Babu. Everywhere we go in Tanzania, we hear of Babu.

“Have you heard, he healed a person with AIDS! And a blind child could see again. I saw it myself. The cup, the kikombe. He hands out the kikombe with a herbal tea from a local plant. The plant it comes from, when it is not boiled, might be poisonous. No, it is a poisonous plant, it's a magical plant. God has chosen Babu to heal us. Africans to cure Africans. Did you hear, our local politicians have gone to see Babu. Oh, and Nelson Mandela went by helicopter - he jumped the line. 30,000 people are being treated each day. Even nurses and some doctors have gone.”

“They did some tests in Kenya: not effective. What should I think now? They will do more research. Babu can't be wrong. All these people he healed, they cannot be wrong.”

“The plant grows all over the Serengeti. The soil conditions aren't everywhere the same. It's only powerful where Babu is. Oh, and it's not effective unless Babu has said his payer over the brewed tea. He gets up early every morning, he hardly sleeps. He does this because god has told him.”

By the time we get to Arusha, the closest town to Loliondo on the Tanzanian side, yet still a days bus ride away, our heads are spinning with stories. Everyone has heard of Babu, some have been to see him, many more have heard and told stories. Everyone has an opinion. In June 2011, more than 3 million people have pilgrimaged to Loliondo, to receive the cup, the kikombe from Babu. Babu just means old man, in a respectful way. Babu is a priest. Loliondo is far away, the roads are poorly developed. A faster way to get there leads through Kenya.

Last year, Babu had claimed that the kikombe would heal HIV/AIDS but very few people came to seek the treatment. Was it because of social stigma? The situation changed dramatically, when Babu claimed that his treatment worked for the following six chronic condition: cancer, diabetes, HIV/AIDS, gastrointestinal, respiratory and cardiovascular illnesses. People started coming from all over Tanzania and even from abroad – whether they were sick or not.

Exaud, a local tour guide offering safaris and hiking tours, decided to be of service to the sick. He made his car available and drove six people to Babu. “Folks in my car were sick but nobody admitted they were HIV positive. Everybody went because of something else. I am sure some had AIDS. But I didn't want to know either, we had a long journey together.”

They waited three days before it was their turn. In the meantime, the conditions for the kikombe awaiters turned rougher by the hour: the village wasn't prepared for such an influx of visitors and there was a lack of food and clean drinking water, shelter, and sanitary facilities. In some cases, people even died of dehydration, before they reached their turn of the kikombe. Also, managing such a crowd demanded volunteers. Exaud was one of them, dishing out kikombe to the sick. Whenever people rushed and pushed, Babu would call them back to their senses, reminding them that if they didn't behave, he'd stop handing out the kikombe all together – that worked.

“One day, a blind boy drank the kikombe and was able to see again. I saw it with my own eyes! You don't believe me … it's true. Ask around.” Exaud tells us.

Miracles like these were much told of, fueling the anticipation and hopeful atmosphere in the crowd.

In the meantime, the effect of Babu's kikombe on Arusha's healthcare system is noticeable.

Dr Chamba in Arusha offers us his perspective on the story. As Babu's kikombe became well-known, the hospital wards around Arusha and Moshi cleared out. Patients left, being taken to Babu by their relatives for a more promising and much more comprehensible treatment. Dr Chamba saw HIV patients coming back from Babu who were still ill. For them is was surprising and even devastating to find out they were still testing positive. Some just declared the test as invalid, going for another test, and another one. Just to find out eventually that they hadn't been cured.

One of Dr Chamba's diabetes patient felt so confident in Babu's ability and treatment that he threw his diabetes medicine out of the car window on the drive back from Loliondo. A few days later, the relatives brought him to Dr Chamba's office. The patient was in a coma.

Babu's kikombe has from mobilized crowds of people for a pilgrimage of hope. The stories of Loliondo have brought feelings of pride and empowerment to Tanzanians, who usually find themselves on the receiving end of development aid and health care. Yet, the kikombe doesn't cure everyone and has even caused much harm for some. What I find most intriguing about this story, is the fact that everything around the kikombe and Babu is so different from medical healthcare experiences. And hardly any of the medical healthcare offerings are met with as much enthusiasm as the kikombe.

