Traditional and Faith Healers in Kenya - Kangemi Paper

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					 THE COMPLEMENTARY ROLE OF TRADITIONAL AND FAITH HEALERS AND
POTENTIAL LIAISONS WITH WESTERN-STYLE MENTAL HEALTH SERVICES IN
                             KENYA



David M. Ndetei*, Director, Africa Mental Health Foundation

Lincoln I. Khasakhala, Research Fellow, Africa Mental Health Foundation

Joyce Kingori, Program, Manager, BasicNeeds UK in Kenya

Alan Oginga, Research and Policy Officer, BasicNeeds UK in Kenya

Shoba Raja, Director, Policy and Practice, BasicNeeds UK in India


*Corresponding author: Prof. David M. Ndetei, University of Nairobi, Kenya & Director,

Africa Mental Health Foundation (AMHF), P.O. Box 48423-00100 Nairobi, Kenya. Tel: (+254)-

020-2716315, Fax (+254)-020-2717168

E-mail: dmndetei@uonbi.ac.ke or dmndetei@amhf.or.ke



Running title: The complementary role of traditional and faith healers in Kenya




                                               1
ABSTRACT

There is scarcely any documented research on the practice, role and effectiveness of faith and

traditional healers in Kenya, and if and how they complement western medicine. The study

aimed to document the perspectives of mentally ill persons and their carers on the role played by

traditional and faith healers in the treatment of mental illness in an informal settlement area in

Nairobi, Kenya. The study was cross-sectional in design and Participatory Reflection and Action

(PRA) techniques were employed. The study involved persons with mental illness and their

caregivers, as well as traditional and faith healers living in an informal settlement in Kangemi in

Nairobi, Kenya. Purposive sampling was used to identify community leaders and community

health volunteers (CHVs) who assisted in the identification and location of traditional and faith

healers in the community.       In turn, the healers identified mentally ill persons and their

caregivers.   The Mini International Neuro-psychiatric Interview was used to determine the

classification of mental disorders among mentally ill persons according to the fourth edition of

the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Focus group

discussions were held with the healers, patients and carers. Faith and traditional healers were

well accepted and their roles appreciated by the leadership and communities living within the

study site. Depression, psychosis, anxiety disorders and alcohol abuse were among some of the

most common disorders seen by faith and traditional healers. Both groups of healers used

similar procedures when treating their patients. There is need for linkages between faith and

traditional healers and contemporary western-style medicine as they play complementary roles.



Key words: Faith healers, traditional healers, informal settlement, Kenya, mental illness




                                                2
INTRODUCTION

Otsyula [6] observed that many patients in Kenya used both contemporary western-style medical

services as well as traditional healers. The patients visited hospitals to seek the cure for illness

while traditional doctors were visited for both the cure and the cause of illness [6].      Several

studies have suggested that many cultures have names for various mental health disorders,

implying that they saw and recognized them in their practices [4]. Traditional healers see and

manage most of the mental health problems in Africa [3].



Traditional and faith healers are an important part of the Kenyan medical care system but they

are poorly understood since they use obscure diagnostic methods. For example, they apply

invasive procedures which can pose a risk to mentally ill persons. There is scarcely any

documented research on the practice, role and effectiveness of faith and traditional healers in

Kenya, and if and how they complement western medicine. The objective of this study was to

document the perspectives of mentally ill persons and their carers on the role played by

traditional and faith healers in the treatment of mental illness in an informal settlement area in

Nairobi, Kenya. The perspectives of the traditional and faith healers were also enquired for.




                                                 3
METHODS

The study was cross-sectional in design. Participatory Reflection and Action (PRA) techniques

were employed where the researchers provided a situation where community members reflected

critically about what they were experiencing, looked for patterns to help analyse their

experiences, identified any new information or skills they may have needed and got this

information and training and then planned for action [10]. A reflective approach gives the

communities opportunities to share their opinions and contribute to decisions or plans being

developed. The study involved persons with mental illness and their caregivers, as well as

traditional and faith healers living in an informal settlement in Kangemi in Nairobi, Kenya.



