Strategies to facilitate collaboration between allopathic and traditional health practitioners
Author(s)Tembani, Nomazwi Maudline
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AbstractThe formal recognition of traditional healing has been controversial for some time with traditional healers being labelled by those of conventional medical orientation as a medical hazard and purveyors of superstition. The support for the development of traditional medicine and establishment of co-operation between traditional healers and allopathic heath practitioners was first promoted in the international health arena by the World Health Organisation. Estimating that 80% of the population living in rural areas of many developing countries was using traditional medicine for the primary healthcare needs, this organisation advocated for the establishment of mechanisms that would facilitate strong cooperation between traditional healers, scientists and clinicians. The study was undertaken in the Amathole District Municipality, Province of the Eastern Cape based on Chapter 2, Section 6(2) (a) of the Traditional Health Practitioners Bill 2003, which required regulation and promotion of liaison between traditional health practitioners and other health professionals registered under any law. The purpose of the study was to develop and propose strategies to facilitate collaboration between traditional and allopathic health practitioners to optimise and complement healthcare delivery. The conceptual framework guiding the study was derived from Leininger’s theory of Cultural Care Diversity and Universality chosen because of its appropriateness. The terms used throughout the study were defined to facilitate the reader’s understanding. Ethical principles were adhered to throughout the research process. To ensure trustworthiness of the study, Guba’s model (in Krefting,1991:214-215) was used where the four aspects of trustworthiness namely, truth value, applicability, consistency and neutrality were considered. A qualitative, exploratory, descriptive and contextual research design was used which assisted in articulating the appropriate strategies to develop to facilitate v collaboration between allopathic and traditional health practitioners. The study was done in two phases. Phase one entailed data collection using unstructured interviews, a focus group interview, literature control and modified participant observation. In Phase two strategies to facilitate collaboration between allopathic and traditional health practitioners were developed. The population in this study comprised three groups of participants. Group 1 consisted of allopathic health practitioners, Group 2 comprised traditional healers and Group 3 was composed of participants who were trained as both traditional healers and allopathic health practitioners. All participants had to respond to three research questions which aimed at: exploring and describing the nature of the relationship between allopathic and traditional health practitioners before legalisation of traditional healing and their experience as role-players in the healthcare delivery landscape in the Amathole District Municipality. eliciting the viewpoints of allopathic and traditional health practitioners regarding the impact on their practices of legalisation of traditional healing and developing strategies to facilitate collaboration between allopathic and traditional health practitioners. Data obtained from each group was analysed using Tesch’s method as described by Creswell (2003:192). Themes emerging from data and the corresponding strategies to address the themes were identified for each group. The participants’ responses to the three research questions revealed areas of convergence and divergence. Of significance was the reflection by the participants on their negative attitude towards each other. They also highlighted that there was no formal interaction between traditional and allopathic health practitioners in the Amathole District Municipality. Their working relationship was characterised by a one-sided referral system with traditional healers referring patients to allopathic health practitioners but this seemed not to be reciprocated vi by the latter group. The exception was the case of traditional surgeons whose working relationship with allopathic health practitioners was formally outlined in the Application of Health Standards in the Traditional Circumcision Act, Act No.6 of 2001. Allopathic health practitioners attributed their negative attitude as emanating from the unscientific methods used by traditional healers in treating patients, interference of traditional healers with the efficacy of hospital treatments and delays by traditional healers in referring patients to the hospitals and clinics. Traditional healers stated that they were concerned about failure of allopathic health practitioners to refer patients who talked about “thikoloshe” and “mafufunyana” to the traditional healers. Consequently, these patients presented themselves to the traditional healers when the illness was at an advanced stage. A reciprocal referral system was perceived by the traditional healers as the core element or crux of collaboration. There were ambivalent views regarding the impact of legalisation of traditional healing on the practices of both traditional and allopathic health practitioners. Elimination of unscrupulous healers, economic benefits, and occupational protection were benefits anticipated by traditional healers from the implementation of the Act. The possibility of having to divulge information regarding their traditional medicines, monitoring of their practice resulting in arrests should errors occur were however, cited by traditional healers as threatening elements of the Act. A lack of understanding the activities of each group with an inherent element of mistrust became evident from the participants’ responses. Ways of fostering mutual understanding between them were suggested which included holding meetings together to discuss issues relating to healing of patients, exposing both groups of health practitioners to research, as well as training and development activities. The participants also highlighted areas of collaboration as sharing resources namely, budget, physical facilities, equipment and information and role clarification especially pertaining to disease management. The participants vii strongly suggested that there should be clarity on the type of diseases to be handled by each group. The need for capacity building of traditional and allopathic health practitioners in preparation for facilitating collaboration was advocated by all and the relevant activities to engage into were suggested. Analysis, synthesis and cross referencing of the themes that emerged from the data culminated in the identification of three strategies that were applicable to all groups of participants and which would assist in facilitating collaboration between allopathic and traditional health practitioners. The researcher coined the three strategies “Triple C” strategies abbreviated as the TRIC strategies. The first “C” of the three “Cs” stands for “change attitude”, the second “C” for “communication” and the third “C” for “capacity building.” Each of the proposed three strategies is discussed under the following headings:- Summary of findings informing the strategy Theory articulating the strategy Aim of the strategy Suggested implementation mechanism As the strategies had to be grounded in a theory which would serve as a reference point, the researcher used the Survey List by Dickoff, James and Wiedenbach (1968:423) as a conceptual framework on which to base the proposed three strategies. The results of this study and recommendations that have been made will be disseminated in professional journals, research conferences and seminars.