So, what can health care learn from Loliondo?

Here is an attempt of extracting the aspects that make the kikombe so powerful. 

# 1 It's a single dose.

A one-off treatment fuels the perception of a silver bullet.

# 2 It's a familiar dosage form.

A cup filled with a herbal brew is something people can relate to. It's simple and it's something everyone has seen before. Maybe because of its simplicity it becomes a powerful carrier for the spiritual aspect.

# 3 It's a local African ingredient.

Why it might work: From Tanzania for Tanzanians, from Africa for Africans. This notion might be experienced as empowering as it brings a solution from within rather from outside.

# 4 It is administered by a spiritual leader.

Church plays an enormous role in local people's lives. The fact that the spiritual leader understands more than the congregation is accepted and also demanded. Babu starts each day with a prayer and places high emphasis on the fact that god has given healing power to this plant and chosen him to facilitate. The language he uses is familiar to people and they know this way of reasoning from their churches. Hearing scientific explanations from healthcare professionals, on the other hand, often seems foreign and alienating to them.

# 5 It's taken amongst a crowd of exhilarated people in a non-medical setting.

The journey and atmosphere while waiting for the treatment is filled with compassion and a feeling of belonging – of being human. People aren't divided up into their conditions, some even take the kikombe as prophylaxis (not recommended but frequently heard of) and others take it more than once (also, not recommended by Babu). The social connections at the site happen naturally, being human and suffering from one ailment or another in Loliondo brings people together. And seeking the kikombe treatment doesn't stigmatize, on the contrary, it is uniting people. Do people even feel as patients here? Also, the crowd is hopeful and full of anticipation to the treatment rather than in most medical settings where patients in the waiting room are quiet, lonely in their worries and thoughts, the lucky ones accompanied by a relative or a friend.

# 6 It only costs as much as a local bus fare

The treatment cost is low. 500 TSH (33 US cents) for a single dose. A single dose it's all that's needed which makes the costs seem predictable. If one ignores the hidden costs of getting to Loliondo and back, and the medical costs for when the treatment turns out to not have helped at all.

# 7 It's a long journey to get to the treatment

Now I'd be really curious to see how some of these aspects could get worked into an experiment for delivering health care. What effect might a collaboration between health clinics and local spiritual leaders have when both are aligned?

What can we learn from Loliondo for designing healthcare services in the developing world? For designing healthcare services in the developed world?

Pictures of Babu and Loliondo with comments from Tanzanians here.

March, 2011:

We are on the plane leaving Asia for Europe. The past three months have been an incredible experience rich in stories and anecdotes, pictures of artifacts and personal health experiences. While there are still so many stories to be written down and shared with you, here are a couple of themes that have bubbled up and sit at a higher level. It's probably not quite accurate to lump China and Indochina together, as there are major differences between each country and region, but given the similarities, I'll attempt it anyways.

1) Maintain the health balance through daily action
One thing that strikes me as major difference between Asian and Western notions of health, is the perception of the default state of health. Growing up in Germany and the UK, I get the sense that being healthy is perceived as normal. If you become ill, something is wrong with you. In China, and it also seems to be the case in Vietnam and Thailand, health is a matter of balance. Everyone seems to be taking something for one ailment or the other. While it is normal to constantly do something for one's health by eating the right foods and taking natural medicine, I wonder how people perceive sickness.

A while ago, I came across an academic paper published by a medical anthropologist that examined how people felt about the common cold versus the flu in Europe. There seems to be an intriguing difference: while people felt that coming down with a cold was their fault, for example they hadn't dried their hair properly after a shower (a Celtic belief) or didn't wear a scarf in cold weather (also a Celtic belief), the flu was perceived as something beyond their control.

Do people feel guilty when they get out of balance, i.e. sick, because they haven't done the right things to prevent it?

