Traditional African medicine

A Kapsiki crab sorcerer of Rhumsiki, Extreme North Province, Cameroon uses a form of divination by interpreting the changes in position of various objects as caused by a fresh-water crab.

Traditional African medicine is a holistic 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 misidentification or misuse of healing plants.

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. 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 Western 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 his or her 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. 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. Approximately 60%-80% of the people in Africa rely on traditional remedies to treat themselves for various diseases. A large percentage of the people in South Africa also rely on traditional remedies to treat their animals for various diseases.

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.
• 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.

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 his or her 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 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. 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.

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.

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 Dr. 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. Dr. 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."

Relationship with modern 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." 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, Dr. 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 African 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 African 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.

See also

• Alternative medicine
• Infant oral mutilation
• Muti
• Traditional healers of South Africa
• Traditional Hausa medicine