Healing and Medicine

African ideas of healing and medicine have been shaped by both indigenous and imported traditions. For thousands of years, African peoples have practiced forms of healing and medicine that involve both natural and supernatural explanations and remedies. The ancient Egyptians developed medical practices that influenced neighboring civilizations, including Greece and Rome. Then Greek and Roman ideas about health and sickness had a similar effect on Islamic medicine. The ripple effect continued as Islam spread to Africa beginning in the A.D. 600s, and people throughout the continent adopted Islamic notions of healing. Later, Christian missionaries brought the practices of Western medicine to Africa. Today, Africans draw on all of these traditions in fighting illness and pursuing health.

IDEAS OF HEALTH AND ILLNESS

Traditional African views of health, sickness, and healing are shaped by beliefs about the nature of the world. These views are often expressed in terms of relationships between the individual, society, and the natural environment. One approach sees the natural condition of the body as a perfect, ordered structure, and any change—such an appearance of redness on the skin—represents sickness.

Another traditional approach is based on the notion of flow and blockage. Just as food and drink must move freely through the body for good health, good will and material wealth must flow through society for the health of the community. Envy or ill will can cause blockages in society and may lead to constipation, infertility, witchcraft, and disease in individuals.

Other approaches are characterized by opposing forces that must be in balance for the health of the individual and society. A medical tradition established by the ancient Greek physician Galen explains sickness as an imbalance of four bodily fluids, or humors. Treatment is aimed at restoring the balance. Purity and pollution are another pair of opposing forces that affect health and illness. Purity exists when the human world is in harmony. When something upsets this harmony, the result is ritual pollution or sickness. Coolness and heat are another set of opposites related to health. Coolness represents grace and good health, while heat indicates conflict and ill health.

These traditional explanations of health and sickness also affect the therapies chosen for a particular disorder. In East Africa the idea of pollution versus purity has influenced the treatment of an intestinal disorder often called “snake in the stomach.” To cure the disorder, healers used laxatives or emetics (substances that cause vomiting) to expel the pollution and cleanse the body of the sufferer. Such treatments suggest that traditional ideas of health and illness combine with practical observation to produce treatments for specific diseases.

MEDICINE AND DISEASE

For most Africans ideas about illness and the methods used to treat it come largely from traditional practices. Of course, modern medicine has been adopted throughout Africa as well. It is, however, often applied in combination with traditional healing. Islamic medicine, used by many Africans today, has also been combined with traditional healing.

Views of Illness

Health and religion are closely connected in Africa. Spiritual forces are often seen as agents of both sickness and its cure. Many diseases are thought to result from the deliberate actions of deities, spirits, or evil humans such as witches. In polygamous households in NIGERIA, for example, a mother might blame her child's sickness on sorcery and witchcraft practiced by another of her husband's wives. This “personalistic” view of illness explains it not as an accident but as the result of willful actions against an individual. Sufferers go to diviners or shamans to determine the cause of the disease and why the individual is affected.

A “naturalistic” view of disease considers illness in impersonal terms. Such explanations are often based on the balance or imbalance of forces such as heat and coolness. Among the HAUSA of Nigeria, for example, childhood malaria is thought to be caused by too much moisture during the rainy season; joint and limb pain can be traced to too much coldness. Illnesses viewed in naturalistic terms are typically treated with herbal medicines designed to restore balance and eliminate the “seeds” of disease in the body.

Herbal and Other Medicines

Many traditional remedies in Africa are based on native plants found throughout the continent. Some of these plants were first collected in the wild by HUNTING AND GATHERING societies thousands of years ago. With the development of settled agriculture, people began to cultivate medicinal plants. Over time, a wide variety of medicinal plants has been identified in different regions. Markets in Africa today typically have sections devoted to the plants of these regions. Healers evaluate natural medicines by their taste, color, texture, and action. They use the medicinal plants for diagnosis and cure and to determine the course of a disease's development. Among the Hausa, for example, if the use of a plant aggravates an existing intestinal disorder, it indicates that the illness is caused by spirits rather than natural causes. This finding affects the choice of treatment.

Modern pharmaceuticals, or drugs, also play an important role in African medicine. Because the practice of medicine is less closely controlled by governments in Africa than in Western nations, pharmaceuticals are relatively easy to obtain without a prescription. However, in many cases these drugs are used as an extension of traditional medicine. For example, traditional healers often note certain symptoms of a disease as it leaves the body and then use drugs that produce similar symptoms to treat the disease. The last stages of childhood malaria are marked by green urine. To hasten the end of the disease, Hausa healers give patients drugs such as laxatives and muscle relaxants that turn the urine green. Such drugs are not intended for use against malaria.

