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Traditional African medicine is a range of
traditional medicine Traditional medicine (also known as indigenous medicine or folk medicine) comprises medical aspects of traditional knowledge that developed over generations within the folk beliefs of various societies, including indigenous peoples, before the ...
disciplines involving
indigenous Indigenous may refer to: *Indigenous peoples *Indigenous (ecology), presence in a region as the result of only natural processes, with no human intervention *Indigenous (band), an American blues-rock band *Indigenous (horse), a Hong Kong racehorse ...
herbalism Herbal medicine (also herbalism) is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine. With worldwide research into pharmacology, some herbal medicines have been translated into modern reme ...
and African spirituality, typically including
diviners 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 history ...
, midwives, and
herbalists Herbal medicine (also herbalism) is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine. With worldwide research into pharmacology, some herbal medicines have been translated into modern remed ...
. Practitioners of traditional African medicine claim to be able to cure a variety of diverse conditions including cancer, psychiatric disorders, high blood pressure, cholera, most venereal diseases,
epilepsy Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrica ...
,
asthma Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, co ...
,
eczema Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can ...
, fever, anxiety, depression,
benign prostatic hyperplasia Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss o ...
, urinary tract infections, gout, and healing of wounds and burns and even Ebola. 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 Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practices ...
, 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 Traditional medicine (also known as indigenous medicine or folk medicine) comprises medical aspects of traditional knowledge that developed over generations within the folk beliefs of various societies, including indigenous peoples, before the ...
was the dominant medical system for millions of people in Africa prior the arrival of the Europeans, 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 Traditional knowledge (TK), indigenous knowledge (IK) and local knowledge generally refer to knowledge systems embedded in the cultural traditions of regional, indigenous, or local communities. According to the World Intellectual Property Organ ...
, which is generally transferred orally. Serious
adverse effect An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a " side effect", when judged to be secondary to a main or therapeutic effect. The term compl ...
s can result from mis-identification or misuse of healing plants. The geographical reach of this article is Sub-Saharan Africa. 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 Colonialism is a practice or policy of control by one people or power over other people or areas, often by establishing colony, colonies and generally with the aim of economic dominance. In the process of colonisation, colonisers may impose the ...
some traditional medical practices were outlawed. During this time, attempts were also made to control the sale of herbal medicines. For example, after
Mozambique Mozambique (), officially the Republic of Mozambique ( pt, Moçambique or , ; ny, Mozambiki; sw, Msumbiji; ts, Muzambhiki), is a country located in southeastern Africa bordered by the Indian Ocean to the east, Tanzania to the north, Malawi ...
gained independence in 1975, attempts to control traditional medicine went as far as sending diviner-healers to re-education camps. As colonialism and
Christianity Christianity is an Abrahamic monotheistic religion based on the life and teachings of Jesus of Nazareth. It is the world's largest and most widespread religion with roughly 2.38 billion followers representing one-third of the global pop ...
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 systems 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,
iridology Iridology (also known as iridodiagnosisCline D; Hofstetter HW; Griffin JR. ''Dictionary of Visual Science''. 4th ed. Butterworth-Heinemann, Boston 1997. or iridiagnosis) is an alternative medicine technique whose proponents claim that pattern ...
, and traditional Asian medicine.


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
incantation An incantation, a spell, a charm, an enchantment or a bewitchery, is a magical formula intended to trigger a magical effect on a person or objects. The formula can be spoken, sung or chanted. An incantation can also be performed during ceremo ...
s to make a diagnosis. The incantations are thought to give the air of mystical and cosmic connections. Divination 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 sacrifices.


