Chapter Two
4.8 Alternative Sources of Diagnosis and Treatment Sought
Most of the male participants reported that they had consulted a traditional healer either prior to or whilst receiving biomedical treatment. The reason for consultation with traditional healers was varied, including the supplementing of biomedical treatment, treating the possible source of illness e.g. bewitchment (ldliso), and establishing a diagnosis. Participants shared mixed feelings regarding the use of traditional healing, as reflected in the following quotes:
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Patient (male): I initially saw a traditional healer when I fell ill. I also used traditional medicine between my hospitalisations and when I went back to hospital, I felt much better.
The above extract indicates the strong influence of traditional forms of healing as a means of diagnosing diseases as well as in the treatment process. Subsclibing to such forms of treatment plays an important role in patient's health care decisions, since with regard to diseases like TB and MDR-TB, symptom identification and management can either be successful or lead to complications, which could have lethal consequences.
In three cases, participants who consulted traditional healers reported that their symptoms still prevailed after being treated. They thereafter sought biomedical treatment. One could hypothesise that this may be due to the participant's need for symptom eradication, or that the condition could not be linked to a specific cause through traditional interpretations, which is reflected in the following quotes:
Patient (male): I saw a traditional healer initially. I took traditional medicine but did not improve. When I went to hospital and was given medication I did stmt to improve.
Patient (male): I saw a traditional healer who told me that I had 'idliso' (bewitched). He prescribed me some medicine, but my condition did not improve. I only noted improvement when I was treated in hospital.
Patient (male x3): I was cured for 'idliso' (bewitchment) and not for TB by a traditional healer.
Patient (male): I went to see a traditional healer for diagnosis only.
The above anecdotes demonstrate that consultation with traditional healers was based on identifying the source of the illness and not merely on symptom eradication. Western
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medicine could be conceptualised as focussing more predominantly on dealing with the symptoms of a specific condition, rather than initially addressing the cause of a condition.
This may possibly explain the lack of faith of some patients in adhering to biomedical treatment for fear of the symptoms reappearance, since the cause of the condition has not been adequately identified or explained to them.
One male participant who reported that he went to see a traditional healer before attending the clinic related his experience as follows:
Patient (male): I saw a traditional healer and was helped. I believe I was bewitched. The traditional healer gave me something to use to get rid of the 'idliso'. He clearly explained to me how the medication would get rid of 'idliso'. He warned me that it might even kill me. Upon using the substance given to me by the traditional healer, I literally saw 'idliso' coming out. I then went to the clinic because I was feeling weak and was bleeding profusely.
This extract clearly demonstrates the importance of the role of providing information to patients regarding their treatment. The complexity related to patient's decision-making processes is clearly explicated in this extract. Having been made aware of the dangers of the prescribed treatment, the patient made an informed decision to use the treatment in aiding to manage his illness. The above situation illustrates that seemingly irrational actions of patients could actually reflect informed, rational choices made by them regarding the dual and parallel treatment of their illness.
Similarly, five female participants reported se'eing a traditional healer, suspecting that they were bewitched, prior to coming to hospital. They reported that only when treatment proved unsuccessful did they go to a hospital. One female participant, who reportedly took traditional medicine for diabetes, together with Western medicine for TB, believed that the interaction between both medications was the cause of her MDR-TB.
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Patient (female): I initially thought I had idliso (bewitched) for which I took traditional medicine. I refused to take treatment (TB medication). However now that I am still not better, I no longer believe that I was bewitched.
Certain participants (male) described what they viewed as cultural illnesses namely 'izibhobo' and 'amahlaba' (sharp pains) and 'umkwebhelo' (hernia), as untreatable by Western medicine. These participants reported seeking help from traditional healers.
Only once such treatment proved ineffective did they consult western medical practitioners for treatment. Subjective interpretations of illnesses were also prevalent amongst staff at the hospital, since one male patient rep0l1ed that a nurse told him that he was too young to suffer from Diabetes. Such an assertion illustrates the influence of subjective interpretations of illness amongst health care professionals, which impacts on the dualism of retaining such interpretations in the light of biomedical practice.
This participant further elaborated that such perceptions, especially coming from an individual who is trained in Western medicine, made him skeptical of Western medicine as an appropriate treatment strategy in managing his illness. He therefore reported using traditional as well as western medicine interchangeably and noted a marked improvement.
Another issue of concern is whether the use of medication from both disciplines (traditional and western) is beneficial to a patient's health status, and if so whether it is disease specific. Concerns such as these are supported by the accounts of other patients.
Another male participant also reported seeking help from a traditional healer, and used the same medicine reportedly used by other participants, with no reported success.
4.9 Lack of Knowledge Amongst Community Members Regarding TBIMDR-TB
Three male participants reported a lack of understanding of TB/MDR-TB amongst community members, which resulted in patients being stigmatized and marginalized by community members with regard to their health status. One participant regarded the
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communities' perception of the disease as being due to bewitchment as misinformed.
Community influences can have a negative impact on treatment outcomes, since in situations where the disease is causally related to cultural illnesses such as bewitchment, the consequence is usually a delay in identification of the disease, which impacts negatively on the patient's prognosis.
Patient (male): People in the communities don't understand this disease, which results in people spreading the disease within the communities.
Patient (male): The government needs to teach people about DOT because other people who contract TB think that they are bewitched. There is a lack of
information in the communities.
Another perception of MDR-TB by community members, as indicated by two male participants, was that:
Patient (male): People in the community say I am HIV/AIDS positive. Some of my family members say subtle statements and look down upon me.
In this case members of the community may be interpreting the symptoms of MDR-TB as being part of the HIV/AIDS syndrome. This is entirely understandable given the high level of co-morbidity between HIVIAIDS and TB and suggests that the social stigma generally faced by TB sufferers is likely to be exacerbated with the explosion of the HIV/AIDS pandemic in South Africa.
Some patients have also reported that when their families visit them, they feel hurt by the restricted contact made with them, due to the fear of transmission of the disease to them.
The majority of female pUl1icipants felt that discriminated against by community members. They also reported that community members often attributed their condition to HIVIAIDS. However, immediate family members were perceived as being supportive
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and understanding of their condition, which was markedly different to the treatment reported by male participants.