In South Africa, the Hospice Palliative Care Association and Traditional Health Practitioners (THPs) have pioneered a partnership to increase access to care for people living with HIV and AIDS.
Traditional medicine is defined as the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses (WHO 2008).
Traditional health practitioners (THP’s) reported difficulty in treating patients with end-stage disease (Graham, 2008). In an effort to increase access to care for people with end-stage HIV, work is being done to build partnerships between palliative care services and THPs in order to up-skill both sectors.
Within South Africa, KwaZulu-Natal province has the highest rates of HIV infection. More than half (54%) of the adult people living with HIV (PLHIV) live in KwaZulu-Natal (SANAC, 2011).
The estimated number of PLHIV in the province is 15.8% of the total population (SANAC, 2011).
The aim of the project was to enable the traditional healers to incorporate a palliative care approach when caring for people with life-threatening illnesses.
Hospice Palliative Care Association (HPCA) initiated formal meetings between THP leaders and palliative care practitioners, where current clinical challenges, approaches to end-stage illness, priorities and possible solutions were discussed.
It was decided that knowledge-sharing and up-skilling in a bi-directional manner would benefit both sectors, as well as their patients. A task team consisting of representatives of both sectors was formed to develop the curricula.
Phase 1 focused on developing the ‘Traditional Health Practitioners’ Training manual’ on Western approaches to HIV, TB and other life-threatening illnesses, the curriculum included universal precautions, prevention, treatment and referral options.
Phase 2 focused on palliative care practitioners receiving training in the THP’s understanding of life-threatening illness, end-stage illness and death.
The pilot training took place at uMgungundlovu District in KwaZulu Natal at Msunduzi Hospice. Training was conducted for 18 THP’s in 2012.
The five-day course was divided as follows: Three days training, one month’s break for practical implementation of the learning, then two days to conclude the training and consolidate learning. A further 23 THP’s were trained in 2014.
In keeping with the vision of HPCA which is: ‘Palliative Care for All’, the development of the Traditional Health Practitioners’ Training manual was in English and isiZulu and has also been translated into seven languages, including: IsiNdebele, Isipedi, IsiXhosa, Sesotho, Setswana, Siswati, and Tshivenda for the further roll out of training for THPs.
A ‘train the trainer’ course was conducted for six professional nurses who were trained to facilitate the training for THP course to be rolled out in other provinces. Subsequently training also took place in Limpopo, Gauteng and the Eastern Cape.
Mobile technology for palliative care
In 2013, with the assistance Open Society Foundations New York, a short message service (SMS) system was developed by Owen Herterich and Claudia Bernett from Parsons School of Design in New York.
The THPs were then trained on the system which proved to be a success, the THPs were enthusiastic about using the new system. SMS’s were also sent out monthly giving the THPs information about various aspects of care.
To make the SMS system more cost effective, a local service provider was sourced to provide a similar system and this has been recognised by the THPs as most helpful. The system allows for ongoing monitoring of usage.
Regular bi -monthly meetings took place between the THPs and HPCA, this was for ongoing refresher training and for encouragement and motivation. The THPs gave feedback on palliative care in their practices, on referrals to hospices and clinics and reported back on the effectiveness of the SMS system. Challenges were addressed as they arose. The funding allowed for the contract for the SMS system to continue for a further eighteen months.
Visits to several THPs’ consulting rooms showed that the training certificate and learner manuals were displayed prominently showing pride in the learning that they have received. They acknowledge the learning has brought a change to their practice and value the respect that has been shown to them by HPCA – as a representative of the mainstream health system – through this project.