Treatments

Traditional practitioners use a wide variety of treatments ranging from standard medical treatments to the pseudoscientific and "magical". Treatments may include
fasting Fasting is the abstention from eating and sometimes drinking. From a purely physiological context, "fasting" may refer to the metabolic status of a person who has not eaten overnight (see " Breakfast"), or to the metabolic state achieved after ...
, dieting, herbal therapies, bathing,
massage Massage is the manipulation of the body's soft tissues. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet or a device. The purpose of massage is generally for the treatment of body stress or pain. In E ...
, 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 Migraines, coughs, abscesses, and
pleurisy Pleurisy, also known as pleuritis, is inflammation of the membranes that surround the lungs and line the chest cavity ( pleurae). This can result in a sharp chest pain while breathing. Occasionally the pain may be a constant dull ache. Other sy ...
. * Some cultures rub hot herbal ointment across the patient's eyelids to treat
headaches Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches. Headaches can occur as a result ...
. * A steaming mixture of herbs is both consumed and inhaled in the treatment of
Malaria Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...
. Fevers are often treated using a steam bath. * Vomiting induced by
emetics Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis ...
is used to treat
alcoholism Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Because there is disagreement on the definition of the word ''alcoholism'', it is not a recognized diagnostic entity. Predomi ...
. * The fat of a boa constrictor is used to treat
gout Gout ( ) is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot and swollen joint, caused by deposition of monosodium urate monohydrate crystals. Pain typically comes on rapidly, reaching maximal intens ...
and rheumatism, and is thought to relieve chest pain when applied
topically A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...
. * 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. * The
terpenoid The terpenoids, also known as isoprenoids, are a class of naturally occurring organic chemicals derived from the 5-carbon compound isoprene and its derivatives called terpenes, diterpenes, etc. While sometimes used interchangeably with "terpenes" ...
s of the blister beetle (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 Johannesburg ( , , ; Zulu and xh, eGoli ), colloquially known as Jozi, Joburg, or "The City of Gold", is the largest city in South Africa, classified as a megacity, and is one of the 100 largest urban areas in the world. According to Dem ...
, 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 Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss o ...
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,
tincture A tincture is typically an extract of plant or animal material dissolved in ethanol (ethyl alcohol). Solvent concentrations of 25–60% are common, but may run as high as 90%.Groot Handboek Geneeskrachtige Planten by Geert Verhelst In chemistr ...
s, and pills. A 2007 study investigated the effectiveness of 16 plants, growing in South Africa's KwaZulu-Natal 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 Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Blood pressure is indicated by two numbers, the systolic blood pressure (the top number) and the dia ...
activity", i.e. reduction of blood pressure. The plants included in the study were: # '' Amaranthus dubius'', a flowering plant, also known as spleen amaranth # '' Amaranthus hybridus'', commonly known as smooth pig-weed or slim amaranth # ''
Amaranthus spinosus ''Amaranthus spinosus'', commonly known as the spiny amaranth, spiny pigweed, prickly amaranth or thorny amaranth, is a plant that is native to the tropical Americas, but is present on most continents as an introduced species and sometimes a nox ...
'', also known as spiny amaranth # '' Asystasia gangetica'', an ornamental ground cover known as Chinese violet. # ''
Centella asiatica ''Centella asiatica'', commonly known as gotu kola, kodavan, Indian pennywort and Asiatic pennywort, is a herbaceous, perennial plant in the flowering plant family Apiaceae. It is native to tropical regions of Africa, Asia, Australia, and islan ...
'', 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 ''Chenopodium album'' is a fast-growing weedy annual plant in the genus ''Chenopodium''. Though cultivated in some regions, the plant is elsewhere considered a weed. Common names include lamb's quarters, melde, goosefoot, wild spinach and fat-h ...
'', also called lamb's quarters, this is a weedy annual plant # '' Emex australis'', commonly known as southern three corner jack # '' Galinsoga parviflora'', commonly referred to as gallant soldier # ''Justicia flava'', also known as yellow ''justicia'' # '' Momordica balsamina'', also known as the balsam apple # ''Oxygonum sinuatum'', an invasive weed with no common name # '' Physalis viscosa'', 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 Genus ( plural genera ) is a taxonomic rank used in the biological classification of living and fossil organisms as well as viruses. In the hierarchy of biological classification, genus comes above species and below family. In binomial nom ...
Aloe within the family
Asphodeloideae Asphodeloideae is a subfamily of the monocot family Asphodelaceae in the order Asparagales. It has previously been treated as a separate family, Asphodelaceae ''sensu stricto''. The family Asphodelaceae has now been proposed to be a nomen conserv ...
. 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'', "cytotoxicity on colon carcinoma cells" and "ferric reducing antioxidant power." Among the constituents of the essential oil are spathulenol and
limonene Limonene is a colorless liquid aliphatic hydrocarbon classified as a cyclic monoterpene, and is the major component in the oil of citrus fruit peels. The -isomer, occurring more commonly in nature as the fragrance of oranges, is a flavoring a ...
. 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 ''Zanthoxylum'' is a genus of about 250 species of deciduous and evergreen trees, shrubs and climbers in the family Rutaceae that are native to warm temperate and subtropical areas worldwide. It is the type genus of the tribe Zanthoxyleae in ...
'', 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 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 Amenorrhea is the absence of a menstrual period in a woman of reproductive age. Physiological states of amenorrhoea are seen, most commonly, during pregnancy and lactation (breastfeeding). Outside the reproductive years, there is absence of menses ...
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 Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, co ...
, 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 Decoction is a method of extraction by boiling herbal or plant material (which may include stems, roots, bark and rhizomes) to dissolve the chemicals of the material. It is the most common preparation method in various herbal-medicine systems. Dec ...
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 Nigeria ( ), , ig, Naìjíríyà, yo, Nàìjíríà, pcm, Naijá , ff, Naajeeriya, kcg, Naijeriya officially the Federal Republic of Nigeria, is a country in West Africa. It is situated between the Sahel to the north and the Gulf o ...
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 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 The term Voodoo doll commonly describes an effigy into which pins are inserted. Such practices are found in various forms in the magical traditions of many cultures around the world. Despite its name, the dolls are not prominent in Haitian Vodo ...
. 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 The Kalahari Desert is a large semi-arid sandy savanna in Southern Africa extending for , covering much of Botswana, and parts of Namibia and South Africa. It is not to be confused with the Angolan, Namibian, and South African Namib coastal d ...
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 "Tribal Dance" is a song by Belgian/Dutch Eurodance band 2 Unlimited. It was their sixth single, released in April 1993 from the band's second album, '' No Limits!'' (1993). The UK release omitted the main rap, but left in more vocals from Ray ...
.