The Kangemi informal settlement is located in Kangemi location, in Westlands Division which is

found in the western district of the city of Nairobi in Kenya. The informal settlement is divided

into 12 „villages‟, each with a village head. The village heads are invaluable associates and

confidantes of the location chief (the local government administrator) and work very closely with

him/her and the three assistant chiefs. Kangemi is an established settlement rather than a typical

urban slum. Many people living here are longtime residents, offspring of longtime residents or

their close relatives. Other residents are people who have migrated from rural areas to set up

temporary homes here. Majority of the residents of this area live below the poverty line on less

than U$1 a day and can barely afford basic necessities. Kangemi Health centre and Gichagi

Dispensary serve as the primary government health care delivery clinics. Private medical clinics,

some of which are owned by individuals, are distributed across the settlement area. A few are

operated by non-governmental organisations, community-based organisations and faith-based




                                                4
organisations. Personnel running these clinics however have no mental health training; meaning

they cannot effectively manage and follow-up cases of mental illness.



Purposive sampling was used to identify community leaders and community health volunteers

(CHVs) who had information on the location of traditional and faith healers in the community.

In turn, the healers identified mentally ill persons that they had seen and followed up for at least

on 2 occasions, together with their caregivers. An assessment was conducted during which

information on age, occupation, symptoms of mental illness seen/referred to the healers and

diagnostic methods used by the healers, was sought. The Mini International Neuro-psychiatric

Interview (versions for adults, children and adolescents) was used to determine the classification

of mental disorders among mentally ill persons according to the fourth edition of the Diagnostic

and Statistical Manual of Mental Disorders (DSM-IV) criteria [7, 8].            Four focus group

discussions (FGDs) with 8-15 participants each were carried out using a semi-structured

interview schedule. There were two groups of faith healers, one with 13 participants and the

other with eight, and one group comprising nine traditional healers. Mentally ill persons and

their carers were interviewed together as one group.




                                                 5
RESULTS

A total of 158 patients/clients (25 children and 133 adults), 44 caregivers, 33 faith healers and 21

traditional healers were recruited into the study.



Acceptability of traditional and the faith healers by the community in the study site

Faith and traditional healers were generally well accepted and their roles appreciated by the

leadership and communities living within the study site. Faith healers were regarded as servants

of God, and were not considered to be doing their work for gain. They were called upon to lead

in prayers at the beginning and end of most community meetings and functions.



Community leaders advised community members to seek treatment from traditional healers with

a good reputation. The leaders frequently visited the traditional healers to make sure they were

not „abusing‟ their clients by overcharging, subjecting them to dehumanising procedures, or

using coercion.    The leaders also required the healers to prepare their herbs in hygienic

conditions and to avoid sharing instruments amongst clients.          The leaders also urged the

traditional healers to register their practice with the Kenya Medical Research Institute (KEMRI),

a government research body with a division of herbal medicine. Community members were

advised by the leaders to report any cases of malpractice by the traditional healers.



Socio-demographic characteristics, family and economic profiles of the faith and

traditional healers (Table 1)

Faith healers were generally younger than traditional healers. There were more males than

females within both groups of healers. The faith healers were predominantly Protestant while




                                                     6
the traditional healers were mainly Muslims and Catholics. Overall, traditional healers had

acquired less formal education than the faith healers, with the majority of the traditional healers

having achieved only primary level (up to eight years of formal education) of education as

compared with faith healers (61.9% and 36.4% respectively).



Twenty-two out of the 24 (91.7%) faith healers and 9 out of the 16 (56.3%)) traditional healers

who were married were in monogamous unions. Majority (95.2%) of the traditional healers had

no other formal employment while 24.2% of the faith healers were in full time employment

elsewhere. High proportions of both groups of healers were living in rental houses. Faith

healers earned higher incomes than traditional healers since most of them were supported by

members of the churches in which they were ministering.