Islamic Medicine

In many parts of Africa, Islamic medicine offers an alternative to traditional African and Western medicine. Islamic ideas take physical, social, and psychological aspects of the individual into account. Key features of Islamic medicine include faith in the healing power of pious individuals and the Muslim holy book, the Qur'an; the ideas of the Greek physician Galen; and guidelines on hygiene and diet. Religious leaders called sharifa, who claim to be descended from the prophet Muhammad, are believed to have special powers that enable them to cure sickness. Sometimes, the healer must deal with jinn, supernatural creatures that cause a person to stray from the proper conduct of a devout Muslim. This loss of direction leads to illness.

Religion, medicine, and politics occasionally interact in Islamic societies. Among the Hausa, for example, the male-dominated nature of Islamic culture has led to a gender split in healing cults. Females tend to follow the traditional cults, while men for the most part rely on Islamic medicine. In the 1980s in Kenya, an Islamic reform movement rejected the idea of spirit-caused illness, challenging the power of the sharifa. Although expressed in medical and spiritual terms, the conflict reflected an underlying political struggle between the two groups.

TRADITIONAL AFRICAN THERAPIES

Traditional African medicine considers that disease may have both a physical and a nonphysical, or “mystical,” aspect. Healers use different types of therapy for these two aspects. The choice of therapy generally depends on the setting in which the disease occurs, its severity, and the response to treatment.

Mundane and Ritualized Therapy

Mundane therapies are those that focus solely on the physical causes and effects of illness. They are aimed at diagnosing the illness and identifying and eliminating its symptoms. Western medical treatment, with its emphasis on diagnosing and treating the physical aspects of disease, would be considered mundane therapy.

Ritualized therapy, which consists of various rituals, is considered appropriate for the mystical aspects of an illness. Healers identify mystical aspects by the tension, anxiety, or fear of human or supernatural pollution in the patient. Ritualized therapy involves the use of powerful emotional or spiritual symbols or actions designed to restore the order that has been upset in some way. It might include making sacrifices to ancestors or counteracting evil spirits, and can only be conducted by priests or diviners.

Divination

Divination remains a common method of diagnosing and treating illness in Africa. A diviner is usually consulted only when the family of a sufferer suspects that the causes of illness are not natural. This may occur when a sick person suddenly becomes worse, an individual dies suddenly and without explanation, an illness strikes one side of a family but not the other, or some social conflict is associated with the illness.

In such cases the diviner is called in to determine what caused the illness, why it struck a particular individual or family, and what the family can do. In many instances the diviner seeks answers in the actions of the patient or those around him or her. For example, poor judgment, rivalries, malicious gossip, social conflict, harmful words, or even poisoning are often identified as the cause of the problem.

Forms of divination vary across Africa. In a technique found in western Africa, shells are tossed from a cup or tray. The pattern made by the shells is related to coded verses that indicate a particular life situation and are used as a basis for diagnosis. Other kinds of African divination involve the “reading” or interpretation of animal bones, carved figurines, or other objects to determine the causes of illness.

Taboos and Words as a Cause of Sickness

The violation of taboos or the use of powerful words are sometimes seen as the source of a victim's misfortune. Taboos include the killing or eating of certain animals that are associated with a particular group and believed to have spiritual power within that group. Such taboos are not merely superstitions. They help people follow healthy lifestyles by restricting consumption of rich foods and alcohol or by prohibiting unhealthy behaviors.

The idea that sickness or misfortune can be caused by anger or ill will as expressed in powerful, hurtful words is also widespread in Africa. This may include spells or oaths spoken against an individual. In treating an individual, the diviner may ask the victim to recall the words spoken by others in association with any misfortunes recently suffered. Such therapy provides a way for the victim to deal with the persons or relationships that may have some bearing on the problem. Treatment may also include rituals involving herbal medicines and the use of healing words and gestures.

Effectiveness of Traditional Healing

Western medicine has often attacked and rejected traditional forms of healing. However, recent research has shed new light on some aspects of African healing and medicine. One example of a new attitude is the growing acceptance of medicinal plants in treating illness. Another example is the recognition that psychological aspects of disease can be just as important as physical ones.

Given the financial problems facing many nations in Africa, as well as the high costs of Western medicine, traditional forms of healing offer possibilities for health care that appeal to African governments. For this reason, many government officials are taking a closer and more serious look at traditional African healing methods and institutions. (See also Disease, Divination and Oracles, Health Care, Spirit Possession, Taboo and Sin.)