Traditional African medicine is a traditional medicine discipline involving indigenous herbalism and African spirituality, typically involving diviners, midwives, and herbalists. Practitioners of traditional African medicine claim to be able to cure various and diverse conditions such as cancers, psychiatric disorders, high blood pressure, cholera, most venereal diseases, epilepsy, asthma, eczema, fever, anxiety, depression, benign prostatic hyperplasia, urinary tract infections, gout, and healing of wounds and burns and even Ebola.
Diagnosis is reached through spiritual means and a treatment is prescribed, usually consisting of a herbal remedy that is considered to have not only healing abilities but also symbolic and spiritual significance. Traditional African medicine, with its belief that illness is not derived from chance occurrences, but through spiritual or social imbalance, differs greatly from modern scientific medicine, which is technically and analytically based. In the 21st century, modern pharmaceuticals and medical procedures remain inaccessible to large numbers of African people due to their relatively high cost and concentration of health facilities in urban centres.
Before the establishment of science-based medicine, traditional medicine was the dominant medical system for millions of people in Africa but the arrival of the Europeans was a noticeable turning point in the history of this ancient tradition and culture. Herbal medicines in Africa are generally not adequately researched, and are weakly regulated. There is a lack of the detailed documentation of the traditional knowledge, which is generally transferred orally. Serious adverse effects can result from mis-identification or misuse of healing plants.
The geographical reach of this article is sub-saharan Africa. Though, of course neighbouring medical traditions influenced traditional African medicine.
History
Colonial era
Science has, in the past, considered methods of traditional knowledge as primitive and backward. Under colonial rule, traditional diviner-healers were outlawed because they were considered by many nations to be practitioners of witchcraft and magic,
and declared illegal by the colonial authorities, creating a war
against aspects of the indigenous culture that were seen as witchcraft.
During this time, attempts were also made to control the sale of herbal
medicines. After Mozambique
obtained independence in 1975, attempts to control traditional medicine
went as far as sending diviner-healers to re-education camps. As
colonialism and Christianity
spread through Africa, colonialists built general hospitals and
Christian missionaries built private ones, with the hopes of making
headway against widespread diseases. Little was done to investigate the
legitimacy of these practices, as many foreigners believed that the
native medical practices were pagan and superstitious and could only be suitably fixed by inheriting Western methods according to Onwuanibe.
During times of conflict, opposition has been particularly vehement as
people are more likely to call on the supernatural realm.
Consequently, doctors and health practitioners have, in most cases,
continued to shun traditional practitioners despite their contribution
to meeting the basic health needs of the population.
Modern period
Nurse at Koidu Hospital in Sierra Leone consulting with patients.
In recent years, the treatments and remedies used in traditional
African medicine have gained more appreciation from researchers in
science. Developing countries have begun to realize the high costs of
modern health care systems and the technologies that are required, thus proving Africa's dependence to it.
Due to this, interest has recently been expressed in integrating
traditional African medicine into the continent's national health care
systems.
An African healer embraced this concept by making a 48-bed hospital,
the first of its kind, in Kwa-Mhlanga, South Africa, which combines
traditional methods with homeopathy, iridology, and other Western healing methods, even including some traditional Asian medicine.
However, the highly sophisticated technology involved in modern
medicine, which is beginning to integrate into Africa's health care
system, could possibly destroy Africa's deep-seated cultural values.
Diagnostics
The diagnoses
and chosen methods of treatment in traditional African medicine rely
heavily on spiritual aspects, often based on the belief that
psycho-spiritual aspects should be addressed before medical aspects. In
African culture, it is believed that "nobody becomes sick without
sufficient reason."
Traditional practitioners look at the ultimate "who" rather than the
"what" when locating the cause and cure of an illness, and the answers
given come from the cosmological beliefs of the people.
Rather than looking to the medical or physical reasons behind an
illness, traditional healers attempt to determine the root cause
underlying it, which is believed to stem from a lack of balance between
the patient and their social environment or the spiritual world, not by
natural causes.
Natural causes are, in fact, not seen as natural at all, but
manipulations of spirits or the gods. For example, sickness is sometimes
said to be attributed to guilt by the person, family, or village for a
sin or moral infringement. The illness, therefore, would stem from the
displeasure of the gods or God, due to an infraction of universal moral
law.
