ARRUPE JESUIT UNIVERSITY

School of Philosophy and Humanities

INTEGRATIVE AFRICAN INDIGENOUS AND WESTERN MEDICINE: A

NECESSARY POSSIBILITY.

By

OGBUAGU Vitalis Izuchukwu SJ

R20238

A Dissertation Submitted in Partial Fulfilment of the Requirements

for the Degree of Master of Arts in Philosophy in the School of Philosophy and Humanities

of Arrupe Jesuit University

Harare, Zimbabwe

April, 2022
 DECLARATION

I do hereby declare that this dissertation is the result of my own research work, with the

exception of specific quotations and ideas attributed to sources duly acknowledged, and it is

the genuine record of that task that I set for myself. It conforms to the degree regulation

requirements of length, being at least 20,000 and no more than 40,000 words long, excluding

notes and bibliography (#28.2).

SIGNED: ………. …………………. DATE………29/04/2022…………

(Candidate)

SIGNED: ........................................................................... DATE:............................................

(Supervisor)

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 DEDICATION

This academic work is dedicated

to the Church under the Roman Pontiff

and

to the Society of Jesus.

Ad Majorem Dei Gloriam

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 ACKNOWLEDGEMENTS

I would like to extend my sincere and heartfelt gratitude to all the personages who
contributed in one way or the other in making this academic work a success. Without their
direct and indirect guidance, help, cooperation and encouragement, I would not have made
headway in this dissertation.

Firstly, I am extremely grateful to Almighty God for His gift of life and health.

I am ineffably indebted to my supervisor, Dr. Stephen Buckland and my second

Reader, Prof. Michael Onyebuchi Eze, for their conscientious proposals, constructive
suggestions, guidance, and encouragement.

I express my unalloyed gratitude to a man with a big heart, Very Rev. Fr.
Chukwuyenum Afiawari SJ, the Provincial North-West Africa Province, Society of Jesus, for
his magnanimity in missioning me to Arrupe Jesuit University and Rev. Fr. Chioma Nwosu
SJ, the delegate of Formation North-West Africa Province, Society of Jesus, for all his
support, as well as Rev. Fr. Gibson Munyoro SJ, the Rector of Arrupe Jesuit Community and
Rev. Fr. Roland von Nidda SJ, the delegate of Hannan community, for all their support.

I extend my appreciation to my able lecturers; Prof. Simon Makuru, Prof. Frank

Abumere, Prof. Heinrich Watzka, Dr. Isaac Mutelo and Dr. David Kaluem for their valuable
epistemic contributions to my academic endeavour in Arrupe Jesuit University.

Lastly, I also acknowledge with a deep sense of gratitude, my parents; Mr. Augustine
and Mrs. Lucy Ogbuagu, my siblings; Stanley, Henry, Linda, Gloria and Charity, my
benefactors and benefactresses, all my Jesuits companions, friends and well-wishers for their
supports, prayers and encouragement.

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 ABSTRACT

The contemporary problems of increasing demand for clinical evidence on the safety, efficacy
and quality of African indigenous medicine or healing practices, disparaging attitude of the
Western health practitioners towards indigenous health practitioners in Africa, as well as the
problem of shortage, unaffordability and inaccessibility of Western medicine and health
practitioners to most Africans in both urban and rural areas, cannot be adequately addressed
without adopting an integrative healthcare model that would improve the affordability,
availability and accessibility healthcare delivery in Africa and bring about holistic approach
to healthcare problems, as well as mutual understanding between African indigenous health
practitioners and Western health practitioners especially through collaborative efforts of both
African indigenous and Western healing systems.
Thus, this dissertation is an integrationist project that seeks to promote the idea that African
indigenous medicine and health practitioners possess what it takes to make them an integral
part of national healthcare systems in Africa alongside Western medicine and health
practitioners, namely; a holistic approach to health, illness and healing, a holistic
understanding of etiology of illness and perception of human nature, embodiment of social,
moral, religious, professional and economic or commercial values embedded in African
culture, affordability, accessibility, acceptability, cultural compatibility and suitability for the
treatment of various diseases, particularly chronic ones. Despite the challenges and concerns
of the anti-integrationists against integration of African indigenous healing practices and
Western medicine in national healthcare systems in Africa, the opportunities for and benefits
of integrating African indigenous healing practices and Western medicine, serve as influential
bioprospecting tools in developing a national policy for integrative healthcare system in
Africa.
In order to make the envisaged idea of this dissertation possible and attainable, I propose an
integrationist project termed; Integrative African Indigenous and Western Healthcare Model,
which should be implemented at national level, as well as six important organizational
strategies or schemes for the proposed conceptual Integrative Healthcare Model, namely; (i)
the dimensions of integration, (ii) the guiding principles and/or values (iii) the structure of
management (iv) the process or the internal dynamics of integration, (v) planning of patient
care, and (vi) the process of evaluation and assessment of care services.
However, before adopting any national policy for integration of African indigenous healing
practices and Western medicine, there is need for some pre-developmental strategies that are
pertinent for successful implementation of the Integrative African Indigenous and Western
Healthcare Model. These pre-developmental strategies, if effectively implemented, can help
to mitigate the challenges or resolve the concerns raised against integration of African
indigenous healing practices and Western medicine.

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 TABLE OF CONTENT

Declaration ii

Dedication iii

Acknowledgment iv

Abstract v

Table of Content vi

List of Figures ix

Introduction x

CHAPTER 1: THE AFRICAN CONCEPTS OF HEALTH, ILLNESS AND HEALING

1.1 Introduction 1

1.2 The African Concept of Health 3

1.3 The African Concept of Illness 8

1.4 The African Concept of Healing 13

1.5 Conclusion 18

CHAPTER 2: AFRICAN INDIGENOUS HEALING KNOWLDEGE

2.1 Introduction 19

2.2 Western Medical Knowledge Hegemony 21

2.3 African Indigenous Healing Knowledge 25

2.4 Instances of Forms of African Indigenous Healing Knowledge 30

2.4.1 Empirical Healing Knowledge 31

2.4.2 Rational Healing Knowledge 33

2.4.3 Mystical Healing Knowledge 34

2.5 Conclusion 36

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CHAPTER 3: AFRICAN INDIGENOUS HEALING PRACTICES

3.1 Introduction 37

3.2 African Indigenous Diagnostic Methods 38

3.3 African Indigenous Healing Methods 42

3.4 Etiology of Illness in African Indigenous Healing Practices 48

3.5 Etiology of Illness and African Conception of Human Person or Nature 54

3.5.1 African Normative View of Human Person or Nature 55

3.5.2 African Metaphysical View of Human Person or Nature 56

3.6 Axiology of African Indigenous Healing Practices 58

3.6.1 Social Values 59

3.6.2 Moral Values 60

3.6.3 Religious Values 61

3.6.4 Professional Values 62

3.6.5 Economic and Commercial Values 63

3.7 Conclusion 64

CHAPTER 4: ROLE OF AFRICAN INDIGENOUS MEDICINE AND HEALERS IN PRIMARY

HEALTH CARE IN AFRICA

4.1 Introduction 65

4.2 Prevalence of Indigenous Medicine in Africa 66

4.3 Specializations in African Indigenous Healing Practices 68

4.3.1 The Diviners 68

4.3.2 The Herbalists 69

4.3.3 The Indigenous Midwives and Birth Attendants 69

4.3.4 The Indigenous Orthopedic Surgeons and Bonesetters 70

4.4 Training of African Indigenous Healers 72

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4.5 Roles of African Indigenous Healers in Primary Health Care 73

4.6 Key Challenges to the Use of African Indigenous Medicine in Primary

Health Care 76

4.7 Conclusion 78

CHAPTER 5: INTEGRATION OF AFRICAN INDIGENOUS HEALING PRACTICES

AND WESTERN MEDICINE

5.1 Introduction 79

5.2 Challenges and Concerns Against Integration of African Indigenous Healing

Practices and Western Medicine 81

5.3 Opportunities for and Benefits of Integrating African Indigenous Healing

Practices and Western Medicine 86

5.4 Towards Integrative African Indigenous and Western Healthcare System 89

5.5 Proposed Conceptual Framework for Integrative African Indigenous and

Western Healthcare Model 92

5.5.1 The Dimensions of Integration 92

5.5.2 The Guiding Principles and/or Values 94

5.5.3 The Structure of Management 96

5.5.4 The Process or the Internal Dynamics of Integration 98

5.5.5 The Process of Planning of Patient Care 99

5.5.6 The Process of Evaluation and Assessment of Care Services 100

5.6 Pre-Developmental Strategies for a Successful Implementation of the

Integrative African Indigenous and Western Healthcare Model 101

5.7 Conclusion 104

General Conclusion 105

Bibliography 109

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 LIST OF FIGURES

Figure Title Page

1 The Guiding Principles and/ or Values for the Integrative African Indigenous

and Western Healthcare Model 96

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 INTRODUCTION

The proposal by World Health Organization and some African integrationist scholars

to integrate both African indigenous medicine/healing practices and Western medicine into

national health care systems in Africa, can be best understood against the backdrop of the

crucial need to develop African indigenous medicine or healing practices to meet up with the

emerging demand for clinical evidence on the safety, efficacy and quality of African

indigenous medicine or healing practices in the contemporary era and the need to make primary

health care more affordable, readily available and accessible for all Africans, most especially

in the aspects of curative and preventive medicine. In view of the objectives of the proponents

of integrative African indigenous and Western medicine, this academic work which is more of

an integrationist epistemic project, seeks to promote the idea that African indigenous medicine

and health practitioners possess what it takes to make them an integral part of national

healthcare systems in Africa alongside Western medicine and health practitioners; a holistic

approach to health, illness and healing, a holistic understanding of etiology of illness and

perception of human nature, as well as embodiment of social, moral, religious, professional

and economic or commercial values embedded in African culture such as affordability,

accessibility, acceptability, cultural compatibility and suitability for the treatment of broad

spectrum illnesses, particularly the chronic illnesses. To achieve this, this academic work tends

to portray through the discussions and arguments put forward in all the five chapters, the

usefulness ad relevance of African indigenous medicine/healing practices in serving the

emerging care needs in primary healthcare systems in Africa.

To realize its aim, this integrationist project is divided into five chapters. Chapter I

which qualifies as the opening chapter, presents the holistic understanding of health, illness

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and healing in the African indigenous medicine which differs from that of the Western

paradigm. The discussions which run through section 1.2 to 1.4, are intended to help the reader

understand and appreciate the differences between African and Western concepts of health,

illness and healing, as well as to understand how the differing perceptions of both healing

systems can be integrated to achieve an improved approach to issues of health, illness and

healing. To realize this intention, this chapter engages the works of indigenous African scholars

like Peter Omonzejele, Patrick Iroegbu, Abayomi Sofowora, Onah Gregory and Eyong Ubana

Usang, Jerome Mbih, Laurenti Magesa, Richard Onwuanibe, Placide Tempels, Janheinz Jahn

and Ayodele Jedege, to show that African indigenous medicine permeates all aspects of human

life, Unlike Western medicine.

Chapter 2 explores the epistemology of African indigenous medicine, as a branch of

African epistemology. The various discussions and arguments in this Chapter from section 2.2

to 2.4 are geared towards showing that African indigenous healing knowledge is not inferior

or unscientific as Western paradigm portrays it to be, rather its scientific nature is embedded

in African indigenous and cultural methods of acquiring, categorizing, labelling, verifying and

validating epistemic claims, which make it as relevant as Western medical knowledge. This

chapter refers to the works of indigenous African scholars like Ejikemeuwa Ndubisi, Elijah

Okon, Barry Hallen, Disan Kutesa, Usman Gbari, John Mbiti and Andrew Uduigwomen, to

show that the various forms of African indigenous healing knowledge differs uniquely from

the Western paradigm, hence they can only be reasonably investigated or analyzed from the

same lens through which African people conceive, interpret and make sense of their reality,

rather than through Western scientific method.

Chapter 3 expounds African indigenous medicines or healing practices with the view

of highlighting the significance and relevance of African indigenous diagnostic and healing

methods and African perception of etiology of illness and its relation to African conception of

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human person or nature, in the contemporary African society. The remarkable discussions in

this chapter include; the unique features or three levels of specialization in African indigenous

healing practices namely: divination, spiritualism and herbalism, the roles of taboos, sorcery

and spirits in etiology of illness in Africa, the African normative theories which consider a

human person as an inseparable part of the universal community of both physical and spiritual

beings, and the African metaphysical theories which view a human person as being constituted

of several physical and spiritual parts that are interrelated and interconnected, and not merely

as a collection of distinct parts, as depicted in Cartesian dualism. The essence of these

discussions is to show that African indigenous healing practices or medicine is as holistic as

African view of reality (as both physical and spiritual). This holistic feature is a treasured value

that should be taken into consideration in any integrationist project.

Chapter 4 discusses the prevalence of indigenous medicine in Africa, some of the fields

of specialization in African indigenous medicine, namely; diviners, herbalists, indigenous

midwives and birth attendants, and indigenous orthopedic surgeons and bonesetters, their roles

and contributions in primary healthcare in Africa, especially in areas of curative and preventive

medicine and the key challenges to the use of African indigenous medicine in in primary

healthcare in Africa. The primary aim of these discussions is to show that that African

indigenous health practitioners play indispensable roles in primary healthcare in Africa, hence

they deserved to be given a better formal recognition (than they are currently given) and

practicing space in the national healthcare systems in African countries alongside Western

medicine.

Finally, chapter 5 which is the crowning chapter, proposes and discusses the need for

integrationist project called Integrative African Indigenous and Western Medicine or

Healthcare Model and how it can be realized. This chapter starts by looking at the challenges

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and concerns of the anti-integrationists against integration of African indigenous healing

practices and Western medicine, the opportunities for and benefits of integrating both healing

systems. Then, to cap all the discussions, the chapter proposes an integrationist project termed;

Integrative African Indigenous and Western Healthcare Model, which should be implemented

at national level, as well as explores six important organizational strategies or schemes for the

proposed conceptual Integrative Healthcare Model, namely; (i) the dimensions of integration,

(ii) the guiding principles and/or values (iii) the structure of management (iv) the process or

the internal dynamics of integration, (v) planning of patient care, and (vi) the process of

evaluation and assessment of care services. Also, some of the pre-developmental strategies for

a successful implementation of the Integrative African Indigenous and Western Healthcare

Model as formulated from WHO Traditional Medicine Strategy (2002-2005 and 2014-2023)

will be highlighted.

Through the whole discussions and articulation of ideas in all the chapters, this

dissertation is meant to contribute to the ongoing academic discourses on African indigenous

healing knowledge and practices, as well as the discourses on integration of African Indigenous

healing practices or medicine and Western Medicine in national healthcare system in Africa. It

proposes and discusses the need for integrationist project called Integrative African Indigenous

and Western Medicine and how it can be realized through the proposed conceptual framework.

It is important to underscore that this dissertation is a philosophical discourse based on

the existing published materials like books and articles in academic journals on African

indigenous healing knowledge and practices, as well as on Western medicine, which are used

for this academic research as opposed to empirical findings. Thus, the method used is therefore

a comprehensive study and critique of the existing literature review.

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 CHAPTER ONE

THE AFRICAN CONCEPTS OF HEALTH, ILLNESS AND HEALING

“For the traditional African, health is not just about the proper functioning of bodily organs.

Good health for the African consists of mental, physical, spiritual, and emotional stability of

oneself, family members, and community; this integrated view of health is based on the

African unitary view of reality” (Omonzejele, 2008:120)

1.1 INTRODUCTION

The way concepts of universals and particulars are grasped, understood or explained is

influenced by the way people perceive the fundamental nature of reality or the way they

develop and articulate their philosophical ideas. This is affirmed by Hegel, who asserts that;

“men do not - certainly not at all times - philosophize in general; but there is a definite

philosophy, with a definite character, which arises among a people and permeates their spirit”

(Qtd. in Etim, 12). The concepts of health, illness and healing are not merely relative to a

people, but are colored by their perceptions and conceptions of reality wherein everything

around them is meaningful. The African concepts of health, wellbeing and illness are greatly

influenced not only by their cultural and religious experiences, but also by their perception or

understanding of the dynamic nature of reality, existence and being, as both metaphysical and

spiritual, as Dime asserts; “the African view of reality emphasizes the structural kin-ship

between man and nature, and man and the spirit world. To Africans, the whole multiplicity of

things which comprise the universe are mystically one and therefore constitute only one thing,

one reality; everything is a part of the other that makes up reality, the total cosmos or universe”

(28). It is within the context of African worldview and metaphysics that African concepts of

health, illness and healing are derived and can be understood as discussed in this foundational

chapter.

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 In section 1.2 of this Chapter which serves as a prolusion to the thesis of this research

work, I will discuss the meaning of health in the African context vis-à-vis Western

understanding of health. I will use the arguments from indigenous African scholars like Peter

Omonzejele, Patrick Iroegbu, Abayomi Sofowora, Onah Gregory and Eyong Ubana Usang, to

support my claim that the conception of health in traditional African society is not just a mere

absence of disease and biological or psychological well-being (as understood in Western

medicine), but it involves as well the spiritual, social, ecological and economic wellbeing of

both the individual and the community (a normativist or holistic view). In the next section 1.3

that follows, using supporting arguments from African scholars like Orhioghene Akpomuvie,

Jerome Mbih, Richard Onwunibe and Placide Tempels, I will discuss the African conception

of illness which is understood as the manifestation of the disharmony between an individual

and the whole community or the human community and the spiritual community. In traditional

African society, the disharmony presented in the form of illness could be a result of either

physical/human causes or spiritual/metaphysical factors or causes. The African normative

conception of illness is at variance with the Western naturalist concepts of illness, which trace

all causes of illness to natural causes with scientific explanations as shown in the

characterizations of illness by Western scholars like Christopher Boorse and Thomas Szasz.

Furthermore, in section 1.4 before the conclusion, I will discuss the African conception of

healing, as a means of restoring the destabilized cosmological harmony between the sick person

or human community and the universal community. The discussions in this section highlights

the distinction between the African concepts of healing and the Western notion of curing a

disease.

The whole of chapter one is geared towards understanding and appreciating the

uniqueness and holistic cultural framework in which African conceptions of health, illness and

healing are framed. With the diversity of cultures in Africa, I do not claim that the concepts of

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health, illness and healing, as discussed in this chapter with specific references to some cultures

in African, are commonly applicable to all cultures in African, but wish to argue that the

indigenous concepts of health, illness and healing are commonly obtainable in some traditional

societies in African. My stance in this chapter is in agreement with the assertions of Lovemore

Mbigi as he avers that “although African cultures display awesome diversity, they also show

remarkable similarities” (75). Therefore, having noted these clarifying points, I believe that the

discourse on African concepts of health, illness and healing is an abstraction that cuts across

some African societies and fairly represents the general orientation of the African

understanding of health, illness and healing without prejudice to any particular culture or view.

