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Traditional African medicine is a range of traditional medicine disciplines involving indigenous herbalism and African spirituality, typically including diviners, midwives, and herbalists. Practitioners of traditional African medicine claim to be able to cure a variety of diverse conditions including cancer, psychiatric disorders, high blood pressure,
cholera Cholera is an infection of the small intestine by some strains of the bacterium ''Vibrio cholerae''. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and ...
, most venereal diseases, epilepsy, asthma, eczema, fever, anxiety, depression, benign prostatic hyperplasia, urinary tract infections, gout, and healing of wounds and burns and even
Ebola Ebola, also known as Ebola virus disease (EVD) and Ebola hemorrhagic fever (EHF), is a viral hemorrhagic fever in humans and other primates, caused by ebolaviruses. Symptoms typically start anywhere between two days and three weeks after becom ...
. Diagnosis is reached through spiritual means and a treatment is prescribed, usually consisting of a herbal remedy that is considered to have not only healing abilities but also symbolic and spiritual significance. Traditional African medicine, with its belief that illness is not derived from chance occurrences, but through spiritual or social imbalance, differs greatly from modern scientific medicine, which is technically and analytically based. In the 21st century, modern pharmaceuticals and medical procedures remain inaccessible to large numbers of African people due to their relatively high cost and concentration of health facilities in urban centres. Traditional medicine was the dominant medical system for millions of people in Africa prior the arrival of the
Europeans Europeans are the focus of European ethnology, the field of anthropology related to the various ethnic groups that reside in the states of Europe. Groups may be defined by common genetic ancestry, common language, or both. Pan and Pfeil (2004) ...
, who introduced western-based medicine, which was a noticeable turning point in the history of this tradition and culture. Herbal medicines in Africa are generally not adequately researched, and are weakly regulated. There is a lack of the detailed documentation of the traditional knowledge, which is generally transferred orally. Serious adverse effects can result from mis-identification or misuse of healing plants. The geographical reach of this article is
Sub-Saharan Africa Sub-Saharan Africa is, geographically, the area and regions of the continent of Africa that lies south of the Sahara. These include West Africa, East Africa, Central Africa, and Southern Africa. Geopolitically, in addition to the List of sov ...
. Though, of course neighbouring medical traditions influenced traditional ''African medicine''.


History


Colonial era

Modern science has considered methods of traditional knowledge as primitive and under colonial rule some traditional medical practices were outlawed. During this time, attempts were also made to control the sale of herbal medicines. For example, after Mozambique gained independence in 1975, attempts to control traditional medicine went as far as sending diviner-healers to re-education camps. As colonialism and Christianity spread through Africa, colonialists built general hospitals and Christian missionaries built private ones, with the hopes of making headway against widespread diseases. However, little was done to investigate the legitimacy of the traditional medical practices, despite the obvious role that the traditional healers played in the basic health needs of their communities; the colonial authorities along with doctors and health practitioners continued to shun their contributions. It was also believed that during times of conflict people were more likely to resort to supernatural explanations and would seek treatment involving the supernatural.


Modern period

For various reasons, in the late 20th century the traditional systems of medical care in developing countries underwent a major revival. These countries also realized that modern
health care system Health, according to the World Health Organization, is "a state of complete physical, Mental health, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World H ...
s and the technologies that they are dependent on are not locally manufactured and maintained thus making them expensive and rendering the population dependent on supply-chains that might be erratic or politicised. Due to this, interest in integrating traditional African medicine into the continent's national health care systems has increased and the use of traditional medicinal plants is being encouraged in some countries. An African healer embraced this concept by starting a 48-bed hospital, the first of its kind, in Kwa-Mhlanga, South Africa, which combines traditional African methods with other alternative medical practices such as
homeopathy Homeopathy or homoeopathy is a pseudoscientific system of alternative medicine. It was conceived in 1796 by the German physician Samuel Hahnemann. Its practitioners, called homeopaths, believe that a substance that causes symptoms of a dis ...
, iridology, and
traditional Asian medicine Traditional Asian medicine is a collective term for several types of traditional medicine practiced in Asia. These include the medical traditions of: * East Asia ** China *** Tibet ** Japan (Kampo) ** Korea ** Mongolia * Southeast Asia ** Cambodi ...
.


