Church in Africa





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Healing of body and spirit


It is said that in Africa to be sick is a luxury that only the rich can allow themselves, because the majority of the population cannot afford the high costs of the treatment. These affirmations are only true if applied to the access to modern/Western medicine. There are other types of therapeutic remedies that are accessible to most inhabitants in the continent and that, at the same time, give answer to the deepest needs of the African spirit.

By Francisco Carrera


Most African countries find themselves forced to import almost all conventional medicines, which makes the selling price to the public excessively high for the average person. On the other hand, financial difficulties have brought most national health systems to the point of collapse, when not to the total break down. Many hospitals and public dispensaries, especially in the rural areas, have been obliged to close or greatly limit their services due to the scarcity of basic medicines and medical personnel. For example, in the past years the Government of Malawi has only been able to budget 1.25 dollars per person a year for the purchase of medicines; and Uganda counts with only one doctor for every 10,000 people in the urban areas and for 50,000 in the rural areas. The HIV/AIDS pandemic has contributed further to the deterioration of sanitary structures in the African continent.
Wealthy patients have always the possibility of resorting to private clinics and hospitals, which have more abundant and qualified medical personnel and sufficient medicines.
What are the options for the majority of Africans who do not receive the necessary medical attention in the public institutions and cannot afford the high prices demanded by private institutions? The answer is to turn to traditional medicine, like their ancestors did for generations before the introduction of modern remedies by the colonial administrators.

African vision of sickness
Approximately 80 per cent of Africans consult habitually experts on traditional medicine – “healers”, “herbalists”, “doctors”… – to treat their sicknesses. Curiously enough, in these last years, and in part as a consequence of the explosion of AIDS, even those who have easy access to modern medicine and can afford it, prefer to put themselves in the hands of traditional doctors. The number of patients who abandon conventional hospitals where they are hospitalized in search of help among traditional healers is constantly growing. It is not rare to see the luxurious cars of important persons – including ministers – approaching the humble “clinics” of local specialists. Those visits are often surrounded by an atmosphere of secrecy because the official position, inherited from colonial times, still maintains an attitude of mistrust and contempt towards the traditional practices, which the western mentality stigmatized as superstitions.
Deep down, the persistence and vitality of traditional medicine is rooted on the vision that African culture has of sickness. Modern medical science is based on the dualistic Cartesian axiom of the separation of mind and body, and its principal objective is to eliminate physical suffering. However, most African societies understand sickness primarily as the physical or mental manifestation of the breaking down of the personal equilibrium or the social relationships.
According to traditional culture, a person’s ailment could be caused by the action of evil spirits, due to his/her failure to abide by the social rules, to his/her lack of respect for the ancestors, or to contamination by objects considered taboo.
In general, it can be said that African traditional mentality considers sickness a kind of punishment by the spirits of the ancestors to those who do not observe the rules of good behaviour of the society to which they belong. The ancestors withdraw their protection from the transgressors of the social norms and leave them exposed to the whims of the evil spirits who cause physical dysfunctions. In the context of this perception of sickness, which is deeply rooted in many inhabitants of the continent, it is as important to find and eliminate the “supernatural” causes of the ailment as to heal its somatic manifestations. Many African patients feel frustrated with the merely rational approach of modern medicine which, according to their perception, does not attack the root of their disease. For this reason, when sick, they turn to those they know will treat both the hidden causes and the physical effects of their affections.

Traditional medical care
Traditional African medicine is the set of knowledge and practices, rationally explicable or not, used in the diagnosis, prevention and elimination of physical, mental, and social disequilibrium. This collection of knowledge and practices comes from experiences and observation that are transmitted from one generation to the next.
The traditional medicine-men, healers, herbalists, etc. are persons recognized in their communities as specialists in the treatment of sickness through the use of plants, minerals, and animal parts and through other methods based on the social, cultural and religious traditions of the population. They are an integral part of the local culture and quite appreciated as healthcare agents, due to their knowledge of the sicknesses and of the appropriate remedies for each one of them.
The practitioners of African traditional medicine are quite numerous and live among the people, in such a way that the sick persons have easy access to them. Uganda, for instance, has a medicine-man per 290 inhabitants; while Malawi, a country with approximately 12 millions people, has registered more than 30,000 healers. Many of the traditional doctors frequently mention a “calling” from the spirits of the ancestors as the origin of their dedication to the healing activities. Others acknowledge that they simply continue with a family tradition that passes from fathers to their children.
But all of them had to undergo between two and five years of training, under the supervision of an experimented traditional healer, to learn the trade before establishing their own practice. The traditional doctor develops his activities on two complementary levels, derived from the African concept of sickness: the supernatural or spiritual, and the corporal or physical level.

