Source: IRIN
No one can tell 64-year-old Fatoumata Kané anything new about the plants and tree bark around her town of Banamba in western Mali, but the traditional healer recently learned how to measure a child's upper arm to detect malnutrition.

Scores of families bring ailing children to Kané each week. She is renowned in the region for her healing powers, but now refers suspected malnutrition cases to the public health centre. The collaboration, initiated by local health agent Oumou Sangaré of Helen Keller International (HKI), is an example of how NGOs are tapping into the influence of traditional healers and local elders to fight under-nutrition.

Across sub-Saharan Africa health experts commonly train traditional healers to detect conditions needing something other than indigenous medicine; the fact is that when illness strikes many people's first move is to go to the local healer.

"It is always people's first choice here," said a doctor in Sierra Leone who requested anonymity. "It's a custom people are addicted to."

It is custom, but often it is also the only health care people can afford or physically access. In some countries in Africa and Asia 80 percent of people depend on traditional medicine for their primary health care, according to the World Health Organization.

Often traditional medicine is the answer. Africa has tens of thousands of plant species, many therapeutic, and the basis for effective remedies. Kouamé Koffi Samuel, a chauffeur in Côte d'Ivoire, said he has first-hand experience of women who are expert at healing closed fractures with massage, herbs and incantations. "I've seen it - it's far more rapid and effective than a cast."

But child under-nutrition is one of the conditions untreatable by such means, health workers say. If a parent does not understand the signs, symptoms and causes, various conditions could be suspected. The Sierra Leonean doctor said some families think immediately of a spell.

"When a child is malnourished people think it's a witch. When a child is very anaemic they say a witch has drawn all the blood from the child."

He added: "We need to do more education on this."

Health experts say one strong conduit for that education are the traditional healers and elderly women who already have people's confidence

"If [Banamba healer Kané] were to tell a woman not to take a child to the health centre, the woman wouldn't do it, no matter what," HKI's Sangaré told IRIN. "Such is the women's trust in her."

Sangaré said she first approached Kané when she noticed that too many malnourished children in Banamba were not getting the medical attention they needed.

Collaborating with local healers

She said initially Kané, who makes her living as a healer, was hesitant but then agreed to talk. They met several times to talk about children's health; Sangaré explained to Kané the role she could have in detecting malnutrition and helping children get the care they need. "Now she's had training and she's helping us detect cases of malnutrition."

Kané, from her home in the Hamdallaye neighbourhood of Banamba, told IRIN traditional and modern medicine can function well together. "I have practiced for more than 20 years now; the gift I have for healing is not going anywhere. But modern medicine can complement it, and vice-versa."

Vanessa Dickey, senior nutritionist with HKI Mali, said collaborating with local healers means more children who need medical care will get it.

"Targeting just mothers can get us only so far," Dickey told IRIN. "People are going to listen to a traditional healer or a grandmother." HKI also has a project in Burkina Faso to boost maternal and child health through the influence of older women, to whom young women invariably turn for advice on pregnancy, motherhood and feeding their families.

"Our object is to screen as many children as we can to see who needs attention," Dickey said. "And traditional healers and grandmothers are the first-line healers in a community."

Traditional plus modern

Nurses and doctors told IRIN it is common to see families consult both a traditional practitioner and a doctor.

Soro Awa, holding her nephew whose mother had recently died in childbirth, talked to IRIN at a Côte d'Ivoire nutritional centre in Korhogo: "Without this centre my sister's son would not be alive," she said. Still, she plans to see the local healer once she returns to the village "to protect the child from sorcery".

"Often, people assume someone has cast a spell on a child, not knowing that a child is malnourished or has an illness that can be easily treated at hospital," said Soro Pènè, from Korhogo's Waraniené village. "Anyway, I am all for traditional healers because they do have their place in our customs and they are very effective in some cases."

Salimata Koné, who runs the Korhogo centre, says some parents bring their children in directly without going to a local healer. But as the Sierra Leonean doctor explains, family pressure often weighs in later. "A parent could have a child treated at hospital, then a friend or family member will come round advising that it's best to also consult the traditional healer."

"It can be OK if people go to both," he said. "But only if the traditional healer is competent and knows the limits of his or her capabilities."

It is not a question of ruling out traditional practitioners, said Dickey. "They can continue to do follow-up. We do urge them not to give malnourished children herbs or teas to consume. The body of a malnourished child is really in chaos; these kinds of plants, which might not harm another person, could be dangerous for a child in this state."

As in so many circumstances, the hard evidence of a healthier child is the most powerful message, Koné in Korhogo told IRIN. "It's important not to condemn the practice of going to a traditional healer; we don't want to frustrate people. But the fact is once a malnourished child regains health after proper diagnosis and treatment, that recovery is concrete proof and has a huge influence on others."

Recovery is the common objective. "My role is to lighten mothers' hearts, by helping heal sick children," said Kané. "When a child is healthy, the mother is relieved and things go better in the household."