And on these grounds, I will speak henceforth of “the African concept of health / illness /

healing”.

1.2 THE AFRICAN CONCEPT OF HEALTH

Etymologically, the word “health” is derived from an ancient English word “hal” or

“hoelth” which means a state of being sound or whole. In Igbo language, “aru ike” which is

usually translated as “health”, implies “idi ndu” (to be alive). Hence, in Igbo society to have

“aru ike” (health) means to have “ndu” (life). Both are regarded as gifts from Chukwu (God)

and are of utmost importance and valued more than material possession. To have a life devoid

of health is often regarded as a fate worse than death (odi ndu onwu ka mma). Among the

Yoruba people, to be healthy means to be well (san). Words like alaafia, sere (not ill), jeun

daadaa, mu daadaa (good appetite), sun daadaa (sleeping well) and wo daadaa (emotional

stability) are often used to express healthy living (Jedege, 327). They imply that the positive

attributes of a healthy person, such as having a good appetite, gaining weight and sleeping well

are signs of healthy living.

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 Among the ancient Greeks, health was regarded as a state of harmony with the

environment. Hippocrates (460-377 B.C.) and Galen (129-199 A.D.) were the first Western

scholars to develop the idea that a healthy body is one where the primary conditions or

properties (hot, cold, wet and dry) of the body are in a state of harmonious balance. In the

Western medieval schools, following Galen, this idea was made famous and formulated in

terms of a harmonious balance among the four bodily humors (black bile, yellow bile, phlegm

and blood), which is influenced by the totality of environmental determinants such as climate,

air, water, food, habits etc. Health is viewed then as a result of the harmony between man’s

physiological environment and his physical environment and lifestyle. This idea is still relevant

in several non-Western indigenous medical practices, such as in Ayurveda medical tradition in

India, where concept of health entails a balance in the three humors of the body; vata (the

breath), pitta (bile) and kapha (phlegm). The proportions of these three humors vary among

persons and their bioactivities vary according to the season, the environment, the lifestyle and

the diet of the person (Nordenfelt, 33).

In contemporary Western Medical anthropology, the concept of health has become

more elusive, complex and dissenting. According to Boruchovitch and Mednik, there are three

identifiably prominent operational definitions of health among Western scholars today; the

pathological concept of health, the World Health Organization’s concept of health and the

ecological concept of health (176). The pathological concept of health which restricts the

meaning of health to “mere absence of disease or impairment”, was first formulated by

Christopher Boorse in 1975, with few philosophical reconstructions by K. W. Fulford (1989)

and Andrew Twaddle (1993), to mark the distinction between disease - an impairment in the

normal functioning ability of the body and illness – and the negative experience of disease such

as pain and discomfort. The problem with the traditional pathological concept of health is that

it has a negative notion of health based on absence of pathology and it overlooks important

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aspects of health such the physical, mental and social well-being. Also, such a traditional

concept describes health as just the opposite end of the same continuum with disease or

impairment. But health is evidently more than just the absence of disease, since it requires an

adequate balance of the various aspects of the whole person.

In another definition by the World Health Organization (WHO) in 1947, health was

construed as a state of complete physical, mental and social well-being and not merely the

absence of disease or infirmity (Chronicle of WHO, 1-2). The organization went beyond the

disease-free notion of health to conceptualize health in a more comprehensive manner by

incorporating as well the physical, psychological and social dimensions of human life.

However, human health cannot be separated from the wellbeing of total planetary biodiversity,

hence the definition given by the World Health Organization is still limited in the aspect of the

wellbeing of an individual in relation to the environment. Since humans live in an

interdependent existence with the totality of the ecosystem, their health depends also on the

healthy interaction with other biotic and abiotic factors of the ecosystem.

The ecological concept of health underscores the relative nature of the concept and the

fundamental interrelationships that exist between the individual or the environment (Onah and

Eyong, 2). It emphasizes the need for a harmonious balance between the bio-psycho-

physiological environment of an individual and the socio-ecological environment. It is built on

the presumption of the interaction among the physical, psychological, social and ecological

dimensions of life. Also, it is value-laden as it entails subjective evaluation of the general state

of the person. Such a concept of health is in tune with the African concept of health, although

it does not take into consideration the spiritual wellbeing of an individual, which is also an

important dimension of health. In the research which they conducted among 22 selected experts

in areas of spiritual health in various fields in Iran, Ahmad et al., found out that although the

definition of spiritual health varies based on the views of the individual experts, there are two

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dimensions of spiritual health that cut across their definitions; religious and existential

dimensions. The religious dimension of spiritual health relates to individuals’ perception of

their health in relation to a supreme power, while the existential dimension relates to their

socio-mental pre-occupations and their way of interacting with themselves, the society and the

nature, the meaning and purpose in life (5). Hence, the indicators of a good spiritual wellbeing

are; connection with the Supreme power, connection with oneself, connection with others and

connection with the nature. Having looked at the prominent operational definitions of health

among Western scholars, I will now turn to the African holistic concept of health, which entails

all facets of life (the physical, psychological, social, economic, spiritual, cultural and

ecological).

While noting that African concept of health is more encompassing and cannot be

understood in isolation from African unitary view of reality, Peter Omonzejele asserts that

health in traditional African context “is not just about the proper functioning of bodily organs,”

but good health for the African consists of physical, psychological, spiritual, emotional and

ecological stability of oneself, family members and community” (120). This assertion implies

that health is not just a personal affair but also a communal affair, since it is understood in

terms of one relationship with the community. The notion of ‘community’ in a popular African

understanding entails both the physical and the spiritual; the gods, ancestors, the living (human

beings and other animate beings), and the non-living or animate beings, as well as the unborn

or yet-to-be born future generations (Ramose, 63; Eze, 625). Both the individual and the

community play some mutual roles in promoting the health of one another. This individual-

cum-community interaction is rooted in African communitarianism where the individual does

not exist independently of the community.

In a similar vein, Abayomi Sofowora affirms that “good health among Africans

represents the harmonious relationship with all that surrounds an African; with God, and with

6
both the visible and invisible beings” (26). This affirmation attests to the fact that for Africans,

good health is more than a subjective affair. Good health in African society is not just to ensure

personal and living community health, but also to make sure that other vital forces or beings

that constitute the community stay healthy so that they can continue to protect the living

community from illness and diseases (Iroegbu, 82). To maintain good health and wholeness,

one must always strive to maintain a harmonious relationship with all the vital forces that

influence human life and wellbeing. This could be achieved by being at peace with the gods,

the ancestors and benevolent spiritual beings that affect one’s health, and by observing and

living out the values and norms as prescribed in the traditions of the society (Iroegbu, 82). In

most traditional African communities, harmony with the gods, ancestors or other spirits is

promoted through daily supplications or seasonal sacrifices.

In contemporary African society, it is not uncommon in most rural or urban

communities to see people offer sacrifices to their ancestors for good health. For instance,

among the Bini and Esan people of Nigeria, it is customary for families to offer parts of their

meals as sacrifice for the ancestors at a designated as ancestral shrines in their homes. It is their

belief that when the welfare or wellbeing of their ancestors) are taken care of through foods

and drinks (e.g., local gin), they (their ancestors) can perform their ancestral functions, which

are basically for the welfare or wellbeing of the living community. In some African

communities, it is a belief that human existence in nature is in the form of a cycle; from birth,

death, life as ancestors and re-incarnation. The ancestors could reincarnate as living beings,

hence it is important to promote their health as well, by offering appropriate sacrifices. For

instance, the Yoruba ethnic group, names like Babatunde (father has come back) and Iyabo

(mother has come back) indicate the belief of this ethnic group in reincarnation. Most ethnic

groups in Africa believe in reincarnation. Thus, it follows logical belief, that healthy ancestors

reincarnate as healthy human beings.

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 Also, as a way of promoting the harmony between a person, the family members or the

community and the ancestor, prayers are offered daily or seasonal at the ancestral shrine, to

plead with the ancestors for good health. In the traditional Igbo communities, the Okpara (head

of household) performs the traditional supplication ritual with Oji (kola nuts) and Ofo (a

symbolic object of authority, justice and decorum) in his hands, the first task in the morning,

to thank God and to ask for good health and protection of his household through the ancestors

or spirits (Igbokwe, 134). As part of his research work, Omonzejele interviewed a traditional

healer from Edo state, Nigeria, who noted that “without ancestral harmony, he would not be

able to effectively manage the physical ailment of his patient, and this is because

spiritual/ancestral harmony precedes physical harmony and health. In other words, ancestral

harmony and atonement play significant roles in wellbeing or health of African people" (122)

Basically, in most traditional African communities, holistic well-being or health of an

individual is linked to maintaining a good nutrition as well as promoting or ensuring a good

relationship with the environment and whole universal community. It also it entails living

according to the prescribed moral and religious values and norms of the community. Having

discussed what the concept of health is in African context, it is imperative to also look at what

Africans actually mean when they say that one is ill or sick. This is because for Africans, illness

or disease is not just a mere malfunctioning of the bodily organ as some Western scholars

portray it, it is more than that.

1.3 THE AFRICAN CONCEPT OF ILLNESS

Some cross-cultural medical anthropological or sociological studies or researches have

shown that the concept of illness, just like health, is influenced by cultural factors that affect

the perception, explanation, characterization, evaluation and treatment of illness and its

experience. The experience of illness is an intrinsic part of cultural and social systems of

meaning, values and rules that guide human behavior; hence it is culturally constructed in the

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sense that how people perceive, experience, diagnose and treat sickness is grounded on their

cultural backgrounds and beliefs, or the social or cultural systems of values and meaning they

found themselves. A research work by Kleinman Arthur, a medical anthropologist, shows that

traditional medical practices are concerned in treating both disease and experience of it,

whereas Western biomedical practices are primarily concerned with the identification and

treatment of disease or curing disease (Kleinman, 30). In another separate cross-cultural

research work with other authors, Kleinman notes that the way people label sickness and the

valuations or responses that flow from those labels, the way they perceive and present the

symptoms of their illness or the manner in which they communicate about their health problem,

when and to whom they go for healing or treatment and how they evaluate healing processes,

are all shaped by cultural beliefs (Kleinman et al., 252). Apart from the concept of illness,

illness behaviors which are normative experience, are shaped by cultural context, hence they

are culture-specific. The observable cross-cultural and historical variations in how the concept

of illness or sickness is understood or experienced is based on the fact there is variation in

nature of knowledge regarding the ontology of illness and this knowledge is applied in

evaluating illness and in making treatment decisions. Cross-cultural researches by scholars like

Peter Murdock (in 1980), George Foster (in 1976) and Allan Young (in 1976), in which

ethnographic literatures from different societies were examined, show that the theories or

concepts of illness vary according to people's beliefs or explanation about the causes of

illnesses; which may be natural explanation or supernatural/personalistic explanation (Garo,

306-307).

In Modern Western societies, theories of illness are categorized into two approaches:

naturalist and normativist approaches to illness. The naturalist approach (naturalism) to illness

maintains that all the causes of illness can be traced to only natural or impersonal causes with

scientific explanations, given that that illness is an objective, empirical and value-free concept

9
(Kingma, 49). Other the hand, the normativist approach (normativism) to illness holds that

illness cannot be reduced to only natural or scientific explanation of its causation, given that

illness is a value-laden, evaluative or subjective concept, by nature anthropogenic; hence no

particular natural or biological theory adequately explains illness or its experience (Kingma,

54).

Naturalists like Thomas Szasz, Christopher Boorse, Justin Garson and Gualtiero

Piccinini, and Sita Ananth define illness or disease as biological dysfunction or a deviation

from normal biological function which is as a result natural causes such as microbes,

physiological imbalance, biological obstruction, malnutrition or organic deterioration

(Kingma, 51). They claim that norms and values are not necessary in assessing what is illness

or disease, but objectively measurable and empirical facts which are universally legitimate and

applicable. Critics (mostly normativists) of naturalist view of illness, often challenge the

universality of the empirical facts used in assessing illness, given that the way people regard

illness, behave during illness, communicate or present their symptoms and to whom they go

for healing or treatment and how they evaluate healing processes, vary from one culture or

society to another, just as Kleinman et al., posited (252). Also, they contend that naturalists

strip illness of those features (norms and values) that make people care so much about illness

or about their sick ones (Kingma, 54). Furthermore, the dichotomy between illness and disease,

as created by naturalists, has resulted to another important dichotomy between curing and

healing, in which a biomedical doctor who believes in a naturalist theory of illness focuses on

curing a disease without allowing active involvement of the patient or the relatives in the

process of healing. For instance, in telemedicine, otherwise known as distance treatment,

diseases are evaluated, diagnosed and treated without the need for a physical contact between

the biomedical doctor and the patient.

10
 The prominent normative theories of illness as conceived by Western Scholars are those

of Caroline Whitbeck (1978), Lennart Nordennfelt (1986), Laurie Reznek (1987), Kenneth W.

M. Fulford (1989), Jerome Wakefield (1992), Richman and Budson, (2000), and Chris Megone

(2000), which consider illness as a state of disability, action failure, harmful condition,

suffering, unluckiness and undesirable condition (Amoretti and Lalumera, 48). In the

normativist outlook, illness is viewed as “a negative experience to have, something that

interferes with human well-being and flourishing or something that individuals or the society

negatively evaluate and dislike” (Amoretti and Lalumera, 54). Normativists deny the naturalist

claim that illness can only be objectively analyzed, but underscore the necessity of including

subjective evaluation of illness. They believe that both health and illness affect the whole

person and they can be assessed with regard to personal or social goals or values. The

normativists’ positions on the concept of illness are typically considered as holistic since they

refer to the whole person rather than a single part of an organism. The normative concepts of

illness are coherent with the African traditional normative conception of illness, wherein all

dimensions of human life (physical, physiological, emotional, spiritual, economic, social,

cultural and ecological) are considered when referring to illness.

Most of the African concepts of illness consider it as “a collapse of cosmic harmony or

the ontological relationship among all beings in the universe” (Magesa, 73; Mbih, 29).

According to Jerome Mbih, in the African metaphysical outlook and medical culture, every

illness has an underlying natural or supernatural explanation (29), unlike in the modern western

medical culture, where natural theories of illness are the only acceptable explanation for illness.

Also, medical ethnographic research by Oke and Owumi (1996) among many ethnic groups in

Nigeria, shows that illness is understood in terms of an etiological account or theory which

traces the causes of illness to two basic factors; natural and supernatural factors (Akpomuvie,

53). The supernatural or personalistic explanations of illness are commonly held theories of

11
disease causation in most African medical cultures (Onwuanibe, 25) which attribute illness to

supernatural factors, and they are categorized into three causation groups: mystical causation

(prenatal fate, attacks or possessions by spirits, ancestral disharmony, punishment from the

ancestors or gods for wrongdoing or violation of taboos), magical causation (sorcery,

witchcraft) and animistic causation (state of spiritual impurities or uncleanliness). These

ontological supernatural causes of illness in African societies will be extensively discussed in

Chapter two.

From the views of most of the African scholars, one could see that dual perception of

illness in Africa medical culture is what distinguishes it from the Western naturalist notion of

illness but similar to the Western normativist view which holds that there are other causes of

illness other than natural causes. In African indigenous medicine, both the natural and spiritual

causes of illness upset the natural ontological harmony between human beings and other beings

in the universe and diminishes the vital force in human beings. The repercussion or effect of

this breach of relationship often manifests either on the person(s) or the community involved,

in the form of illness or sickness, and could possibly lead to death (White, 2). Vital forces

convey resistance or immunity to evil, illness or sickness and could be likened to what is called

the human immune system in Western medicine. Illness or sickness result when the vital force

in human beings is weakened by external physical or spiritual agents or factors (Tempels, 23).

In furtherance of his point on consequences of diminution of vital force in human beings,

Placide Tempels states that, “words like ‘wafwa ko, ‘kufwa’ and ‘fukwididila’ in Bantu

language, which translate to ‘you are dying’ or ‘your vital force is lowered’ or ‘our vital energy

has been sapped’, indicate the progressive loss of life force or immunity and vulnerability to

illness, which occurs when one’s vital force or immune system is weakened” (23). In a

traditional African society, when one is ill or sick, through his or her consent and that of the

family or kin or community, the process of healing is initiated to restore the person back to a

12
state of harmony or health. Illness is not only viewed as a personal affair but also as communal

affair; hence the experience of illness not only arouse a variety of feelings in the sick person

but also in the family members, kin or community that take care of the person, even as they all

in a search for treatment (Akpomuvie, 53). The responsibility of the family, kin or community

towards the sick person is explicated in African ethics of care, which is also rooted in African

communitarianism.

1.4 THE AFRICAN CONCEPT OF HEALING

According to Egnew, “healing is generally considered as a core function of medicine,

but in Western medical practice, there is no working definition of healing or an explication of

its mechanism more than the physiological processes associated with curing disease (256). In

Western medical practice, the pathological term curing is often preferred to healing which is

regarded as a normative medical term. However, Szawarska, a medical anthropologist from

Poland, clearly states that “curing and healing are two aspects of health care that are central to

the practice of medicine; both are two goals of medicine, but are mostly viewed by medical

anthropologists as two distinct medical concepts and approaches to treating illnesses'' (2).

According to Szawarska, the dichotomy in the understanding of curing and healing arises from

the following: (i) the distrust between Western medicine and non-Western indigenous

medicine. (ii) the differing patient’s experience of being cured or being healed. (iii) The social

or cultural understanding of the relationship between medical doctors and patients, and their

roles to each other (85-87). For Szawarska, curing is a pathological term for treatment of

disease often used in the naturalist theories of illness, while healing is a normative or holistic

term for treatment of illness from the normativism outlook on illness. While explicating the

dichotomy between curing and healing, Szawarska notes that, “some Western scholars see

curing as a restorative process of eradicating all evidence of disease or correcting a health

problem (from the naturalist perception of disease), and healing as a multidimensional

13
transformative process of achieving a balance in the physical, mental, emotional, social and

spiritual aspects of human experience” (88). The dichotomy in the understanding of curing and

healing can also be seen in the role or experience of the patient during treatment. Szawarska

observes that patients tend to perceive healing rituals and activities as an engaging experience,

in which they participate actively in the process of getting well, while they see curing as passive

experience in which they have limited involvement in the process of getting better (88). Despite

the social distinction between the concept of curing and healing, the two medical concepts have

something in common; improving the well-being or restoring the health of the sick person.

Although there is a gradually integration and social acceptance of the aspect of healing

in contemporary Western medicine, there is no consensus among Western scholars as to what

exactly does the healing process entails, but the following elements appears in various

definitions of healing by different scientists, as Egnew states in his research: healing as (i)

making whole again, (ii) a total wellbeing and function (iii) a harmony between the body, mind

and spirit, (iv) a spiritual experience, and (v) a transcendence of suffering (257). While

highlighting the importance of healing in Western medicine, Szawarska notes that;

“To focus entirely on curing a disease might be sufficient to make a patient completely

better, simply because patients, apart from having a disease, are also part a wider

socio-cultural fabric, which makes them react to being unwell in a specific manner

and which also makes them attach a particular meaning to the episode of being unwell.