According to the type of imbalance the individual is experiencing, an
appropriate healing plant will be used, which is valued for its symbolic
and spiritual significance as well as for its medicinal effect.
When a person falls ill, a traditional practitioner uses incantations to make a diagnosis. Incantations are thought to give the air of mystical and cosmic connections. Divination
is typically used if the illness is not easily identified, otherwise,
the sickness may be quickly diagnosed and given a remedy. If divination
is required, then the practitioner will advise the patient to consult a
diviner who can further give a diagnosis and cure. Contact with the
spirit world through divination often requires not only medication, but sacrifices.
Treatments
Traditional practitioners use a wide variety of treatments ranging from "magic" to biomedical methods such as fasting and dieting, herbal therapies, bathing, massage, and surgical procedures. Migraines, coughs, abscesses, and pleurisy
are often treated using the method of "bleed-cupping" after which an
herbal ointment is applied with follow-up herbal drugs. Animals are also
sometimes used to transfer the illness to afterward or for the
manufacture of medicines for zootherapy. Some cultures also rub hot
herbal ointment across the patient's eyelids to cure headaches. Malaria
is treated by both drinking and using the steam from an herbal mixture.
Fevers are often treated using a steam bath. Also, vomiting is induced,
or emetics, in an attempt to cure some diseases. For example, raw beef is soaked in the drink of an alcoholic person to induce vomiting and nausea and treat alcoholism. In the Bight of Benin, the natives have been known to use the fat of a boa constrictor to allegedly cure gout and rheumatism, and it also is thought to relieve chest pain when rubbed into the skin. Within South Africa some examples of zootherapy are the utilization of the bones of baboons as a treatment for arthritis, or the rubbing of the terpenoids of the blister beetle (Mylabris sp.) into the skin as a treatment for skin diseases. Approximately 60%-80% of the people in Africa rely on traditional remedies to treat themselves for various diseases.
A recent systematic review estimated that close to 60%
(58.2%)[4.6%-94%] of the general population in sub-Saharan Africa use
traditional and complementary medicine product. A large percentage of the people in South Africa also rely on traditional remedies to treat their animals for various diseases.
Ebola survivors in Sierra Leone have recently been reported to using
traditional and complementary medicine alone or together with
conventional medicine.
Medicinal plants
Prunus africana with stripped bark.
Africa is endowed with many plants that can be used for medicinal
purposes to which they have taken full advantage. In fact, out of the
approximated 6400 plant species used in tropical Africa, more than 4000
are used as medicinal plants.
Medicinal plants are used in the treatments of many diseases and
illnesses, the uses and effects of which are of growing interest to
Western societies. Not only are plants used and chosen for their healing
abilities, but they also often have symbolic and spiritual
significance. For example, leaves, seeds, and twigs that are white,
black and red are seen as especially symbolic or magical and possess
special properties.
Examples of some medicinal plants include:
Preparing and drying out freshly dug traditional medicines (muti)
- Pygeum (Prunus africana): Pygeum is not only used in traditional African medicine, but has developed a following around the world, as a cure for mild-to-moderate benign prostatic hyperplasia, claimed by its users to increase the ease of urination and reduce inflammation and cholesterol deposits. In traditional African practice, the bark is made into tea, whereas elsewhere in the world it is found in powders, tinctures, and pills. Pygeum has been sold in Europe since the 1970s and is harvested in mass quantities in Cameroon and Madagascar each year.[1]
- Securidaca longipedunculata: This is a tropical plant found almost everywhere across the continent with different uses in every part of Africa. In Tanzania, the dried bark and root are used as a laxative for nervous system disorders, with one cup of the mixture being taken daily for two weeks. In East Africa, dried leaves from the plant are used in the treatment of wounds and sores, coughs, venereal diseases, and snakebites. In Malawi, the leaves are also used for wounds, coughs, venereal diseases, and snakebites, as well as bilharzia, and the dried leaves are used to cure headaches. In other parts of the continent, parts of the plant are used to cure skin diseases, malaria, impotence, epilepsy, and are also used as an aphrodisiac.
