Pamene Palibe Dokotala used by Traditional Birth Assistants in Kasungu (German Technical Cooperation /GTZ)
The GTZ is an international cooperation enterprise for sustainable development with worldwide operations. It promotes complex reforms and change processes, often working under difficult conditions. Its corporate objective is to improve people’s living conditions on a sustainable basis. GTZ has been active in Malawi on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ) for more than 30 years. Malawi is a priority partner country for German and international Development Cooperation.
Developing the Medical Dialogue in Malawi
In Malawi, some traditional healers claim to be able to cure AIDS. Biomedical institutions and practitioners object to those claims, while implying their own absolute authority in matters of health. Meanwhile, the argument has little impact on the behaviour of most Malawians and many continue to go to traditional healers. There is a draft Traditional Medicine Policy but Parliament has yet to ratify the draft and the two sides in the argument remain at a stand-off.
In 2004, GTZ agreed to work with the Herbalist Association of Malawi (one of the three largest traditional healers’ associations) on applying the medical dialogue method in Kasungu, a district near
the centre of Malawi. Kasungu ranked last of the country’s 27 districts for take-up of HIV testing; 91% of its population had never been tested and did not know their HIV status.
Focus group discussions
Over two weeks, 140 traditional healers including herbalists, traditional birth assistants and spiritual healers, and 40 biomedical practitioners including doctors, nurses, midwives and health surveillance assistants and local NGOs took part in focus group discussions. The topics included local sexual practices, beliefs and taboos, modes of transmission for HIV, and methods of prevention, diagnosis and treatment. The discussions were transcribed and analysed in order to provide material for use in the subsequent workshop and in HIV prevention campaigns.
Implementation in Kasungu West and beyond
Over the weeks following the workshop, the traditional healers and biomedical practitioners established a Task Force Team to oversee implementation of the plan of action. The Team developed a system of mutual referrals (by traditional healers to biomedical practitioners and vice versa).
An evaluation one year later found that collaboration between the traditional healers and biomedical practitioners was working smoothly. For example, maternal mortality had been significantly reduced because traditional midwives were now referring critical cases to the hospital in timely manner; traditional healers and midwives were using the latex gloves provided by the district hospital to protect themselves and their patients from HIV infection.
Dissemination of Pamene Palibe Dokotala
150 Pamene Palibe Dokotala books were given to Traditional Birth Attendants(TBAs) for the project in Kasungu to assist TBAs with consultations for per and post natal care, deliveries and referrals of complicated cases to health facilities.
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