5. Examples of indigenous health practices: Negative features

A number of indigenous procedures and types of behaviour believed by their practitioners to be crucial to the healing of illnesses can in fact cause harm to the patient. These are practised in good faith but, because of their very nature, they lead to physical or psychological damage. Only a few such practices are discussed here, with examples from various Kenyan communities.

The phenomenon of plastic teeth

The idea of "plastic teeth", believed to be a major cause of diarrhoea, is widespread in East Africa. In Kenya, it has been established that the belief and the related practices exist in most of the societies studied, including the Kamba, Abagusii, Kikuyu, Luo, Pokot, Digo, Duruma and Luyia.

Among the Luo of South Nyanza, it is believed that "plastic teeth", known as jimo in Dholuo, are abnormal teeth which appear in a baby's mouth long before the normal milk teeth appear. The teeth may appear any time from birth to the age of three months. The teeth appear in the gums but do not sprout. They look like maize germ and arc soft like plastic. The plastic teeth appear where the real milk teeth appear later.

Jimo are believed to come naturally, but usually appear in certain families. Jimo in most cases affect first-born children; both male and female are thought to be affected.

Jimo arc believed to cause severe diarrhoea, usually of an intermittent nature. Other symptoms include high temperature, loss of weight and poor appetite. In order to stop the diarrhoea and related symptoms, the Luo carry out one or more of the following forms of treatment.

The first form of treatment, carried out when the jimo-related diarrhoea is not severe and the jimo are still small, involves rubbing the gums or pressing on them. The leaves of a plant called ochok are chewed or ground into a pulp, which is then placed at the tip of the index finger and rubbed onto the gums at the point where the jimo are "growing". The pressing continues for three days if the child is a girl and for four days if it is a boy. The rubbing is carried out first thing in the morning and last thing in the evening.

Sometimes a more drastic form of rubbing is involved. A millipede is wrapped in ochok leaves and then rubbed on the gums thought to be affected by jimo.

The third form of treatment involves the extraction of jimo from the gums, using a sharp object such as a home-made knife. After the jimo arc extracted, a herbal mixture is applied on the gums to prevent sepsis and to speed up healing.

Abagusii also believe in "plastic teeth", which they refer to as ebisara. Ebisara arc believed to affect only young children, usually from about four weeks to three months after birth. They cause intermittent diarrhoea, a type believed not to respond to normal treatment.

Ebisara are treated in two ways which closely resemble the Luo ones. The gums of a child with diarrhoea are rubbed with the crushed or ground leaves of ekerundu or some other plant. The rubbing is also done with a bare index finger. If the diarrhoea does not stop with rubbing, the ebisara are extracted with a sharp object as is done among the Luo.

The perception and treatment of "plastic teeth" is more or less similar in many other communities; the term used for the phenomenon implies that the "teeth" are soft and plastic-like. Usually, treatment is either by rubbing or extraction. The most critical linking feature in the phenomenon as it occurs in many areas is that it is related to diarrhoea.

Dr Onyango, a dentist with public health training, has discussed this issue extensively with the author. He thinks that "plastic teeth" are normal undeveloped milk teeth. Before milk teeth erupt, the gums of some children may appear swollen to the extent that some sections of the gums protrude. If this happens when the child has diarrhoea, then the phenomenon of "plastic teeth" is believed to be present.

It is known that diarrhoea among such young children is quite common to the point where it is assumed to be incidental to growing up. In any case, the teething process can lead to diarrhoea.

Most health workers in Kenya do not know about the phenomenon of "plastic teeth". There was no discussion about "plastic teeth" in any of the several maternal and child health clinics visited by the author and research assistants. Mothers argue that cosmopolitan health workers do not understand "plastic teeth". Any diarrhoea seen to be resulting from them is not treated with cosmopolitan medicine. We recorded several cases where cosmopolitan treatment was stopped until the traditional treatment for "plastic teeth/diarrhoea" had been carried out. Extraction of the "plastic teeth" can lead to infection and much discomfort for the child to the extent that feeding becomes difficult.

Incisions, scarifications and excisions

A number of indigenous medical procedures involve incisions, scarifications or excisions.

A common feature of these procedures is the letting of blood. Their medical efficacy is questionable. In fact some of the procedures are performed for cultural, rather than medical, reasons. There are several negative effects of these procedures. These include septic infections, trauma due to excessive bleeding and sometimes shock. There is also the possibility of tetanus being transmitted through contaminated instruments. Nowadays, there is the very serious possibility of getting AIDS from sharing razor blades or knives when incisions, scarifications and excisions are performed en masse. What is interesting is that most people who have these procedures performed on them. and even the specialists who perform them, are not aware of the risks of infection.

Diagnosis, dosage and "panaceas"

The diagnosis of illness in an indigenous setting can be problematic. There are no instruments which enable specialists to arrive at an accurate diagnosis of illnesses whose origins have to do with internal organs such as the heart, liver and lungs. Sometimes a generic term "abdominal disease" is used to refer to several different diseases affecting different organs. For example, an infection of the lungs may be treated with emetics and purgatives aimed at clearing the digestive system!

Both lay people and specialists using indigenous medicine are inaccurate about the dosage of medicines used. Herbs growing in hot, dry areas have a different concentration of active ingredients from those growing in wet, cold areas. The age of the herb can also influence the concentration. Because of the absence of written records, the dosage of herbs dispensed may change from time to time. Since some of the drugs are extremely potent, an increase of the dosage beyond a certain point can be fatal.

Perhaps the most dangerous practice in indigenous medicine is the claim by some practitioners that they can cure all diseases, including AIDS, high blood pressure, diabetes and heart problems. While it is possible that indigenous medical practice may have some impact on a number of complicated chronic illnesses, it cannot be true that any practitioner can cure all diseases. The wild claims about panaceas usually lead to delayed referral for appropriate treatment, sometimes with serious consequences.

A herbalist takes a bite of medicine before giving it to a critically ill patient.

Implications for health services delivery and development

Most cosmopolitan health practitioners arc well aware of at least some of the negative aspects of indigenous medicine. In fact, they are rarely aware of the positive aspects of indigenous medicine, such as those indicated in the previous chapter. Cosmopolitan medical practitioners need to distinguish between the negative and positive aspects of indigenous medicine.

There is need to discourage the use of negative indigenous medical practices. This can best be done by suggesting safer procedures which can be undertaken in a non-hospital setting. Sensitivity is called for when attempts arc made to discourage these practices, because they have deep cultural roots. It is important for medical curriculum developers to include an objective and thorough study of indigenous medical practice in any medical training programme so that cosmopolitan practitioners have a balanced understanding of this important resource.

I have not reported on more extreme negative aspects of indigenous medicine, and there arc many. These have an unfavourable effect on the delivery of health services and the improvement of health conditions. Health care providers and all others working in health development should play a role in dealing with those concepts and practices which hinder the full development of human health, and where such exist in indigenous medicine.