HEALING AND MEDICINE: HEALING AND MEDICINE IN AFRICA

Traditional African healing falls into three basic categories of treatment: common folk remedies known to most family members that usually do not require ritual observances; secret remedies handed down from mother to daughter or from father to son; and treatments administered only by priests or other specialized healers. These specialists, including priests, undergo training periods and initiations, and receive payment for their services. Africans do not distinguish between body and mind as far as treatment for illness is concerned. While much of African healing is based on practical knowledge and experience, it is also situated within specific social and religious contexts that frequently require ritual actions.

Religious Background

All African religions are monotheistic; that is, they are based on belief in a single divine being (Smith, 1950), but in most cases this Creator or Architect has lost interest in the everyday affairs of human beings. Thus, when people call on this being for help or approach him for healing or blessings, they usually make their supplications through or to intermediaries. In some cases the belief system includes other beings, the result being a pantheon of gods or more frequently a collection of spirits and shades. Some writers refer to the shades as ancestors, ancestor spirits, or the living dead who serve as intercessors.

African cultures and their associated religions should be understood within their respective geographical and ecological contexts. West Africa differs in many respects from the rest of Africa, while lesser features distinguish between east-central and southern Africa. These differences were originally highlighted in Melville J. Herskovits's discussion of culture areas in Africa, but are also obvious in the religious structure. Geoffrey Parrinder explained in his 1949 study of West African religion that the supreme being frequently emerges as the first among equals. Examples include Onyame among the Akan people, which includes the Asante of Ghana and the Ivory Coast; Mawu among the Fon and Ewe of Benin; or Olorun among the Nigerian Yoruba. Below the supreme being are intermediary deities or chief divinities that are nonhuman in origin and often associated with natural forces. These gods require temporary dwelling places and priestly service. Spirits and shades, who are closer to living people than either the supreme god or lesser deities, are on the third level. Below the shades is a fourth level of sacred charms and amulets with special powers.

People in the rest of sub-Saharan Africa hold a very strong belief in deceased family members who have been ritually set apart as shades. They may ask these deceased relatives to intercede with the supreme being, who is known as Mulungu among the Kamba and uMvelinqangi (the First Being) or uNkulunkulu (the Great-Great One) among the Zulu. The Kamba recognize Mulungu as a creator and preserver, and they venerate the spirits of the departed. These people believe that their ancestors play a major role in maintaining their physical and mental health. Normally they offer the shades sacrifices or food gifts accompanied by requests for blessings, health, and cures. There need not be a special meeting, a formal setting, or a religious gathering for offerings and prayers. When people take a meal, they flick small pieces of food over the shoulder, pour out a few drops of beer, give thanks, or make a short specific request of the shades. They may also invoke the shades in praise songs and formal addresses when they offer sacrifices or perform other rituals. They may eulogize, plead with, or even threaten the shades—as when a Zulu warns an ancestor to cure or bless him by saying, "If I die, there will be no one to bring you sacrifices."

Healing in Africa represents an attempt to answer two basic questions: How did the illness or traumatic accident happen? And why did it happen (to me or to my family)? The unseen world also contains forces, both good and evil, that must be controlled or employed by specialists in healing. An exception to this rule might be the Nuer of Sudan, who believe that all misfortunes derive from God. In fact the members of this group have very few medications and doubt even their efficacy (Evans-Pritchard, 1956).

Health

An absence of health and well-being suggests illness (a cultural concept) or disease (a pathological concept). Patients suffer illnesses, but modern physicians diagnose and treat diseases. Traditional healers address the illness while attempting to cure the disease. In all of Africa, an imbalance in the body, or between the body and the social or natural environment, is caused by sorcery and witchcraft, which operate in the religio-magical field.

The Akan hold a representative West African concept of health in that they understand it as a correct relationship with one's environment, both natural and social (Appiah-Kubi, 1981). The Akan regard health and disease as inextricably connected to social behavior and moral conduct. Illness represents an unbalanced relationship with the environment, although it may also result from the malevolence of an evil spirit or witch. The essential person for treating illness in this context is the priest-healer.

