Mixing Herbalists and Modern Medicine : Health: An experimental project teaches traditional village healers in Africa how to provide family planning and basic drugs.

When a woman comes to Margaret Odera Jagero because she is having trouble becoming pregnant, Jagero--a traditional healer from a small village in western Kenya--mixes up a secret herbal remedy that she learned from her grandfather. But when a woman comes to tell Jagero that she wants no more children, the healer supplies her with birth-control pills.

Jagero, 56, is one of several dozen traditional healers from isolated Kenyan villages who have been trained in family planning and primary health care as part of an experimental project of the African Medical and Research Foundation.

Her village has no doctor, nurse or dispensary and is miles from the nearest clinic. She said that before the AMREF project began, she had nothing to offer women who wanted to avoid pregnancy and that she is delighted to add family planning to her repertoire of skills.

Until recently in Kenya and other African countries, traditional healers and Western-style medical practitioners had little contact with one another. Herbalists kept a low profile because they feared health officials would consider them witch doctors and would try to prevent them from practicing. Organizations funding health education and family-planning programs, including AMREF, tended to recruit and train their own community health workers for each project.

But in the past few years, faced with the AIDS crisis and an urgent need for population-control efforts, some health experts have begun to consider traditional healers as potential allies.

Traditional healers like Jagero have one powerful advantage over the community health workers normally recruited for such projects, said AMREF’s Robert Morgan: They are already making a living as practitioners. Community health workers are “an artificial group,” he said. “Usually when the project ends, they stop working.”

In contrast, village herbalists in Kenya and other African countries practice their skills all their lives. Morgan reasoned that if AMREF could train such traditional healers to provide family planning and basic drugs as well as their usual herbal remedies, the organization might be able to make a longer-lasting contribution to the health of isolated rural communities.

Once the healers pass an examination on primary health care, they become eligible to dispense certain medications under a UNICEF program known as the Bamako Initiative. The initiative provides low-cost drugs to treat common conditions such as malaria, nutritional anemia, eye infections, diarrheal infections and intestinal parasites. Morgan approached Steven Nyapola, an herbalist and former chief of Bar Olengo, a village in western Kenya’s Siaya District, who rounded up a handful of other herbalists to meet with AMREF workers. Morgan said the healers were surprised when their visitors began asking them about their practices.

“One of them said, ‘We thought you were coming here to arrest us. What do you want?’ ” Morgan recalled.

Morgan said the AMREF team asked the herbalists whether there were any diseases they thought the hospital treated better than they did. “Conveniently, they named all the primary health-care diseases--like malaria, anemia, diarrhea,” he said.

To the surprise of the AMREF workers, the healers were also eager to learn about family planning. So AMREF persuaded district health-management teams from Kenya’s Ministry of Health to design a training course for village herbalists and traditional birth attendants that included topics such as birth control, breast-feeding and child care, nutrition, household sanitation and hygiene, dental care, mental illness and adolescent problems. Morgan said groups of traditional healers from the Bar Olengo area and five other locations in western Kenya have completed the course and that most have passed a Ministry of Health examination on primary health care. The program is still battling formidable logistical problems, particularly the difficulty of moving regular shipments of drugs and birth-control devices from Nairobi warehouses over muddy, rutted roads to the remote villages where the healers practice. But, he said, the project’s early results appear promising.

In several of the villages where the herbalists and birth attendants practice, AMREF surveys show increased use of birth control since the healers were trained in family planning. In Siriwo, the area where training and certification of the healers proceeded most smoothly, surveys indicated that the use of birth control by men rose from 8% in July 1990 to 31% in November 1992. Birth control use by women increased from 6% to 23% over the same period. Some of the other villages show more modest, but still statistically significant, increases.