Diagnostics

The medical diagnoses and chosen methods of treatment in traditional African medicine rely heavily on spiritual aspects, often based on the belief that psycho-spiritual aspects should be addressed before the medical aspects. There is the belief among the practitioners of traditional healing that the ability to diagnose and treat illnesses are a gift from God. Rather than looking for the medical or physical reasons behind an illness (or a spell of bad luck), traditional healers attempt to determine the root cause underlying it, which is believed to stem from a lack of balance between the patient and their social environment or the spiritual world. In other words, supernatural causes, not natural causes, are attributed to illnesses. According to the type of imbalance the individual is experiencing, an appropriate healing plant will be used, which is valued for its symbolic and spiritual significance as well as for its medicinal effect. When a person falls ill, a traditional practitioner uses incantations to make a diagnosis. The incantations are thought to give the air of mystical and cosmic connections.
Divination Divination (from Latin ''divinare'', 'to foresee, to foretell, to predict, to prophesy') is the attempt to gain insight into a question or situation by way of an occultic, standardized process or ritual. Used in various forms throughout histor ...
is typically used if the illness is not easily identified, otherwise, the sickness may be quickly diagnosed and a remedy prescribed. Sometimes the practitioner will advise the patient to consult a diviner who can give a diagnosis and recommend a treatment. It is believed that contact with the spirit world through divination often requires not only medication, but
sacrifice Sacrifice is the offering of material possessions or the lives of animals or humans to a deity as an act of propitiation or worship. Evidence of ritual animal sacrifice has been seen at least since ancient Hebrews and Greeks, and possibly exi ...
s.


Treatments

Traditional practitioners use a wide variety of treatments ranging from standard medical treatments to the
pseudoscientific Pseudoscience consists of statements, beliefs, or practices that claim to be both scientific and factual but are incompatible with the scientific method. Pseudoscience is often characterized by contradictory, exaggerated or unfalsifiable claim ...
and "magical". Treatments may include fasting, dieting, herbal therapies, bathing, massage, and surgical procedures. Examples of the pseudoscientific treatments include: * The use of "bleed-cupping" (also called "wet cupping"), followed by herbal ointment and herbal drugs to treat
Migraine Migraine (, ) is a common neurological disorder characterized by recurrent headaches. Typically, the associated headache affects one side of the head, is pulsating in nature, may be moderate to severe in intensity, and could last from a few hou ...
s, coughs,
abscess An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends b ...
es, and pleurisy. * Some cultures rub hot herbal ointment across the patient's eyelids to treat headaches. * A steaming mixture of herbs is both consumed and inhaled in the treatment of Malaria. Fevers are often treated using a steam bath. * Vomiting induced by emetics is used to treat alcoholism. * The fat of a boa constrictor is used to treat gout and
rheumatism Rheumatism or rheumatic disorders are conditions causing chronic, often intermittent pain affecting the joints or connective tissue. Rheumatism does not designate any specific disorder, but covers at least 200 different conditions, including art ...
, and is thought to relieve chest pain when applied topically. * Animals are also sometimes used to transfer the illness to afterward or for the manufacture of medicines for zootherapy. For example, the bones of baboons are used to treat
arthritis Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In som ...
. * The terpenoids of the
blister beetle Blister beetles are beetles of the family Meloidae, so called for their defensive secretion of a blistering agent, cantharidin. About 7,500 species are known worldwide. Many are conspicuous and some are aposematically colored, announcing their ...
(Mylabris sp.) are rubbed into the skin as a treatment for skin diseases. Consensus between traders of the components of the medication used by practitioners of traditional African medicine regarding what should be used to treat different illnesses varies considerably, even within a small area such as the Faraday Street market in Johannesburg, South Africa. However, approximately 60%-80% of the people in Africa rely on traditional remedies to treat themselves for various diseases. A 2018 systematic review estimated that close to 60% of the general population in sub-Saharan Africa regularly use traditional and complementary medicine products for themselves and to treat their animals for various diseases. Ebola survivors in Sierra Leone have recently been reported to use traditional medicine alone or together with conventional medicine.