Socio-demographic profiles of persons with mental illness and carers (Table 2)

Sixty-eight percent of the patients were aged between 19 and 45 years. Majority (78.5%) were

female and similar proportions were married (31.7%) or divorced (30.5%). More than three-

quarters (78.2%) belonged to the Protestant denomination, 53.4% had primary level education

and 63.3% were unemployed at the time of the interviews. Ninety percent of the patients lived in

rental houses. Caregivers were mainly aged between 19 and 45 years (65.9%). More than two-

thirds (68.2%) were female, 61.4% were married and they were predominantly Protestant

(61.4%).   Nearly half (45.4%) were unemployed and 81.8% lived in rental houses.




                                                7
Psychiatric diagnoses by the faith and traditional healers

Depression was the most common diagnosis made among mentally ill adults (13 males and 62

females) who visited faith healers. (Traditional healers diagnosed only two cases of depression).

Traditional healers made diagnoses of depression according to the presenting symptoms which

included perennial sadness, lack of interest in or no involvement in any activities and sleeping all

the time. Psychosis or „madness‟ was another commonly made diagnosis. The traditional

healers labelled the psychoses according to their different presentations. Abnormal behaviour

was also commonly labelled as demon possession and the belief among members of the various

ethnic groups living in the study area was that one was bewitched because of some wrongdoing

or was born with the problem.



Anxiety disorders which manifested themselves through symptoms such as insomnia, panic and

worry were also diagnosed by faith healers. Symptoms of alcohol abuse and drug-induced

psychosis were seen among people abusing alcohol. These symptoms included loss off or

inability to retain jobs, lack of interest in members of the opposite sex even for those who were

of marriageable age.



Symptoms Profiles Checklist by Carers

Carers of mentally ill persons and family members recognized a wide range of symptoms that

were suggestive of mental illness. Some of the symptoms included hearing voices or talking to

one self, seeing dead relatives and speaking to them, wanting to kill one self, walking naked or

removing clothes in public. Other common symptoms described by the carers were inappropriate

behaviour or speech, lack of sleep, unreliability, thinking a lot, being unkempt and becoming




                                                 8
withdrawn from the family or friends. Some of the severe symptoms that were described

included laughing inappropriately, feeding or sleeping on collected garbage, wearing rags or

nylon papers, disturbing others, getting excessively angry for no apparent reason, becoming

violent, chasing chicken, stealing without fear, and refusing to eat. Family members became

worried if the mentally ill person refused to take a bath/shower, became violent or destructive,

made a lot of noise, played dangerously on the roads, threatened to commit suicide, ate garbage

or got involved in heavy drinking. Other worrying symptoms described were lack of sleep,

walking aimlessly, beating/biting others, inappropriate dressing, running around aimlessly or

disappearing from home without informing family members, inability to sleep alone or wanting

to sleep when the doors are wide open at night, forgetfulness, loss or lack of libido and extreme

sadness or crying for no reason.



DSM-IV diagnoses of patients (Table 3)

Both groups of healers saw similar types of psychiatric disorders. Traditional healers had a

wider range of diagnostic categories under their care than faith healers. Traditional healers

treated more cases of epilepsy than faith healers (52.4% vs 27.3%) while faith healers treated

more cases of depression than traditional healers (39.4% vs 9.5%).



Treatment procedures

These are summarised in Table 4. There were similarities in the treatment procedures followed

by faith and traditional healers, the common ones being counselling and utilisation of the family

social support system. Use of herbs and invasive procedures were predominantly reported

among the traditional healers. Before commencing treatment, all the healers explained the




                                               9
procedure that they were going to use on the patients. The healers stressed to their clients that

they had to believe in the treatment for it to work.



Follow-up

Most faith healers required the carer to provide updates on the patient‟s progress and response to

treatment at every appointment. The healers gave appointments depending on the patients‟

problems, either when they paid the family a visit or when the carer and the patient came to their

clinics. Prior to the visit, arrangements were made on how they should meet and what was

required of the mentally ill person, carer and the family.     The healers clarified to carers and

mentally ill persons what would take place at every appointment. During each visit, the healers

counterchecked that the herbs were being taken as prescribed and also enquired if they had

caused any problems.