2) Fine-tune well-being
Western medicine is known and admired for it is fast acting and solves a big problem quickly. It excels at fixing life threatening emergencies. However, its strength isn't to create sustained well-being . Traditional Chinese Medicine (TCM), herbs and other remedies take longer but enhance one's well-being as they bring the body back into a balanced state. In China, severe and chronic conditions, such as diabetes or hypertension, are not only treated with Western medicine, but also with TCM. In Vietnam and Thailand, it seems that people also complement their treatments with additional herbal medicine from pharmacies that cater both, Western and herbal medicines.

3) Strengthen cultural health identity by practicing local health rituals
Strong presence of Western development organizations seem to push local practices of healing to the periphery, it seems. Cambodia and Laos, the two least developed countries in the region, seemed to have the highest numbers of development organizations, and a correlation with lowest number of herbal pharmacy shops visible and accessible from the street. Are there any development organizations that includes local health practices?

So, when people are poor and cannot afford western medicine, they perceive their local health practices as poor man's solution. It's cheaper and more accessible than western medicine. Health organizations often lump local practices together with superstitions and so practices get pushed to the periphery. Until they are stopped being practiced, maybe.

On the flip side, as people become more well-off, when is Western medicine THE cure versus A cure? What difference does it make for people in their journeys from sickness to wellbeing when local health practices are included by the western medicine healthcare provider vs sought out by themselves? In China, it seems that cultural health practices bring a cultural pride and identity to people. What happens, when people loose this notion of cultural health-self?

Story:
Southern Medicine - Vietnam's medical identity?

4) Including the spiritual world for a complete health stakeholder map
Accidents, disease or disability are commonly linked to people's superstitions and beliefs in ghosts and spirits of the ancestors. While in the West, scientific explanations are sought, it seems that the Asian approach looks into both worlds: the spiritual and the scientific. It's easy to claim that the more educated and developed people are, the more they focus on the scientific explanations. The stories that I've come across suggest something else: both worlds exist in parallel – just to play safe? Or, are there important socio-cultural needs that aren't addressed by the rational scientific approach? The spiritual aspects deal both with the emotions of the individual as well as the family and larger community.

Stories:
Laos - Angry spirit causes accident
Vietnam - Ancestor's spirits top doctor's orders

5) ...?

This is by no means a complete list, and I am curious to hear from you. What patterns have you observed? What is missing? 

Vietnam seems to have one additional medical framework: Southern Medicine. Our Vietnamese friend Van explains, “while Western Medicine comes mostly in white tablets, Chinese Medicine consists mostly roots and animal parts, Southern Medicine, unique to Vietnam, is herbal leaves.”

It's fascinating to me, how Vietnam's three medical mindsets reflect the geopolitical forces the country has been exposed to throughout history: 1000 years under Chinese rule, French colonial rule and of course US military activity during the American War as the Vietnamese refer to the Vietnam war.  

A people that has been pushed and pulled in so many directions throughout history makes me wonder whether there is such a thing as a 'medicinal identity'. When is it of importance to have a set of remedies that is a true product of one's own culture and people, and not imported or introduced by outside rulers? Are there any studies that have shown a treatment to be more effective when cultural pride is involved, such as developed by culture X for culture X? I China, I've seen this design aspect being played out in consumer electronics and the claim that Chinese understand much better what Chinese need. How about in the health space?

In Sapa and Hanoi, we come across many shops selling Southern Medicine. It seems like they come in clusters occupying entire streets or certain areas of town. Van tells us that each herbal store in Hanoi is owned by a family and that the knowledge is passed down from father to son for multiple generations. We browse through them and they are a mixture of Chinese and Southern Medicine: dried roots, alcohol tinctures, various animal parts and dried leaves. We walk into a couple of them to try and find someone to talk with, but as it turns out the herbalists are busy during Tet (Vietnamese New Year), and the women and teenagers tending to the stores weren't able to answer any of my questions. They only pointed us to the self-explanatory drugs and supplements, such as weight-loss enhancers which are mostly imports from China. It seems that the younger generation isn't that interested in learning the family knowledge. But since the entire country isn't in its representative state, I don't want to draw any conclusions.

Have you had any experiences with Southern Medicine and would like to share your story? I would love to talk with you, please get in touch.

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