Participatory Development Methods Help Forge a Partnership for Healing in Baguinet

Across most of rural sub-Saharan Africa, traditional healers provide therapy to the sick and injured in their communities. Many healers employ an impressive array of herbal medications to alleviate the acute symptoms of common illnesses. Healers also serve as midwives, mental health counselors and spiritual advisors to families in conflict.

These multiple roles give traditional healers tremendous influence at the local level, especially in towns and villages where primary health care services supported by the Government of Guinea or donor organizations are limited or unavailable. In recent years, many African governments and donor organizations have recognized the influence of traditional healers, and they have made positive efforts to integrate local healers into the broader frameworks of national health programs. South Africa is considering a national accreditation and licensing program for its traditional healers, and nationally registered associations for traditional healers operate in several other countries.

These efforts contrast sharply with policies adopted during the colonial period and in the first decades after independence, when traditional healers as a group were frequently dismissed as “quacks” or “witch doctors” and forced to practice their craft outside the formal sector of legally sanctioned medicine. This adversarial approach created parallel health delivery systems that intensified competition between government-supported rural health workers and traditional healers and prevented the development of integrated referral networks for critically ill patients.

ADF’s participatory approach to rural infrastructure development has helped bridge the gap between government-sponsored primary health care and traditional healing in the Rural Development Community (CRD) of Baguinet. In the late 1990s, ADF field representatives helped the village of Gnankahoure create community forums that identified and prioritized local needs through a broad-based participatory appraisal process. The village was divided into four constituent groups – adult men, adult women, elders and youth. Each of these groups produced lists of important local issues and recommendations on how to address them.

One member of the women’s group, Mariana Kamara, 65, pushed for construction of a rural health center and drew on the respect she had earned from 36 years as a community-based healer to win wide support in the village for a new clinic.

Kamara is proud of her craft, which she learned from her mother. She treats skin wounds and open sores with hot water and herbal astringents, and she is adept at differentiating malaria from other types of fever. She has also delivered most of Gnankahoure’s children over the past two decades.

Kamara knew, however, that she did not have the medicines or expertise to treat severe cases of malaria and diarrhea, and she had seen many patients die before they could reach the nearest clinic in Baguinet or the government hospital in Fria.

“That’s why I wanted a clinic here in Gnankahoure, with a health worker who knows how to treat these illnesses before they become too severe,” Kamara says. “There are many things I can do to help the people here. But there are also things I can’t do. The health worker and I work very well together now. I take the cases that I can treat – skin infections and some types of coughs and fevers, and childbirth. And when I know that I cannot help someone or there are complications, it is a comfort to know that he is here.”

He is Alpha Lary Diallo, 45, a community health agent who received his medical training at the Kindia Vocational School. Diallo was assigned to the Gnankahoure clinic by the Government of Guinea after ADF provided funding the build the clinic and install a public well in the village.

Diallo and Kamara have developed a close relationship over the two years since his arrival in Gnankahoure. Kamara sits on a village committee that oversees clinic operations and maintenance of the well. The two also work together to train village women in midwifery.

“Before I arrived, the village did not have access to malaria medicine other than quinine tablets,” Diallo notes. “Madame Kamara had to refer the severe cases to Fria, which is 32 kilometers away. When women had complications with childbirth, they had to be carried nine hours in a hammock over the mountain road if a vehicle wasn’t available. Now she refers the difficult cases to me. We have a radio that calls a vehicle in the event of an emergency. My work here is greatly helped by her, and she is my strongest advocate in the community.”

The success of the Kamara-Diallo healing partnership underscores the long-term benefits of participatory approaches to development that engage local stakeholders at every level of decision-making, project implementation, assessments, and follow-up.