A study, entitled ACE Inhibitor Activity of Nutritive Plants in Kwa-Zulu Natal,
was conducted by Irene Mackraj and S. Ramesar, both of the Department
of Physiology and Physiological Chemistry; and H. Baijnath, Department
of Biological and Conservation Sciences; University of Kwa-Zulu Natal,
Durban, South Africa to examine the effectiveness of 16 plants growing
in Africa's KwaZulu-Natal region, concluding that eight plant extracts may hold value for treating high blood pressure (hypertension). The plants (known locally as muti) used by traditional healers that the team examined were:
| Plant | Description |
|---|---|
| Amaranthus dubius | a flowering plant, also known as spleen amaranth |
| Amaranthus hybridus | commonly known as smooth pig-weed or slim amaranth |
| Amaranthus spinosus | also known as spiny amaranth |
| Asystasia gangetica | an ornamental, ground cover known as Chinese violet. Also used in Nigerian folk medicine for the management of asthma. |
| Centella asiatica | a small herbaceous annual plant commonly referred to as Asiatic pennywort |
| Ceratotheca triloba | a tall annual plant that flowers in summer sometimes referred to as poppy sue |
| Chenopodium album | also called lamb's quarters, this is a weedy annual plant |
| Emex australis | commonly known as southern three corner jack |
| Galinsoga parviflora | commonly referred to as gallant soldier |
| Justicia flava | also known as yellow justicia and taken for coughs and treatment of fevers |
| Momordica balsamina | an African herbal traditional medicine also known as the balsam apple |
| Oxygonum sinuatum | an invasive weed with no common name |
| Physalis viscosa | known as starhair ground cherry |
| Senna occidentalis | a very leafy tropical shrub whose seeds have been used in coffee; called septic weed |
| Solanum nodiflorum | also known as white nightshade |
| Tulbaghia violacea | a bulbous plant with hairless leaves often referred to as society or wild garlic |
Of the 16 plants, Amaranthus dubius, Amaranthus hybridus, Asystasia gangetica, Galinsoga parviflora, Justicia flava, Oxygonum sinuatum, Physalis viscosa, and Tulbaghia violacea
were found to have some positive effects, with the latter proving to be
the most promising with the ability to lower one's blood pressure. The unique infrageneric diversity of Aloe L. (Aloaceae/Asphodelaceae) and the broad therapeutic uses in southern Africa, suggest its cultural significance in the subcontinent. Palms are very commonly used as ritual elements, as well as an ingredient in ATM.
Some people in Grahamstown, South Africa use traditional plants and weeds as an alternative.
Cannabis sativa (intsango). The fresh leaves are made into a decoction that is taken three times a day to treat asthma,
it is also used as steam. In other parts of South Africa it is used to
cure bronchitis, headaches, labour pains and hypertension.
Cannabis Sativa plant
Carduus tenuiflorus (uMhlakavuthwa). The plant is used to
extricate poison or diseases from a sick person. It is believed the
plant sucks out the cause of the illness in itself.
Carduus tenuiflorus plant
Datura stramonium (uQhwangu-qhwangu). Fresh leaves fare used as a bandage that soothes pain and swelling. It's also used as an antiseptic after circumcision.
With the latter, the plant is only used once, it should not be used
repetitively as it can be harmful due to its potency. The fresh leaves
are also applied on boils twice a day.
Datura stramonium plant
Emex australis (inkunzane). This root is used on infants
suffering from restlessness or constipation. It is used as a root
decoction. Adults also use the decoction to treat constipation.
Emex australis plant
Galenia secunda. It is used to treat kidney pains in adults.
The root is mixed with the roots of emex australis (inkunzane). Two
teaspoons of the decoction are taken twice a day. It is also
administered to babies with colic using two drops a day.
Lantana camara (iqunule). It is used to treat back/ abdominal
pains. The roots are boiled in water and drunk as tea twice a day. Also,
it is used to treat gonococcal infection and urinary problems caused by
sexual intercourse.
Lantana camara plant
Opuntia ficus-indica (itolofiya). It is used to treat sores
between toes and the fingers, these sores are caused by igazi elimdaka
(dirty blood). These toes tend to become swollen and ooze pus. The fresh
leaf is baked in an open fire, the inner jelly is then used to apply on
the sores.
Rumex sagittatus (ibhathatha. The root infusion is put in cold
water and used as a body wash. It is used to cleanse the body of
misfortunes and evil.
Rumex sagittatus plant
Schinus molle (ipepile). The leaf decoction is taken orally to
treat fever and influenza. The leaves are added to boiling water and
the steam used to treat fever.
