Epigraph Vol. 17 Issue 1, 2015
Traditional Healers and the Treatment of Epilepsy: An African Perspective
One of the major themes at the 2014 African Epilepsy Congress was the role of traditional healers in the treatment of epilepsy. Although no one knows for sure, it is likely that the majority of people with epilepsy go to these caregivers who are established and respected members of their communities. There are many reasons why people who have had seizures consult traditional healers first. The African Epilepsy Congress brought together practitioners of traditional and modern medicine in a single venue to discuss their differing points of view on the causes for the disease and how it might be treated. The discussions provided extraordinary insights into the patients' beliefs about their disease, the implication of the disease within the community, and their understanding of how the disease should be treated.
In preparing this article, I interviewed two traditional healers: Gugu Ngubane and Gugu Madlakes who work in the countryside around Cape Town, South Africa; Ms Johannan Keikelame, a social worker who has done a number of studies on the role of traditional healers in treating epilepsy in rural South Africa; and Professor Daliwonga Magazi, a pediatric neurologist from the University of Limpopo, South Africa.
All agreed that the importance of the traditional healers arises from the complex beliefs about the causes of epilepsy, which influences the interpretation of the disease and how it should be treated. Traditional healers define epilepsy as a disease caused by confusion of brain nerves, and the actual seizure is the action done by the person when sick with epilepsy, a sickness that is always present and active. Many consider a person with epilepsy to be possessed and the condition is often viewed as punishment for wrongdoings of the family. However, in some cases a person may be convulsing for a greater good. In these cases the convulsions could be an attempt to remove bad spirits surrounding the family, and by convulsing, the bad spirits are removed. In other cases the convulsions may be a calling from the ancestors for that person to be a traditional healer. Until that person accepts the calling, the convulsions will continue. The definition and the belief about the possible causes are the same for a child and an adult, but the causes most often have a spiritual basis.
Although the spiritual causes have a major position in the traditional beliefs about the basis of epilepsy, there are other, more sinister forces that may bring the illness about. Witchcraft, bewitchment, poisoning, the presence of an evil spirit, or the casting of a spell on a family by someone who is jealous are all considered possible causes of epilepsy. In this theory of disease there are forces inside the afflicted person that fight with the blood and cause the disease.
These beliefs play a major role in people's choices of treatment. They choose to follow traditional treatment paths in part because they believe that traditional medicines work well in people with epilepsy, and the natural history of seizures and epilepsy may help support the beliefs. For febrile seizures, there may be only a single seizure, so treatment appears effective. Some forms of epilepsy have only rare seizures, so again treatment may appear effective. If the basis for the seizures is believed to be witchcraft or possession by evil spirits, the treatment must be more spiritual, and that treatment cannot be delivered in a hospital. Ultimately many people choose to seek help from the traditional healers because they believe that epilepsy must be treated by traditional medicine.
Although the lack of access to modern medicines often plays a significant role in people's seeking help from traditional healers, people also don't go to hospital because it often appears that modern medicine does not work and doctors prescribe the same medication every time and the seizures still persist. There is often the expectation that the modern medicines will cure the disease, so when the medication runs out or people stop taking the drug, the seizures return, so they see little benefit from the medicine or the effort to obtain it. Still, some people believe that occasionally modern medicines do work to treat seizures. However, if evil spirits are diagnosed as the cause then the spirit has to be removed first by a traditional healer before medications can work. For some patients who have what would be diagnosed by modern practitioners as psychogenic seizures, it is quite possible that traditional practices could be far more effective than modern. There are no data on this potential area of better efficacy of traditional practice.
Traditional medicine can have an important role in the treatment of epilepsy when used together with modern approaches. The local healers can help identify patients in the community and refer them to a hospital. Some practitioners believe that some of the traditional medicines have a true anticonvulsant effect, while others believe that some mix of western anticonvulsants with traditional medicines will be more effective. It is important to remember that traditional healers have a very strong influence on their local community, and they may play a huge role in reducing the stigma of epilepsy in the community. They do sometimes refer patients to hospitals and clinics. Once they have removed the evil spirit, the patient can be referred to a hospital. Some healers feel that once a patient sustains a burn from a seizure then that patient can no longer be treated by traditional medicine and has to be referred to a hospital.
Another reason for going to a traditional healer is the difficulty in accessing modern medicine from a village. There are no adequate local support services, and it can be very expensive to travel to the health facility. Further, the family may be required to purchase expensive medicines and pay for expensive tests, although no comparison has been made between the costs of traditional versus modern medicine. The traditional healers may also be preferred because they have a more holistic approach and occasionally visit the family for history-taking. Even when the family does not have money, the patient will be treated and the family will thank the traditional healer later. These local practitioners will not advertise, because patients will come based on recommendations by other people who have been treated by them.
In developing the much-needed infrastructure for epilepsy care, it is likely that the traditional healers will play a role. They are trusted by the local community, and they work within the local belief system of the causes and treatments of epilepsy. It may be best, until conditions in the communities change significantly, that traditional healers be educated in the basics of epilepsy care and that the medical community work in partnership with them.
In Senegal the neurologists have given day-long workshops with the traditional healers as part of a broader outreach to improve knowledge and care about the disease. These workshops were built around a respect for the position and role that these local leaders have in their communities as well as the recognition that the healers could become important partners. The healers were receptive to the western concepts about epilepsy. Although it remains unclear how these new relationships between traditional and modern will evolve, these workshops have come at a time when epilepsy and seizures have risen from seventh on the list of reasons for referral to hospitals to second.
In a region of the world with limited medical resources this collaboration with the recognized community medical professionals may provide new avenues to providing much needed access to care for people with epilepsy. Perhaps the key to this successful collaboration is the development of a respectful partnership with the traditional healers. They often play a major role in transitioning people with epilepsy from the older, more spiritual understanding of the epilepsies to the current neurobiological concepts of the disease.
About the Author
Dr Edward Kija is a consultant Pediatrician and a Lecturer from Muhimbili University in Tanzania currently doing a Fellowship in Pediatric Neurology at Red Cross War Memorial Children's Hospital in Capetown, South Africa supported by the African Pediatric Fellowship Program. He did his undergraduate and postgraduate training in Tanzania at the University of Dar es Salaam and Muhimbili University, respectively. He has been working as a consultant Pediatrician for the Muhimbili National Hospital in Dar es Salaam, Tanzania since 2011.
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