Traditional Medicine in Contemporary Ghanaian Society: Practices, Problems, and Future Outlook
∗ By Kimberly N. Foote © Kimberly N. Foote, 1999 ∗
The Akan Studies Institute thanks Kimberly Foote for kindly sharing her research. However, the views expressed herein do not necessarily represent those held by the Akan Studies Institute and are solely those of the author and her research participants. The author retains full copyright privileges to her work.
Acknowledgements Foremost, I thank Ma for her immeasurable support, concern, and encouragement, which has always motivated me to face challenges and excel. I wish to thank Dr.’s Kwadwo and Naana Opoku-Agyemang for providing me with the opportunity to undertake this study in Ghana and for providing me assistance with organizing my ISP ideas. Thanks to Dr. Emmanuel Adow Obeng for his useful advice and guidance with this project. Special thanks to “Mr. Kofi” and Philip Kweku “Anyway” Dadzie for serving as translators where my limited Fante failed me! I express sincere thanks to Dr. Kwame Gyan, the Adu family, and the Wristberg family for opening their homes and hearts to me. To all my sistahs around the globe for their moral support! Finally, I express utmost regards to everyone who agreed to share a piece of their personal lives, work, experiences, and opinions with me to make the bulk of this project a reality. May their work continue to successfully aid in serving the needs of both rural and urban Ghanaians.
Abstract This study was undertaken to explore the strength of the traditional medical system in Ghana. This paper describes the practices of five Ghanaian traditional healers [in the Fante area on the coast] and discusses the extent of their association with the orthodox medical system.1 I was interested in examining the reasons traditional healers opt to cooperate with or shun the orthodox medical system. This paper also explores a Western-trained doctor’s perspectives of the role of traditional medicine in Ghanaian society. Current scientific research into herbal medicine is also discussed. Finally, this paper discusses the importance of the interplay between the traditional and orthodox medical systems to enrich Ghana’s health care system and to serve the needs of all Ghanaians.
1 Editorial note
Introduction The year 2000 quickly approaches, and with it, the prospect that the whole world population will have access to the same quality of health care. Since 1978, the World Health Organization (WHO) has been the forerunner of this vision, which Ghana’s Health Policy has incorporated.2 This vision seems plausible enough, considering the many technical advancements that have been made in the areas of pharmaceutics, biology, chemistry, and general health care in the 1990’s alone. However, in 1999, even in the United States—considered one of the most “developed” countries in the world—there are some U.S. citizens who do not have access to proper, quality health care. Where does this leave the future of health care in so-called “underdeveloped” and “third world” countries like Ghana? A 1988 population survey of Ghana showed that in rural areas—where more than half of the population lived—the proportion of Western-trained doctors to patients was 1:49,892, whereas this ratio was considerably less in urban areas—1:5,609.3 Orthodox-trained practitioners often opt not to work in rural areas because of poor facilities or sometimes leave and work in countries where there exist greater financial rewards for practicing medicine. Even though rural Ghanaians have disproportionate access to Western-based health care compared to urban Ghanaians, a majority of rural Ghanaians still manage to receive health care through indigenous traditional medical systems.
2 E. Evans-Anfom. Traditional Medicine in Ghana: Practice, Problems and Prospects. (Accra: Ghana Publishing Corporation, 1990), 43. 3 P.A. Twumasi. Social Foundations of the Interplay Between Traditional and Modern Medical Systems. Accra: Ghana Universities Press, 1988.
Statement of the ProblemThis study attempts to investigate the efficacy, strength, and scope of Ghana’s traditional medical system in modern-day society and to explore the role it plays in conjunction with the orthodox medical system. For example, what are some practices of traditional healers, and how are they viewed by their patients and by orthodox medical practitioners? How much effort are the Ghanaian government and/or orthodox medical practitioners putting into researching, quantifying, and administering herbal medicines to better serve the needs of both urban and rural Ghanaians? What is the degree of interaction between traditional and orthodox medical practitioners? How are traditional and orthodox medical practitioners interacting to promote a widespread understanding of the scientific importance and medical effectiveness of herbal medicines? This paper will focus on the lives and work of Ghanaian traditional healers in attempt to show the importance and authenticity of their healing. The paper will then discuss how some of these healers cooperate with the orthodox medical system and why others lack trust in the system. This paper will also explore the current perspective that some of Ghana’s medical doctors and researchers have regarding the role and future of traditional medicine in contemporary Ghanaian society. Finally, based on the findings of this study, this paper will attempt to assess the feasibility of incorporating Ghana’s traditional medical system into the orthodox system by the year 2000 to fully serve the needs of all Ghanaians. Literature Review Dr. E. Evans-Anfom in his book Traditional Medicine in Ghana: Practice, Problems and Prospects (1990), provides very a comprehensive analysis of the major
practices, problems, and the future of the traditional medical system in Ghana. In his first chapter, he identifies types of traditional healers, discussing the difference in training and practices of traditional and orthodox medical practitioners, and shows the importance of the traditional medical system in the lives of rural Ghanaians. In his second chapter, he discusses setbacks of the traditional medical system, providing three case studies of patients treated by traditional healers. In his final chapter, he discusses work being done by the Ghanaian government and orthodox medical facilities to improve and regulate the use of phytomedicines4 and to incorporate traditional medicine into mainstream society. Most importantly, he recognizes the importance of including traditional healers into the health care system. P.A. Twumasi, in his Social Foundations of the Interplay Between Traditional and Modern Medical Systems (1988) also explores these subjects and offers many suggestions about training traditional healers and incorporating the study of traditional medicine in medical schools to enrich Ghana’s health care system. Ivan Addae-Mensah, in his Towards a Rational Scientific Basis for Herbal Medicine (1992), and E. Ayitey-Smith, in his Prospects and Scope of Plant Medicine in Health Care (1989), convey that herbal medicine is important because it continues to serve much of Ghanaian society. They discuss scientific research performed on various plants used to treat ailments like malaria, hypertension, diabetes, and schistosomiasis. Ayitey-Smith also advises against premature integration of the traditional medical system into the orthodox system, arguing instead for development of the traditional medical system.
4 Plant medicines.
Methodology Data for this project was collected through secondary sources gathered from the academic and project advisors, interviews, observations, and active participation. Two traditional bone-setters (Vincent Aweh and Yaw Mahama), a TBA (Afua Akyeampomah), and two herbalists (Kewu and an anonymous herbalist) were interviewed to learn about a variety of different ways in which traditional medicine is practiced in Ghana.5 Philip Dadzie served as interpreter for interviews with Kewu and “Mr. Kofi” served as translator for the interview with Mahama. The author also observed the traditional healers at work and to gain a broader perspective of healing. Dr. Akosua Jemmott, an African American doctor living and working in Ghana, was briefly interviewed at one of her workplaces, the Nipa Hia Mmoa Ayaresabea Herbal Clinic in Accra. Dr. Philip Ziama Abu, an orthodox medical doctor working at the University of Cape Coast (UCC) Hospital, was interviewed to understand a Western-trained doctor’s perspective on the role of Ghana's traditional medical system. To gain insight into the extent of current research and interest in phytomedicines in Ghana, the author visited the Noguchi Memorial Institute for Medical Research in Accra and the Centre for Scientific Research into Plant Medicine at Mampong-Akwapim. The author also had the opportunity to attend a session of the 20th African Health Sciences Congress and 20th Anniversary Celebration of the Noguchi Memorial Medical Research Institute where various researchers presented their findings on research into phytomedicines.6
5 See Appendix for all Interview Questions. 6 The conference (theme—“Health Research and Development in Africa: Meeting the Challenges of the Year 2000 and Beyond”) was held in Accra, 19-23d April 1999.