Medicinal plants

There are many plants in Africa that can be used for medicinal purposes and more than 4000 are used for this purpose in the tropical regions of Africa. Medicinal plants are used in the treatments of many diseases and illnesses, the uses and effects of which are of growing interest to Western societies. Not only are plants used and chosen for their healing abilities, but they also often have symbolic and spiritual significance. For example, leaves, seeds, and twigs that are white, black and red are seen as especially symbolic or magical and are believed to possess special properties. One example of a medicinal plant is Pygeum (), which has been used as a treatment for mild benign prostatic hyperplasia in Europe since the 1970s. Although used extensively in Africa, there is insufficient evidence for its effectiveness in treating fever, inflammation, kidney disease, malaria, stomach aches and other conditions. In traditional African practice, the bark is made into tea, whereas elsewhere in the world it is found in powders, tinctures, and pills. A 2007 study investigated the effectiveness of 16 plants, growing in South Africa's
KwaZulu-Natal KwaZulu-Natal (, also referred to as KZN and known as "the garden province") is a province of South Africa that was created in 1994 when the Zulu bantustan of KwaZulu ("Place of the Zulu" in Zulu) and Natal Province were merged. It is locate ...
region, in lowering blood pressure "by acting as an ACE inhibitor." Of the 16 plants, only one (Tulbaghia violacea) showed promise. It then was tested on rats and "demonstrated hypotensive activity", i.e. reduction of blood pressure. The plants included in the study were: # ''
Amaranthus dubius ''Amaranthus dubius'', the red spinach, Chinese spinach, (), spleen amaranth, hon-toi-moi, yin choy, hsien tsai, or Arai keerai () is a plant species. It belongs to the economically important family Amaranthaceae. This plant is native to South ...
'', a flowering plant, also known as spleen amaranth # '' Amaranthus hybridus'', commonly known as smooth pig-weed or slim amaranth # '' Amaranthus spinosus'', also known as spiny amaranth # '' Asystasia gangetica'', an ornamental ground cover known as Chinese violet. # '' Centella asiatica'', a small herbaceous annual plant commonly referred to as Asiatic pennywort # ''Ceratotheca triloba'', a tall annual plant that flowers in summer sometimes referred to as poppy sue # '' Chenopodium album'', also called lamb's quarters, this is a weedy annual plant # ''
Emex australis ''Rumex hypogaeus'' (Synonym (taxonomy), synonym ''Emex australis''), commonly known in English as southern threecornerjack, devil's thorn, or double gee (also doublegee, from the old Afrikaner name dubbeltge-doorn - 'double thorned'), is a herb ...
'', commonly known as southern three corner jack # '' Galinsoga parviflora'', commonly referred to as gallant soldier # ''Justicia flava'', also known as yellow ''justicia'' # ''
Momordica balsamina ''Momordica balsamina'' is a tendril-bearing annual vine native to the tropical regions of Africa, introduced and invasive in Asia, Australia, Central America, and North America, where they have been found in some parts of Florida. In 1810, T ...
'', also known as the balsam apple # ''Oxygonum sinuatum'', an invasive weed with no common name # ''
Physalis viscosa ''Physalis viscosa'' is a species of flowering plant in the nightshade family known by many common names, including starhair groundcherry, stellate ground-cherry and grape groundcherry in English, and ''arrebenta-cavalo'', ''balãozinho'', and '' ...
'', known as starhair ground cherry # ''Senna occidentalis'', a very leafy tropical shrub, also called septic weed # ''Solanum nodiflorum'', also known as white nightshade # ''Tulbaghia violacea'',a bulbous plant with hairless leaves often referred to as society or wild garlic. A 2008 literature survey was made to assess the botanical knowledge and uses within traditional medicine in Southern Africa for the genus
Aloe ''Aloe'' (; also written ''Aloë'') is a genus containing over 650 species of flowering succulent plants.WFO (2022): Aloe L. Published on the Internet;http://www.worldfloraonline.org/taxon/wfo-4000001341. Accessed on: 06 Nov 2022 The most wid ...
within the family Asphodeloideae. Most common medical uses were for the treatment of "infections, internal parasites, digestive ailments and injuries." Socially the plants are used as ingredients in tobacco snuff. A 2014 literature survey found that at least 12 palm species in sub-Saharan Africa are used in various ritual practices, including the use of palm oil in healing mixtures. In 2016 an ''in vitro'' study of the essential oil from ''Erigeron floribundus'', used as a medicinal plant in Cameroon, demonstrated good activity against ''
Staphylococcus aureus ''Staphylococcus aureus'' is a Gram-positive spherically shaped bacterium, a member of the Bacillota, and is a usual member of the microbiota of the body, frequently found in the upper respiratory tract and on the skin. It is often positive ...
'', "cytotoxicity on colon
carcinoma Carcinoma is a malignancy that develops from epithelial cells. Specifically, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that arises from cells originating in the endodermal, mesodermal ...
cells" and "ferric reducing antioxidant power." Among the constituents of the essential oil are
spathulenol Spathulenol is a tricyclic sesquiterpene alcohol which has a basic skeleton similar to the azulenes. It occurs in oregano among other plants. History and occurrence A volatile oil was extracted from waterwort distillery (''Artemisia vulgaris'') ...
and limonene. As a result of a study conducted from 2011 to 2016, a traditional medicine from the tropical Olon tree, and another species of genus '' Zanthoxylum'', was found to have synergistic compounds that kill both mosquitoes and their plasmodium parasites. A 2000 study of thirty-three species of plants, found in the
Eastern Cape The Eastern Cape is one of the provinces of South Africa. Its capital is Bhisho, but its two largest cities are East London and Gqeberha. The second largest province in the country (at 168,966 km2) after Northern Cape, it was formed in ...
province of South Africa, that are considered weeds, alien invaders or problem plants were investigated for their uses in traditional medicine. The plants included: *''Anredera cordifolia'' (). Swollen feet from poor circulation and/or liver and kidney problems are treated with a leaf poultice, while the sap is used to treat a rash caused by contact with dirty water. upright=0.5, Cannabis Sativa plant * ''Araucaria bidwillii'' (). Grated bark mixed with water is consumed to treat amenorrhea caused by congenital problems, tuberculosis and malnutrition. * ''Bidens pilosa'' (). The water from the boiled roots is consumed to treat infertility in women. Bathing in water in which the leaves have been soaked is believed to protect one from evil spirits (), ill feeling, jealousy or animosity. Also used to treat diarrhoea, colic, rheumatism, syphilis, earache, constipation, intestinal worms, Malaria, ring worm, jaundice and coughs. * ''Cannabis sativa'' (). Various parts of the plant are used to treat asthma, bronchitis, headache, epilepsy, pains, colds, influenza, labour pains, hypertension, diabetes, malaria, blackwater fever, blood-poisoning, anthrax, dysentery, tetanus, menstrual cramps and rabies. * ''Carduus tenuiflorus'' (). The patient is given an emetic and instructed to vomit onto the plant. The belief is that the plant will "suck out the cause of the illness." * ''Datura stramonium'' (). The leaves are used to treat pain and swelling (including after a circumcision), boils and abscesses, measles, asthma and headaches, tetanus, foot ailments and respiratory conditions. * ''Emex australis'' (). A decoction of the root is used to treat constipation, biliousness and other stomach complaints and to stimulate appetite. * ''Galenia secunda'' (). The roots are mixed with ''Emex australis'', boiled and used to treat kidney pains in adults and colic in babies. * ''Lantana camara'' (). The roots are boiled and the liquid consumed for lower back or abdominal pain, or used as an enema to treat gonococcal infections and urinary tract infections. It is also used to treat coughs, colds, jaundice, rheumatism and as a contraceptive. * ''Opuntia ficus-indica'' (). A poultice of the cooked leaves is used to treat sores between toes and the fingers caused by fungal infections. The belief is that these sores are caused by "dirty blood" (). * ''Rumex sagittatus'' (). A cold water infusion of the roots are used as a body wash as it is believed to cleanse the body of misfortunes and evil. * ''Schinus molle'' ( or ). Fever and influenza are treated by consuming a leaf decoction or steaming. A combination of leaves and bark is used to treat wounds. * ''Araujia sericifera'' (). It is used to treat , which is described by Ngubane as an extreme form of depression coupled with psychotic symptoms such as delusions, hysteria, violent outburst and suicide ideations. The roots are mixed with other medications to treat it. * ''Argemone mexicana'' (). This root decoction is mixed with the roots of the rubus pinnatus (iqunube) and is administered through the use of an enema to cure kidney pain.


