African traditional medicine–potential route for viral transmission?
1998; Elsevier BV; Volume: 352; Issue: 9121 Linguagem: Inglês
10.1016/s0140-6736(05)79558-1
ISSN1474-547X
Autores Tópico(s)HIV, TB, and STIs Epidemiology
ResumoIn Africa, heterosexual contact is the main route of transmission of HIV-1 and hepatitis B. We describe two potential non-sexual routes of viral transmission related to traditional medical practices in KwaZulu-Natal, South Africa. We also discuss how government antiwitchcraft legislation has altered traditional medical practice and increased the risk of transmission.The first and most common practice. Umgcabo is used as protection against malicious spells, harmful buried medicines, nightmares, headaches, epistaxis, lightning, and bullets (often sought by taxi drivers). The treatment may need to be repeated every 6 months and frequently involves whole families. In Zambia, entire village communities have been subjected to umgcabo by diviners.1Auslander M “Open the Wombs!” The symbolic politics of modern Ngoni witchfinding.in: Comaroff J Comaroff J Modernity and its malcontents: ritual and power in postcolonial Africa. Chicago University Press, Chicago1993Google Scholar Umgcabo involves making multiple skin incisions with a razor blade, usually a new blade broken in half for each patient. The healer then takes the muthi (an oily suspension of up to 15 substances, usually of plant origin) and rubs this into the cuts, transferring blood from finger to muthi, thus to the next patient from this and any reused blades. The preparation may vary according to the disorder being treated, but in practice any one healer tends to use the same muthi for all conditions treated by umgcabo.The second practice ukutshobha, is a treatment for physical ailments such as fainting, lethargy, swollen legs, and lameness, rather than a preventative measure like umgcabo. This treatment involves injection with a porcupine quill or sharpened bicycle spoke. The skin is punctured every 5-10 cm down both sides of the body and at every fifth puncture, the quill is dipped into a bucks horn containing the muthi (figure). The preparation differs from umgcabo, and is used on individuals rather than groups, but throughout a day, many patients are treated with the same quill and muthi. The horns are frequently lent out to third parties to treat themselves and family members.For the treatment of AIDS, one healer claimed he used a combination of ukutshobha, umgcabo, and oral medicine. Zulu traditional medicine at the turn of the century was fundamentally different to the current practice described. The accounts of Bryant and Krige2Bryant AT. Zulu medicine and medicinemen. Capetown, Struik, 1996.Google Scholar, 3Krige EJ The social system of the Zulus. Shuter and Shooter, Pietermaritzburg1988Google Scholar detail a medical system based on two distinct but interdependent branches, the diviner or diagnostician (isangoma) and the healer (inyanga) who selected and applied the remedies. The healers who had more obvious western counterparts (eg, herbalist, homoeopath) were recognised in colonial law in 1910 and granted licences to practice as herbalists among their own people. The diviners, part of their role being to sniff out witches, fell into the same category as witches under The Witchcraft Suppression Act of 1895, which remains in force today.4South Africa Commission of Inquiry into Witchcraft Violence and Ritual Murder in the Northern Province of the Republic of South Africa. Report of the Commission of Inquiry into Witchcraft Violence and Ritual Murders in the Northern Province of the Republic of South Africa. Pietersburg, 1995.Google Scholar The Act made divination, including medical diagnosis by divination, a criminal offence. To avoid the consequences of the law and to remain in practice, many diviners registered as herbalists, which gave rise to a new form of practitioner, the diviner/healer, who was untrained in the use of about 700 potential medicinal herbs.2Bryant AT. Zulu medicine and medicinemen. Capetown, Struik, 1996.Google Scholar, 5Hutchings A Scott AH Lewis G Cunningham AB Zulu medicinal plants: an inventory. University of Natal Press, Pietermaritzburg1996Google Scholar The result was a decrease in specific treatments for particular conditions and an increase in non-specific therapies and the indiscriminate use ofumgcabo and ukutshobha.The potential risk of viral transmission is reinforced by the western equivalents of needle-sharing, non-sterile acupuncture, and haemotherapy. Interviews with current practitioners of traditional medicine suggest that they would welcome advice on aseptic technique and treatments