Data Analysis This study analyzed the collected data through description and interpretation of the practices of traditional healers and of the current research into phytomedicines. This method of analysis proved most useful in presenting the information and formulating an examination of the future of traditional medicine in Ghanaian society. Limitations of Study Given time constraints, the author was not able to see each of the traditional healers interacting with patients for an extensive period. This information would have further enriched analysis of the effectiveness and validity of their treatment. It would have also been useful to interview patients receiving treatment at orthodox hospitals to compare beliefs about the quality and effectiveness of their treatment. Also due to time constraints, the author was unable to spend sufficient time at the Centre for Scientific Research into Plant Medicine, the Noguchi Institute, and the Nipa Hia Herbal Clinic for a more comprehensive understanding of the work done at these facilities. Finally, it would have been helpful to record interviews to retain information for future consultation. 5
Chapter 1: An Overview of Traditional Medicine in Ghana 1990 estimates show that two-thirds of the world’s population live in rural settings and rely most on traditional medicine because the orthodox medical system functions predominantly in urban settings.7 This study defines “traditional medicine” on the basis of the WHO (1976) definition as the sum total of all the knowledge and practices, whether explicable or not, used in diagnosis, prevention, and elimination of physical, mental, and social imbalance and relying exclusively on practical experience and observation handed down from generation to generation, whether verbally or in writing.8 Ghanaians do not utilize orthodox medical care extensively for several reasons. Orthodox medical treatment is expensive and often inaccessible to a majority of Ghanaians. Because hospitals and clinics may be located far from a Ghanaian’s place of residency, he or she must be able to pay transportation costs. However, due to underdevelopment in many villages, patients who can afford transportation sometimes find that no access roads lead to hospitals and clinics. Upon arrival at the hospital or clinic, the patient must pay for a consultation fee and any medicine administered. Poor patients may often ask their orthodox medical practitioner to administer only the amount of medicine they can afford, which anyone educated in basic health care realizes is unsafe and inadvisable.9 More rural patients may not be aware of orthodox treatment options and may also be ignorant and thus fearful of orthodox medical treatment that is foreign and unfamiliar. On the other hand, traditional medicine is based in the community, accessible, and relatively
7 E. Evans-Anfom, Ibid., 13. 8 S. Osafo-Mensah. Head, Pharmacology and Toxicology Departments of the Centre for Scientific Research into Plant Medicine. Interview by author, 15 April 1999, Mampong-Akwapim, Ghana, work journal, possession of author. 9 Philip Ziama Abu. General Medical Practitioner at UCC Hospital. Interview by author, 14 April 1999, Cape Coast, Ghana, work journal, possession of author.
affordable. In addition to the above considerations, strong ties to indigenous religion, culture, and traditional medical system play a role in deterring rural Ghanaians’ from accessing orthodox medical treatment. Before the Europeans introduced the orthodox medical system into Africa, indigenous Africans widely practiced and respected traditional medicine. Traditional medicine, linked with traditional religion, is an age-old practice. Early humans relied on religion, superstitions, and taboos as a means to explain seemingly supernatural forces of the unseen world.10 The first healers probably used plant and animal materials in trial-and-error fashion to alleviate ailments from which early humans suffered. Supernatural or spiritual forces were probably linked to these cures because these medicines cured illnesses in unseen and unknown ways. Additionally, because humans were thought to have both natural and supernatural aspects, treatment of ailments relied upon consideration of supernatural causes. It has also been suggested that traditional healers involved the supernatural to protect their secrets and to fill the patient with a sense of awe that a deity has influence in ascribing certain herbs to heal ailments.11 Religion was strongly associated with the social and cultural makeup of African communities before European influence. Thus, Africans initially viewed foreign European concepts of religion—as well as health care—with suspicion. Though the practices of traditional healers vary, there are two main divisions: those who ascribe a supernatural cause to illness and those who do not.12 The WHO
10 E. Evans-Anfom, Ibid., 1. 11 Peter Sarpong. Ghana in Retrospect: Some Aspects of Ghanaian Culture. (Accra: Ghana Publishing Corporation, 1974), 16. 12 E. Evans-Anfom, Ibid., 15.
(1976) defines a “traditional healer” as A person who is recognized by the community in which he lives as competent to provide health care by using vegetable, animal and mineral substances, and certain other methods based on the social, cultural and religious background as well as on the knowledge, attitudes, and beliefs that are prevalent in the community regarding physical, mental, and social well-being, and the causation of disease and disability.13 In general, traditional healers consist of traditional birth attendants (TBAs) or midwives, bone setters, and herbalists, who all learn their trade through apprenticeship. Also considered traditional healers are the okomfo and faith healers, who rely on divination or spiritual guidance to heal.14 As in the orthodox medical system, there are quacks, who claim to practice herbal medicine authentically and are often found in places like the market or tro-tro advertising “wonder drugs.” Despite the many differences in the style of practicing traditional medicine, traditional healers share important common features. They have lived extensively in the community in which they practice and therefore know the religious beliefs and culture of the community. They also provide humanistic consultation with their patients, which is now lacking from the treatment provided by many orthodox medical practitioners. One of the major disadvantages of the traditional medical system concerns the passing of knowledge of traditional medical treatment. Because the traditional medical practitioner, who generally is illiterate, passes the knowledge along orally, information can be lost over time. The illiterate traditional healer also cannot enrich his/her practice by reading about other healing techniques and learning about things such as basic human anatomy and administration of quantified medicinal doses. Another major setback
13 E. Evans-Anfom, Ibid., 12. 14 E. Evans-Anfom, Ibid., 29-30.
concerns the secrecy involved in the passing of this knowledge. Understandably, healers wish to pass the knowledge along to only those people who demonstrate ambition, strong character, and a willingness to learn the trade of healing. Unfortunately, healers sometimes fear competition from an apprentice and may initially teach the apprentice limited information, thus dying with the unspoken information.15 As a result, the apprentice will practice with incomplete knowledge of herbal remedies and with less skill than his/her predecessors. Finally, traditional healers lack the knowledge and equipment to make a proper diagnosis of a patient’s medical condition and tend to treat symptoms instead of the central cause of a disease. The supernatural aspect of traditional treatment seems to deter orthodox medical practitioners’ interest in researching traditional medicine. Some traditional healers, before administering an herbal treatment, might ask their patients to bring an animal to be ritually slaughtered. Some healers may recite magical chants or may perform a spiritual ritual before administering the patient an herbal treatment. Sometimes, the healer may believe that the wrath of another person, a spirit, an ancestor, or a witch can cause the patient’s malady. Typically, the healer gives the patient no rational explanation for performing these spiritual rites. Many orthodox medical practitioners express frustration with this aspect of traditional healing, deeming it unscientific and unnecessary.16 It seems that this may simply be an excuse to deny the value and importance of an unorthodox form of healing in a society that esteems Western-based thinking. Some orthodox practitioners do see the psychological relevance of spiritual diagnosis and treatment, but this treatment does not benefit patients who do not share the religious and cultural beliefs
15 E. Evans-Anfom, Ibid., 32-33.
of the healer.17 Whatever the reasons for lack of orthodox interest in traditional medicine, however, retard the progress and development of the traditional medical system. It also allows room for non-Africans to come again into Africa, “discover” something that is not theirs, monopolize it, and profit solely from it. Despite hindrances faced when interacting with traditional healers, some African researchers have persisted in trying to work with them to learn more about phytomedicines. Fortunately, many traditional healers are beginning to reveal their knowledge of herbs—even if only to a certain extent—which helps to expand upon researchers’ knowledge of phytomedicines. Chapter 2: Sharing Family Secrets: Cooperative Traditional Healers The interchange of information between traditional healers and orthodox medical
16 Philip Ziama Abu. Ibid. 17 Dr. Nii Ayi Ankrah, Clinical Chemist for the Noguchi Memorial Institute for Medical Research. Interview by author, 22 April 1999, Accra, Ghana, work journal, possession of author.