Spirituality

Some healers may employ the use of charms, incantations, and the casting of spells in their treatments. For example, there is the belief among the Ibos of Nigeria that medicine men can implant something into a person from a distance to inflict sickness on them, in a process referred to as''egba ogwu.'' To remove the malignant object, the intervention of a second medicine man is typically required, who then removes it by making an incision in the patient. A form of
sympathetic magic Sympathetic magic, also known as imitative magic, is a type of magic based on imitation or correspondence. Similarity and contagion James George Frazer coined the term "sympathetic magic" in '' The Golden Bough'' (1889); Richard Andree, however ...
is also used, in which a model is made of the victim and it is believed that actions performed on the model are transferred to the victim, in a manner similar to the familiar voodoo doll. Superstitious beliefs regarding spirits are also exploited and people are convinced that "spirits of deceased relatives trouble the living and cause illness." In these instances "medicine men prescribe remedies, often in the form of propitiatory sacrifice, in order to put them to rest so that they will no longer trouble the living, especially children." According to Onwuanibe, Africans hold a religious world view which includes divine or spiritual intervention in medical practice. For example, the !Kung people of the Kalahari Desert believe that the great God Hishe created all things and, therefore, controls all sickness and death. Hishe presents himself to these medicine men in dreams and hallucinations, giving them curative power and this god is generous enough to give this power to the medicine men, they are expected to practice healing freely. The !Kung medicine men effect a treatment by performing a tribal dance.


Traditional medicinal practitioners

Many traditional medicinal practitioners are people without formal education, who have rather received knowledge of medicinal plants and their effects on the human body from their forebears and by observation. Traditional practitioners and their practices vary but common features among them are a personal involvement in the healing process; protection of the therapeutic knowledge by keeping it a secret; and being rewarded for their services. In a manner similar to orthodox medicinal practice, the practitioners of traditional medicine specialize in particular areas of their profession. Some, such as the inyangas of
Eswatini Eswatini ( ; ss, eSwatini ), officially the Kingdom of Eswatini and formerly named Swaziland ( ; officially renamed in 2018), is a landlocked country in Southern Africa. It is bordered by Mozambique to its northeast and South Africa to its no ...
are experts in herbalism, whilst others, such as the South African sangomas, are experts in spiritual healing as diviners, and others specialize in a combination of both forms of practice. There are also traditional bone setters and birth attendants. Herbalists are becoming more and more popular in Africa with an emerging herb trading market in Durban that is said to attract between 700,000 and 900,000 traders per year from South Africa, Zimbabwe, and Mozambique. Smaller trade markets exist in virtually every community. Their knowledge of herbs has been invaluable in African communities and they among the few who could gather them in most societies. Midwives also make extensive use of indigenous plants to aid childbirth. African healers commonly "describe and explain illness in terms of social interaction and act on the belief that religion permeates every aspect of human existence."


