Traditional Medicine

Particularly in rural areas in sub-Saharan Africa, traditional healers are the first point of contact for primary healthcare.  Approximately 70% of Ghanaians reside in a rural area where access to biomedical health services is difficult.(1)  Particularly in the northern region, many roads are not passable in the rainy season, inhibiting Ghana Health Service outreach activities and patient access to hospitals. When rainfall is high, several of the districts in northern Ghana, often referred to as “overseas”, can become completely surrounded by Volta Lake, making access to healthcare extremely problematic. (2) Moreover, the number of eye care professionals available in Ghana often fail to meet population needs. In the northern region, with a population of over 2 million, there is only one ophthalmologist and 12 ophthalmic nurses.(3)  While the ratio of medical doctors to population in Ghana is a mere 1: 20 000, the ratio of traditional healers to population is 1: 200. (4),(5)  

In addition, poverty is widespread.(6) Even if individuals in the northern region are able to access eye care, the costs of medical procedures for conditions such as cataracts are high. Although the costs for traditional procedures vary widely, traditional methods of treatment are generally much more affordable than biomedical treatment. For example, while the average cost of cataract surgery in the northern region is 120 Ghana cedis – approximately $80 U.S. – the cost of the traditional procedure, couching (discussed in more detail below), ranges from 2 Ghana cedis to 70 Ghana cedis – $1.30 to $46 U.S. Traditional healers also frequently accept non-monetary items in lieu of financial payment for the couching procedure. A study found that couching was paid for with items such as cloth, kettles, groundnuts, and livestock such as sheep and guinea fowl.  Although health insurance, which covers eye care in northern Ghana, was introduced in 2005, the yearly cost for an adult plan – 15 Ghana cedis, of approximately $10 U.S. – may deter health insurance registration.(7) Other barriers to biomedical cataract surgery include lack of awareness and fear.(8),(9)

Herbal Treatments

There is limited published information about the specific traditional eye medicines or eye care practices used in Ghana in other parts of sub-Saharan Africa. To date, comprehensive investigations aimed at producing inventories of traditional eye medicines and determining those that might be potentially harmful or curative have not been completed. (10) Some authors have suggested that one reason for the lack of literature may be the difficulty in eliciting information from traditional healers on the specific identities of the medicines they use.(11),(12) In Ghana, herbalists have stated that the principle reason why specific herbal treatments are not shared easily is because some of the herbs can be poisonous if administered improperly. Moreover, since traditional healing is a business, some healers consider their herbal knowledge as personal property which they must avoid sharing in order to avoid a loss of status in their community.(13)

One year-long study which was carried out by Ntim-Amponsah and colleagues (2005) in Accra, Ghana alongside a population study on the epidemiology of glaucoma was able to elicit some direct information from healers. The study interviewed 1537 individuals on their use of alternative eye care services as well as 55 herbalists and 21 chemical shop attendants. These healers learnt the practice mostly from family members and to a lesser extent, “direct divine instructions”. The most common eye condition treated was red eye, Apollo (acute haemorrhagic conjunctivitis –AHC). The commonest routes of administration for herbal preparations were direct instillation into the eye, nose, and mouth or combined oral, nasal and ocular administration.

This study was unable to evaluate the accuracy of diagnosis and referral habits, or learn the exact identities of the herbal treatments used. However, the authors noted that most healers make an attempt to classify the eye diseases they treat, although some classifications are largely incorrect in biomedical terms. Moreover, chemical sellers and herbalists dispensed the same preparation for all red eyes despite the varying causes of red eyes. In addition, it was noted that the administration of harmful herbal preparations, which lead to corneal destruction, directly into the eye is problematic as topical administration may account for undesirable effects on the cornea and conjunctiva.(14)

Chilo

One of the most common non-herbal traditional medicines used in the northern region is chilo.
1

Figure 1. A young boy with chilo applied to his eyes. Note the particularly dark line on the bottom lid.

2 

Figure 2. A woman selling chilo at the Gbullung market.

3

Figure 3. Chilo container and application stick purchased in Gbullung.

Chilo, which resembles black eyeliner, is made from a type of black mineral. It is ground and applied like eyeliner to the top and bottom lids of the eye. Chilo is applied for several reasons. First, it is believed to enhance beauty. Second, it is applied for health reasons.  Individuals believe that when applied, chilo allows the eye to be clean and clear from infection. It is often used to treat conjunctivitis; however, in reality, it tends to make the allergy or infection worse. Chilo’s small particles act as a foreign body in the eye, which exacerbates the itchiness and damages the conjunctiva; this often causes corneal scarring. Furthermore, if the infection is bacterial and if the chilo is shared among several individuals, conjunctivitis spreads to many in the community. Additionally, some community members believe that chilo has spiritual power that strengthens the eye and allows the wearer to have a visual acuity beyond the capabilities of a normal human.

Footnotes

(1) Tabi, M.M., Powell, M., Hodnicki, D. “Use of Traditional Healers and Modern Medicine in Ghana.” International Nursing Review. 53 (2006): 52-58.

(2) Ghana Health Service. “Northern region.” Accessed on 12 Nov 2010. <http://www.ghanahealthservice.org/region.php?dd=9&region=Northern Region>

(3) Merabet L.B., Wanye S. “Letter to the Editor, Eye Care in the Developing World: How soon
is now?”Optometry and Vision Science. 85.7 (2008): E608-E610. Accessed on 21 Oct. 2010. < http://journals.lww.com/optvissci/Fulltext/2008/07000/To_the_Editor__Eye_Care_in_the_Developing_World_.20.aspx>

(4) 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>

(5) Tabi, M. & Frimpong, S. “HIV Infection of Women in Developing Countries.”International Nursing Review. 50 (2003): 40-50. Accessed on 20 Oct. 2010. < http://onlinelibrary.wiley.com/doi/10.1046/j.1466-7657.2003.00206.x/full>

(6) Ghana Health Service. “Northern region.” Accessed on 12 Nov 2010. <http://www.ghanahealthservice.org/region.php?dd=9&region=Northern Region>

(7) Merabet L.B., Wanye S. “Letter to the Editor, Eye Care in the Developing World: How soon
is now?”Optometry and Vision Science. 85.7 (2008): E608-E610. Accessed on 21 Oct. 2010.
<http://journals.lww.com/optvissci/Fulltext/2008/07000/To_the_Editor__Eye_Care_in_the_Developing_World_.20.aspx>

(8) Omoti, A.E. “Complications of Traditional Couching in a Nigerian Local Population.” West African Journal of Medicin.. 24.1 (2005): 7-9. Accessed on 19 Oct. 2010.
< http://www.ajol.info/index.php/wajm/article/viewFile/28153/21940>

(9) Ntim-Amponsah, C.T., Amoaku, W.M.K. and Ofusu-Amaah, S. Alternate Eye Care Services in a Ghanaian District. Ghana Medical Journal. 39.1 (2005): 19-23.

(10) Courtright, Paul. (2000). Collaboration with African Traditional Healers for the Prevention of Blindness. New Jersey: World Scientific Publishing.
< http://www.who.int/ncd/vision2020_actionplan/documents/cath.pdf>

(11) 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>

(12) Ntim-Amponsah, C.T., Amoaku, W.M.K. and Ofusu-Amaah, S. Alternate Eye Care Services in a Ghanaian District. Ghana Medical Journal. 39.1 (2005): 19-23.

(13) Ibid.

(14) Ibid.