Submitted in fulfilment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, 2012. / Background : The current alarming growth of diseases and complications, especially in Africa, makes the integration of traditional and conventional health practices a priority in medical training, research and planning, and the funding of health services. Unplanned and/or unintended treatment non-compliance and unnecessary deaths from diseases like tuberculosis and Human Immunodeficiency Virus are escalating in spite of health information and/or education, support groups and awareness events. The World Health Organisation recommends Directly Observed Treatment Strategy for illnesses like tuberculosis, and suggests the inclusion of traditional health practitioners in the strategy because they are constantly in contact with the community and could therefore be utilized as reminders, support system, doctors and care givers. Therefore it is a high priority that traditional health practitioners be integrated into partnership with conventional medicine practitioners, as they are considered the entry point to primary health care programmes in South Africa. Aim of the study The aim of this study was to explore the nature of the partnership between the African traditional and conventional health care in the eThekwini District. Methodolody : A qualitative, multiple case study design was used to explore the partnership between African traditional and conventional health care within the South African health care system in the eThekwini district of KwaZulu-Natal Province. In attempting to explore and understand the extent to which both these health care systems work together, a qualitative research method was used. All ethical issues were considered after which individual interviews were conducted using an interview guide and a tape recorder. A cross-case synthesis was used to analyse data. Results : Results from the study suggest that a partnership is far from being implemented by both the Traditional Health Practitioners and Conventional Health Care Practitioners. It is apparent that they both do not share a common vision. The government has some responsibility and a major role to play in guiding such a partnership and making sure that the South African community is provided with best practices governed by policies and legislation that are transparent, fair and legally binding to everybody involved.

The Haida language, Xaad Kil is dangerously close to extinction and in need of heroic action. The purpose of this study is to find out what ancient traditions and beliefs we could incorporate into our language revitalization efforts. Drawing on archival literature and community knowledge, I found almost 100 traditional ways to support Xaad Kil revitalization. There are four main chapters: Haida foods, Haida medicines, Haida rituals and ceremonies and Haida supernatural beings that could contribute to Xaad Kil revitalization. The food chapter features two-dozen traditional foods from salmon to berries that support a healthy lifestyle for Haida language speakers and that could strengthen our connections to the supernatural world. The Haida medicine chapter features two dozen traditional medicines from single-delight to salt water that could heal, strengthen and purify the Haida language learner. The ritual and ceremony chapter features over two-dozen rituals from devil’s club rituals to labret piercing ceremonies that could strengthen Haidas and our language learning. The supernatural being chapter features twenty-three supernatural beings including Greatest Crab and Lady Luck that could bring a language learner wealth, knowledge, luck and strength. This study suggests that a Xaad kil learner and the Xaad kil language need to be pure, protected, connected, lucky, strong, healthy, respected, loved and wise. The path to these qualities is within the traditions and beliefs featured in this research. This study is significant because it shows that the language revitalization answers are within and all around us. / Graduate / 0290 / 0326 / lucybell@uvic.ca

Thesis (MPA (Public Management and Planning))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The Department of Health estimates that 80 percent of South Africans consult traditional healers before consulting modern medicine. The aim of this study is to investigate the extent of the use of traditional medicine in local communities in the Limpopo Province, and add value to a draft policy that was introduced by the Minister of Health. (South Africa, Department of Health 2007a) Traditional healers are regarded as an important national health resource. They share the same cultural beliefs and values as their patients. They are respected in their communities. In South Africa, traditional healers have no formal recognition as health care professionals. Despite the advantages of modern medicine, there is a dramatic evolution in traditional medicine developing and developed countries. In recognition of the value that traditional medicine has added to people’s health needs, government organisations have realised the gap and needed to embark on public participation to bring to light the solution, by implementing a relevant policy (Matomela 2004). According to research done by Pefile (2005), positive outcomes that resulted from the use of traditional medicine include a more holistic treatment, a wider choice of health care that suits people’s needs, and scientific advancement, this paves a way forward for a policy to be put into place for the legal recognition of traditional medicine. New legislations have been brought about in regulating traditional medicine and practitioners. This paper provides a synopsis of government initiatives to close the