Formation of linkages between the healers and other medical professionals

At least 39.4% of the faith healers reiterated the need for linkages between themselves and other

mental health service providers. They believed that forming such a relationship would enable

them to learn from others while at the same time allowing the patients to make an informed

decision on where to go for treatment. The association if formed would allow a quicker referral

system for those cases that one healer cannot handle/treat. A few stated that there was need to

form links with hospitals but not with traditional healers because the latter were not honest.



Some faith healers felt they should be based in hospitals for the express purpose of offering

prayers because “both doctors and the patients need God”. Some conditions are spiritual and




                                                 10
therefore there is need for synergy between prayers and hospital medicine. A few felt that the

link could create amicable relationships between the healers, health workers and among patients

because in sickness, one requires spiritual counselling and healing.



Majority of the healers felt that the medical professionals (doctors) should create a programme

allowing the sharing of ideas on how to handle and treat the mentally ill person and to be able to

complement each other. Traditional healers reported that formation of linkages would create

order and allow them to help each other in research since being on the ground, they are better

placed to identify clients with mental illnesses. A few felt they should be given some rooms in

the hospitals to perform their duties since there were a number of patients who had been referred

from hospital to them and mentally ill persons required follow-up. Others were of the view that

there was need for them to have exchange programmes with medical service providers and

through these, they could learn and share ideas. Other reasons given were that there are cases that

respond better to traditional medicine than to conventional drugs/treatment and either party can

access other drugs, or express their role in the management of mentally ill persons.



Carers and mentally ill persons also felt that faith healers and medical professionals should form

linkages because for one, hospitals offer drugs while churches are better at counselling and

offering encouragement. On linkage with traditional healers, the carers felt that there should be a

way of referring a patient once it is noticed that there is no improvement with the treatment

offered.




                                                11
DISCUSSION

Faith and traditional healers are accepted, consulted and are part of the normal community life

within this study site.      They do not operate in secret and there are informal regulatory

mechanisms to monitor and vet them particularly the traditional healers, including ensuring good

clinical practices that protect their clients.



The traditional healers were mainly in the 31+-year age bracket and formed a heterogeneous

group comprising members who had taken over the practice from a family member (mainly a

grandparent). These findings were similar to those of Gessler et al [1] who reported that the

practitioner was initiated into the practice by ancestral spirits.   The findings that faith healers

were generally younger than the traditional healers, majority of the healers were male and they

were in full-time practice are similar to Tanzanian findings [1].



Users of services offered by the faith and traditional healers were economically worse off than

the healers. The economic status of the patients meant that they could not afford mental health

services offered in public and private facilities, even where the public services were highly

subsidized. Therefore, the healers reached a socio-economic class of people who could not

access other services, just like in the rest of Africa [9]. The traditional healers used herbs and

allegedly had extensive knowledge about the curative power of herbs of plant origin. Traditional

healers in this study relied on divination to determine the cause of mental illness as has been

reported elsewhere [2]. The findings of this study illustrated that faith and traditional healers in

the study area did indeed handle people with DSM-IV diagnoses as has been demonstrated in

another study [5].




                                                 12
Faith healers were predominantly Protestant and this reflected the major religious denomination

in Kenya. They relied on the use of prayer using holy water or ash for healing, findings which

have been reported elsewhere [2]. Counselling and family therapy were common trends in both

traditional and faith healing models. However, traditional healers also administered herbs

(pharmacotherapy) and used surgical procedures. In the absence of knowledge on the chemical

nature of the herbs, it is not possible to ascertain the safety or the efficacy of such herbs. This is

one area where scientific study of the herbs would be useful. Although there are several

laboratories that are willing to help, the traditional healers are suspicious that their “secrets” may

be stolen and therefore the only way to patent their “medicines” is to protect them, especially

with regards to information on where they source them from.



Both faith and traditional healers made elaborate follow-up and domiciliary visits that the public

and private health services modelled on Western medicine cannot match. However, the spiritual

aspect had negative connotations, especially when the illness was attributed to witchcraft

practiced by evil people, who, if identified would be subject to vigorous and dangerous social

sanctions.




