ftv. {U,(~-~S-.G qfo"2..40 KNOWLEDGE, ATTITUDES, AND PRACTICES SURVEY OF TRADITIONAL HEALERS IN FATICK, SENEGAL: FINAL REPORT (USAID GRANT #685-0281-G-OO-1254-00) I. INTRODUCTION This report entails a detailed exposition of the recent Healers Knowledge, Attitudes, and Practices (RAP) Survey (USAID-Senegal Grant #685-0281-G-00-1254-00) in Fatick, Senegal. The preliminary report that has already been submitted described the history of the project up to the final meeting held June 27-28, 1992 at Le Centre Saidou Nourou Tall in Mbour. In this document, the relevant data will be reviewed and the applicability of this data to helping solve some of the health care problems of contemporary Senegal will be discussed. The report will be divided into four sections: (I.) Introduction, (II.) Healers Survey, (III.) Villagers Survey, and (IV.) Comment. The data base is voluminous and not all of the information can be covered by this report. However, the sa1 ient results will be highlighted and the print-out made available for those wishing to review the figures in detail. Much information still reposes in the mass of raw data gleaned from nearly 900 questionnaires (includes the healer and village surveys) and this constitutes a valuable repository that can be mined in the future to answer other questions. II. HEALERS SURVEY QUESTIONNAIRE The questionnaire contained 330 separate items in nine sections. Section VI, containing 21 questions concerning the diagnosis and treatment of specific illnesses could, theoretically, be repeated 50 times because there were 50 illnesses listed in the survey. This could Page Two Traditional Medicine Survey maximally give an additional 1,050 items. In practice, this did not occur because no healer listed more than 10 illnesses in his healing "repertoire." All the interviews were conducted in Serer by interviewers who were bi-lingual in French and Serer and who thus transcribed all the responses onto the questionnaire in French. The numbers in parentheses next to each item listed below represent the number of valid questionnaires for each item. The percentages recorded are the valid percentages, that is they are computed on the basis of the number of valid questionnaires for each item. A. IDENTIFICATION DATA 1. Interview Months: The healer survey was carried out between December 16, 1991 and February 26, 1992. In the healers' survey, 76 or 20.2% of the questionnaires were completed in December, 178 or 47.3% were completed in January, and 122 or 32.4% were completed in February, for a total of 376 completed questionnaires. This number represents 98% of the total number of healers (383) belonging to the Healers' Association at Malango (Fatick). 2. Reasons for Non-participation: There were six members or 1.6% of the 383 belonging to the Healers' Association who did not participate in the survey. Two of these individuals refused outright and four do not actually practice traditional medicine. 3. Arrondisement (District) of the Interview (375): 93 or 24.9% of the interviews were conducted in Diakhao, 25 or 6.7% in Fatick, 95 or 25.3% Page Three Traditional Medicine Survey in Fumela, 78 or 20.8% in Niakhar, and 83 or 22.1% in Tattaguine. 4. Interviewer Participation (376): There were four interviewers who conducted the survey: Coly performed 93 or 24.7% of the interviews, Dione 93 or 24.7%, Ngom 93 or 24.7%, and Sarr 97 or 25.8% of the inter- views. s. Duration of Interview (370): Interviews ranged from 30 minutes to 5 hours 20 minutes in length; the median duration of the interviews was 99 minutes (1 hour 39 minutes). B. SOCIa-DEMOGRAPHIC DATA 6. Age of the Healers (369): Healers' ages ranged from 16 to 94 years, the median age being 59.5 years. Two hundred twenty-one (221) or 59.8% of the respondents, ranged in age from 50 to 69. It was thought initially that the preponderance of the healers toward the older end of the age scale indicated that there were few younger persons entering into this calling. This was found anecdotally to be misleading. In Serer culture, no apprentice "hangs out his shingle" until his teacher and master has died. Thus a bUdding healer may be apprenticed for years, even into middle age and beyond. This information did not become available until the survey was well in progress so there were no questions included to ascertain the number of active apprentices among the healers. 7. Gender of the Healers (376): Three hundred eleven (311) or 82.7% of the healers were men and 65 or 17.3% were women. By inter-ethnic comparison, the Lebu healing rituals of Ndepp are controlled mostly by Page Four Traditional Medicine Survey women. 