TARKWA, Ghana (May 1, 2000 12:02 a.m. EDT http://www.nandotimes.com) - The drumming and clapping grow louder, and the singing reaches fever pitch. A woman, supported by two assistants, throws back her head and screams.
Crouched in front of her, a man in a bright red robe sucks ferociously at her leg, then spits a nail into a dish.
By the end of the two-hour ceremony, priest Daniel Sofo has purportedly removed about 20 nails, needles and pebbles from the bodies of a half-dozen patients at his healing camp - a neat compound of thatched huts where Christianity mixes with traditional healing rituals.
In a country where traditional healers far outnumber Western-trained doctors, the first stop for many sick people is a herbalist, fetish priest or spiritualist like Sofo.
Now, after decades of resisting their influence, doctors, aid workers and government officials have decided to work with the traditional healers in an effort to improve basic health care.
"Almost every Ghanaian has sought out the help of a traditional healer at one point in his life," says Emanuel Nathan Mensah, director general of the national health service. "There are pockets across the country where doctors and traditional healers are working well together, but we want to formalize it."
In one of the first such moves in Africa, President Jerry Rawlings signed a law in February officially recognizing traditional healers and seeking to integrate them into the formal health care sector.
The legislation requires that traditional healers belong to a recognized professional associations from which they need approval of a local administrator and a traditional chief.
The health department is also preparing a course for traditional healers covering the hygienic preparation of herbal remedies and how to diagnose chronic diseases such as tuberculosis, polio and AIDS.
The approach is winning favor with Western-based development groups like the World Health Organization, which has started urging cooperation between the traditional and modern medical communities in Africa.
In Tarkwa, a sprawling gold-mining town on Ghana's western frontier, there is just one run-down hospital with three doctors for a region of about 150,000 people. But there are an estimated 400 traditional healers in the town and surrounding villages.
Religion, often a mix of Christian and traditional beliefs, is central to life in Tarkwa, home to such businesses as the Trust in God Beauty Salon and God is the Way liquor store.
For Kabina Takyi, 35, it was easier to go to a village priestess than to make the hours-long journey down a bumpy dirt road to the hospital in town.
Frail and emaciated, he lies on a mat in a mud shrine perfumed with incense, where high priestess Agnes Aidoo makes incantations over a cup of water to summon spirits that will guide the treatment.
Aidoo, a kindly old woman in a yellow print dress whose hands are deformed by leprosy, treats the curse that she says is causing Takyi's illness. But she sends him to the hospital for drugs for his physical complaints: chest pains, breathing difficulties and a persistent cough.
"I wouldn't have gone (to the hospital) if the high priestess hadn't told me to," Takyi says. "My faith in her work is so strong."
As in most West African societies, the people here believe illnesses have spiritual as well as physical causes. Belief in the power of traditional healers runs deep, and they are venerated in their communities.
They are also cheaper than Western doctors, and patients can settle their bills with a chicken or other food item if they don't have cash.
Realizing the influence of traditional healers, the aid group CARE International enlisted their help three years ago in the fight against AIDS in Tarkwa.
With a large and mobile mining population, many of them migrants from other parts of the country or nearby Nigeria or Ivory Coast, there is a high incidence of sexually transmitted diseases.
CARE started training traditional healers in the detection and treatment of these illnesses, encouraging them to refer more serious cases to the hospitals. Healers who participated in the one-week course also were given a wooden penis to teach their followers how to use condoms.
"These people have unparalleled access," says a CARE spokeswoman, Wendy Driscoll. "That is what we are tapping into."
The results have been impressive. The number of referrals from traditional healers has soared by the thousands, says Bernard Boateng-Duah, senior medical officer at the Tarkwa government hospital.
Doctors, in turn, have come to appreciate what traditional healers can contribute.
"It has opened my eyes," Boateng-Duah says. "I looked at Western health care as the ultimate way, but when we talk to the traditional health care providers, we find there are a lot of things we can learn from them."
He has studied some traditional remedies and believes there are herbs that are effective against hypertension, abscesses and worms, among other ailments. When he can, he likes to give his patients the choice of using herbal preparations instead of the hospital's usually more expensive drugs.
He also believes patients with incurable ailments like AIDS can benefit emotionally from consulting spiritualists, who provide an explanation for their condition and hope of relief.
Other hospitals have started making use of traditional expertise on the premises, enlisting the help of locals who set broken bones, for example.
Traditional healers welcome their newfound respect and status within the medical community.
"There is no rivalry at all," said Sofo, a young and charismatic healer whose patients are mostly women. "If there is a spiritual aspect to the problem, I take care of it. Problems that I find are physical, I refer to hospital."
Many healers used to refuse to refer patients to Western doctors.
Sofo says hospital staff would remove the protective talismans he gave his patients to protect them from spirit attacks. herbalist Yacuba Abdalla says that when he referred patients suffering from chronic diarrhea or vomiting, hospital staff blamed his preparations.
These days doctors sometimes refer patients to Abdalla for bone setting. In return, he's happy to throw in a little sex education while peddling his remedies in the streets and on the trains.
"Now the hospital refers patients to me. And when I can't manage, I refer them to the hospital," Abdalla says. "So I feel that they are doing their part and I am doing mine."