Traditionelle afrikanische Medizin

Traditional African medicine is a holistic discipline, which uses the theory that whole entities have an existence other than as the mere sum of their parts, involving extensive use of the indigenous herbalism combined with aspects of African spirituality. According to the World Health Organization (WHO) the definition of traditional medicine may be summarized as the sum total of all the knowledge and practical, whether explicable or not, used in the diagnosis, prevention and elimination of physical, mental, or social imbalance and relying exclusively on practical experience and observation handed down from generation to generation, whether verbally or in writing. Traditional African medicine typically involves diviners, midwives, and herbalists. Practitioners of traditional African medicine claim to be able to cure various and diverse conditions such as cancers, acquired immunodeficiency syndrome (AIDS), psychiatric disorders, high blood pressure, cholera, infertility, most venereal diseases, epilepsy, asthma, eczema, hayfever, anxiety, depression, benign prostatic hyperplasia, urinary tract infections, gout, and healing of wounds and burns. In contrast with western medicine, which is technically and analytically based, traditional African medicine takes an approach where good health, disease, success or misfortune are not seen as chance occurrences but are believed to arise from the actions of individuals and ancestral spirits according to the balance or imbalance between the individual and the social environment.

Regional map of Africa.

History

Colonial Era

Datei:Colonial-Africa.png

Colonial Africa in 1913.

Modern science has, in the past, considered methods of traditional knowledge as primitive. Under colonial rule, traditional diviner-healers were outlawed because they were considered by many nations to be practitioners of witchcraft and declared illegal by the colonial authorities creating a war against witchcraft, magic, and sorcery. During this time, attempts were also made to control the sale of traditional herbal medicines. After Mozambique obtained independence in 1975, attempts to control traditional medicine went as far as to send diviner-healers to re-education camps. Also, during times of conflict, opposition to traditional medicine is 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. 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 traditional practices, many foreigners simply believing that the native medical practices were pagan and superstitious and could only be suitably fixed by inheriting Western methods.

Modern Period

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 their health care systems and the technologies required, thus proving Africa's dependence of traditional medicine. Due to this, recent interest has been expressed in integrating traditional African medicine into the continent's national health care systems. A traditional African healer embraced this concept by making a 48-bed hospital, the first of its kind, in Kwa-Mhlanga, South Africa which combines traditional African medicine 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 in its traditional medical practice.

Diagnostics

The diagnoses and chosen methods of treatment in traditional African medicine rely heavily on spiritual aspects, often times believing that psycho-spiritual aspects should be addressed before medical aspects. 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. Traditional healers' ability to diagnosis illnesses is considered a gift from both God and his ancestors among traditional healers. 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. 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. Richard Onwuanibe of Cleveland State University puts the traditional African method of diagnosis in context as follows:

A general observation about causes and cures of sickness in the traditional practice reveals that the native African refers them, in most cases, ultimately to persons-human or spiritual-rather than to natural causes, which are seen as resulting from the manipulations of men, spirits, gods, or God. By tradition, Africans are not materialists; they are ethico-religious, and this orientation is reflected in their medical practice. Nobody becomes sick without a sufficient reason, which is interpreted ultimately in terms of human and super-natural agency. Since the native Africans have a view of a moral universe in which humans, spirits, gods, or God interact, all sicknesses and epidemics are often regarded as an imputation of guilt by the individual, family, village, or the people as a whole. These maladies are regarded as signs either of the displeasure of the gods or God at the victim's sin or those of his family or community, or the ill will of some malevolent enemy. In other words, illness is considered a consequence of a breach of universal moral law by the victims... Sickness may also be due to the spirit of a relative of the sick person, who had not been put to rest by sacrifice. The cause of mental derangement is more than merely physical. It is ultimately connected with some disturbance in the spirit world. Hence, natural causes, such as climatic conditions and viruses, are considered in relation to the interplay of natural and supernatural forces.

When a person falls ill, a traditional practitioner is called who then uses incantations to make a diagnosis. Incantations are thought to give the air of mystical and cosmic connections in the ordered world of traditional thought. 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 African medicine practitioners use a wide variety of treatments ranging from "magic" to biomedical methods such as fasting and dieting, herbal therapies, bathing and massage, and surgical procedures. Migraines, coughs, abscesses, and pleurisy are often cured 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 cured by both drinking and using the steam from an herbal mixture. Fevers are often cured using a steam bath. Also, vomiting is induced, or emetics, to cure some diseases. For example, raw beef is soaked in the drink of an alcoholic to induce vomiting and nausea and cure alcoholism. In Bight of Benin, the natives have been known to use the fat of a boa constrictor to cure gout and rheumatism which supposedly relieves chest pain when rubbed into the skin.

Medicinal plants

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. The weather and events are also said to be manipulated by diviners by the use of plants.

Examples of some medicinal plants include the following:

Prunus africana with stripped bark.

