Traditional healers play key role in epilepsy management
2 November 2009
Members of a Kenyan community perceived traditional healers to be more understanding of their circumstances - listening more and offering deferred payments - as well as giving better explanations for their illness, according to research at the Kenya Medical Research Institute (KEMRI)/Wellcome Trust Collaborative Programme in Kenya.
"Things like flexible payment and proximity of treatment provider are important, but these factors shape decisions about when treatments will be sought, and are less important in deciding which specific treatment option to access," says Dr Nathaniel Kendall-Taylor, who led the research.
"The primary factor in initial decisions was the family's understanding of what caused the symptoms - an understanding that is shaped by the cultural theories of causation that the family holds. As the family gains experience with the condition and its various treatments, a different set of factors become more important in their decision-making - mainly their perception of the effectiveness of past treatments sought."
The researchers surveyed a group of 10 families, 8 traditional healers and 12 biomedical health workers in the Kenyan district of Kilifi, north of Mombasa, over a 10-month period.
They found that convenience played a part in deciding whether to seek traditional or biomedical treatment for epilepsy. While traditional healers are located in every community, biomedical facilities, the level of staff training and access to anti-epileptic drugs varies widely.
But cultural factors played a bigger role. Healthcare workers were often wealthier and better educated outsiders, but had little interaction with the community. Some patients reported disappointment at the briskness of their visit and the lack of support from staff, which made them less likely reveal personal information.
In contrast, many traditional healers knew their patients and their families personally. They were willing to take time to listen to a patient's problems and involved their family in the consultation, the constant communication making both patient and family feel actively involved in the treatment process.
Their explanations also helped to link the causes, treatment and symptoms of the condition, including reasons for why symptoms were sporadic and why some treatments failed.
The researchers suggest that better consideration of these factors could help in the rollout of healthcare interventions, particularly neuropsychiatric conditions, in developing countries.
"Biomedical practitioners would benefit from considering the cultural context of neuropsychiatric conditions," says Professor Charles Newton, a Wellcome Trust Senior Fellow at KEMRI.
"Training in culturally accessible ways of framing epilepsy, symptoms, causation, and treatment may improve access to antiepileptic drugs and reduce the treatment gap."
Image: A traditional healer's home in Kenya. Credit: make_change on Flickr
Reference
Kendall-Taylor NH et al. Comparing characteristics of epilepsy treatment providers on the Kenyan coast: implications for treatment-seeking and intervention. Rural Remote Health. 2009;9(4):1253.