gap and address the concerns of integrating traditional and modern medicine. The thesis addresses the challenges involved in incorporating the two disciplines for the best possible impact of local communities in accessing their rights as vested in the constitution. The study is a qualitative study where relevant practicing traditional healers, users, Western doctors, nurses, managers and government policy makers were interviewed regarding the draft policy on traditional medicine. This was to obtain information on the challenges, gaps and possible solutions regarding the integration of African traditional medicine into the health care system of Southern Africa. Findings show the following: a majority of traditional healers do not agree to scientific trialling and testing on the herbs that they prescribe, and Western doctors feel that traditional healers should only treat patients spiritually unless they have a scientifically tested scope and limitations on their field. The study also found that traditional healers want to be registered and integrated into the health care system, but do not agree to have regulated price fixing. Other conclusions included that the communities seek traditional help for cultural reasons and more benevolent purposes, but are changing their focus towards seeking medical help from clinics where it is provided for them. However, people within the communities are still confused whether to seek traditional or western medicine and therefore seek both. It was found that medications are not readily available in district clinics and hospital waiting times force people into seeking traditional help. Nurses, doctors and caregivers acknowledge that traditional healers are hampering the health care of patients by delaying hospital treatment of patients hence progressing illnesses. However, they also state that traditional healers help people spiritually and mentally. Therefore policy makers have found solutions to educate healers and create regulatory boards to limit and create a scope of practice for traditional healers. Recommendations and solutions for the relevant policy are as follows: It is recommended that traditional health practitioners should only be allowed to practice and train over the age of 21. They must be prohibited from certain procedures, for example: drawing blood, treating cancers, and treating AIDS/HIV. They should only be allowed to practice midwifery if they have had training. They should be prohibited from administering injections and supervised drugs, unless trained at a tertiary level traditional healers can be used as home caregivers, spiritual healers, and traditional advice counselling entities in the communities. Traditional healers must be prevented from referring to themselves as a ‘doctor’ or ‘professor’. This misleads people into believing that they are allopathic doctors. ‘Traditional health practitioners’ must realise that they are holistic healers, and must be addressed as such. A strong recommendation is to rename ‘traditional health practitioners’ as ‘spiritual practitioners’. With regards to regulations, it must be imperative that every practicing traditional health practitioner be registered annually with the relevant board. A good suggestion is for traditional health practitioners (THP) to attend formal training courses, under an experienced herbalist, and it should be documented on paper. A written record of the location of practice, and specialty must also be documented. There must be policies on health and safety, hygiene and sterility that need to be in place. It is suggested that training on patient confidentially must be taught and implemented. A code of conduct and a standard of professional ethics must also be implemented. Health and safety regulations pertaining to the profession and the citizens must be listed. Efforts towards dispelling myths and making people aware, thereby filtering out the positive side of the traditional medicine (e.g. medical benefits with some herbs), and rooting out the ‘quack’ practices (e.g. the use of amulets around a patient’s body to cure diseases) should be practiced. Pertaining to co-operative relationships between modern medical doctors and traditional practitioners, it is recommended that the use of exchange workshops between the two professionals needs to be developed. Also scientific information and technology must be available to traditional healers. A continued professional development (CPD) programme should be a mandatory requirement, as for all other health care professionals. It seems the development of traditional hospitals, in which a scope of practice is defined, can be used as a recovery ward and a spiritual guidance centre. The above recommendations will encourage a healthier, safer and transparent health care system in South Africa, where all disciplines of medicine co-exist in one National Health Care System. / AFRIKAANSE OPSOMMING: Nadat navorsing deur die Departement van Gesondheid gedoen is, is daar gevind dat 80 persent van Suid-Afrikaners tradisionele genesers besoek. Die doel van hierdie navorsing is om ondersoek te doen na die gebruik van tradisionele medisyne deur landelike gemeenskappe in die Limpopo Provinsie, en om ook ‘n bydrae te lewer tot die konsepbeleid wat deur die Minister van Gesondheid bekendgestel is (South Africa, Department of Health 2007a). Tradisionele genesers kan beskou word as ‘n belangrike hulpbron in die nasionale gesondheidsdiens. Hulle deel in kulturele gelowe en waardes van hulle pasiente en word ook gerespekteer in hulle gemeenskappe. Suid-Afrika egter, gee geen erkenning aan tradisionele genesers of die feit dat hulle in die gesondheidsdiens is nie. Ondanks die feit van moderne geneesmiddels, is daar ‘n