It is helpful to have some understanding of traditional medicine in Africa before delving into the specific context of traditional eye care in Ghana. It is important to note that although it has become commonplace in Africa and in academia to refer to medical practitioners working outside the realm of biomedicine as “traditional healers”, this term is slightly misleading since it suggests a homogenous body of medical thought and practice. In reality, there is extreme diversity in both the theories and practices that are employed within traditional healing. Nevertheless, this module will discuss some of the characteristic features of traditional medicine in the African context.
Healthcare delivery in sub-Saharan Africa is pluralistic, consisting of both traditional and biomedicine. According to the World Health Organization (WHO), 80% of the African population uses some form of traditional medicine for primary healthcare.(1) In fact, people often move back and forth between self-care, clinics, and healers.
This differs from healthcare practices in the North American context, where traditional medicine, or “Natural Health Products”, as it is sometimes termed, is often used by a smaller %age of the population in a complementary fashion to the dominant biomedical health care system (this is sometimes referred to as Complementary and Alternative Medicine). For example, it is estimated that 71% of the Canadian population regularly uses Natural Health Products in this manner. (2)
Traditional medicine consists of health knowledge, skills and practices based on indigenous beliefs and experiences, which use animal, herbal or mineral-based medicines and/or spiritual therapies for the prevention, diagnosis and treatment of physical and mental illnesses and for the general maintenance of well-being. (3) Home remedies and popular knowledge of herbs and other medicinal substances make up a large portion of traditional medicine in Africa.(4) For this reason, many elderly people might be labelled as traditional healers since they possess some common knowledge about how to treat ailments using herbs. However, for more than rudimentary complaints, “real” healers are consulted. In general, traditional healers in Africa often undertake training from another existing healer after experiencing a “divine call”. (5) In Ghana, there are many types of healers who vary in their approach to diagnosis and treatment. The most common type of healer is the priest or priestess of deities and gods. These healers are responsible for curing organic and spiritually-based diseases and often employ healing techniques such as divination and rituals.(6) Sacred or faith healers use prayers, herbal medicine, and incantation. (7) In addition, secular healers or traditional pharmacists prepare and use herbal medicine from specific parts of plants such as selected leaves or roots. Finally, plant drug peddlers are located in most towns and villages; these individuals sell herbal medicines in various locations such as bus stops and street corners.(8) Specialization among healers is common; some healers, like bone setters, focus on specific illnesses and treatments.(9) Both male and females can be healers, although there are normally gender-specific healing roles; in particular, female healers tend to treat primarily women and children and may serve as traditional birth attendants.(10) While some healers practice full time, some pursue healing as a secondary occupation.(11)
With regard to the regulation of the practitioners of traditional medicine, in many countries, governments have developed national policies that include legislation regulating the practice, training and licensing of traditional healers. For example, in 2000, Ghana passed the Traditional Medicine Practice Law, which established a Traditional and Alternative Medicine Council which would be responsible for the registration and licensing of traditional medical practitioners. However, as of 2008, the law has not been implemented. In Ghana, a Bachelor of Science degree in herbal medicine was introduced in 2001. However, because of the lack of proper implementation of legislation regulating the practice of traditional healers in Ghana, official training remains largely absent, and the majority of training is still obtained via informal apprenticeships. Furthermore, in Ghana, a code of traditional medical practice encompassing the terms of professional practice for healers has been produced; it is not yet clear how compliance with the code is being monitored or enforced.(12)
Van der Geest explains the social character of African traditional medicine and its comprehensive theory of health when he states:
"The description and explanation of illness is often phrased in terms of social interaction, in particular between members of one kinship group. The origin of illness, its treatment and prevention is linked to the quality of human relationships. Jealousy, hatred and moral wrong-doing are associated with physical and mental dysphoria. Ancestors and witches are believed to play a crucial role in bringing about illness and other misfortune. Disorder in the community leads to disorder in the health condition of its members. An illness of one family member therefore is seen as an illness of the entire family. Finding a solution to the problem is the responsibility of the group to which the sick person belongs… ‘Health’ cannot be adequately translated in many African languages…‘Well-being’ or even ‘happiness’ seem better English terms to capture the meaning of traditional African medical concepts. As a consequence, the English term ‘medicine’ is also a misnomer… Medicine is any substance that can bring about a change, anywhere, anyhow. Medicines heal a sickness, catch a thief, help someone to pass an exam, make a business prosper, kill an enemy and win someone’s love."(13)
As Van der Geest explains, African traditional medicine differs largely from Western biomedicine in that it entails much more than restoring the processes of the physical body. This medical perspective is more holistic in that it addresses the patient’s physical, mental and social well-being. Diagnosis is made primarily through interpreting the patient’s history rather than through physical examination. Sorcery and witchcraft are commonly proposed disease etiologies.(14)
Social theories of medicine, specifically witchcraft, are present in Ghana. In the study on couching discussed in a later module, sixteen individuals were interviewed about their choice of couching for cataract treatment. To participants believed that their blindness was a result of witches completing spiritual acts that destroyed their eye(s). In particular, one man noted that people use witchcraft when they see someone in the community who is well off. He said: “the people, they just look at someone prospering and it pains them so they will do whatever they can do to tarnish the image of the person”. Another man explained how the juju man (a spiritual leader in the community) can determine when blindness is caused by witchcraft, and how this spirit can be dealt with: "A juju man came and said that someone had caused me to have my eye problem. The juju man used his juju and got something [a spirit] from my house and removed it. He sent it to the chief palace. The juju man said that my enemy came and brought this into the house."
