Doc's Work in Africa Blends Traditional Healing, Modern Medicine

Michigan State University neurologist Gretchen Birbeck spends about three months every year treating patients and doing research in the African nation of Zambia where she witnesses first-hand the blending of traditional healing methods with modern medicine.

In a piece she wrote for the May issue of The Lancet Neurology, a new journal published by The Lancet, a highly respected British scientific publication, Birbeck details how the two methods of health care not only co-exist, but actually complement one another.

"Often the relationship between the traditional healers and the westernized medical environment is an antagonistic one," she said. "That doesn't serve patients at all."

"In Zambia, the healers spend a lot of time with their patients," Birbeck said. "It's not a 15-minute consultation. They can spend more than an hour with them, talking about a lot of different things. I have a lot of respect for what they do."

The local healers are particularly effective, she said, in helping patients who are experiencing physical symptoms that are the result of psychological problems.

"The traditional healer often can bring whatever it is that's bothering the patient to the forefront and then get the whole family involved in supporting this person," she said.

As a neurologist, Birbeck treats an unusually high number of epilepsy patients while in Zambia. In fact, the rate of epilepsy there is approximately 12 cases in every 1,000 persons, much higher than the U.S. rate, which is one to two cases per 1,000 people.

One type of seizure, known as a jacksonian seizure, begins in the hand and then spreads up the arm to the body, a fact not lost on the traditional healers who often will tattoo or scar the person's affected hand.

"So by the time I arrive I can look at the patient and see that not only do they have epilepsy, but that their seizures start in a particular hand because the traditional healer who was there before me has already taken the history," Birbeck said.

Another example: The traditional healers see many patients with certain chest infections that result in fluid build-up in the chest cavity. Once again, the healer has noted this fluid build-up and has marked it on the person's chest by tattooing or scarification.

"Quite often this has already been beautifully mapped out by the healer," Birbeck said. "This makes my job a lot easier."

However, she said, as useful as the tattoos and scarifications may be, the practice also may put people at risk of developing HIV or hepatitis since it is unlikely that the traditional healers properly clean their cutting instruments between patients.

Birbeck and other researchers have no idea why the epilepsy rate is so high in Zambia, as well as in other African and underdeveloped countries. She noted that high epilepsy rates in certain Latin American nations are linked to a parasitic infection, but no one is sure if that's the situation in Africa.

What is known is that there is a huge stigma attached to the disease in Africa.

"It's usually interpreted as a spiritual problem," Birbeck said. "People are thought to be possessed during a seizure."

Adding to the problem are fears of contagion that result in taboos against touching a person who is having a seizure. This results from the belief that if a person comes in contact with the saliva of someone during a seizure, that person will also develop epilepsy.

"If someone has a seizure and falls into a fire -- not an uncommon occurrence in Zambia -- not even family will help," Birbeck said. "You don't see minor burns associated with epilepsy, you see terrible burns."

In Zambia, Birbeck said, people with epilepsy are less likely to be employed, get properly educated or get married. She said often people with epilepsy will marry into other families in which epilepsy is common, possibly adding to the genetic components of the disease.

Now an MSU assistant professor in the departments of Neurology and Ophthalmology and Epidemiology, Birbeck first went to Zambia while a medical student at the University of Chicago. She spends most of her time at a mission called Chikankata where she treats not only patients with neurological disorders, but everything else from HIV to malaria to tuberculosis.

She said her time in Africa makes her a better physician.

"I can't get lazy and just order up a test," she said. "My exam skills have to remain fairly honed. So in that respect it's a very good experience. I have to continuously use those skills while I'm there, and it prevents me from letting them atrophy while I'm back in the United States."