The Kamba of eastern Africa distinguish between God-given and natural diseases. "'Witchcraft' (merged conceptually with sorcery) has become a 'catch-all' explanation for myriad disorders in interpersonal relations. It was also a widely acceptable cause of personal failings ranging from lack of success in business, love, and school to sudden illness or strange disease, and especially barrenness and impotency" (Good, 1987, p. 223). Among the Taita, however, religious practices are directed toward turning away anger in any form and restoring peace, health, and general well-being. The Swahili regard restoration to health as the result of correcting an imbalance in the body. This view is related to the beliefs of other Muslim groups in West and East Africa (Trimmingham, 1969; du Toit and Abdalla, 1985).

The Zulu of southern Africa are representative of a wide range of Bantu-speaking peoples. The term isifo refers to disease manifested in somatic symptoms, various forms of misfortune, and a general state of vulnerability to misfortune and disease. Harriet Ngubane (1977) explains that illnesses among the Zulu fall into two categories. The first group is caused by biological factors associated with living and aging. Diseases in this category are not the patient's fault and can be treated or cured by potent nonritual means, including Western medicine. Diseases in the second category result from imbalances between a person and the natural environment, or in the sufferer's interpersonal relations. Treatment requires the restoration of order and balance. Good health flows from the internal and external harmony of a person's life with the social as well as the physical universe. Ideally a person is in harmony internally, in external social relationships, and in relation to nature.

Healing

Illness does not necessarily involve an individual event as much as it reflects a disturbance in social relations. The effect of such disturbances in the body or the social setting may result in illness without disease. Disorder may manifest itself in physical, emotional, spiritual, or social discomfort. Treatment must therefore involve restoration of the body or of the person's overall human nature, and it must occur in the familiar social setting. The personnel involved in healing span the range from diagnosticians and healers in contact with spirits to ethnobotanical specialists and applied psychologists. In West Africa the Akan distinguish among priests or priestesses, herbalists, bonesetters, and birth attendants. The Yoruba of Nigeria differentiate between priests of the Ifá cult, the babaláwo who specialize in divination and psychotherapy, and oníşègùn or herbalists. It is common in East Africa to find healers categorized as diagnosticians, herbalists, birth attendants, and surgeons who perform male and female circumcisions. In southern Africa diagnosticians and herbalists are the major categories of healers, although individual practitioners may become specialists.

Diviner-diagnosticians

Throughout Africa the diagnostician is essentially the person who receives and interprets communications from the supernatural world. Appiah-Kubi states that "Traditional Akan practitioners often determine the cause of disease … [now] patients complain that it is they who make their own diagnosis, while the modern doctor merely puts a label on their disease" (1981, p. 75). In many cases material objects are employed as receivers of messages from the spirit world. Diagnosticians may make use of divining bones, as among the Sotho and Tonga; divining bowls, as among the Venda; or direct communication with the spirits, as among the Nguni-speakers. Nguni-speaking diagnosticians may listen for voices or ask the patient to respond to questions. While asking the questions, the diviner is in fact watching the dilation of the patient's eyes, listening to respirations, and touching the patient to note changes in body temperature. Edgerton (1971) describes the questions that were asked by Abedi, a psychiatrist among the Hehe of Tanzania. "Abedi was probing carefully for an understanding of the social context of the illness. Who might be an enemy? What is the patient fearful about?" (p. 296).

The peoples of West Africa distinguish among priests and assistants who are dedicated to the service of a particular god, seers, and herbalists. The priest or priestess, who is also called a medium, is found in Asante, Ewe, Fon, Yoruba and other societies. The medium enters a trance state and sits in front of the shrine while communicating with the god residing in the shrine. Among the Ga such mediums, if married, must leave their families—although male mediums are allowed to remarry following their training. The medium is appointed by the village chief or priest. Training takes two to three years and is accompanied by strict discipline. The Fon and Yoruba have "convents" for the training of mediums: the course of instruction takes nine months for a boy but three years for a girl. The Bariba of Benin regard healing at the domestic level as an extension of the nurturing role. Thus they prepare medicines for skin diseases, respiratory disorders, and gastrointestinal ailments for children and even adult members of the family. They also treat themselves for malaria or diarrhea. The adults consult female or male healers called medicine people for more severe disorders. The male medicine people, however, are always considered senior to the females. There is also a widespread belief that women of childbearing age are dangerous and may contaminate medicines; consequently only men or postmenopausal women may administer strong medicines to combat dangerous or stubborn afflictions.

