Ruth Ansah Ayisi
MAPUTO, Dec 21 2006 (IPS) – A motley group of about 20 men and women eyed each other tentatively as they met for the first time to discuss how they could jointly fight HIV/AIDS.
On one side of the table were doctors, nurses and counsellors, who had just finished a busy afternoon discussing the treatment of people living with HIV. On the other side sat traditional healers, or cureindeiros as they are known here, who had been bussed in by the Mozambique Red Cross, some from the rural areas.
The need for these discussions has become pressing in a country where certain traditional practices not only undermine women s equality, but are also the cause of HIV infection among women. Nonetheless, the atmosphere was uneasy in May 1st Health Clinic, situated in one of the bustling suburbs in the heart of the capital, Maputo.
At first nobody wanted to kick off the debate, despite the efforts of Amelia Macaringue, the vibrant facilitator from the Mozambique Red Cross. She asked, How can you work together to prevent the spread of HIV? Do you think you can come up with a plan of action?
What difficulties do you think you will face working together and how can they be overcome?
The questions about the difficulties sparked a reaction. Aurelio Morasse, a traditional healer, responded: I am educated too. I was a teacher before, so I know what I am talking about. There are illnesses that only a traditional healer can cure, but you (the doctors) do not refer them to us.
We know how to cure people of evil sprits, for example, and some infectious illnesses. Who knows, we could come up with the cure for AIDS.
From the other side of the table Madelena Anapenje, a medical doctor, argued back: But you are spreading HIV by using the same razors on different people. And how can we refer people to you when we do not understand what you are doing, because you keep your practices secret?
This historic face-to-face meeting earlier this month followed years of the Mozambique Red Cross working separately with traditional healers on HIV prevention, conducting workshops on safer practices.
Yet, despite these efforts and others on prevention, Mozambique still has not managed to stem the rise of HIV/AIDS. About 600 people are infected each day, most of them under the age of 24 years. The prevalence rate among 15-59 year-olds is 16.2 percent, one of the world s highest.
It is having devastating effects with which Mozambique, as a poor country, cannot cope. Mozambique s health service network is one of the weakest in the region with around half of the population having no access to it. The country s 600 doctors are concentrated in Maputo.
Macaringue said that because so many people turn to traditional healers for health care they could make a big difference, especially if given more opportunity to work together with Western-style doctors.
Traditional healers have huge influence in communities. They are popular health care providers for most people, both in rural areas and in the cities. People should not only focus on their negative practices, she argued.
However, she conceded that some of their practices continue to spread HIV/AIDS. One of these is the purification rite which traditional healers recommend after death in a family. This involves a male family member having unprotected sex with a female family member.
In some villages the healers have told them if that does not happen or if a condom is used, the rest of the family members will die.
The 31-year-old Julia Mondlane*, who lives in a rural village in Chokwe district in the southern province of Gaza, told IPS that she refused to perform the purification rites following the death of her husband. Since then she has come under tremendous pressure from her family.
When my husband died, his older brother said he would perform the purification ceremony with me and then take responsibility for me and my children, said Mondlane.
But he is much older than my husband and I see him more like a father figure, so I refused. Since then my children have been ostracised by my husband s family. Her children are aged seven and 12.
Her late husband, a former miner in South Africa, died after an illness which was probably AIDS-related. Although she is looking healthy, Mondlane could be infected too. This did not stop her brother-in-law wanting to have sex with her for the sake of tradition .
According to Macaringue, there have been gradual changes to these practices, and more traditional healers are adopting and advocating safer practices.
For example, Alice Chauque, a traditional healer, told IPS that she sees about 50 sick people a month in the rural railway town of Moamba, some 45 kilometres from the South African border. Many of them suffer from HIV-related illnesses.
I have changed my practices after participating in training provided by the Red Cross. We used to think that the cause of AIDS was someone having bewitched someone else. Now I know how it is transmitted.
If I have to vaccinate (cut) my patients to get rid of an evil spirit, I ask them to bring their own razor blades. I use gloves because some of my patients bleed a lot when I cut them.
She believes drinking herbs rather than having unprotected sex could also be an effective purification ceremony. I also know when I cannot treat someone I should refer them to the hospital. I know when one of my patients should go to the hospital to start treatment with antiretroviral drugs. I feel we can work well with doctors in the hospital.
Macaringue said that although it has been relatively easy working with the traditional healers separately, it has been difficult to get the doctors and traditional healers together. The meeting was a success because they started with a face-to-face dialogue.
The next challenge is to arrange follow-up meetings. The healers and the doctors agreed that this was the start of monthly joint meetings, but no date was set for the next gathering.