du Toit Anina, Pretorius Chrisma
Department of Psychology Stellenbosch University Stellenbosch South Africa.
Epilepsia Open. 2018 Jul 10;3(3):374-382. doi: 10.1002/epi4.12240. eCollection 2018 Sep.
Countries in sub-Saharan Africa are plagued by poor healthcare facilities, lack of specialist care, and limited financial resources. People with seizures often rely on the help of traditional health practitioners (THPs). Traditional health practices are not acknowledged in Namibia and remain unregulated and open to exploitation. We conducted a qualitative study to gain an understanding of THPs' perceptions and experiences in delivering seizure care in Namibia.
This study formed part of a larger mixed-method study that explored seizure care among healthcare providers (HCPs) in Namibia. Semi-structured interviews were conducted with 11 THPs in Namibia. Thematic analysis was used to identify themes and subthemes in the data. Themes were interpreted using the different levels of Bronfenbrenner's Ecological Systems Theory to illustrate the perceptions and experiences of THPs in the management of seizures.
THPs distinguish between seizures with physical causes and those caused by witchcraft, evil spirits, and supernatural forces. THPs acknowledge the role of Western medicine in the treatment of medically explained seizures (physical causes). Seizures as a result of medically unexplained symptoms (spiritual) are deemed best treated by traditional medicine (TM). Diagnostic and treatment practices are person-specific and are guided by divination and the use of plant and animal material. Treatment success is measured by the complete absence of seizures. Biomedical treatment is seen as lacking due to its focus on seizure control and failure to provide a permanent cure.
In countries with limited healthcare resources, the untapped potential of THPs may play a valuable role in bridging the treatment gap for seizures. Incorporating THPs into the healthcare system depends on proper regulation and clear demarcation of roles between service providers. Improved referral practices and collaboration between service providers will be of benefit for people with seizures who are often exposed to stigma and discrimination.
撒哈拉以南非洲国家面临医疗设施差、缺乏专科护理以及财政资源有限的问题。癫痫患者常常依赖传统医疗从业者（THP）的帮助。在纳米比亚，传统医疗做法未得到认可，仍不受监管且容易被滥用。我们开展了一项定性研究，以了解纳米比亚传统医疗从业者在提供癫痫护理方面的看法和经历。
本研究是一项更大规模的混合方法研究的一部分，该研究探讨了纳米比亚医疗服务提供者（HCP）之间的癫痫护理情况。对纳米比亚的11名传统医疗从业者进行了半结构化访谈。采用主题分析法识别数据中的主题和子主题。运用布伦芬布伦纳生态系统理论的不同层次对主题进行解读，以说明传统医疗从业者在癫痫管理中的看法和经历。
传统医疗从业者区分有身体原因的癫痫发作和由巫术、邪灵及超自然力量引起的癫痫发作。传统医疗从业者承认西医在治疗有医学解释的癫痫发作（身体原因）方面的作用。由无法用医学解释的症状（精神方面）导致的癫痫发作被认为最好用传统医学（TM）治疗。诊断和治疗方法因人而异，并以占卜以及使用植物和动物材料为指导。治疗成功的衡量标准是癫痫发作完全消失。生物医学治疗被认为存在不足，因为其专注于癫痫控制且未能提供永久治愈方法。
在医疗资源有限的国家，传统医疗从业者未被开发的潜力可能在弥合癫痫治疗差距方面发挥重要作用。将传统医疗从业者纳入医疗保健系统取决于适当的监管以及服务提供者之间角色的明确划分。改善转诊做法以及服务提供者之间的合作将有利于经常遭受污名化和歧视的癫痫患者。