The supernatural level
The healer - as an expert on the feelings, beliefs and the dominant norms of conduct norms of the community to which the patient belongs - tries first to establish the “spiritual” cause of the ailment. Listening to the sick person or to his/her relatives, using divinatory techniques and putting himself in contact with the spirits of the ancestors, he will decide on what has broken the equilibrium of the person or the group and which evil forces are causing the sickness.
Once the deep cause has been established, the traditional doctor will prescribe the actions to follow – reparation of an injustice, reconciliation between antagonized persons, performance of the rites due to the ancestors, etc. – to restore the equilibrium within the individual or the social group. He also resorts to prayers and invocations destined to recover the favour of the ancestors and to send away the evil spirits.
It was this somehow “mysterious” aspect of the activities of the traditional healers what made westerners - missionaries included – dismiss them as ‘witchcraft’ and superstition. However, Hippocrates himself had already warned that one could not be a good doctor without being a good priest at the same time.
African traditional medicine maintains a strong connection between healing and spirituality because the population of the continent live deeply the psycho-religious values of the human person.

The physical level
Once the primary causes of the ailment are determined and treated, the traditional practitioners moves on to eliminate the corporal manifestation of the sickness. To do this, they make use of their vast knowledge of medicinal plants and of the therapeutic properties of certain animal parts and minerals.
Their own experience, added to the accumulated experience of their predecessors for generations, allow the healers to offer effective and cheap remedies for the main ailments afflicting the population of the continent, like malaria, stomach infections, respiratory problems, rheumatism, arthritis, sexual dysfunctions, anaemia, parasite infections, mental problems, bone fractures, etc.
After diagnosis of the type of sickness the patient suffers from, the traditional medicine-man selects the plant or collection of plants – leaves, roots, barks, stem…. – adequate to the treatment of the ailment. Sometimes, he will also use parts of animals or minerals whose curative properties complement those of the plants. With all those ingredients, the healer prepares a cooked paste or an infusion that the patients take orally or are applied to them topically. He may also incinerate those ingredients and apply the resulting powder on the small incisions done in the skin.
Most traditional doctors treat all kinds of diseases, but some of them stand out for their success in curing a concrete sickness and attract patients from all parts of the country where they practice and even from neighbouring countries.
Some healers claim to have identified medicinal plants which kill the AIDS virus and affected persons flock to them in the thousands searching for a miraculous remedy. However, such claims have not been tested and proven to be true, and most traditional practitioners recognize not to have found the cure for this epidemic. What some official bodies certify – like, for instance, the responsible of the National Programme of AIDS Control in Uganda – is that there are herbalists who have found effective remedies for the relief of the ailments that accompany the AIDS infection and that they help to improve health conditions of those patients.

Acknowledgement and integration
The World Health Organization (WHO) has recommended since the 1970s the inclusion of traditional practitioners in the national systems of health because of their knowledge of medicinal plants, their closeness to the local populations and their knowledge of all the elements that intervene in a sickness. According to WHO, the uncertain health situation of the African continent does not allow wasting the medical and pharmaceutical experience of the local healers; it would be a serious mistake to ignore the fact that they are the ones who provide medical attention to most Africans, especially in the rural areas.
The traditional practitioners, on their part, are creating associations in some parts of the continent to obtain the official recognition and certification that would allow them to exercise their activities without legal impediments. These organisations also encourage among their members the exchange of information about the treatment of the different diseases.
In recent years, there has been a change of attitude among official institutions and conventional medicine representatives towards traditional healers. In Malawi, the University and the Health Ministry give a certificate of professional aptitude to herbalists whose remedies pass a series of scientific tests. In Senegal’s Traditional Medicine Centre (CEMETRA), modern medicine doctors and traditional healers work together attending the patients and investigating medicinal plants. In Mulago Hospital of Kampala, Uganda, there is also a good collaboration among the two and there are doctors who combine modern science and traditional practices in the treatment of the patients. Similar experiences are taking place in other African countries.
Some governments, like that of Swaziland with 40% of adult population affected by the HIV/AIDS virus, have integrated healers in their campaigns against the epidemic. Health officials explain the characteristics and ways of transmission of the disease and the preventive methods to the traditional practitioners. The last, based on the prestige and the trust they enjoy among the people, are much more capable of promoting the changes of customs necessary to halt the spread of AIDS. A greater participation of traditional doctors in the sanitary systems of African countries would contribute to improve the health conditions in the continent and to reduce its dependence on external suppliers of medicines. Their knowledge of medicinal plants could become the starting point for the development of a local pharmacology, capable of producing medicines and commercialising them at affordable prices for the benefit of the population.

