Old meets new in West Africa’s medicine mix

For many African families, going to a modern healthcare centre does not rule out a visit to a traditional healer or diviner.

Indeed, according to the World Health Organization, most people in the developing world rely mainly on traditional medicine. But, despite their value to communities, the services of traditional healers are largely unrecognised by the formal health sector.

Governments and researchers in several countries have begun to bridge the gap between the two healthcare systems, including using modern science to confirm the effectiveness of ancient remedies. And in some West African countries, where traditional medicine is being integrated into existing health systems, the use of both systems of medicine is actively encouraged.

The Association for the Promotion of Traditional Medicine (PROMETRA), an international non-governmental organisation based in Dakar, Senegal, for example, is dedicated to preserving and restoring African traditional medicine and indigenous science. It conducts research on plants that are effective in treating infectious diseases, including some that relieve the symptoms of HIV/AIDS.  

The Senegalese Ministry of Health is setting up a forum on traditional medicine and pharmaceuticals, which is intended to bring together information about the practitioners and their knowledge into accessible databases and to integrate best practices of indigenous medicine into the public health care system.

However, the training that traditional healers undergo still remains largely outside the formal system. According to a 1991 study by the Centre for Research In Traditional Medicine in Fatick, 93.1 per cent of Senegal’s healers are trained in the use of plants by other healers.

The informality of their training has not stopped traditional healers from running hospitals and clinics. The traditional hospital in Keur Massar, for instance, is located in a quiet village not far from the country’s congested capital, Dakar, and consists of about ten huts, each with one or two beds.

From headaches to miscarriages

Four healers see an average of 20 patients every day — mainly elderly people with rheumatic complaints, but also women seeking treatments for illnesses ranging from headaches to miscarriages. The healers also treat conditions such as asthma and tuberculosis. One elderly man waiting to be seen by a healer claims he was cured of hyperthyroidism here.

The conditions treated, which are listed at the entrance, are as varied as asthma and tuberculosis

The consultation fee is the equivalent of US$2, with the same amount charged for the medicine and a massage. But this is just a guide price — according to tradition, patients can pay their healer according to how satisfied they are with the treatment. Most patients visit the clinic shortly after they receive their salary, indicating that healthcare is a priority even when it is challenging to make ends meet.

Hamady Diew has been practising traditional medicine at the Keur Massar clinic since 1987. He was trained by his uncle, who died in 1998 aged 78, after teaching his nephew only about one-quarter of his knowledge. The memory of this respected teacher is kept alive through a picture of him, which hangs in the main consultation room and pharmacy, along with his purple coat.

"The ham-ham (traditional knowledge) is very useful, but [it] can be also very dangerous," says Diew.

Hamady Diew

The danger, he says, resides not just in the toxicity of the substances used, but also in the spiritual powers invoked. Students therefore have to be selected carefully, from the immediate family. Diew’s uncle chose him over his own three sons; and Diew himself is passing on the knowledge to a nephew and a brother-in-law.

The practitioner and the teacher are responsible for using their knowledge responsibly and ensuring the safety of their patients. Hamady Diew has also offered assistance to university students and even researchers from Belgium, France and the United States who have enquired about his healing methods.

Beneficial and toxic elements

Traditional medicine is also being integrated into the national health plan as a complement to Western medicine in Côte d’Ivoire, where the Ministry of Public Health established a national programme for promotion of traditional medicine in 1995.

One Ivoirian healer helping traditional medicine gain wider acceptance is Axel Avoni Koblan, who began his training in the use of therapeutic plants at the age of ten. Koblan, who holds PhD in philosophy from Cocody University in Abidjan, believes that healers need at least 20 years of training to reliably identify medicinal plants.

This, he says, is because of the close similarity between plant species. Some plants that closely resemble healing plants are actually poisonous. In the case of the ornamental tree Calotropis procera, with its medicinally useful bark but lethal flowers, the same plant has both beneficial and toxic effects.

Koblan describes the oral method of teaching traditional knowledge as "vivid yet logical". For instance, he says, one is taught "to leave early in the morning and to not talk to anyone" in order to gather plants before their active compounds evaporate in the sunlight, rendering them useless.

Medicinal plants are preserved in jars and sachets, then dried and powdered for use internally or externally. Patients are given a dose based on their age and weight, and are also instructed in how to prepare the treatments. For two months, there is no need for them to even meet the healer. Family members can collect their medicines for them instead. However, after two months, patients have to be seen directly to have their status re-evaluated.

In addition to the 200 or so medicinal plants used in Senegal, healers prescribe specific amulets containing various substances to ward off ‘evil spirits’ or ‘mechanical obstructions’.

As an educated professional, Koblan tries to lend scientific validity to traditional methods of diagnosis and treatment. He prepares his medicines in a small laboratory next to his consultation and waiting rooms. In collaborating with modern laboratories he documents the cases he treats and cures. 

The modern laboratories diagnose diseases such as thrombocytic leukaemia and Koblan treats them using herbs and traditional knowledge. Laboratories collaborate with the healers by providing the biochemical analysis used in diagnosing patients and confirming the effectiveness of the cure.

Axel Avoni Koblan

Koblan’s treatments for sterility, diabetes, blood diseases, chlamydia and trichomonas infections, typhoid fever, malaria and even stroke have now been confirmed by rigorous laboratory testing in Abidjan, and he is preparing to submit the results for publication in peer-reviewed journals.

Many healers take a professional approach to their work. Diew, for instance, records his patients’ names, their diseases and prescribed treatment. National healers’ associations in Senegal started certifying traditional practitioners in 2000, and the identity cards bearing the healer’s photograph are valid for ten years.

Mutual validation of the healers’ knowledge

Sakku-Wer, an association with about 100 members, including Diew, meets once a year to share and extend their understanding of healing methods. Most practitioners have aptitudes specific to their region and ethnic group for which they are famous. The healers of Casamance are renowned for curing broken bones, while the Sereres are famous for their ability to avoid the bites of venomous snakes. By meeting and exchanging knowledge of specific skills, healers ensure the continuity and mutual validation of their craft.

Traditional medicine is no longer the first port of call for everyone, but many still seek the services of the healers as well as treatment with Western medicine. Diew says he sends patients to a Western-medicine hospital if he feels that it would be more appropriate. He adds that traditional and modern systems of medicine should be used to complement each other so as to benefit both rural and urban populations.

Koblan, who is committed to bridging the gap between the practitioners of traditional knowledge and the formal medical establishment, shares this sentiment wholeheartedly.

In developing countries such as Senegal and the Ivory Coast, which are open to Western technology but rooted in their own cultural and social values, traditional and modern medical therapies tend to converge. The result is a symbiotic approach, which links the formal relationship between patient and physician with the more spiritual bond between patient and traditional healer.

The health authorities’ increasing acknowledgement of traditional healers is a step towards offering holistic healthcare for everyone.

Mihaela Serbulea is a postdoctoral fellow at the United Nations University’s Institute of Advanced Studies. One of her main research interests is access to safe and effective healthcare. She investigates ways of integrating traditional medicines in the public health systems of developing countries. For more details please click here.