• 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 Longepedunculata: 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 various other parts of the continent, parts of the plant are used to cure skin diseases, malaria, impotence, epilepsy, and is 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 Kwa-Zulu Natal region and concluded that eight plant extracts may hold value for treating high blood pressure (hypertension). The plants used by traditional healers that the team examined were:

• 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.

Magic

Some healers may employ the use of charms, incantations, and the casting of spells in their treatments, which most foreigners coin as magic. However, the dualistic nature of traditional African medicine between the body and soul, matter, and spirit and their interactions with one another can also be seen as a form of magic. Richard Onwuanibe gives once peculiar 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 traditional medical practitioners which is more widely known is sympathetic magic in which a model is made of the victim and what is done to the model is transferred to the victim, 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.

Religion

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 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.c Usually there are several medicine men performing at the same time. To cure they go into trance, which varies in depth as the eremony 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

Successful Cesarean section performed by indigenous healers in Kahura, Uganda. As observed by R. W. Felkin in 1879.

Many traditional medicinal practitioners are simple, uneducated people who have been passed down a vast knowledge of medicinal plants and their effects on the human body. Traditional healers have a deep and personal involvement in the healing process and protect the therapeutic knowledge by keeping it a secret. Similarly to orthodox medicinal practitioners, the practitioners of traditional medicine specialize in particular areas of their profession. Therefore, we find some traditional African medicinal practitioners who are experts with herbs while others are experts in spiritual healing, while others still specialize in a combination of both. There are also traditional bone setters and birth attendants. Diviners, who are spiritual healers, are responsible for determining the cause of illness, which is commonly believed to stem from ancestral spirits and other spiritual influences. 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 a year from South Africa, Zimbabwe, and Mozambique, with smaller trade markets existing in virtually every community. Traditionally, their knowledge of herbs has been invaluable in African communities and were the only ones who could gather them in most societies. Traditional 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 traditional African societies, the payment for a treatment contributes to how effective it will be. Traditional healers 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 for traditional medicine have changed over time, however, today many traditional healers are asking for monetary payments, especially in urban settings.

Learning the Trade

Healers learn the trade of traditional medicine in several ways. Some healers learn 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 they gain inspiration. Through this training, psychological stability is eventually attained. Another route is to be passed down the knowledge and skills informally through a close family member such as a father or uncle, or even a mother or aunt in the case of midwives. Yet another way is under the apprenticeship of an established practitioner who formally teaches you the trade over a long period of time and is paid for their tutoring. The training to become a traditional African healer is complex, depending on the kind of medical practice that the aspiring practitioner wants to be apart 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 the services of traditional healers 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 showcase 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 traditional 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 Western 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)	1:700-1,200 (Venda)	World Bank, 1993
	1:17,400 (Homeland areas)		Savage, 1985* Arnold and Gulumian, 1987*
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

Note: References with an asterisk are in Cunningham, 1993.

This table showing the ration of traditional medical practitioner to patient and Western practitioner to patient shows that in many parts of Africa, practitioners trained in Western medicine are few and far between. Because of this, traditional medicine practitioners 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 these traditional practitioners, many people would go untreated and the results would undoubtedly be fatal.

Also, medications and treatments that Northern pharmaceutical companies manufacture are far too costly and not widely enough available for most Africans. Many rural African communities are not able to afford the high price of pharmaceutics and can not readily obtain them even if they could; therefore, traditional traditional healers are their only means of medical help. According to Dr. Sekagya Yahaya Hills, who is a modern dentist and a traditional healer in Uganda, there are that promising signs that some of the plant-based remedies offered by traditional healers 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 STIS in Africa which summarized the important role of traditional medicine in Africa, 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 traditional 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 Western Medicine

Many Western societies do not agree with the traditional practices of medicine in Africa and believe that the continent would be better served by integrating Western practices into African's health care system more wholly. This process, however, has proved to be a failure in much of Africa, especially in more rural areas.

How the Western medical system has failed in Africa:

• Facilities are inaccessible for much of the population. In some urban areas

the average waiting time at a hospital or clinic can be as much as 8 hrs.

• The staff are poorly trained and unmotivated. Many staff members believing

they hold superior knowledge, treat patients inconsiderately.

• Patients are frequently not told the nature and cause of their illness.
• There are inadequate technical services leading to poor quality care.
• The treatment costs too much, even for state run hospitals and clinics.
• Governments spend a large proportion of the Per Capita gross national

product on western health care.

• Treatment is divorced from the patient's culture, family and community.

Patients are removed from the family and community, stripped of their identity and forced into a sterile hospital setting.

• The treatment only addresses a patient's biological manifestation of the

illness and does not attempt to heal spiritual aspects of illness.

(Adapted from Lashari 1984:175 - 177, Ojanuga 1981:407 - 410 and Yangni-Angate 1981:240 - 244)í Debie LeBeau (1998)

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 traditional healers and Western techniques, Dr. T. Adeoze Lambo, a Nigerian psychiatrist, stated, "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."

References

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