                                                 13
CONCLUSIONS

Currently, traditional and faith healers are the only ones providing mental health services within

the study area. They are well accepted and recognized. Their number is higher than can ever be

matched by western-trained medical service providers.        They serve clients who are socio-

economically disadvantaged and therefore provide a useful and vital service. Traditional and

faith healers manage most of the mental health problems in this area and therefore they need to

be recognized and involved in the provision of mental health services. These services can be

incorporated within a range of community-based services in local settings to provide all the

benefits of mental health treatment processes following adaptation and policy briefs formulation.



RECOMMENDATIONS

(i)     There is a need to formalise links between faith healers, traditional healers, community

        and medical professionals.

(ii)    A provision should be made to integrate traditional medicine in the management of

        mental disorders since most communities recognise the traditional healers role in the

        management of diseases in the communities. This will lead to inclusion of traditional

        medicine into the mainstream health care system and empower the traditional healers and

        the community to carry out their traditional medicine practice without fear or intimidation

        from the public.

(iii)   Provision of training and policy guidelines to address the needs of traditional and faith

        healers in understanding the management of mental disorders. This will reduce

        unnecessary invasive procedures that are used by some healers in their treatment

        processes and also train the healers in the understanding of psychiatric symptoms.




                                                14
(iv)   The traditional healers should form a link with KEMRI so that the medicinal plants can

       be identified and documented since the derivatives of these plants are used for treating

       selected disease/conditions. This will allow dissemination of information and knowledge

       and increase awareness of the importance of conservation of indigenous medicinal plants.

       This also will raise the level of technical skills in the post-harvest handling and

       preparation of the herbs for use (treatment).




                                                15
ACKNOWLEDGEMENTS

  The Africa Mental Health Foundation provided logistical support for this study. The authors

  would like to thank: BasicNeeds (UK) in Kenya for providing a grant to support this study;

  the community members of Kangemi informal settlement for their participation in this study;

  Grace Mutevu for preparation of the manuscript; and, Patricia Wekulo for providing editorial

  assistance.




                                            16
REFERENCES

1. Gessler MC, Msuyu DE, Nkunya MH, Schar A, Heinrich M, Tanner M (1995)

   Traditional healers in Tanzania: Sociocultural profile and three short portraits. J

   Ethnopharmacology 48 (3): 145-160

2. Kale R, (1995) South Africa‟s health. Traditional healers in South Africa: A parallel

   health care system. BMJ 310: 1182-1185

3. Makanjuola ROA, Adelekan ML, Makanjuola AB, Ndom RJE (1987) Traditional mental

   health practitioners in Kwara State, Nigeria. Yoruba healers in psychiatry II:

   Management of psychiatric disorders. (1987) Afr J Med Sci16: 61-67

4. Ndetei DM (2007) Traditional healers in East Africa. Int Psychiatry 4 (4): 85-86

5. Ngoma MC, Prince M, Mann A (2003) Common mental disorders among those attending

   primary health clinics and traditional healers in urban Tanzania. Br J Psychiatry 183:

   349-355

6. Otsyula W (1973) Native and Western healing: the dilemma of East African psychiatry.

   J Nerv Mental Dis 156: 297-299

7. Sheehan DV, Lecrubier Y, Harnett-Sheehan K, Amorim P, Janavs J, Weiller E, Hergueta

   T, Baker R, Dunbar GC (1998) The Mini International Neuropsychiatric Interview

   (M.I.N.I.): The development and validation of a structured diagnostic psychiatric

   interview for DSM-IV and ICD-10. J Clin Psychiatry 59 (suppl 20): 22-33

8. Sheehan DV, Lecrubier Y, Harnett-Sheehan K, Janavs J, Weiller E, Bonora LI, Keskiner

   A, Schinka J, Knapp E, Sheehan MF, Dunbar GC (1997) Reliability and validity of the

   Mini International Neuropsychiatric Interview (MINI) according to the SCID-P . Euro

   Psychiatry 12 (5): 232-241




                                           17
9. Swantz L (1990) The medicine man among the Zaramo of Dar-es-Salaam. University

   Press, Dar-es-Salaam

10. Training and Research Support Centre (TARSC), The Ifakara Health Research and

   Development Centre (IHRDC), The Southern African Regional Network on Equity in

   Health (EQUINET) and CHESSORE Zambia (2006) Participatory methods for a people

   centred health system: Training workshop, meeting report. Bagamoyo, Tanzania

   February 28 to March 4.