practitioners is essential to scientific research into phytomedicines, considering that many of these healers apparently provide effective treatment. Besides sharing their knowledge of herbs with outsiders, some of these healers have even begun to work in conjunction with the orthodox medical system. The traditional bone setter Yaw Mahama, for example, has not spent years in medical school; in fact, many traditional healers have received little or no formal, Western education. Yet, currently in Ghana, some orthodox practitioners refer their orthopedics patients to him! Both he and the traditional bone setter Vincent Aweh also refer their patients to orthodox hospitals for treatment. Similarly, the TBA Afua Akyeampomah has received little formal education but is noted in her local area for her skill as a birth attendant. She was also the first in her area to complete a government-sponsored training program in hygienic practices. These three traditional healers are sharing their knowledge of herbs, long kept in their families, with outsiders and are cooperating with the orthodox medical system. This chapter will describe the practices and ethics used by these traditional healers and discuss the degrees of interaction they have with the orthodox medical system. Yaw Mahama Located halfway between Moseaso and Anyinam in Ghana’s Eastern Region, Yaw Mahama lives with his elderly mother and his children, whom he currently sends to school.18 Raised in the area, he has been setting bones using herbal preparations for over 37 years. Mahama, a Moslem, has received no formal education, but the art of setting bones has always existed in his family, for as long as he can remember. He alluded that long ago during a war, members of his family possessed the ability to rejoin broken battle
18 See Appendix, Illus. 1 [this illustration is not included in this version].
sticks and could heal bones in the same manner. His mother taught him the trade of setting bones, and he currently teaches the trade to his children while practicing independently. Renown in the area for the quality of his meticulous work, he sometimes sees over ten patients each week, who come from all over Ghana and even foreign countries to see him.19 He advises that injured patients come as soon as possible for his treatment so that he can realign the bone with relative ease. Patients arrive to Mahama’s compound and explain their symptoms to him or to one of his children apprenticing in bone setting. He will then touch the affected area to determine the actual site of injury.20 He then packs an herbal preparation onto the affected area, places a certain wood around it, and ties the wood in place to support the bone as it heals. When a bone breaks out of the skin, Mahama places the bone back inside the skin and realigns it, following these same procedures. When a patient crushes a bone, Mahama explained that he begins the meticulous process of removing the bits of bone and placing them back into their proper place. Using the bark of a certain tree, he presses it each day to the injured bone to heal the bone and skin. Mahama believes every bone contains “juices,” which, when a bone breaks, pump out to cover and seal the break.21 The special tree bark apparently speeds this process. He also uses a special massage for aching bones and administers herbal enemas for lower back pain.22 Mahama also treats new-born babies whose skulls have been crushed by the mother’s narrow pelvis during delivery or by a fall from the mother. Mahama treats only humans; however, at least three people in the local area
19 Yaw Mahama. Traditional bone setter. Interview by author, 10 April 1999, Moseaso/Anyinam area, Ghana, work journal, possession of author. 20 Yaw Mahama. Ibid. 21 Yaw Mahama. Ibid.
attested to a claim he makes when patients feel skeptical about the effectiveness of his work. He will break a chicken’s wing and apply his herbal medicine to both the chicken and the patient, asserting that both the chicken’s and the patient’s bones shall be healed in fifteen days. If, after fifteen days, the injury has not fully healed, Mahama suspects an evil spirit may be associated with causing the injury. He admitted that, in this case, he could still probably treat the patient using his herbal medicine. Other people in the area also referred to a young Ghanaian soldier who, while on assignment in Lebanon, received a serious bone fracture.23 The young man consulted some of the best orthopedics hospitals in Europe, but despite the technologically advanced equipment and knowledge of European, Western-trained medical doctors, they could not properly treat the soldier. After being sent to Mahama, the soldier’s crushed bone healed properly. Because Mahama believes some injuries have a supernatural basis, there is the possibility that this belief served as a “placebo effect” in expediting this particular patient’s treatment. Upon the author’s arrival to Mahama’s compound, two patients sat waiting on a bench outside the main building. Mahama, treating the arm of one of a middle-aged man, fully wrapped the upper arm with a piece of cardboard about six inches long. After Mahama used a tie to hold the cardboard in place, the patient tied a bandanna around his forearm and neck to make a sling. The second patient, a middle-aged woman, had injured her left shoulder in a tro-tro accident. A small gauze bandage was visible on her bare shoulder, the skin of which was discolored a shade of black. Mahama’s daughter, a young girl around 17 years old who assists treating patients, took the woman’s arm gently and began to raise it and stretch it out in all directions. During this treatment, the woman
22 See Appendix, Illus. 2 [this illustration is not included in this version].
screwed her face and whimpered in pain, but with a straight face and a firm grip, Mahama’s daughter continued her work unabated. A young boy around eight years old with an injured right arm arrived shortly afterwards. His family had waited a long time to have Mahama treat his arm. Mahama’s daughter, wrapping both of her hands around the boy’s thin, wiry arm, began to twist her hands in quick, firm movements up and down his arm. She continued to work diligently as the boy shrieked loudly, twisted his body across the bench in agony, and began to wail. The adults sitting around the boy began to smile and laugh knowingly, seemingly telling him that the pain would soon end. Mahama explained that the boy’s treatment was especially painful because the time that had elapsed between the initial injury and first treatment had caused the complication to become much more serious. After the massage, the young boy stood, his injured arm dangling at his side as he angrily swiped at his tears and gasped for breath. Mahama does not administer medication to assuage the pain during treatment but wishes medical doctors could collaborate with him to administer drugs like painkillers to his patients.24 This idea does not appear far-fetched, considering that Mahama says that Korle-Bu Teaching Hospital in Accra brought him to their facility to set bones there. In addition, both Mahama and some people present at his compound affirmed that orthodox medical doctors occasionally refer some of their orthopedics patients to him! Despite Korle-Bu’s request to have Mahama remain with its hospital staff, Mahama said he refused, feeling he would better serve the needs of his patients by practicing in his indigenous area. Respecting his wishes to remain in his local area, the Ghanaian government instead wishes to start a formal clinic where Mahama sets bones to make his
