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The Tanga AIDS Working Group (TAWG) A Traditional Medical Island of Hope By David Scheinman Samwell Mtullu, MD Firmina Mberesero, MD Mohammed Kassomo, Traditional Healer (TH) The World Bank April 30, 2003 Who are we?… a thumbnail introduction • We’re TAWG and have treated 4,000 patients since 1991 with plant-based medicines provided by traditional healers. • We’re a multidisciplinary NGO linking physicians, health workers, healers, people living with HIV/AIDS (PLHAs), botanists, social scientists, and community members. • We promote and support collaboration between indigenous and modern health systems. • We’re well integrated -- our offices are in the government’s regional hospital. What is TAWG’s goal? • Our Goal: to bridge gap between traditional and modern medicine to treat PLHAs & reduce AIDS transmission. • Signature Activity is treating PLHAs with traditional medicine enabling them to continue or resume their normal activities. • Our medicines are effective, cheap, non-toxic, and readily available locally. • Our achievements can be replicated throughout Africa IF selected healers are taken seriously. What do we do? Core activities 1. 2. 3. 4. 5. 6. Treatment; bridge gap between hospital, healer, and patients Home Care Program Ethnobotanical Research AIDS Education for Community and Healers Partnerships Run 3 information centers on HIV/AIDS. 7. Distribute IEC Material 8. Video shows, discussions, & condom distribution. 9. Collaborate with 20 community theatre groups. 10. Run Youth programs & STI Clinics. 11. VCT Centers 12. Train traditional healers in counseling & homecare. Some Headlines Traditional healers carry the burden of care for HIV/AIDS throughout Africa, so let’s join forces. 80% of Africans visit TH’s. Hippocrates, an early herbalist, advised physicians to do no harm AND to share their knowledge Plants -- unlike us -- can’t run from attackers so fight by producing own antidotes in form of anti biotics, fungals, and virals. We borrow these to treat our own opportunistic infections. THs know what works! Wild Plants represent the largest known therapeutic arsenal for combating major killer diseases. Background – It Began in Pangani • TAWG sprouted in 1990 from collaboration between THs and doctors in Pangani – a sleepy Tanzanian coastal town. • Started by chance; real serendipity. • German doc saw patients who were treated by THs. • He and health workers from the District Hospital began dialogue with THs. • This evolved into regular meetings and referral network. Background • Healers responded VERY enthusiastically. • Discussed all diseases and identified who does what best. • Waziri Mrisho - 84 years old, offers to treat HIV/AIDS patients in hospital. • Patients surprisingly improve and Mrisho’s plant medicines wind up in doctors’ kits. • Plants are botanically identified and integrated cooperation begins. • From this simple experience sprung TAWG. Quick Point: Voluntarily began cooperation with only an idea, support from the District Medical Officer, and zero funding!!! How do we work? TAWG’s Signature Treatment Program • Patient can also be • Initially test for HIV, treated directly by TH. counsel, and give patient option to enroll in TAWG’s • Patients treated for free program. -- we pay healer to • Provide pre and post HIV collect. test counseling for patients and their families. • On request, we distribute medicines • HIV-positive patient can throughout Tanzania. enroll in TAWG program -use traditional medicines collected by a healer, distributed by Hospital. How does TAWG’s Signature Treatment Program Work? • We prescribe medicines at doses provided by healers. • Physicians and nurses subsequently monitor patients. • Patients use our medicines to treat and prevent illness. • Many say ours only treatment -- modern or traditional -- that worked. • Most patients try conventional medicines before seeing us. • More people join TAWG earlier now. Previously had many terminal patients. • Standard treatment is 4 plant medicines. • Major side effect is increased appetite! What do the patients say? • Patients report TAWG’s most valuable activity is treatment. • Patients use the traditional medicines to treat and prevent opportunistic infections caused by HIV/AIDS • TAWG patients enthusiastically claim that the medicines work. After nearly 11 years of TAWG administering these medicines, we think they are right. • There is a compelling body of anecdotal and observational data from patients and staff. For example our medicines help to: • • • • • • • • Increase appetite Gain weight Stop diarrhea Reduce fever Clear up oral thrush Resolve skin rashes and fungus Cure herpes zoster Heal ulcers What else do patients say? • Many clients say our • Most patients begin treatment only one that seeing results from yielded results. between a few days and • Many patients treated a month after entering with modern and treatment. traditional medicine before • Medicines have not visiting TAWG. proven to be very helpful • Reduces argument for when HIV/AIDS is in an placebo effect - many advanced