1. Doris Burtscher – Medical Anthropologist/MSF OCG International Aids Conference 2010 Vienna “TB is a disease that is flying to the air” traditional concepts and perceptions of tuberculosis and drug-resistant tuberculosis and the potential for home-based care

2. PERSONAL BACKGROUND Study of Social and Medical Anthropology in Vienna, Austria Specialisation in Ethnomedicine and Medical Anthropology in West Africa Ethnomedical Research with traditional healer in Senegal for Master and PhD MSF Field Experience: Mauritania, Kenya, Sierra Leone, Zimbabwe, Liberia, Niger, Swaziland and Lebanon Other NGO: Albania individual interview Swaziland, 2008

3. OBJECTIVES Determine practicability and acceptability of home-based care Describe traditional habitat Explain traditional concepts of disease transmission in general and tuberculosis transmission in particular Study perception and behaviour towards tuberculosis patients Assess basic hygiene traditional homesteads in Nhlangano health zone

4. MSF in SWAZILAND Decentralised integrated care for HIV/AIDS and tuberculosis to health clinics Hospitals have limited capacity expert client giving a health talk Difficult access to health care for patients – “one stop” strategy Co-infection TB/HIV drug-resistant tuberculosis is an emergency

5. SWAZILAND Matsanjeni

6. Heath Facilities in Shiselweni Region Nhlangano Hlatikulu Matsanjeni

7. METHODS – target groups home-based care providers, tuberculosis patients, expert clients people living with HIV/AIDS, health staff, traditional healers, chiefs headmen, community elders household members etc. refill at New Haven Clinic, Hlatikulu health zone

8. QUALITATIVE METHODS Individual Interviews (narrative and semi-structured) Group Interviews (natural, focus, and narrative) METHODS group interview with home-based care providers

9. RESULTS Traditional concepts of disease transmission “sifu semoya” Traditional ideas about tuberculosis “ sidliso” and drug resistant tuberculosis “ thayizeze/legwamile” and its transmission traditional healers/sangomas

10. RESULTS Traditional habitat and the potential of home-based care Perception and behaviour towards tuberculosis patients Traditional habitat and the potential of home-based care - “ kagogo” house Perception and behaviour towards tuberculosis patients sangoma and expert client advocating together for HIV testing and counselling

11. RECOMMENDATIONS community mobilisation home-based care treatment supporter health promotion HIV positive person under ARV treatment with MSF

12. CONCLUSION HIV testing and counselling knowledge and understanding of population and their culture appropriate answer to meet the needs overcoming ethnocentric attitudes

13. Thank you very much for your attention! Grandmother with orphans doris.burtscher@vienna.msf.org