Patients not only feel pain, they also suffer. And while a painkiller might be sufficient

to deal with physical pain, it might not be sufficient to deal with suffering. This is

where healing comes in” (5).

Healing process goes beyond the healer and the person in need of healing. Unlike in curing,

what is so much at stake in healing is the holistic wellbeing of the individual as well as the

14
whole community bound by specific social relationships or ties (Vermeylen and van der Horst,

179). The term ‘healing’ rather than ‘curing’ is preferably used when referring to medical

treatment in an African context, since its meaning is more encompassing and holistic as African

understanding of health and illness.

In differentiating Western healing practice from other indigenous healing practices,

most medical anthropologists use the term “traditional or indigenous healing” to refer to other

healing other the Western understanding of medical treatment. Traditional healing is often

referred to as a heterogenous and indigenous healing system which is based on the culture of a

people and it varies from one culture to another. According to WHO, indigenous healing is

“the sum total of all knowledge and practices, whether explicable or not, used in

diagnosing, preventing or eliminating a physical, mental or social disequilibrium, and

which rely exclusively on past experience and observation handed down from

generation to generation, verbally or in writing” as well as “health practices,

approaches, knowledge and beliefs incorporating plant, animal and mineral based

medicines, spiritual therapies, manual techniques and exercise, applied singular or in

combination, to treat, diagnose and prevent illness or maintain wellbeing” (8).

In most traditional African societies, the process of healing is a holistic one (Thorpe; 23). This

assertion implies that the healer deals with the whole person and provides treatment for the

psychological, physical, social and spiritual symptoms. The holistic nature of the African

healing process reflects the African conceptualization of human beings as a composite of

interrelated and interdependent physiological, rational, ideational and spiritual constituents, as

discussed in Chapter two, unlike the mind-body dualism of Descartes. Since human being in

African metaphysical outlook is made up of interdependent physical and metaphysical parts,

natural or physical causation is not separated from spiritual or metaphysical causation of

15
illness; both are addressed together as issues of health from two interwoven perspectives of

healing: spiritual and physical healing.

African indigenous healing systems are preserved mostly in oral traditions, because of

the value Africans attach to “spoken word”. In his work on African culture, Jahn, a German

writer and influential scholar of literature from sub-Saharan Africa, observes that “all the

activities of African people and all the movement in nature, rest on the word, on the productive

power of the word” (126). As such,

“If there were no word, all forces would be frozen, there would be no procreation, no

change, no life…For the world holds the course of things in train and changes and

transforms them. And since the word has this power, every word is an effective word,

every word is binding. There is no harmless or non-committal word. Every word has

consequences. Therefore, the word binds the muntu. And the muntu is responsible for

his word.” (Jahn, 133).

Jahn’s observation shows that most Africans believe that healing is effective through the word

of the medicine man. Without the healing power of the word, medicines of the indigenous

healers cannot be effective. Also, the reconciliation session of the African healing palaver is

effective through the use of words. The words of the medicine man offer hope and assurance

of healing, and create trust in the healing process. A person is not just healed by medicine only

but by the words that are proclaimed by the medicine man. Hence, a strong medicine man is

known by his strong medicines which are effective through his strong words.

Healing in African society is perceived as a means of restoring the harmony between

man and the universal orders. It entails both physical and metaphysical means or methods of

reinstating the physical, psychological, spiritual, social, cultural, economic and ecological

well-being of the sick person or community. As a holistic system of healing, it stretches to all

16
aspects of human life and takes into account all the human conditions and experiences of being

unwell. According to Onah and Eyong, African indigenous healing “is a part of the complex

religious attempt by Africans to bring the spiritual and physical aspects of the universe as well

as man who lives in it, into a harmonious unity and wholeness” (3). Since human life and health

is considered important and valuable, the ultimate focus of African indigenous healing

practices is to initiate the reconciliation process between the sick person or patient and the

causal agent or vital forces, to re-integrate the healed person back into the whole community

(of both the living and spiritual beings) and to bring about a social order or harmonious

coexistence among the individual, the entire community and the supreme being or the living

dead beings or spirits. In a case, where the patient’s illness is as a result of breach of relationship

with a family or community, the entire family or community may be called upon to participate

in the reconciliation and healing processes. Basically, the African healing system “creates a

safe physical, social and psychological space for a dialogue between the healer and the sick

person in order to find the cause and solution to the person’s illness” (Scheid, 21). Generally,

in the African indigenous healing practices, rituals, sacrifices and reconciliation as well as

traditional herbs and medicines (bwanga in Bantu or Ogwu in Igbo) are part of the means of

complete healing and restoring the sick person or sick physical community back to the natural

state of harmony. Identifying the cause(s) of illness is very crucial for successful treatment; in

this case divination plays an important role in African indigenous healing practice.

17
1.5 CONCLUSION

In this chapter, I discussed the African conception of health, illness and healing vis-à-

vis Western concept of health, illness and healing. And through the discussions, I have shown

that Africans have a more holistic conception of health, illness and healing that permeates all

aspects of life (physical, physiological, emotional, spiritual, economic, social, cultural and

ecological) than the Westerners. To establish that a person is healthy or sick in most traditional

African societies does not just entail only objective evaluation and empirical measurements,

but it also presupposes an evaluation of the general state of all aspects of the person. This

holistic understanding of health, illness and healing in African indigenous healing context,

explained why some patients whose illness cannot be unraveled or cured in Western medicine

are usually referred to indigenous healers for holistic treatment. It also explained why a patient

feels relieved from the burden of moral guilt, the anxiety of being sick and fears of dying, after

undergoing the indigenous healing rituals and practices.

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 CHAPTER TWO

AFRICAN INDIGENOUS HEALING KNOWLEDGE

“Knowledge or science, and its methods of investigation, cannot be divorced from a people’s

history, cultural context and worldview. Worldview shapes consciousness and forms the

theoretical framework within which knowledge is sought, critiqued and or understood”

(Sarpong, 2002)

2.1 INTRODUCTION

The genesis of academic discourse on African healing knowledge is not disconnected

from the history of early indigenous discourses on African knowledge systems which began

with indigenous scholars like Placide Tempels, Léopold Sédar Senghor, Paulin Hountondji,

Bolaji Idowu and John Mbiti. Before the emergence of indigenous academic discourses on

African philosophy, the assumption of the colonial empiricists was that African was a tabula

rasa until their arrival; Africa was described as a granary of ignorance and as terra incognita

or dark continent. Hence, most of the early indigenous academic discourses of Africa were

epistemic attempts to establish and argue that Africa has its own systematic ideology and

understanding of nature of reality, existence and being, its own ways of knowing and its own

idea of God. The recent upsurge of research interest on African epistemology stems from the

denigrating attitude of Western scholars towards African indigenous knowledge systems or

sciences, often framed as barbaric, superstitious and scientific. Many African scholars have

made their different academic submissions on African knowledge systems or sciences in

comparison to Western scientific knowledge. Although they have divergent opinions regarding

the epistemic validity and scientific character of African knowledge, most of them tend to

portray in their works the idea of the “unique and holistic nature” of African indigenous

19
systems or ways of knowing. However, all their epistemological reflections on African

knowledge are geared towards articulating important issues concerning the existence, nature,

forms or sources and scope of African knowledge and proving indeed that Africans have their

own ways of knowing and understanding reality.

As a way of contributing to the ongoing discourses on African indigenous healing

knowledge and practices, the whole arguments and discussions this chapter two are geared

towards showing that “Nku di n amba n’eghere mba nri” (“the firewood found in a land cooks

foods for the people of the land”); more meaningfully, that African indigenous healing

knowledge and practices are not inferior or unscientific as Western paradigm portrays it to be.

Hence, with this intention in mind, in section 2.2, I will briefly discuss the historical

development and epistemic nature of Western medical knowledge, as a subsidiary of Western

scientific knowledge system. Then I will show through counterarguments that the notion

“Western scientism; a belief that Western science and scientific method are the best or only

objective means by epistemic claims or truth can be verified” is a stratagem devised by Western

positivists to colonize and dominate other non-Western knowledge systems or sciences; a kind

of epistemic bullying. I argue that the hegemonic attitude of Western positivists over non-

Western knowledge, has a negative and undermining effect on the development of indigenous

sciences. In the next section 2.3, I will also discuss the historical development, epistemic nature

or characteristics and method of verification of African indigenous healing knowledge, as a

subset of the African indigenous knowledge system. Through the discussions in this section, I

will show that African indigenous healing knowledge, though termed “unscientific” by

Western imperialists, is scientific in its own historical and cultural context, and as relevant as

Western medical knowledge, hence it deserves a fairer scholarly recognition than it gets, in the

global medical scholarship. Furthermore, in section 2.4 and its following subsections, I will

20
briefly discuss the most common forms of African indigenous healing knowledge; empirical,

rational and mystical healing knowledge.

2.2 WESTERN SCIENTIFIC KNOWLEDGE HEGEMONY

The history of Western medical knowledge is as old as the history of Western scientific

knowledge that started during the Greek civilization and reached its crescendo in the modern

scientific endeavor of the West. Early Western epistemologists and contemporary positivists

are convinced that there is a universal way of knowing premised upon objective principles that

supposedly underpin and guide all natural phenomena and human societies (Asakitikpi, 93).

Although, it is a popular concession that each field of knowledge has its own subject-matter,

the theoretical stance of Western scholars remains that the practical ways of deriving and

applying truth are universal or should be the universal and acceptable or applicable in all

situations or societies.

The history of Western Knowledge hegemony began in 19th Century during the time of

Auguste Comte, who was one of the forerunners of positivist epistemology (modern

positivism); an empiricist philosophical theory that holds that only facts derived by reason and

logic from sensory experience can make a true or positive knowledge, hence other ways of

knowing such as theology, metaphysics or spiritual or intuition which are not acceptable in

Western scientific knowledge cannot make legitimate epistemic claims. He expounded his

positivist epistemic theory by offering an account of social evolution; proposing that the society

in its quest for truth undergoes three successive phases of human evolution and development

called according to general “laws of three stages'' such as; the theological phase (the starting

point of human development), the metaphysical (the transition state) and the positive phase

(the last state of human evolution). As Comte reasoned, the first two phases of human evolution

and development being lesser and debased stages, are characterized by knowledge systems that

21
ascribe spiritual and abstract forces to human and natural actions (Giddens, 12-13). The final

stage of the trilogy of human development is the scientific or positive stage, where empirical

science is valued as the only highest or the only genuine form of knowledge. Positivists after

Comte continued to produce research in various fields of knowledge that conforms to Comte’s

notion of Western scientism; that reality can be only be explained or proven through Western

science founded on empirical evidence while other non-Western indigenous sciences,

knowledges or explanations of reality that do not accede to the positivist ways of knowing must

be dismissed or rejected as mere superstitions and therefore, irrational.

Furthermore, in a continued epistemic hegemony of denigrating other knowledge

systems that do not conform to Western rationality and principles of logic, Steven Lukes argues

that “a knowledge is irrational and should be rejected if it falls under any of the following

criteria: (i) if it is illogical or inconsistent or self-contradictory; (ii) if it is partially or wholly

false; (iii) if it is nonsensical; (iv) if it is situational, specific, or ad hoc; (v) if the ways in which

it come to be held or the manner in which it is held are seen as deficient in some respects” (206-

207). Underneath Lukes’ criteria (iii, iv and v) is an assumption or a notion of Western

scientism; that an epistemic claim can only be verified and validate using only Western

scientific criteria or methods. The criteria iii, iv and v are not only illogical to a rational mind

but also unreasonable to indigenous people whose knowledge cannot satisfy all the criteria.

Just as societies differ from one another in their ways of viewing and understanding reality, so

also is knowledge; the way and manner in which it is sought, understood, held and justified

differs from one society to another and it is sometimes situated within a particular socio-

cultural framing. Hence, an epistemic claim which is seen as nonsensical in a particular society

could make some sense in the society where it is held. An epistemic claim makes more sense

only within its own cultural context. According to Owusu-Ansah and Mji, “knowledge or

science and its methods of investigation and ways of analyzing and interpreting social and

22
natural realities cannot be divorced from a people’s history, cultural and worldviews” (1).

Worldview forms consciousness and shapes the theoretical scheme within which knowledge is

pursued, understood, justified, verified and validated. For Emeagwali and Shizha (2016)

“scientific knowledge, in whatever form, definition and cultural context it may exist, is found

in all societies” (6). Their claim is based on a generalization from an observation that since

each society has its own way of perceiving and understanding reality, and interacting with the

natural world, there are knowledge which are indigenous to a particular society. And according

to World Bank (2004), this indigenous knowledge involves “skills, innovations, experiences

and insights of people in their respective local communities, accumulated over years and

applied to maintain or improve their livelihoods” (Qtd. in Masoga and Kaya, 22). This

definition lends credence to the fact that indigenous knowledge cannot be disconnected from

or analyzed outside the cultural, social, political, economic and spiritual realities of the

indigenous people. Hence, it is not surprising that the African methods of acquiring,

categorizing, labeling, verifying and validating knowledge of reality differs from that of

Western society. If knowledge has a social or cultural origin and relevance, it should be

examined within its own particular focus, without universalizing it in a way that Western

scientism seeks to do. It is discriminatory and oppressive to adopt one method of epistemic

investigation as universal, just like the positivists do.

One of the dangers Western scientism is that it undermines development and creativity

of indigenous knowledge. Ian Hutchinson (2011) offers an insight on the effect of Western

scientism on indigenous knowledge or sciences, as he avers that, “the health of science is in

fact jeopardized by scientism, not promoted by it. At the very least, scientism provokes a

defensive, immunological, aggressive response from other intellectual communities, in return

for its own arrogance and intellectual bullyism. It taints science itself by association” (143).

For instance, most of the early academic publications by indigenous African scholars were

23
done out of the Western epistemic provocation which painted Africa as a continent of ignorance

without any civilization before colonial invasion. With the various criticisms against the

hegemony of Western scientific knowledge, it is not unreasonable to argue that Western

scientific method, grounded on reason and empirical observation or sensory experience of the

physical or natural world or reality, is inadequate for the analysis of indigenous knowledges

that are grounded on empirical experience of the physical or material world, and as well as

extra-sensory experience of the metaphysical, immaterial or spiritual world. Rather, indigenous

knowledge should be analysed or investigated within its own indigenous method of epistemic

analysis.

Non-Western indigenous knowledge or sciences like for instance, the African

indigenous knowledge system or sciences are better understood and appreciated when they are

not detached from the historical, practical, social, cultural and communal dimensions within

which they are embedded, which cannot be. This view aligned with Owusu-Ansah and Mji’s

affirmation that “African indigenous knowledge and its methods of acquisition, has a practical,

collective and social or interpersonal slant” (2). In fact, the works of Elias Mpofu (2002) and

Bame Nsamenang (2006) show that African indigenous conceptions of human intelligence

accentuate the practical, interpersonal and social domains of human intellectual functioning

and are quite different from the cognitive academic intelligence that dominates Western

paradigm (Mpofu, 179-180; Nsamenang, 293-294). For instance, unlike Western

epistemologists which emphasize only rational and experiential knowledge, African

indigenous knowledge is not gained through reason and sense experience alone, but also

through extra-sensory, mystical or spiritual experience, intuition, imagination, feeling,

proverbs and innate ideas which defy Western logical analysis. Other notable distinctive

features of African indigenous knowledge are that; it is largely communitarian, it is less

transferable, it has unitary ontological feature and it is based on the notion of “life-world

24
embeddedness. With these some notable difference between Western scientific knowledge and

African indigenous knowledge, one cannot unreasonably support the positivists hegemonic

claim that that reality can only be explained or proven through Western scientific method. The

investigation and evaluation of indigenous epistemic claims is more reasonable, plausible and

practicable from the same lens through which the indigenous people conceive, interpret and

make sense of their reality. Hence, if one speaks of investigation and evaluation of African

indigenous healing knowledge, one should do that from the viewpoint of African understanding

and interpretation of reality, as both natural and supernatural.

2.3 AFRICAN INDIGENOUS HEALING KNOWLEDGE

According to Anselm Jimoh and John Thomas, “African epistemology deals with what

an African means and understands when he makes a knowledge claim. This consists of how

the African sees or talks about reality” (55). Similarly, Godfrey O. Ozumba in his book, A

Concise Introduction to Epistemology, defines African Epistemology as “Africa’s way of

carrying out its inquiries into the nature, scope and limits of knowledge” (171). The deduction

from these definitions is that Africa has its own peculiar or unique ways of establishing or

verifying epistemic or truth claims, which are largely pragmatism; a practical approach which

based on the testimony of an eye-witness (a third party) and oath-taking. Hence, the very notion

of epistemology of African indigenous medicine is hinged on the fact that such concepts as

truth, rationality and knowledge of medicine can also be explained using African thoughts and

theories as provided by the African religious and cultural experiences without appealing to

Western thought.

Epistemology of African indigenous medicine, as a branch of African epistemology, is

therefore defined as African ways of carrying out inquiry into the nature, forms, scope, validity

and limit of African indigenous healing knowledge. It involves the study of how the indigenous

25
healers or doctors acquire their healing knowledge, the justification and verification of the truth

of their healing epistemic claims. African healing knowledge is as old as African society. It

existed alongside other knowledge since the inception of African traditional society when

Africans started making scientific discoveries; when the first African cavemen discovered how

to make fire, paints from plants and make ornaments. The archaeological discoveries of oldest

bronze, iron and copper artifacts as well as objects of ivory, pottery, glass and stone beads, by

Isiah Anozie (1939) and Charles Thurstan Shaw (1959, 1964) in Igbo Ukwu, Igbo community,

and also the archaeological discoveries of oldest human paintings, drawings and ornamental

objects coated with iron oxide by Henshilwood (2007) and Henshilwood et al. (2001, 2011) in

some caves in South African proves that African was indeed the cradle of scientific knowledge

and that the indigenous knowledge capabilities to explore nature, preserve the ecosystems and

create value have a long history in the continent.

