How traditional healers became allies in Ebola response

Beni – At the entrance to the Centre de médecine tradi-moderne du village, a health centre offering conventional and herbal treatments, in Beni town, a painted mural shows a man and a woman washing their hands. “Plants are life, handwashing saves lives” a caption reads. In a smoke-filled room inside, a woman cooks green fruits on a charcoal stove and crushes them into a black powder to treat hernia. In the three-bed clinic next door, patients can choose to be treated with plant remedies or with modern medicine by nurses who are trained in both.

When Ebola erupted in the Democratic Republic of the Congo’s (DRC) northeastern Ituri and North Kivu provinces, traditional practitioners in small clinics such as this were the first port of call for many who fell ill in rural communities. While it was the DRC’s 10th outbreak of the disease, it had never been seen in this part of the country before. Most traditional healers did not triage patients or have basic protection for themselves or their patients. Infection prevention and control was next to nothing. The virus was passed from patient to healer and on to the next patient, with disastrous effects on the mortality rate.

“When a sick person came, we just treated them straight away,” says Oscar Ngabia, the secretary of the traditional healer’s association in Beni. “When Ebola came here, we didn’t believe in it, that’s why we continued to treat people as we had done before.” He says people here had heard of Ebola but associated it with the dramatic late-stage symptoms, rather than the first signs, which can easily be confused with other illnesses. When people came for treatment and died very suddenly, they assumed it was witchcraft.

To break the chain of transmission, the World Health Organization (WHO), the Ministry of Health and other partners worked with traditional healers, providing them with kits to protect themselves. They were also trained and received support in infection prevention and control. But it took some persuasion for the measures to be adopted.

“People learn through experience unfortunately”, says Abdoulaye Ouedraogo, WHO Infection Prevention and Control Team Lead in Beni. “We started training and told them: ‘any sick person who comes to you, be careful, do not touch them with your bare hands, you must wear gloves’. At first, they thought it was nonsense. But when they began to get Ebola, and sadly some of them died, then they began to realize that what we were telling them could be true. Little by little, we got them to understand that when you’re treating someone, it’s not just so that you can exchange your life for theirs.”

The first steps were to practice triage, so that any suspect patients could be sent to an Ebola transit centre, and to use protection for themselves and for their other patients. The association of traditional practitioners also attended meetings of local health officials, where they reported deaths or other concerns from their members’ clinics to the authorities, and relayed important developments back to their members. Anything used to treat suspect Ebola patients needed to be safely disposed of and replaced. This new way to treat patients has now been integrated into traditional practices, its effectiveness proven through the toughest of challenges.

“Infection prevention and control categorically changed the way traditional practitioners care for patients,” says Mr Ngabia. “It’s the only way to protect ourselves from illness: protective equipment like gloves, boots, soap, protective clothing. It saved a lot of lives.”

This new way to treat patients has now been integrated into traditional practices, its effectiveness proven through the toughest of challenges.

WHO