BOTSWANA: People living with HIV turn to homeopathy
PlusNews
global HIV/AIDS news and analysis

MAUN, 21 February 2008 (PlusNews) - The nondescript town of Maun in
northern Botswana is often no more than a way-station on the road to
the luxury safari camps of the Okavango Delta, a haven for wildlife
and one of Africa's most popular tourist destinations.

For Hilary Fairclough, a former nurse from England,  a visit to Maun
while accompanying her partner on a work trip in 2000, planted the
seed of an idea that has brought her back twice a year since then.

She was stunned by the toll HIV/AIDS was taking on the Batswana, at a
time when antiretroviral (ARV) drugs had yet to become available in
the public health sector, and in 2002 she returned to find out if
there was a demand among people living with HIV for her services as a
trained homeopath.

Very few homeopaths practice in Botswana, and not many people in Maun
had heard of this alternative form of medicine before her arrival, but
the Maun Homeopathy Project, as it later became known, has since
treated 1,500 HIV-positive people in the area.

The service, which is free thanks to donations from the project's
supporters in the UK, is provided by two volunteer homeopaths she
recruits from the UK to spend three months at a time in Maun.

Many of the project's patients are now taking ARV medication, but
report that the homeopathic remedies help them deal with the sometimes
unpleasant side effects as well as opportunistic infections and
depression, and improve general wellness.

"It's been really welcomed," Fairclough told IRIN/PlusNews. "People
have been very open. I think they feel supported by us because we
listen, but I believe the medicines also really help people."

The homeopathy debate

Despite being around for over 200 years, the efficacy of homeopathy is
still being debated. Supporters of conventional medicines tend to view
it as a placebo at best and quackery at worst. In an opinion published
this week in The Star, a South African daily newspaper, Mark Colvin, a
doctor and epidemiologist, described homeopathy as based on "an absurd
premise" that has never been scientifically substantiated.

Homeopathy's supporters respond that homeopathic medicine operates so
differently from conventional medicine - treating the whole person
rather than just their illness - that the conventional means of
measuring effectiveness are inadequate.

Fairclough, who practices homeopathy in the UK when she is not doing
fund-raising and administration for the project in Maun, is dismayed
to have been drawn into the controversy after the project was
mentioned in several opinion pieces in the UK press during December
2007.

The media debate was sparked by a London symposium on the homeopathic
response to HIV and AIDS, but the question of whether or not public
health services such as the UK's National Health Service (NHS) should
fund homeopathic treatment was also raised. NHS funding for two
homeopathic hospitals has since been cut.

"I think it's a very small number of people who are anti-homeopathy in
the UK, who have a powerful voice," Fairclough said. "Here [in
Botswana], people feel there's room for different approaches."

She believes part of the appeal of homeopathy in Botswana is because
it has elements of both traditional and western medicine. "It comes in
a pill, but the approach - taking into account mind, body and spirit -
is more Batswana. People are very comfortable with it," she said.

It depends on the individual

Kelebogile, a slight woman in her late forties, has been a patient of
Fairclough's since 2002. She began taking ARVs in 2003, but still
takes what she calls "the small pills" because they have helped her
with "many problems".

Consultations are held at the the Lutheran Church in Maun, where the
project runs a twice-weekly clinic. Kelebogile's consultation lasted
about 30 minutes and did not include a physical examination.

Photo: Hilary Fairclough/MaunHomeopathyProject
Hilary Fairclough visits one of her patients at their home.
"You don't give the same medicine to everyone who has HIV," Fairclough
said. "It depends on the individual - what stresses or traumas they
might have, and how they react to their life situations."

She selected three different bottles of pills from her case of
remedies and dispensed a few of each into plastic bags: one for
Kelegobile's ailment, one for her emotional state and the other to
help stimulate her immune system.

Overstretched health service

To understand why patients queue up outside the Lutheran Church,
sometimes travelling from villages several hundred kilometres away,
one has only to look to Botswana's overstretched public health
service.

