Traditional healers and global surveillance strategies for emerging diseases.

A recent position paper by the Centers for Disease Control and Prevention (CDC) stresses that surveillance is critical to an effective defense against new and reemerg-ing infectious diseases and indicates that current international monitoring of such diseases is fragmentary and inadequate (1). Other major studies have also recorded the weaknesses in the present disease reporting system (2-4). The concept of " global surveillance " implies the coordination of existing networks as well as the addition of state-of-the-art electronic networks to ensure close monitoring of and rapid response to outbreaks, even in the most remote locations (1,2,5-8). Plans for strengthening current surveillance efforts include a global consortium with specialists in epidemiology and infectious diseases working in close collaboration with international agencies, ministries of health, universities, and research laboratories (1,2,6,9-11). Existing programs at the World Health Organization, CDC, the Pan Ameri-can Health Organization, and elsewhere will be reconfigured to work as a more cohesive system (1). Secure networks will be developed for 1) the transmission of sensitive information; 2) automatic reporting from physicians' offices, hospitals, and laboratories ; and 3) the integration of existing and planned information systems. The field application of computer technology, satellite imagery that allows geographically oriented information to be visually and analytically linked to images of the environment, and the development of new statistical and mathematical modeling methods are under discussion (1,3,12). As medical anthropologists, we note the absence in current plans for global reporting systems of " traditional " or non-Western health care providers, who in communities worldwide are usually the first, and often the only, health specialists to see patients with new or reemerging diseases. These local health specialists, called traditional healers, may have a role to play in the early identification of new or reemerging diseases and could assist in coordinating responses to outbreaks and providing public health education at the local or regional levels. Most people around the world have little access to modern medical systems (13-15). Even though immunizations and antibiotics increasingly find their way into indigenous systems, healers, midwives, bone setters, herbalists, and other traditional health experts provide most or all medical care. The more remote, indigent, or traditional the population, the greater the likelihood that it will have little access to modern medical care (13,16). If such care is sought, it will be only as a last resort, should traditional healers prove unable to address the illnesses (16). In many communities, …