Schinus molle plant
Anredera cordifolia (idlula). The plants' leaves are crushed
and applied on swollen feet whose cause is attributed to poor blood
circulation. It is also used to treat kidney or liver problems. The
leaves' sap is then used to treat the rash that is caused by one's
contact with dirty water.
Anredera cordifolia leaves
Araucaria bidwillii (indiyandyiya). This is used to treat amenorrhea
caused by congenital problems, tuberculosis and malnutrition. The bark
is grated and one tablespoon of the remains is mixed with 750ml of cold
water. The mixture is taken orally once a day.
Araujia sericifera (iquwa). It is used to treat amafufunyana,
amafufunyana is described is described by Ngubane as an extreme form of
depression coupled with psychotic symptoms such as delusions, hysteria,
violent outburst and suicide ideations. The roots are mixed with other
medications to treat amafufunyana.
Argemone mexicana (ikhakhakhakha). This root decoction is
mixed with the roots of the rubus pinnatus (iqunube). It is administered
through the use of an enema to cure kidney pain. The mixture should be
used immediately as if left to stand for long it becomes harmful.
Bidens pilosa (umhlabangubo). It is used to treat
infertility in women. The roots are cleaned, boiled in
water then taken orally. Also, it is used to wash one's body after the
leaves have been soaked overnight in the bathing water. Thus bathing
water is believed to protect one from evil spirits (imoya emdaka).
Recent discoveries
- Other plants scientifically studied in 2016 include Erigeron floribundus, a medicinal plant used in Cameroon, inhibited Staphylococcus aureus nicotinate mononucleotide adenylyltransferase (NadD) yet had no effect the human analogue. Among the constituents of the essential oil are spathulenol and limonene.
- A traditional medicine from the tropical Olon tree, and another species of genus Zanthoxylum, was found to have synergistic compounds that kill both mosquitoes and their plasmodium parasites.
Spirituality
Famous
Bedik diviner outside Iwol, southeast Senegal (West Africa). He
predicted outcomes by examining the color of the organs of sacrificed
chickens.
Some healers may employ the use of charms, incantations, and the casting of spells in their treatments. The dualistic
nature of traditional African medicine between the body and soul,
matter, and spirit and their interactions with one another are also seen
as a form of magic. Richard Onwuanibe gives one form of magic the name
"Extra-Sensory-Trojection." This is the belief among the Ibos of Nigeria
that medicine men can implant something into a person from a distance
to inflict sickness on them. This is referred to by the Ibos asegba ogwu.
To remove the malignant object, the intervention of a second medicine
man is typically required, who then removes it by making an incision in
the patient. Egba ogwu involves psychokinetic processes. Another form of magic used by these practitioners, which is more widely known, is sympathetic magic,
in which a model is made of the victim. Actions performed on the model
are transferred to the victim, in a manner similar to the familiar voodoo doll.
"In cases where spirits of deceased relatives trouble the living and
cause illness, medicine men prescribe remedies, often in the form of
propitiatory sacrifice, in order to put them to rest so that they will
no longer trouble the living, especially children."
Using charms and amulets to cure diseases and illnesses is an uncertain
and clouded practice that requires more scientific investigation.
The Kalahari Desert (shown in red) and the surrounding Kalahari Basin (in orange).
In African cultures, the act of healing is considered a religious
act. Therefore, the healing process often attempts to appeal to God
because it is ultimately God who can not only inflict sickness, but
provide a cure. Africans have a religious world view which makes them
aware of the feasibility of divine or spirit intervention in healing
with many healers referring to the supreme god as the source of their
medical power. For example, the !Kung people of the Kalahari Desert
believe that the great God Hishe created all things and, therefore,
controls all sickness and death. Hishe, however, bestows mystical powers
for curing sickness on certain men. Hishe presents himself to these
medicine men in dreams and hallucinations, giving them curative power.
Because this god is generous enough to give this power to the medicine
men, they are expected to practice healing freely. The !Kung medicine
men effect a cure by performing a tribal dance.
