|African Indigenous Medicine - An Anthropological Perspective for Policy Makers and Primary Health Care Managers (AMREF, 1992, 50 p.)|
Indigenous health practices affect the way cosmopolitan medical services are perceived and used by indigenous people. For those conditions which have been shown to be amenable to indigenous treatment, cosmopolitan medicine may not be readily used. For conditions which are seen to be better treated using cosmopolitan methods, for example those requiring surgery with anaesthesia, indigenous practices are readily discarded. The most common situation, however, is mat which requires me utilization of both indigenous and cosmopolitan services in a complementary fashion. Various indigenous health practices, both curative and preventive, will be discussed with a view to showing that some may be useful, others harmful and still others neither useful nor harmful. Understanding this distinction is critical in the attempt to utilize indigenous resources in health development. In this chapter, useful indigenous practices are discussed while in the next some negative practices are considered.
Through trial and error, indigenous communities discover and adopt practices which are efficacious in the management of different illnesses. Examples of such practices existing among Abagusii and Marakwet are presented here.
Herbal therapies of various kinds are effective in the management of indigestion problems, worms and cuts in both communities. The exact efficacy of the herbs is difficult to assess since some of it may be due to the placebo effect. Marakwet use herbal mixtures to prevent cuts and wounds from becoming septic. The herbs seem to work very well. There are, however, several serious problems pertaining to dosage, preservation and poisoning in the use of herbs. These issues arc not dealt with effectively in indigenous medicine because of the few technological options available.
Child delivery with the assistance of TBAs is another positive practice common among both the Abagusii and Marakwet. Even where the delivery itself occurs in a hospital setting, the mother receives the bulk of her prenatal and postpartum care from TBAs. TBAs have a very good understanding of the birth process and, where they have received appropriate retraining, are able to refer clients with problems to the relevant specialists. The TBAs provide the psychological support and counselling which are not always available in cosmopolitan health facilities. Retrained TBAs can identify anaemia and other complications and provide relevant advice. The TBAs, however, still face a number of problems such as the lack of basic instruments with which to monitor the mother's blood pressure and foetal condition. There is also the common problem of infection developing from the use of contaminated materials and instruments.
Psychological support is a useful element in indigenous health practice, especially in the management of chronic conditions.
The Marakwet carry out a number of psychosocial procedures aimed at enhancing individual or community health or preventing illness. Some are also aimed at treating existing illnesses. Such practice is based on their broad conceptualization of health and the causation of illness. A number of rituals, ayebisio (pl.), are performed to achieve one or more of the three purposes mentioned earlier - reinforcement, prevention and treatment.
The commonest ayeba is that performed when it is thought that the patient or his family are in some way responsible for an illness, for example, through theft, abusing others or quarrelling. The ayeba performed in such a case involves a prayer for the family conducted by elders. After prayers to Asis, the elders bless the sick person by covering him with green leaves, a symbol of life for Marakwet. The ceremony is cathartic.
Other ayebisio are performed to enhance health in general. This happens when an individual thinks that because of past behaviour he is not liked by other community members. The condition of unpopularity is believed to exacerbate even minor ailments so the appropriate ayeba has to be performed.
Another type of psychosocial procedure carried out by Marakwet is called lyopso. Lyopso is a cleansing ceremony aimed at preventing interpersonal and ritual forces from affecting an individual's health.
Among Marakwet, ritual impurity is believed to be brought about by types of homicide or a ritual oath, muma. If a person has committed homicide or sworn a ritual oath falsely, he needs lyopso to cleanse his impurity.
Among Abagusii, various rituals and ceremonies are performed to heal patients whose illnesses are thought to involve interpersonal and/or spiritual forces. The ritual that is most commonly performed among Abagusii is ekeng'wanso, literally, sacrifice. Ekeng'wanso is performed both to cure and to prevent illness.
Village elders perform a healing ritual (musical) for the man in the centre (head down).
All these rituals are performed to relieve the people involved from fears and to restore the confidence and courage needed to face life's challenges. Such procedures have one major common feature - they are performed by and for the group, the community. This feature reveals the communal nature of illness as perceived in the African setting.