Payments

Traditional healers, like any other profession, are rewarded for their services. In African societies, the payment for a treatment depends on its efficacy. They do not request payment until after the treatment is given. This is another reason many prefer traditional healers to western doctors who require payment before the patient has assessed the effectiveness of the treatment. The payment methods have changed over time, with many practitioners now asking for monetary payment, especially in urban settings, rather than their receiving good in exchange, as happened formerly. There are also a growing number of fraudulent practitioners who only interested in making money, especially in urban areas.


Learning the trade

Some healers learn the trade through personal experience while being treated as a patient who decide to become healers upon recovery. Others become traditional practitioners through a "spiritual calling" and, therefore, their diagnoses and treatments are decided through belief in supernatural intervention. Another route is to receive the knowledge and skills passed down informally from a close family member such as a father or uncle, or even a mother or aunt in the case of midwives. Apprenticeship to an established practitioner, who formally teaches the trade over a long period of time and is paid for their tutoring, is another route to becoming a healer.


Importance

In Africa, traditional healers and remedies made from indigenous plants play a crucial role in the health of millions since as many as 85% of African routinely use these services for primary health care in
Sub-Saharan Africa Sub-Saharan Africa is, geographically, the area and regions of the continent of Africa that lies south of the Sahara. These include West Africa, East Africa, Central Africa, and Southern Africa. Geopolitically, in addition to the List of sov ...
. The relative ratios of traditional practitioners and university trained doctors in relation to the whole population in African countries underscores this importance. Across Sub-Saharan Africa, from Ghana to
Eswatini Eswatini ( ; ss, eSwatini ), officially the Kingdom of Eswatini and formerly named Swaziland ( ; officially renamed in 2018), is a landlocked country in Southern Africa. It is bordered by Mozambique to its northeast and South Africa to its no ...
there are, on average almost, 100 traditional practitioner for every university trained doctor. This equates to one traditional healer for every 200 people in the Southern African region, which is a much greater doctor-to-patient ratio than is found in North America. In many parts of Africa there are few practitioners trained in modern medicine and traditional healers are a large and influential group in primary health care and an integral part of the African culture. Without them, many people would go untreated. Medications and treatments that Western pharmaceutical companies manufacture are far too costly and not available widely enough for most Africans. Many rural African communities are not able to afford the high price of pharmaceuticals and can not readily obtain them even if they were affordable; therefore, healers are their only means of medical help. Because this form of medicine is "the most affordable and accessible system of health care for the majority of the African rural population," the African Union declared 2001 to 2010 to be the Decade for African Traditional Medicine with the goal of making "safe, efficacious, quality, and affordable traditional medicines available to the vast majority of the people." Excessive use of plants is an ecological risk, as this may lead to their extinction.


Traditional African medicine in relation to women

Women in Sub-Saharan rural African communities are almost entirely responsible for domestic work in their households. These women are often at higher risk for disease and poverty than their male counter-parts and have less control over their daily lives than them. A literature survey from 2001 found that these women defined 'good health' as the ability to perform domestic duties and the state of being disease free. Furthermore, the study found that they attributed poor health to supernatural, evil forces, that illness is seen as a form of punishment from spirits. In another study, which explored the HIV/AIDS epidemic in Ghana, women identified HIV/AIDS with reprobate behaviour, such as "prostitution, promiscuity, and extramarital relationships", or traveling to areas outside the community. These women endure arduous conditions and a traditional healer plays an instrumental role in their daily lives. The traditional healer provides health care to the rural communities and represents him/herself as an honorable cultural leader and educator. An advantage of the traditional healer in rural areas is that they are conveniently located within the community. Modern medicine is normally not as accessible in rural areas because it is much more costly. Older rural women particularly tend to utilize traditional healers in their communities. Younger women and the urbanized have been found to be renouncing the use of traditional healers. A 2001 study of rural Ethiopian women where HIV was present found that they rejected the presence of HIV in rural villages and claimed it was an urban illness, despite the presence of HIV in the rural communities. However, these women also claimed that their communities did not advocate for prevention, but rather treated an illness once it was present.