dramatiese evolusie wat besig is om plaas te vind in die Westerse Wêreld. Die erkenning en waarde van tradisionele medisyne wat bydra tot mense se gesondheidkwaliteit, het daartoe gelei dat Staatsorganisasies begin insien het dat daar ‘n gaping is en dat publieke peilings gedoen word om ‘n oplossing te vind en ‘n beleidsdokument saam te stel wat tradisionele genesers insluit (Matomela 2004). Die ondersoek wat Pefile (2005) gedoen het, het positiewe resultate getoon by die gebruik van tradisionele medisyne wat ‘n holistiese behandeling in ‘n wyer verskeidendheid van medisyne insluit by gebruikers. Ook die wetenskaplike vooruitgang van tradisionele medisyne het daartoe bygedra dat ‘n beleidsdokument in plek gesit word vir die wettige erkenning daarvan. Nuwe wetgewing is in werking gestel om beheer uit te oefen oor tradisionele genesers en tradisionele medisyne. Hierdie dokument verskaf ‘n sinopsis van die Staat se inisiatiewe om die gaping tussen moderne medisyne en tradisionele medisyne aan te spreek en ook om landelike gemeenskappe toe te laat om hulle reg uit te oefen soos wat in die Grondwet vervat is. Die studie is kwalitatief waar relevante praktiserende tradisionele genesers, verbruikers, Westerse dokters, verpleegkundiges, bestuurders en staatsdiensbeleidvormers ondervra is oor ‘n konsep beleidsdokument oor tradisionele medisyne. Dit was gedoen om informasie rakende die uitdaging , gapings en 'n moontlike oplossing te vind vir die integrasie van Afrika se tradisionele medisyne in die gesondheidsorgsisteem van Suidelike Afrika. Belangrike bevindings sluit die volgende in: die meerdeerheid tradisionele genesers stem nie saam dat wetenskaplike toetse gedoen word op kruie wat hulle voorskryf nie; tradisionele genesers will geregisteer en geïntegreer word in die gesondheidsorgsisteem maar stem nie saam oor prysregulering en prysvasstelling nie; Westerse dokters is van mening dat tradisionele genesers net pasiënte geestelik moet kan behandel tensy hulle ‘n wetenskaplik getoetse doel en beperkings in hulle veld het; Westerse dokters glo dat tradisionele genesers dwarsboom die gesondheidsorgsisteem deurdat hulle behandeling vetraag; die gemeenskap soek tradisionele hulp op vir kulturele redes en ander welwillendheidsredes maar gaan soek mediese hulp by klinieke waar dit aan hulle verskaf word; mense van gemeenskappe is verward en raadpleeg beide tradisionele genesers en Westerse dokters vir hulp; sommige medisyne is nie altyd by klinieke beskikbaar nie en mense sien nie kans om in lang rye te wag by hospitale nie en dit noop dat hulle tradisionele medisyne gebruik; verpleegkundiges en gesondheidswerkers erken dat tradisionele genesers mense vertraag om gesondheidsorg en behandeling by hospitale te kry, maar verstaan ook dat tradisionele genesers aan mense geestelike hulp verleen; en besleidskrywers moet oplossings vind om tradisionele genesers op te voed en om komitees te stig wat tradisionele genesers se ruimte van praktisering in toom te hou. Die volgende word as voorstelle tot aanpassing van die genoemde beleidsdokument geïdentifiseer:- Tradisionele genesers mag alleenlik praktiseer en opleiding verskaf na die ouderdom van 21 jaar. Hulle moet verbied word om sekere prosedures, byvoorbeeld die trek van bloed; behandeling van HIV/VIGS; om voor te gee dat hulle mediese praktisyns is; om vroedvroue te wees slegs indien gekwalifiseer daartoe; om inspuitings toe te dien en medisyne uit te reik slegs indien hulle tersiëre opleiding gehad het. Tradisionele genesers se dienste kan gebruik word as gemeenskapsgesondheid hulpwerkers, geestelike genesers, en kan tradisionele advies en begeleiding aan die gemeenskap lewer. Tradisionele genesers moet belet word om die titels “Dokter” en “Professor" te gebruik. Tradisionele genesers moet daarop let dat hulle holistiese genesers is en moet daarvolgens aangespreek word. Hulle moenie pasiënte mislei deur voor te gee dat hulle allopatiese geneeshere is nie. “Tradisionele genesers” moet hernoem word na “geestelike genesers”. Tradisionele genesers moet by ‘n erkende organisasie geregistreer word en moet so-ook jaarliks registrasie hernu. Formele onderrig wat deur ‘n ervare kruiegeneser aangebeid word moet bygewoon en gedokumenteer word. ‘n Geskrewe rekord van die ligging van die praktyk en betrokke spesialisering moet bygehou word. Beleidsvoorskrifte wat verband hou met gesondheid en veiligheid, hygiene en sterilisasie moet in die tradisionele gesondheidgeneserspraktyk geïmplementeer word. Opleiding in pasiëntkonfidensialiteit moet aangeleer en toegepas word. Samewerking en werkswinkels tussen moderne mediese dokters en tradisionele gesondheidgenesers moet geïmplementeer en ontwikkel word. Mediese wetenskapsinligting en tegnologie moet aan tradisionele genesers bekendgemaak word. Voorts moet ‘n voortgesette professionele ontwikkelingsprogram (POP) aan alle gesondheidswerkers voorgeskryf word. Dit blyk wenslik te wees om tradisionele hospitale tot stand te bring waar die bestek van praktyk gedefinieer word. Sulke hospitale kan dien as plekke waar pasiënte aansterk en geestelike onderskraging geniet. ‘n Etiese kode en standaard vir professionele etiek moet geskep word vir tradisionele genesers. Gesondheids- en sekureitsregulasies moet van toepassing wees en geïmplementeer word. Pasiënte moet ingelig word oor die wegdoen van mites en fabels. Daardeur kan die positiewe sy van tradisionele medisyne (byvoorbeeld mediese voordele van kruie), en uitroei van “kwakke” (byvoorbeeld dra van gelukbringers om die lywe), verdryf word. Dit sal die aanmoediging van ‘n gesonder, sekuriteitbewuste en deursigtige gesondheidsorg sisteem bewerkstellig in Suid-Afrika waar alle dissiplines van medisyne saam bestaan in die Nasionale Gesondheidsorgsisteem.

