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Dr. Rodwell Vongo has travelled the vast divide between the not-so-distant past and the place that is Zambia now. His sprawling farm in Makeni, just outside the capital, where he lives and grows the herbs he uses to treat his patients, cost him 35,000 kwacha about 30 years ago when he bought it with his severance pay from a bank job. That money now would buy little more than a cup of coffee at the pricey Taj Pamodzi Hotel in Lusaka, where he is a regular guest and speaker at conferences addressing the AIDS epidemic.
Zambia has changed, but the traditional healing he practices is still the most accessible and most affordable form of health care here and the one that more than 80 percent of his fellow citizens will turn to before they go to a doctor. Traditional birth attendants—midwives—are more likely to help women through delivery in rural areas than doctors or nurses, and the area that still has the highest rate of male circumcision—now proven to reduce HIV transmission among heterosexuals by at least 60 percent—is the North Western Province, where the practice is part of a coming of age ritual.
Dr. Vongo, head of the 40,000-member Traditional Health Practioners Association of Zambia (THPAZ), sits on the board that coordinates global donations for Zambia.
“You can’t ignore our numbers,” he said.
So recently, when a group of civil society organizations met at the hotel to announce their intention to come to an agreement on working together more effectively to fight the diseases for which they receive donor money—AIDS, malaria and tuberculosis—he was there.
“The people who give us the money, they don’t have the money anymore,” he said several days after the meeting. That includes international donors, including the US, and foundations, which have struggled to balance their own budgets during the last few years of global economic setbacks. It also includes The Global Fund to Fight AIDS, Tuberculosis and Malaria, which last year suspended donations after an audit of Zambia’s recipients showed mismanagement, high salaries and misappropriations were keeping much of the money from reaching its intended beneficiaries.
All of this makes effective use of the money more urgent than ever, particularly in efforts to prevent new infections, he said.
“If you don’t deal with the cultural beliefs, taboos and rituals then you cannot successfully mitigate against HIV,” he said. “There are rituals that must be handled with delicacy, not dismissal. You do that dismissal at your own peril.”
He worries that traditional midwives are ignored in the name of bringing western medical care to all delivering mothers.
“It is impossible, it will never happen,” he said. “In some of the remote areas the hospital is 100 kilometers away—even if it were 10, they would never get there. They need to keep empowering the midwife.”
Then there is “widow inheritance,” a practice of widows being married—inherited—by their deceased spouses’ closest surviving male relative. The practice has been widely publicized and derided in AIDS prevention campaigns that are carried to villages. Yes, the practice presents a problem in the era of AIDS, Dr. Vongo conceded. “You could also be inheriting a disease.” But he added that insulting an age-old tradition that exemplified the importance of family ties in rural Zambia is a strategy unlikely to carry a compelling message. Efforts that recognize the impetus behind traditions and help families find new ways to stay together in the face of unemployment, urbanization and epidemic would be more effective, he said.
“We have a beautiful country, endowed with endless resources,” he said. “It saddens me that the life span at independence (in 1964) was 65 and now it has dropped to about 38 years. It saddens me that we have failed as medical people, healers included.”