Traditional African healers and the HIV/AIDS epidemic


Role

For patients with HIV/AIDS, traditional healers provided a local, familiar, and accessible option compared to biomedical personnel who were usually overbooked and located farther away. Traditional healers were seen as having an authoritative role in physical, psychological, and spiritual aspects of health. In the early 1980s in southwestern Uganda, it was reported that many locals infected with the disease ("Slim") after showing symptoms of diarrhoea and weight-loss would consult traditional healers due to their belief in the connection between the disease and witchcraft.


Criticism

During the HIV/AIDS epidemic traditional healers' methods were criticised by practitioners of modern medicine, and in particular the use of certain herbal treatments for HIV/AIDS. According to Edward Mills, herbal remedies are used as a therapy for HIV-symptoms such as "dermatological disorders, nausea, depression, insomnia, and weakness." While some of these remedies have been beneficial, the herbal treatments
hypoxis ''Hypoxis'' is a genus of flowering plants of the family Hypoxidaceae. The genus has an " almost cosmopolitan" distribution, occurring in Africa, the Americas, Asia, and Australia.Singh, Y. (Natal Herbarium, Durban)''Hypoxis''.PlantZAfrica.com: ...
and sutherlandia "may put the patients at risk for antiretroviral treatment failure, viral resistance, or drug toxicity" since they interact with antiretroviral treatments and prevent the expression of
CYP3A4 Cytochrome P450 3A4 (abbreviated CYP3A4) () is an important enzyme in the body, mainly found in the liver and in the intestine. It oxidizes small foreign organic molecules (xenobiotics), such as toxins or drugs, so that they can be removed from t ...
and
P-glycoprotein P-glycoprotein 1 (permeability glycoprotein, abbreviated as P-gp or Pgp) also known as multidrug resistance protein 1 (MDR1) or ATP-binding cassette sub-family B member 1 (ABCB1) or cluster of differentiation 243 (CD243) is an important protein ...
. This results in the inhibition of drug metabolism and transport. Peltzer et al. also found that an important issue with herbal medicines used in traditional medicine is that when a patient decides to see a doctor in addition to a traditional healer, they do not always mention that he or she is taking an herbal medicine. Herbal medicines can interact with the modern medicine prescribed by the doctor to treat HIV and negatively impact the patient. Peltzer et al. mentions that a "IGM-1 seem to be effective in symptom improvement, but generally no significant effect on antiviral or immunity enhancement among reviewed herbs was seen" for the treatment of HIV. Since HIV is such a volatile disease, it is imperative to try to boost the patient's immunity, not just relieve symptoms. The ethical issue, as presented by modern medicine, is the complete lack of clinical trials to test any traditional African medicine before practicing with it on the public. Modern medicine in the United States is subject to The Nuremberg Code and the related Declaration of Helsinki which are the basis for the
Code of Federal Regulations In the law of the United States, the ''Code of Federal Regulations'' (''CFR'') is the codification of the general and permanent regulations promulgated by the executive departments and agencies of the federal government of the United States. ...
issued by the United States Department of Health and Human Services, to oblige humane behavior in experimenting on the public for the good of society. Since traditional African healers do not have to adhere to the Nuremberg code, there is a potential danger to society when healers do not practice medicine humanely. Traditional healers have also been under scrutiny during the HIV/AIDS epidemic for unsanitary medical practices. The "re-use of medical instruments and lack of hygienic habits such as hand washing" have contributed to the spread of infectious diseases by traditional healers. A study of traditional healers in Nigeria found that 60% of the population was at risk because of the contamination spread by tradition healers. Women experience the most fatal impact from the HIV/AIDS epidemic. When industrial development required the labor of men from rural communities, the men often left those communities and while away at the migratory camps many of these men would have sex with prostitutes, become infected with HIV and return home with it. Furthermore, since traditional medicine does not have an early detection method, infectious diseases are often spread unknowingly, allowing the 3.1 million people infected with HIV in sub-Saharan Africa to grow exponentially to 25.4 million in 2004. The patriarchal culture that defines traditional marriages in rural areas, places female sexuality under male control and decrees that women are not permitted to discuss and practice safe sex with their partners, which results in a higher risk for HIV exposure for women in rural areas.


Modern medicine

Sub-Saharan countries have found ways to unite modern medicine with traditional medicine due to the urgency of the HIV/AIDS epidemic. In South Africa, the Kundalia Foundation has provided funding to train traditional healers on HIV/AIDS. The training included prevention, safe sex, and knowledge about the virus.