Traditionally, Abagusii believe that ekeng'wanso is essential for good health to prevail and for the prevention of all sorts of calamities. The ekeng'wanso is offered to Engoro, creator, and chisokoro, ancestors. Basically, ekeng'wanso involves the killing of an animal of prescribed colour, age and sex. The meat is consumed by kin members and sometimes close friends are invited. The performance of ekeng'wanso does not usually require the presence of a specialist. Any adult household head can lead the performance of ekeng'wanso.. The ceremony provides the occasion where past quarrels, unpaid debts, dishonoured oaths and other interpersonal problems are discussed. The ceremony is aimed at healing existing illnesses and preventing others from occurring. Treatment with materia medica precedes ekeng'wanso and continues after it where necessary.
Ogoosia is another ceremony performed by Abagusii in their health seeking process. Ogoosia means literally "to cool down". The ceremony is performed when it is suspected that somebody with malicious intent is afflicting a family member by exacerbating what would otherwise be a simple illness. The ceremony involves the killing of a sheep and the use of leaves and flowers to bless the afflicted person. Kin and neighbours attend and appropriate songs are sung. An appeal is made anonymously but publicly to the individual who may be causing the affliction to stop his malice.
Ogokorerana is a ceremony performed when several misfortunes including, but not restricted to, illness, strike a family and it proves difficult to apportion responsibility. Ogokorerana is prescribed by a diviner and he may be present to direct the performance. The ceremony takes various forms and involves the eating of a meal in which family members and neighbours participate. Ogokorerana is a prayer to the ancestors to protect the family from misfortune and illnesses in particular.
Among families which no longer believe in the efficacy of traditional rituals and ceremonies, Christian fellowships and prayers replace the traditional forms. The multi-faceted causation of illness, requiring multi-dimensional therapy, is fully understood and accepted. In a number of instances, there is a quasi-Christian performance with traditional trappings. This is true especially among Abagusii, many of whom profess one or another form of Christianity.
In Africa illness is never merely a physical phenomenon. Social and spiritual factors are seen to be involved in some, especially chronic, illnesses. For the individuals and families concerned, the social and spiritual factors need to be dealt with before complete healing is achieved. Efficacy of treatment procedures, therefore, goes beyond the removal of physical symptoms and signs.
Some scholars have erroneously portrayed non-western indigenous societies as lacking an understanding of both the concept and practice of prevention. This portrayal seems to be due to a superficial study of indigenous medical systems, even before these came into contact with western civilizations. Studies in several Kenyan communities have shown that traditionally all these societies believed that certain diseases could be prevented while others could not. Belief in the possibility of preventing illness led to a number of practices aimed at achieving this objective. These involved the use of both materia medica and appropriate ceremonies or rituals.
The Kikuyu, for example, believed a wide range of procedures and prohibitions to be essential for the prevention of illness. In cases where an individual was believed to be suffering from an infectious illness such as ohere, scabies, or ruhayo, severe cough, people avoided, or at least limited, close contact with the individual. If the head of a family suspected that family members, and especially children, were malnourished, he made attempts to procure the appropriate foods so as to prevent illnesses resulting from lack of adequate food. If an illness was associated with Ngai, God, appropriate ceremonies were performed to treat a particular patient but just as importantly to prevent the illness from afflicting others. Charms and amulets were and are still worn by children and even adults to protect them from getting illnesses whose causation was thought to result from interpersonal problems, such as kurogwo. (getting cursed). People who have been cursed perform the relevant ceremonies to prevent the negative effects of the curse.
The Pokot perform elaborate procedures in which both materia medica and ceremonies are believed to be important to prevent illness. Periodically the head of a family organizes the performance of the ighat, a preventive ceremony. During ighat, a set concoction of about ten herbs is prepared and a goat slaughtered. All family members drink the herbal mixture and plenty of soup prepared from the slaughtered goat. The aim of ighat is to strengthen family members, both physically and spiritually, so that they can repel any attacks of illness. Ighat has existed among Pokot for as far back as they can remember.
