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From http://www.canada.com/health/story.html?id=475eda5e-ecf6-4e93-b617-6760ddfd272d&page=2
Cultural and traditional medicine practices frustrating control of deadly outbreak
Emma Ross
Canadian Press
Friday, May 27, 2005
GENEVA (AP) - Health experts trying to stamp out the worst ever outbreak of the deadly Marburg virus are focusing more attention now on the dangerous practices performed and recommended by traditional healers in Angola.
Treatments such as herbal infusions delivered as enemas, together with a local culture that believes injection is the best way to take everything from vitamin supplements to pain killers, are among the key factors driving the continuation of the outbreak in the Uige province of northern Angola, World Health Organization scientists said Thursday.
The outbreak, which was first identified March 21, has been contained in Uige. The peak has now passed and the number of infections is tailing off, but new cases are still emerging and any one of these could spark a new crisis, said Dr. Mike Ryan, the WHO's outbreak response director. So far, the toll stands at 380 cases, of which 318 have died.
In the absence of a vaccine or drugs for the disease, traditional healers have been filling the gap, selling treatment and vaccine concoctions that not only don't work, but also are likely making the problem worse, said Pierre Formenty, the WHO's hemorrhagic fever expert co-ordinating efforts at the scene of the outbreak.
Although the remedies themselves are probably not harmful, they create a false sense of reassurance, lulling people into believing they are protected from contracting or transmitting the infection, which makes them less likely to be vigilant about taking precautions.
The method of administration is the greatest cause for concern, Formenty said.
"The cure they are selling is a sort of soup based on plants, most of the time. They administer it in the rectum. For the vaccine, there is a drink," Formenty said. "Most of them have claimed to have treated hundreds, if not thousands, of Marburg patients."
"They say they are wearing gloves and that they are not using needles, but they are still claiming to have cured Marburg patients with their soup," Formenty said. "We hope they are just drinking it."
Much of the time the treatments are sold in markets and the healers advise customers how to use it at home.
"Nobody is trying to harm anyone here. They are trying to help in the way that they think they can help but it's become a very commercialized practice and introducing any kind of probe into the rectum is dangerous because it can cause bleeding. If that person has the infection and you reuse the probe, it can transfer the disease to the next person," Ryan said from the WHO's headquarters in Geneva.
Another unhelpful cultural practice is the reliance on syringes to deliver even the most basic of medicines.
"There are also partially trained nurses going from suburb to suburb giving vitamin injections to people to help them fight infection. But if they are reusing the needles - and we believe they are - it could play a role in the transmission of the disease."
To combat the problem, international health experts are now focusing on gently trying to get greater co-operation from the traditional healers and other private practitioners. They held a major training workshop for more than 100 traditional healers in Uige on Wednesday, to educate them on the nature of the disease and safety precautions such as wearing gloves, proper disinfection and not using any instruments.
Addressing the problem of the traditional healers is a sensitive task and if it is mishandled, it could be disastrous for the effort to control the disease, Ryan said.
"The population is just coming out of 27 years of war . . . and there's a general mistrust of outsiders," Formenty explained.
WHO officials have registered 157 traditional healers in Uige.
"They were the ones who looked after the people during the war. They never closed their offices and they are therefore trusted by the population."
Keeping the community on board is crucial to success, Ryan said.
"If you push too hard and you try in any way to humiliate the traditional healers, who are relied upon by the community, you will drive the whole thing underground and then we'd have a much more serious problem," he said.
"You have to strike a fine balance between the communities feeling their system is being criticized and losing their involvement, and doing what medically and scientifically is the right thing to do - which would be to get all of the needles and the traditional healers out of the equation for the period of the response," Ryan said.