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 are experts in herbalism, whilst others, such as the South African sangomas, are experts in spiritual healing as
diviners 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 history ...
, and others specialize in a combination of both forms of practice. There are also traditional bone setters and birth attendants.
Herbalists Herbal medicine (also herbalism) is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine. With worldwide research into pharmacology, some herbal medicines have been translated into modern remed ...
are becoming more and more popular in Africa with an emerging herb trading market in
Durban Durban ( ) ( zu, eThekwini, from meaning 'the port' also called zu, eZibubulungwini for the mountain range that terminates in the area), nicknamed ''Durbs'',Ishani ChettyCity nicknames in SA and across the worldArticle on ''news24.com'' from ...
that is said to attract between 700,000 and 900,000 traders per year from South Africa,
Zimbabwe Zimbabwe (), officially the Republic of Zimbabwe, is a landlocked country located in Southeast Africa, between the Zambezi and Limpopo Rivers, bordered by South Africa to the south, Botswana to the south-west, Zambia to the north, and ...
, and
Mozambique Mozambique (), officially the Republic of Mozambique ( pt, Moçambique or , ; ny, Mozambiki; sw, Msumbiji; ts, Muzambhiki), is a country located in southeastern Africa bordered by the Indian Ocean to the east, Tanzania to the north, Malawi ...
. 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 A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery. The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; co ...
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 Apprenticeship is a system for training a new generation of practitioners of a trade or profession with on-the-job training and often some accompanying study (classroom work and reading). Apprenticeships can also enable practitioners to gain a ...
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. 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 Ghana (; tw, Gaana, ee, Gana), officially the Republic of Ghana, is a country in West Africa. It abuts the Gulf of Guinea and the Atlantic Ocean to the south, sharing borders with Ivory Coast in the west, Burkina Faso in the north, and To ...
to Eswatini 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 The pharmaceutical industry discovers, develops, produces, and markets drugs or pharmaceutical drugs for use as medications to be administered to patients (or self-administered), with the aim to cure them, vaccinate them, or alleviate symptoms. ...
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 Ecology () is the study of the relationships between living organisms, including humans, and their physical environment. Ecology considers organisms at the individual, population, community, ecosystem, and biosphere level. Ecology overlaps wi ...
risk, as this may lead to their extinction.