of the muthi which might lower the risk of transmission of HIV-1 and hepatitis B. In Africa, heterosexual contact is the main route of transmission of HIV-1 and hepatitis B. We describe two potential non-sexual routes of viral transmission related to traditional medical practices in KwaZulu-Natal, South Africa. We also discuss how government antiwitchcraft legislation has altered traditional medical practice and increased the risk of transmission. The first and most common practice. Umgcabo is used as protection against malicious spells, harmful buried medicines, nightmares, headaches, epistaxis, lightning, and bullets (often sought by taxi drivers). The treatment may need to be repeated every 6 months and frequently involves whole families. In Zambia, entire village communities have been subjected to umgcabo by diviners.1Auslander M “Open the Wombs!” The symbolic politics of modern Ngoni witchfinding.in: Comaroff J Comaroff J Modernity and its malcontents: ritual and power in postcolonial Africa. Chicago University Press, Chicago1993Google Scholar Umgcabo involves making multiple skin incisions with a razor blade, usually a new blade broken in half for each patient. The healer then takes the muthi (an oily suspension of up to 15 substances, usually of plant origin) and rubs this into the cuts, transferring blood from finger to muthi, thus to the next patient from this and any reused blades. The preparation may vary according to the disorder being treated, but in practice any one healer tends to use the same muthi for all conditions treated by umgcabo. The second practice ukutshobha, is a treatment for physical ailments such as fainting, lethargy, swollen legs, and lameness, rather than a preventative measure like umgcabo. This treatment involves injection with a porcupine quill or sharpened bicycle spoke. The skin is punctured every 5-10 cm down both sides of the body and at every fifth puncture, the quill is dipped into a bucks horn containing the muthi (figure). The preparation differs from umgcabo, and is used on individuals rather than groups, but throughout a day, many patients are treated with the same quill and muthi. The horns are frequently lent out to third parties to treat themselves and family members. For the treatment of AIDS, one healer claimed he used a combination of ukutshobha, umgcabo, and oral medicine. Zulu traditional medicine at the turn of the century was fundamentally different to the current practice described. The accounts of Bryant and Krige2Bryant AT. Zulu medicine and medicinemen. Capetown, Struik, 1996.Google Scholar, 3Krige EJ The social system of the Zulus. Shuter and Shooter, Pietermaritzburg1988Google Scholar detail a medical system based on two distinct but interdependent branches, the diviner or diagnostician (isangoma) and the healer (inyanga) who selected and applied the remedies. The healers who had more obvious western counterparts (eg, herbalist, homoeopath) were recognised in colonial law in 1910 and granted licences to practice as herbalists among their own people. The diviners, part of their role being to sniff out witches, fell into the same category as witches under The Witchcraft Suppression Act of 1895, which remains in force today.4South Africa Commission of Inquiry into Witchcraft Violence and Ritual Murder in the Northern Province of the Republic of South Africa. Report of the Commission of Inquiry into Witchcraft Violence and Ritual Murders in the Northern Province of the Republic of South Africa. Pietersburg, 1995.Google Scholar The Act made divination, including medical diagnosis by divination, a criminal offence. To avoid the consequences of the law and to remain in practice, many diviners registered as herbalists, which gave rise to a new form of practitioner, the diviner/healer, who was untrained in the use of about 700 potential medicinal herbs.2Bryant AT. Zulu medicine and medicinemen. Capetown, Struik, 1996.Google Scholar, 5Hutchings A Scott AH Lewis G Cunningham AB Zulu medicinal plants: an inventory. University of Natal Press, Pietermaritzburg1996Google Scholar The result was a decrease in specific treatments for particular conditions and an increase in non-specific therapies and the indiscriminate use ofumgcabo and ukutshobha. The potential risk of viral transmission is reinforced by the western equivalents of needle-sharing, non-sterile acupuncture, and haemotherapy. Interviews with current practitioners of traditional medicine suggest that they would welcome advice on aseptic technique and treatments of the muthi which might lower the risk of transmission of HIV-1 and hepatitis B.
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