A phenomenological study of traditional health practitioners and nurses caring for HIV positive patients : towards a macro-cognitive model of collaboration

Abstract

Literature has shown that traditional health practitioners and nurses provide care to patients living with HIV. While this is the case, little is known about their experiences of caring for patients living with HIV, and what their perceptions are towards collaboration. It is for this reason that this study aimed to explore the experiences of traditional health practitioners and nurses in their management of HIV positive patients, with a view to using the phenomenological accounts of these healthcare providers to propose a model for collaboration between the traditional and biomedical health systems. The study followed a qualitative research design and adopted descriptive phenomenology. Purposive and snowball sampling methods were used to enrol 33 participants in the study. Of the 33, 20 were nurses whilst the rest were traditional health practitioners. Multiple semi-structured interviews, observations and field notes were used to collect data. Data were analysed following the phenomenological explication process as outlined by Thomas Groenewald (2004). The study discovered the following major themes amongst nurses: experiences of working in the ART clinics with patients living with HIV; ART initiated patients defaulting from care; caring for children living with HIV; work for support and staff; some patients still use traditional medicine; the perceived role of traditional health practitioners; and collaboration, as well as the preaching of miracle healing by pastors persuading ART initiated patients to default from treatment. Additionally, the following themes emerged from the interviews with traditional health practitioners: Traditional health practitioners caring for patients living with HIV; treatment of symptoms presented by living with HIV; the experience of working with patients living with HIV; accepting patients living with HIV; experience of caring for patients living with HIV; patient referrals to biomedical clinics, perceptions regarding collaboration; and the role of traditional health practitioners’ organisations. A model on the process to be undertaken for collaboration to be implemented is proposed. The study recommends structured psychological and managerial support for nurses based in the ART clinics. It also recommends educational and awareness workshops on issues of stigma and discrimination amongst all health care professionals. Furthermore, the study recommends the regulation of traditional health practitioners and professionalisation of the referral system to further help with patient tracing when required. Attitude-changing workshops for nurses and traditional health practitioners are recommended to alleviate the negative perceptions they have towards each other. The study is concluded by suggesting that the government, in collaboration with other stakeholders, should initiate a way forward on the role of traditional health practitioners in primary health care, particularly in HIV management.