The sight conjures up stereotypical Western images of traditional African healthcare: An enormous pot sits on red-hot coals, bubbling away and giving off a pungent smell of mixed herbs. A glance inside reveals various strips of vegetation, some roots, and a few shreds of bark being stewed up in a brownish liquid.
Then, an elderly man dips a tin can, which serves as a ladle, into the concoction, pours some though a sieve and leaves it in a plastic bucket to cool.
But there is something not quite right. The elderly man, a traditional healer called Mohammed Kasomo, may have the nickname to go with the job - Bongo Mzizi, Swahili for the Root Genius - but he's working in a modern hospital and wearing second hand designer clothes.
This fusion of the traditional and modern is taking place in Tanga, a northeastern region on the Tanzanian coast, where the Tanga AIDS Working Group is combining modern voluntary counselling and testing methods with the knowledge of local healers in treating opportunistic infections associated with HIV/AIDS.
Reliance on ancient remedies
Tanga is a region where faith in traditional medicines is still strong. With health workers estimating that the region has a ratio of one doctor to 33,000 people while there is one traditional healer to 156 people, this reliance is hardly surprising. But the Tanga partnership evolved because biomedical doctors were worried about the number of treatable cases that were being taken to traditional healers and only reached hospital when it was too late to save patients.
"The idea came from some German doctors who were working on the district health teams in the area," Dr. Samuel Mtullu, the AIDS working group project coordinator, said. "They had a problem because many people who had treatable problems were choosing to go to traditional healers before coming to the hospital."
"Many treatable cases died. So they decided to strike up a relationship between the hospital and the healers," he said.
And, since 1990, traditional healers have been receiving basic training in the form of seminars. In addition, meetings between modern and traditional healers have been held to discuss cures and an effective referral network has been set up.
The link between the collaboration and tackling HIV/AIDS was made after Bongo Mzizi recognised the similarity between the infections that people with AIDS experienced and those he was treating.
He asked to be given the chance to use his herbs to treat AIDS patients and, before long, the patients' appetites improved, they gained weight, and they suffered from fewer infections.
"The original three herbs were Mohogora, to increase appetite and reduce fever; Mkusu, for skin infections, and Mvuti, which is used to help abdominal discomfort," Bongo Mzizi said. "But then we found another, Zingiri, which we apply topically to cure oral and vaginal fungus."
He added, "They work well. In fact, our biggest complaint is that people's hunger comes back too much and it became expensive to eat again."
The herbs are packaged in powder form. Every two weeks some 700 patients receiving treatment go to the hospital for their doses and take them home where the herbs are boiled into a tea.
So far, at least 4,000 people have been treated by the AIDS working group and, although they are not curing AIDS, health workers say that there are marked improvements in people's standards of living.
"A lot of patients are getting relief from these medicines," Dr Justin Nguma, an HIV/AIDS specialist with over 20 years experience in Tanzania, said. "We don't know exactly what these medicines may have that is providing this relief but there is some research that is going on and, before long, we'll be able to know what it is."
Similarly, in a 2002 case-study, the Joint UN Programme on HIV/AIDS (UNAIDS) described the work of the Tanga AIDS Working Group as "an outstanding example of how positive results can be achieved in the fight against AIDS by using local, culturally relevant expertise and resources to provide low-cost care and prevention for people living with AIDS."
Whatever scientific composition of these healing herbs, the patients who are on them appear, for the moment, content with resorting to the traditional remedies for the treatment of AIDS.
Helen Rafael Madaga, a 46-year-old Tanga resident who became infected with the virus seven years ago, is one of the patients on the traditional medicine. She said that more should be done to help its development.
After falling ill, Madaga sought the help of traditional doctors and the church before deciding to have an HIV test and being referred to the AIDS working group.
"I took the herbs once I found out that I was infected, I kept on taking them for six months and they have helped me feel stronger. I now take them only when I feel infections coming on and I usually feel better.
"I don't know or care what is in them, but I have confidence in the herbs.
"If I have a problem like malaria, and there is a modern treatment, I will use that. I have heard of antiretroviral [ARV] drugs but we don't have them, so we make do with what we have here.
"They should make the traditional medicines easier to take, maybe by making them into tablets, because they are very strenuous, especially if we are travelling. Then they can also look like modern medicine," Madaga said.
Not a cure, but hope
However, Dr Mtullu is under no illusion that they have found the ideal solution. Inevitably, people do die and, as is common all over Tanzania, the stigma attached to the disease means that 20 percent of the patients do not return to complete the treatment, he said.
"Also, many people think that they have been cured because they have been freed from the infections for some time," he said. "Because of the language the healers themselves use, it can be confusing and the patients are convinced they are healed but we insist that this is not a cure for AIDS. It is a temporary relief."
Nonetheless, for the moment, people with AIDS are living longer and better lives. And observers, and those involved in the project alike, are confident that the AIDS working group can be an example of a new collaboration, where the lack of trust between traditional and biomedical health workers is broken down and knowledge and experience is shared.
"I am very happy that the Ministry of Health has recognised their [traditional healers'] role and there is now a unit at the ministry which takes care of the interests of the traditional healers in an effort to register them and make them come forward with their medicines for research and development," Nguma said.
"As such, if we continue to encourage them and work with them, I see traditional healers as partners in the development of vaccines and treatments for AIDS," he said.