Ruth Maclean
Practitioners of traditional medicine – the first port of call for 80% of Guineans – could be invaluable in helping fight other killer diseases, such as malaria
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| Mory Kaba sells herbs at his shop in Kissidougou. Such traditional healers enjoy communities’ unquestioning trust, and were vital in spreading key health messages during the Ebola outbreak. Photograph: Kate Holt |
Dressed in a stripy shirt and white skullcap, Mory Kaba roots around behind bottles of mysterious dark liquids and pulls out a small package. A new patient has just arrived at the traditional healer’s shop in Kissidougou.
Kaba’s table is spread with khaki-coloured powders and brown pellets. His patient, a middle aged woman with £1 to spend, has fever, stomach pain, a headache and sore feet. He sells her a twist of yellow powder, gives her instructions, and writes down the sale in his ledger.
“If I’ve tried two or three times to cure someone and nothing works, then I send them to the hospital,” Kaba says. “I haven’t seen this lady before, but I have treated these symptoms in the past, so I’m giving it a go.”
Motorbikes cocooned in bubble wrap whizz past his wooden walls: they are all protected against the rain like this in Guinea, where despite its mineral wealth and fertile land the poverty is relentless as its downpours.
Traditional healers, who in this west African country mainly forage for remedies in the forest, are believed to be the first port of call for around 80% of sick Guineans. A dire shortage of health workers means there is not much competition for these men and women who live in the communities they treat. They are thought to have divine powers, and enjoy unquestioning trust.
This trust proved crucial during the Ebola outbreak, when traditional healers were persuaded to refer patients to treatment centres and were taught how to stop it spreading.
Now, the government is considering trying to integrate traditional healers into the healthcare systems more generally in Guinea, to help fight other diseases including malaria, cholera, meningitis and measles.
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| Mory Kaba, a traditional healer, in his shop in Kissidougou. Photograph: Kate Holt |
“We believe that they should be part of the health system. Better to organise them, and rely on them as a surveillance system,” says Guy Yogo, Unicef’s deputy representative in Guinea, who is in discussions with the government about bringing them into the fold. “If the government agrees that they should be part of the health system, then my view is that it’s worth investing, because they are not asking a lot. When people are organised, they comply more easily. If we leave them outside the health system, they won’t comply.”
The Ebola outbreak, which killed more than 11,000 people and was only finally declared over in Guinea in June, was a terrifying experience for those who lived through, or near it. Doctors and nurses were dying, medicine ran out and clinics closed their doors. Family members would suddenly die horrible deaths. Strangers in alien-looking suits would come to take away the bodies – bodies that should, according to important local customs, have been touched and washed and buried by the community. Rather than traditional white shrouds, bodies were buried in black bags – something Guineans believed would surely send them straight to hell.
“The pharmacies were empty. There were no more drugs – nothing! Traditional healers were the only option,” Yogo says.
However, in some cases their attempts to treat Ebola made the situation worse, as they contracted the virus themselves and passed it on to patients.
One study found that an explosion of Ebola cases stemmed from a well-known healer who had tried to treat the virus and died. Then, 14 women caught the disease at her funeral, just over the border in Sierra Leone, and spread it throughout their communities.
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In a shady clearing in Kissidougou, a tall man in a white coat with a Christmas tree drawn in felt-tip on the chest presides over a meeting of dozens of elderly healers – men and women – with Hawa Sakho, a Unicef representative.
“People always start with us. During Ebola, I called all of the traditional healers and told them that if someone is sick, to see if it’s Ebola and send them to the hospital,” says Fakoly Kourouma, the president of a local association of healers. “People were scared of the hospitals, though. We tried to convince them. Sometimes I took patients there myself.”
Now, many healers are used to passing patients on to the hospitals, and they do it for other diseases they cannot treat. Referring patients to health centres, however, is not necessarily a sound financial strategy for a healer.
“It was very difficult, because it took work and money away from them,” Yogo says.
The healers don’t always see themselves in competition with health services, though.
“The hospitals can treat some things we can’t and vice versa,” Kourouma says. “If someone puts a curse on you, we can treat you – the hospital can’t. If you have a broken leg, we put something on it and touch it and a few days later it’s fixed … ”
After the meeting, Unicef’s Sakho explains how the organisation works with the healers so that the sick get the treatment they need. “Most of the time we do training with them – how to treat a patient, hygiene, when a patient is in the house, you need to put them in a separate room from your family – things like that.”
This helped stem the spread of Ebola in communities, but also protected the healers themselves. Laye Mamady Doumbouya, a traditional healer in Siguiri, made a narrow escape.
For years the sick, the impotent and the cursed have visited him at his modest compound to buy his medicine. He is blind and sits, surrounded by peanut shells and flies, in the plastic chair where he has sat in for many years, waiting for patients.
One night in 2014, Doumbouya’s household had been asleep for hours when a patient arrived, brought by friends.
“I told them that I didn’t have enough space in my house, so I couldn’t accept him that night,” Doumbouya says. “They spent the night in their car, and when I woke up in the morning I noticed that they were still there. So I sent my sons to look for medicine leaves in the bush so that I could treat him, but by the time my sons came back, the man had already died.”
The man, it turned out, had run away from home after his mother died from Ebola and he was listed as a contact. Doumbouya had never seen anybody with Ebola before, though he had heard of the disease, and his precaution of not touching the man and not letting him in the house probably saved his family, who were quarantined immediately.
“Luckily, none of my family got sick, but we were victims of stigma,” he says. “Neighbours avoided my family and people stayed away from my wife when she went to the market.”
Ebola was a terrifying disease, and has understandably made people suspicious.
“For people to start using the health system again, trust will have to be rebuilt,” says Yogo. “People wanted good answers about Ebola – why was there this disease, and why couldn’t the health workers deal with it? Ebola was a really scary disease.”
He believes that traditional healers are ideally placed to help restore confidence.
“They are the first-line counsellor in communities. The community believes they hold some sort of divine power. They are well-respected, and they’ve been effective helping us lifting resistance and rebuilding trust in the communities.”
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