By Flavia Nassaka
Finally, new regulations to stop quack `doctors’
Do you want to lose or gain weight, find a lost love, cure infertility or increase the firmness of your erection? Don’t despair; there is someone in Uganda ready to offer an instant cure.
It is not unusual in Uganda to see an advert on TV, Radio, and newspapers of a “doctor” offering the most strange and outlandish services.
It could be an offer of a “natural weapon” to protect your family, ensure marital fidelity, or a promotion at the work. How much of this is real and how much is the work of con-artists preying on the superstitious?
Many doctors trained in the Western sciences, like Dr Simon Eyoku, of Mulago National Referral Hospital in Kampala, dismiss the claims as they largely focus on the biomedical causes of disease.
“Some herbalists pass false messages and end up treating diseases they aren’t supposed to treat,” he says.
But traditional healers, like Dr Dr Kharim Musaazi, dismiss the doubters.
“There are some things Western medicine cannot fathom,” he says.
He is referring to the belief that some traditional healers are also diviners, employing spirits to intervene in people’s problems. Many say they have rare knowledge of the curative powers of plant materials. They use leaves, seeds, stems, animal parts, the bark or roots to treat symptoms.
In reality, alternative medicine, herbalism or traditional medicine is a grey area in which many members of the public remain suspicious of traditional healers. They view them as charlatans and sorcerers. Some traditional healers have been lynched by angry mobs. That is partly why the government wants to step in and regulate the practice of herbal medicine and traditional healing.
On September 11, 2013 the government approved the “Indigenous and Complementary Medicine Bill” to be debated by parliament. If passed, the law would regulate the practices of herbalists and set standards for verifying the safety and efficacy of their medications.
But it has already run into trouble from, you guessed it – the traditional healers, including Dr Musaazi. One of the sticking points is the practice among herbalists of advertising their prescription.
The information about the work of herbalists advertised in the media is seen by some as deceptive, exaggerated, and false. The new law wants the herbalists to adopt an ethical code similar to that of other health practitioners in the country.
“Ethically, doctors are not supposed to directly advertise because we believe our profession is a calling and in practice – we don’t front the idea of profit,” says Dr Simon Eyoku. However, Dr Musaazi says the media platforms help them to create awareness. “It is not necessary for the bill to address this,” he says.
Part of the confusion is that Dr Kharim Musaazi is no doctor at all, in the sense that he does not have a university degree in western medicine. He is what is called a traditional healer, witchdoctor, or herbalist; depending on who you ask. It might be somewhat confusing but many herbalists in Uganda prefer to be called `doctor’. There was, however, nothing traditional about Dr Musaazi when we met.
Dressed in khaki Dockers pants and pale navy blue shirt loosely hanging over the trousers, he looks nothing like your typical African traditional healer. It is Dr Musaazi’s office which offers the first hint that he does not deal in western medicine.
Located in bustling south west of Kampala city called Makindye, his four-room house with its peeling blue outside wall paint and rusty doors and windows that creak, is part office, part herbal medicine clinic, and part herbal medicine manufacturing plant. To enter, one must leave their shoes at the door and go barefoot as in a typical traditional healer’s shrine.
One corner of the office room is lined with tins and bottles of herbal concoctions. In another room, men and women are busy sorting various plants, leaves, stems, and roots and their extracts. These are the raw materials for his herbal prescriptions. In yet another room, some of them are being boiled in a huge pan whose aluminium colour has turned brownish because of overuse.
Soon they will be packed and dispensed to an endless queue of waiting patients. In a country with one western medicine doctor for every 20,000 patients but one herbalist for every 200-400 people, herbal cures for all manner of ailments are much sought after. Uganda is no different from other African countries where, the World Health Organisation estimates, 80% of people regularly seek services of herbalists and healers to treat common ailments.
It could be stomach problems, diarrhoea, skin infections, infected wounds and sores, fevers, colds, coughs; parasitic diseases such as malaria, bilharzia and trypanosomiasis. Or it could be sexually transmitted diseases, tuberculosis, pneumonia and devastating afflictions associated with HIV/AIDS.
But the outcomes of prescription are sometimes unexpected. Some patients, like Aziiz Kasirye, are happy after treatment. A diabetic, Kasirye started off using western medicines and insulin injections. He says his condition did not improve until another diabetic recommended herbal medicine a year a year ago. He says he is now better.