Traditional African medicine in relation to women

Women in
Sub-Saharan 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 African co ...
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 and
sutherlandia ''Sutherlandia'' is a genus of flowering plants in the family Fabaceae containing six known living species. The genus was once organized as having a single species, ''S. frutescens'', but later expanded to include more based on morphological ch ...
"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 and P-glycoprotein. 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 issued by the
United States Department of Health and Human Services The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
, 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 The Nuremberg Code (german: Nürnberger Kodex) is a set of ethical research principles for human experimentation created by the court in '' U.S. v Brandt'', one of the Subsequent Nuremberg trials that were held after the Second World War. Tho ...
, 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 Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practices ...
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 The pharmaceutical industry discovers, develops, produces, and markets drugs or pharmaceutical drugs for use as medications to be administered to patients (or self-administered), with the aim to cure them, vaccinate them, or alleviate symptoms. ...
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 Neurosis is a class of functional mental disorders involving chronic distress, but neither delusions nor hallucinations. The term is no longer used by the professional psychiatric community in the United States, having been eliminated from th ...
. 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 Traditional knowledge (TK), indigenous knowledge (IK) and local knowledge generally refer to knowledge systems embedded in the cultural traditions of regional, indigenous, or local communities. According to the World Intellectual Property Organ ...
, 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 ("Sleeping sickness") but no clinical studies had been conducted on them. A 2008 literature survey found that only a small proportion of ethnoveterinary medicine plants in South Africa had been researched for biological activity. A literature survey conducted in 2013 identified several compounds (mostly glucosides, sterols and sterolins) contained in the '' Hypoxis'' species, (known locally as ''inkomfe'' or ''African potato'') that had been isolated and tested with "promising prospects reported in some studies". South African sangomas have been long and vocal advocates of a local traditional plant called ''unwele'' or ''kankerbos'' ('' Sutherlandia frutescens'') claiming it assists in the treatment of
HIV/AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual ...
,
cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
and
tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, i ...
. 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 and
sutherlandia ''Sutherlandia'' is a genus of flowering plants in the family Fabaceae containing six known living species. The genus was once organized as having a single species, ''S. frutescens'', but later expanded to include more based on morphological ch ...
"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 and P-glycoprotein. There have been attempts to assess some traditional medicines through
clinical trial Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, diet ...
s, 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 effect An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a " side effect", when judged to be secondary to a main or therapeutic effect. The term compl ...
s of South African traditional medicines are not well documented; there has been limited research into
mutagenic In genetics, a mutagen is a physical or chemical agent that permanently changes genetic material, usually DNA, in an organism and thus increases the frequency of mutations above the natural background level. As many mutations can cause cancer i ...
properties and heavy metal contamination. Serious adverse effects, even death, can result from misidentification or misuse of healing plants. For example, various aloe 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 interactions is unknown, especially interactions between traditional treatments and antiretroviral 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 Sierra Leone,)]. officially the Republic of Sierra Leone, is a country on the southwest coast of West Africa. It is bordered by Liberia to the southeast and Guinea surrounds the northern half of the nation. Covering a total area of , Sierr ...
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 * Pharmacognosy * San healing practices * Traditional and Modern Health Practitioners Together against AIDS * Traditional Hausa medicine * Yorùbá medicine *
Plant Resources of Tropical Africa __NOTOC__ Plant Resources of Tropical Africa, known by its acronym PROTA, is a retired NGO and interdisciplinary documentation programme active between 2000 and 2013. PROTA produced a large database and various publications about Africa's useful ...


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