Loma Marshall, who took expeditions to South West Africa with her
family to study the !Kung people, writing two books on their findings,
describes the ceremonial curing dance as follows:
At the dances not only may the sick be cured, but pending evil and misfortune averted. The !Kung believe that the great god may send Gauwa or the gauwas at any time with ill for someone and that these beings may be lurking awaiting their chance to inflict it. The medicine men in the dances combat them, drive them away, and protect the people. Usually there are several medicine men performing at the same time. To cure they go into trance, which varies in depth as the ceremony proceeds... When a man begins, he leaves the line of dancing men, and still singing, leans over the person he is going to cure, going eventually to every person present, even the infants. He places one hand on the person's chest, one on their back, and flutters his hands. The !Kung believe that in this way he draws the sickness, real or potential, out of the person through his own arms into himself... Finally, the medicine man throws up his arms to cast the sickness out, hurling it into the darkness back to Gauwa or the gauwasi, who are there beyond the firelight, with a harp, yelping cry of "Kai Kai Kai."
Loma Marshall does not give any information as to whether or not the
dance is successful in curing the patient but says that it purges the
people's emotions for their "support and solace and hope."
Traditional medicinal practitioners
Inyanga/Sangoma from Johannesburg, South Africa
Many traditional medicinal practitioners are people without formal
education, who have rather received knowledge of medicinal plants and
their effects on the human body from their forebears. They have a deep and personal involvement in the healing process and protect the therapeutic knowledge by keeping it a secret.
Successful Cesarean section performed by indigenous healers in Kahura, Uganda. As observed by R. W. Felkin in 1879.
In a manner similar to orthodox medicinal practice, the practitioners of traditional medicine specialize in particular areas of their profession. Some, such as the inyangas of Swaziland are experts in herbalism, whilst others, such as the South African sangomas, are experts in spiritual healing as diviners,
and others specialize in a combination of both forms of practice. There
are also traditional bone setters and birth attendants. Herbalists are becoming more and more popular in Africa with an emerging herb trading market in Durban that is said to attract between 700,000 and 900,000 traders per year from South Africa, Zimbabwe, and Mozambique. Smaller trade markets exist in virtually every community.[1]
Their knowledge of herbs has been invaluable in African communities and
they were the only ones who could gather them in most societies. Midwives
also make extensive use of indigenous plants to aid childbirth. African
healers commonly "describe and explain illness in terms of social
interaction and act on the belief that religion permeates every aspect
of human existence."
Payments
Traditional
healers, like any other profession, are rewarded for their services. In
African societies, the payment for a treatment depends on its efficacy.
They do not request payment until after the treatment is given. This is
another reason many prefer traditional healers to western doctors who
require payment before the patient has assessed the effectiveness of the
treatment.
The payment methods have changed over time, with many practitioners now
asking for monetary payment, especially in urban settings, rather than
their receiving good in exchange, as happened formerly.
There are also a growing number of fraudulent practitioners who only interested in making money, especially in urban areas.
Learning the trade
Some
healers learn the trade through personal experience while being treated
as a patient who decide to become healers upon recovery. Others become
traditional practitioners through a "spiritual calling" and, therefore,
their diagnoses and treatments are decided through the supernatural. In some cultures, a sign of calling can come from mental disarrangement said to be caused by agwu Nshi,
the spirit of divining, through which the healer gains inspiration.
Through this training, psychological stability is eventually attained.
Another route is receive the knowledge and skills passed down
informally from a close family member such as a father or uncle, or even
a mother or aunt in the case of midwives. Apprenticeship
to an established practitioner, who formally teaches the trade over a
long period of time and is paid for their tutoring, is another route to
becoming a healer.
The training is complex, depending on the kind of medical practice that
the aspiring practitioner wants to be a part of. Once the trainee is
officially initiated as a healer, they are, in some societies,
considered to be half-man and half spirit, possessing the power to
mediate between the human and supernatural world to invoke spiritual
power in their healing processes.
Importance
In
Africa, the importance of traditional healers and remedies made from
indigenous plants play a crucial role in the health of millions.
According to the International Development Research Centre (IDRC), one estimate puts the number of Africans who routinely use these services for primary health care as high as 85% in Sub-Saharan Africa.
The relative ratios of traditional practitioners and university trained
doctors in relation to the whole population in African countries
showcases this importance. For example, in Ghana,
in Kwahu district, for every traditional practitioner there are 224
people, against one university trained doctor for nearly 21,000. In Swaziland,
the same situation applies, where for every healer there are 110 people
whereas for every university trained doctor there are 10,000 people.
According to Nairobi-based specialist in biodiversity and traditional
medicine with the IDRC Francois Gasengayire, there is one healer for
every 200 people in the Southern Africa region which is a much greater
doctor-to-patient ratio than is found in North America.