23 Yaw Mahama. Ibid.
work environment more hygienic and to house patients needing extended treatment.25 Mahama welcomes this support, feeling it would greatly aid his work by bringing him more patients and allowing them to have a comfortable place to stay, especially for those patients with critical injuries.26 He stressed that this refurbishing is solely for the benefit and comfort of his patients. Wishing not to profit from his work, he also charges a mere ¢300 for the initial treatment, and ¢400 after the patient is fully cured. Though the fee is relatively minute—less than US$1.00—some patients still cannot or do not pay. Mahama, dedicated to performing his work, which he feels is a gift from Allah, says he does not refuse a patient unable to pay, and would continue to treat someone who may not be able to pay him. “It’s not that I don’t like money,” he admitted, “but medicines have their own laws. In this world, there are things which are important and precious…charging too much will dull the power of the medicine with greed.”27 He continued to say that healers who use their knowledge of herbs to profit personally from treating patients only lessen the effectiveness of their medicine. Unlike orthodox medical doctors, Mahama’s work is not governed by the Hippocratic Oath, but his own personal ethics are very similar to the Oath. The practice of orthodox medical doctors today is ruled so much by strict laws and insurance policies that it is difficult for them to practice according to the Oath. Yet, Mahama has no obligation to follow this Oath, and still practices with high moral standards and values. Mahama may have received no formal, Western education, but many orthodox doctors could learn from him—not only his bone-setting techniques but
24 Yaw Mahama. Ibid. 25 See Appendix, Illus. 3. 26 See Appendix, Illus. 4. 27 Yaw Mahama. Ibid.
also his concern for his patients and his practice. He is a “doctor” in the true sense, more so than some people who have gone through the six or more years of medical schooling to receive a degree. Vincent Aweh Vincent Aweh, a traditional bone setter of Adisadel Village, Cape Coast, in Ghana’s Central Region, also shares a similar view of the meaning of “doctor.” 28 Starting at thirteen years old, Aweh, a Roman Catholic born and raised in Nandomtom in Ghana’s Upper West Region, has been treating bones for over thirty years. His grandfather, who knew how to set bones with massage and herbs, taught the skill to Aweh’s father, who in turn taught it to him because he expressed interest in learning it. He stressed learning the skill from practical experience rather than through books. Aweh calls himself a doctor, even though he worked on his family’s farm when he was young, never receiving formal education.29 Because Aweh was the last-born of six children, his brothers already provided enough help on the family farm when Aweh reached working age. Therefore, he, along with others in his situation, had to find work where jobs were available to earn extra money for the family. During the 1960’s, Aweh migrated back and forth between his hometown and southern Ghana to work, finally settling in Cape Coast in 1972 to work at the UCC Sanitary Section. Upon his first arrival to Cape Coast, he treated very few patients, but after successful treatment, patients spread news of his ability to heal bones. He visits his patients who are too injured to walk to his home for treatment. His patients come mainly from the local Cape Coast area, such as from town, Abura, 3d Ridge, and 4th Ridge. Aweh currently lives with a family of his own, teaching the trade of
28 Vincent Aweh. Traditional bone setter, April 1999, Adisadel Village, Cape Coast, Ghana.
setting bones to his thirteen-year-old son Steven, who has also taken interest. Aweh treats many different bone injuries, but unlike Mahama—who may use massage, herbal ointments, or maybe even herbal enemas—Aweh’s methods of treatment are generally consistent. He uses a combination of massage and kyowete, a brown-colored ointment made of powdered herbs mixed with shea butter, or shea butter alone when the herbs to mix kyowete are unavailable.30 He first inquires about when his patient’s injury occurred and asks the patient to describe the symptoms. He informs the patient that his treatment will hurt, but explained that if the massage is particularly painful, the patient may request that he pause, or he may give the patient a glass of water to drink. Using the his thumbs, Aweh firmly presses hardened fingers into the area of the suspected injury and the surrounding area. He must also clip his fingernails short to avoid scratching or poking the patient. During the initial massage, the patient will wince or cry out most when he presses the injured area. Aweh smoothes on the kyowete or shea butter in three strokes lengthwise around the injured area, smears it crosswise, and covers it with his hand to pray silently: God Jesus, you, who touch the blind people and they see, the leper and they feel, the deaf and they hear…you have risen from the dead, so now I ask you to send the Holy Spirit to my hands on which I touch this person to cure this sickness, in the name of God. Amen.31He then warns the patient not to touch his hands as he begins the massage, since his grandfather told him that this would dull the power of the medicine.32 He massages with constant pressure to spread the blood that has formed in the partition created by a dislocated or broken bone. Because of the painful treatment process, Aweh advises that
29 Vincent Aweh. Ibid. 30 Vincent Aweh’s family and friends in Nandomtom periodically send him the herbs from the Upper West area to prepare kyowete. 31 Vincent Aweh. Ibid. 18 April 1999.
the doctor using this technique must have “hardened” hands and “strong eyes,” and should not look into the patient’s eyes to avoid feeling remorse about causing the patient pain.33 After massaging, Aweh rotates the patient’s foot or hand for an injured ankle or wrist, or he pushes and pulls the limb to set the bone back in its proper place. He may hear a small popping sound as the bone slides back into its proper partition. For a broken bone, Aweh may sprinkle cold water on the affected area and pack mud on this area to reduce inflammation. He will then apply two narrow pieces of wood on either side of the injured bone and wrap the wood with a rope, string, or cloth to prevent the bone from shifting while it heals. For a dislocation, Aweh may wrap a block of ice in a piece of cloth and slowly but firmly rub the ice across the injured area to spread the blood. He may also advise the patient to apply ice to the injury at home. The patient drops Aweh’s ¢2,000 in payment on the ground since “the medicine came from the ground,” he explained, and he collects the money and lightly taps the massaged area, silently saying, “Go in peace.”34 The patient may return daily or over the next few days to continue the same treatment. When not at his regular job at UCC, Aweh treats a variety of bone injuries in the mornings and evenings when the weather is coolest. A broken bone may take up to two weeks to heal, whereas a dislocated bone may only require a two- to three-day healing period. Young children heal much quicker than older men and women, since young people have a “hole” in the center of the bone, which helps in the healing process, Aweh explained.35 It was gathered that he was describing the characteristics of bone marrow.
32 Vincent Aweh. Ibid. 14 April 1999. 33 Vincent Aweh. Ibid. 14 April 1999. 34 Vincent Aweh. Ibid. 15 April 1999. 35 Vincent Aweh. Ibid. 14 April 1999.
For a dislocated shoulder, Aweh must first press very hard into the shoulder to discover the area of injury. He raises the patient’s arm up and towards the back, and brings the hand down to touch the side of the face. The arm is then pulled upward, dropped, and swung back and forth. For injuries to the ribs, he must press the suspected injured area to determine the affected ribs. The area is massaged for two to three days. Aweh mentioned that breaks to the ankle and wrist are most difficult to treat since these areas contain several tiny bones. For an injury to the finger or toe, Aweh massages, rotates, pushes, and pulls the digit. For a neck injury, the patient sits as Aweh very lightly massages the neck to loosen stiff muscles. He then slowly rotates the patient’s head side to side and, grasping the chin and the back of the head, pulls the head upwards a few times. For an injury to the hipbone, the patient must stand and bend slightly forward, resting his/her arms on something supportive. He presses in the side of each hipbone and then presses the back side of each hip bone. When someone receives a blow to a bone in general, blood rushes to the surface of the bone, so Aweh must massage the area first with the ointment and later with ice to spread the blood. When a patient develops a knot from a blow to the head, Aweh places one hand at the back of the head for support and uses the bottom of a calabash to forcibly and rapidly press the affected area to spread the accumulated blood beneath the swelling. Like Mahama, Aweh does not treat bones to earn money for himself. “The work is not from me but from God,” he said with a smile, “…God gives me my daily bread because of the work I do.”36 Aweh attends to wealthy and poor patients alike—though few of his patients are wealthy—and will accept whatever payments his patients can
