"Where is the spirit?" The question came from a voice at the back of the conference room following Philip Aduma's presentation on how Kenya's Maseno University is helping traditional healers to standardise how they diagnose and treat illnesses.
The sceptical questioner wanted to know how it was possible to introduce Western healthcare standards to a traditional system, some of whose practitioners he said invoke the spirit-world as part of their craft.
"I am a little disappointed. You are trying to convert traditional healers into modern healers, but where is the spirit?" he asked again.
Speaking at last week's COHAB 2005 conference on biodiversity and health, Aduma, the university's deputy vice chancellor, acknowledged that he had no simple answer to the question.
But in a later interview with SciDev.Net, he said the question was valid: most modern scientists have yet to find a way to talk to people (including many scientists) who believe that spirits, God or other paranormal forces, can help treat illness.
Wall of suspicion
Aduma added that he and his university colleagues have tried hard to engage with spirit-based healers. However, they have mostly encountered a wall of suspicion, and a belief that dialogue with researchers trained in Western science will lead to unwelcome values being imposed on them.
Another audience member, Darshan Shankar of the India-based Foundation for Revitalisation of Local Health Traditions, said that this scepticism needed to be understood in its historical context.
"In the past, modern scientists have regarded non-Western traditional knowledge as being backward, and no more than a supplier of raw materials for drug discovery and development," he said.
He added that traditional medical systems have their own standards, but these needed to be reinforced, primarily through each system's own framework, with the help of protocols from Western science (see The evolution of global standards for traditional medicine).
Standardising traditional medicine
Spirit-based healers might be playing hard to get, but Aduma and his colleagues have had more success in helping Kenya's other traditional healers appreciate the value of standardising diagnosis and treatment.
The World Health Organization says that 80 per cent of people in rural parts of the developing world regularly use traditional healers for primary healthcare. This is for several reasons. Traditional healers are less expensive than medical doctors. Drawing on centuries of knowledge and practices, the healers are trusted to deliver what they promise. Lastly, there are too few medical doctors in rural areas.
But in Kenya (as in many developing countries) improving the way traditional medicine is regulated is still in its infancy. Moreover, product packaging, weights and measures and standard prescriptions – all intended to protect public health – are not yet the norm in traditional medicine.
And so, over the past two years, Aduma and colleagues have helped some 60 healers to modernise the diagnostic and dispensing side of their work.
The healers come from the Luo communities around Lake Victoria. During workshops and advice sessions, they have learned to prepare medicines hygienically; package them in small bottles instead of pages ripped from old newspapers; and to weigh or measure ingredients, instead of relying on memory to make up prescriptions.
Aduma's team also encourages the healers to give their patients written prescriptions, to store medicines safely and securely and to start keeping patient records in their clinics.
The researchers have helped the healers catalogue their medicinal ingredients and the plants from which they are derived. They also tested each ingredient for toxic effects – finding that none was harmful to people.
"The healers clearly know their toxicology," Aduma said.
Through the project, funded with the help of Canada's International Development Research Centre, the healers have come to trust the university researchers and each side has learnt much about the other, Aduma said.
But it has taken many months, many visits to healers' clinics and some hints from psychology to gain that trust.
"We could not go dressed like this [in a shirt and tie]," Aduma revealed. "This would raise suspicions immediately that we were more educated than they were. We had to wear simple clothes like sandals and caps."
But with the financing for the project at an end, Aduma talked of an unforeseen problem: the healers are now trained in modern medical dispensing practice, but have no money for equipment such as plastic bottles, weighing machines, or pens and paper.
The money needed isn't much — US$20,000 will keep the healers in enough bottles, pens and machinery for a year — but so far the Kenyan government has not been keen to pick up the bill.
A typical visit to a healer costs US$2.50. This would rise to US$2.80 if the healers passed on the costs of their new equipment to patients. However, they argue that most patients cannot afford an increase of more than ten per cent in consultation fees, so they need a subsidy.
"The healers initially saw us as a threat, yet in time we have become friends. We raised their expectations, but now I am worried that we could lose it all," Aduma said.