Co-operation between traditional healers and medical personnel.

To the Editor: It is my opinion that meaningful co-operation between traditional healers and scientific medical practice is impossible, because of the fundamental difference in the concept of disease causation that underlies the practice of both sides. The articles in the insert to the SAMJ of December 1994 ('Bridging the gap') provided a welcome explanation of the way in which the traditional healers and their practices form an integral part of the culture and beliefs of the African people. Many practices, including the holistic approach to disease, should serve as examples to us. However, the non-scientific basis for the treatment of disease is to the ultimate disadvantage of the ill individual, and application of traditional practices is in many instances directly harmful, in addition to delaying or denying access to scientific medicine. No one doubts the pharmacological activity contained in many plant species: a riffle through Watt and BreyerBrandwijk provides ample proof of this. The same reference provides proof that these properties are not unknown to science, and are not the sole preserve of herbalists with their prolonged, intensive apprenticeship. Moreover, the scientific knowledge is free of the magical connotations which are an integral part of the inyanga's ethos, and were also an integral part of the practice of medicine in the prescientific days. One has only to read references In Cuipepper's work to realise that many of the properties attributed to herbals were magical. Apart from an oblique reference to the abathakathi, there is little mention of the darker side of traditional healing. The myriad stories of bewitchment, ritual murder and infant stealing are part and parcel of the practice; one cannot separate them. Permitting divination, for instance, to flourish, tacitly acknowledges the right of witchcraft to continue, and one cannot readily proscribe the one and not the other. The major advantage quoted by many of the role of the traditional healer is in the realm of psychiatry. To the extent that mental illness is a product of a society, it is agreed that the logical person to treat these disorders is the traditional healer. The same arguments about herbals can be advanced against traditional healers by psychiatrists the fact that the understanding and delivery of psychiatric care to the black African is imperfect does not mean that we must allow him sub-standard care. The only way to overcome the 'problem' of the traditional healer is through provision of improved scientific health care, both in availability and quality. These include expanded local health care personnel, improved access at entry level, readily understood referral practices, greater involvement in preventive care, and acknowledgement that the individual is responsible for staying well. It makes little sense to train a person whose entire being is bound up in one philosophy to administer a totally different one better to start with a person who does not have the same emotional and ideological investment. I feel that better provision of medical care at all levels will ultimately be to the benefit of individuals and the community, and that the authorities must accept that . aspects of traditional culture are going to come under