state. expected to get well with western or traditional • Some patients go on and meds -- but didn’t. off treatment Patient Results • Patients who survive for 6 months generally live 2-5 yrs. -- some even for 10 years. • Medicines given to patients in powder form to make tea, or mix with coconut oil/water for topical applications. • Our goal is effective treatment. We provide any treatment, traditional or conventional, that contributes to patient well-being. • Due to treatment, many patients resume cooking, cleaning, farming, and becoming active parents again….quality of life improves – length too. • Patient improvement has priority over research. Ethnobotanical and Medical Research • Selected healers provide • Through research with local healers, identified promising medicines at prescribed treatments for HIV/AIDS doses for specific related opportunistic conditions. infections. • Patients monitored for • Key: identifying efficacy and side effects. knowledgeable healers and • Research supplemented cultivating relationships. by literature reviews. • Give healers professional respect, trust, access to • College interns help build hospital, fair price for their research capacity time & plants, and 1 seat amongst our healers. on TAWG’s Board of Directors. • Also a PLHA on board! How do we do it? • Show pictures to healers. Recognize condition? • Use illustrated field guides developed by Shaman Pharmaceuticals. • Describe symptoms. • If healers identify condition and have a plant, take sample & botanically identify at Lushoto Herbarium. • Collect plant with healers and compensate for their time. More about how we do it… • Conduct literature review through NAPRALERT and other sources. • Get dosages from healers. • Give to patients under physician’s supervision. • If works, give to more patients. • May carry out observational study with students, healer, and patient. • Monitor results and draw conclusion. • Examples of success: Anti-fungals from Masai and anti viral for herpes from Zigua tribe. Zigua medicine was tested in a lab and showed positive results against herpes. Partners • • • • • • • • World Bank IK Program Oxfam German Church Group (EED) USAID (initially) Peace Corps Crises Corps Gent University – Environmental support Advisor from APSO (Irish Aid) Initially Shaman Pharmaceuticals and Tibotec, two tiny biotech companies. Achievements Have Cumulatively treated around 4000 patients since 1991. Presently we treat 400 patients free of charge at three sites. Our Home Care nurses are tops; really excellent. Improved capacity of healers to assess patient progress. Successfully ran Community to Community exchanges with support of World Bank IK Program IK Program brokered relationship between NIH and TAWG More Achievements We are pioneers in developing innovative collaborative programs with healers. We effectively link modern and traditional medicines. Enjoy good relationship with local government, other HIV groups, and the private sector. Our initiative has enabled us to obtain moderate financial support. Lessons Learned • Act creatively - we had • Individual healers are an idea and secured easy to work with; funding later. groups are not. Lots of jealousy and rivalries. • Pieces will never be in correct configuration. • Our experience - most Act and refine as you healers are open, evolve cooperative, and eager to share and • Solve local problems collaborate. with local knowledge! • Patients enjoy mix of • Identify local traditional and western knowledge and put it medicine. to work Lessons Learned (cont.) • TM research --unlike pharmaceutical research --begins with patient. Patients have taken our medications for generations. • Modern drug research begins in lab and ends with patient. Another reason to just get moving. • THs very interested in joining forces with western trained health workers. • Need to make more traditional medicines available for more people. • Don’t wait for central governments. Local government very receptive. • Develop partnerships for professional, technical, financial assistance. • Link with private and public sectors. Dreams, Needs, and Conclusions Our priorities are: Carry out more research with healers to find additional efficacious plants Learn how to grow and produce selected plants. Evaluate numerous remedies used by patients and healers throughout Africa. Produce capsules, salves, and extracts to reduce bulk of medicines. Now, each patient requires two kgs. of bulky roots and shoots per month! Reduce needs of patients to heat medicines by making extracts and tablets. Dreams con’t…. Stigma: Little confidentiality/privacy with raw traditional medicines. Tablets and extracts can be easily transported and taken privately. Grow and produce plants for affordable phytomedicines. Could be a good local business for healers. Support research to assess efficacy of our treatment. Have IK Program continue to broker for us. And finally, enable many more people to get back on their feet by using our traditional medicines. By keeping more people alive, we will automatically reduce the numbers of newly orphaned children. i