A 27-year losing battle for recognition
Zolani Kraai | Friday July 28, 2017 15:55
While the role of traditional health practitioners is well-recognised and appreciated in many progressive countries, including China and Japan, locally dingaka have spent their lives on the terraces, trodden underfoot by modern medicine.
Many traditional health practitioners (called dingaka in the vernecular) had hoped a landmark World Health Organisation (WHO) report highlighting the importance of incorporating traditional expertise and medicine into the fight against HIV/AIDS, would change paradigms among health authorities. The WHO report entitled Prospects for Involving Traditional Health Practitioners was produced in July 1990 in Francistown and showed that research policies in most countries did not reflect the role of traditional medicine in the delivery of health care.
The report recommended the recognition of the vital role that dingaka play in national HIV/AIDS prevention and control activities. WHO recommended that all countries should formulate national policies on traditional medicines.
Dingaka cheered. Finally, after being looked down upon, after being dismissed as primitive, clueless and dangerous, an authoritative body was recommending their engagement. A policy they believed would quickly come into place and allow them to test their time-honoured practices and medicines and help the fight against, not only HIV/AIDS, but many other ailments was in the offing.
But even today, nothing of the sort has happened.
A conference on traditional health medicine this week found that it had taken five years, from 1990 to 1995, for the policy’s draft guidelines to be finalised and presented to Parliament. Legislators have since come and gone and the policy still sits on the shelves of irrelevance.
The policy was designed to guide training, research and ethical issues in traditional medicine, lending credibility to the field. The policy would have roped in dingaka, government institutions, churches, local authorities, dikgosi, non-governmental organisations and the private sector. It would also seek to protect patients from substandard care, while also educating and guiding practitioners and the community.
Heated debates marked the two-day conference organised by the Ministry of Health and Wellness this week, as dingaka’s frustrations boiled over.
Gaborone-based, but Sefhophe-born traditional doctor, Khumo Keorapetse remembers contributing to the policy back in the 2000s only to hear nothing of it after that.
He said the policy had been on the list of bills to be presented to Parliament and was returned to dingaka once for further interrogation of sensitive issues, before disappearing again. Mmegi was this week able to confirm that the policy and its associated bill had never gone to Parliament.
“We contributed immensely to the draft, but no concrete feedback is forthcoming. The draft policy guidelines underlined the recognition of the role of dingaka and defined our rights, privileges, and responsibilities as health care providers.”
Nonofo Tlhalefang, who operates from Old Naledi, recalls that the policy was also intended to address the influx of foreign traditional practitioners. Today, many esoteric practitioners promise Batswana all manner of miracles and cures, operating in the vacuum created by the absence of the policy.
Tlhalefang said the policy was also designed to protect dingaka from malpractice suits and prosecution under existing penal laws.
“Our communities have been cheated by fly-by-night practitioners and the damage affects even most practitioners who are certified and diligently doing their jobs,” Tlhalefang said.
Botswana University of Agriculture and Natural Resources (BUAN) Professor of Pharmacognosy, Daniel Motlhanka urged dingaka not to give up in advocating for the policy to become recognised.
Motlhanka, a herbalist who also specialises in biological and pharmaceutical sciences, said it was time for effective collaboration between government health institutions and traditional practitioners in parallel health care.
“The herbalist must also be involved in prescription and scientific validation of plants used in traditional medicine,” he said.
Motlhanka urged traditional health practitioner associations to introspect in the running of their affairs, especially on matters of strengthening institutional systems.
“Reconsider evaluating your organisational status, whether you want to remain a society, council, trust or association. You must work within clear legal frameworks, and ensure that you also apply serious attention to your constitutions,” he advised.
The dingaka recalled a 2015 statement by the health ministry’s deputy permanent secretary, Havuna Jibri, who said the ministry was ‘working hard’ to finalise a draft bill incorporating the policy.
That was just an unfortunate delaying tactic, delegates at this week’s conference said. Health and Wellness’ permanent secretary (PS), Shenaaz El-Halabi yesterday said the delays in the finalisation and implementation of what is known as the Traditional Health Practice Bill have been due to the challenges of registering the various categories of practitioners, among others.
“The list includes herbalists, traditional doctors, sangomas, faith healers, traditional birth attendants, healers of song, bone menders (thobega), blood suckers (didupe), hydrotherapies (basebeletsi), prophets (baporofeta), to name but a few,” she said. “All these categories do not undergo the same kind of training.”
According to the PS, a National Reference Committee has been established comprising representations from nine traditional healers’ associations. The committee meets quarterly with Health Ministry officials and has been instrumental in the development of the draft bill.
“We are in the process of addressing pertinent questions emanating from the draft bill through consultation and some of these relate to the definition of a traditional health practitioner, establishing of the governing council membership and criteria for testing before registration,” she said.
The last question on testing is tricky. The essential question is how to determine the effectiveness and efficacy of the practice in question.
“The problem is that all traditional health practitioners undergo different training, while some do not undergo training at all. They state that they had a dream and gift from their ancestors.
“They could not therefore be subjected to testing before registration because there would be no one to test them.”
Traditional health practitioners, meanwhile, are now focusing on sharpening their methods in order to prepare for the introduction of the policy and its associated bill, starting with the basics. Motlhanka took the lead, urging practitioners to ensure cleanliness of containers and hygiene of handling.
“Avoid collection of herbs at sites close to dumping sites, mining areas, sewage ponds and industrial sites,” he told the conference.
He also warned dingaka against spiking their herbs with antiretroviral drugs and antibiotics, a habit that is apparently common.
“That could cause serious complications such as severe overdoses and can precipitate drug resistance, not only to HIV positive patients on treatment, but other illnesses as well,” he said.