In eastern, central, and southern Africa there exists a widespread therapeutic tradition based on the role of diagnostician-diviners. These healers' names are variations on the root ngoma. The term is associated with drums and the rhythms of song and dance. Thus Victor Turner titled his 1968 study of the Zambian Ndembu therapies The Drums of Affliction. Typical health problems treated with Ngoma therapy include impotence in men, infertility in women, epilepsy, snake bites (in Tanzania), the testing of dreams and visions, and personal difficulties of human or spirit origin. Some forms of Ngoma therapy are effective variations of psychotherapy.

A clear pattern exists in East Africa, where the Kamba recognize a category of religio-medical specialists. Although this group includes both genders, medicine women are more common than medicine men. Aided by supernatural powers, they practice divination, curing the sick, and invoking ritual protection for livestock and fields. The Giriama of Kenya recognize diviners, mostly women, who are innocent mediums through whom powerful Islamic and other foreign spirits communicate. These women practice diagnosis as well as divination. Among the Swahili the "spirit doctor" is consulted by patients who suspect that their illnesses are produced by sorcery.

Diviner-diagnosticians among the Sotho peoples of southern Africa employ divining bones. Among the Nguni, including the Zulu, the ancestral shades are said to guide the diviner. The diviner's profession is not hereditary. Any person can become ill, which is a sign of calling, and undergo a lengthy initiation. While the author was carrying out research in an urban area outside of Durban in 1974, a boy about thirteen years of age had dreams about the neighbors. Time and again these dreams proved uncannily correct. A short while later the author was invited to a sacrifice and farewell for the boy, who had obviously been "called" by the shades and was being sent to northern KwaZulu-Natal for traditional training. Diviners, however, are usually women who do not choose to become diviners but are chosen by the shades. The shades do not take possession of the diviner's body but "sit" on her shoulders and whisper into her ears. Among the neighboring Swazi, the shades may also "call" an apprentice. The diviner's training lasts an average of three years and costs several hundred dollars in cash as well as one or more cows and goats for sacrifice to the shades.

Herbalists

Most African societies recognize persons with specialized knowledge concerning plants and their therapeutic properties as well as diviners and spirit doctors. What is meant by pharmacopoeia in Africa, however, is best described as faith in the curative properties of compounds with a vegetal base. What these products lack in curative value is compensated by the ritual that enhances the patient's faith. African healers have an extensive knowledge of the properties of barks, roots, leaves, and herbs, as well as the catalytic effects of plant combinations or mixtures. Every African society has a category of herbalists who dispense remedies on the basis of either spirit guidance or symptom recognition. Such plant-based remedies may be administered as plasters, sedatives, purges, or cures. Their success requires two basic ingredients: the power of the practitioner's thought and will, and the patient's faith. Herbalists, who may be either men or women, are "called" by the shades in dreams, visions, or waking summons.

As in many other contexts, medicinal plants in West Africa may be personified. Before digging a root or cutting a branch or leaf for treatment purposes, the herbalist must put down some eggs, a mashed yam, or a sacrificial bird; otherwise the plant will lose its potency. Among the Azande of Sudan a young person who feels called to be a herbalist will start a long and costly training period. The teacher scrutinizes the student's intent to provide medicine to strengthen the soul and confer special powers. When the training has been completed, the candidate is admitted to the society of his or her colleagues. Among the Azande, this ceremonial reception involves undergoing a public burial after which the initiate joins the association of medicine people. As long as Africans regard sickness and misfortune as religious or spiritual experiences, traditional curers will continue to practice their callings.