Ratios of doctors (practicing modern medicine) and traditional medical practitioners to patients in east and southern Africa:
| Country | Doctor:Patient | TMP:Patient | References |
|---|---|---|---|
| Botswana |
|
TMPs estimated at 2,000 in 1990 | Moitsidi, 1993 |
| Eritrea | Medical doctors estimated at 120 in 1995 |
|
Government of Eritrea, 1995 |
| Ethiopia | 1:33,000 |
|
World Bank, 1993 |
| Kenya | 1:7,142 (overall) | 1:987 (Urban-Mathare) | World Bank, 1993 |
|
|
1:833 (Urban-Mathare) | 1:378 (Rural-Kilungu) | Good. 1987 |
| Lesotho |
|
Licensed TMPs estimated at 8,579 in 1991 | Scott et al. 1996 |
| Madagascar | 1:8,333 |
|
World Bank, 1993 |
| Malawi | 1:50,000 | 1:138 | Msonthi and Seyani, 1986 |
| Mozambique | 1:50,000 | 1:200 | Green et al. 1994 |
| Namibia |
|
1:1,000 (Katutura)
1:500 (Cuvelai)
1:300(Caprivi)
|
Lumpkin, 1994 |
| Somalia | 1:14,285 (Overall)
1:2,149 (Mogadishu)
1:54,213 (Central region) 1:216,539 (Sanag) |
|
World Bank, 1993; Elmi et al. 1983 |
| South Africa | 1:1,639 (Overall)
1:17,400 (Homeland areas)
|
1:700-1,200 (Venda) | World Bank, 1993 (Venda and Overall), Savage, 1985* Arnold and Gulumian, 1987* (Homeland areas) |
| Sudan | 1:11,000 |
|
World Bank, 1993 |
| Swaziland | 1:10,000 | !:100 | Green, 1985; Hoff and Maseko, 1986 |
| Tanzania | 1:33,000 | 1:350-450 in DSM | World Bank, 1993; Swantz, 1984 |
| Uganda | 1:25,000 | 1:708 | World Bank, 1993; Amai, 1997 |
| Zambia | 1:11,000 |
|
World Bank, 1993 |
| Zimbabwe | 1:6,250 | 1:234 (urban)
1:956(rural)
|
World Bank, 1993; Gelfand et al. 1985 |
*TMP refers to Traditional Medical Practitioner
Note: References with an asterisk are in Cunningham, 1993.[6]
This table showing the ratio of traditional medical practitioner
to patient and Western practitioner to patient shows that in many parts
of Africa, practitioners trained in modern medicine are few and far
between. Because of this, healers prove to be a large and influential
group in primary health care and an integral part of the African culture
and are required for the health of its people. Without them, many
people would go untreated.
Medications and treatments that Western pharmaceutical companies
manufacture are far too costly and not available widely enough for most
Africans. Many rural African communities are not able to afford the
high price of pharmaceuticals and can not readily obtain them even if
they were affordable; therefore, healers are their only means of medical
help. According to Sekagya Yahaya Hills, who is a university-trained
dentist and a traditional healer in Uganda,
there are promising signs that some of the plant-based remedies offered
by medicine-men are not just affordable, but also effective, even in
treating AIDS. Hills read his Declaration of Traditional Healers at the 13th International Conference on AIDS and sexually transmitted infections
(STIs) in Africa, which summarized the important role of traditional
medicine, stating: "As traditional healers, we are the most trusted and
accessible health care providers in our communities. We have varied and
valuable experience in treating AIDS-related illness and accept the
great responsibility of continuing to do so."
Because this form of medicine is "the most affordable and accessible
system of health care for the majority of the African rural population,"
the African Union declared 2001 to 2010 to be the Decade for African
Traditional Medicine with the goal of making "safe, efficacious,
quality, and affordable traditional medicines available to the vast
majority of the people."
Excessive use of plants is an oecologic risk, as this may cause their extinction.
Traditional African Medicine in Relation to Women
Women
in sub-Saharan rural African communities are almost entirely
responsible for domestic work in their households. These women are often
at higher risk for disease and poverty than their male counter-parts
and have less control over their daily lives than them. A study done by
Berhane et al. (2001) found that these women defined ‘good health’ as
the ability to perform domestic duties and the state of being disease
free. Furthermore, the study found that they attributed poor health to
supernatural, evil forces, that illness is seen as a form of punishment
from spirits.