36 Vincent Aweh. Ibid. 15 April 1999.
afford to give him. Like Mahama, he believes that the medicine could not work if he were to charge a high price to a patient who could not afford it. Aweh explained that he therefore does not demand the ¢2,000 of his patients, and he sends all the money he earns from treating bones to the elders of his hometown. The money is used to get more medicine and is equally distributed amongst all the families in Nandomtom for their end-of-year celebrations.37 Like Mahama, Aweh also stressed that God gives the gift of healing so people can help one another, especially to help those who are sick and in need. Aweh was observed treating three patients, one of whom the author herself attempted to treat! The first two patients, young men on their second or third treatment for dislocated bones, arrived together one evening outside Aweh’s kitchen. Aweh and the first patient, who had dislocated his left wrist, both sat on small stools. Aweh pressed his fingers around the wrist area as the young man winced, applied only shea butter since he did not have enough kyowete to use, and prayed. Biting his lip, Aweh began to rub the patient’s wrist hard, the whole time keeping his eyes focused on the patient’s wrist as the patient squirmed. After the massage, he twisted the patient’s hand in all directions, pulled it, and tapped it, saying, “Go in peace.” The patient dropped a ¢2,000 note on the ground in between them. The second patient had dislocated his right ankle and could not walk during his first treatment with Aweh.38 As the patient limped slightly over to the stool, Aweh dragged another stool near him and asked the author to participate. Following the same procedures demonstrated by Aweh, the author attempted the massage, her fingers becoming slack as the patient squirmed in pain. Aweh occasionally interrupted to suggest
37 Vincent Aweh, Ibid. 15 April 1999.
maintaining a firm pressure on the injured area, though most of the procedure was completed to Aweh’s relative satisfaction. On successive visits to Adisadel Village, this patient always greeted the author amicably, pointing to his ankle, and demonstrating how easily he could walk around only a few days after treatment. The final patient, a plump woman around 35 years old, had initially visited the hospital for her injured right ankle about four days before her second treatment with Aweh. He walked to her home to treat her since her injury had rendered her unable to walk. She sat on a small stool outside in front of her house, surrounded by family members who witnessed the treatment. Aweh, sitting on a small stool, spread three swipes of shea butter on her slightly swollen ankle, prayed, and began to massage while biting his lip. Though the woman screamed almost immediately, Aweh dutifully avoided looking into her eyes. Three times during treatment, she reached to move his hands off her ankle, and he jerked his hands away each time, shaking his head and murmuring, “Umm-umm.”39 After the massage, he slowly rotated her foot in small movements and tapped it. Aweh then slowly pressed a block of ice, wrapped in cloth, around the woman’s ankle and foot, noting that she screamed most when the ice touched an area on the right side of her foot. After treatment, she breathed heavily and wiped her eyes, which were wet with tears. Aweh spoke to her family in Fante, telling them to mix a paste of ground ginger and water, spread it on her ankle and foot, and wrap a cloth around it. He later mentioned in privacy that perhaps due to the woman’s weight, excess water had collected in the affected ankle and foot, and the ginger would help dry the water and reduce the swelling in two day’s time.
38 Vincent Aweh, Ibid. 15 April 1999.
Like this woman, some of Aweh’s patients have initially received unsatisfactory hospital treatment, but upon hearing about the quality of Aweh’s work from his former patients, people often go to him for secondary treatment. Occasionally, for very critical or complex injuries, such as a crushed bone, a seriously fractured wrist or ankle, or a broken forearm Aweh recommends that the patient receive treatment at an orthodox hospital, “so you don’t waste the person’s time and so the injury can be treated in good time.”40 He cooperates with the orthodox medical system when necessary for the benefit of his patient’s health and recognizes that the work of the orthodox medical system sometimes exceeds his work. Unlike the orthodox hospital, Aweh does not use painkillers, and admitted that he would not use them because he does not have the proper training to administer them. Despite the painful treatment, patients continue to come to him, which reveals much about their belief in his ability. Due to financial considerations, Aweh regrets that he does not yet have a license for practicing traditional medicine. Without a license, Aweh cannot house patients at his residency for treatment and is liable for any damages the patients receive as a result of his treatment. However, patients faithfully continue to arrive to him for treatment. Though Aweh has received no offers to work with orthodox medical practitioners, he expresses willingness to teach his trade to others. He also recognizes the importance of keeping his patients’ information confidential. His family has begun to teach the trade to people other than family because these people’s villages did not have bone setters. Though Aweh considers bone setting a gift from God, he mentioned that in the days before Christianity was introduced to his people, the bone setters would heal in the name 39 Vincent Aweh. Ibid. 18 April 1999.
of their grandfathers—their teachers—or perhaps their ancestors. Though he could not identify how these grandfathers learned, he said that they did not learn the use of herbs through a juju or okomfo.41Afua Akyeampomah In the small town of Moseaso in Ghana’s Eastern Region, resides another traditional healer recognized in the local area for her skill and for her cooperation with the orthodox medical system. Afua Akyeampomah, an elderly TBA, considers herself the top TBA in her local area.42 She learned her trade by assisting her mother, a TBA, whose own mother taught her how to deliver babies. Akyeampomah’s mother learned the use of herbs through her uncle, an herbalist who would administer herbs to her mother and to other women experiencing various pregnancy-related ailments.43 Though this knowledge is generally kept in the family, Akyeampomah admitted that she cannot teach her younger sister because this sister now has ill health. She instead currently teaches the trade to a willing and capable woman in the area. She explained that to be a TBA, one must have a virtuous character to keep the patient’s information confidential and must have a brave heart because the work may involve the death of the mother or infant. She charges a meager ¢5,000 for her treatment, but like Mahama and Aweh, she does not wish to profit from her work, since she believes God guides her. Besides delivering babies, she provides pre- and post-natal care, advises pregnant women, and uses herbal medicines to treat pregnancy-associated complications. Women may come to her for a number of complications. Generally, when pregnant women seek
40 Vincent Aweh. Ibid. 16 April 1999. 41 Vincent Aweh. Ibid. 18 April 1999. 42 See Appendix, Illus. 5 [this illustration is not included in this version]. 43 Afua Akyeampomah. Traditional Birth Attendant. Interview by author, 10 April 1999, Moseaso, Ghana,
prenatal care, she prepares an herbal soup to be consumed once each week until delivery time. She also examines the patient’s eyes, feet (for swelling), checks for fever, and advises her to eat a well-balanced meal incorporating foods like vegetables, groundnut, pineapple, banana, pawpaw, eggs, snails, and crab into her diet. Akyeampomah can also administer an herbal enema to barren women to help them conceive. For women who miscarriage often, she offers herbs to be mixed into palm nut stew and eaten. For pregnant women who experience severe breast pain, she can give herbs that soothe the pain. For excess bleeding during delivery, she administers a mixture of a certain herb, charcoal, and ginger lukewarm water. To treat delivery-associated fevers and cramps, she steeps certain herbs and asia tree bark in a pot. This preparation makes the patient urinate constantly, which she says relives the fever and cramps. To help bring forth the afterbirth, she gives the patient milk to drink. As a certificate holder of the National Traditional Birth Attendants Programme (28 February 1992) and the Eastern Region Ministry of Health Primary Care Programme (two-week training in midwifery), Akyeampomah actively works in conjunction with Ghana’s orthodox medical system. She admitted that she knew much about delivery and the treatment of pregnancy complications before her participation in the government-sponsored training programs. However, she learned hygienic techniques, learned when to send her patients to the hospital for treatment, and began a log of patients in her care. She was given a hygienic kit containing items like a scrub-brush, bowls, and a towel to wash her hands thoroughly before delivery, and cotton to wash the new-born baby’s face and to disinfect the patient’s vagina. She showed a small jar containing a string soaked in
work journal, possession of author.
