1. The Tanga AIDS Working Group (TAWG) A Traditional Medical Island of Hope By David Scheinman Samwell Mtullu, MD Firmina Mberesero, MD Mohammed Kassomo, Traditional Healer (TH) The World Bank April 30, 2003

2. Who are we?… a thumbnail introduction We’re TAWG and have treated 4,000 patients since 1991 with plant-based medicines provided by traditional healers. We’re a multidisciplinary NGO linking physicians, health workers, healers, people living with HIV/AIDS (PLHAs), botanists, social scientists, and community members. We promote and support collaboration between indigenous and modern health systems. We’re well integrated -- our offices are in the government’s regional hospital.

3. What is TAWG’s goal? Our Goal: to bridge gap between traditional and modern medicine to treat PLHAs & reduce AIDS transmission. Signature Activity is treating PLHAs with traditional medicine enabling them to continue or resume their normal activities. Our medicines are effective, cheap, non-toxic, and readily available locally. Our achievements can be replicated throughout Africa IF selected healers are taken seriously.

4. What do we do? Core activities 1.Treatment; bridge gap between hospital, healer, and patients 2.Home Care Program 3.Ethnobotanical Research 4.AIDS Education for Community and Healers 5.Partnerships 6.Run 3 information centers on HIV/AIDS. 7.Distribute IEC Material 8.Video shows, discussions, & condom distribution. 9.Collaborate with 20 community theatre groups. 10.Run Youth programs & STI Clinics. 11.VCT Centers 12.Train traditional healers in counseling & homecare.

5. Some Headlines  Traditional healers carry the burden of care for HIV/AIDS throughout Africa, so let’s join forces. 80% of Africans visit TH’s.  Hippocrates, an early herbalist, advised physicians to do no harm AND to share their knowledge  Plants -- unlike us -- can’t run from attackers so fight by producing own antidotes in form of anti - biotics, fungals, and virals. We borrow these to treat our own opportunistic infections. THs know what works!  Wild Plants represent the largest known therapeutic arsenal for combating major killer diseases.

6. Background – It Began in Pangani TAWG sprouted in 1990 from collaboration between THs and doctors in Pangani – a sleepy Tanzanian coastal town. Started by chance; real serendipity. German doc saw patients who were treated by THs. He and health workers from the District Hospital began dialogue with THs. This evolved into regular meetings and referral network.

7. Background Healers responded VERY enthusiastically. Discussed all diseases and identified who does what best. Waziri Mrisho - 84 years old, offers to treat HIV/AIDS patients in hospital. Patients surprisingly improve and Mrisho’s plant medicines wind up in doctors’ kits. Plants are botanically identified and integrated cooperation begins. From this simple experience sprung TAWG.

8. Quick Point: Voluntarily began cooperation with only an idea, support from the District Medical Officer, and zero funding!!!

9. How do we work? TAWG’s Signature Treatment Program Initially test for HIV, counsel, and give patient option to enroll in TAWG’s program. Provide pre and post HIV test counseling for patients and their families. HIV-positive patient can enroll in TAWG program -- use traditional medicines collected by a healer, distributed by Hospital. Patient can also be treated directly by TH. Patients treated for free -- we pay healer to collect. On request, we distribute medicines throughout Tanzania.

10. How does TAWG’s Signature Treatment Program Work? We prescribe medicines at doses provided by healers. Physicians and nurses subsequently monitor patients. Patients use our medicines to treat and prevent illness. Many say ours only treatment -- modern or traditional -- that worked. Most patients try conventional medicines before seeing us. More people join TAWG earlier now. Previously had many terminal patients. Standard treatment is 4 plant medicines. Major side effect is increased appetite!

11. What do the patients say? Patients report TAWG’s most valuable activity is treatment. Patients use the traditional medicines to treat and prevent opportunistic infections caused by HIV/AIDS TAWG patients enthusiastically claim that the medicines work. After nearly 11 years of TAWG administering these medicines, we think they are right. There is a compelling body of anecdotal and observational data from patients and staff.

12. For example our medicines help to: Increase appetite Gain weight Stop diarrhea Reduce fever Clear up oral thrush Resolve skin rashes and fungus Cure herpes zoster Heal ulcers

13. What else do patients say? Most patients begin seeing results from between a few days and a month after entering treatment. Medicines have not proven to be very helpful when HIV/AIDS is in an advanced state. Some patients go on and off treatment Many clients say our treatment only one that yielded results. Many patients treated with modern and traditional medicine before visiting TAWG. Reduces argument for placebo effect - many expected to get well with western or traditional meds -- but didn’t.

