was mainstream in the 19th century, began to be considered unscientific and unconventional since no one could pinpoint what compounds or molecules -- if any -- were efficacious.

Plants have medicinal qualities due to the substances they produce to protect themselves from pathogens. We just "borrow" these substances to treat our own viral, fungal, and bacterial infections. Many medicines are extracted from the roots, root bark, and bark of plants since these areas are the most vulnerable and provide a plant's first line of defense against an invader.

Imagine a poor plant, permanently rooted in one place, in the ground and defenseless, with nowhere to run or hide. Vulnerable, you bet; but that's just the beginning. Within seconds of an attack, plants begin producing and excreting a potent array of substances that are lethal or toxic to the invading virus, bacteria, fungus, insect, or even mammal. Individual plants can produce up to approximately 1,000 unique chemicals. Hence a natural anti-viral produced by a plant to defend itself can also be used by a human as an anti-viral. It's that simple.

Traditional healers in Tanzania have been identifying, experimenting, and using these substances to treat patients for millennia. By combining forces with them, we have access to thousands of years of research results. This is commonly known as Indigenous Knowledge (IK).

Many of today's modern medicines are derived from plants. Over 120 pharmaceutical products are produced from plants, and 74% were first used by native cultures! Yes, the correlation between healer use and positive lab results is clear. Data clearly indicates that plants collected from healers provide more solid leads toward developing new drugs than random screening. Twenty-five percent of our present perscription drugs are derived from plants. The best known are quinine from the cinchona tree, morphine from the poppy, aspirin from the willow, digitalis from foxglove, vinblastine and vincristine (first choice drugs treating Hodgkin's Disease, Acute Leukemia, various lymphomas, Advanced Breast Cancer, and now HIV related Kaposi's Sarcoma) from the rosy periwinkle -- which grows right here in Tanga -- and now cotexin from artemisia for treating malaria.

 Traditional Healers in Tanga, Tanzania

Tanga District, in the northeastern corner of Tanzania, has approximately 670 traditional healers (Waganga). 337 are in Tanga Urban District and 333 are in Tanga Rural. The average age of a healer is 52. Most are Muslim and have been practicing for an average of 19 years. There is one healer for every 343 residents of Tanga town and one healer for every 146 rural residents. There is only one western trained medical doctor in Tanzania for every 33,000 residents. Ergo, many more people receive health care from healers than from conventional health workers. Many healers have participated in TAWG Seminars.

These figures positively correlate with data from sub-Saharan Africa. Healers are already in place throughout Africa; health ministries do not have to employ or assign them since virtually all villages have residential healers and traditional birth attendants. This is especially true in rural areas where modern medicine is much less available than in towns. Hence, synergistically combining forces with healers to combat HIV/AIDS and promote public health makes excellent sense.

Healers in Tanga are mostly herbalists, diviners, mediums, surgeons, midwives, and traditional psychiatrists. The majority use some of the many medicinal plants available in our biologically diverse region. The Eastern Arc range of mountains, which includes Amani in Muheza District, is one of only 20 designated biological hotspots in the entire world. A hotspot is a region characterized by an unusually diverse range of species, many endemic to the area. Amani has the second highest amount of biodiversity in Africa -- a site in Cameroon is first.

Healers have specialized knowledge for treating physical, cultural, and psychological ailments. They are readily accessible, very affordable, usually have credibility, and in Tanga have a treasure trove of biological diversity from which to collect efficacious plants.

Healers and Doctors Join Forces in Tanga

To win the war against HIV/AIDS, healers should be active partners in the health care system. This is actually happening today in Tanga, where traditional healers and modern physicians have joined forces in an exciting and promising program implemented by TAWG. TAWG is an innovative non-governmental organization (NGO) that links traditional healers, physicians and health workers, botanists, social scientists, and people living with AIDS (PLWAs). TAWG's goal is to bridge the gap between traditional and western biomedicine by treating PLWAs with traditional medicine. TAWG has received support from OXFAM, The World Bank, and USAID.

TAWG evolved from meetings a German physician and his Tanzanian colleagues initiated with traditional healers in Pangani, a sleepy coastal town 50 kilometers south of Tanga in 1990. The health workers observed that many patients -- this is true throughout sub-Saharan Africa -- concurrently visited both the hospital and traditional healers. Hence they decided to make contact with local healers in hopes of initiating a referral network. They were successful, and their network evolved into TAWG.