disinfectant, for cutting the baby’s umbilical cord. She also showed a small plastic hospital bowl used to collect the placenta, but admitted with a smile that she does not use this because, from her experience, it is too small to contain the placenta. For the safety of her patients’ health, the government has put certain restrictions and regulations on the treatment she can administer. She first sends her patient to a medical officer to determine how many months the patient is into the pregnancy. She will not deliver babies for women having a first child, or who are hunchbacked, bleed easily, or have asthma, vericose veins, or severe cough. She will also send a patient to the hospital if the labor lasts longer than a day. The Ministry of Health has given her referral notes for this purpose, but she admitted that she has not had to refer anyone. She showed a log beginning 8 March 1992 and ending 8 May 1997 and listing columns for the patient’s address, parent’s and baby’s names, the baby’s date of birth and sex, and whether the baby was born still or alive. She had delivered several babies in the five-year period, and each had been born alive. The practices of Akyeampomah, Mahama, and Aweh are essentially like those expected in the orthodox medical system. Each employs some form of consultation and follow-up treatment and highly abide by doctor-patient confidentiality. They each follow an ethical system of treatment and express a willingness to treat anyone in need. Aweh’s and Mahama’s patients undergo physically painful treatment and yet were observed to return for follow-up treatment. Akyeampomah’s log evidences the many babies she has successfully delivered over the past few years. Some patients who frequent these healers face stigmatization, considering that the Western world views their type of healing as primitive and inadequate. Yet, patients continue to seek their treatment, and their
popularity attests to the quality of their treatment and the necessity of their practices in the lives of many Ghanaians. The three healers have also recognized the necessity of involving themselves in the orthodox medical system. Though the practice of traditional healing has remained in their families for ages, they have begun to pass information to outsiders. Through their cooperation with governmental regulations, they have slightly altered their practices by either using hygienic methods or referring their patients to orthodox hospitals for treatment. Mahama has worked in an orthodox hospital and expresses willingness to have a formal clinic built by his workplace. Akyeampomah has completed training programs, and Aweh plans to attain a practicing license to better serve his patients. Aweh and Akyeampomah also recognize that they must sometimes refer their patients to orthodox hospitals, and have begun to share some of their family secrets of traditional healing with people outside their families, including the author. These may seem like a small degree of interaction with the orthodox medical system, though, however little, this is a first step in building bridges between traditional and orthodox medical practitioners and is also necessary for the survival and development of the traditional medical system. Chapter 3: Guarding Secrets: Suspicion of the Orthodox Medical System In Ghana, some traditional healers currently regard the involvement of the orthodox medical system into traditional medicine with suspicion. These traditional healers continue to practice independently and hesitate to share their knowledge of herbs
with outsiders, despite offers to work with the orthodox medical system. Some of these healers are merely quacks who refuse to share information that they know is faulty. However, other healers are authentic practitioners with understandable reasons. Some may strongly adhere to the tradition of passing the knowledge in the family and may refuse to share the knowledge with outsiders and some fear exploitation of their knowledge and talents. Kewu and a healer (anonymous) are two such traditional herbalists who express hesitation about involving themselves with the orthodox medical system. After briefly describing their practices, this chapter will investigate some reasons for this hesitation. KewuIn the Pedu/Abura area of Cape Coast resides a feisty 76-year-old herbalist known by the nickname Kewu.44 Originally from Ekumfi-Atua, Mankesim, in the Central Region, he has never received formal education but claims to have practiced as an herbalist for a long time. At a young age, he learned the use of herbs from his grandfather, who practiced as an herbalist and spiritualist. His mother also knew the uses of herbs for female disorders. As a Methodist, he believes that God plays an important role in his life and in his healing. He first consults God before going to find plants for treatment and before administering treatment.45 He was observed collecting some of herbs from the Pedu area and showed the author where he mixes his preparations in Pedu. Kewu feels that other Christians view his work positively, because he saves lives. The bulk of Kewu’s clients comes from the Cape Coast area, and he sometimes sells his preparations in the market in Cape Coast and Takoradi.
44 See Appendix, Illus. 6 [this illustration is not included in this version].
He distinguishes himself from the okomfo in that he feels the okomfo diagnose more by spiritual means and sometimes must consult herbalists like himself to know the proper herbs to use. He uses herbal preparations to treat conditions like high blood pressure, asthma, menstrual cramps, pregnancy-related complications, headaches, ulcers and other stomach disorders, jaundice, and malaria. Despite the distinction he makes between himself and okomfo, he believes that some illnesses have spiritual causes, and must even sometimes refer such serious cases to okomfo for treatment. Generally, after his initial treatment fails, Kewu suspects that there may be a spiritual dimension to the ailment. He also believes that evil spirits sometimes cause the disease known as eser-akyow (“the skies above have caught you”), characterized by a vast accumulation of phlegm and stiff joints.46 He mentioned that he once treated a young boy suffering from this ailment by cutting the boy’s cheek and applying charred herbs to the cut. Sometimes, he revealed, the disease is caused by the patient’s past wrongdoing, and Kewu asks this patient for a confession. He claims that upon confession, the patient’s health improves. A psychologist might consider such an ailment a psychosomatic disorder, in which the patient’s worrying, for example, may manifest itself into physical symptoms. Psychotherapy, one Western-based treatment for this disorder, might determine, for example, that a patient with this disorder harbors feelings of guilt toward another person, which brings on seemingly unexplainable physical symptoms. Unfortunately, it would be difficult for Kewu and orthodox medical practitioners to communicate and realize such similarities in their practices, because Kewu displays a general lack of trust of the orthodox medical system. He mentioned that orthodox doctors
45 Kewu. Herbalist. Interview by author, 19 April 1999, Pedu/Abura area, Cape Coast, Ghana, work
have approached him and asked him to reveal the herbs he uses to treat certain disorders. He refused each time, saying that he feels these doctors would take the information, and not share their profits with him. When asked how he knows these doctors would do this, he replied that he is wise enough to know their mentality, but that he would agree to work with them if they wanted to share the profit. Kewu also does not highly esteem the work of orthodox medical practitioners. Generally, he feels they do not have the proper training to treat diseases efficiently. He considers parts of their diagnosis, such as taking the patient’s temperature, a waste of time, and feels that he can diagnose a disorder right away from a description of symptoms or from observing the patient. Their inability to provide quick diagnosis and treatment, he believes, leads to unnecessary loss of lives. Though some of his claims may be justified, his criticism may stem largely from a misunderstanding of orthodox medical practitioners’ motives and practices. The Nipa Hia Mmoa Ayaresabea Herbal Clinic Similarly, herbalist at the Nipa Hia Mmoa Ayaresabea (“humans need help healing place”) Herbal Clinic in Accra also intends to keep the secrets of his herbal cures well guarded. A member of the Traditional Medical Practitioners Council, he finds the proper herbal treatments to use through dreams, and treatment with herbs has existed in his family. Though he has received college education, he has no medical degree but still considers himself a doctor because he uses his own medicines to heal.47 Since its opening in 1985, the Clinic has provided pediatric and pre-natal care and has treated afflictions like diabetes, hypertension, and sickle cell. Patients, who come not just from Ghana but
journal, possession of author. 46 Kewu. Ibid. 19 April 1999. 47 Akosua Jemmott. Naturopathic Physician for the Nipa Hia Mmoa Ayaresabea Herbal Clinic. Interview by author, 25 April 1999, Accra, Ghana, work journal, possession of author.