8. Ethnicity (374): Three hundred fifty-one (351) or 93.4% of the healers were ethnic Serer, 10 or 2.7% were Wolof, 8 or 2.1% were Pulaar, and the small remainder were Bambara, Sarakhole, and Moorish. These ratios are to be expected in a region where the important Serer kingdom of Sine once held sway. 9. changes of Residence (374): Two hundred seventy-seven (227) or 74.1% of the respondents live and work in the village where they were born. This figure reveals a striking degree of geographic stability which, along with other indicators (see 11. Marriage), seem to suggest that the healers strongly represent a conservative, stabilizing force in their communities. 10. Religion (374): One hundred forty-seven (147) or 39.9% of the healers identified themselves as exclusively Muslim, 124 or 33.2% as a mixture of "Muslim-Animist,1I 40 or 10.7% as exclusively Christian, 37 or 9.9% as a mixture of IIChristian-Animist," and 25 or 6.7% as purely Animists. A preferable designation for IIAnimist" might have been "Serer- traditionalll but whatever the case, these responses indicate that traditional Serer beliefs still hold sway even among those practicing other organized religions (Islam and Christianity). This is rather the rule throughout Muslim (and Christian) Africa, where incoming religions are modified in the African pattern. 11. Marriage: Three hundred thirty-five (335) or 89.1% of 376 respon­ dents were married at the time of the survey. One hundred seventy-eight (178) or 47.8% of 372 respondents had one spouse, 100 or 26.9% had two Page Five Tradi~ional Medicine survey spouses, 32 or 8.6% had three spouses, 18 or 4.8% had four spouses. Of the 38 of 372 respondents that were not married at the time of the survey, 36 or 94.7% were widowed. Though there are no figures on re- marriage after divorce, these data would still seem to indicate a high level of domestic stability among the healers. 12. Children (374): Three hundred sixty-two (362) or 96.8% of the respondents reported having living children, though 277 or 74% of them have lost at least one child. 13. Principal occupa~ion (361): Only 43 or 11.9% of the respondents practice traditional medicine as their principal occupation. Two hundred ninety-seven (297) or 82.3% of them practice agriculture, with or without livestock raising, as their principal occupation. Thus only a small minority of the healers can make a living exclusively as practitioners. c. WORK HABITS OF THE HEALERS 14. Days per Week of Practice (371) and Numbers of Patients Seen (359): Three hundred five (305) or 82.2% of 371 respondents indicated that they see patients six or seven days per week. Two hundred fifty-nine (259) or 72.1% of 359 respondents reported having seen between one and seven patients in the week immediately preceding the interview. Eighty-two (82) or 22. 8% of 359 reported having seen no patients in the week preceding the interview, 26 or 7.2% reported having seen 10 patients, and two respondents reported seeing 50 patients in the week preceding the interview. 15. Condi~ions Under Which the Healer will CalIon the Patient (371): Page six Traditional Healers Survey One hundred eighty-six (186) or 50.1% of the respondents reported visit- ing the patient to treat a problem. Of these 186 respondents, 181 or 97.3% make "house calls" upon request of the patient or patient's family; one hundred thirty-two (132) or 70.9% of these 186 do so by appointment. 16. Treatment "prerequisites": Two hundred fifty-two (252) of 353 or 71. 3% of the respondents required payment in advance for treatment. Ninety-one (91) of 352 or 25.8% of the respondents indicated that finan- cial support from the client's family was required for certain treat- ments. One hundred forty-two (142) of 353 or 40.2% responded that the husband's presence was required for the treatment of married women and 102 of 350 or 29.1% responded that the husband's permission, with or without his presence, was sufficient to treat married women. 17. Work at Malango Center (372): Only 78 or 21% of the respondents work at the Malango Center, a traditional healing clinic in Fatick af- filiated with the Traditional Healers' Association. Largely this is due to limited facilities that can only accomodate 10-15 healers on a given day. The Malango Center operates seven days a week and at least four of the healers reside there permanently. Since opening formally in Febru- ary, 1989, nearly 5,000 patients have been seen there. 18. Membership in the Healers' Association (366): One hundred forty (140) or 38 . 3% of the respondents reported hav ing belonged to the Association since its inception (circa 1975); 115 or 31. 4% reported having joined within the 12 months prior to the time of the interview.