Herbal remedies may be selected for a variety of reasons. Their efficacy may be related to such qualities as taste, smell, appearance, and texture. Color is among the most common signatures of effectiveness. The Hausa of northern Nigeria use red plants (including henna, red root, and blood root) to treat wounds and to fortify the blood. Such yellow plants as goldthread or goldenrod are used to treat jaundice. Milky latex is used to stimulate lactation in women after childbirth. One of the most important problems that traditional doctors confront is infertility. Plants that produce copious amounts of flowers, fruits, or seeds are used as fertility enhancers in the same way that plants which readily shed their ripe fruit are used to ease the process of childbirth.

The Giriama of Kenya use the term muganga for both diviners and herbalists, although they also indicate a healer's field of specialization within this generic classification. Examples include a diviner who is called a "doctor of the head" and a herbalist who is called a "healer of the basket." This differentiation underscores the belief that both practitioners are doctors whose healing skills range quite widely. Swahili herbal doctors learn their profession from their fathers. They share a basic belief in the balance theory of illness with Muslims beyond Africa. The concept of balance is not limited to the body and its functions but extends to social morality as well.

The basic term for herbalist, based on the root -nga, appears throughout eastern, central, and southern Africa, although the specific distinctions between diagnosticians and herbalists may have become blurred in some instances. Thus the Shona (Gelfand, 1962) distinguish between nganga who use divining bones and nganga who treat ailments with herbs and other medicaments. Many groups, however, combine these healing functions in one person. Good (1987) speaks of the East African mganga. Elsewhere, the Shona refer to nganga, speakers of Sotho to ngaka, and speakers of Nguni to nyanga. These healers are called by the shades and undergo apprenticeships in which botanical and ritual knowledge is passed from mother to daughter or from father to son. Treatments or prescriptions may call for sacrifices to placate the spirits or shades who may have been afflicting the patient with bad luck or poor health. The first form of treatment administered is purification through administration of an enema or induced vomiting. The second is the use of herbal medicines. The Zulu word umuthi (literally "tree" or "shrub") applies to noxious as well as curative substances of vegetable origin. The same root for tree is found throughout the Bantu-speaking world—umuti among the Lamba of Zambia, muti among the Shona of Zimbabwe, and amuti among the Herero of Namibia—and points to the vegetative base of all healing. A researcher among the Zambian Bemba explains, "I know no Bemba charm which does not contain the roots, bark, or leaves of at least two different trees" (Richards, 1961, p. 232).

Social context

African patients rarely consult a diagnostician or healer unless they are accompanied by a family or village member. Sickness occurs in the social setting, and therefore curing must also take place in that setting. Referring to these support groups, Charles Good (1987) refers to the "significant others," while Jan Janzen, writing in 1978 about the people of lower Zaïre (now Congo), illustrated the importance of the "therapy managing group" who must be part of the diagnosis and treatment. Members of this support group accompany the patient to consultations with the diagnostician and are involved in the rituals and administration of medications that follow such meetings.

Childbirth

Among the Bariba of Benin practicing midwives are usually postmenopausal women with several living children. The midwives occupy a curious position in the hierarchy of healers. Some women serve as informal assistants at problematic deliveries of neighbors and kin. Women who have served an apprenticeship under a midwife, however, may employ ritual incantations, gestures, and sympathetic magic as well as herbal medicines when they assist a woman in labor. Some Africans view midwives as true healers while others regard them as technicians.

Islamic influences are clearly present among the Wolof of Senegal and Gambia. Before a newborn infant is allowed to suckle, the child must drink a potion made from washing off a verse from the Qurʾān that had been written on a wooden slate. This verse is meant to keep away malevolent spirits. A goat is also sacrificed. Rituals surrounding birth are performed not only to strengthen the mother and child, but also to keep evil forces at bay. In addition, powers in the supernatural realm always receive recognition. The Gikuyu in Kenya recognize a normal birth by secluding the mother for a few days, following which she shaves her head and the father sacrifices a sheep in thanksgiving to God and the shades. This act of sacrifice, accompanied by brewing beer, is also performed to mark the birth of a Zulu child.