                                     18
Table 1: Distribution of faith and traditional healers by socio-demographic and socio-
economic status, n (%)
                                           Faith healers          Traditional healers   All
Variable
Age (years)
       19-30                               6 (18.2)               2 (9.5)               8 (14.8)
       31-45                               17 (51.5)              8 (38.1)              25 (46.3)
       46+                                 10 (30.3)              11 (52.4)             21 (38.9)
Gender
       Male                                19 (57.6)              16 (76.2)             35 (64.8)
       Female                              14 (42.4)              5 (23.8)              19 (35.2)
Marital Status
       Single                              6 (18.2)               3 (14.3)              9 (16.7)
       Married                             24 (72.7)              16 (76.2)             40 (74.1)
                Monogamous                 22 (91.7)              9 (56.3)              31 (77.5)
                Polygamous                 2 (8.3)                7 (43.7)              9 (22.5)
        Widowed                            1 (3.0)                0                     1 (1.9)
        Divorced/separated                 2 (6.1)                2 (9.5)               4 (7.4)
Religion
        Muslim                             1 (3.0)                5 (23.8)              6 (11.1)
        Catholic                           1 (3.0)                2 (9.5)               3 (5.6)
        Protestant                         31 (93.9)              12 (57.1)             43 (79.6)
        Other                              0                      2 (9.5)               2 (3.7)
Level of Education (years)
        None                               1 (3.0)                4 (19.0)              5 (9.3)
        Primary (1-8)                      12 (36.4)              13 (61.9)             25 (46.3)
        O Level (9-12)                     16 (48.5)              4 (19.0)              20 (37.0)
        Tertiary (13+)                     4 (12.1)               0                     4 (7.5)
Employment
        None                               24 (72.7)              20 (95.2)             44 (81.5)
        Part-time                          1 (3.0)                1 (4.8)               2 (3.7)
        Full-time                          8 (24.2)               0                     8 (14.8)
Type of housing
        Rental                             29 (87.9)              20 (95.2)             49 (90.7)
        Own/family                         4 (12.1)               1 (4.8)               5 (9.3)
Living with
        Parent                             1 (3.0)                0                     1 (1.9)
        Spouse                             30 (90.9)              19 (90.5)             49 (90.7)
        Other                              2 (6.0)                2 (9.6)               4 (7.6)
Estimated income per month (Kshs)*
        <1000                              0                       5 (25.0)             5 (9.4)
        2000-5000                          13 (39.4)              11 (55.0)             24 (45.3)
        5000-10000                         9 (27.3)               0                     9 (17.0)
        >10000                             11 (33.3)              1 (5.0)               12 (22.6)
        Not known                          0                      3 (15.0)              3 (5.7)

*Kshs = Kenya shillings
At the time of the study, the exchange rate was US$ 1 = Kshs 71