But other patients, like Mary Butamanya, vow never to use herbal medicines again. Butamanya was suffering from what she describes as chronic cough when a popular concoction of herbs mixed in clay, called emumbwa, was prescribed. She says a few hours after taking her first dose, she developed itchy blisters all over her body and was rushed to the hospital. She says a doctor told her the ‘mumbwa’ contained a certain plant extract that reacted badly with her body.
It took her two months to regain her normal skin condition. It is not clear why, but while thousands have found herbal medicine to be the only solution to their predicaments, many have suffered; some lost their lives while others have lost time and money.
Under the proposed law, the government would form a council to oversee the work of all herbalists in the country. This would include, Chinese and other international herbal medicine dealers.
New proposed law
The Ugandan law appears to be crafted along the same lines as that of South Africa which is leading continental efforts to bring traditional healers under the legal framework. In early 2005, its parliament approved a law to recognise the country’s estimated 200,000 healers then as health-service providers. Those registered would, for example, be allowed to prescribe sick leave and offer treatment for numerous conditions.
Part of the drive for the new law is recognition that traditional healers, with or without a supporting law, are already providing services within communities. Most experts say bringing them within the primary-healthcare fold, the new law would help flush out harmful practices by introducing a regulatory council.
But the herbalists are against the proposed new regulatory council. They say it is unnecessary because they already have an organisation that oversees their work throughout the country called the National Council of Traditional Healers Associations (NACOTHA).
The association has 146 subordinate associations and 500,000 herbal practitioners are subscribed. Its general secretary, Dr Musaazi, says they have petitioned parliament to stay its passing the new law because some clauses are unclear and others are unfair. The herbalists want more representation on the proposed council.
Musaazi says the herbalists are unhappy that they were not consulted about the Bill yet they are the key stakeholders and that the Bill does not also clearly define practitioners of indigenous and complimentary medicines. Some of the aspects of the law NACOTHA opposes are not new. The Uganda National Council for Science and Technology (UNCST), and the government’s Natural Chemotherapeutics Research Laboratory, have scientists already screening and verifying herbal medicines.
Among them is Fred Nakwagala, a consult physician. He says their work can be more effective if they trust the practitioners that they work with. “Some herbalists imitate what they saw their elders do without confirmation of whether these concoctions are actually safe,” he says.
Nakwagala says although herbs are vital, researchers have in various studies found herbal medicine to be prepared in a crude and wasteful way. He says some herbs aggravate diseases since herbs used to treat minor diseases can have serious side effects. For example, a 2012 study conducted in Rakai; central Uganda, by Dr. Steven J. Reynolds and others found that traditional herbal medicine use was leading to substantial increase in liver diseases in patients. They recommended strong guidelines and clinical studies on herb safety. Nakwagala says some wasteful practices could lead to extinction of some rare herbal extracts.
“Herbalists need to be approved before operating,” says Nakwagala, ““If we leave this segment unregulated very many people’s lives will be at stake.”
Florence Nakachwa, the head of Herbal Unit at National Drug Authority, agrees with Nakwagala. She says the law proposed by the government is urgent because hundreds if not thousands of herbalists practice without any license and, therefore, the safety of their prescriptions is doubtful.
She notes that lack of documentation on the safety and efficacy of traditional healers’ services has made this segment of primary health care lag behind since the government cannot include such treatments in national programs to reduce the disease burden. “Leaving these health practitioners on the side-lines can have serious consequences,” she says.
The World Health Organization (WHO) advocates for incorporating safe and effective traditional medicine into primary health-care systems. In 2002, the organization issued its first comprehensive guidelines to help countries, such as Uganda, develop policies and laws to regulate traditional medicine.
This shows that although western medicine is the most recommended it has not replaced traditional medicine but has just created a big line of choices for patients. Practitioners such as Musaazi remain central to the lives of many.
“There is need for some standardisation of operations,” says Dr Tamale Ssali; a herbalist, “for instance, people should be able to consult registered and licensed traditional healers at proper premises. Currently, traditional healers are operating in all sorts of places like taxi parks, streets and even backyard rooms. That can only change with a law in place.”