14. Patient Results Patients who survive for 6 months generally live 2-5 yrs. -- some even for 10 years. Medicines given to patients in powder form to make tea, or mix with coconut oil/water for topical applications. Our goal is effective treatment. We provide any treatment, traditional or conventional, that contributes to patient well-being. Due to treatment, many patients resume cooking, cleaning, farming, and becoming active parents again….quality of life improves – length too. Patient improvement has priority over research.

15. Ethnobotanical and Medical Research Selected healers provide medicines at prescribed doses for specific conditions. Patients monitored for efficacy and side effects. Research supplemented by literature reviews. College interns help build research capacity amongst our healers. Through research with local healers, identified promising treatments for HIV/AIDS related opportunistic infections. Key: identifying knowledgeable healers and cultivating relationships. Give healers professional respect, trust, access to hospital, fair price for their time & plants, and 1 seat on TAWG’s Board of Directors. Also a PLHA on board!

16. How do we do it? Show pictures to healers. Recognize condition? Use illustrated field guides developed by Shaman Pharmaceuticals. Describe symptoms. If healers identify condition and have a plant, take sample & botanically identify at Lushoto Herbarium. Collect plant with healers and compensate for their time.

17. More about how we do it… Conduct literature review through NAPRALERT and other sources. Get dosages from healers. Give to patients under physician’s supervision. If works, give to more patients. May carry out observational study with students, healer, and patient. Monitor results and draw conclusion. Examples of success: Anti-fungals from Masai and anti viral for herpes from Zigua tribe. Zigua medicine was tested in a lab and showed positive results against herpes.

18. Partners World Bank IK Program Oxfam German Church Group (EED) USAID (initially) Peace Corps Crises Corps Gent University – Environmental support Advisor from APSO (Irish Aid) Initially Shaman Pharmaceuticals and Tibotec, two tiny biotech companies.

19. Achievements  Have Cumulatively treated around 4000 patients since 1991.  Presently we treat 400 patients free of charge at three sites.  Our Home Care nurses are tops; really excellent.  Improved capacity of healers to assess patient progress.  Successfully ran Community to Community exchanges with support of World Bank IK Program  IK Program brokered relationship between NIH and TAWG

20. More Achievements  We are pioneers in developing innovative collaborative programs with healers.  We effectively link modern and traditional medicines.  Enjoy good relationship with local government, other HIV groups, and the private sector.  Our initiative has enabled us to obtain moderate financial support.

21. Lessons Learned Act creatively - we had an idea and secured funding later. Pieces will never be in correct configuration. Act and refine as you evolve Solve local problems with local knowledge! Identify local knowledge and put it to work Individual healers are easy to work with; groups are not. Lots of jealousy and rivalries. Our experience - most healers are open, cooperative, and eager to share and collaborate. Patients enjoy mix of traditional and western medicine.

22. Lessons Learned (cont.) TM research --unlike pharmaceutical research --begins with patient. Patients have taken our medications for generations. Modern drug research begins in lab and ends with patient. Another reason to just get moving. THs very interested in joining forces with western trained health workers. Need to make more traditional medicines available for more people. Don’t wait for central governments. Local government very receptive. Develop partnerships for professional, technical, financial assistance. Link with private and public sectors.

23. Dreams, Needs, and Conclusions Our priorities are:  Carry out more research with healers to find additional efficacious plants  Learn how to grow and produce selected plants.  Evaluate numerous remedies used by patients and healers throughout Africa.  Produce capsules, salves, and extracts to reduce bulk of medicines. Now, each patient requires two kgs. of bulky roots and shoots per month!  Reduce needs of patients to heat medicines by making extracts and tablets.

24. Dreams con’t….  Stigma: Little confidentiality/privacy with raw traditional medicines.  Tablets and extracts can be easily transported and taken privately.  Grow and produce plants for affordable phytomedicines. Could be a good local business for healers.  Support research to assess efficacy of our treatment.  Have IK Program continue to broker for us.

25. And finally, enable many more people to get back on their feet by using our traditional medicines. By keeping more people alive, we will automatically reduce the numbers of newly orphaned children. i