24 Understanding and management of terminal illness within tanzanian traditional medicine

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BackgroundPalliative care (PC) need in Africa is projected to rise by 300% over the next 20 years.1 Late presentation and poor community awareness of services are recognised challenges to effective healthcare delivery.2 3Traditional and faith healers (TFH) hold cultural importance and provide a significant proportion of primary healthcare in Africa.4 5 This project sought to explore their understanding and management of terminal illness with the aim of improving PC delivery through collaborations between TFH and allopathic services.MethodologyData were collected through semi-structured qualitative interviews with traditional healers (n=11) and faith healers (n=8) working within the Kilimanjaro region of Tanzania. Participants were recruited through convenience and purposive sampling. Interviews were audio-recorded and translated transcripts analysed by thematic analysis.FindingsAll TFH had experience of terminally ill and dying patients. Participants had a holistic approach to healthcare with themes of biological psychological social and spiritual factors identified throughout conceptualisation and management of both terminal illness and death. This also informed opinions towards collaboration seeing healthcare professionals and TFH holding different roles within these areas.ConclusionsThe overlap with allopathic explanatory models of health (i.e. the BioPsychoSocial model) provides positive grounds for future collaborations. TFH could complement allopathic PC services through culturally acceptable spiritual care perceived to be lacking in hospitals. Joint dialogue and education between practitioners is necessary to begin collaboration. A significant challenge to this is mistrust between traditional healers and faith healers. The findings merit further research into patient’s preferences and experiences of TFHs in terminal illness.ReferencesGrant L, Downing J, Namukwaya E. Palliative care in Africa since 2005: Good progress but much further to go. BMJ Supportive & Palliative Care2011;1(2).Harding R, et al. Current HIV/AIDS end-of-life care in sub-Saharan Africa: A survey of models services challenges and priorities. BMC Public Health2003;3(33).Lewis EG, Oates LL, Rogathi J, Duinmaijer A, Shayo A, Megiroo S, Bakari B, Dewhurst F, Walker RW, Dewhurst M, Urasa S. ‘We never speak about death.’ Healthcare professionals’ views on palliative care for inpatients in Tanzania: A qualitative study. Palliat Support CareAugust 2017;22:1–14.World Health Organisation. WHO: Traditional medicine strategy: 2014–2023 2013. Geneva: World Health Organisation Geneva.Stanifer JW, et al. The determinants of traditional medicine use in Northern Tanzania: A mixed-methods study. PLoS One2015;10(4):e0122638.

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