The two Dr Mullers

2009-11-18 00:00

“THERE are two Dr Mullers,” announced Townhill Hospital medical manager Dr Liz Thomson. “The one Dr Muller who likes to keep his paperwork­ colour-coded and in a neat pile, and the other who is comfortable attending a party of traditional­ healers and having a good time. The second­ is the real Dr Muller.”

It was a fitting description of the newly retired chief specialist and metropolitan head of the Department of Medicine based at Grey’s Hospital, Dr Jim Muller.

Widely known for a meticulous approach to his work and dedication to his profession, he also seemed to have little hesitation about donning a traditional animal-skin headdress and beaded tie, brandishing a miniature warrior’s shield and doing a few traditional dance steps before being fêted as guest of honour at a colourful farewell thrown for him by KwaZulu-Natal traditional healers under a tent in Snathing on a recent Wednesday afternoon.

Muller, who retired at the end of September after lengthy service in the city’s public hospitals, is to join his family in his wife’s native country of Denmark. The physician is credited with playing a major role in bridging some of the divides between traditional healers and Western-trained doctors in the province and campaigning for their gradual integration into the formal health-care system.

Chief professional nurse at Edendale Hospital Mqansa Makhathini, who was also master of ceremonies at the unique farewell function, said traditional healers were surprised by a warm welcome when they approached Muller in 2000 to discuss the mutual benefits of closer ties. Muller was then a consultant in charge of medicine at Edendale Hospital and drew into the discussions a number of other supportive doctors, one of whom is Muller’s successor as the head of medicine at Grey’s, Dr Bongani Thembela.

Makhathini said that the healers made the overture because they were keen to learn from Western doctors. They also wanted to engage them in their bid to have their activities properly recognised and supported by the state.

“Muller is an open- minded physician, but he’s not the kind of person to accept anything uncritically,” said Makhathini, who was originally tasked by the late senior traditional healer Mpungushe Shange to liaise between the healers and doctors, a role he still fulfils today. Makhathini said that his own personal calling has been deferred, with the blessing of his ancestors, in the interests of his liaison and research function.

As a result of that meeting in 2000, regular knowledge exchange sessions, which are still held monthly, were instituted between the two parties. Two years later, Mwelela Kweliphesheya, a provincial traditional healers’ association aimed at research, education and training, was formed. Makhathini said that Muller­’s support has also resulted in healers now being represented at a range of uMgungundlovu District Municipality health committees dealing with tuberculosis, antiretrovirals, lethal communicable diseases and ethics. The physician also facilitated links between the healers of Mwelela Kweliphesheya and the South African Medical Association (Sama) during his chairmanship of the midlands branch of the association. These links produced guidelines for collaboration between traditional healers and biomedical practitioners.

For Muller, the glaring problem in those early days of collaboration was a lack of communication.

“Patients would go to a healer and then come to us. But there was no communication between the two systems,” he said. As a result, he said, patients think that doctors don’t trust traditional healers and even among some doctors there’s the belief that traditional remedies are, at best, ineffective and at worst, harmful.

“I think one needs to learn to take a broader view. There may be things that healers do and understand that we don’t and to which they can make a contribution.”

Muller said that his sense was that healers had taken steps to understand better how doctors approach ill health, but attempts by doctors to understand their traditional counterparts better had occurred only on an incidental basis.

Muller said the role of healers in the formal health- care system was now even more pressing with recent proposals to introduce a National Health Insurance system to fund health care for the entire population, a large majority of which, said Muller, use the services of traditional healers. “There has been no planning regarding how the healers might be brought in to the formal system,” he said.

Through the Grey’s Hospital ethics committee, Muller has pushed for changes to the existing Traditional Health Practitioners Act of 2007, to allow healers to perform rapid HIV/Aids testing as part of their practice and thus play a role in reducing the burden placed on the health system by HIV/Aids.

Currently, the legislation prohibits South Africa’s estimated 200 000 traditional health practitioners from performing HIV testing because it is not a traditional philosophy, although 40 members of Mwelela Kweliphesheya have undergone accredited training for tuberculosis and HIV-related counselling.

Thus the legislation does not appear to allow for any expansion or development of traditional practices. However, Muller believes that training traditional healers to test would constitute a good expression of task-shifting, a strategy that is supported by the Department of Health which involves the passing on of a task to a less-skilled person who is trained and properly supervised.

Makhathini, who is also an adjunct lecturer at the Nelson R. Mandela School of Medicine at the University of KwaZulu-Natal and is pursuing doctoral research on the subject of traditional healers, said healers believed that having already undergone accredited training for HIV/Aids-related counselling, they were now ready for testing.

“There is a real and urgent need to scale up voluntary counselling and testing [VCT] if we are to achieve the national strategic plan’s objectives to reduce the rate of new HIV infections by 50% by 2011,” he said.

Makhathini said that traditional leaders are well placed to conduct testing. “They have influence, are highly respected in their communities and can offer complete confidentiality,” he said. “Their approach is a holistic one. If necessary, they will involve the whole family in the healing process.”

For Muller, much of the weakness of the current situation lies in the fact that traditional healers are treated differently from mainstream medical doctors. He said that Sama (KZN midlands) had adopted the view that traditional healers should be held to the same standards as the mainstream medical profession. This would involve having all healers registered, their training needs assessed and their practices codified and standardised.

“It’s a long, drawn-out process,” he said, “but the healers should be held to the same standard because we are seeing the same patients and the safety of the patients is most important.”

Makhathini said that the healers will miss Muller but they are confident that the support among remaining doctors is adequate to ensure ongoing co- operation between healers and doctors.

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