Download Best Practices of the Tanga AIDS Working Group (TAWG)

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.
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