22827 HIV/AIDS: Traditional Healers, V Community Self-assessment, and Empowerment Z q M ost African countries have on hov traditional healers and indig- ratified the African Charter on enous knowledge can empower com- Human and People's Rights, munities to deal with the social conse- which states the rights to health, edu- quences of the pandemic, and, at the - cation, and "promoting, safeguarding, same time, be able to ensure that gov- and reinforcing mutual respect and tol- ernment resources are actuallv being erance." In Sub-Saharan Africa alone, used to their benefit. some 17.2 million have died of HIV/ U.N. Secretary General Kofi Annan AIDS which includes some 3.7 million asked recently for an addition of $7 bil- children under the age of 15. Fighting lion to $10 billion per year as a mini- the disease has so far concentrated on mum transfer from rich countries to prevention, and only limited attention Africa to fight HINT/AIDS. But some ex- has been directed towards treatment perts in the region says that even such and the social and human rights aspects sums will have little impact until Afri- related to the pandemic. This seems to can nations build up their health sys- put the Charter to the test. Although tems to administer the drugs and moni- several wvestern pharmaceutical compa- tor the health of those receiving them. No. 37 nies have lowered expenses for HIV/ The formal health care system onlv October 2001 AIDS retroviral treatment, these medi- cines are still beyond the reach of most 1K Notes reports periodically on Africans. And even if medicine was pro- Indigenous Knowledge (IK) initiatives vided free of charge, countries in Sub- in Sub-Saharan Africa. It is published Saharan Africa lack the medical infra- by the Africa Region's Knowledge and Learning Center as part of an evolving structure to distribute the medicine, IK partnership between the World and it is doubtful if health systems can Bank, communities, NGOs, develop- ment institutions and multilateral be expanded at the speed and quality organizations. The views expressed in required. Finally there is a high risk this article are those of the authors that the resources allocated to fight and should not be attributed to the the disease will notS be fully accessed World Bank Group or its partners in PX the disease will not be fully accessed this initiative. A webpage on IK is by the beneficiaries for whom it was available at //www.worldbank.orgafr/ intended. The focus here is, therefore, ik/default.htm 2 reaches 10 to 20 percent of the people, and those mainly in disease is transmitted from one person to another often rc- urban centers at hospitals and clinics. Traditional healers sult in human rights violations by exclusion or isolation of provide primary health care for 80 percent of the population individuals and families with I-IIV/AIDS. And the social ef- and live in the communities where help is needed; they are fects affect the poor the most. Many communities have bc- the ones who today treat many patients for HIV/AIDS-related come aware that HINV/AIDS is transmitted via blood and diseases. Some healers have already been successful in ex- sexual intercourse, but there is also a widespread misconcep- tending the lives of patients with HIV/AIDS using medicines tion that transmission occurs by shaking hands, eating or thev from locally grown medicinal plants. A good example is bathing together, wearing the same clothes, using the same the work being done near Tanga in Tanzania. tools, or for children sleeping in the same bed. Education Should W'estern medicine finally become available at af- and information on how HIT/AIDS is being transmitted has so fordable rates to poor communities, traditional healers could far been the core initiative in fighting the disease. Little at- be the ones to distribute the medicine and ensure that pa- tention has been directed towards lifting the social stigma tients take the right doses. While traditional healers will related to the pandemic in spite of the fact that "what we need to be educated to do this, it will be less expensive to cannot speak about we can do nothing about. ' Individual and upgrade their knowl1edge than to expand the formal health social empowerment is essential for communities to handle system. Building on existing systems seems to have a higher the challenge, which is mainly left to them in the HIV/AII)S chance of sustainability. crisis. Moreover, when resources for the Wb"orld Bank-assisted HI /AII)S does not respect boundaries of class, culture or Multisector Aids Program (L\IP) initiatives begin to flow, race, but lack of knowledge and misconception on how the communities should be empowered to access and monitor resources intended for them. A very useful tool of empower- ment was applied in the transitional period from apartheid up to the election in South Africa where NG,Os and civil K K N otes rights organizations managed to mobilizc communities all would be of interest to: over the country. The campaign was the largest ever under- taken anvwhere at the time. The method was rooted in the Name facilitation of communities to create their own human rights charter based on democracy and respect for individuals of all Institution races (Dorsey 1997). The idea was based on Paulo Freire's democratic proposals of problem-solving edlucation where Address "men and women develop their power to perceive critically the way they exist in the world with which and in which they find themselves; they come to see the world not as a static reality but as a reality in the process of transformation" (Freire 2000). _*>wlu.l111fi1lual1|1.z . *[.] x * _ *To apply the successful experience of social mobilization in the fight against HIT/AIDS, a mini epidemiological study has to be undertaken by community members and for the comnmu- nity. Traditional healers (especiallywomen healers) could be key facilitators in this process. W\hat is important in commu- =33 * *3 S nity-managed research is the process its members go through, which differs fundamentally from a social assess- ment in which data collection is the most important. The 3 process of community-managed research could be facili- The aim of such community research is: (i) to begin a pro- tated, apart from the traditional healers, by a local NGO/ cess within the community to focus on HIV/AIDS, so as to CBO to balance any attempt by local elites to dominate the enable people to talk about the disease; (ii) to increase process. Among the issues to be dealt with are the following: awareness that the disease is not an abstract phenomenon * Where does the community think HIV/AIDS comes from? talked about on the radio but something concerning mem- * How does a person get the disease? bers of their own community; (iii) to get personal stories * Are there particular places where the risk for getting the which may help others in the same situation; (iv) to raise disease is high? awareness among risk groups; (v) to make the disease be- * Are there many community members who often go to come a concern for the community-e.g., on how the disease these places? can be prevented and how the patients and their families in- * Are there particular groups at high risk? cluding orphans can be helped; and, finally and very impor- * Who in the community are seriously ill? tant, (vi) facilitate the community toformulate their own Bill * What occupation did the ill persons have at the time they of Rights. Each Community Bill of Rights will have unique became ill? features depending on the particular local conditions. But * Has there been change in the person(s)' occupation since what the communities have agreed upon they will also be they became ill? eager to enforce and to install social sanctions against those * How have the symptoms developed over time? who violate what is in the best interest of the community as * Who did they contact when they first fell ill? a whole. * Did they get some medical help and where did they get it? * Has their social conditions changed after they became ill and how has it changed? * What happens to a family (socially and economically) that "Charter Making and Participatory Research" by Ellen has a member with HIV/AIDS? Dorsey in Human Rights Educationfor the Twenty-First Cen- * What initiatives have been taken by the community, by the tury edited by George J. Andreopolos and Richard Pierre government, or by the municipality/district in relation to Claude, University of Pennsylvania Press, Philadelphia 1997. the HIV/AIDS pandemic? Pedagogy of the Oppressed by Paulo Freire., 30th Anniver- * Is anybody aware of resources for which the community can sary Edition, Continuum, New York 2000. apply in order to fight HIV/AIDS? This article was written by Maja Naur, Ph.D. in sociology, and consultant to the World Bank. For more information, e-mail maianaur(&)msn.com or mnaur(a)worldbank.org 4