Healers responded enthusiastically to the initiative. They relished being taken seriously and treated like fellow professionals. The initial dialogue evolved into meetings where participants discussed how to treat various ailments, when to refer a patient to the hospital, public health issues, and how to cooperate with bio-medical personnel. One day the subject was HIV/AIDS.

Waziri Mrisho, a wizened 84-year-old healer, slowly stood up and asked if he could try treating HIV/AIDS in-patients. He mentioned that his grandfather had shown him some plants that treated HIV/AIDS symptoms. The group agreed, and Waziri treated a few confirmed HIV+ patients with three plants TAWG still uses today.

Bio-medical personnel soon observed -- to their delight and great surprise -- that patients treated with Waziri's three plants generally developed improved appetites, gained weight, suffered from fewer and less severe opportunistic infections, and enjoyed improved health and well being. The plant remedies soon became the hospital's standard HIV/AIDS treatment for patients who preferred herbal medicine.

The original three plants -- along with others that have been added -- are still used to treat a variety of opportunistic infections commonly caused by HIV/AIDS. Waziri was a real pioneer. He readily shared his knowledge and generously agreed to have his plants scientifically identified by botanists from the Lushoto Herbarium in Lushoto, Tanga Region.

TAWG eventually developed a home care service to deliver the plant remedies to HIV/AIDS patients and their families. Home visits are the foundation of the TAWG's day-to-day work. Activities include monitoring general health, administering traditional remedies, and providing counseling for patients and their relatives.

In 1994, TAWG was officially registered as the Tanga AIDS Working Group (TAWG) with the Ministry of Home Affairs. TAWG is the leading HIV/AIDS NGO in Tanga Region. Its staff are highly qualified, dedicated, and committed to improving the quality of PLWAs lives. Members have expertise in counseling, psychology, medicine, education, botany, research, medical anthropology, and management.

TAWG's work is a good example of how positive results can be achieved in the fight against AIDS by knitting together local expertise and resources, indigenous knowledge, and modern health workers into a fabric that provides effective low cost treatment for people living with AIDS.

TAWG's Treatment Program

TAWG's signature activity is treating patients in the hospital or at home with medicinal plants. In the newspaper Nipashe on February 23, 2002, TAWG spokesperson Dr. Samuel Mtullu reported that TAWG's treatment generally improves and lengthens patients lives. He added that some patients who had HIV related opportunistic infections visibly improved after taking the traditional medicines.

The medicines are more effective, however, if treatment is initiated during the early stages of HIV/AIDS. The medicines are low cost, effectively treat selected opportunistic infections, readily available, are provided to patients free of charge, and have been used for Tanzanian healers for centuries. Given in the proper form and dosage, they are very safe.

TAWG's medicines increase appetite, help patients gain weight, stop diarrhea, reduce fever, clear up oral thrush, resolve skin rashes and fungal infections, treat herpes zoster, and clear ulcers. Treating patients extends their longevity, improves the quality of their lives, and reduces the number of orphans since parents remain alive.

TAWG also works closely with the government, runs seminars for traditional healers, and has an effective education and HIV/AIDS prevention program.
TAWG currently treats around 400 patients in Tanga, Pangani, and Muheza Districts. Since TAWG began in 1990 they have treated around 2,000 patients. During the last six months, the amount of patients treated has doubled, indicating the rising number of HIV/AIDS cases.

TAWG's collaboration with traditional healers and the Ministry of Health has created a small island of hope in our seaside town. Patients are now living longer and better lives, so consequently there are fewer recently orphaned children. Healers have taken the prevention and public health messages back to their villages -- many even distribute condoms -- and most now know when to refer a patient to the hospital.

Though not a cure, the traditional medicines prolong life by combating pathogens similar to those that attack plants. At least now, patients in Tanga Region have a low cost effective alternative to expensive imported anti retro-virals.

These expensive new therapies, by the way, often lose their knockout punch over time. Hence, treating patients with traditional medicines has as much validity now as it did thousands of years ago. By having healers and doctors synergistically combine forces, new trails are being blazed which benefit all of us.


TAWG welcomes inquiries and visitors. See for yourself or call TAWG for more information. Here are TAWG's coordinates:

Location: Cliff Block Bombo Hospital Tanga, Tanzania
Address: Box 1374 Tanga
Phone/FAX: 255-27 264-2266
Email: tawg@kaributanga.com
Website: http://user.tanga.net/tawg
Contacts: Dr. Samuel Mtullu - Coordinator
Dr. Anna Chaze - Chairperson
Dr. Firmina Mberesero - Former Chairperson and Board Member
Ken Down - Project Advisor
David Scheinman - Board and Founding Member





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