Saturday, May 1, 1999 Published at 23:02 GMT 00:02 UK
Healing mental illness the traditional way
Traditional healers are used by many Ugandans
Traditional healers may be able to plug gaps in primary mental health services in Africa, according to Anglo-Ugandan research.
Primary care services have been identified as playing an important role in mental health care.
But in Africa, resources for primary care are scarce and staff often have only a basic knowledge of mental health, say the researchers.
They argue that traditional healers may be an inexpensive answer to the problem, although they say there may also need to be training to ensure "unacceptable" practices are not used.
They say there is already evidence that traditional healers in Uganda have close contacts with local doctors and hospitals.
And the healers appear keen to develop this.
The researchers interviewed 29 healers from the Pallisa district of eastern Uganda.
Almost all had a family member who was also a healer. Nineteen had suffered from an emotional problem that had been treated by a healer.
About half thought that physical problems were caused by evil spirits, curses or witches, but many also blamed poor sanitation and nutritional problems.
However, all believed mental health problems were caused by evil spirits, witches or curses. A minority thought that accidents, stress, fatigue and alcohol could also play a role.
Only three took any patient history and only one took any physical examination, which involved taking a person's pulse.
The most common way of assessing mental illness was by observation of symptoms, which included bizarre content of speech, removing clothes, having a suspicious attitude, being withdrawn, having an untidy appearance and looking frightened.
The healers' patients were referred by local hospitals, other healers and word of mouth.
Mental health was the most common problem they treated.
Most healers had a restricted range of problems they dealt with.
Herbal treatments, such as eardrops, nasal drops and medicine taken orally were used by many. Exorcism of evil spirits was also practised.
Almost all referred patients to local hospitals. Only one did not co-operate with orthodox medical services and he also did not co-operate with other healers.
The researchers, from Makere University in Kampala, the School of Public Nursing in Kampala and Guy's Hospital, said the Ugandan healers were broadly similar to those in other parts of Africa.
They believe it would be possible for healers to work side by side with health workers, either in the same premises or by a two-way referral service.
The researchers, led by Emilo Ovuga of Makerere University, say the spiritual nature of healing may help mentally ill people.
However, they are concerned that some of their practices could be seen as "unacceptable" by orthodox practitioners, such as those aimed at scaring the evil spirits out of the patient.
"It is the healing component of their work, with its associations to meanings of sickness, which may be considered to be important, particularly in relation to those with mental disorders and to acceptability and satisfaction," they write in the British Journal of Psychiatry.
They add that healers "need to be helped" to recognise "their limitations", to refer severe cases to health workers as early as possible and to develop "good practice".