East Africa’s Healers Embrace Modern Medicine to Treat Depression
WHY YOU SHOULD CARE
Traditional healers and modern psychiatrists are on opposite ends of the medical spectrum. Now they’re partnering to bridge Zanzibar’s mental health treatment gap.
By Anne Kidmose
- A vast majority of Africans trust traditional medicine over modern medicine.
- As mental health crises increase, though, traditional healers are beginning to recognize that they don’t always have the appropriate treatment.
- They’ve begun partnering with their adversaries — psychiatrists — by referring some patients to hospitals.
At the beginning of October, 33-year-old Dume, who prefers to use his middle name only, believed he had been bewitched. He didn’t feel like himself. Thoughts were racing through his head and he kept hearing someone call out his name although no one was around. Terrified by how confused their son had become, Dume’s parents called a traditional healer in their village in eastern Unguja, the main island in the Zanzibar archipelago.
When Dini Uwezu Makame arrived to treat Dume, he immediately knew something was very wrong. But instead of attempting to exorcize an evil spirit, or a jinn, or remove a curse — widely believed to be the cause of mental illness in Zanzibar — Makame referred Dume to the district hospital, where he received antipsychotic medication.
“If someone hears or sees something that others do not, I send them to the hospital,” says Makame, who wears a bright blue soccer jersey. “Previously, I would give them herbal medicine.” In his rustic office, a cow tail with bead embroidery and a fez hanging above it like a crown are displayed on one wall.
The 29-year-old traditional healer, or mganga in Kiswahili, is part of a new movement of healers who are collaborating with mainstream medical practitioners to reduce the mental health treatment gap in the semiautonomous archipelago. While healers often use remedies such as powdered roots, saffron-inked scriptures dissolved in water or incantations to treat mental health conditions, they are increasingly becoming the link to modern mental health services.
Training traditional healers actually works in Africa.
Victoria Mutiso, Africa Mental Health Research and Training Foundation
Since 2017, the U.K. charity Health Improvement Project Zanzibar (HIPZ) has trained nearly 50 traditional healers in how to detect signs of mental illness and provide basic problem-solving therapy, as well as how to refer severe cases to Zanzibar’s clinics or its psychiatric hospital. Over the past three years, district hospitals and primary health care units have seen a growing number of reported psychiatric cases, from 64 per year to 164.
An estimated 80 percent of health issues in East Africa are treated by traditional healers. The rate for mental health issues could be even higher, says Haji Fatawi, HIPZ’s mental health coordinator. “If someone has a fever, they are more likely to go to the hospital,” he says. “But when it comes to hallucinations or symptoms of depression, people seek care from traditional healers.”
While psychiatric services are often hard to access — there are approximately 30 psychiatrists in a country of more than 50 million people, according to World Health Organization estimates — traditional healers are never far away. Zanzibar alone is home to an estimated 800 traditional healers, and across Africa, the number of healers is about 100 times that of conventional practitioners.
With the number of Africans suffering from mental health conditions — especially depression and anxiety — likely to increase due to competition for jobs, which has been exacerbated by the pandemic-related economic disruption, solutions are in high demand. Training traditional healers in recognizing mental disorders and forming links to hospitals could be the innovative fix the continent needs, says Dr. Victoria Mutiso, director of the Nairobi-based Africa Mental Health Research and Training Foundation.
“People seek psychosocial support from the healers because primary care workers don’t always have the time,” Mutiso says. “Training traditional healers actually works in Africa.”
A 2018 study in Kenya showed that trained healers and lay health workers could help reduce the treatment gap — the proportion of patients who remain untreated — to 32 percent from an average of 75 percent in low-income countries.
Still, there are challenges before Zanzibar’s new collaborative model finds acceptance among politicians, donors and researchers in Africa, says Mutiso.
“There is resistance everywhere. Even at international conferences, people think that traditional healers are some weird-looking guys,” she says. “Stakeholders on the ground do not believe in the traditional systems.”
Forming links between healers and hospitals might also prove less straightforward in practice than in theory. Although traditional healers in Zanzibar attend quarterly meetings on collaborations with hospitals, only a handful regularly refer patients with symptoms of mental disorders.
During the past two years, 37-year-old healer Mudu Mohammad Nuru has referred only two psychiatric cases. And while he explains that he does not receive that many patients, he also admits to prioritizing traditional medicine.
“I am on the jinn side myself,” he says, claiming that mental illnesses can have both supernatural and social causes. He first tries traditional healing with patients, and if symptoms persist, refers them to the hospital. “But my treatment works,” he claims.
Dume is grateful that his traditional healer referred him to the hospital immediately. Western medicine helped end the hallucinations and return mental clarity. “If not for the mganga, I would have still been at home,” he says.
- Anne Kidmose, OZY Author Contact Anne Kidmose