African indigenous healing knowledge is relatively less transferable than Western

medical knowledge, holistic and largely communitarian in nature. It is less transferable given

that it resides only with the indigenous healers (mostly in form of oral tradition) who are most

times unwilling to pass it down to anyone, except to their apprentices and initiates, through

years of rigorous training. The less transferable nature of African indigenous healing

knowledge can be seen as an indigenous method of intellectual property protection from

exploits. It is holistic in nature, given its socio-cultural and spiritual dimensions. Also, it is

communitarian in terms of discovery and experimentation, mode of transmission and sharing,

which are often communal rather than personal. The collective character of African indigenous

healing knowledge is rooted in the African notion of collective responsibility – a collective

ethic – which approves that the existence and survival of a people is through harmonious

interdependence and interconnectedness. The collective nature of African indigenous healing

knowledge implies that even though it is held by few people (the indigenous healers) in a

26
community, it is seen as part of the whole body of knowledge systems of the community; hence

it is collectively owned by the community and it cannot be disassociated from the social,

cultural, religious, political and economic realities of the community. In other words,

communal healing knowledge is expressed in individual healing knowledge. The variations of

African indigenous healing knowledge, practices and methods across all cultures and

communities in Africa reflect its divergent communitarian nature. The communitarian nature

of African indigenous healing knowledge is important because it is part of what holds the

people together as a community. Hence, the reason why an African person who is sick must

consult the healer in his or her community before seeking help outside. Another distinguishing

characteristic of African indigenous healing knowledge is that it is intergenerational but mostly

in the form of oral tradition. It is handed over from one generation to another mostly through

oral tradition; those who hold the knowledge, hold it in trust for future generations. The

metaphysical dimension of African indigenous healing knowledge is another unique feature

that distinguishes it from that of the Western medical knowledge. The rational, empirical and

metaphysical dimensions of African indigenous healing knowledge reflect its embeddedness

in African culture, tradition and religion, as well in African ontology that treat both the subject

(man) and material (nature) or immaterial (spirit) object of knowledge as two aspects of the

same reality.

The unitary ontological feature of African indigenous healing knowledge is another

important feature that distinguishes it from Western medical knowledge. In epistemology of

African indigenous healing, the subject (the healer) is not disconnected from the object

(whether nature or spirit) he knows; both are seen as one inseparable continuum. Both the

healer and nature or spirit are seen as part of the same universal community. It is from the close

existing relationship between the indigenous healer and the universe (nature and spirit) that the

healer explores his or her healing knowledge. Hence, African healing knowledge comes from

27
co-operation between the healer and the universe (both nature and spirit); there cannot be

knowledge if the healer detaches himself or herself from the universe. This is because the

universe itself is imbued with life force(s) that animate(s) every being in the universe. As an

animated and active participant in events of nature, an African healer articulates and construes

what he or she sees, feels, reasons, imagines and intuits from his faculties and experiences into

knowledge which is both personal and communal since he cannot separate himself from his

community. In the knowing process, the healer is not only perceiving and thinking of the object

of knowledge, but also experiencing it through physical and metaphysical or spiritual means.

This aspect of African indigenous healing knowledge makes sense in the African context, since

their indigenous healing knowledge constitutes the lived experiences of co-existence with the

natural and spiritual world for many years.

Furthermore, African indigenous healing knowledge is based in the notion of “life-

world embeddedness” wherein the healer’s perceptions about health, illness and healing are

intricately bound to a cascade of experience or life events with both natural and supernatural

attributes. The natural attributes reflect Africans’ perception of the physical world, the meaning

they attach to it, and how they respond to that world. The supernatural attributes reflect the

unseen world that is made up of the gods, the ancestors and other transcendental beings,

including vital forces. The supernatural is an objective reality since it may reflect an

intersubjective reality that is shared by both the healer and the patient. African indigenous

healers do not only attempt to ground their healing knowledge on spiritual reality that is

inaccessible to ordinary human mind, but they also access the realm. They do so by employing

various supernatural means. Although African indigenous healers can constitute knowledge

through various epistemic sources as discussed in section 2.3, at the same time, they are also

seen as custodians of that knowledge through their position as spiritual guardians of the

community, as well as interpreters of the natural and supernatural causative factors of ill-health.

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They use appropriate cues, anecdotes, and linguistic symbols to interpret and explain realities

of both the natural and spiritual world to their patients, bearing in mind that their explanatory

activities are geared towards the ultimate goal of healing their patients.

Just like in Western epistemology, the justifications of the healing knowledge of the

African indigenous healers do not actually confer infallibility on all their epistemic claims.

Indeed, an ethno-medical investigation of the African healing system in South Africa, by Alex

Egodotaye Asakitikpi, shows that most indigenous healers recognize and point to the inherent

limitations of the knowledge they possess. According to Asakitikpi, the healers “understand

fully well that their frailty as humans, their personal experiences and idiosyncrasies as healers,

impact on the intricate work they undertake on behalf of their patients and the community as a

whole” (99-100). As he mentioned, for instance, one of the healers he interviewed claimed she

had difficulties deciphering the symbols presented to her by the ancestors in her attempt to

explore the possible cause(s) of the medical condition of an HIV/AIDS patient. According to

the healer, there is a pattern from the divination she did that seems to explain the behavior of

the virus, but she cannot decipher the code as symbolically presented. She had no doubts that

through further procedural probe, it is possible to gain better insight into the cure for the virus.

The difficulties of the healer in establishing the truth of the mystical belief she accessed from

the spiritual realm shows that not every epistemic claim by African indigenous healers are true

or reliable, hence in most traditional African societies, in cases of doubt or want of proof for

the healer’s beliefs or epistemic claims, a third party is called to testify, but if such testimonial

claim is also in doubt, oath-taking becomes the final way of confirming the truth of the healer’s

epistemic claims.

Since African indigenous healers consult the metaphysical or spiritual world of the

gods, ancestors and other spirits during the healing process, it becomes difficult to assess the

accurate measure of its reliability or truth using the Western scientific method. At the

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supernatural level, it is difficult to ascertain or verify the validity of any healing claim made by

the healer, although those made by the patient can be verified empirically. While the former

may be difficult to investigate using western empirical methods, its truth can still be socially

examined through the healing testimonies shared by many of the patients who got their

sicknesses interpreted and healed through the divination of the African indigenous healers. To

ascertain the truth of a given epistemic claim by a healer, another African indigenous healer

with similar insights into the working model of the supernatural can also be called upon to

verify the truth of the healer’s epistemic claims. From the body of evidence or testimonies

offered by the patients or other indigenous healers, a conclusion can then be drawn on whether

the claims made by the healer are true, accurate, authentic, and reasonable within the cognitive

framework of the reality being examined. Through this indigenous method of epistemic

verification, the validity and truth of the African indigenous healer’s claim are only verified by

those who understand the logic of the spiritual reality or have experienced it and not by Western

scientists whose method is quite different and inadequate in verification of indigenous

knowledge.

2.4 INSTANCES OF FORMS OF AFRICAN INDIGENOUS HEALING

KNOWLEDGE

African scholars like Christopher Anyanwu (1981, 1983), Elijah Okon John (2009),

Ejikemeuwa Ndubisi (2015), Christopher Ani (2013) and Andrew F. Uduigwomen (2009),

believe that Africans have their own ways of conceptualizing, interpreting and apprehending

reality based on their own lived experiences, and they have their own forms of knowledge such

as; rational knowledge, empirical knowledge, intuitive knowledge, sage knowledge, common

sense knowledge, mystical knowledge and wholistic/holistic knowledge. Some of this

knowledge is acquired through various ways that defy Western empirical methods of epistemic

verification and validation. Empirical, rational and mystical knowledge being the most

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common forms of African indigenous healing knowledge, are briefly discussed in the following

subsections with reference to some African societies for a better understanding of how they are

acquired and their cultural eccentricities.

2.4.1 Empirical Healing Knowledge

This is the type of African indigenous healing knowledge that is gained through many

years of observation, experimentation and sensory experience of nature. In most traditional

African communities, it is a belief that the older the healer, the more knowledgeable or

experienced he becomes in the art of healing. This belief is based on the assumption that a

healer’s empirical beliefs and hypotheses of different kinds of illnesses, healing medicines and

herbs, and other healing skills accumulate into empirical knowledge and is validated, after

many years of experiential medical practice and observation of the effectiveness of his healing

practices. Hence, according to Ifeanyi Menkiti, this form of knowledge is based on sense-

experience of the healer, as expressed in the Igbo proverb, “what an old man sees while sitting

cannot be seen by a young man whilst standing, even if he climbs highest Iroko tree” (173).

For Menkiti, there is a sort of ontological progression in experiential knowledge as the healer

grows older in the art of healing. Hence, the older indigenous healers are seen as repositories

and custodians of knowledge of healing practices and skills such as knowledge of divination,

healing herbs, natural and spiritual healing methods.

The difference between African and Western empirical knowledge lies in the means of

testing or verification; In epistemology of African indigenous healing, there is no experimental

testing of the healing hypotheses and beliefs in the laboratory like in Western medicine before

applying them to the patients. However, Elijah Okon John argues that African indigenous

empirical knowledge is subjected through a series of indigenous experiments to ascertain its

truth. According to John, empirical knowledge “comes to an African man through various

senses of the body. But before the man’s observation qualifies as knowledge, it must be tested

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through indigenous experiments” (166). For an African indigenous healer to lay claim to

knowledge of any healing skill, he must have practiced it, or be able to offer first-hand account

of such knowledge or produce an eye-witness (in this case, the patients treated) who can offer

testimonial-knowledge of such healing skill. The justified empirical beliefs (confirmed through

many years of medical practice) of the healer concerning certain healing skills are taken to be

true in most traditional African societies. What the healer feels, sees, hears, touches and tastes,

is taken to be first-hand account and hence it is treated as experiential knowledge. The factuality

and reliability of healing knowledge gained through many years of sense-experience is also

captured in Ejikemeuwa Ndubisi’s submission;

“The African person holds that knowledge is gained through what we see, hear, touch,

taste or smell. This is embedded in the idea of ‘afu n’anya e kwere’ (to see is to

believe). The idea that ‘Mr John is in the class or that snow is falling now’ is within

the domain of empirical knowledge. The African finds it very difficult to doubt what

he has witnessed with the empirical senses” (295).

In one of his academic works on Yoruba epistemology, Barry Hallen (1998) argues that

“empirical Knowledge (imo) in Yoruba is based on sensory perception, mainly visual

perception (irirn) of the external world. In other words, what someone sees (Igbagbo), when

conjoined with cognitive activities or mind (eriokon) like understanding, comprehension,

consciousness, judgment, and proposition pertaining to such experience are regarded as true

(ooto)” (832). In differentiating between empirical knowledge and beliefs, Barry Hallen (2004)

argues that “imo is obtained through first-hand information, observation and sense-experience.

Imo can be subjected to verification and confirmation. Igbagbo is obtained through second-

hand information however it would later become imo after some empirical testing” (297).

Yoruba thought permits that the past is a reliable, though not an infallible, guide to the present

and to the future. Therefore, if the past as held in the mind contradicts the present sense

32
experience, Yoruba thoughts expect that the epistemic belief based on the present sense

experience should be doubted, if not rejected or declared false. The number of years of

experience of an indigenous Yoruba healer, therefore matters a lot in determining the

authenticity or realism of his healing knowledge claims and in confirming his healing

proficiency and mastery. In ethno-anthropological research of the epistemic basis of indigenous

healing knowledge among indigenous healers in Uganda, Disan Kutesa clearly notes that 41%

of the indigenous healers reported that their knowledge of the ethnomedicinal properties of

healing herbs and medicines and other healing skills comes through sense-experience (both

perceptual and testimonial) acquired through many years of practice (198).

2.4.2 Rational Healing Knowledge

This is a type of African indigenous healing knowledge that is gained either through

inferential (deductive) reasoning by drawing conclusion from logical premises (beliefs) that

are grounded on previous knowledge of the healer or through non-inferential (inductive)

reasoning by drawing conclusions from logical evidential supports or observation (beliefs) that

are grounded on previous knowledge of the healer. Rational healing knowledge is gained if the

healer knows or is certainly aware that all his or her healing beliefs (accumulated from past

experiences) involved in his inductive or deductive reasoning are true. According to Usman

Sylvester Gbari, “this type of knowledge is amplified by the past experiences” (182) of the

indigenous healers. The more a healer has experiences of healing practices, the more the

inferential or non-inferential knowledge he or she gains. Hence, it takes years of practice for

an indigenous healer to have an experiential compendium of illnesses, symptoms and healing

methods that he or she uses to diagnose various illnesses in future. This type of rational healing

knowledge is similar to Western rational way of knowing, except that its premises or beliefs

emerge from African cultural and traditional experiences.

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2.4.3 Mystical Healing Knowledge

This is the type of African indigenous healing knowledge acquired through supernatural

or spiritual means that are beyond the ordinary sense perception or experience. According to

Levy Jaki, “human knowledge comes from two realms, quantities and no-quantities, and these

two realms are irreducible to one another” (19). In most traditional African societies, it

popularly believed that, “divine beings are actively engaged in the epistemic experience of

humans as they directly or indirectly reveal things to human beings in their experiences” (Ani,

309). Similarly, John Mbiti (1990) while highlighting the relevance of mystical knowledge in

African society, notes that; “every African who has grown up in the traditional environment

will, no doubt, know something about this mystical power which often is experienced, or

manifests itself, in form of magic, divination, witchcraft and mysterious phenomena that seem

to defy even immediate scientific explanations….” (189). In the African context, mystical

healing knowledge is exclusively reserved for those individuals who serve as intermediaries

between the gods, ancestors or other spiritual beings and human beings, namely; the diviners,

priests and some healers. They are believed to have certain innate abilities or mystical powers

that enable them to access the spiritual realm for information or truth that pertains to the

physical world. According to ethno-anthropological research of the epistemic basis of

indigenous healing knowledge among indigenous healers in Uganda, by Disan Kutesa, 52% of

the indigenous healers reported that their knowledge of the ethnomedicinal properties of

healing herbs and medicines and other healing skills, are from gods, ancestors and spirits (199).

Access to the spiritual realm is often through divination which is beyond Western scientific

explanation.

Despite the various indigenous justifying arguments for mystical knowledge, there are

still objections from some scholars like P. O. Bodunrin, who believes that for such things as

mystical experience and extra-sensory perception to be true, there must be a convincing method

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of testing to prove the existence of mystical knowledge. And according to Bodunrin (1995),

this method must meet some scientific (scientifically organized experiments) and logical

requirements (376). In responding to Bodunrin, Andrew Uduigwomen (2009) explains that it

obviously follows that Bodunrin is in support of the tradition of the logical positivists who

maintained that any meaningful epistemic claim must be subjected to Western scientific

verification, but he is mistaken, because “in African traditional setting, scientific

experimentation is not resorted to if a disagreement arises between two parties regarding what

one claims to observe. Rather, the testimony of a third party is sought to settle the difference”

(172). Uduigwomen’s argument is reasonable given that one cannot logically claim that

because something cannot be sensorily perceived; it therefore does not exist. Although mystical

knowledge cannot be proved using Western scientific methods, it does not necessarily mean

that it cannot be true, since its truth lies beyond the natural world that only African indigenous

science can explore or explain. One may argue that mystical healing knowledge is unsafe to be

used for medical interventions, but the fact remains that many patients have been healed

through it. Instead of discarding all the mystical healing beliefs or knowledge of the indigenous

healers, just because it cannot be explained by Western method or conform to Western forms

of knowledge, it is more commendable to subject it to investigation using the African

indigenous way of epistemic verification (as discussed in section 2.3).

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2.5 CONCLUSION

In this chapter, I have discussed the epistemology of African indigenous healing vis-à-

vis Western paradigm, and through the discussions I argued that Africans have their own

indigenous healing knowledge, since knowledge, in whatever definition, form and cultural

context it may exist, is found in all societies, and is affected by the way each society conceives,

understands and interprets reality. By dismissing the misconceptions of Western positivists

regarding non-Western indigenous knowledges, I argued that African indigenous healing

knowledge is not inferior or unscientific as Western scientism framed it to be, rather its

scientific nature is embedded in African indigenous and cultural methods of acquiring,

categorizing, labeling, verifying and validating epistemic claims. With reference to the works

of indigenous African scholars like Ejikemeuwa Ndubisi, Elijah Okon, Barry Hallen, Disan

Kutesa, Usman Gbari, John Mbiti and Andrew Uduigwomen, I also argued that African

indigenous healing knowledge differs uniquely from the Western paradigm, hence they can

only be reasonably investigated or analyzed from the same lens through which African people

conceive, interpret and make sense of their reality, rather than through Western scientific

method.

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 CHAPTER THREE

AFRICAN INDIGENOUS HEALING PRACTICES

“The African concept of treatment is comprehensive and holistic. The healer treats the body,

soul, and spirit. He achieves this by unraveling the physical and spiritual causes of an

ailment. Treatment could be the use of herbs, sacrifices, divination and incantations”

(Omonzeleje, 2008; 122).

3.1 INTRODUCTION

The World Health Organization (2002) defined traditional/indigenous medicine or

healing practices as “the sum total of all knowledge, skills and practices based on the theories,

beliefs and experiences indigenous to different cultures, whether explicable or not, used in the

maintenance of health as well as in the prevention, diagnosis, improvement or treatment of

physical and mental illnesses” (WHO, 2). In line with WHO’s definition, African

traditional/indigenous medicines or healing practices can be defined as the sum total of all

knowledge, skills and practices based on the theories, beliefs and experiences indigenous to

different African cultures, used to promote and sustain health and holistic wellbeing, as well

as to prevent, diagnose, improve or treat physical, mental and spiritual illnesses. African

indigenous healing practices or medicine is a holistic healthcare system which comprises three

levels of specialization namely: divination, spiritualism and herbalism. The African indigenous

healing practices differ from one African community to another, based on the cultural, religious

background and beliefs that are prevalent within a particular African community. Hence, the

aim of this chapter is to highlight the significance and relevance of African indigenous

diagnostic and healing methods and African perception of etiology of illness and its relation to

African conception of human person.

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 In section 3.2 of this chapter, I will discuss the diagnostic methods in African

indigenous medicine, namely; divination, physical examination of the patient’s illness and

questioning to know the patient’s medical history or to uncover the cause(s) of his or her illness.

After these, I will proceed to section 3.3, to discuss some of the African indigenous healing

methods and approaches which mostly consist of spiritualism and herbalism. In section 3.4, I

will discuss the African perception of the etiology of illness, as well as how this perception

relates to African conception of human person or nature in section 3.5. Finally, in section 3.6,

I will discuss the relevance of some of the values of African indigenous healing practices.

3.2 AFRICAN INDIGENOUS DIAGNOSTIC METHODS

In African indigenous healing practices, every sickness or illness is traceable to a cause

(either natural or spiritual cause), which has to be diagnosed and identified by an indigenous

healer, medicine man or herbalist or spiritual or telepathic diviner (Dibia in Igbo, Babalaalawo

or Onisegun in Yoruba or Okomfo in Akan, N’yanga or Sangoma in Bantu) before any

particular treatment or healing can commence. The process of diagnosis begins either with

divination or consultation of the spirit world to find out the physical or metaphysical cause(s)

of an illness, or with careful physical examination of the patient’s illness and questioning of

the patient to know his or her medical history or to uncover the root cause(s) of the illness. The

African diagnostic process appears not only illogical to Western diagnostic techniques, but it

defies the Western ways of knowing.

