Musa* fidgets on his bed in Ward 5F, a male medical ward in Edendale Hospital, trying to get comfortable.
His throaty cough indicates tuberculosis, while the raised purple lumps on his face reveal a cancer called Kaposi’s Sarcoma. Musa makes frequent trips to the toilet, his long, bony body shuffling slowly along.
‘I want to be discharged but I am just waiting for ama-pillies,’ Musa tells ‘Treatment Warriors’ Bonisiwe Thabethe and Nontando Dlamini.
He recites the names of the antiretroviral medication to show that he has been given drug readiness training. All that he is now waiting for is his girlfriend. She is going to be his ‘treatment buddy’ so also needs to be trained about ARVs. Once she has been trained, the ward doctor will prescribe ARVs and Musa can start taking them.
Thabethe ‘ known to everyone as ‘Mam T’ — and Dlamini have plucked Musa from certain death and fast-tracked him for ARV medication. He has a miniscule CD4 count of 13, which means he may not survive even if he starts ARVs.
But if he had been referred to the AIDS treatment clinic, as is normal practice at most busy hospitals, he would have had to wait for weeks or months to get medication ‘ a potentially fatal delay for a man in his weakened state.
Ngenzeni Mbhele observes the interaction closely, writing notes on each patient in a hardcover exercise book. Mbhele has been a traditional healer for the past 33 years, but she is now on a six-week internship at the hospital, experiencing firsthand how healthworkers deal with HIV/AIDS.
The internship for traditional healers is being run by iTeach, a non-governmental organisation headed by the energetic Dr Krista Dong, which has been based at Edendale since 2005.
iTeach’s main aim is simple: ‘Save lives,’ says Dong.
The organisation has identified six essential components to ensure HIV and TB treatment is successful: effective HIV awareness; widespread HIV testing; early ARV treatment initiation, scale-up of ARV treatment; provision of good care for those on treatment and, finally, ensuring that patients adhere to their treatment.
iTeach’s staff of 20 work throughout the hospital and in the 17 clinics within the catchment, implementing simple, cost-effective solutions to repair weaknesses in this chain of care.
Doctors in the five huge medical wards are encouraged to notify the iTeach ‘treatment warriors’ when they see patients who might have HIV or TB. The ‘warriors’ immediately go to the bedside and evaluate patients. If they are in critical need of treatment, they fast-track and monitor them to ensure they don’t fall through the many cracks in the overburdened system.
In the two years since the ‘warrior’ progamme was started, they have evaluated 846 patients, half of whom have been found eligible and survived to start ARV treatment.
But for many, this help comes too late. Called ‘the sickest-of-the-sick’ by the fast-track programme, the average CD4 count of these patients is about 40.
‘Despite our best efforts, thirty percent of these patients die, most within three weeks of being identified,’ says Dong. ‘People have to get treatment earlier; before their immune system is severely damaged and treatment is less likely to work.’
The organisation has also been working with traditional healers for a number of years to help with the early diagnosis of HIV and successful treatment.
‘About 80 percent of our patients consult traditional healers. But the vast majority of HIV programmes and health care professionals in South Africa take a hard line, saying that you can’t use both ARVs and traditional medicine,’ says Dong, a Harvard-trained infectious diseases specialist.
‘Simply telling a patient they must not use traditional medicines while on ARVs, only results in patient hiding their use from the doctor or nurse,’ says Dong.
‘The idea that patients must choose between ARVs and traditional medicines or long-standing cultural practices, causes some to avoid coming forward for ARVs until they are very sick and desperate.’
Two practices that are a frequently prescribed by traditional healers to cleans the body, include ‘uku phalaza’ (induced vomiting) and ‘ukuchatha’ (induced diarrhea). For patients with advanced AIDS or TB who might be dehydrated, this could be dangerous.
‘Advice from traditional healers is well respected and likely to be followed by patients who see them,’ said Dong.
‘By working with traditional healers to ensure healers are knowledgeable about the health risks associated with AIDS, we are developing strategies to optimise patient safety and that patients are willing and able to follow. We are not encouraging patients to see healers, but addressing the fact that patients do access both systems of care, and we want to ensure that it is done safely.’
Healer Veli Msomi has been a traditional healer for 29 years and fully subscribes to the importance of treating HIV and TB with ‘Western’ medicine.
‘We noticed some time ago that there was something new as a person would come with a sickness and we would give them the right herbs to treat their symptoms, but they would come back again, maybe in a month, with the same thing,’ says Msomi, who speaks in a slow, measured voice.
‘I do understand that some diseases are not traditionally related. Even though I am a sangoma, if I am sick I don’t just mix my herbs. I go to the clinic first to get a diagnosis and to be fully checked,’ she adds.
‘When a person is dizzy and tired, they could be having high or low blood sugar. I could prepare medicine for high sugar but you might have low sugar and it would kill you.’
Joking that the training is turning her into a professor, Msomi says she is very proud that she can now give her clients good advice: ‘Since 1998, different organisations have come to us to give us training. They have given us workshops and certificates but there are no follow-ups to see if we understand what we have been taught.
‘Here, traditional healers are collaborating with Western doctors. We are sitting with the doctors, getting to know each others’ practices.’
Since their involvement with iTeach, the healers have resolved to advise their clients to avoid induced vomiting and diarrhoea during the early months of TB and ARV treatment.
Mbhele says it is ‘easy to explain to clients that their livers can be damaged if they take some traditional treatment and ARVs at the same time’.
‘Once a patient is doing well, if they are still requesting herbs, we can then counsel them and they can take them.’
Dong is full of praise for the healers, who she describes as the ‘easiest to train and most skilled counsellors’ she has ever worked with.
In the four years that iTeach has worked with the healers, not a single one has ever asked for anything in return for their involvement as they say it is their calling to do this work.