In West Africa, juju refers to the supernatural power ascribed to a fetish – a man-made object which has supernatural power over others. It can also refer to the use of a fetish to carry out witchcraft.(15) As Afi Dzokoto and Adams explain, social representations of illness such as juju are not limited to so-called “traditional” settings such as rural villages. Rather, they are also prominent in urban settings, and other “modern” places.(16) As Jean and John Comaroff argue in their discussion of “occult economies,” these social explanations of illness provide both a means and motivation for illness experience and can be seen as an attempt to assign meaning to seemingly unexplainable misfortune, particularly in instances of economic deprivation.(17)
(2) “About Natural Health Products.” Health Canada. Accessed online on 10 June 2010. http://www.hc-sc.gc.ca/dhp-mps/prodnatur/about-apropos/cons-eng.php.
(3) “General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine.” World Health Organization. Accessed online on 10 March 2011. http://whqlibdoc.who.int/hq/2000/WHO_EDM_TRM_2000.1.pdf
(4) Van der Geest, Sjaak. “Is there a role for traditional medicine in basic health services in Africa? A plea for a community perspective.” Tropical Medicine and International Health, 2.9 (1997): 903-911. Accessed on 11 Nov. 2010. <http://onlinelibrary.wiley.com/doi/10.1046/j.1365-3156.1997.d01-410.x/pdf>
(5) Courtright, Paul. (2000). Collaboration with African Traditional Healers for the Prevention of Blindness. New Jersey: World Scientific Publishing.
(6) Hevi, J. In Ghana, Conflict and Complementarity. The Hastings Center Report, 5–7.
(7) Patterson, L. “2nd Annual Conference on Traditional Medicine in Ghana, Africa.” Accessed on 4 May 2011. <htpp://http://www.ccnh.edu/newsletr/holtimesv8n4/conference.html>
(7) Tabi, M.M., Powell, M., Hodnicki, D. “Use of Traditional Healers and Modern Medicine in Ghana.” International Nursing Review. 53 (2006): 52-58.
(8) Patterson, L. “2nd Annual Conference on Traditional Medicine in Ghana, Africa.” Accessed on 4 May 2011. <htpp://http://www.ccnh.edu/newsletr/holtimesv8n4/conference.html>
(9) Courtright, Paul. (2000). Collaboration with African Traditional Healers for the Prevention of Blindness. New Jersey: World Scientific Publishing.
(10) Patterson, L. “2nd Annual Conference on Traditional Medicine in Ghana, Africa.” Accessed on 4 May 2011. <htpp://http://www.ccnh.edu/newsletr/holtimesv8n4/conference.html>
(11) “Regulating Complementary Medical Practitioners: An International Review.” Anna Dixon, King’s Fund.
(12) Van der Geest, Sjaak. “Is there a role for traditional medicine in basic health services in Africa? A plea for a community perspective.” Tropical Medicine and International Health, 2.9 (1997): 903-911. Accessed on 11 Nov. 2010. < http://onlinelibrary.wiley.com/doi/10.1046/j.1365-3156.1997.d01-410.x/pdf>
(15) Afi Dzokoto, Vivian & Adams, Glen. “Understanding Genital-Shrinking Epidemics in West Africa: Koro, Juju, or Mass Psychogenic Illness?” Culture, Medicine and Psychiatry. 29.1 (2005): 53-78. Accessed on 4 Mar. 2011. < http://www.springerlink.com/content/m344757tr23jkq72/>