Characteristics of the healers
Nineteen healers were interviewed; 18 were male (Table
1). Seven traditional healers were interviewed from Tanna, four from Luganville, Santo, five from Port Vila and three from Epi (Table
1). Just under half (7) of the traditional healers preferred to be known by the name “
kastom doctor/
dokta” and two thirds (10) had been a traditional healer for ten years or more (Table
1). Most of the healers reported living in the same community long-term (i.e. ten years or more). The communities they served ranged from 50-3,000 people (Table
1). Of those who could report how many patients they treated, almost three quarters (9) said they treated more than 100, with a range of 50-4000 patients per year (Table
1).
Table 1
Demographic and other characteristics of 19 traditional healers in Vanuatu
Sex (n = 19) | | |
Male | 18 | 95 |
Age group (n = 19) | | |
18-29 years | 1 | 5 |
30-39 years | 1 | 5 |
40-49 years | 3 | 16 |
50-59 years | 3 | 16 |
60 years and over | 4 | 21 |
Age group not recorded | 7 | 37 |
Location (n = 19) | | |
Epi | 3 | 16 |
Port Vila | 5 | 16 |
Santo | 4 | 21 |
Tanna | 7 | 37 |
Name of healer (n = 17) | | |
Kleva*
| 1 | 6 |
Kastom^ dokta
#
(or dokta) | 7 | 41 |
Healer | 1 | 6 |
Other | 8 | 47 |
Length of time as healer (n = 15) | | |
1-4 years | 2 | 13 |
5-9 years | 3 | 20 |
10-19 years | 4 | 27 |
20 years of more | 6 | 40 |
How learned to be a healer (n = 19) | | |
Ancestors | 1 | 5 |
Grandparents | 3 | 16 |
Parents | 4 | 21 |
Spirit or God | 5 | 26 |
Other | 6 | 32 |
Number of people in community (n = 15) | | |
51-100 | 4 | 27 |
101-200 | 2 | 13 |
200 or more | 9 | 60 |
Number of people treated in a year (n = 12) | | |
Less than 50 | 1 | 8 |
51-100 | 2 | 17 |
101-200 | 2 | 17 |
201 or more | 7 | 58 |
Eight of the healers learned their practice from their ancestors while others learned from a spirit, God or by other means (Table
1). Many of the healers recounted that they first learned how to be a traditional healer when confronted by an illness.
“Mi bin lanem ol samting ia from wan taem we angkel blong mi hem i bin fuldaon mo brekem han blong hem mo mi garem hem mo go luk wan kleva. Mi askem kleva ia blong i tijim mi mo mi bin pem hem wetem wan buluk mo wan stamba blong kava”.
“I have learned mine through my uncle who fell and broke his arm and I took him to my custom doctor. That was where I asked the man to teach me and I bought it [the knowledge] with a cow and a kava stem” (Male traditional healer, TH4).
Many of the healers described that they could treat “lots of illnesses” or “everything” while others were more specific and described a range of illnesses and symptoms that they routinely treated.
“Suga, main wan ia nao, hae blad, cancer, kidney problem, heart problem, waet liver problem, hemia nao olgeta main wan we ol man I stap luk mi from”.
“Most people come to see me for diabetes. Also high blood pressure, cancer, kidney problems, heart problems, white-liver problems, these are the main ones” (Male traditional healer, TH9).
Illnesses and symptoms that were commonly reported were: hypertension, cancer, diabetes, headaches and “kastom illnesses”. We did not know if the biomedical terms were part of the healer’s diagnostic vocabulary, or if they adopted these labels from their patients.
Four of the healers said that they would not treat TB; four were also reluctant to treat severe blood loss. While some healers stated that they would treat “everything”, others said that they avoided certain conditions such as: yaws, “chronic conditions”, AIDS, diabetes, paralysis, “heart problems”, “wet dreams” and asthma.
Treatment of lung diseases
When asked if they treated
short wind, 15 (83%) responded that they did (Table
2).
Short wind was frequently interpreted as asthma by the healers, although not always.
Short wind was attributed to food (5, 31%), alcohol or smoking (3, 19%), and pollution by menstrual blood (3, 19%) (Table
2):
Table 2
Reported practice of treatment of lung diseases by traditional healers in Vanuatu
Treat short wind (n = 18) | 15 | 83 |
How do people get this sickness# (n = 16) | | |
Alcohol/ smoking | 3 | 19 |
Food | 5 | 31 |
Hereditary | 1 | 6 |
Other natural cause | 2 | 13 |
Other spiritual cause | 2 | 13 |
Sexual intercourse with menstruating women | 3 | 19 |
Symptoms of short wind* | | |
Cough | 8 | 42 |
Discoloured eyes | 3 | 16 |
Fever | 2 | 11 |
Haemoptysis | 3 | 16 |
Fatigue | 5 | 26 |
Shortness of breath | 8 | 42 |
Weight loss | 5 | 26 |
Other symptoms | 10 | 52 |
“Mi save se man we i kasem sotwin hem i mas stap silip blong gat seks wetem waef o wan woman we i stap luk sikmun from toti blad i go insait lo bodi blong hem mekem se hem i sik”.