The use of traditional medicine through the use of medicinal plants in Africa and especially in South Africa has long been considered an important characteristic of people's daily lives and socio-cultural heritage. Cotyledon Orbiculata is among the medicinal plants that are used by South African traditional practitioners for the treatment of epilepsy and painful conditions such as corns, warts, toothache, earache, boils and various other ailments. However, the claim of therapeutic successes of medicinal plants by traditional medicine practitioners are hardly subjected to scientific scrutiny. This study therefore, investigated the anti-epileptic property of Cotyledon Orbiculata by studying the effects of the methanol extract of the plant against chemically induced seizures by pentylenetetrazole, picrotoxin, bicuculline and N-methyl-DL-aspartic acid in mice. The study also investigated the analgestic effects of Cotyledon Orbiculata by studying the effect of the plant extract on pain induced by acetic acid and hot plate thermal stimulation.

Medicinal bulbs form part of the diversified flora in South Africa. The plants are used extensively in South African traditional medicine in the treatment of various ailments. Due to the ever-increasing demand and the unrestricted collection of medicinal plants from the wild, many of these slow growing bulbous plant species are driven into over-exploitation and extinction. The main parts collected for use are the underground bulbs, leading to the destructive harvesting of the whole plant. This form of plant harvesting poses threats to the long term sustainability of these plant resources from their natural habitats. Sustainable harvesting of these plants should be within the limits of their capacity for self-renewal. However, this seldom occurs with the often inconsiderate medicinal plant gatherers. Conservation of these plants is therefore necessary. A strategy that would take into consideration the sustainable harvesting and perhaps simultaneously provide similar medicinal benefits, would be the substitution of bulbs with leaves of the same plant. This study was aimed at evaluating the seasonal pharmacological and phytochemical properties in bulbs/corms and leaves of medicinal bulbs with a view of promoting the substitution of bulbs with leaves in traditional medicinal use. Four medicinal bulbous plants, Tulbaghia violacea, Hypoxis hemerocallidea, Drimia robusta and Merwilla plumbea were evaluated for the pharmacological and phytochemical properties in their bulbs/corms and leaves in spring, summer, autumn and winter seasons, with a view of promoting the use of leaves as a conservation strategy. Dried plant materials were sequentially extracted with petroleum ether (PE), dichloromethane (DCM), 80% ethanol (EtOH) and water in each season. The extracts were tested for activities against Gram-positive (Bacillus subtilis and Staphylococcus aureus), Gram-negative (Escherichia coli and Klebsiella pneumoniae) bacteria and the fungus Candida albicans using the in vitro microdilution assays to obtain minimum inhibitory concentrations (MIC) and minimum fungicidal concentrations (MFC). The four plant species were also evaluated for their ability to inhibit cyclooxygenase (COX-1 and COX-2) enzymes. Spectrophotometric methods were used to evaluate saponin and phenolic contents of samples from the four plant species in each season. Antibacterial activity was fairly comparable between bulbs/corms and leaves of H. hemerocallidea, T. violacea, and M. plumbea, with at least one extract showing some good activity (MIC < 1 mg/ml) in most of the seasons. Bulb extracts of D. robusta did not show good antibacterial activity while the leaf extracts showed good activity (0.78 mg/ml) against B. subtilis in spring, summer, and autumn and S. aureus (0.78 mg/ml) in autumn. The best antibacterial activity was recorded in winter, with MIC values as low as 0.195 mg/ml from the DCM bulb extracts of T. violacea against K. pneumoniae and S. aureus and PE corm extracts of H. hemerocallidea (0.195 mg/ml) against B. subtilis. Good antibacterial activity from water extracts were only recorded from corm extracts of H. hemerocallidea in summer, autumn and winter, H. hemerocallidea leaf extracts in autumn and winter, and M. plumbea bulb extracts in autumn. The leaf extracts of all the screened plant species demonstrated good fungicidal activity in autumn, with H. hemerocallidea corm water extracts recording an MFC value as low as 0.39 mg/ml. The leaf extracts of H. hemerocallidea (water), D. robusta (DCM) and M. plumbea (DCM) had good MFC values of 0.78 mg/ml each, in spring. The