1. INTRODUCTION
2.4 A REVIEW OF THE WESTERN TRAINED HEALTH CARE WORKERS (doctors and nurses)
In the modem health care system the doctor and the nurse form the most important health care personnel. Other professionals include the radiologists, social workers, occupational therapists, physiotherapists, speech and language therapists, laboratory technicians, and assistants. Nurses and doctors are divided into many specialities. They practice through a model called the biomedical model which is different from the traditional healers' model.
Human beings are seen as biological beings made up of cells, which make tissues, then organs and systems. The emphasis in this model is on biological homeostasis, physical manifestations and signs. The physical working parts of the person are of prime importance. Hence this model aims at biological homeostasis, the curing or control of disease, or repair of trauma or malformation (Pearson & Vaughan, 1986).
The biomedical model then consists of preventive medicine, surgery, pharmaceutical services, maternal and child health services compared to the traditional healers' model which consist of traditional midwifery, herbalism, ritual manipulation and taboos: both prescriptive and preventive (Pretorius, 1991).
Nurses and doctors tend to approach illnesses in the same way. They have a process of assessing, diagnosing, managing and evaluating. They tend to possess a similar body of knowledge about the anatomy, physiology and chemical components of the body as well as alterations that take place and are referred to as illnesses. They are involved in the three levels of prevention under
Primary Health Care being primary prevention, secondary prevention and tertiary prevention.
They are both guided by codes of conduct. Both undergo formal acquiring of knowledge and skills in their fields, though the doctor takes longer years and acquires more in depth knowledge than the nurses. This places the doctor in a position to diagnose and prescribe what the nurse would have to administer. They both have legally clear status, they belong to an association and have a body oflegislation, which is the Council.
''Each registered nurse, enrolled nurse, midwife, nursing assistant or nurse specialist shall act at all times in such a way as to show respect ofthe clients' cultural, religious, socioeconomic status and taboos, collaborate with other health care professionals and citizens in promoting community and national efforts which support health, and acknowledge limitations and not carry out procedures they are not skilled in" (Swaziland's Code of Conduct for Nurses, 1985, p.l).
2.4.1 Summary
From the above literature about traditional healers and briefly about modem health care workers some similarities and differences can be noted. The literature helps in the understanding of who the traditional healers are, how are they trained and how they approach illnesses as well as the treatment of diseases. It is noted that healers also have a process of diagnosis and treatment. It has been noted that they do lack a body of knowledge about the anatomy and physiological functioning of the body, but rely mainly on symptoms. Their ways of diagnosis differ from the modem professionals, since the modem professionals rely on signs and symptoms and the use of certain techniques to come to a conclusion, whereas the traditional healer might use mystic means, like throwing of the bones. While the source of medicines seems to be similar, they differ in that most modem medicines are refined and tested for efficacy and some of them are
synthesized in laboratories, while traditional healers use the raw parts, animals, plants and minerals without any refinement. The world of ritualists and spirits is very different from the biomedical way. The way traditional healers name illnesses is very different from the modem system. These differences and similarities are key points to collaboration. Each system must know the capabilities and limitation of the other, but still show respect for the other's system of practices. The traditional healers are lacking in legal bodies, but they have made attempts to have associations like most of the modem health care professionals. Understanding the traditional healer and traditional medicine leads us to the attempts that have been made towards collaboration between the two systems. The positive ad negative attempts towards collaboration can be analysed appropriately.
2. 5 THE CONCEPT OF COLLABORATION
Collaboration according to Henneman, Lee and Cohen (1995) is an important concept for nursing.
It is a complex phenomenon whose definition has remained vague or highly variable. Despite its elusiveness, its essence continues to be sought after as a means of improving working relationships and patient outcomes. The term collaboration has been used synonymously with
cooperation or compromise which is inappropriate.
According to Henneman et al (1995) the term 'collaborate' is derived from the Latin word which means work together or work jointly. Collaboration is typically described as a process which stresses joint involvement in intellectual activities. In health it has been described as a joint communication and decision-making process with the expressed goal of satisfying the patient 's well and illness needs while respecting the unique qualities and abilities of each professional. It is non hierarchical in nature. It assumes power based on knowledge or expertise as opposed to power based on role or function.