Like the homeopathic remedies, ARVs are free in Botswana, but with a
national HIV infection rate of 24 percent, second only to Swaziland,
the need is overwhelming. Just as the government has sought to expand
access to ARV treatment, doctors and nurses have been leaving the
country to take better-paying jobs in South Africa and other
neighbouring countries, or even in Australia and the UK.

"At the moment, we have five doctors and we're supposed to have 13,"
said the chief medical officer at Maun Hospital, Dr Richard Kambinda.
The hospital's HIV/AIDS clinic is supposed to be staffed by three
doctors, but Kambinda said it was lucky if it had one at any given
time. The machine used to establish the CD4 count, which determines
when a patient should start taking ARVs, or how well they are doing on
treatment, has been broken for several months.

"In the hospital they don't ask so many questions, they do everything
quickly," Kelegobile commented. "They only give you painkillers,
always painkillers."

Botswana's ARV treatment programme has often been cited as a model for
other countries in the region, but some people, including the
hospital's former chief medical officer, Dr Eric Beltz, believe it has
sacrificed quality for quantity.

In the hospital they don't ask so many questions, they do everything
quickly ... They only give you painkillers, always painkillers.
Beltz, who moved to Australia three years ago but was visiting
Botswana when IRIN/PlusNews spoke to him, worries that the rapid scale-
up of the HIV/AIDS treatment programme, combined with the shortage of
staff to monitor drug adherence and treatment failure, will create
significant problems with drug resistance in the not too distant
future.

His concerns are shared by Israel Tjiharuka, who runs a counselling
centre for people living with HIV in the village of Sehitwa, about
100km from Maun, where the homeopathy project runs an outreach clinic
once a month.

"In our hospitals the doctors are busy - they'll just refill [ARV
prescriptions], they won't ask any questions," he told IRIN/PlusNews.
"People aren't educated about what side effects they might experience
on certain drugs, so they don't complain."

Although Sehitwa will soon get a clinic that will dispense ARVs, at
present villagers still have to travel to Maun to pick up their
medicine. Adherence was a problem, said Tjiharuka. "Sometimes people
don't have money to go to Maun, so they stay without."

During a recent visit to Sehitwa, Fairclough was asked to make a home
visit to Nabebeng, 44, a woman who has been on ARVs for two years, but
is now bedridden. She was hunched under a blanket outside her home,
the several layers of clothing she wore despite the heat not enough to
hide her too-thin frame. "I feel hunger, but my heart does not want to
eat," she told Fairclough.

Nabebeng had begun experiencing pains in her side and in her legs when
she started taking ARVs, but when she told staff at the hospital they
only gave her painkillers. Fairclough prescribed a remedy for liver
toxicity as well as a "grief remedy" to help her cope with her
boyfriend's death the week before.

Although Fairclough regularly treats patients for side effects from
ARVs, she is careful to describe homeopathy as "complementary" to ARV
treatment. "I've had a couple of patients say they just want the
homeopathy, but I say 'no, it's not enough, you need the ARVs'. It
might be that homeopathy could keep people from needing ARVs for
longer, but we can't afford to conduct that kind of research."

Future plans

Alex Sarefo and Wasanapi Kapii, two young men working with the project
as volunteers, translate for the homeopaths but eventually hope to
conduct their own consultations. With a view to future sustainability,
the project is funding them to complete a three-year UK-based long-
distance course to qualify as homeopaths.

"At first I was so sceptical, until I saw the changes happening in
patients, and then I started reading up on it and understanding the
science behind it," said Sarefo, who started helping at the project
after taking a break from his medical studies in Zimbabwe

Kapii hopes to open his own homeopathy practice after he qualifies,
while Sarefo talks of starting a homeopathy school and advocating for
the wider use of alternative medicines like homeopathy. "There's no
prejudice here towards alternative medicine and I feel it has to be
kept that way."

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