DCM leaf extracts of T. violacea also showed good fungicidal activity (0.78 mg/ml) in summer, while corm water extracts of H. hemerocallidea had an MFC value of 0.39 mg/ml in winter. There were no fungicidal activities recorded from all the bulb extracts in all the seasons. All the PE and DCM extracts in all the tested plant samples recorded between moderate (40-70%) and high (> 70%) COX-1 and COX-2 inhibition levels across all seasons. The EtOH corm extracts of H. hemerocallidea also demonstrated moderate to high inhibitory activity against COX-1 enzyme across all seasons. Bulb and leaf extracts of T. violacea showed selective inhibitory activity for COX-2 enzyme in all the seasons. The highest COX inhibitory levels were recorded in COX-2 from the PE leaf (spring) and bulb (autumn) extracts of T. violacea, with both recording 100% inhibitory activity. Phytochemical analysis revealed higher total phenolic compounds in bulbs/corms and leaves of all the analysed plant species, to be either higher in spring or winter. Plant material collected in autumn had the least levels of total phenolics. An almost similar trend to that of total phenolics was observed for flavonoids, gallotannins and condensed tannins in most plant samples, with higher levels either in spring or winter. Total saponins were consistently higher in winter than in the other seasons in all the screened plant species. There were in some cases, relationships between the peaks in the levels of some phytochemical compounds and the observed levels of bioactivity in different assays. The results obtained from this study demonstrate that the leaves of the screened plant species may substitute or complement bulbs in the treatment of certain ailments in traditional medicine. Thus, plant part substitution can be sustainably utilised in the conservation of these plant species while retaining the same medicinal benefits. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

The use of traditional medicine is a popular practice in South Africa especially among rural dwellers due to several reasons such as availability of natural products, cultural beliefs, preference of natural products to synthetically derived drugs and the high cost of modern drugs. Traditional healers in South Africa play key roles in administering treatment for all sorts of ailments using plants. The aim of this study was to evaluate the efficacy of seven selected medicinal plants that are used in traditional medicine to treat stomach-related ailments for their pharmacological and phytochemical properties. Plant material was extracted sequentially with ethyl acetate (EtOAc), ethanol (EtOH) and water. The extracts were evaluated for their antimicrobial activities using the microdilution technique against two Gram-positive (Enterococcus faecalis ATCC 19433 and Staphylococcus aureus ATCC 12600) bacteria and a Gram-negative (Escherichia coli ATCC 11775) bacterium. A modified microdilution technique was used to screen for antifungal activity against a yeast-like fungus (Candida albicans ATCC 10231). Only the EtOAc extract of Tetradenia riparia demonstrated good antibacterial activity against the Gram-negative E. coli, all the other extracts that were active only showed good antibacterial activity against the two Gram-positive (E. faecalis and S. aureus) bacteria with MIC values <1 mg/ml. None of the extracts that exhibited good inhibitory activity showed corresponding bactericidal activity against the bacterial test strains, suggesting that the observed activity were all inhibitory. Good antifungal activity with an MIC value <1 mg/ml was observed in only 5 extracts, and none of the extracts exhibited corresponding fungicidal activity. The in vitro colorimetric assay for anthelmintic activity against Caenorhabditis elegans revealed that almost all the extracts possessed moderate to high anthelmintic properties. The EtOAc extract of T. riparia had the best activity at MLC value of 0.004 mg/ml. The anti-inflammatory activity of the plant extracts was tested using the cyclooxygenase assays to determine their inhibitory potential against COX-1 and COX-2 enzymes. All the EtOAc extracts demonstrated both COX-1 and COX-2 inhibitory activity in the range of 50.7 ± 2.4 to 99.5 ± 0.5%. Apart from the EtOH extracts of C. multicava that showed high inhibitory activity against both COX-1 and COX-2, all the other EtOH extracts were COX-2 selective. Aqueous extracts exhibited poor inhibitory activity against both COX-1 and COX-2 enzymes with the exception of T. riparia and Coddia rudis that showed good inhibitory activity (69.1 ± 0.9 and 92.65 ± 0.7%) against COX-1 and