“I know that a person who gets sick with asthma has been having sex with his wife or a woman who has been menstruating, that is the infected blood that gets into his body making him sick of shortness of breath” (Male traditional healer, TH4).
Some healers mentioned that short wind was like TB, or led to TB.
Treatment of TB and collaboration with the national TB programme
Three of the healers stated that they had treated TB, another said he would collaborate with the hospital on TB and another stated that he had treated “unclean lungs”. Two healers stated that they treated cough. Just over half of the healers (10, 53%), said that, if needed, they would treat TB with leaf or
kastom medicine, while others said that they would treat it with massage, water and prayer (Table
3). Leaves were rubbed or placed on a patient, administered in a drink or given to patients to ingest or chew. The healers stated that there were different kinds of leaves for TB if one symptom was predominating, i.e. a leaf for cough, another for haemoptysis etc., and that various combinations of leaves could be offered together. Further, if a patient was not improving the leaf could be changed:
Table 3
Reported practice of treatment of tuberculosis by traditional healers in Vanuatu
Treatment of TB# (n = 19) | | |
Kastom medicine* | 4 | 21 |
Leaf medicine^ | 6 | 32 |
Massage | 2 | 11 |
Water | 1 | 5 |
Don’t treat | 2 | 11 |
Send to hospital | 2 | 11 |
Other treatment | 2 | 11 |
Treatment of strong wet cough# (n = 19) | | |
Kastom medicine | 4 | 21 |
Leaf medicine | 6 | 32 |
Massage | 1 | 5 |
Water | 2 | 11 |
Don’t treat | 4 | 21 |
Send to hospital | 1 | 5 |
Other treatment | 1 | 5 |
Referral practices (n = 16) | | |
Refer patients for wet cough | 12 | 75 |
Refer patients to health clinic | 11 | 69 |
Work practices | | |
Work with health clinic (n = 15) | 9 | 60 |
Willingness to work with NTP (n = 18) | 18 | 100 |
Conditions for working with NTP (n = 7)‡
| | |
No conditions required | 2 | 29 |
Money | 2 | 29 |
Token of appreciation | 2 | 29 |
House | 1 | 14 |
“Blong ol kaen man olsem ia, bae mi givim tritmen blong sik fiva fastaem bifo mi lukluk lo wet long bodi blong hem. Blong kaen sik we ol i kof, mi gat wan difren lif mo tritmen blong hem. Sapos wan sik man i stap go bunbun tumas, bae mi mas givim meresin blong i leftemap wet blong hem mo sapos kof blong hem i no go daon, bae mi mas givim tritmen blong bodi wet blong hem fastaem bifo mi lukluk lo kof we hem i gat. Hemia i blong jenisim blad i go klin bakegen, taswe hem i save gat paoa bakegen. No, blo kof wetem blad, hemia i gat narafala meresin blong hem bakegen”.
“But for these kinds of people I would treat the fever separately and then his body weight. With cough I have a different leaf or treatment for that… If the patient is going skinny I give medicine for losing weight, if the cough is going down then I might have to treat his body weight first before the cough. This [is] to try and change the blood to fresh one so that he can regain his strength. [Also] for coughing up blood there is also a different medicine” (Male traditional healer, TH4).
While the majority of healers responded that they would treat a wet-cough with leaf medicine (10, 53%), four said that they could not treat a strong wet-cough but would refer these patients to the hospital (Table
3). Three quarters (12, 75%), of the healers had referred someone to a hospital for a strong wet-cough (Table
3). Further, just over half of the healers (9, 60%), reported a previous collaboration with the Government health care system, while six (40%) had never collaborated (Table
3).
One of the main points of interest in this study was whether the healers would be willing to collaborate with the NTP and under what circumstances. All of the healers who responded to this question (n = 18) indicated a willingness to work with the NTP. The remaining healer was not asked the question (Table
3).
Most, however, did not respond when asked about conditions under which they would work with the NTP. Those who responded (n = 7) indicated that a small token of appreciation including money, would be appreciated:
“Suga, main wan ia nao, hae blad, cancer, kidney problem, heart problem, waet liver problem, hemia nao olgeta main wan we ol man I stap luk mi from”.
“If we were to help each other and you thought that you would want to pay me then that would be up to you and I would like to learn more about TB because this is a very strong sickness” (Male traditional healer, TH13).
Two healers said that no payment (monetary or otherwise) would be needed.