Divination as a method of diagnosis in African indigenous medical practices, is used

by diviners and medicine men to unravel and diagnose the health problems of their patients.

Through this traditional technique, the medicine man is guided by the best way of healing the

sick person. According to Croucamp,

38
 “Divination is a technology that is used to initiate a process of accessing and collecting

information through the use of randomly arranged symbolic objects, and then using

the cognitive capacity for analytical and analogical interpretation of the relationships

between these objects. Therefore, it is a transpersonal field of information where

healing knowledge can be accessed” (5).

Through divination, information or knowledge that transcends the ordinary mind can be

accessed or revealed. While highlighting the revealing nature of divination, Ozekhome opines

that divination brings about revelations by “revealing the unknown and at times cloudy future,

unmasking the abysmal tunnel of the dark, nebulous past, and analyzing the vibrant but

malleable present. Because of the revealing powers of divination, Omonzejele argues that “it

is usually the first step in African indigenous healing practice” (122). Divination which is seen

as an indigenous African knowledge system, through which knowledge, information or truth

that beyond ordinary sense observation and perception, defies the Western means of knowing,

hence it is not easily amenable to Western rationality and scientific system of validation.

However, such methods of acquiring mystical knowledge are still reasonable or rational within

the context of African sciences as discussed in chapter two.

The various ways of divination include; osteomancy, tasseomancy, lithomancy,

pendulum reading, Norse Runes, Celtic ogham, tarot card and readings, psychic automatic

writing, full moon water scrying etc. (Chaitanya et al., 3). Osteomancy, otherwise commonly

known as throwing of bones, is the most common way of divination in Africa. During the

process, the diviner throws the divining bones, which consist of animal bones and other

variables or meaningful objects, on a mat or strip of leather or flat wooden material or inside a

marked circle on a ground. The divining bones or objects represent certain psycho-socio-

spiritual polarities (White, 3). Also, they represent all the vital forces that affect human beings.

Other ways of divination involve communication with the spirit of the dead (necromancy) and

39
interpretation of dreams, nightmares, omens or appearance of spirits. Although there may be

little or no Western scientific validation of divination, its revealing potency can be

substantiated in African sciences as discussed in chapter two. In contemporary African society,

there is still a strong belief that causes of illnesses beyond Western medicine understanding,

can only be unraveled through divination.

An ancient form of divination system in Africa, recognized by the United Nations

Educational, Scientific and Cultural Organization (UNESCO) as an important African cultural

heritage, is the Ifa divination system in Yoruba communities. Contrary to other forms of

divination that employ spirit mediumship, Ifa divination does not rely on the diviner having

spiritual powers but rather on a system of interrelated objects and signs that are interpreted by

a diviner, the Ifa priest or Babalawo. The Ifa priest makes use of the Ifa literary corpus called

Odu Ifa, which consists of 256 parts which are partitioned into verses called Ese, and are

chanted by the priest in poetic language. Each part of the Odu Ifa has its specific divination

significance and meaning, which is interpreted by the Ifa priest using a sacred divination chain

and palm-nuts. In the Nsukka community of Igbo ethnic group, the divination instrument called

the Afa or Eha consists of four strings or chains, each containing four half-shells of the seeds

of bush mango (ujuru) or almond (apipi). The apipi or ujuru half-seeds are the most significant

parts of the afa strings. The strings also contain cowrie shells connected to the end of each

string. During divination, the diviner, called dibia afa/eha, throws the strings, one string at a

time on the mat, so that they lie in parallel rows, with the ends of the strings towards the dibia

afa. After casting the four strings, the diviner gives interpretations of the whole casts, which

represent information about reality, by reading the significantly-patterned apipi or ujuru. On

the other hand, in Ijaw land in Nigeria, Igbadai divination is carried out using the Igbadai

divining frame, which is carried on the shoulders of four young men. The diviner puts his

questions to the Igbadai divining frame, which operates on “Yes-or-No” principles. If the

40
answer is “Yes'', the frame mystically pulls the bearers forward, but if the answer is “No” it

pulls them backward (Dime, 8-88).

In Akan communities in Ghana, the Adebisa divination employs spirit mediumship.

During the process, the diviner, Adebisafo consults Nyamewaa-Nyame (God) or Namanom

Nsamanfo (the ancestors) or Abosom (the deities), who reveals the knowledge of all things in

the physical and spiritual realms to the Adebisafo through his Okra (the soul or divine

consciousness). The Okra acts as a medium of nkom - the spiritual communication between the

diviner and the spiritual beings. Similarly, the Nguni divination in Bantu-speaking

communities in Southern Africa, also employs spirit mediumship.

Apart from divination, African indigenous diagnostic methods can take the form of

communication and discourse between the indigenous healer and the sick person or the

community involved, in order to find out or establish the natural or supernatural cause(s) of an

illness. Bujo Bénézet, while writing about African healing palaver, clearly states that healing

in an African community “takes the form of an extended dialogue between the indigenous

healer and the patient…By means of questions and replies…the healer challenges the sick

person not only to supply information about his illness but also, if need be, to give an opinion

about it” (46). For instance, the patient may have some knowledge about an offense or taboo

committed against another person or family members or the community, and by revealing the

truth, he or she hastens the reconciliation part of the healing process. If necessary, the person

or family members or whole community involved, could be summoned to participate in the

reconciliation process. Reconciliation acts as medicine to promote healing (Scheid, 21). During

the healing process, bodily sickness is not only healed, but also as well the interpersonal or

family or communal relationship that was broken. Basically, African indigenous healing

practices create a safe psychological atmosphere for the patient to confess his or her guilt,

41
accept responsibility for the wrongdoing and reconcile with those whom he or she has hurt or

offended (Scheid, 21).

3.3 AFRICAN INDIGENOUS HEALING METHODS

After establishing the root cause(s) of a sickness, there are different methods of healing

employed by the indigenous healers to ensure complete recovery of the sick person or

community. These methods depend on the underlying cause of the sickness. If the sickness is

as a result of spiritual cause(s), the diviner uses any or a combination of spiritual healing

methods like spiritual cleansing, spiritual protection, sacrifices, exorcism, appeasing the gods

and pouring of libation. On the other hand, if the illness is established to have physical cause(s),

any or combination of physical healing methods like prescription of herbs, application of clay,

surgery, psychosocial counseling or reconciliation, can be used. Nevertheless, oftentimes

healers use a combination of spiritual and physical healing methods to treat their patients

depending on the type and nature of the illness.

Spiritual Cleansing

Spiritual baths are part of spiritual healing in some African communities. This remedy

is prescribed by the indigenous healer to a patient, whose sickness is caused by spiritual

manipulations. It involves herbal bath, sacred water bath and animal blood bath. This healing

practice is common among the Ewes in Ghana (Westerlund, 127). The spiritual bath serves as

a way of cleansing the sick person from any spiritual cause or spell. After the bath, the person

is expected to offer certain items for sacrifice such as kola nut, eggs, dove, cat, fowl, dog, etc.

These sacrificial items are believed to be for thanking or appreciating the gods or the ancestors

for granting the sick person healing.

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Spiritual Protection

In any spiritually-rooted case where a sickness is diagnosed to be as a result of an attack

by evil spirits or charms of evil people, the indigenous healer usually prescribes charms,

amulets, talisman or magical black powder for body marks, to drive away evil spirits or powers

and protect the sick person from future attack. These spiritually prepared items can also be used

to expel evil powers or dangers that may have befallen a family or community (Westerlund,

111-113).

Sacrifices

As a procedure of spiritual treatment, sacrifices are sometimes offered on demand by

the gods or the ancestors for spiritual healing of the sick person. Sometimes, it involves animals

being slaughtered or buried alive or foods being sacrificed to appeal to the gods or ancestors

for healing. Among the Ewes and some ethnic groups in the northern region of Ghana, animals

like dogs or cats are buried alive at midnight to heal the soul of the sick person at a point of

death (White, 30). There is a belief that the lives of these animals are offered to the gods to

save the life of the sick person. Sometimes, these sacrifices are offered in addition to the use

of secret herbs for complete healing. In South Africa, these sacrifices also sometimes include

human sacrifices known muti or ritual murder (Scholtz, 118). In some situations, sacrifices are

performed to consecrate the medicinal herbs and make them more potent.

Exorcism

In some traditional African communities, exorcism is one of the spiritual healing practices. It

is a practice of expelling evil spirits or demons from the sick person who are confirmed to be

possessed. There is a belief that certain illnesses are due to possession by evil spirits. For

instance, in some African societies like the traditional Igbo societies, mental illness or madness

43
(ara or agwu) is often attributed to spiritual possession. It is a belief that insanity or madness

is nothing but a physical manifestation of the metaphysical effect of external forces or spirits

on their victims (Nwoko, 37). Hence, when exorcism is carried out on a psychiatric patient, he

or she regains her mental consciousness and freedom from external metaphysical influence.

The rituals of exorcism on an insane person are performed by a traditional priest called Dibia

ara, and they include activities like invocations of spirits, incantations, pouring of libations,

drumming, singing, dancing, rubbing of traditional powder (nzu) on the patients or spraying it

in the air, and touching the patient with animal tails (ọdụ anụ). Sometimes, herbal medicines

are also used in combination with exorcism. This approach of healing is also common in many

traditional communities in Ghana, where the exorcism is usually carried out in the Tigari

shrines (Avorgbedor, 9-24).

Appeasing the Gods or Ancestors

In cases of illnesses caused by invocation of curses, violation of taboos or offending

the gods, the ancestors or the spirits of the dead relatives, the indigenous healer or the diviner

appeases the gods, the ancestors or the spirits with sacrifices, in order pacify their wrath or

anger. The rituals are done depending on the type and nature of the illness, either by sacrificing

an animal or by pouring libation. Research by Timothy Insoll, among the Talensi ethno-

linguistic group in the upper Eastern Region of Northern Ghana, shows that after the rituals,

the sacrificial animals (e.g., cows, donkeys, sheep, goat, dog, fowl and dove) are divided and

distributed accordingly to those who are present in the shrine (234-235).

Libation

Libation (itu mmanya in Igbo) is a traditional rite in which liquid offering is poured on

the ground or on a deity, accompanied by some incantations or reciting of words. It is believed

to be a form of prayer, for soliciting the assistance or help of the gods or the ancestors. The

44
liquid offering can be traditional dry gin, wine, whisky or schnapps. In traditional Igbo

communities, pouring of libation is performed using palm wine (nkwu enu). The Ga and the

Ewe of Ghana, sometimes use corn flour mixed with water for libation (White, 4). In some

African communities, pouring of libation is divided into three main parts; invocation,

supplications and conclusion. In the first part, the presence of the gods or the ancestors are

invoked and invited to accept the offering of drink, meant to heal the sick person or community.

In the traditional Igbo communities, the presence of the gods and the ancestors is invoked by

saying: “Eke kere uwa, anyi ekele gi, Ala nurukwa mmanya, nna na nna nna anyi ha bia nuru

nu mmanya,” meaning “The Creator of the earth, we greet you, let the earth goddess drink

wine, our ancestor, come and drink wine.” The invocation of the gods and the ancestors is a

way of inviting them to the ritual of healing. During supplication, requests are made to the

invoked gods or ancestors, for healing and blessing upon the sick person or community. If the

sickness is as a result of their wrath, they can be asked for forgiveness and restoration of health

to the sick person or community. The conclusion of the libation involves thanking the gods or

the ancestor for accepting the liquid offering or libation and the prayers made to them. Also,

curses may be invoked on those who may wish the person or the community further evil or

sickness using proverbs like: “na ekpe azu, (anyi si) egbe bere ugo bere, nke si ibe ya ebela,

nku kwa ya,” meaning “lastly, (we declare) let the kite perch, and let the eagle perch as well,

anyone that says the other should not perch, let its wings break.” Generally, the practice of

libation is an essential aspect of African culture and religion, it is a mark of devotion to the

gods and the ancestors, and it helps not only to maintain and sustain the cosmological

relationship or communion between man and the spiritual community, but to restore the

relationship when it is breached.

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Herbalism

The use of herbal remedies has been part of the African indigenous healing practices

since ancient times and it is the most commonly used healing method in Africa today. Herbal

medicine, also known as phytomedicine, refers to the use of herbal extracts, preparations or

products for therapeutic purposes or benefits. Before prescribing any herbal therapy, the

indigenous healer, in this case the herbalist (Dibia Ngbologwu in Igbo), takes a comprehensive

examination of the patient’s symptoms, family history and medical history. The prescription

involves a single herbal preparation or mixture of various herbs, usually in form of extracts,

decoctions, snuffs, tinctures, gruels, teas, distillates, fractions, infusions, emollients, pills,

syrups, ointments, poultices etc. (Vickers et al., 126). The herbs may be prepared from the

whole plant or from the cellular parts of the plant like the bark, leaves, flowers, fruits, bulbs,

rhizomes, tubers and roots or from the acellular parts like oils, gums, exudates, balsams and

gels (Ezekwesili-Ofili and Okaka, 194). Evidence-based information gathered from the

testimonies of those treated with herbal therapy, has it that Allium sativum (garlic) is used for

treating respiratory infections and intestinal worms’ infections, Azadirachta indica (Neem tree)

for treating malaria, Abelmosclus esculentus (okra) for treating catarrhal infections, dysuria and

gonorrhea, and Aloe barbadensis (Aloe vera) for treating vertigo and for wound dressing.

Others include; Garcina kola (bitter kola) used as poison antidote and for treating inflammation

and diabetes, Zingiber officinale (ginger) is used for treating colds, cough and inflammation,

Artemisia afra (African wormwood) for treating dyspepsia and constipation, Cyperus

esculentus (Tiger nut) for treating stomach and bowel disorders, Cymbopogon citratus (lemon

grass) for treating fevers, jaundice and diarrhea, Chrysophyllum albidium (African white star

apple) for treating malaria, sleeping sickness and yellow fever, (Iwu, 111-338). The common

methods or routes of administration of these herbs are oral, topical, nasal and rectal. Other

methods include active (smoking) or passive inhalation (steaming and inhaling) and sitz bath.

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 In many African communities, the knowledge of these herbs, the methods of

preparations and administration are shrouded in secrecy, and reside only with the herbalists

who are most times unwilling to pass down their knowledge to anyone, except their trusted

family relatives and initiates. The empirical knowledge of most of the ethno-curative values

and efficacies of these herbs accumulates over time from evidence-based observations and

testimonies of those healed.

Psychosocial Counseling

For illness that is as a result of breach or violation of a taboo or custom, sometimes, the

sick person is counseled on the rules of treatment, the code of conduct or good behavior as

established by the norms guiding the community, the type of foods to eat or avoid etc. Good

behavior, in traditional African society, entails observing and living the values and norms

established by the community, participating in religious rituals and practices, respect for elders,

family, kin and the community members. Failure to follow the prescribed health rules and

guidelines can result in the benevolent spirits withdrawing their protection and blessings, and

therefore making the person vulnerable to illnesses. Adhering to the counsels of the healer is

also important in ensuring that other methods of treatments work effectively.

Clay Application

Application of a mixture of white clay (nzu in Igbo) is also a relevant physical method

of healing. A mixture of clay and herbs is applied to the entire body of the sick person, for

some days. This method is based on the belief that humans are made from the dust or clay;

therefore, if there is any bodily problem, one would have to return to clay for healing. It is

mostly used in cases of skin diseases. However, a mixture of clay prepared with charm, can be

used for preventive measures to drive away evil spirits responsible for illnesses.

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Reconciliation

In some traditional African societies, it is believed that one of the causes of illness is

as a result of breach of relationships among members of the broadly extended community of

the living, the dead, the unborn and God (Scheid, 20). Hence, reconciliation serves as a way

of healing and restoring the broken relationship or communion. The indigenous healer helps

the sick person to uncover his or her moral transgressions, to make amends, to reconcile with

those he or she has offended, and in so doing be healed.

3.4 ETIOLOGY OF ILLNESS IN AFRICAN INDIGENOUS HEALING

PRACTICES

As earlier highlighted in chapter one while discussing African concepts of illness,

illnesses in most traditional African societies are attributed to both natural and supernatural

causations; hence, the methods treatments are also natural and supernatural. Although most

African indigenous healers believe that some illnesses can have an underlying natural or

physical etiological factor, the most popular belief is that some illnesses are caused by

supernatural or spiritual factors. An indigenous healer can only proceed with treatment when

he or she establishes the underlying cause(s) of an illness, either through divination or careful

physical examination of the ailment and questioning of the patient.

Natural Causes of Illness

Illnesses such as common cold, slight fever, stomach ache, headache and coughs are

generally attributed to natural (physical or physiological) causes since one can suffer from them

from time to time, hence they are taken as part of normal life and are usually of a changing

natural condition. During preliminary diagnosis diseases with mild symptoms are usually

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attributed to natural factors such as germs, stress, climatic change, change of lifestyle, nutrients

deficiency, natural toxins or poisons etc. In such cases where the natural cause of an illness is

established, herbal drugs or medicines, physical counseling or other natural treatments or

interventions such as change of diet, lifestyle, environment etc., are prescribed for recovery of

the patient’s health. According to Maurice Iwu, “herbs are prescribed based on the

symptomatology of the disease” (396).

Spiritual Causes of Illness

In some contemporary African societies, indigenous healers are usually consulted

before or after the Western medical practitioner has been consulted. This is because, according

to the African worldview, not all diseases have natural causes. In fact, in “sub-Saharan African

worldview, somatic manifestations of illness are sometimes merely symptoms of a spiritual

pathology; once the spiritual part of a person is impaired, this is manifested physically” (Mbih,

22). In most traditional African societies, if an illness is severe and symptoms persist, the

patient is likely to resort to a diviner, who will determine whether the illness has an underlying

spiritual cause(s). The method the diviner may use for diagnosis may vary from one culture to

another, but fundamental to all divination methods is the experience of the diviner. He or she

bases the diagnostic decision on information gathered from the patients, previous knowledge

of the client and other public opinions, in addition to consultation from the gods, ancestors or

spirits. Divination methods may be unclear to the rational mind, but they are undoubtedly

effective diagnostic methods for establishing the supernatural cause(s) of illnesses or diseases.

In African supernatural causation theories, causes of illnesses are mostly attributed to factors

such as: (i) sorcery, (ii) breach of taboos, (iii) spirit intrusion or possession, (iv) spirits of the

dead, and (v) spiritual curses.

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Sorcery

In some traditional African societies, illness could be as a result of spell or magic cast

or through witchcraft or sorcery. Witchcraft itself is not a cause of disease, but in most

traditional African communities, there is a belief that witches and wizards could use

supernatural powers to inflict illness in their victims. It is a belief that certain types of

witchcraft inhibit physiological functions or block the efficacy of the indigenous medicines,

and by “removing the blockage through spiritual rituals and sacrifices, the healer makes it

possible for the indigenous medicines to work” (Langwick, 10).

