Traditional healers and medicine are essential and in most cases serve as the primary sources for people living in societies, where the state is unable to provide important basic social services.
In an attempt to explore these complex and critical issues, the Platform for Dialogue and Peace (P4DP), a Liberian research NGO – with support from a U.K. based charity, lunched a study to understand the role that traditional healers, herbalists, spiritualists including country doctors, Zoe, etc play in health matters.
In particular the transmission and mitigation of the Ebola Virus Disease (EVD) and how this group of health providers could help strengthens the national health services of Liberia.
The Platform for Dialogue and Peace Executive Director, James Suah Shilue
Liberia suffered close to two decades of civil war that has a catastrophic impact on essential social and economic infrastructures. Consequently, the state has been unable to provide effective basic social services like- good healthcare, education, safe drinking water and electricity to both rural and urban population. In the absent of these essential services, people will engage in various means to meet their basic health needs.
P4DP’s workshop in this regard, marks an important part of the study and was intended to provide training for local facilitators- individuals who were selected in nine of the fifteen counties of Liberia, on how they could be of help in the identification and selection of individuals that have vast understanding of traditional healers as well as their contributions to the fight against the deadly Ebola Virus.
It could be recalled that during the outbreak of the recent Ebola crisis in Liberia, all hospitals and health care centers were closed, when medical practitioners unknowingly died from Ebola while trying to serve their patients. Distinguishing who is and not affected by the EVD was quite a challenge for health providers because the various health facilities never had advanced equipment and trained personnel.
Although some improvements have been made in the area of basic service delivery, overall the systems remain highly vulnerable to corruption with bribes sought in exchange for services. Mechanisms of accountability to sanction such behavior are limited. This not only limits access, but also reflects poorly on government ability to provide for a population in significant need.
According to a 2012 Fragility Assessment study, the number of functioning health facilities in Liberia increased from 354 to 550, while the approximate number of health workers increased from 5,000 to more than 8,000. Sadly, hospitals in Liberia remain in generally poor physical condition and are staffed with insufficient numbers of productive, responsive, and qualified staff in key areas of competence.
Liberia is home to approximately 0.5 doctors, nurses and midwifes per 1000 population, far below the World Health Organization’s (WHO) 2.3 per 1000 benchmark associated with achieving an 80% coverage rate of deliveries.
Whilst the number of mid-level cadres, particularly nurses and midwives has been steadily increasing since 2000 (due to concerted investment into their production and work at primary care levels), growth in the number of physicians remains low. Addressing this deficit was paramount in the first PRS.
About sixty-three percent of sector deliverables were realized through the National Health Policy Plan, which focused on restoring basic health services such as under-five mortality, malaria and functional health facilities. But even with these improvements, access remains skewed in favor of urban populations and those who can afford private health care.
The Ministry of Health and Social Welfare data shows that only thirty-four percent of urban and forty percent of rural residents are said to have health clinic in their areas. Meanwhile, the Government’s investments in the total number of health facilities in Liberia has increased from 618 in 2010 to 725 in 2014, according to the HMIS data. In 2014, there were 35 hospitals, 51 health centres, 639 clinics and 137 pharmacies.
A facilitator making a presentation during the training
Twenty-two percent of the health facilities were private-for-profit of which nine out of ten were located in the urban counties of Montserrado and Margibi.
That said, on the overall, progress in health sector have shown little or no impact in the lives of many Liberians and therefore no wonder that the health sector quickly disintegrated under the weight of the EVD outbreak, revealing the high degree of fragility that still persists in the health care system specifically and the system of governance and institutions as whole.
Understandably, the most accessible health-care options for the vast majority of Liberians remain the traditional health provider. While the acute shortage of efficient medical equipment and trained service providers contributed to the paralysis that the biomedical health centers face during recent health emergency, the crisis was also exacerbated by ‘cultural and traditional practices’.
Historically both herbal and spiritual traditional practitioners have alleviated the ills of millions of Africans caused by what western medicine classifies as acute or chronic diseases, infections, traumas, and psychological illnesses. However, the scale and disaster of the recent Ebola epidemic has been attributed to the weak health systems and chronic traditional and cultural practices.
For example, some ethnic groups were adamant in washing their deads despite been warned by biomedical authority to desist from such practices. Couple of Liberia prominent doctors got killed by Ebola.
Stories abound also about the death of pastors, imams and spiritualist who continued to place their hands on members of their institutions that were even showing signs of the EVDs. A high profile self- proclaimed traditional hearler, who claimed that he could cure Ebola in Nimba County, also died from Ebola.
All these make such a study by a Liberian NGO a good initiative. But exploring ways to see how ‘alternative medicines’ can be “ institutionalized” and complement the biomedical practice cannot be done without scientifically investigating firstly the extent to which local populations are utilizing and relying on these healers and second, how traditional healers understand deadly disease, example Ebola, and their capacity to cope with them.
Elucidating how P4DP intends to grapple and unpack the study, P4DP Director, James Shilue, said they will rely on a mixed-methods qualitative approach involving the participatory action research (PAR) method to elicit local understandings and experiences of health care provision.
Speaking further, he pointed out that training local facilitators will enable the study to be locally owned and driven in order to win the trust of those who seek and provide various services.
According to him, “it only through such approach that we can develop a more nuanced understanding of alternative medicine and their public health potential, which we think could serve to strengthen national health systems long after the outbreak has been brought to an end.
At the end, we will be contributing to strategic health-seeking options that promote diversification and, therefore builds resilience and reactivity into the public health system”, Shilue noted.
In his brief remarks, Mr. Jallah, Director for Culture at MIA, said he likes the idea of engaging the traditional healers because they are important in the society. Mr. Jallah said his department will be willing to provide some assistance that P4DP would need in carrying out the research. He reassured the research team of his fullest support.
He said this project is about knowing the contributions of urban and rural herbalists and healers are giving to the society and what help they can get in return from government and the international community.
In an attempt to debunk the notion that all traditional practices are harmful, Mr. Joko Moses Kuyon- a Traditional High Priest and Chair of Bong County Cultural and Traditional Body, vehemently refuted the generally held view that Zoes are not supposed to be included or talked about.
Instead, the culturist lamented that Zoes are friends of the society who want to ensure that societal norms are protected and respected. He said like all traditional healers, Zoes are Traditional Scientists, while Bodeo handle the disciplinarian aspect and spiritualist, mostly in the Church and Mosque, are engage with offering prayers for healing, peace and prosperity.
Acknowledging the efforts of the traditional people, Jackson Speare, Head of Secretariat of CSO Consortium on NRM, observed that when the communities’ structures and people were included in the fight against Ebola, the country noticed the beginning of the nose dive.
He added that he was optimistic that with the involvement of the traditional people in the research intended to highlight the efforts of traditional healers and their contributions to society, we will have a better understanding and appreciation as to how to support them support our health care system in a positive way.
The highly insightful and interactive workshop ended, after a break up session which allowed participants to extensively delve into anticipated challenges of the study and feedback with presentations and concrete recommendations followed by a summary by The Master of ceremony, Alphonso Woiwor.