Surgery

Traditional African healers possess an extensive knowledge of human anatomy. Some of this knowledge is gleaned from observing the carcasses of hunted or domestic animals, while other anatomical information is obtained from treating human victims of hostilities or accidents.

One form of specialization among the Akan in West Africa was the bonesetter. Such a person was skilled in treating patients with rheumatism and arthritis. The bonesetter also functioned as an orthopedic surgeon, helping to repair broken limbs.

The most common forms of surgery are related to life-cycle changes. These procedures may involve extracting the incisor teeth; scarification; and various forms of circumcision of males (removal of the prepuce, subincision, or superincision) and females (removal of the prepuce of the clitoris, clitoridectomy, or infibulation). In many societies these latter events take place in the context of elaborate rituals presenting the initiates to the shades. The addresses made on these occasions are prayers complete with supplication, praise, and personal commentary. Postsurgical treatment of patients involves herbs, poultices, and wraps with astringent or disinfectant properties.

A number of societies employ cupping, or placing a horn over a bleeding incision, as a form of therapy. The Kamba and Maasai of Kenya used thorns to suture incisions. The former of these groups are reported to have removed the uvula of patients, while the Maasai also perform amputations of limbs with hopelessly complicated fractures. The Zimbabwean Shona fill a bleeding wound with spider webs. The resulting contraction of blood vessels stanches the flow of blood. Trephination is performed in Uganda and Nigeria. Robert Anderson (1996, p. 360) recounts the method of carrying out this procedure among the East African Kisii and Bakuria. Following severe trauma to the head resulting in fracture, the patient's head is shaved and a cut made through the skin, muscle, and underlying connective tissue. Bleeding is controlled by the application of herbal powders and charcoal. The surgeon scrapes away the bone with a sharp knife, taking care to avoid penetrating the dura mater, which is the outermost of three layers of protective membrane surrounding the brain and spinal cord.

Protection

Protection may simply refer to maintaining the personal and environmental balance essential to health. It may involve matching hot and cold items, or sour and sweet substances. Rituals for protection are performed for both persons and residences. In the case of persons, such rituals are prophylactic and normally take the form of taboos. These may include meticulous avoidance of forbidden objects and the careful execution of ritual observances. A taboo limits contact between people and objects that may be defiling or between healthy persons and those who are either contaminated or weak, such as postpartum mothers, newborn infants, and others in various marginal conditions. The Yoruba have a smallpox deity served by a priest who is immune to the disease following recovery from it. They also use their left hand to handle dirty objects in order to keep the right hand clean for eating. In African villages, disease and misfortune are religious experiences and must be approached from a religious perspective. That is why these same protection rituals are currently being performed for Christians (Oosthuizen et al., 1988).

The Yoruba use the same word oogùn for medicine and charm. A good doctor is an oníşègùn, while a witch (the owner of medicine) is an oloogùn. Medicines cure while charms ward off danger. The most powerful protective charm found among the Asante as well as among the peoples of Benin and Nigeria, is a small broom of palm fibers with sacred objects attached. It is the object of sacrifices and takes evils upon itself. Most houses are protected by charms hanging above the doorway. Muslims use yellowed and dusty pieces of paper floating from the roof inscribed with texts from the Qurʾān. Nearly all the fields are protected with charms as well as the entrances to villages. Travelers in the area frequently enter a village by passing under a protective arch. The Ndebele medicine men supply medicated pegs for the gates of a new homestead. It is common to find a plant called inthelezi growing outside a Zulu home. These objects serve to safeguard the home and its inhabitants against sorcery, witchcraft, and, in Ethiopia, the evil eye.

Healing Mind and Body

The mind and the body are separately recognized and treated using mystical powers. The mind can also be treated directly employing therapies, herbal preparations, and consciousness altering substances.