Breach of Taboos

In some traditional African communities, illness can also be as a result of infringement

of taboos, which constitute an integral and unique part of African traditional religion and social

structures. Although “most of the taboos have been watered down by the influence of Western

culture or modernity and other religious beliefs, like Christianity and Islam” (Essel, 373), there

are some taboos that are still prevalent in some contemporary African societies. Taboos are not

only observed in African society but also in other societies of the world. According Lynn

Holden (2000), “taboos are not a feature of primitive societies as it was assumed by some

anthropologists some time ago, but it is a characteristic of any society” (Qtd. in Omobola, 222).

Etymologically, taboo is derived from the Polynesian term “tabu” which means

forbidden. It is synonymous to Kadesh in Hebrew or sacer in Greek. In Igbo language it is

known as Nso and in Akan, it is called Akyiwade or Musuo. In a narrow perceptive, taboos are

purely of cultic or religious usage, while in a broader sense, they are of socio-economic and

political usage. According to Joseph Osei, taboos are “a set of cultic or religious prohibitions

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or forbidden acts instituted by traditional religion authorities as instruments for moral and

religious sanctity as well as for promoting and sustaining life and wellbeing of a community”

(43). Also, David Westerlund defines taboos as “social or religious customs or norms that

prohibit or restrict a particular act or practice or forbid association with a particular person,

place or thing” (139). The term is also “applicable to any sort of social or moral prohibition or

religious sanctions regarding certain time, places, actions, events and people within a

community” (Omobola, 222). The importance of taboos in African society, according to

Steiner, is “to sustain the harmony between the gods, other spiritual beings and the ancestors

(the invisible community) and human beings and other rest of creation (the visible

community)” (Qtd. in Omobola, 223). This harmony is maintained through moral or social

order which is preserved by tradition, to endure and sustain the operation of the universe and

security of life. Taboos are then seen as moral or social codes of attitude or behavior intended

to promote harmony in the universe.

In some traditional African Societies, there is a belief that the violation of taboos can

result in punishment from God, the ancestors or gods, in the form of illness or can cause cosmic

disequilibrium, which may make people to become ill. Peter White posits that, “disobeying or

violating any of these taboos has some repercussions or effects which most often manifest

either on the person(s) or the community involved, in the form of illness or sickness, and which

could possibly lead to death” (2). Similarly, Laurenti Magesa rightly notes that “good moral

attitude promotes and sustain one’s or communal life force, but disobedience and contemptuous

attitude towards custom and tradition passed on by the ancestors devitalizes the life force”

(Magesa, 51-53). The diminution of life or vital force results in illness. This vital force which

conveys resistance to illness could be likened to the human immune system in Western

medicine. According to Placide Tempels, in Bantu language, words like “wafwa ko”, which

translate to “you are dying” or “your vital force is lowered” or “your vital energy has been

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sapped”, indicate the progressive loss of life force or immunity (23), and vulnerability to

illness, which occurs when one’s vital force or immune system is weakened.

In his article “The Value of African Taboos for Biodiversity and Sustainable

Development” Joseph Osei explained the common forms of taboos in African societies, such

as; environmental taboos, birth control taboos, economic taboos, medical health taboos and

personal safety taboos (46-52). These taboos vary among different ethnic groups or cultures.

Examples of environmental taboos among the Akan and Ewe include; Clearing a sacred forest,

felling of forbidden trees, hunting of forbidden animals or hunting animals during sacred days.

According to their beliefs, violating any of these taboos will incur the wrath of the gods like

the earth goddess Asase Yaa and the goddess of the sea Maame Wata (Osei, 47). Particularly

on the types of taboos among various Yoruba communities, Odejobi Omobola describes seven

categories of taboos according to Thorpe (1967) as follows; taboos to avoid accident, taboos

about religion, taboos on respect for elders, taboos on cleanliness, taboos on moral values,

taboos against being wasteful and taboos on things that are difficult to explain (224-226).

Particularly in Akan culture, it is a taboo to engage in a sex with a woman during her

menstrual period or shortly after childbirth. According to Joseph Osei,

“The cultural explanation for this taboo is that the woman in theses stages has impure

blood that will pollute the male spiritually and turn him into a wimp easily dominated

not only by other males but also by his own wife. Behind this veil of mystical

explanation however is the well know biological fact that it is not safe to have sexual

intercourse in both instances for both the male and the female. The male can easily

get an infection from the impure blood in the menstrual discharge and the female can

also easily receive infection from the male because of the unusual susceptibility to

infection during these periods. Besides the fear of infection, there is also the need for

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 the man to wait while the woman recuperates from complications and stress

accompanying childbirth” (Osei, 51).

Also, it is a taboo to engage in a sex with a close relative. Beside the cultural significant

of this taboo, Osei stresses that “the taboo protects human life by prohibiting sexual acts that

could cause genetic diseases including hemophilia, sick cell anemia and other birth defects.

Also, this is important in avoiding the Oedipus complex syndrome and its variations” (Osei,

52). In addition, it prevents homozygosity which increases the possibility of offspring being

affected by deleterious or recessive alleles or traits.

Spirit Intrusion or Possession and Spirits of the Dead

In some African cultures, there are beliefs that when the spirits are wronged, they can

inflict the offender(s) with illness (Magesa, 175) and that illness can be caused by spiritual

possession. In some Igbo communities, as Kenneth Chukwuemeka Nwoko rightly notes, “it is

a belief that insanity or madness is but a physical manifestation of the metaphysical effect of

external forces or spirits on their victims” (37). Hence, the necessity of exorcism as a healing

method devised to free the possessed patient from external metaphysical or spiritual influence.

Furthermore, it is a belief among some African cultures, that the ancestors can inflict illness on

the living as punishment when they are offended or ignored (Mbih, 29). On this belief, Charles

Nyamiti lucidly posits that; “when the ancestors are neglected or forgotten by their living

relatives, they become angry with them and could send them misfortunes in the form of illness

as punishment. Their angry anger is usually appeased through prayers and ritual sacrifices”

(16).

Illness can also be due to the restless spirit of a dead relative of the sick person, whose

burial ritual or sacrifice was not performed (Onwuanibe, 25). It is a popular belief in some

traditional African societies, that when a relative dies, the necessary burial rituals or sacrifices

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ought to be done so that his or her spirit may rest well in the spiritual realm of the ancestors.

Failure to perform the burial rituals or sacrifices for the deceased relative, could provoke the

spirit of the dead relative to seek redress by inflicting illness on the living relatives. For

instance, in some Igbo communities, it is a belief that when a dead person is not buried with

the necessary burial rituals or sacrifices, that the spirit of the person can inflict illness or evil

on the living relative, as a way of demanding for proper burial. Hence, burial rituals and

sacrifices are pertinent duties of the living to their dead relatives.

Spiritual Curses

In some African communities, an individual or the whole living community could become ill

through invocation of curse in the name of a particular god or deity. For instance, in Akan

communities, one can invoke a sickness upon an offender in the name of the river deity “Antoa”

(White, 2). In some Igbo communities, curses are invoked in the name of “Ala” the earth

goddess. The invocation of curses is seen as a means of seeking divine justice or redress from

the gods by the one who was offended.

3.5 ETIOLOGY OF ILLNESS AND AFRICAN CONCEPTION OF HUMAN

PERSON OR NATURE

Without a proper understanding of what makes the individual human a person and the

significance of constituent parts of the human body and what this implies for disease etiology

in African indigenous medicine, effective healing would be unachievable. According to the

traditional African outlook, the human body is not merely a discrete system made up of

measurable and rational parts, as posited by the Western paradigm, rather, it is made up of

several interdependent and interrelated parts. The African relational model of the human person

or nature encompasses the whole being, that is to say; the bodied and disembodied dimensions,

as well as the social and ecological aspects of human life. Therefore, illness arises from a

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breakdown of harmony among these interconnected parts of the body; and for any effective

treatment to take place, the entire parts of human person must be considered. A traditional

African conception of the human person that is intimately implicated in African healing

practices is the relational model which is viewed from two perspectives: normative view and

metaphysical view. The two perspectives are symmetrical, interconnected and interrelated.

From the normative approach, the individual is viewed as a social being whose essence is

defined by his or her ability to engage in a purposeful social relationship with his or her

community. However, from the metaphysical perspective, the human person is viewed as a

living being composed of several physical and spiritual parts that are interrelated and

interconnected, and not merely as a collection of distinct parts, as depicted in Cartesian

dualism.

3.5.1 African Normative View of Human Person or Nature

The African normative view considers the social status of a human person. David Lutz

rightly notes that, “one of the striking features of the culture of sub-Saharan Africa is their non-

individualistic character” (314). Human beings in the African context are conceived as

communal beings; they are not just individual beings living independent of one another, but

part of a universal community, living interdependently. An African person is defined only in

relation to other persons in the community, as expressed in Kom axiom, “wul nɨn ghɨ wul bôm

wul”, or in Shona truism: “munhu munhu muvanhu”, or in Zulu/Xhosa aphorism; “umuntu

ngumuntu ngabantu” translated as “a person is a person because of/ through other persons”.

According to Jerome Tosam Mbih, “the indigenous African normative approach to the human

person is described as relational because it is characterized by lived-dependencies between

members of the human/physical and spiritual community” (26). The normative relational

model attends to the whole person as a part of the universal community (made up of both

natural and supernatural realities). According to John Mbiti (1970), “the spiritual universe is a

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unit with the physical, and (…) these two intermingle and dovetail into each other so much so

that it is not easy, or even necessary, at times to draw the distinction or separate them” (74).

The components of the physical and spiritual reality are intimately connected to each other

such that when any components are impaired, the well-being and health of the others are also

affected. It is from this understanding that Polycarp Ikuenobe argues that “Africans conceive

of the universe as a composite, unity and harmony of natural forces. Reality is a holistic

community of mutually reinforcing natural life forces consisting of human communities (…),

spirits, gods, deities, stones, sand, mountains, rivers, plants, and animals” (2). All the beings in

the universe are interconnected through vital forces and they interact with each other in a

harmonious way.

In the African normative outlook, the notion of community includes all beings physical

and spiritual, organic and inorganic, animate and inanimate, visible and invisible, the living

(umutu), the living dead (abaphansi or ancestors) and the non-living, as well as the unborn or

yet-to-be born future generations, that make up what is called an African community (Eze, 625;

Ramose, 63; Irele, 16). All the beings that make up an African community live and act together

in universal solidarity to each other. In sub-Saharan African normative outlook on the human

person, there is, therefore, no ontological disconnection between the natural, and supernatural

dimensions of human life; both are intimately linked; one is the extension of the other. This

explains why disease etiology, in African indigenous medicine, is not perceived solely in terms

of natural causation, but also supernatural causation.

3.5.2 African Metaphysical View of Human Person or Nature

The African metaphysical view of human person or nature has to do with analyzing the

constituent parts of the human person, both the physical and non-physical or spiritual parts,

their functions and significance within the general scheme of reality. From a sub-Saharan

ontological view, a human person is made up of several composite parts which are related,

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although the identification of these constituent parts of the human person varies from one

culture to another.

According to Wiredu, there are five constituent parts of a human person in Akan

culture. These are: (i) okra, which refers to the life principle and source of human dignity and

destiny of the person, (ii) sunsum, (spirit), which is the charisma principle, (iii) moyga, the

character from the mother, (iv) ntoro, the character from the father, and (v) nipadua, the

physical body (Ozumba, 3). Contrary to this view, Kwame Gyekye (1984) argues that there are

only two constituent parts of the human person within the Akan culture; okra, known as the

soul and nipadua, known as the body (201-202). Wiredu is skeptical of accepting that okra

should translate as ‘soul’ in English because the soul is purely immaterial but okra for him, is

a quasi-material substance. His hesitation is based on the fact that it is a common belief among

the Akan people that it is only the ‘native doctors’ that can see the okra. According to Anselm

Jimoh, “it is also believed that the okra can be allergic to specific kinds of food such that if an

individual consumes the type of food that his/her okra is allergic to, the individual falls sick”

(3). Besides these pentalistic and dualistic notions of the constituent parts of the human person

within the Akan culture, we have the tripartite analysis by Appiah Kwame. For Kwame, the

human person is made up of “the body (nipada) made from the blood of the mother (mogya),

the spirit (sunsum) that is derived from the father and the okra which is a life force that leaves

the body when the person dies physically” (28).

The Yoruba ethnic group have a tripartite notion of the constituent parts of a human

person. They claim that a human person consists of both material and non-material elements

such as; (i) the ara (body), (ii) emi (soul) and (iii) ori (the metaphysical head). Ara consists of

all the internal and external material components, such as the opolo (brain), oju (eyes), eti

(ears), eran ara (skin), eje (blood), okan (heart), ese (leg), ifun (intestine) and so on (Abimbola,

73-75; Oladipo, 15-16). Contrary to the tripartite Yoruba notion of human person, the Igbo

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people, believe that mmadu (human person) has dual nature; the material aspect called ahu

(body) and the immaterial or spiritual aspect known as muo/ mkpuruobi/chi (spirit). Both are

thought to be ineluctable and inseparable components of mmadu (Isiguzo et al., 236).

Rather than being contradictory, the various classifications from the three African

cultures considered above complement one another; they show not only the different nuances

that are present in different cultures, but also, they appeal to a common African understanding

that a human person is a product of both material and immaterial constituents that are

interrelated. According to Meinrad Hebga, these constituents are “more or less regarded as the

different levels of being and operations of the same being; they are not merely aggregation of

distinct parts, as in mind-body dualism of Descartes” (88-92). Each component of a human

being is not merely a part of a person, but a whole, or still each constituent can be viewed as a

different sphere in which a human person can operate. African indigenous healing practices,

being rooted in African metaphysics, considers a human person as a collection of inseparable

material and immaterial parts (i.e., biological, psychological, social and spiritual elements) that

are meant to be repaired when they become dysfunctional during sickness. Hence, illness is not

only considered as a biological or psychological dysfunction but also as a social and spiritual

dysfunction.

3.6 AXIOLOGY OF AFRICAN INDIGENOUS HEALING PRACTICES

Axiology (etymologically derived from Greek words “axios” and “logos” which means

“study of value”) is a branch of philosophy which deals with study of values and value

judgements. It entails questions about the nature and classification of value, how values are

experienced and the important roles of values in a society. Value, on the other hand, denotes a

sense of what (ought to be) is good, right or wrong, or what deserves admiration. Therefore,

values guide or influence people’s attitude, ethical behavior or actions within a society. Every

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society has certain values that it upholds and promotes. Hence, according to Gabriel Idang

“there is no society without a value system” (4). Each society has its own value systems that

explain what things are good, how good they are and their goodness is related to one another.

Hence, values occupy a central position in all societies and cultures, most especially in African

cultures. They permeate every aspect of life of an African person, such as the religious,

political, social, moral, aesthetic, economic, cultural and even personal aspects of living.

Although value systems may differ across all cultures in Africa, there are some commonalities

that cut across most of the cultures. African indigenous healing medicine, being part of African

cultures, embodies certain cultural, moral, religious, professional and economic values that

make it relevant in this 21st century, despite being side-lined, discriminated and denigrated by

Western imperialists who emphasis that all knowledge, theories and hypotheses must be tested

and validated through Western scientific methods of experiments and observations. Looking

at the social, moral, religious, professional and economic or commercial values of African

indigenous healing practices values piecemeal would give us a clear understanding of how they

manifest in African indigenous healing practices and the importance attached to them.

3.6.1 Social Values

Social values in African indigenous medicine entails those beliefs and praxes in forms

of healing observances, rituals, rites and sacrifices that are performed during the course of

healing to ensure total wellness, as well as after healing to prevent reoccurrence of the illness.

They differ from one African culture or society to another. Some of these rituals include

incantations, pouring of libations, ceremonial dance, animal sacrifices, spiritual bath, etc as

earlier discussed in chapter one. For instance, among the Kung people of Kalahari Desert,

Ovamboland (northern Namibia and southern Angola) and Botswana, ceremonial curing dance

is performed, not only to cure the sick but to avert or prevent impending or subsequent illness

or evil. Loma Marshall describes the ceremonial curing dance as follows:

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 “During the dance, the medicine men combat any illness and evil, drive them away

and protect the people. Usually there are several medicine men performing at the same

time. To cure, they go into trance, which varies in depth as the ceremony

proceeds…When a man begins, he leaves the line of dancing men and still singing

leans over the person he is going to cure, going eventually to every person present,

even the infants. He places one hand on the person’s chest, one on his or her back, and

flutters his hands. The Kung people believe that in this way he draws the sickness,

real or potential, out of the person through his own arms into himself… Finally, the

medicine man throws up his arms to cast the sickness out, hurling it into the darkness

back to Gauwa or the Gauwasi who are there beyond the firelight…” (Qtd. in Gibbs,

272-273).

Healing rituals and ceremonies, not only promote active participation of both the patient and

his or her family or community in the process of healing, but also, reduce anxiety or fear and

induce in the patient trust and hope of getting better or healed, which are very important in the

psychology of healing. In fact, healing rituals involving dance play an essential role in relieving

and treating symptoms of psychological distress, as well as in placating the impact of

psychological trauma. According to Monteiro and Wall (2011), African healing dance

“embodies many curative properties that are released through movement, rhythms, self-

expression, communion, as well as the mechanisms of cathartic release. These properties allow

individuals to shift emotional states, oftentimes, creating an experience of wholeness” (239).

Furthermore, healing rituals promote good and active healer-patient relationships.

3.6.2 Moral Values

The moral values of African indigenous healing practices are embedded in communal

or religious moral ethics, in form of medical observances or healing bylaws, which are mostly

in form of oral traditions, to ensure the quick and total recovery of the patients, and in form of

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medical taboos that guides the actions, attitudes and behaviors of people in a community, as

traditional prophylactic means of preventing illness. Medical observances and taboos vary

among differing African cultures. For instance, it is a common taboo among many cultures in

Africa to kill someone; this is because it is a popular belief that human life, which is a gift from

God, has an intrinsic value that makes it sacred and inviolable. Moral values of African

indigenous medicine require that life should be cared for, protected and preserved. Hence

certain medical procedures like abortion, euthanasia and assisted suicide are morally wrong in

most (if not all) African cultures. Instead of resorting to any of the medical procedures that

terminate life, mutual care and palliative care rooted in various African notions of

communitarianism in Igbo are encouraged in African indigenous medicine. In African ethics

of mutual and palliative care, values like harmonious living, solidarity, complementarity, co-

operation, compassion, empathy, kindness, sacrifice, generosity, hospitality, love, mutual

sharing and caring of the sick person till the point of death are fostered and promoted through

various philosophies of Afro-communitarianism such as Ubuntu (humanity through or towards

other) in Bantu culture or Igwebuike (strength in number) in Igbo culture.