from Nigeria, Togo, Benin, and even the UK and U.S., are charged ¢5,000 for a registration card and ¢8,000 for consultation and medicine. Dr. Akosua Jemmott, an African-American now living in Ghana, assists the herbalist at the Clinic diagnosing patients and arranging for outside laboratory tests. Dr. Jemmott, initially educated as a Registered Nurse in New Jersey, practiced as a midwife before eventually training in Washington to become a naturopathic physician. She explained that she became interested in herbal medicine because of her disenchantment with the bureaucracy of the Western medical system, and because of the toxicity of and high cost of synthesized Western drugs. Her interest also stemmed from her childhood in America, where she witnessed an older generation of southern-raised African Americans who had knowledge of herbs to treat certain ailments. Dr. Jemmott now assists at the Clinic and also works at the Mampong-Akwapim Centre’s clinic once each week. She is currently trying to form her own clinic and is interested most in prevention of disease by using curative herbs in food and by using food as medicine to keep the body in homeostatic balance. The Clinic herbalist claims that God guides his treatment. According to Jemmott, each morning he prays with the patients, making them aware that he is only a vessel through which the almighty Onyame heals them. He also feels he cannot teach anyone and that God must give even Dr. Jemmott the gift of healing.48 However, he wishes to open a training institution where orthodox and traditional medical practitioners can work together to give patients access to the best possible treatment. Dr. Jemmot said that he feels highly suspicious of government interference, citing
48 Dr. Jemmot believes that some of his knowledge may have come from some kind of training.
the example of a Ghanaian herbalist who was murdered recently, apparently for his knowledge of an herbal cure for AIDS.49 He allows the assistance of Dr. Jemmott but is still cautious about the information he reveals to her. Because of the Clinic’s high reputation for its effective treatment, the media and orthodox medical institutions in Ghana have implored the Clinic herbalist to share his knowledge.50 This inability for this herbalist and the orthodox medical system to collaborate is unfortunate, considering that the Clinic, which does not advertise its services, has limited space and assistance to treat the 200 to 250 patients who continue to arrive each day for treatment. On a Sunday morning, approximately 130 prenatal patients were observed waiting in a small, hot waiting room, and many of them had arrived at 4:00am when the Clinic opens. The independent, secretive practices of traditional healers like Kewu and the Clinic herbalist make it difficult for scientists to research into phytomedicines. It would be essential to include the knowledge of the Clinic herbalist, since his reputation for providing quality treatment is attested by the many patients who arrive daily and wait long hours for his treatment. The effectiveness of Kewu’s treatment is debatable since none of his patients were available for consultation. Chapter 4: A Western Approach to Traditional Medicine While some traditional healers do not associate with the orthodox medical system due to suspicion, some orthodox medical practitioners tend to disregard or renounce traditional medicine because they feel it is primitive and unscientific. This widens gaps between traditional and orthodox medical practitioners, allows for them to misunderstand
49 Dr. Akosua Jemmott. Ibid.
and make generalizations about each other. It hinders the exchange of information between both groups. Dr. Abu, a Western-trained medical practitioner, has provided useful insight on how orthodox medical doctors view traditional medicine and its future role. The current scientific research into phytomedicines also shows advancements made in improving upon the practice of traditional healers by making herbal medicines safe for use. A Western-trained Doctor’s Perspective Dr. Abu, trained for seven years in the Soviet Union to become a medical practitioner, currently works at the UCC Hospital out-patients' department. He admits that his interest in becoming a doctor stemmed from his childhood, when he admired the work of orthodox doctors, who seemed immortal because they were able to treat illnesses. Though Abu grew up in a village where traditional healers practiced widely, he says his belief in their ability began to change when he reached secondary school. When receiving Western education in science, he became suspicious of traditional healers, especially the superstitious aspect of their healing. He also mentioned that in the past, people did not take other people’s money because greed was low but that “today, everyone wants money…a majority of [people proclaiming to have “wonder-drugs”] are crooks.”51 He admitted, however, that the traditional medical system is more widely patronized in rural Ghana because of ignorance of orthodox medicine, belief in herbal medicine, limited orthodox medical facilities in rural areas, accessibility of facilities, and the cost of medicine. Dr. Abu expressed that he has no problem with the use of herbal medicines to
50 Dr. Akosua Jemmott. Ibid.
treat ailments; he instead feels skeptical about the practice of traditional healing. He admitted that most orthodox medical practitioners have low interest in traditional medicine but at the same time are faced with finding cheaper treatment methods. He feels the work of such facilities as the Centre for Scientific Research into Plant Medicine and the Noguchi Memorial Institute for Medical Research, has low influence in serving the lives of Ghanaians. He believes that government corruption and lack of adequate scientific research into phytomedicines prevents extensive study of phytomedicines. He also acknowledged that Ghanaians trained in foreign countries like America to become medical doctors are too often tempted to practice because of the prospect of making large sums of money there. He feels that the most important thing now is to educate traditional healers about proper medical diagnosis and treatment. Orthodox Research into Traditional Medicine Since 1973, the Centre for Scientific Research into Plant Medicine has functioned to conduct scientific research into phytomedicines, test the pharmacology and toxicity of drugs, perform clinical trials, and to establish herbariums to grow herbs. The Centre also has an out-patients' clinic, which sees up to 60 patients per day treating them with herbal medicine. S. Osafo-Mensah, the Centre’s Public Relations Officer and Head of the Pharmacology and Toxicology Departments, stated that the Centre now has information on 1,000 different plants and hopes that government hospitals will use some of these plants by the year 2000.52 The Centre has made significant advancements in herbal treatments for malaria, enlarged prostate, Parkinson’s disease, Type II Diabetes, sickle
51 Dr. Philip Abu. Ibid. 52 See Appendix, Illus. 7 & 8 [these illustrations are not included in this version] ; S. Osafo-Mensah. Head, Pharmacology and Toxicology Departments of the Centre for Scientific Research into Plant Medicine. Interview by author, 15 April 1999, Mampong-Akwapim, Ghana, work general, possession of author.
cell anemia, and malaria. The Ministry of Education has also issued a policy that requires final-year medical students take a one-week educational tour of the Centre.53 Osafo-Mensah also expressed the Centre’s interest in soon seeing increased interactions between herbalists and doctors in all hospitals and to start a school for herbalists to control and regulate herbal medicine and weed out quacks.54 Currently, one orthodox medical doctor and one herbalist consult each other at the Centre to expose one another to their perception of certain diseases, diagnosis of diseases, and prescription of medicines. Despite the Centre’s good intentions, the work of the Centre alone is not sufficient in meeting “health care for all by the year 2000” goals. Because the Centre has only one location, in Mampong-Akwapim, its treatment facility—like many orthodox hospitals—is inaccessible to a large proportion of Ghana’s population. Though the Centre occasionally holds workshops for herbalists and the general public and holds press conferences about the Centre’s work and future aspirations, the Centre does not advertise much. The Centre’s work is popular, considering that President Rawlings visited the Centre’s presentation at the 6th Ghana International Trade Fair in Accra.55 However, even Osafo-Mensah himself noted that orthodox medical practitioners do not take enough interest in the Centre’s work for a number of reasons. Despite the opportunities available at the Centre for performing quality research into phytomedicines, orthodox practitioners are suspicious of claims about the effectiveness of certain phytomedicines and often scorn the work of herbalists. Dr. A. A. Sittie at the Centre expressed that the traditional and orthodox medical systems would
