When Americans think about the problem of getting modern medical care to the people in Africa who need it most, Anthony Okello is not the solution that comes immediately to mind. He's a medicine man, apprenticed as a teenager to the wandering witch doctor who treated him for a fever that other doctors couldn't cure. When a patient goes to Okello complaining of rashes and diarrhea, as Lucy Ajam did recently, he recognizes the typical symptoms of AIDS for what they are. He immediately sent Ajam to the nearest hospital to start her on antiretroviral drugs (ARVs)--an approach even a traditionalist like Ajam heartily endorses. "For minor cases, I still use local herbs," says Ajam, 51, a roadside bread vendor in Alenga, Uganda, a sprawling settlement overlooking the Nile River. "But it's the ARVs that are keeping me alive."
Like many other African countries battling AIDS, Uganda is struggling to make the most of a sudden influx of dollars from First World donors like the Bill and Melinda Gates Foundation, whose disease-fighting war chest just doubled in size, thanks to a $30 billion endowment from financier Warren Buffett. Uganda is planning to use its money to provide ARVs to every Ugandan who needs them, but the flood of money for medical care is running into a roadblock common in almost every Third World country: an infrastructure incapable of delivering it. In Uganda, for example, there is only one doctor for every 20,000 citizens--and there far fewer doctors in rural areas like Alenga. It's a challenge simply to identify the needy in this country, much less ensure that patients stick to their therapies.
By contrast, there's a practicing medicine man for every 150 Ugandans, which is why traditional healers like Okello are playing an increasingly important role. "Traditional healers are in the neighborhood, and they're open 24 hours," says Dr. Dorothy Balaba, executive director of Traditional and Modern Health Practitioners Together Against AIDS (THETA), an aid group based in Kampala, Uganda's capital. For 80% of the Ugandan population, traditional healers represent the treatment of choice.
But decades of suspicion and mistrust between African and European medicine practitioners aren't so easily overcome, and not every traditional healer is so eager as Okello is to pitch in.
Take, for example, Yahaya Sekagya. Like Okello, his history was shaped by medical trauma. As a teenager he was consigned to a mental hospital for visions he says were calling him to traditional medicine. "It was misdiagnosed and misunderstood by Western medicine," says Sekagya, 43. Although he ended up going to medical school--more out of contrariness than conviction--he also spent six years studying at a medicine man's shrine. Now he's the director of the Ugandan chapter of Prometra, a Senegal-based advocacy group promoting traditional medicine. Sekagya runs an outdoor school in a forest south of Kampala. About 100 students gather weekly under a leafy canopy. Instructors line up herbs on a thin wooden table cut from a single log. Along with the basics of hygiene and anatomy, students learn the identification and uses of local plants. Meanwhile, spiritualists chant, dance and drum to call down spirits and consult them for cures.