Another study, done by Mill (2001), explored the HIV/AIDS epidemic in
Ghana. Women identified HIV/AIDS with reprobate behavior, such as
“prostitution, promiscuity, and extramarital relationships”, or
traveling to areas outside the community.
These women endure arduous conditions and a traditional healer
plays an instrumental role in their daily lives. The traditional healer
provides health care to the rural communities and represents him/herself
as an honorable cultural leader and educator. An advantage of the
traditional healer in rural areas is that they are conveniently located
within the community. Modern medicine is normally not as accessible in
rural areas because it is much more costly. The socio-economic
inequality of rural communities and high costs, which limit access to
western health, is validated in the study of traditional medicine in
South Africa for HIV patients by Peltzer et al. Older rural women
particularly tend to utilize traditional healers in their communities.
Younger women and the urbanized have been found to be renouncing the use
of traditional healers.
Berhane et al. (2001) also studied a group of women in a rural
region of Ethiopia where HIV was present. These women rejected the
presence of HIV in rural villages and claimed it was an urban illness.
HIV was present in the rural communities of Ethiopia, where the study
was conducted. However, these women also claimed that their communities
did not advocate for prevention, but rather treated an illness once it
was present.
The HIV/AIDS epidemic revealed a criticism of traditional
healers’ methods in healthcare from those of modern medicine. A
particular problem is the use of certain herbal treatments for HIV/AIDS.
According to Edward Mills, herbal remedies are used as a therapy for
HIV-symptoms such as “dermatological disorders, nausea, depression,
insomnia, and weakness.” While some of these remedies have been
beneficial, the herbal treatments hypoxis and sutherlandia “may put the
patients at risk for antiretroviral treatment failure, viral resistance,
or drug toxicity.”
Hypoxia and sutherlandia put patients at risk when using antiretroviral
treatment because they interact and prevent the expression of CYP3A4
and P-glycoprotein. This results in the inhibition drug metabolism and
transport.
Peltzer et al. also found that an important issue with herbal medicines
used in traditional medicine is that when a patient decides to see a
doctor in addition to a traditional healer, they do not always mention
that he or she is taking an herbal medicine. Herbal medicines can
interact with the modern medicine prescribed by the doctor to treat HIV
and negatively impact the patient. Peltzer et al. mentions that a “IGM-1
seem to be effective in symptom improvement, but generally no
significant effect on antiviral or immunity enhancement among reviewed
herbs was seen” for the treatment of HIV. Because HIV is such a volatile
disease, it is imperative to try and boost the patient's immunity not
just relieve symptoms.
The ethical issue, as presented by modern medicine, is the
complete lack of clinical trials to test any traditional African
medicine before practicing with it on the public. According to Aceme
Nyika, modern medicine obeys Nuremberg Code, an ethic's principle
followed by doctors and scientist, to obligate humane behavior in
experimenting on the public for the good of society. Because traditional
African healers do not have to adhere to Nuremberg code, there is a
potential danger to society when healers do not practice medicine
humanely.
Traditional healers have also been under scrutiny during the
HIV/AIDS epidemic for unsanitary medical practices. Mills explains how
the “re-use of medical instruments and lack of hygienic habits such as
hand washing” have contributed to the spread of infectious diseases by
traditional healers. A study of traditional healers in Nigeria found
that 60% of the population was at risk because of the contamination
spread by tradition healers.
Sub-Saharan countries have found ways to unite modern medicine
with traditional medicine due to the urgency of the HIV/AIDS epidemic.
In South Africa, the Kundalia Foundation has provided funding to train
traditional healers on HIV/AIDS. The training included prevention, safe
sex, and knowledge about the virus.
Women experience the most fatal impacts from the HIV/AIDS
epidemic. As mentioned in Nelm and Gorski's research, when industrial
development required the labor of men from rural communities, the men
often left those communities. In African culture, the sexuality of a man
is emphasized. While men were away at the migratory labor camps, many
men would have sex with prostitutes and become infected with HIV.
Upon return, some men brought back infectious diseases such as HIV,
which they would spread to their wives, as well as to any other sexual
partner.
Furthermore, because traditional medicine does not have an early
detection method, infectious diseases are often spread unknowingly. For example, in sub-Saharan Africa 3.1 million people infected with HIV grew exponentially to 25.4 million in 2004.