COX-2 respectively. The standard plate incorporation assay for the Ames test was carried out to determine the potential genotoxic effects of the plant extracts and this revealed that all the extracts were non-mutagenic towards Salmonella typhimurium tester strains TA98, TA100 and TA1537 without metabolic activation. However, further studies incorporating metabolizing enzymes are needed to confirm the safe use of the studied plants. Phytochemical analysis revealed relatively high amounts of total phenolics, gallotannins and flavonoids in all the evaluated plants. Total and steroidal saponins were detected in only two plant samples, Canthium spinosum and Cassinopsis ilicifolia (bark). These findings present useful information on the types of bioactive compounds that could be responsible for the pharmacological activities observed among some of the plant extracts. The results obtained in this study showed different levels of pharmacological activities among all the evaluated medicinal plants which provide scientific validation for their use in traditional medicine as antimicrobial agents. Phytochemical analysis provides valuable information for further study that will be aimed at isolation and identification of the bioactive principles in the evaluated plant species. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.

The purpose of this study was to get a better sense of what collaborative efforts between the allopathic and indigenous health systems to address HIV/ AIDS look like 'on the ground' with the hope that revealed successes and failures could inform other initiatives. The pilot investigation took the form of a small case study of the Community Health and HIV/AIDS project at the Valley Trust in KwaZulu Natal's Valley of a Thousand Hills where HIV/AIDS collaboration with traditional healers has taken primarily three forms: 1) incorporation in the formal primary health care system as CHWs (TH/CHWs); 2) formal short-term HIV/AIDS training (Trained); and 3) informal second-hand HIV/AIDS training or information sharing (Untrained). The investigation focused primarily on how the indigenous healers' involvement in the Valley Trust's varying training programs affected their knowledge ofthe disease, their engagement in HIV/ AIDS awareness and prevention efforts, their treatment of HIV/AIDS patients, and their perception and relationship with the formal medical system. The findings show that collaboration between traditional and formal health services, in the form of the Valley Trust's training, results in 'better' HIV/AIDS work by participating traditional healers through enhanced performance on HIV/AIDS knowledge tests. As indicated by their superior performance on correlating knowledge indices, TH/CHWs engaged in the most effectual community prevention activities of the three groups. Additionally, the TH/CHW group appeared to have the most confidence and experience in treating patients with HIV/AIDS. Additionally as compared to the other two groups, their treatment methods were more varied, induding psycho-spiritual ceremonies, diet, traditional medicinal herbs, and support of biomedical efforts. Given the comparative success of TH/CHWs, it was ironic that only the healers' themselves indicated wanting more izangomas to serve as Community Health Workers. As leaders among participating healers, TH/CHWs were critical to the success of the Valley Trust's collaborative project. The findings of this case study suggest that the nature of the varying trainings offered by the Valley Trust accounted for the primary difference in the effectiveness of the healers' subsequent HIV/AIDS work. The study implies that both the skills-based nature and long-term supervision of the CHW training were instrumental in their superior performance. These findings point to the fact that indigenous healers can not function effectively as extension services without investment in infrastructure development and ongoing support. In terms of the collaboration between biomedical and indigenous health systems operating at the Valley Trust, the primary point of contention between the participating parties was the collaboration's unidirectional referral system (healers would refer patients to the clinic and not vice versa). Discrepancies in the collaborative partners' perceptions of one another, which were revealed in the study, point to the need for greater dialogue and formal linkages between participating groups. A referral system of some content and magnitude appears to be the most critical and pressing issue the new structure needs to address. / Thesis (M.Dev. Studies)-University of Natal, Durban, 2002.

