I have only a few weeks left on my mission in Bentiu. Numbers in our nutrition programme have decreased over the last few months, which is a good thing. Nonetheless, the team are still busy as our project is set to undergo major change, handing over our nutrition activities to the ministry of health and other NGOs and also planning the start of a full TB and HIV programme here in Bentiu. This will provide a much needed life-saving service for the people of Bentiu and northern Unity state whose only previous access to TB treatment was in MSF’s hospital in Leer south of here, an arduous journey and one that is not even possible for a few months during the rains each year.
I am also trying to cram in all the things that I wanted to do but never got around to before because of being too busy. One that I really don’t want to miss out on is a visit to a local traditional healer. Like almost everywhere else in the world many people here resort to traditional and alternative treatments for a variety of reasons such as cultural beliefs, traditions, lack of access to mainstream medical care or dissatisfaction with the care they have received.
After a bit of arranging I find myself accompanied by two of our national staff nurses sitting outside a traditional tukul dwelling having a conversation with James*, a renowned local traditional ‘bone setter’ (there is no actual word for James’ line of work, people just refer to it as traditional treatment). It’s a relaxed atmosphere. James is open and friendly and has no issues with me taking notes and pictures and writing this piece. There is no traditional garb or chanting. He is wearing western clothes but somewhat disconcertingly is waving a hack saw blade in his hand for most of our chat.
James hasn’t had any formal training. He did not go to school or study. His father practiced the same methods and he learned from him growing up. He doesn’t profess to have any magical powers saying only he learned the trade from his father. He focuses only on fractures and bone problems. There are an array of other traditional healers to deal with other problems. Throughout our conversation he expresses absolute confidence in his methods saying "I have never come across a case that I cannot manage and I enjoy the work."
I am interested to know what exactly James does and he has a case on hand to show as an example of his work. A 15-year-old boy is brought forward. Wrapped around his right leg are a collection of random pieces of material acting as dressings. These are covered by a lattice of sticks obviously serving as a kind of splint. When I ask what happened to him I am told he suffered a gunshot wound to the leg in a crossfire two years ago. He had been to the hospital where he was told the leg needed to be amputated. Rejecting this offer, his family had brought him to James.
James explains that the boy had a big wound and a fracture but now "he has become good" thanks to his treatment. He says that the sticks are used to splint the broken bone and not allow it to bend. They are left on for three weeks only. Also he has given the boy injections of antibiotics including penicillin and erythoromycin. The boy can carry the leg a little alright but even from a distance it looks very swollen and multiple flies are circling over one area of the dressing where I suspect a festering wound lies underneath.
I ask James what type of treatment he has given the wound. He assures me he dresses the wound regularly using iodine as an antiseptic. Also, he says he washes it with warm water "to make the movement of the blood OK". The use of warm water seems almost a universal treatment here for everything from diarrhoea to rashes. It sounds harmless but I have seen children with burns following parents pouring boiling water on their skin in the mistaken belief there would be some health benefit.
When I ask James if any particular sticks need to be used to make the splint or if they come from a particular tree the question is greeted by rapturous laughter. This type of traditional medicine at least is based only a partial understanding of mechanics and not on any magical beliefs. I also get a look at some of James’ ‘instruments’ – fairly old looking scissors, a new-looking artery forceps and a few other items. He explains he uses the hacksaw for cutting parts of protruding bone from open fractures. He shows me the solution he uses to disinfect the instruments – a bottle of ‘Tetol’ (no not a typo!).
While the word ‘traditional’ is used to describe this treatment, it doesn’t come cheap. It can cause harm to people’s finances as well as their health. The course of treatment costs 1,000 South Sudanese Pounds (about €250) per person. Whilst James comes across as a modest man he is known to have four wives and very many cows, clear signs of wealth in South Sudan. He is busy, he says, claiming that he does not even have enough space in the tukul to accommodate all his cases. I am told by one of our nurses that during the war there were even more cases coming here.
Before I leave, James proudly shows me one of his other ‘success stories’. He shows me a young man who had sustained an injury to his upper arm and shoulder. He is happy and smiling and seems pleased with the treatment. However the head of the humerus (upper arm) bone is quite obviously dislocated from the shoulder joint. He has limited movement of his arm.
Bentiu does not have a specialist orthopaedic surgeon. James himself says he would like to have some cooperation with the ministry of health, perhaps so he can refer cases there or maybe because he wants to get some medication supplies from the ministry. These type of ‘traditional’ practices will continue until a proper health infrastructure is in place and probably even beyond that. This is certainly a public health challenge. Part of the solution may involve working with people like James, perhaps training them as community health workers, though such work would certainly not be as lucrative.
Of course there are many different types of traditional healers here in South Sudan, and elsewhere in the world, of which James is only one. For many people their treatment is highly valued and respected. It’s definitely good to learn more about people like James and get a better understanding of what they do. I thank James and head back to the ‘conventional medicine’ world.
*Name changed to preserve anonymity