Relationship with modern medicine

Traditional African medicine served the people in Africa prior to the establishment of science-based medicine, but with the arrival of Europeans this changed. Although modern scientific medicine is successful in developed countries, it doesn't have the same positive impact in many of the underdeveloped African countries. Though science-based practices can make an impact in health care practices, in certain areas such as in the spread of various diseases, it cannot integrate wholly into the culture and society. This makes the traditional African practitioners a vital part of their health care system. There are many reasons why the modern medical system has not been as effective in Africa as it has in more developed parts of the world. Hospitals and medical facilities are difficult for many Africans to get to. With vast areas of land and poor road and transportation systems, many native Africans have to travel immense distances on foot to reach help. Once they arrive they are often required to wait in line for up to 8 hours, especially in urban areas, as the lack of clinics and resources cause over-crowding. Patients are often not told the cause of their illness or much information about it all, so they have no way to prevent or prepare for it. The technology used is usually of poor quality, which impairs the quality of treatment. Modern medicine can also be too expensive for the average African to afford, making it difficult for them to receive proper care. Finally, modern medicine removes native Africans from the culture and tradition and forces them into a setting that they are not comfortable with, away from their family and traditions which are of utmost importance to them. They do not get the proper spiritual healing that their culture seeks and traditional ideology requires. However, there has been more interest expressed recently in the effects of some of the medicinal plants of Africa. "The pharmaceutical industry has come to consider traditional medicine as a source for identification of bio-active agents that can be used in the preparation of medicine." Pharmaceutical industries are looking into the medicinal effects of the most commonly and widely used plants to use in drugs. In comparing the techniques of African healers and Western techniques, T. Adeoze Lambo, a Nigerian psychiatrist, stated in 1979, "At about three years ago, we made an evaluation, a programme of their work, and compared this with our own, and we discovered that actually they were scoring almost sixty percent success in their treatment of neurosis. And we were scoring forty percent-in fact, less than forty percent."


Effectiveness

Herbal medicines in Africa are generally not adequately researched, and are weakly regulated. There is a lack of the detailed documentation of the traditional knowledge, which is generally transferred orally. A literature survey in 2014, indicated that several African medicinal plants contain bioactive anti-trypanosomal compounds that could be used for the treatment of
African trypanosomiasis African trypanosomiasis, also known as African sleeping sickness or simply sleeping sickness, is an insect-borne parasitic infection of humans and other animals. It is caused by the species ''Trypanosoma brucei''. Humans are infected by two typ ...
("Sleeping sickness") but no clinical studies had been conducted on them. A 2008 literature survey found that only a small proportion of
ethnoveterinary medicine Ethnoveterinary medicine (EVM) considers that traditional practices of veterinary medicine are legitimate and seeks to validate them ( Köhler-Rollefson and Bräunig, 1998). Many non-Western traditions of veterinary medicine exist, such as acupunc ...
plants in South Africa had been researched for biological activity. A literature survey conducted in 2013 identified several compounds (mostly
glucoside A glucoside is a glycoside that is derived from glucose. Glucosides are common in plants, but rare in animals. Glucose is produced when a glucoside is hydrolysed by purely chemical means, or decomposed by fermentation or enzymes. The name was o ...
s,
sterol Sterol is an organic compound with formula , whose molecule is derived from that of gonane by replacement of a hydrogen atom in position 3 by a hydroxyl group. It is therefore an alcohol of gonane. More generally, any compounds that contain the go ...
s and
sterolin ABCG5 and ABCG8 genes encode for two proteins sterolin-1 and -2, respectively. Sterolin-1 and –2 are two ‘half’ adenosine triphosphate binding (ATP) cassette (ABC) transporters which found to be indispensable for the regulation of sterol a ...
s) contained in the ''
Hypoxis ''Hypoxis'' is a genus of flowering plants of the family Hypoxidaceae. The genus has an " almost cosmopolitan" distribution, occurring in Africa, the Americas, Asia, and Australia.Singh, Y. (Natal Herbarium, Durban)''Hypoxis''.PlantZAfrica.com: ...
'' species, (known locally as ''inkomfe'' or ''African potato'') that had been isolated and tested with "promising prospects reported in some studies". South African
sangomas Traditional healers of Southern Africa are practitioners of traditional African medicine in Southern Africa. They fulfill different social and political roles in the community, including divination, healing physical, emotional and spiritua ...
have been long and vocal advocates of a local traditional plant called ''unwele'' or ''kankerbos'' (''
Sutherlandia frutescens ''Sutherlandia frutescens'' (cancer bush, balloon pea, sutherlandia, phetola ("it changes") in seTswana, and insiswa ("the one that drives away the darkness") in isiZulu; syn. ''Colutea frutescens'' L., ''Lessertia frutescens'' (L.) Goldblatt & ...
'') claiming it assists in the treatment of HIV/AIDS, cancer and tuberculosis. A review of preclinical data on ''Sutherlandia frutescens'' show no toxity and justify controlled clinical studies. However, when used in conjunction with antiretroviral treatments, the herbal treatments
hypoxis ''Hypoxis'' is a genus of flowering plants of the family Hypoxidaceae. The genus has an " almost cosmopolitan" distribution, occurring in Africa, the Americas, Asia, and Australia.Singh, Y. (Natal Herbarium, Durban)''Hypoxis''.PlantZAfrica.com: ...
and sutherlandia "may put the patients at risk for antiretroviral treatment failure, viral resistance, or drug toxicity" since they interact with antiretroviral treatments and prevent the expression of
CYP3A4 Cytochrome P450 3A4 (abbreviated CYP3A4) () is an important enzyme in the body, mainly found in the liver and in the intestine. It oxidizes small foreign organic molecules (xenobiotics), such as toxins or drugs, so that they can be removed from t ...
and
P-glycoprotein P-glycoprotein 1 (permeability glycoprotein, abbreviated as P-gp or Pgp) also known as multidrug resistance protein 1 (MDR1) or ATP-binding cassette sub-family B member 1 (ABCB1) or cluster of differentiation 243 (CD243) is an important protein ...
. There have been attempts to assess some traditional medicines through clinical trials, although none have so far reached phase III.