3.6.3 Religious Values

There is a nexus between African traditional religion and African indigenous medicine,

since most of the African healing beliefs and practices spring from African religious beliefs

and practices. In most African traditional societies, there are some popular religious beliefs or

values that inform most of the indigenous healing practices. They include beliefs in the

existence of a Supreme Being (known as Nyame in Akan, Chukwu in Igbo,

Mungu/Mulungu/Unkulunkulu/Ruhanga/Ngai in Bantu, or Olodumare in Yoruba, Osanobua

in Esan) who is the source of life or vital forces, the existence of spiritual realm of spiritual

beings, supernatural or mystical powers and supernatural causes of illness, the existence of

human soul and life after death and the existence of good and evil. Most Africans have a belief

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that there is a relationship between the natural reality and supernatural reality, and a

communication between both. Hence, indigenous diviners are seen as mediators between the

natural realm and the supernatural realm and custodians of metaphysical truth, while other

indigenous healers are seen as custodians of supernatural or mystical healing knowledge. Their

instructions guide the actions and behavior of patients for quick and holistic recovery from

illnesses. Indigenous healing practices provide an avenue through which African religious and

cultural beliefs and heritages are preserved and respected.

3.6.4 Professional Values

Professional values in African indigenous medicine are those values that guide the

professional behavior or conduct of indigenous healers in their healing practices. Some of these

values include, spiritual prudence, selfless service, compassion and integrity. Indigenous

healers are also expected to have adequate knowledge of natural healing medicines, methods

and practices, as well as knowledge of supernatural reality to act as intermediaries between

people and the gods or ancestors. In some African societies, the healing knowledge of African

indigenous healers are conceived as a free gift from God, the gods or the ancestors, hence they

are not expected to be materialistic or money-minded, since their healing practices are not for

profit-making, but for selfless service to humanity. This explains why healer’s fees are very

cheap, affordable and accessible, and in some cases free. In cases where the healers charge fees

for treatment, payments are often not exclusively monetary, and there is always a room for

small initial payment before treatment and complete payment after the patient is healed. In

some rural areas, indigenous healers collect their payments after the patient is fully healed. The

integrity of the indigenous healers lies not in their profession, but in their good character as

well as in the trust and faith people have in them, as custodians of metaphysical truth and oracle

of the gods and ancestors. Their professionalism is guided by the moral codes of ethical conduct

that inform their actions, behavior and healing practices.

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3.6.5 Economic and Commercial Values

The economic value of African indigenous healing practices is that they are cheaper or

more affordable, and more accessible to many African people than Western medicine. This

value has contributed to the increasing demand for African indigenous medicines and healing

practices. The high demand for African indigenous medicines and healing practices explains

why African indigenous healers still enjoy increasing patronage, most especially in the rural

areas of African countries where a lot of low-income people dwell. Another important potential

commercial value of African indigenous medicine which is being explored is its broad-

spectrum efficacy against many diseases. Researches have shown that a number of African

indigenous medicines are effective therapeutic medicines in the management of a broad

spectrum of diseases. According to Mander et al., among the South African black population,

African indigenous medicine is thought to be desirable and necessary for treating a range of

health problems that Western medicine does not treat adequately” ((Qtd. in Abdullahi, 117)).

In Nigeria, a number of effective medicinal plants in management of various diseases have

been documented by scholars like Sofowora, 1993; Fasola, 2001, Obute, 2005; Aiveola and

Bello, 2006; Ogunshe et al., 2008, as well as those used for the treatment of opportunistic

infections associated with HIV/AIDS (Enwereji, 21). In his research work, Weintritt (2007)

identified at least 522 medicinal species used in the treatment of numerous illnesses in Nigeria

(122-129).

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3.7 CONCLUSION

In this chapter, I have discussed the diagnostic methods in African indigenous

medicine, namely; divination, physical examination of the patient’s illness and questioning to

know the patient’s medical history or to uncover the cause(s) of his or her illness, as well as

some of the African indigenous healing methods and approaches (comprising of both natural

and spiritual healing methods) namely; spiritual cleansing, spiritual protection, sacrifices,

exorcism, appeasing the gods and pouring of libation, prescription of herbs, application of clay,

surgery and psychosocial counseling or reconciliation. Also, I discussed the African perception

of etiology of illness, as well as how this perception relates to African conception of the human

person and the relevance of some of the values of African indigenous healing practices. I have

shown through these discussions that African indigenous healing practices or medicine is as

holistic as the African view of reality and that it is still very relevant in contemporary African

society. Hence, the focus should be on how to improve the quality, quantity, safety and efficacy

of the relevant African healing practices, as well as make them an integral part of national

healthcare systems alongside Western medicine in Africa as I will propose in chapter five.

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 CHAPTER FOUR

ROLE OF AFRICAN INDIGENOUS MEDICINE AND HEALERS IN PRIMARY

HEALTH CARE IN AFRICA

“The sun was relentless. So were the dozens of faces stubbornly waiting to enter the tiny thatched hut

in Zimbabwe where Nhamburo Masango, a traditional healer, sat among herbs, bones and other

remedies. An old man in front of me had a skin rash, another person had a swollen leg, and

somewhere a child complained of a stomach ache. No one, it seemed, was discouraged by the long,

winding queue” (Itai Madamombe)

4.1 INTRODUCTION

The generic term “traditional/indigenous healer” or “traditional/indigenous health

practitioner” is used to describe “a person who is recognized by the community in which he or

she lives as competent to provide health care by using vegetable, animal and mineral substances

and certain other methods based on the social, cultural and religious background as well as on

the knowledge, attitudes and beliefs that are prevalent in the community regarding physical,

mental and social well-being and the causation of disease and disability” (WHO 1978: 9).

Based on this broad definition, it will be hard to find a society in the world without indigenous

medicine and practitioners. Whereas at practical level there is a wide diversity among the

indigenous healers (who are often called alternative or complementary health practitioners) as

one moves from one society or culture to another, there is a basic philosophical view that is

common to most of the indigenous healing practitioners, which is their acceptance of a shared

worldview which emphasizes the relationship between the macrocosm and the microcosm (the

environment or the universe and the living beings). Other common dimensions are focus on

the non-material or non-physical aspects of life and a holistic or comprehensive approach to

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health. Among the African indigenous medicine and health practitioners or healers, the key

unifying features that can are observable from one African culture to another include not only

the holistic concepts of health and illness and multi-causality approach to illness as discussed

in chapter one, but also the afro-religious and cultural dimensions, Afro-communitarian

character, general focus on preventive care and attribution of importance healer’s wisdom.

Some of these defining features have implications in the role that the African indigenous

healers play in primary healthcare.

In this chapter, the focus is on highlighting the indispensable role and contributions of

African indigenous medicine and healers in development of primary health care in Africa. With

this in mind, in section 4.2 I will start by discussing the prevalence of indigenous medicine in

Africa, before proceeding to section 4.3 to discuss some of the fields of specialization in

African indigenous medicine. Then in section 4.4, I will look at the informal and formal training

of African indigenous healers from apprentice to specialist and then to consultant. In the next

sections 4.5, I will discuss some of the prominent roles and contributions of African indigenous

healers, before proceeding to section 4.6 to highlight some of the major challenges to the use

of African indigenous medicine in primary health care in Africa. The aim of this chapter is to

press home the point that African indigenous medicine and health practitioners play special

contributory roles in primary healthcare systems in Africa, hence they deserve a practicing

space alongside Western counterparts in national healthcare systems in African countries.

4.2 PREVALENCE OF INDIGENOUS MEDICINE IN AFRICA

Various statistics by different researchers have shown that there is an increasing

demand for indigenous healing and herbal medicines in contemporary African societies. For

instance, in countries like Ghana, Mali, Zambia and Nigeria, herbal medicine is the first line of

treatment for 60% of children with high fever resulting from malaria (WHO, 2002). Carpentier

et al., (1995) in their ethno-medical research in Burkina-Faso, reported an increasing demand

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for indigenous medicine in the cases of rheumatic and neurological illnesses. Notably,

according to the research by Roberts (2001), about 60-70% of the population in Ghana depends

primarily on indigenous medicine for their healthcare needs (Qtd. in Mintah et al., 317).

Similarly, ethno-medical research in South Africa by Lekotjolo (2009) and Mander et al.

(2007), show that about 27 million South Africans (usually the black South Africans) depend

on indigenous medicine for treating illnesses, while in Tanzania Makundi et al. (2006) found

out that indigenous health care has contributed very significantly to the treatment of degedege

(convulsions) in rural areas (Qtd. in Abdullahi, 117). In South Africa, there was a report that

the indigenous medicine industry is worth up to R 2.3 billion per year (Clarke, 5). A report by

Amira and Okubadejo (2007) shows that a significant number of hypertensive patients

receiving conventional treatment at the tertiary health facility in Lagos, Nigeria, also used

indigenous or alternative medical therapies (2-4).

A number of factors or values have been observed as being responsible for the

increasing demand of African indigenous medicine and upsurge of scholarly interest in

assessing and evaluating the effectiveness of the African phytomedicines. Okigbo and Mmeka

(2006) attributed the high demand of African indigenous phytomedicine to its affordability,

acceptability, safety, cultural compatibility and suitability for the treatment of various diseases,

particularly chronic ones (83). On the other hand, inadequate accessibility, unavailability and

unaffordability of Western medicines in both urban and rural areas in Africa, may have

contributed to the prevailing patronage of African indigenous medicine, especially in the rural

areas. In a recent study by the World Health Organization (WHO) and Health Action

International (HAI) in 36 developing countries, Western medicines were reportedly way

beyond the reach of large sections of the populations (Cameron et al., 240).

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4.3 SPECIALIZATIONS IN AFRICAN INDIGENOUS HEALING PRACTICES

There are different fields of specialization in African indigenous medicine and each

specialization has its own specific features and functions; sometimes, these fields often overlap

with each other, since professional boundaries are not clearly defined. Also, there are stages of

professionalization in African indigenous medicine ranging from apprentices, specialists and

consultants (Karim et al., 7). Researchers (Iwu Maurice, 2014: 386; Okonkwo, 2012: 72-74;

Karim et al., 1994: 7; Freeman and Motsei, 1992: 1183-1184; Gumede, 1990: 51; Last and

Chuvunduka, 1986: 32-33; Green and Makhubu, 1984: 1071-1072; Ulin et al., 1980: 15-16;

Good et al., 1979: 143) have identified different fields of specializations or categories of healer

in African indigenous medicine such as; diviners, herbalists, indigenous midwives and birth

attendants, indigenous orthopedic surgeons and bonesetters, indigenous psychiatrists and other

specialists. It is not unusual to a healer to belong to more than one field of specialization. Only

the first four fields of specializations or categories are discussed in the following subsections.

4.3.1 The Diviners

The Diviners are usually consulted to diagnose what is wrong with the patient, as well

as why the patient was afflicted. Their responsibilities include also to prescribe the solution to

the patient's illness and to perform the necessary rituals for healing of the patient. In their

communities, they are recognized for their powers of extrasensory perception, and the

instruments they use during divination vary across African communities as discussed in sub-

section 1.4.1 of Chapter one. As a close professional body (not open to everyone except those

chosen by the gods or ancestors), they observe strict codes of conduct (in form of oral tradition)

that guide their profession. Some diviners sometimes possess knowledge of herbal medicine.

Consultation fees of the diviners are usually cheap and their healing services are affordable to

everyone in a community.

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4.3.2 The Herbalists

The African indigenous herbalists (Dibia mgbologwu in Igbo) are knowledgeable in

many aspects of physical healing just like the general physicians in Western medicine (Iwu,

387; Gumede, 85), except that they make use of herbal medicine in their therapeutic

procedures. They know the functions of various organs of the body and usually determine the

nature of the patient’s illness during physical examination of the patient’s body and analysis of

all obvious signs and symptoms of diseases. By devoting much time and personal attention to

a patient, the herbalist is able to penetrate deeply into the physiological and psychological state

of the patient and ascertain the nature of his or her illness. After careful diagnosis, but without

expressing any opinion regarding the origin of the illness, the herbalist prescribes a regimen of

drugs (Iwu, 387). Also, African indigenous herbalists are known to possess an extensive

knowledge of indigenous pharmacopeia. Karim et al. describe the services of the herbalists as

comprehensive; with their expertise on curative and preventive healthcare (7). Some African

indigenous herbalists are specialists in a particular disease and have become renowned

consultants in their fields of specialization, with apprentices who are learning under them.

4.3.3 The Indigenous Midwives and Birth Attendants

Indigenous midwives and birth attendants occupy a prominent and special position in

African indigenous healing practices and their roles in indigenous primary health care is

indispensable. They provide basic health care, support and advice before, during and after

pregnancy or childbirth. Beside acting as caregivers for pregnant women and their babies,

indigenous midwives sometimes act as marital counselors. Their services are affordable and

accessible, hence why their services are in high demand in low-middle income African

countries where primary health care services are inadequate and unaffordable. Also, trust and

respect for indigenous beliefs are responsible for the preference for indigenous midwives and

birth attendants. A recent analysis of child deliveries in sub-Saharan African from 2011 and

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2015, by Crowe et al. (2012) estimates that 130 to 180 million births, approximately 42-48%

of all births occurred outside conventional health facilities, and 90% of these births were

attended by indigenous birth attendants and midwives (6-7). Particularly in Ghana, the

Maternal Health Survey of 2014, shows that 16% of births were supervised by indigenous birth

attendants (Qtd. In Aziato and Omenyo, 2).

Apart from diagnosing stages of pregnancy, correcting the position of the fetus and

assisting women during labor, indigenous midwives and birth attendants administer herbal

medicine for easy delivery, healing of the womb after birth (in cases of hemorrhage associated

with delivery) and for fertility purposes, as well as offer postpartum care services. According

Iwu Maurice, in some parts of Africa, “there is a clear distinction between the indigenous

midwife who offer antenatal and postnatal care services to women and the birth attendants,

who simply assist and attend to pregnant women during birth” (388). In many African

communities, the indigenous midwives are mostly elderly women skilled in birth delivery,

maternal care and child care with many years of practical experience after apprenticeship. Since

it is very cheap in many African communities, midwifery is not usually a full-time profession.

Most of the birth deliveries by African indigenous midwives and birth attendants are through

normal vaginal delivery, hence birth by cesarean delivery is not common. However, one of the

most remarkable examples of indigenous cesarean delivery ever documented is the eyewitness

account by a missionary doctor named Felkin, of a cesarean section performed by a Banyoro

surgeon in Uganda in 1879 (Qtd. In Iwu, 389).

4.3.4 The Indigenous Orthopedic Surgeons and Bonesetters

Indigenous orthopedic surgeons and bonesetters repair bone fractures, dislocations, and

other bone injuries by using wooden splints to immobilize and straighten the fractures, as well

as hot water to dissolve any blood clots and spiritual incantations and herbal medicines

accompanied with massage to hasten the healing of the damaged bones, connective tissues and

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nerves. Prior to treatment, they make diagnosis ascertain the nature and severity of fractures

and dislocations by palpation and feeling of the affected area to identify cardinal signs of pains,

swelling, deformity, abnormal movement, crepitus, loss of functionality and presence of a gap

or fragments in the affected area.

Indigenous orthopedic surgeons and bonesetters have attained a good level of success

in African indigenous medicine relatively comparable to Western-trained orthopedic

physicians in most African countries. In his book, Handbook of Traditional Medicine, Iwu

Maurice reports that 84 cases of bone fractures which he monitored, were successfully repaired

by indigenous bonesetters without recourse to Western medicine, despite being rated as severe

cases by Western-trained orthopedic physicians. Research conducted in eight indigenous bone

setting centers in Calabar, Nigeria, by Udosen et al. (2006), shows that 100% of the patients

interviewed preferred indigenous bone setting to Western orthopedic treatment despite the

painful experience and the high rate of complications which they reported. The reasons for this

include: high cost of treatment in Western orthopedic hospitals, fear of surgery or amputation

and fear of medical jargon and application of plaster of Paris (173). Indigenous bonesetters are

often capable of stopping the deterioration of gangrenous limbs that would normally require

amputation in Western orthopedic hospitals. Patients have often been withdrawn from Western

orthopedic hospitals by dissatisfied family members and sent to indigenous bone setting centers

to receive a better and faster treatment without amputation. I have witnessed a case of a victim

of a car accident who was told by Western trained orthopedic doctor that his deteriorating left

leg will be amputated to save the unaffected thigh region, but being unsatisfied with the option

of amputation, consulted a native bonesetter who examined and successfully repaired his leg.

Despite the successes recorded by indigenous bonesetters in Africa, there are still some cases

where they failed or even caused more complications, as a result of the challenges which they

face in their practice.

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4.4 TRAINING OF AFRICAN INDIGENOUS HEALERS

For certain categories of African indigenous healers such as diviners, a person does not

choose to be a healer, but he or she is chosen by the ancestors or gods. Sometimes, it is inherited

from generation to generation. The person chosen to a healer realizes his or her divine call

through dreams and spiritual apparitions, accompanied by some spiritual disturbances that

indicates that the ancestors or gods have chosen him or her to be a healer or diviner (Karim et

al., 10; Gumede, 70-73). In his book, Traditional Medicine in Modern Zimbabwe, Chavunduka

Gordon speaks of “spirit mediums who have inherited or are believed to have inherited their

healing spirit from a deceased healer in the family or from an alien spirit” (48). The authenticity

of the call to vocation or profession of divination can be verified by a diviner who advises the

person to adhere to the calling of the ancestors or gods. The person then passes through formal

training that involves some spiritual rituals or ceremonies that take between months and years

depending on how fast the trainee is able grasp the art of divination. In Southern Africa, if it is

established that the ancestors or gods have chosen an individual, a ritual ceremony is held at

which the person is initiated as a novice (Chavunduka, 63). The novice leaves his/her home to

live with and be taught by a master Sangoma of good repute. This form of informal

apprenticeship entails disciplining the body and mind through rituals and some religious

abstinences. Sometimes, the novices can live in self-imposed celibacy (Gumede,75). During

apprenticeship, the novice passes through a number of tests which take over a number of years

(Chavunduka, 75). When the tutor is satisfied that the person has mastered the art of divination

and healing, the relatives are informed and a graduation ceremony is arranged. The celebration

involves some spiritual rituals and prayers for the ancestral spirits to guard and guide the new

diviner and healer in his or her healing practices. A sacrificial animal is slaughtered, the blood

is allowed to flow on the ground. When the animal has been skinned and opened up, the older

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diviner takes out the gallbladder and sprinkles the gall on the new diviner from head to toe

(Gumede, 75).