Witchcraft and sorcery

A study of African health would be incomplete without recognizing the role of mystical powers that may be manipulated by diviners and other specialists. Witchcraft and sorcery occur when people are under severe stresses and strains in life, or when they experience tension, whether actual or potential. People may believe themselves to be victims of witchcraft, or they may employ it against their competitors or enemies. The well-known Africanist Mary Douglas remarks that "the African is almost as liable to die from a poisonous idea put into his head as a poisonous herb put into his food" (quoted in Nottingham, 1959, p. 7). Such beliefs may produce illness in a person without an identifiable disease agent. (The opposite, disease without illness, is finding expression in the pandemic of HIV/AIDS.) From the point of health, sorcery and witchcraft enable people to deal with their failures and frustrations. The witch is generally believed to be inhabited by a power more evil than good that directs her or his nefarious acts. The sorcerer is a person who knowingly directs injurious magic to other persons. Magic may be either good or evil. The medicine man uses good magic essentially for the benefit of a patient, village, or society. When this power is employed maliciously it becomes black magic, evil magic, or sorcery. These terms allow people to explain away their failures or blame them on unseen evil forces or other persons employing these forces. M. G. Marwick describes the social context of sorcery in his masterful 1965 study of the Cewa of Zambia.

Ethnopsychiatry

"Medicine-men," says John Mbiti, "are the friends, pastors, psychiatrists and doctors of traditional African villages and communities" (1969, p. 171). For this reason, one cannot speak of ethnomedicine without also considering ethnopsychiatry. This form of treatment completes the holistic approach to illness-disease-sickness, anxiety-relief, grief-causality, foreboding-interpretation, and stress-relaxation. Ethnopsychiatry is a specialty that deals with culturally defined forms of social deviance. Africans live in a world peopled by vengeful ghosts and spirits, witches and sorcerers, and angry or jealous relatives and neighbors. Akan society has cultural mechanisms that allow it to absorb most forms of psychiatric disturbance. One mechanism that is found very widely in Africa is confession, which lowers guilt and stress levels, removes social tensions and accusations, and usually decreases symptoms. The traditional healer as psychiatrist explains the causes of illness in animistic terms familiar to patients who grew up in a world peopled by spirits. The medicines that are prescribed for psychiatric problems frequently produce psychopharmacological effects. In West Africa emetics and purgatives are followed by herbal compounds that act as tranquilizers and sedatives. According to one study, however, some Yoruba patients complained that they were given "poisons" to make their madness worse so that the healer could charge higher fees. The plant that was used is a species of the genus Datura that contains hyoscine, or scopolamine—a hallucinogenic agent. The Yoruba also employ Rauwolfia, which is the source of reserpine. Mind-altering substances are also employed in other parts of Africa; Cannabis sativa, for example, is used during childbirth among the Sotho.

Robert Edgerton (1966) conducted some of the early research in East Africa dealing with this subject. Among the Hehe of Tanzania, the Sebei of Uganda, and the Pokot and Kamba of Kenya, village members can list culturally defined behaviors that identify a person as psychotic. Among these are violent actions, sleeping or hiding in the bush, wandering around naked, and talking nonsense. Edgerton explains that the social group, rather than a diagnostic label, defines abnormality. He illustrates how the negotiations among patients, healers, family members, and friends structure the definition of mental illness. It is also this group that recognizes, defines, and responds to psychosis through a process of interpersonal relations.

One of the classic cases of psychiatric treatment is derived from the work of the Nigerian psychiatrist T. A. Lambo (1964). He found numerous individuals suffering from schizophrenia and other psychotic disorders on his visits to Nigerian villages. These persons were not institutionalized but considered a part of everyday village life. In October 1954 two projects were started at a village named Aro. The first project was a day hospital that allowed patients to go home at night. This phase lasted for two years. The second phase involved extending the day hospital to a village care service. The advantages of community involvement and social acceptance of healers and patients were so clearly evident that this village hospital model was expanded to other countries. Lambo believes that cooperation with indigenous healers contributed to the understanding of psychopathology and the psychodynamics of mental illness in Africa in relation to cultural and social variables.

See Also

Afflication, article on African Cults of Affliction; African Religions, overview article.

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Brian M. du Toit (2005)