Safety

A small proportion of ethnoveterinary medicine plants in South Africa have been researched for toxic effects. The possible adverse effects of South African traditional medicines are not well documented; there has been limited research into mutagenic properties and heavy metal contamination. Serious adverse effects, even death, can result from misidentification or misuse of healing plants. For example, various
aloe ''Aloe'' (; also written ''Aloë'') is a genus containing over 650 species of flowering succulent plants.WFO (2022): Aloe L. Published on the Internet;http://www.worldfloraonline.org/taxon/wfo-4000001341. Accessed on: 06 Nov 2022 The most wid ...
plants are widely used in traditional African medicine, but some varieties, such as '' Aloe globuligemma'', are toxic and can cause death. The potential for traditional African medicine and
pharmacokinetic Pharmacokinetics (from Ancient Greek ''pharmakon'' "drug" and ''kinetikos'' "moving, putting in motion"; see chemical kinetics), sometimes abbreviated as PK, is a branch of pharmacology dedicated to determining the fate of substances administered ...
interactions is unknown, especially interactions between traditional treatments and
antiretroviral The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multipl ...
drugs for HIV/AIDS. Herbal treatments are frequently used in Africa as a primary treatment for HIV/AIDS and for HIV-related issues. Collaboration with traditional healers has been recommended to determine what herbal treatments are used for HIV and to educate people supplying alternative treatments against unsafe practices. Given the demands of the local population on the use of traditional African medicine, it has been proposed that South African medical schools should inform medical students about traditional, supplementary and alternative medicine and the possible conflicts and interactions with modern medicine. Use of traditional African medicines as antivirals instead of using specific antiretroviral drugs, is especially a risk with HIV. Cultural expectations play an important role in treatment as a 1985 study amongst the Mende people of Sierra Leone showed that treatment decisions were made "largely on traditional notions of the efficacy of a medicine of a particular color, consistency, taste, size and reputed success in treating analogous illnesses". This led to the inappropriate use of many modern medicines by the Mende.


See also

*
Infant oral mutilation Infant oral mutilation (IOM) is a dangerous and sometimes fatal dental procedure performed by some practitioners of traditional medicine in many areas of Africa. Description Typically, a parent may take a sick child to a traditional healer, who w ...
*
Pharmacognosy Pharmacognosy is the study of medicinal plants and other natural substances as sources of drugs. The American Society of Pharmacognosy defines pharmacognosy as "the study of the physical, chemical, biochemical, and biological properties of drug ...
*
San healing practices In the culture of the San (also known as Ju/'oansi, !Kung, or Bushmen), an indigenous people of Botswana, Namibia, South Africa, and Angola, healers administer a wide range of practices, from oral remedies containing plant and animal material, ...
*
Traditional and Modern Health Practitioners Together against AIDS Traditional and Modern Health Practitioners Together against AIDS (THETA) is a non-government organization in Uganda that promotes collaboration between Traditional African medicine, traditional healers and Biomedicine, biomedical practitioners to ...
*
Traditional Hausa medicine This article is about traditional Hausa medicine practised by the Hausa people of West Africa. Hausa medicine is heavily characterized by Islamic influence and traditional, African-style herbology, and religious practices which are still prevalent ...
*
Yorùbá medicine Yorùbá medicine, or egbòogi, is an African system of herbalism practiced primarily in West Africa and the Caribbean. Basic philosophies According to A D Buckley, Yorùbá medicine has major similarities to conventional medicine in the sense th ...
* Plant Resources of Tropical Africa


References

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External links


PROMETRA Official Website

THETA Uganda Official Website


Bibliography

* Bruchhausen, Walter (2018). Medicalized Healing in East Africa: The Separation of Medicine and Religion by Politics and Science. In: Lüddeckens, D., & Schrimpf, M. (2018)
Medicine - religion - spirituality: Global perspectives on traditional, complementary, and alternative healing
Bielefeld: transcript Verlag. , pp. 23–56. {{DEFAULTSORT:African Traditional Medicine 01 Oral tradition Pseudoscience Traditional knowledge