2. 5. 1 The attributes of collaboration
Henneman et a1 (1995) stated the following attributes:
a) Two or more individuals are involved in a joint venture.
b) Willingness is shown to participate in planning and decision-making
c) Members view themselves as part of a team, and contribute to a common product or goal.
d) All participants offer their expertise, share in the responsibility for outcomes, and are acknowledged by other members of the group for their contribution to the process.
e) Power is shared (based on knowledge and expertise versus role and function).
2.5.2 Modern Collaborative Model (Henneman et aI, 1995).
defming attributes antecedents consequences empirical reference joint venture individual readiness supportive, nurturing Multidisciplinary
Environment round, standards
cooperation understanding! reinforces confidence, use of 'We' vs 'I endeavour acceptance self worth and importance statements
willing participants confidence in promotes 'win-win attitude Dialogue between
one's ability members of the
Shared planning recognition of esprit de corp team Boundaries of
disciplines
Team approach excellent interpersonal cohesiveness High scores on
communication collaborative
practice scales contribution of environment of
expertise orientation
Shared responsibility organizational improved productivity values
non-hierarchical interdependent improved patient outcome relationship visionary leaders
Arcand (1992) calls for the urgent collaboration of nurses in the management of cancer. Six principles which she said were central to creating effective partnerships at all levels included commitment, consensus, competence, coordination, communication and courage. All parties involved should have these principles. These principles reflect some attributes in collaboration.
Phipps et al (1995) define collaboration as a relationship of interdependence. The ability to work together collaboratively involves trust and respect not only for each other but for the work and perspectives each contributes to the care of the patient. Collaboration among health care workers improves patient outcome and thus reduces patient cost. This results in improved quality care of
the patient.
Phipps et al (1995) discuss the concept of collaboration as a framework whereby each self-care remedy is determined ifit is detrimental and whether it will antagonize a patient's regimen. If the remedy is not harmful, instead of negating a culturally relevant folk treatment and implementing a culturally incompatible regimen, the practice should be incorporated. Patients who have chronic illnesses will stop all treatments that are culturally incompatible immediately after discharge, and this could be interpreted as non-compliance to the regimen by the western trained health care workers. The health care professionals must make an effort to find out from the patient and the family their rationale for using other remedies or practices which might be detrimental or helpful.
They can then be in a position to incorporate them easily or explain to the patients why they are detrimental.
Though Phipps et al (1995) did not mention the use of traditional healers and traditional medicine, it is known that in Africa traditional healers form part of the culture and they are also part of alternative remedies that most patient tum to. Their practices are viewed by many Africans as cultural practices. These beliefs and values of Africans cannot be changed overnight. It is very important for the biomedical personnel to find out about these traditional practices in order to have a positive collaborative relationship whereby the good practices can be encouraged for the same goal of improving care of the patient or management of the patient. It is not easy to collaborate with someone if you do not even know the extent of their knowledge as well as their scope of practice. This does not apply only to traditional healers, but also to other alternative treatments such as acupuncture, aroma therapy, homeopathy etc.
Langford (1988) states that collaboration means working together in a joint intellectual effort. The key term is 'joint'. It implies that in collaboration there is no superior or subordinate, order-giving or order-taking, relationship. A common usage implies an equity among the participants in the relationship, both in working and sharing reward. Complementary skills and knowledge are necessary, but is not mandatory for collaboration to exist. Mutual recognition that no one person holds all the knowledge, skills or resources necessary to meet goals, is required in order for true collaboration to exist.
Collaboration is not always necessary since there are situations where one person can offer the care alone effectively, but it can be necessary in situations such as:
a) those in which a general operating mode of the population organization brings together skills most frequently needed for the population served.
b) where the goal to be met requires assembling skills or knowledge not held by one member.
This is true where chronic illnesses are concerned.
2.6 PROJECTS DEVELOPED IN FOUR COUNTRIES TO INITIATE