Abagusii have several ways of preventing the physical, interpersonal and spiritual aspects of illness. Babies and young children are routinely given a mixture of herbs to prevent a wide range of illnesses. The herbs are administered orally with food or drink, applied as ointment or rubbed onto incisions made on the skin.
To prevent the interpersonal and spiritual aspects of illness, Abagusii use a process called ogokireka omochie, "protecting the homestead". The process involves spraying the homestead with amanyansi, some of which is then prepared as a drink and given to all family members to drink. Amanyansi is a herb believed to possess both medicinal and mystical powers of preventing illness. A sheep is also slaughtered and its stomach contents sprayed around the homestead.
Ogotakera is another procedure which Abagusii use to protect a baby from harmful interpersonal or spiritual agencies. If a baby is sickly and seems threatened by death, the mother and a group of elderly ladies take the baby to a cross-roads point, and lay him by the road side. Anybody passing through the place has to pray for the baby's good health and survival. The prayer and well wishes are accompanied with the presenting of gifts to the baby. The gifts may not have material value but are believed to show that the giver wholeheartedly wishes that the baby be protected by God from all kinds of illness. Ogotakera is completed by a prayer said at sunrise by the baby's mother. The mother holds the baby towards the rising sun and says "Erioba onderere" which means "Sun (God), rear this baby for me".
Due to the spread of Christianity and western ideas, these procedures may not be acceptable to all members of a given community. Some members, because of Christianity or the wish to appear modem, may opt for Christian prayers and the laying on of hands in place of the indigenous practice. Even individuals who normally would not go to church may ask for prayers to be said for them to be healed.
Implications for health service delivery and development
A number of positive health practices exist among Kenyan societies. Practices such as the use of herbal treatment, psychosocial support and indigenous child delivery need to be studied in detail with a view to encouraging those which are useful.
Concern for effective indigenous health practices will go a long way in facilitating more effective use of cosmopolitan medicine. Kenya's 1989-1993 Development Plan calls for more research to collect information on appropriate traditional diagnostic, therapeutic and rehabilitative technologies which could become part and parcel of formal health research and programmes (p. 244).
Most cosmopolitan health workers in Kenya, as elsewhere in Africa, argue that indigenous people are not keen about preventive health services. They point to the poor use of immunization services as proof of their argument. The examples given show that traditionally African societies had concepts relating to prevention and took measures to prevent illness. It is true that some of the concepts were mistaken and many of the preventive measures ineffective. What is important for this discussion, however, is the fact that the societies were concerned about the prevention of illness. This concern has been increased with the introduction of cosmopolitan medicine, education and Christianity all of which emphasize preventive health care.
It is true to some extent that African societies are less enthusiastic about preventive cosmopolitan medical care than about its curative side. This does not arise merely from the absence of notions of the prevention of illness. An ethnographic study of this problem by the author indicates that there are several reasons why cosmopolitan preventive health services are less popular than curative services.
The most critical factor accounting for the low popularity of preventive health services provided through official health systems is that their effectiveness is not fully demonstrated. For example, a child who has received all the required vaccinations may still get one of the diseases against which he has been vaccinated. In many cases health workers do not discuss this possibility with clients. Indigenous medical systems have explanations for the failure of therapy. This means that a measure which may have proven ineffective in preventing an illness in a particular case may be taken in future because a specialist or the affected family can explain the failure. The positive effects of preventive biomedical services are not easy to demonstrate, chiefly because the western biomedical concept of prevention differs from indigenous concepts which tend to be comprehensive and usually not so specific. What cosmopolitan medical workers say about preventive health services is in many cases not clear to the indigenous population.
There are also several socio-economic factors which make it difficult to carry out preventive measures whose efficacy has not been widely demonstrated. The same problem has occurred with certain types of curative care.
It is important, therefore, that, as more and more preventive health services are planned for indigenous people, attempts are made to integrate these services within indigenous concepts and practices. To achieve the proper contextualization, it is important for cosmopolitan health care providers to understand what their clients think and do about the prevention of disease. Quite a number of the indigenous concepts of prevention can be used to motivate individuals and communities to participate in modem disease prevention.