Traditional Healing

I’ve had some interesting conversations with people lately about traditional Malagasy healing practices coming into conflict with western biomedical treatment. So I thought I’d write about the differences in worldviews and practices and how those differences have affected the health of rural communities here. The issue of traditional medicine came up a few weeks ago, when a very sick women came to the clinic. She was suffering from some sort of stomach illness and her family had brought her to our village to seek medical treatment too late. Her condition was quite grave at this point, and there wasn’t much the nurse could do except suggest that they travel as quickly as possible to the regional hospital in Sambava with better facilities, where they might be able to do something for her. The nurse’s wife explained to me later, that this family practiced “Ody Gasy,” or traditional medicine, and only after they had tried every possible alternative treatment did they decide to come to the health clinic as a last resort. Practicing traditional medicine had delayed their seeking western medical treatment, which limited the amount of help the nurse could offer, as this woman’s condition had deteriorated so rapidly.

I often here people in the community mention traditional healing methods, such as eating, drinking or breathing in the vapors from the leaves of medicinal plants in the forest or going to traditional healers for special therapies or “massages.” I had even met a traditional healer once, who claimed to be able to cure sexually transmitted diseases and illnesses causing swelling of the legs and breasts (filariasis/elephantiasis). Every market day, there are always a few stalls of people selling dried leaves, powders and various bottles of tonics that claim to have healing properties for every kind of malady. So I was curious to find out what the possible motivations were for those who opt for the traditional methods rather than seeking treatment from the medical clinic first.

My initial thought was that money may play a role in the decision-making process. I often here people at the clinic talking about not having enough money to buy the necessary medicines for their illness at the pharmacy. Perhaps people who were worried they wouldn’t be able to afford the medical treatment seek out other alternatives instead. This idea was quickly dispelled when the nurse’s wife explained that many traditional Malagasy treatments are actually more expensive, especially if the family requests a home visit from the traditional healer. While an initial diagnostic consult at the health clinic is free, even just a visit with the traditional healer can cost several thousand Ariary (a few US dollars, but still quite a sum for those in rural areas). Many of the simple, government subsidized medications like Tylenol, cough medicine and vitamins at the pharmacy cost 10,000Ariary (5USD) or less (and some, like Malaria treatment, are free), but some of the medicinal plants needed for traditional healing can surprisingly cost 30-50,000Ariary (25USD). Additionally, vaccinations for children under 1 year are free at the clinic, but many of the people who practice traditional medicine don’t get their children vaccinated. These facts made reconsider my initial conjecture.

Another thought was that the physical distance from health centers might influence people’s decision, especially if there are traditional healers living in the more remote, rural areas. If one couldn’t make the three hour trek through the woods to get to the health clinic, it would make sense that they would at least seek out a healer living in their community or in a village nearby. This factor may influence those living in isolated regions, but it is not a factor for the community where I live. Our village has a clinic with a very competent and reliable nurse and a pharmacy stocked with basic medicines, so the community members don’t have to travel more than 15 or 20 minutes to reach good medical care. However, there are still several traditional healers and many people practicing traditional medicine right in our village and in some of the surrounding communities. Some people in the vicinity of our clinic still choose to seek out traditional methods rather than making the short trip to see the nurse.

Another possible factor could be the clinic staff. Some Malagasy are embarrassed to seek medical treatment for things like sexually transmitted diseases for fear of judgment by the doctors or midwives. In particular, many people complain about the health care providers in the referral clinic down the road. I have frequently heard from community members that they are afraid to seek treatment at the larger health center in town, as they claim that the doctor and midwives who work there are often short with the patients and chastise them for not completing their vaccines, for being illiterate, or for not having money to bring with them to the clinic to purchase their prescribed medicines. I could definitely see fear of the medical staff as a reason for Malagasies choosing to seek alternative care, especially concerning the larger clinic down the road. However, I have a feeling this boundary isn’t as big of an issue in my immediate area, as the nurse at the rural clinic where I work treats his patients very well and is viewed as a friend and well-respected community member by many of those with whom he lives and works.

