HEALTH COOPERATION AND INCORPORATION

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The question of tradition and modern healing practice does not pose a great problem to the consumer, He will use both facilities with or without the knowledge or approval of either. His concept of disease allows for this. While modern medicine can procure a cure it does not deal with what is regarded as the basic cause of his illness which may be a curse, the vengeance of a god, the evil machination of another person, etc. The objective of the traditional healing practice in this situation is to counteract the basic cause, thereby making modern medicine effective and lasting in its cure. In other words, the traditional system complements the modern system. It is rather like lighting candles and praying for the recovery of a loved one and after recovery, having a thanksgiving service in church.

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It creates a problem if the objectives of two system are the same, which means that the patient is receiving medication for the same aspect of the illness from two different sources at the same time. This problem is easy to deal with if the fact is know. I tell my patients that the two medicines may counteract each other, or lead to overdosage, and that he should try one first, but not use the two together. If a patient has the belief that his illness has been caused through some supernatural means, it may not be necessary to argue this point at the initial stage of treatment. This point may be taken up with the patient and relatives only after the patient is better.

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Cooperation between the traditional healing and modern doctor depends on the personality of both, the self-confidence of both, and method of treatment proposed by both, some traditional healing have brought patients to me and i have not objected to my patient using traditional healers, provided what is going to be done to the patient does not conflict with my treatment. For example, i do not approve of any traditional medicine to be taken by mouth while the patient is still on medication, for reasons which i take pains to explain.

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The traditional healer may fell uneasy about the co-operation, or may fell his status enhanced by the co-operation,depending on the level of expertise and confidence he has. There is no doubt that they fell a sense of competition in which they are at a disadvantage, and for this reason some of them make extravagent claims to be able to treat successfully all types of physical and mental disorders.

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The impression i have is that most modern doctor are indifferent to traditional healers. They fell disgusted and angry when time and money has been spent on traditional healing without success and patient is then brought to them in a very bad shape. It annoys them when read statement to the effect that because of their scientific training, they have been alienated from the people, and cannot empathise with them. This statement may be the true to some extent, but it is not peculiar to developing countries. Doctors, on the whole, tent to use their middle class norms to assess their patients. Only recently some medicial students doing their clinical psychiatry with me described a situation as being unfit for human habitation. i had to remind them that they very modern teaching hospital setting does not reflect the generality of the population, and furthermore, it may be foreign to the generality of the population.

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we once had to have an emergency consultation on the second level of two storey building, The patients was asked to come up, the stairs, the elderly lady climbed up the staircase on all fours It then dawned on me that she might not have had to climb up such a staircase in all her life, and the situation most have been threatening to her. Yet i had taken it for granted. This question of cooperation between both systems, and incorporation of traditional healing practice into the health care system poses a greater problem for the authorities. It may be helpful to examine closely the situations where traditional healer are reported to have been used and incorporated into the official health delivery system. I suspect that in these situations the traditional healers are few, and they form a cohesive body. They deal mainly with psychosocial problems, and they very seldom use herbs. Some methods they used include ritual dancing, which in addition to it cathartic effect also may lead to dissociation, possession, and trance. The therapeutic effect of this has been well documented and related to brain-washing [7]. The objective of therapy may not necessarily be directed to the individual patient, but to the group to which the patient belongs [8]. In another situation, like the zar, the patient is integrated into the cult group and not his own primary group. In these situations, there is not likely to be much conflict, if any at all between the modern health service and the traditional healing system. In fact the modern health service can learn a lot form the traditional healing practice.

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