53 S. Osafo-Mensah. Ibid.
benefit Ghanaians by running parallel instead of having traditional and orthodox practitioners working side-by-side.56 He expressed that because of the disparity between the education and beliefs of traditional and orthodox practitioners, this system would be more feasible and more likely to succeed, but that traditional practitioners must receive proper education about diagnosis, standardization of doses, and lab tests to aid their practice. Dr. Alex Nyarko, a pharmacologist at the Noguchi Institute for Medical Research in Accra, also expressed frustration with the government’s interest in traditional medicine.57 Dr. Nyarko expressed that one major problem currently facing researchers is the lack of coordination between the facilities researching phytomedicines. Though scientists may have much pharmacological information about a drug, they have not performed the necessary clinical trials.58This became evident at the 20th African Health Sciences Congress’s panel on “Phytomedicines.”59 Many of the researchers into phytomedicines presented extensive findings of the pharmacology and toxicity of certain drugs or chemical extracts used to treat ailments like malaria, diabetes, and herpes simplex virus. However, one of the audience members commented that these researchers had performed little or no clinical trials. Dr. Nyarko, who helped facilitate the panel, reminded everyone of the long process of toxicology research and clinical tests. Dr. Nyarko did suggest a reorganization in the research into phytomedicines, stating that facilities should perhaps concentrate on
54 S. Osafo-Mensah. Ibid. 55 Osafo-Mensah has a poster in his office documenting Rawling’s visit. 56 Dr. A. A. Sittie. Centre for Scientific Research into Plant Medicine. Interview by author, 22 April 1999, Accra, Ghana, work journal, possession of author. 57 Like the Centre, the Noguchi Institute has a team of scientists devoted to researching phytomedicines to make them safe for use. 58 Dr. Alex Nyarko. Pharmacologist for the Noguchi Memorial Institute for Medical Research. Interview by author, 15 April 1999, Accra, Ghana, work journal, possession of author.
researching cures for a single ailment, employing a wide range of doctors and scientists to study this ailment to fully understand its properties. One researcher expressed with regret that facilities like the Centre at Mampong-Akwapim have the provisions for conducting large amounts of research and writing important medical dissertations, but unfortunately, there is not enough interest in the study of traditional medicine. At another panel, entitled “Phytomedicines in Modern Medicine: The Way Forward,” one panelist argued that like India and China, where traditional medical systems are officially recognized, African countries must begin to take a leadership position and put more stringent regulations on the exportation of plants. This would prevent foreigners from entering Africa and stealing information about herbal medicines. Conclusions As the year 2000 approaches, several herbal clinics can be currently seen across Ghana, people still go to the markets and tro-tros to sell herbal cures, and traditional healers continue to provide health care for a majority of rural Ghanaians. In addition, there are some orthodox medical doctors in Ghana who continue to believe that every ailment cannot be treated with Western medicine. Recognizing the psychological aspect of traditional medical treatment, they recommend that their patients visit traditional
59 22 April 1999. GIMPA, Accra.
healers! The traditional medical system in Ghana continues to function on a mass scale, and must be considered a vital part of the overall health care system to satisfy “health care for all by the year 2000” visions. This study has shown that though the practices of some traditional healers closely resemble those of orthodox medical practitioners, a lack of communication between the two types of practitioners hinders this understanding. This study has also shown that though the Ghanaian government has shown some interest in the development of the traditional medical system and research into phytomedicines, these efforts are few, often ineffective, and uncoordinated. Currently, integration of Ghana’s traditional medical system into the orthodox system by the year 2000 seems an unfeasible plan, considering the limited interest still given to traditional medicine. Attempts to expedite this integration also would presently be inadvisable, since there have been few genuine attempts to introduce traditional and orthodox medical practitioners to the idea of collaborating. Instead, Ghanaians would benefit from an organized plan to simultaneously develop and improve upon both the traditional and orthodox medical systems. Whereas government programs attempting to integrate the systems have failed, the government must now test other means at promoting interaction between the two systems. Both traditional and orthodox medical practitioners must recognize the similarities instead of differences that exist between the two medical systems to provide common ground for dialogue. Something must be done to make intentions of researchers known and to incorporate training programs and regulations to ensure the quality of traditional healers’ work. Even scientists researching phytomedicines must take into account that though anyone can learn the use of herbal medicine, in environments where
people still have a strong connection with their religion and culture, an outsider may not be socially acceptable to practice as a healer. To accomplish this vision, the government must be willing to endeavor to work with dedication and sincere concern and keep realistic goals. Though this vision may seem too elaborate, it is extremely necessary because both Ghanaian citizens and the economy could both benefit from this interest. A 1990 estimate showed that Ghana spends the equivalent of US$45 million to import foreign-made drugs, and nine years later, this figure must have risen drastically.60 Each day that the government does not acknowledge the traditional medical system for its worth in Ghanaian society, the country grows deeper in debt to foreign countries who have effectively used propaganda to convince Ghanaians that anything African is inherently wrong. Ghana sits on top of a “gold-mine” of thousands of different plants, roots and herbs that may contain chemicals to treat and cure diseases that are currently leading to humans’ potential extinction. If action is not taken soon to study, preserve, and protect these medicines, these medicines may find themselves—along with every other African product that foreigners have deemed profitable and thus exploitable—in the hands of foreign control. Suggestions for Further Study Given the time constraints, this study could not possibly have provided a complete, comprehensive picture of the future of traditional medicine in Ghana. Future research into the traditional medical system can investigate how Ghanaians from all echelons of society can work together to enrich the quality of the health care system.
60 E. Evans-Anfom, Ibid., 52.
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Appendix When interviewing the traditional healers, the following questions were asked: 1. Where were you born? (For how long have you lived in ?) 2. What is the exact nature of your work? 3. How and when did you become interested in your work? Who taught you your work? 4. Describe your formal education background. 5. Describe in detail your apprenticeship. How long have you been practicing independently? 6. Who do you treat? Where do your patients come from? How do they find out about you? What kind of payment do you accept for your services? 7. Does God play a role in your work? How? 8. How is your role different from that of herbalists or okomfo? 9. How does your work bring you into contact with professional medical doctors, hospitals, or the government? How do they perceive your work? 10. How do you perceive orthodox medical doctors? 11. Do you enjoy your work? Why/why not? 12. Give an example of how a patient might approach you for your help and how treatment begins. Can you cite any unique cases you have treated? When interviewing orthodox medical practitioners, the following questions were asked: 1. Where were you born? 2. Describe the exact nature of your work. 3. How and when did you become interested in your work? 4. As a Western-trained doctor, what are your views of traditional medicine? Growing up, how did your impressions of traditional healers change? 5. What role does Western medicine play in the lives of Ghanaians, both rural and urban? 6. What interest does Western-trained medical professionals take in traditional medicine and its practitioners? Additional questions asked to Mr. S. Osafo-Mensah at the Centre for Scientific Research into Plant Medicine: 1. Tell about the history of the Centre. 2. How accessible is the Centre to urban and rural Ghanaians? Who does the Centre’s clinic serve? 3. How much effort is put into the beautification of medicines? 4. How is the Centre viewed by other orthodox institutions? 42
Additional questions asked to Dr. Akosua Jemmott at the Nipa Hia Mmoa Ayaresabea Herbal Clinic: 1. How long has the Clinic been functioning? Who set it up? Who funds it? Do you need a license to run it? Who are your patients? 2. Tell about the educational background of the doctors practicing at the Clinic. Describe your current work at the Clinic. 3. Describe how you became interested in working in traditional medicine.
4. Illustrations 44