This idea of embarrassment was also reinforced during a group discussion with the SIDA Club (anti-AIDS club) students at the local middle school. We were talking about treatment of STIs, so I asked them about the possible reasons they thought some Malagasies might use “Ody Gasy” to treat their STI rather than going to the clinic. Several of the male students said that they would be embarrassed to go to a clinic, especially if a female provider such as a midwife were the one providing the treatment. Additionally, some of them offered that people might be afraid of getting a shot, which might be a reason for them to avoid the clinic.

Relating to the issue of embarrassment over seeking treatment at a clinic, there are frequent occurrences here of young women using the leaves of medicinal plants as a form of abortion. There have been several cases at the clinic of teenagers still in school who have miscarried after consuming leaves of particular plants they had collected from the forest to take care of their unwanted pregnancies. As abortion is illegal in Madagascar, these young women are faced with the dilemma of telling their parents that the precious savings they have spent on expensive school fees for the year is wasted, so they seek out other means of dealing with the issue. The fact that traditional medicines are used in this instance could reinforce the idea that embarrassment plays a role in the decision-making process, especially considering that family planning methods are free and confidential for anyone who chooses to come to the clinic, regardless of their age or marital status. However, lack of forethought and lack of power and status of the women in the said relationship also come into play with this issue of unwanted pregnancies.

After my conversation with the nurse’s wife, I’ve come to think that the Malagasy’s worldview, especially with respect to their view of the particular cause of their illness, may be the biggest factor in deciding which type of treatment to seek first. While there does seem to be some flexibility in many people’s worldview here, in the sense that they are willing to practice both western and traditional medicine, many do seem to prioritize based on which practice they ascribe more validity to. Their values and belief system may have a significant influence in this prioritization. Very interestingly, the nurse’s wife noted that most people in our community who attend church (i.e. ascribe to the Christian faith) do not practice “Ody Gasy.” She explained that for the most part, only those who “tsy mivavaka,” or, do not pray, seek out the traditional healers. This pattern seems to suggest that those who value the traditional belief system over adopted western practices tend to value traditional medicine more than biomedicine, which would make sense. Additionally, it seems that if a person suspects witchcraft has played a role in the particular illness, they will seek traditional treatment accordingly.

In one particular case a few weeks earlier, a child in family living down the road had died of a fever, because they came to the clinic too late. Apparently this family had gotten into an argument with another family in the area over rights to some farmland. Soon after the argument, their child felt sick. The family believed that this illness was brought upon by the other angry family, who had essentially “cursed” them. Because the family believed the illness was due to malicious intent from someone in their community practicing witchcraft, they decided that traditional healing methods rather than western medicine would be the best treatment for the child. Only when they had tried everything to counteract the curse did they contact the nurse. At this point, the child unfortunately was already on her deathbed.

According to his wife, the nurse has frequently asked people who practice traditional medicine to avoid waiting until it is too late to go to the clinic. His suggestion to those who use “Ody Gasy” is to only try it for a short time and then also to seek treatment at his health center. It shows a respectful openness and flexibility on his part that he is does not invalidate the community members’ belief systems, but simply attempts to get them the best healthcare possible. I also wonder if it would be possible to go a step further and work with the traditional healers themselves to encourage them to promote concurrent use of benign traditional healing practices and western biomedicine.

In particular, eliminating any traditional medicines that could cause harm to the patient would be very helpful. One of the issues is that some of these plants from the Malagasy rainforest do actually have legitimate medicinal qualities, but most who use them do not know in what quantities and in what forms to take them. Consequently they end up doing more harm to themselves than good. Training traditional healers in proper use of more benign medicinal plants and discouraging the use of self-medication in addition to a timely referral process to the health clinic could be a potential middle ground for those wishing to maintain their cultural practices and belief systems.