The New York Times

Monday, December 6, 1999

Mozambique Enlists Healers in AIDS Prevention

By RACHEL L. SWARNS

BEIRA, Mozambique -- The traditional healer stretches her hands to the heavens and her body trembles, her rattles hiss and her shack rumbles as she cries out to the spirits of her ancestors.

Then she opens her eyes and gets down to business.

"Have you ever heard of condoms?" she asks her astonished patients, who have come to whisper about two-timing husbands and sexually transmitted diseases. "You should wear them to protect yourself from these diseases."

Meet Eufr sia Fernandes, one of the newest and most unlikely foot soldiers in Mozambique's national crusade against AIDS.

For nearly two decades, government officials derided traditional healers like Ms. Fernandes as quacks and enemies of the state. They burned the healers' tools and barred them from practicing.

In the early 1990's, Ms. Fernandes had to hide her drums and sneak into the countryside to chant and cure. During the civil war that ravaged this nation until 1992, other healers allied themselves with the rebel army, promising soldiers spiritual protection against the government's bullets.

But today, traditional healers -- known as curandeiros -- are being embraced by the government as vital bearers of the safe-sex message in an impoverished country where millions of people still lack adequate access to doctors and modern medicine.

Next year the government plans to expand on this national strategy by linking teams of trained healers directly to hospitals, which have been overwhelmed by an influx of patients infected with H.I.V., the virus that causes AIDS.

The traditional healers will treat the patients at home -- freeing up hospital beds for other sick people -- and using herbs and plants that health officials here say effectively treat opportunistic ailments, like diarrhea and pneumonia, that afflict people whose immune systems are impaired by AIDS.

The program is still a small one. Fewer than 100 of the thousands of practicing healers in this country have attended the seminars on AIDS and sexually transmitted diseases, and the government is still sorting out how the linkages between hospitals and healers will work.

But health officials say they plan to expand the program, leaving the healers to marvel at their newfound freedom and to push their businesses out into the open.

In the dusty market here, where hawkers sell mangoes, bananas and colorful squares of cloth, a healer named Ousmane Ba posted a sign promising treatment of headaches, sterility and asthma. "Children under 2 don't pay," his sign said.

The regional office of the Association of Traditional Doctors of Mozambique rents an office here, and every Tuesday and Thursday, people lodge their complaints before its grievance board. The board fines healers who abuse their powers and bars amateurs from dabbling in the field.

Last year, Ms. Fernandes opened a tiny consultancy on a bustling residential block with the blessing of the local authorities. She still counsels the bewitched and exorcises spirits, but she also sells condoms and tells her patients how to avoid AIDS and other diseases.

"Before, I couldn't work openly like this, right here in the city," said Ms. Fernandes, 39. "Now, I play my drums and there's no problem."

In a country where nearly 15 percent of the population is believed to be infected with H.I.V., the government's change of heart was critically important, health officials say.

Ricardo Trindade, a deputy director in the Health Ministry, said only about 50 percent of the population had access to the fledgling national health system, whose predecessor was virtually destroyed during the 16-year civil war. The rest rely almost exclusively on traditional healers.

"The majority of people in Mozambique seek treatment from curandeiros, even those who go to hospitals," Trindade said. "The government's changing attitude is definitely a good thing."

The chilly relationship began warming decisively two years ago, the healers say, when the government officially recognized their professional association and began warning them about AIDS.

Health officials feared that the healers themselves were unwittingly spreading the fatal disease. The healers typically use razor blades in their treatments, making small incisions in the flesh and pressing medicines directly into the blood. And they were often using the same blade on dozens of people.

A private group, Population Services International, began offering seminars on AIDS and other sexually transmitted diseases. The healers were urged to boil razors, to encourage patients to buy their own razors and to sell condoms along with homemade remedies for malaria, cholera and other ailments.

Titosse Ofisso, the regional president of the healers' association in Nharichonga, said he welcomed the new thinking.

"People don't know you need to use clean razors or that if you don't put condoms on, you can spread your disease to someone else," said Ofisso, 22, whose rural village lacks electricity and indoor plumbing. "People don't even know what condoms are. They still ask me, 'What is this?' "

Ms. Fernandes was reluctant at first to take part in the program.

But after attending the seminar, she said she no longer worried much about mixing the modern with the traditional. After all, she has always been pragmatic when it comes to patients suffering from diseases she cannot treat on her own.

"If someone comes here with diabetes and a bad spirit, I take out the bad spirit and send them to the hospital," she said. "Now, when people have sexual diseases, I tell them to wear this condom so it doesn't spread."

It is the healers' broad popularity that makes them so valuable to health officials. More than 70 percent of Mozambique's population are rural people, who hold tight to their traditions.

Francisco Zonjo, 66, a retiree, turned to the healers when medical doctors could not explain why several relatives had fallen sick and died.

Carlitos Pereira, 19, turned to the healers when he lost his job as a bus conductor and his wife suffered several miscarriages.

Santos Aleixo, 42, a musician with a virulent skin disease, turned to the healers after a local hospital turned him away because he could not afford the doctor's fee of $12.50.

Members of the healers' association acknowledge that they cannot cure all ailments and social problems, even though some claim such powers. They say they want to work more closely with health professionals, to get some training and to share their knowledge of the herbs and plants and, maybe, to help find a cure for AIDS.

In the meantime, they are proud to have finally won the respect of government officials and to have a clear role to play in preserving the nation's health.

"The problem of AIDS is out there," said Chapal Maconha, the president of the regional healers' association here. "But the people don't have televisions and they don't know about condoms. They don't know people are dying.

"In the outskirts there are no hospitals, no clinics to help them, to tell them what is happening. But there are curandeiros. We are the secret weapon. We can spread the message. We can help save the people."