Traditional healers and epilepsy treatment on the Kenyan coast

Abstract

From 2005-2007, we addressed problems of access to epilepsy care in Kilifi, Kenya from an anthropological perspective. Researchers have identified a lack of attention to contextual constraints on treatment decision-making (Garro, 1998, p. 321; Good, 1986, p. 164). Few studies have examined the social and procedural factors that shape and constrain the treatment choices for epilepsy, such as the roles of providers in the community and the structural differences between biomedical and alternative treatments. To address this shortcoming, we employed a comparative ethnographic approach to explore the distinguishing characteristics of services for childhood epilepsy in Kilifi. We focused on how treatment-seeking is facilitated or deterred by the availability of treatment options and characteristics of service providers, rather than by characteristics of the persons in need of treatment (see Finkler 1994 for a notable example of this approach). To our knowledge, this was the first study to contrast features of service providers as potential determinants of treatment choice for children with epilepsy.In addition to gathering qualitative data on biomedical health providers, we conducted participant observations and interviews with a group of traditional healers in Kilifi. Each healer was seen in a series of meetings over a period of 10 months. Our research revealed complex explanations of epilepsy symptoms and treatments that had cultural and social meaning for treatment seekers. Our data also indicated important differences between traditional and biomedical treatment options. This essay briefly discusses the traditional healer component of the study, and presents aspects of their services that help explain the local popularity of this treatment option.The local term for epilepsy in Kilifi District is Kifafa. Traditional healers expressed consistent definitions of the symptoms and causes of Kifafa. One healer described Kifafa as, "…a problem that comes when a person falls on the ground and shakes like this [demonstrates a convulsion]. His arms move like this and his legs do this…When the person wakes up he does not remember what has happened…This is Kifafa if it comes again and again." Traditional healers attributed epilepsy and other illnesses to natural spirits or Nyagu, curses or Majini, and ancestral spirits. Healers employed a different treatment ideology for each of the three spirit-based causes of childhood epilepsy.

Socio-Cultural Determinants of Health-Seeking Behaviour on the Kenyan Coast: A Qualitative Study

“…Triangulating our results with focus group discussion, observations and surveys could have been used to increase validity of our data. However, the high agreement in our respondents and the patterns of results closely mirroring earlier disease-specific studies (such as those by Kendall-Taylor [11] , [12] and Mwenesi [30] ) attest to the validity of both our data and our conclusions. Further study of the potential influence of socio-demographic aspects e.g.…”

“…Previous research in Africa has investigated parental perceptions of the aetiology of different diseases, and their health-seeking behaviour. The focus has largely been on describing socio-cultural determinants of health-seeking behaviour in the context of specific health conditions; but these studies have largely focussed on malaria [8] , [9] , malnutrition [5] , [10] and epilepsy [11] – [13] . However, there is a need to take a non-disease-specific perspective, since in certain cases some health-related beliefs and practices may be pervasive and may influence health-seeking behaviour in different contexts.…”

Parents’ and Professionals’ Perceptions on Causes and Treatment Options for Autism Spectrum Disorders (ASD) in a Multicultural Context on the Kenyan Coast

“…Failure to observe these traditions could have repercussions possibly leading to a curse that could result into ASD. Studies conducted in Kenya have shown that preferences are given to traditional healers in treatment of epilepsy and disability because these conditions are believed to be caused by evil powers [ 21 , 22 ]. Traditional healers are believed to be well placed in treating calamities associated with cultural beliefs and practices.…”

Health care utilization and outpatient, out-of-pocket costs for active convulsive epilepsy in rural northeastern South Africa: a cross-sectional Survey

“…Understanding determinants of traditional healer utilization in this context is warranted as the cultural understanding of epilepsy has been shown to be an important determinant in care-seeking behavior [ 29 ]. Identifying ways of working with traditional healers to reduce the epilepsy treatment gap, however, may be more productive than attempting to change individual’s behavior.…”