Also, the patriarchal culture that defines traditional marriages in
rural areas, decrees that women are not permitted to discuss and
practice safe sex with their partners. This patriarchal traditional
South African culture, which places female sexuality under male control
results in exposing women in rural areas to a higher risk for HIV.
Relationship with modern Western medicine
Before
the establishment of science-based medicine, traditional medicine was
the dominant medical system for millions of people in Africa but the
arrival of the Europeans was a noticeable turning point in the history
of this ancient tradition and culture. Although modern scientific medicine is successful in developed countries, it doesn't have the same positive impact in many of the underdeveloped African countries.
Though Western practices can make an impact in health care practices,
in certain areas such as in the spread of various diseases, it cannot
integrate wholly into the culture and society.
This makes the traditional African practitioners a vital part of their
health care system. There are many reasons why the Western medical
system has not been as effective in Africa as it has in more developed
parts of the world. Hospitals and medical facilities are difficult for
many Africans to get to. With vast areas of land and poor road and
transportation systems, many native Africans have to travel immense
distances on foot to reach help. Once they arrive they are often
required to wait in line for up to 8 hours, especially in urban areas,
as the lack of clinics and resources cause over-crowding. Patients are
often not told the cause of their illness or much information about it
all, so they have no way to prevent or prepare for it. The technology
used is usually of poor quality, which impairs the quality of treatment.
Modern medicine can also be too expensive for the average African to
afford, making it difficult for them to receive proper care. Finally,
Modern medicine removes native Africans from the culture and tradition
and forces them into a setting that they are not comfortable with, away
from their family and traditions which are of utmost importance to them.
They do not get the proper spiritual healing that their culture seeks
and traditional ideology requires.
However, there has been more interest expressed recently in the effects of some of the medicinal plants of Africa. "The pharmaceutical industry
has come to consider traditional medicine as a source for
identification of bio-active agents that can be used in the preparation
of synthetic medicine."[6]
Pharmaceutical industries are looking into the medicinal effects of the
most commonly and widely used plants to use in drugs. It's apparent
that there are some things that can be learned from traditional African
practice. In comparing the techniques of African healers and Western
techniques, T. Adeoze Lambo, a Nigerian psychiatrist, stated in 1979,
"At about three years ago, we made an evaluation, a programme of their
work, and compared this with our own, and we discovered that actually
they were scoring almost sixty percent success in their treatment of neurosis. And we were scoring forty percent-in fact, less than forty percent."
Effectiveness
Herbal medicines in Africa are generally not adequately researched, and are weakly regulated. There is a lack of the detailed documentation of the traditional knowledge, which is generally transferred orally.
Several African medicinal plants have shown encouraging
anti-trypanosomal effects but the research is only in the concept stage. A small proportion of ethnoveterinary medicine plants in South Africa have been researched for biological activity. Research identified favorable, possible future use of the Hypoxis species, (known locally as inkomfe or African potato) in both ATM and modern medicine. South African sangomas have been long and vocal advocates of a local traditional plant called unwele or kankerbos (Sutherlandia frutescens) claiming it assists in the treatment of HIV/AIDS, cancer and tuberculosis. Sufficient preclinical data on Sutherlandia frutescens yields plausible hypotheses that may account for the reputed efficacy.
Safety
A small proportion of ethnoveterinary medicine plants in South Africa have been researched for toxic effects. The possible adverse effects of South African traditional medicines are not well documented; there has been limited research into mutagenic properties and heavy metal contamination. Serious adverse effects, even death, can result from misidentification or misuse of healing plants. For example, various aloe plants are widely used in TAM, but some varieties, such as Aloe globuligemma, are toxic and can cause death. The potential for ATMs and pharmacokinetic interactions is unknown, especially interactions between traditional treatments and pharmaceutical antiretroviral drugs for HIV/AIDS. Herbal treatments are frequently used in Africa as a primary treatment for HIV/AIDS and for HIV-related issues.
Collaboration with traditional healers has been recommended to
determine what herbal remedies are used for HIV and to educate people
supplying alternative treatments against unsafe practices. Given the demands of the local population on the use of ATMs, it has been suggested that South African medical schools should review their curriculum regarding traditional, complementary and alternate medicines.
Use of TM, using their antiviral efficiency instead of using
specific antiretroviral drugs, is especially a risk with HIV. The hope
to find a cure for Ebola or Marburg virus infections has been unsuccessful up to now.
However, this problem is also true for modern medicine.
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