Le problème de la responsabilité médicale se pose avec acuité dans le monde. S'agissant de nos Etats comme le Sénégal nous observons une timide évolution de la responsabilité. Cette dernière est induite par le type d'offre de soins. Cette interdépendance s'exprime au niveau de la nature de la responsabilité et de son régime juridique. Dans le cadre d'une offre publique de soins, la responsabilité est administrative et relève de la compétence du juge administratif. Dans le cadre de l'offre privée de soins, la responsabilité est civile et est de la compétence du juge judiciaire. A travers cette étude, nous avons observé que l'offre de soins est diversifiée du fait des nombreux acteurs et déséquilibrée du fait de l'absence de couverture de santé généralisée. Nous avons également constaté que les mécanismes traditionnels d'engagement de la responsabilité sont surannés dans certains cas, ayant pour conséquence la difficulté d'indemnisation des victimes. Une amélioration de la réglementation des pratiques médicales, y compris de la médecine traditionnelle, et une meilleure prise en charge des dépenses de santé de la population sénégalaise seraient souhaitables. Au vu de ces constats, nous préconisons donc l'accélération de l'adoption du Code de la santé publique du Sénégal et la création d'une Commission Régionale d'Indemnisation des accidents médicaux et des infections nosocomiales dans l'espace de l'Union Economique Monétaire Ouest Africaine, comme il en existe une en France. / The problem of the medical liability arises with acuteness in the world. In Senegal, we observe a shy evolution of the liability. This last one is inferred by the type of healthcare services. This interdependence expresses at the level of the nature of the liability and its legal regime. Within the framework of public healthcare services, the liability is administrative and recovers from the competence of the administrative judge. Within the framework of the private healthcare services, the liability is civil and is the competence of the judicial judge. Through this study, we observed that the healthcare services are diversified because of the numerous actors and unbalanced because of the absence of cover of generalized health. We also noticed that the traditional mechanisms of commitment of the liability are outmoded in certain cases, having for consequence the difficulty of compensation of the victims. An improvement of the regulations of the medical practices, including the traditional medicine, and a better coverage of the expenses of health of the Senegalese population would be desirable. In view of these reports, we thus recommend the acceleration of the adoption of the Public health code of Senegal and the creation of a Regional committee for Compensation of the medical accidents and the hospital-borne infections in the space of the Monetary Economic union the West African, as there is there one in France.

En Côte d’Ivoire, la problématique de l’accessibilité aux soins reste entière en raison de l’insuffisance des infrastructures sanitaires et du manque de ressources financières. Aussi, la population a t-elle souvent recours à l’odontologie traditionnelle pour répondre à ses besoins prioritaires de santé. Cependant, l’absence de données factuelles dans un contexte de pluralité de soins constitue un handicap pour la définition d’une politique de santé bucco-dentaire efficiente. L’objectif de la présente étude a été de décrire l’activité des tradipraticiens, puis de déterminer les facteurs influençant le recours et le renoncement aux soins bucco-dentaires des populations. L’étude de type transversale pilote a portée sur un échantillon de 28 tradipraticiens et 927 adultes. Les résultats ont montré que les consultations bucco-dentaires répresentaient le 1/5 de l’ensemble des activités des tradipraticiens. La majorité des tradipraticiens a déclaré prendre en charge les douleurs bucco-dentaires et était disposé à collaborer avec la médecine conventionnelle. Les tradipraticiens ont déclaré être satisfaits des honoraires perçus. Les ressources végétales et minérales étaient principalement utilisées pour la confection des remèdes. S’agissant de l’étude menée auprès des usagers, alors que les adultes non scolarisés avaient recours en majorité aux tradipraticiens, ceux qui disposaient d’une assurance de santé ou qui avaient le niveau d’étude du secondaire ou plus ont consulté préférentiellement le chirurgien-dentiste. Les adultes ayant un niveau d’étude secondaire ou plus ont eu recours à un tradipraticien en raison de sa proximité. Le recours au tradipraticien en raison de l’efficacité des soins a été plus évoqué par les adultes ayant un âge compris entre 30 et 44 ans, par ceux résidant en milieu urbain et par ceux situés à plus de 15 km du cabinet dentaire. Quant au recours au chirurgien-dentiste en raison de la confiance faite aux soins modernes et la propreté des cabinets dentaires, il a été majoritairement le fait d’adultes vivant dans des habitats modernes. Le renoncement aux soins traditionnels en raison de l’automédication a été le plus évoqué par les femmes. Les adultes situés entre 5 et 15 km du cabinet dentaire ont majoritairement renoncé aux soins traditionnels en raison de la non perception de leur nécessité. Le manque de ressources financières a été le plus évoqué par les adultes vivant en milieu urbain pour justifier leur renoncement aux soins modernes. La non perception de la nécessité des soins a été plus évoquée par les adultes situés entre 5 et 15 km du cabinet dentaire pour justifier le renoncement aux soins modernes. Cette étude a mis en évidence la relation entre l’accessibilité aux soins bucco-dentaires et la pauvreté. Ainsi l’amélioration de l’accès aux soins bucco-dentaires doit s’inscrire dans le