Medicinal plants
The practitioners of African traditional medicine base their treatment of diseases on remedies that are mainly extracted from medicinal plants found in the continent. Diarrhoea, malaria, respiratory problems, and sexual dysfunction or infections, are four groups of sicknesses that frequently affect a wide section of the African population. To combat them they use the following types of plants:

1. For the treatment of diarrhoea (common, dysentery, cholera etc) they use species like nilotica acacia, annona senegalensis, elephantorhiza elephantine, and sclerocarya birrea 

2. Against malaria, which is a cause of high rate of deaths among the children and adults in many African countries, are very effective: Mormodica balsamina, especially efficient for curing the vomits associated with bile and fever; Spirostachys Africana, for headaches that accompany malaria; Raunvolphia caffra, rich in anti-malaria alkaloids; and Bridelia cathartic.

3. Remedies for different infections like asthma, bronchitis, cough etc., are: Orquidea Anexilla Africana, for treatment of asthma; Opuntia spp, expectorant against bronchitis and cough; the bark of Warburgia salutaris, for the cure of cough and cold; Rauvolfia caffra, which contains reserpine, is very efficient in treating hypertension.

4. For the treatment of sexual dysfunctions and infections: Sarcostema viminale, for infertility; Prumus Africana and Hypoxis Hemerocallidea, for the hypertrophy of the prostate; the fitosterol in the principal component of a series of plants that are used for curing impotency and prostate hypertrophy. Pharmaceutical companies
The cost of a medicine, a therapy is often equal to a year’s income for a poor person living in Africa. Because they are costly, certain life-saving drugs are not included in the - periodically updated - World Health Organisation list of essential medicines, that is medicines used by the majority of people and therefore necessarily produced in large quantities. The cost of medicines is also affected by the exclusive right of the pharmaceutical companies to produce a drug protected by a patent and to decide its price for the period during which the patent is valid. A patent is valid for 20 years. Only when the patent is no longer valid does the drug become generic and can be produced by other companies and the law of competition involves a possible lowering of prices. Lower prices also for patented drugs which are produced locally: in these cases the aim is to reach a proportion between income per head and the price of a medicine, according to the country in which it is produced and sold.
Political and commercial conventions of the World Trade Organisation (founded in 1995, to prevent the sale of counterfeits and check the stages of patenting and production) sanctioned in 1996, by the TRIPS agreement (Trade-Related Aspects of Intellectual Property Rights), guarantee this system will be maintained. TRIPS agreement prohibits the local production of medicines and establishes rigid norms on sale, use and importation, creating an ulterior growth in price, since only the entity which holds the patent can set the cost of the drug; local producers have to buy costly licences to participate in a market - the drug market - in which they can never compete with the world giants; the presence of the latter discourages activity of research and development even technological at the local level. What is more: the local people receive no profit from the patent testing since the producer can choose the place of production.
The year 2008 was the last year granted to the world’s 48 poorest countries to get in line with the TRIPS agreement, or suffer trade sanctions. Pharmaceutical companies claim that costly medicines are due to costly research, although research is often sustained by public funds. Despite enormous profits, multinational companies do not invest in research for drugs to save people from diseases that continue to kill in developing countries, neither do they foresee a policy of different prices according to the country in which the medicines are sold. A ray of sunshine in this sad situation was a law signed in 1997 by Mandela, allowing, among other things, local production of medicines and parallel importation with the intention of combating AIDS.
In 1998 a group of pharmaceutical companies took legal action against the mentioned law but had to desist three years later thanks also to numerous personages and NGOs (Medicines sans Frontiers, for example, which also launched a campaign for equal access to medicines which certainly convinced many countries to include this matter in the international political debate, although much remains to be done). An event which could have been a turning point in the management of the medicine crisis in third world countries, was an agreement on life saving medicines signed in 2003, by 146 member countries of the World Trade Organisation: however the norms inserted in the agreement were full of unclear clauses, which have impeded serious implementation of the guidelines.

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