                                                  19
Table 2: The socio-demographic and socio-economic profiles of patients and carers, n (%)

                                                       Mentally ill persons (N = 79)   Carers (N = 44)
Variable
Age (years)
        18-30                                                    33 (41.8)                15 (34.1)
        31-45                                                    35 (44.3)                15 (34.1)
        46+                                                      11 (13.9)                12 (27.3)
Gender
        Male                                                     17 (21.5)                14 (31.8)
        Female                                                   62 (78.5)                30 (68.2)
Marital status
        Single                                                   17 (21.5)                11 (25.0)
        Married                                                  25 (31.7)                27 (61.4)
        Widowed                                                  10 (12.7)                 5 (11.4)
        Divorced/separated                                       24 (30.5)                  1 (2.3)
        Cohabiting/other                                          3 (3.8)                      0
Religion
        Catholic                                                 17 (21.5)                12 (27.3)
        Protestant                                               61 (78.2)                27 (61.4)
        Other                                                     1 (1.3)                  5 (11.4)
Level of formal education (years)
        None                                                      7 (8.9)                  2 (4.5)
        Primary (1-8)                                            47 (59.4)                21 (47.7)
        O Level (9-12)                                           24 (30.4)                18 (40.9)
        Tertiary (13+)                                            1 (1.3)                  3 (6.8)
Employment
        None                                                     50 (63.3)                20 (45.5)
                Period of unemployment
                < one year                                        7 (14.0)                 1 (2.3)
                1-2 years                                         4 (8.0)                     0
                >2 years                                         20 (40.0)                13 (29.5)
                Never worked                                     19 (38.0)                30 (68.2)
        Part-time                                                 9 (11.4)                11 (25.3)
        Full-time                                                20 (25.3)                12 (27.2)
Type of housing
        Rental house                                             71 (90.0)                36 (81.8)
        Own/family house                                          6 (7.5)                  6 (13.6)
        Other                                                     2 (2.5)                   2 (4.5)
Income per month (Kshs)
        <1000                                                    27 (34.2)                 6 (13.6)
        2000-5000                                                31 (39.2)                20 (45.5)
        5000-10000                                                1 (1.3)                   4 (9.1)
        Does not know/unspecified                                20 (25.3)                14 (31.8)
Living with
        Parent (s)                                               47 (59.5)                15 (44.1)
        Spouse                                                   11 (13.9)                11 (25.0)
        Other (sibling, aunt, uncle, friend, child)              23 (29.1)                18 (40.9)




                                                      20
Table 3: DSM-IV disorders in patients visiting faith and traditional healers

                                 Prevalence of disorders

   Disorders
                                                   Children               Adults
Depression                                             4                    79
Bipolar I disorder                                     2                     7
Schizophrenia                                          1                    13
Panic disorder without organic cause                   -                     7
Panic disorder with organic cause                      -                     5
Obsessive Compulsive Disorder                          -                    15
Posttraumatic Stress Disorder                          -                    15
Alcohol Dependence/Abuse                               -                     3
Mental Retardation (delayed milestones)                1                     -
Total number of diagnoses                             25                   143


                Proportion of mental disorders seen by the healers, %
                                          Faith healers           Traditional healers

Anxiety disorders                           -                      -
Demon possession                            12.1                   -
Depression                                  39.4                   9.5
Epilepsy                                    27.3                   52.4
Madness (psychosis)                         9.1                    4.8
Suicidal behaviour                          6.1                    -
Misuse of alcohol                           -                      -
Cerebral malaria                            -                      -
Mental retardation (delayed milestones)     -                      -
Migraines                                   -                      -




                                             21
Table 4: Treatment procedures followed by faith and traditional healers

Treatment procedures                                                Faith    Traditional
                                                                   healers     healers
Prayers for the sick (in all cases)                                   √
Combined counselling and prayers                                      √
Combined counselling, prayers and family therapy                      √
Application of ointment or cleansed water                             √
Counselling with the mentally ill person and/or with the carer        √          √
Family therapy                                                        √          √
Exorcising of demons from the mentally ill person                     √          √
Lifting of a curse from the mentally ill person                       √          √
Administration of herbal preparations (in 76% of all the cases)                  √
Combined administration of herbal preparations and counselling                   √
Combined counselling, administration of herbal preparations and
family therapy                                                                   √
Massaging with herbal preparation                                                √
Inhalation of steam from herbal preparations                                     √
Treatment of mentally ill person with own secretion (urine)                      √
Making small skin cuts and rubbing herbal preparation                            √
Sacrificial offerings e.g. slaughtering of sheep, goat, hen, etc                 √
Advising the family to perform specific rituals to appease                       √
ancestors




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posted:10/17/2011
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