cadre global de la lutte contre les inégalités sociales, de l’alphabétisation et de l’aménagement du territoire. En outre, l’odontologie traditionnelle doit être valorisée pour venir en aide au système de santé dans un contexte marqué par l’insuffisance des ressources financières / In Côte d'Ivoire, the issue of access to care remains unanswered due to the lack of good public health infrastructure and very limited financial resources. As a result, poor and disadvantage people often prefer to address their priority health needs to traditional healers. However, the lack of evidence data in a context of plurality of care is a handicap for the definition an efficient oral health strategy. The main objectives of this study were to describe the activities of traditional healers practicing in the department of Dabou and determine the various factors influencing the populations in using them or not in oral. The cross-sectional pilot study focused on 28 traditional healers and 927 adults. The results showed that the consultations represented 1/5 of all the activities of the traditional healers. The majority of traditional healers reported that they were called to heal oral pain of patients and were ready to work with conventional medicine. Traditional healers declared to be satisfied by the level of fees. However 15 traditional healers reported to have another job. Vegetable and mineral resources were mainly used for making medicines. Regarding the survey of users, the main determinant of seeking care was the educational level of respondents. While no schooling adults visited in priority traditional healers, those who had health insurance and those who had secondary educational level or more preferably consulted the dentist. Adults with secondary educational level or more claimed to have been to a traditional healer because of its proximity. The effectiveness of care as a reason for attending a traditional healer was more often mentioned by adults within 30 and 44 years, by adults living in urban areas and those living at a distance of more than 15 km from the dental office. Seeking modern treatment because of the confidence and the cleanliness in dental offices was more the fact of adults living in a modern home. The renunciation of traditional care because of self-medication was more often reported by women. Abandoning the traditional treatments because of failure to perceive the need of care was mentioned by adults ranged between 5 and 15 km from the dental practice. Lack of financial resources was cited by most adults living in urban areas to justify the renunciation to modern health care. Failure to perceive needs for care was mentioned by adults ranged between 5 and 15 km from office dental to justify their abandonment of modern oral health care. This study gave evidence of the complex relationship between access to oral health care and the level of poverty. Thus, improving access to oral health care must fit into the overall framework of the fight against social inequality, illiteracy and the territory development. In addition, traditional odontology should be valued and integrated in any strategy the health system given the low level of current financial resources to the public health sector in Côte d’Ivoire

Dans cette thèse nous avons abordé les tradipratiques à l'île Maurice et nous avons tenté de délimiter une zone d'interculturalité où se situent ces tradipratiques, partagées par les différentes communautés religieuses et ethnoculturelles de l'île et s'insérant dans un fonds commun mauricien. Ainsi, nous avons constaté qu'il existe une conception commune de la maladie, du corps, des Invisibles et des traitements qui font partie de cette zone interculturelle, issue du contact de cultures et de la créolisation. Nous avons ainsi été amenée à envisager l'imbrication du sacré et du profane au sein des tradipratiques et fait le constat que ces deux facettes sont indissociables et nécessaires à l'efficacité des traitements. Nous avons également envisagé les rituels de soins sous leur aspect identitaire, mettant en évidence le rôle central joué par les ancêtres dans les traitements, la transmission transgénérationnelle du don de guérison et de voyance, mais également comme agents à l'origine de certains syndromes. Ce qui nous amène à souligner l'aspect identitaire des rituels de soins venant répondre à la nécessité de réaffirmer les liens aux ancêtres, la filiation du patient et celle de sa famille, l'insérant dans un groupe et renforçant ainsi son identité. / In this PhD thesis, the traditional medicinal practices were considered within the context of Mauritius Island and we have attempted to delimitate an area of interculturality where traditional medicinal practices are taking place and are shared by the different religious and ethnocultural communities of the island and are inserted in a common Mauritian ground. Thus, we have discovered that there is a common conception of the disease, the body, the invisibles, treatments, making part of this intercultural zone and resulting from the contact with cultures and creolization. We have thus considered the interweaving of the sacred and the secular within the traditional practices and made the statement that these two aspects were inseparable and necessary for the efficiency of treatments. We have also considered the healing rituals from the angle of identity while revealing the central role played by the ancestors in these treatments, in the inter-generational transmission of the gift of healing and clairvoyance but also as agents causing specific syndromes. This leads us to stress out the necessity to reaffirm the links toward the ancestors, the filiation of the patient and his family, inserting him in a group and therefore reinforcing his identity.