'The Medicine Is Not For Sale': Practices Of Traditional Healers In Snakebite Envenoming In Ghana

Author summaryMany snakebites in tropical lower and middle-income countries are treated at the community level by traditional healers whose services are often accessible, affordable and offer care within the realms of local tradition and culture. A drawback of traditional care, however, is the associated delay or non-presentation of patients in need of antivenom and medical management at hospitals. We conducted interviews with traditional healers in two separate areas of rural Ghana to chart the socio-cultural context, perceived problems, treatment approaches, health seeking behaviors, and possibilities for future collaboration in snakebite treatment and management between hospitals and traditional healers. Healers described a holistic treatment approach, addressing physiological, psychological, and spiritual complications of snakebite. Healers reported high success rates with therapies ranging from herbal medicine to minor surgical interventions. Major factors precluding hospital health seeking of patients were identified as costs, poor accessibility, lack of antivenom and insufficient pain control. Gaps in clinical management are modifiable factors that, if improved, are likely to increase clinical health seeking. Our findings emphasize that traditional healers can provide a critical link between snakebite patients and hospitals, making their involvement crucial to the rural expansion of snakebite research and emergency care.BackgroundSnakebite envenoming is a medical emergency which is common in many tropical lower- and middle-income countries. Traditional healers are frequently consulted as primary care-givers for snakebite victims in distress. Traditional healers therefore present a valuable source of information about how snakebite is perceived and handled at the community level, an understanding of which is critical to improve and extend snakebite-related healthcare.MethodThe study was approached from the interpretive paradigm with phenomenology as a methodology. Semi-structured interviews were conducted with 19 traditional healers who treat snakebite patients in two rural settings in Ghana. From the Ashanti and Upper West regions respectively, 11 and 8 healers were purposively sampled. Interview data was coded, collated and analysed thematically using ATLAS.ti 8 software. Demographic statistics were analysed using IBM SPSS Statistics version 26.FindingsSnakebite was reportedly a frequent occurrence, perceived as dangerous and often deadly by healers. Healers felt optimistic in establishing a diagnosis of snakebite using a multitude of methods, ranging from herbal applications to spiritual consultations. They were equally confident about their therapies; encompassing the administration of plant and animal-based concoctions and manipulations of bite wounds. Traditional healers were consulted for both physical and spiritual manifestations of snakebite or after insufficient pain control and lack of antivenom at hospitals; referrals by healers to hospitals were primarily done to receive antivenom and care for wound complications. Most healers welcomed opportunities to engage more productively with hospitals and clinical staff.ConclusionsThe fact that traditional healers did sometimes refer victims to hospitals indicates that improvement of antivenom stocks, pain management and wound care can potentially improve health seeking at hospitals. Our results emphasize the need to explore future avenues for communication and collaboration with traditional healers to improve health seeking behaviour and the delivery of much-needed healthcare to snakebite victims.