25 January 2013

Zimbabwe: N'angas Ill-Equipped to Tackle HIV, TB

ALTHOUGH traditional and faith-based treatments are liked and trusted by many because they are cheaper than conventional medicine, there are greater chances of them fuelling HIV and TB prevalence because of lack of knowledge by practitioners.

Many people are flocking for help to cultural and faith-based practitioners who claim that they can cure TB and HIV delaying early treatment and diagnosis.

A snap survey by this reporter showed that most traditional and faith-based organisations do not have enough knowledge on HIV and TB.

"I just heard that there is TB and HIV on radio but I cannot read the newspaper since I did not go to school. All these medicines that I use to treat my patients come to me in the form of dreams then I will go into the bush to extract them," said Sekuru Julius Malazi a self-styled traditional healer from Chitungwiza.

Sekuru Malazi uses a small hut to conduct treatment sessions. The room is poorly ventilated and this exposes his patients to TB infection.

At his shrine you could see hundreds of people gathered with different health problems which include TB and HIV and he assists them without any form of protection.

"My spirit does not allow me to use masks and gloves. I work bare-handed like this. It is the same spirit that guides me to diagnose and cure all forms of illnesses," he added.

This poor treatment practice is being used by many cultural and faith healers who are mushrooming across the country as they try to eke a living.

Some of them are affiliated to reputable associations, which is a true reflection that there is poor monitoring and evaluation of work from grassroots level.

Most of them claim that they have operating licences but they do not abide by the ethical guidelines in terms of how they are supposed to carry out their duties in areas which they are supposed to operate in.

The Traditional Medical Practitioners' Council of Zimbabwe, which is administered by the Ministry of Health and Child Welfare, provides licences and they have the right to confiscate them whenever there is malpractice by practitioners. Some faith healers make their clients drink prepared solutions which are mixed with lemons, salt, ash and other toxic substances which cause further harm to patients. The concoctions do not have measurements.

They can even go to the extent of making them inhale dark smoke on the pretext that they would be casting out evil spirits which also fuels the spread of tuberculosis. Vertical transmission is also imminent as the practitioner or caregiver has more chances of getting infected while carrying duties.

However, high medical costs in both private and public hospitals are forcing people to rely on cultural and faith-based treatments which is cheaper and easy to consume.

Another traditional practitioner, Sekuru Mbewe Kachuruka (42), said there is grater need for information dissemination and to educate such groups as they are crucial members of the community.

"Modern medicine comes from natural resources which we have to utilise and there are so many traditional and faith healers nationwide. If they are not educated about preventative measures and precautions that they are supposed to use when assisting patients it would be a total disaster," he said.

Sekuru Mbewe added that these practitioners are also at risk of contracting disease as they do not have enough resources like protective clothing yet they get in touch with patients frequently. Most patients first visit their surgeries before visiting hospitals and clinics due to cultural and traditional beliefs that have become strongly attached to them.

"Some people come to our surgeries as they think that they have been bewitched but we also refer them to clinics because we do not have the X-ray machines to examine them. Once we know the actual cause of illness we can then help with treatment," he added.

He said they are usually invited to health-related workshops conducted by local NGOs where they are taught issues to do with cleanliness, stigma, and HIV and TB transmission among others.

Founder and president of the Zimbabwe National Practitioners' Association, Friday Chisanyu, said TB and HIV- related illnesses require emergency attention to avoid further spread.

"There should be no delay in HIV testing for TB patients. All those who claim to have its cure must be scientifically approved by a registered laboratory," he said.

He urged both faith and traditional practitioners to refer such cases to health institutions. He said safer methods of using traditional medicine should be encouraged at all levels in the primary health care delivery system.

"Traditional and faith healers should neither use sharp objects on different patients nor conduct their duties in poorly ventilated rooms as this contributes to the spread of HIV and TB. We are conducting trainings so that they understand that TB is a major public health problem in the country," he said.

Zimbabwe is ranked 17 on the list of 22 high burden TB countries in the world. According to World Health Organisation, Global Tuberculosis Control Report of 2009, Zimbabwe had an estimated 71 961 new TB cases in 2007 with an estimated incidence rate of 539 cases per 100 000 population.

Director of the TB and HIV Unit in the Ministry of Health and Child Welfare Dr Owen Mugurungi said TB can be prevented by keeping people from becoming infected with TB as well as keeping them from getting the disease through early treatment and implementing precautions in institutional setting to reduce its transmission.

"TB is spread from person to person through the air, people with TB of the lungs spray the bacteria into the air when they cough, talk, laugh or sneeze. People nearby can breathe the bacteria and become infected," he said.

Dr Mugurungi encouraged people to use properly ventilated rooms and to always practise good hygiene to avoid spreading the disease. He said TB can be tested using sputum test, X- rays while HIV can be detected through an HIV test not by physically examining the patient. Most TB and HIV deaths can be averted if TB and HIV services work together more effectively and services are scaled up.

Recently, the Joint United Nations Programme on HIV and Aids reported that there has been a 1 percent reduction in tuberculosis associated HIV death in the last two years. The reduction was due to a sharp increase in the numbers of people with HIV and TB co-infection accessing antiretroviral therapy (ART) and a 45 percent increase between 2009-2011 yet TB remains the leading cause of death among people living with HIV.

UNAids and the Stop TB partnership have signed a new agreement to accelerate action to achieve the 2015 goal of reducing death from TB among people living with HIV by 50 percent.

People living with HIV are 20 to 30 times more likely to develop active TB than people without HIV infection.

An estimated 8,7 million people became ill with TB worldwide in 2011 among whom more than 1 million were living with HIV.

Pregnant women and children are particularly at risk, if a pregnant women living with HIV also has TB, the risk of death for the mother and child is higher and the risk of HIV transmission to the child more than doubles.

In 2011, 430 000 out of 1,7 million Aids-related deaths (25 percent) were caused by HIV associated TB.

UNAids executive director Michael Sidibe said TB and HIV is a deadly combination.

"We can stop people from dying of HIV and TB co-infection through integration and simplification of HIV and TB services," Sidibe said.

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