For other categories of African indigenous healers, the healing profession is freely

accessible; one can choose to become a healer or can be chosen by the ancestors or gods. To

qualify as competent indigenous healer the person must pass through the stage of

apprenticeship under a practicing healer of repute for few years (though varies from one culture

to another) to learn or acquire the art, knowledge and skills of healing and healing herbs

(Chavunduka, 50; Karim et al., 10). Nowadays, there are formal schools or institutions of

indigenous healing established by established by renowned indigenous healers or by the Guild

of Healers to impart knowledge to younger ones (Iwu, 385). In some countries like Guinea,

Sierra Leone and Tanzania, colleges that offer diploma or degree programmes in African

indigenous medicine have been established. Also, Kwame Nkrumah University of Science and

Technology Ghana has a Bachelor of Science Degree programmes in Herbal medicine for

training indigenous medical herbalists. In many sub-Saharan African countries, many

indigenous healers have been registered and given license to practice by government-

established regulatory bodies.

4.5 ROLES OF AFRICAN INDIGENOUS HEALERS IN PRIMARY HEALTH

CARE

In primary health care, especially in areas of curative and preventive medicine, African

indigenous healers have proved their relevance. The efforts and contributions of the African

indigenous healers in curbing the increasing prevalence of communicable diseases in Africa

was officially recognized in 2000 by the World Health Organization, when it adopted the

African Regional Strategy on Traditional Medicine. Some African indigenous herbal medicine

has been proven to be an effective therapeutic drug for communicable diseases like malaria,

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cholera, HIV/AIIDS, sexually transmitted diseases (STDs) etc. In malaria treatment, most of

the African indigenous healers use a single therapy (ST) and combination therapy (CT)

involving a mixture of potent and extensive-broad spectrum herbal medicines prepared in

different forms (as discussed in subsection 1.4.2 of chapter one) for treatment of mild and

complicated cases of malaria (caused by Western-drug resistant malaria parasites). A good

number of African indigenous healers are also involved in the management of HIV/AIDS using

different effective herbal medicines which have been shown to possess significant activity

against HIV, at concentrations that are comparable to the Western-synthesized antiretroviral

drugs (Matthee et al., 493). These indigenous antiretroviral herbal medicines contain

“compounds that either interfere directly in various stages in the replication cycle of HIV or

strengthen the patients’ immune system against the devastating effect of the infection: these

include substances that exhibit the following inhibitory activities against HIV: protease

inhibition, virus adsorption, glycosylation, virus-cell fusion, assembly/ release, translation,

integration, etc.” (Iwu, 400). Most of the indigenous herbal medicines used for management of

HIV/AIDS are used in poly-herbal formulations. A typical example is the “combination of a

mixture of Astragalus membraceous, Tinospora cordifolia, Glycyrrhiza glabra, Aloe

barbadensis, Andrographis paniculata, Garcinia kola, and Moringa oleifera leaf extract” (Iwu,

401). Lamorde et al. (2010) reports that in Uganda, the plants which were most commonly used

by indigenous medicine practitioners for treatment of HIV/AIDS and other related conditions,

include Aloe spp., Erythrina abyssinica, Sarcocephalus latifolius, Psorospermum febrifugum,

Mangifera indica and Warburgia salutaris (43).

Apart the successes recorded in the management of malaria and HIV/AIDS in Africa,

African indigenous healers have also achieved some feats in other aspects of curative and

preventive care such as, primary treatment of arthritis and other inflammatory disorders and

primary treatment of sexually transmitted diseases like, genital herpes, chlamydial genital

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infections, syphilis, trichomoniasis, gonorrhea, genital warts, vaginitis and vulvovaginitis, as

well as treatment of skin infections likes athlete’s foot, ringworm, smallpox, chicken pox,

measles, etc. and opportunistic infections like toxoplasmosis, candidiasis, coccidioidomycosis,

cryptosporidiosis, tuberculosis, herpes simplex virus infection, histoplasmosis, pneumonia,

salmonella septicemia etc. In the aspect of the role of African indigenous healers in

management of diabetes, a study conducted in Kinshasa city Democratic Republic of Congo,

from July to September 2010 by Mvitu-Muaka et al., establishes that the antioxidant nutrients

found in fruits of Dacryodes edulis and leaves of Gnetum africanum, play a vital in the

prevention of type 2 diabetes mellitus (T2DM) and diabetic retinopathy (DR) among the local

indigenes that consume them (6-8).

Furthermore, in aspects of psychiatric and psychosomatic disorders, African indigenous

healers have not recorded much success, and this defeat may be attributed to the ineffectiveness

and inconsistency of the diagnostic and treatment methods employed by most of the African

indigenous psychiatrists. Most African indigenous psychiatrists often use divination or other

spirit-medium methods to diagnose the cause(s) of mental illnesses. After establishing the

cause(s) which in most cases are attributed to supernatural factors, primary treatment often

includes sacrifices, rituals (in form of incantation, invocations and exorcism), dances and

sometimes flogging, accompanied by secondary treatment like the use of herbal medicines.

Apart from the spiritual and physical healing methods, some of the African indigenous

psychiatrists believe that “sleep and rest, especially in a serene ambience, can reinvigorate the

psychiatric patients and return to them a minute level of rationality (Nwoko, 41).

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4.6 KEY CHALLENGES TO THE USE OF AFRICAN INDIGENOUS MEDICINE

IN PRIMARY HEALTH CARE

Despite the progress report on African indigenous healers in the task of actualization of

affordable and accessible primary health care in Africa, the use of African indigenous medicine

in the primary health care is still being undermine by many challenges, of which only the key

challenges – lack of safety and efficacy data or information and the problem of ensuring quality

rational use of African indigenous medicines – are discussed here. These challenges point to

the need, and as requested by the World Health Organization, to develop a plan for making

African indigenous medicine or healing practices an integral part of the national healthcare

systems in African countries. Therefore, these challenges can be issues of the past if African

indigenous medicines and health practitioners are fully integrated into national healthcare

systems in African countries alongside the Western paradigm with adequate national policies

or strategies, regulatory measures, developmental programmes and funding.

First, the quantity and quality of safety and efficacy data available on African

indigenous medicines are inadequate to support their extensive use in the mainstream national

healthcare systems. This challenge is due lack of adequate clinical research and proper

ontological documentation on the pharmaceutical properties and medical applications of most

of the indigenous medicines used by the indigenous healers. Also, lack of safety monitoring

and regulation (in most African countries) of indigenous healers and their collection,

preservation, processing, packaging, storage, product life and distribution as well as clinical

application of the indigenous medicines on patients creates issue of distrust on the safeness of

the indigenous medicines, within most of the Western health practitioners and some consumers

who may want to use them. Sometimes, usage in tradition, is considered as a reason for

exemption of African indigenous medicine and practitioners from safety monitoring and

regulations. Moreover, it is a common belief among most Africans that indigenous herbal

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medicines are safe to use since they are natural unlike synthetic Western drugs, but clinical

reports on the toxicity (not just only the over publicized antimicrobial properties) of the

indigenous herbal medicines have been a matter of clinical concern to the Western health

practitioners and researchers.

The second challenge is the problem of ensuring quality rational use of African

indigenous medicines. Lack of adequate information for consumers on the pharmacological

properties, usage and dosage of indigenous medicines, lack of good communication between

African indigenous healers and Western counterparts and inadequacy of formalized

professional training programmes for African indigenous healers are some of the major

problems in assuring rational use of African indigenous medicines. In addition to these key

problems, is the problem of inadequate academic research, case studies and reviews on clinical

trials and applications of African indigenous medicines. Ethnographic, epidemiological,

observational, survey and cohort studies are important for developing comprehensive data and

guidelines on quality rational or clinical use of African indigenous medicines.

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4.7 CONCLUSION

In this chapter, I have discussed some of the major fields of specializations in African

indigenous healing practices, namely; the diviners, the herbalists, the indigenous midwives and

birth attendants, and the indigenous orthopedic surgeons/bonesetters, and their roles in curative

and preventive medicine in primary health care in Africa. Also, I have discussed both the

informal and formal training of the African indigenous healers and the key challenges to use

of African indigenous medicine in primary health care in Africa. I have shown through these

discussions that African indigenous health practitioners play indispensable roles in primary

healthcare in Africa, hence they deserved to be given a better formal recognition (than they are

currently given) and practicing space in the national healthcare systems in African countries,

alongside Western medicine. This view forms the hub of the arguments in the next chapter

concerning integrating relevant African indigenous healing practices and Western medicine in

the national healthcare systems in African countries.

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 CHAPTER FIVE

INTEGRATION OF AFRICAN INDIGENOUS HEALING PRACTICES AND

WESTERN MEDICINE

“Integrative medicine shifts the orientation of medicine to one of patient-centered rather than

disease-centered, engaging the mind, spirit and body, as well as the community” (Gaudet, 67)

5.1 INTRODUCTION

As emphasized earlier in chapter two, that Western healing system cannot claim to have

complete mastery of knowledge of all diseases or to provide solutions to all health problems,

since the understanding of health and illness in Western medical ontology is restricted to

biophysical and psychological aspects of human life, hence curing or healing cannot stretch

beyond these boundaries. Understandably, Western medicine has achieved notable feats in the

treatment of somatic diseases and unprecedented advancements in field of medicine. But

through Western medicine alone, the vision of the World Health Organization (WHO), which

entails increasing the availability, accessibility and affordability of primary healthcare in

developing countries and achieving health for all, cannot be realized. Hence, in contemporary

African society, where accessibility to and affordability of Western medicine is very limited

due to high rate of poverty and disapproval of Western therapeutic methods by traditional

conservatives, there is a dire need for integration of both the African indigenous healing

systems and Western medical system for a holistic, improved, affordable and accessible

healthcare. Also, the increasing demand for Africa indigenous medicine for health care needs,

which is estimated at 80% of African population by World Health Organization and the

growing recognition of the important role that African indigenous medicine plays in the global

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healthcare sector, have necessitated the need for the development and integration of relevant

African indigenous healing practices into mainstream national health care systems.

The pursuit of integration of both African indigenous healing practices and Western

medicine, has been challenged by some indigenous scholars whose major concern is that

integration can lead to appropriation or annexation of the African indigenous healing systems.

Nevertheless, the necessity of integrative African indigenous and Western healthcare cannot

be totally ignored especially in this contemporary era, wherein emerging illnesses or diseases

continue to resist or defeat the existing Western therapeutic medicines, methods and practices,

in addition to increasing demand for clinical evidence on the safety, efficacy and quality of

African indigenous medicines and practices. Hence, the question that the anti-integrationists

must answer is: can the indigenous healing system in Africa cope alone with the challenges of

present and emerging health problems, as well as the increasing demand for quality, safety,

efficacy and accessibility of clinical evidence to support the claims of the indigenous healers?

Can it survive this contemporary era of technological advancement, globalization and evolving

healthcare needs?

After addressing some of the major concerns of the anti-integrationists or hindrance

against the integration of African indigenous healing practices and Western medicine in section

5.2 of this chapter, I will also discuss the opportunities for and benefits of integrating African

indigenous healing system and Western medical system in section 5.3. Then, I will proceed to

section 5.4, where I will argue for integrative African indigenous and Western medicine or

healthcare as an effective and sustainable healthcare model for expanding the horizons or reach

of African indigenous medicine and improving the outcomes of primary healthcare in Africa.

In section 5.5, I will propose an integrationist project termed Integrative African Indigenous

and Healthcare Model, and will discuss the six important organizational strategies or schemes

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for the proposed conceptual Integrative Healthcare Model. Finally, in section 5.6, I will

highlight some of the pre-developmental strategies for a successful implementation of the

Integrative African Indigenous and Western Healthcare Model.

5.2 CHALLENGES AND CONCERNS AGAINST INTEGRATION OF AFRICAN

INDIGENOUS HEALING PRACTICES AND WESTERN MEDICINE

According to the report by the World Health Organization (2010), “African indigenous

medicine has demonstrated great potential of therapeutic benefits in its contribution to modern

medicine. More than 30% of modern medicines are derived directly or indirectly from

indigenous medicinal plants” (WHO, 8). Estimation suggests that about 80% of the African

population rely on traditional medicine for their primary health care needs (Bannerman, 320-

325; Qtd. in Tabi et al., 52). As a way of affirming the contributions of African indigenous

medicine to health care delivery, the WHO in its Alma-Ata Declaration of 1978, officially

recognized African indigenous medicine and practitioners as important resources in achieving

health for all Africans by year 2000. In pursuit of its mandate, the WHO Regional Committee

for Africa, in 2000, adopted a Regional Strategy on Traditional Medicine for the African

countries, objectives of which are to support African countries: (i) to integrate African

indigenous healing practices into the national health care system, (ii) to achieve health for all

in the African region by increasing the availability and affordability of African indigenous

medicine, (iii) to optimize the safety, efficacy, quality African indigenous medicine, and (iv)

to promote therapeutically rational use of relevant African indigenous medicine by providers

and consumers. In order to realize the first objective, the strategy urged member-states of the

African Union, to develop and implement national policies for the development and

institutionalization of African indigenous medicine as an integral part of emerging health care

systems. In response to the request by WHO Regional Committee for Africa, the African

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Union, in 2001, adopted the WHO African Regional Strategy on Traditional Medicine. The

period 2001-2010 was therefore declared as the Decade for African Traditional Medicine, with

annual celebration on 31st August of every year to commemorate African Traditional Medicine

Day. Also, all member-states were entreated to prepare a Plan of Action for implementation to

achieve the objectives of the strategy.

Though the WHO pursuit of integrating African and Western healthcare system is

approved by those who see it as a way of accelerating the development of African indigenous

medicine and improving the accessibility and affordability of healthcare systems in African,

nevertheless it is has been criticized by those who are skeptical that integrating African

indigenous healing practices and Western medicine can lead to complete assimilation,

appropriation and suppression of indigenous medical knowledge and practices. Their

arguments against integrative African indigenous and Western medicine stem from the fact that

during colonization, most of the African indigenous healing knowledge, theories and practices

were appropriated by the colonial imperialists into the conventional Western medicine without

acknowledging the contributions of the indigenous healers. What is now called modern

medicine is not an exclusive heritage of Western tradition but as a result medical colonization

of indigenous medical knowledge and practices by Western medicine (Mbih, 39). For instance,

most of the Western drugs used as conventional treatment are made from the medicinal

constituents that are derived or extracted from indigenous medicinal plants without

acknowledging or recognizing the contribution of the indigenous healers who discovered the

medicinal plants. Notably, the first natural physostigmine, a Western synthetic medicine for

management and treatment of antimuscarinic toxicity and glaucoma, was isolated for the first

time in 1860 by Jobst and Hesse, from the seed of West African liana called Calabar bean,

without recognizing the contribution of the indigenous community from where it was collected

to Germany. Although the argument of the anti-integrationists is obviously valid, with adequate

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national policies for protection and preservation indigenous healing knowledge, practices,

innovations and intellectual property rights, the concerns of the anti-integrationists can be

addressed. According to WHO (2010), effective adoption and implementation of suitable

national policies on indigenous intellectual property rights (IPRs) can chart a roadmap for

research, protection and preservation of African indigenous healing knowledge, practices and

innovations (5). In order to properly safeguard African indigenous healing knowledge, skills

and practices from any unauthorized appropriation or biopiracy, unfair competition and illegal

or unethical commercial or non-commercial exploitation, there is need for African countries to

adopt a suitable National Sui-generis System; a kind of localized and modified Intellectual

Property System (IPS) with the intention of properly accommodating the special features of its

subject matter (i.e. African indigenous healing knowledge, skills and practices).

Another important concern or challenge against integrating African indigenous

medicine and Western medicine is the issue of distrust on the part of the Western medical

practitioners who have refused to work with the indigenous healers or recognize their

contributions in health care delivery, or who sometimes prefer to work only with the herbalists

excluding the spiritualists because of the scientifically demonstrable pharmacological

potentials of the indigenous herbs. The Western physicians consider the work of the

spiritualists as “too abstract, subjective and devoid of scientific objectivity” (Mokgobi, 50).

Pearce Olu (1982) investigated the possibility of integrating the Western and indigenous health

systems in Nigeria and found out that although Western physicians were in favor of

collaboration between the two health care systems, they would rather collaborate with only one

category of indigenous healers (i.e., herbalists) as they (Western physicians) are more

interested in the pharmacological or medicinal constituents of the herbal resources than other

forms of indigenous healing e.g. divination, exorcisms and spiritual rituals, (1612-1615). In

another study in South Africa on the perceptions of the people on integration of indigenous

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healing and Western healing, Hopa et al., (1998) found out that general physicians focus groups

were skeptical about the integration and further questioned the authenticity of the indigenous

healing practices. The group also perceive the indigenous healers as mostly illiterate (9-12).

The distrust or discriminatory attitude of the Western health practitioners to African indigenous

healing practices and practitioners can be resolved through interpersonal relationships and

interaction, collaboration, constant communication and cross-referral of patients that come

with integration. Krah et al. (2018) in their research among indigenous healers and Western

health workers in Ghana, note that in cases where is interpersonal relationship, Western health

workers are more likely to collaborate with indigenous healers; cross-referrals flourish, than in

cases where there is no existing interpersonal relationship.

Apart from the concerns raised by anti-integrationist, there are some challenges that

may hinder successful integration of African indigenous healing practices and Western

medicine, which include the problem of trust and secrecy by indigenous healers, the

discriminatory attitude of biomedical healthcare workers towards indigenous medicine,

declining interest among young people in learning indigenous medicine and lack of

governmental budget or funding for indigenous health care.

On the problem of trust, Mbih notes that the “indigenous healers are usually

apprehensive of about the real intention of integration” or motives of those advocating for

integration, hence they are “unwilling to divulge some of their therapeutic knowledge and

procedures” to Western health practitioners (Mbih, 38). According to Maboe Mokgobi,

“secrecy comes about as a result of fear amongst most of the indigenous healers, that Western

scientists would appropriate their ideas about medicinal plants and roots and modify them as if

it is theirs” (52). This fear is substantiated by the fact that during the colonial era, indigenous

science and therapeutic knowledge have been appropriated and patented in ways that were not

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beneficial to the local community. Also, the high turnover and mobility of biomedical health

workers “undermines the establishment of a relationship of trust between the indigenous

healers and biomedical health staff” (Krah et al.159). However, the problem of trust on the part

secretive indigenous healers can be resolved before integration through a Sui-generis

Intellectual Property System (IPS) in order to motivate and encourage indigenous healers to be

open with their indigenous healing knowledge, skills, practices and innovations with assurance

that they will not be exploited by Western health practitioners, but will be compensated by

anyone who wants to use their intellectual properties.

Furthermore, studies have shown that biomedical perceptions on indigenous medicine

is precipitated by insufficient understanding of indigenous healing practices by biomedical

health practitioners coupled with status difference (based on education) between indigenous

healers and biomedical physicians (Homsy et al., 905-97). Hence, there is need to include some

relevant aspects of the African indigenous medicine in the curricula of colleges of health

sciences and other higher institutions of learning, in order to promote sufficient understanding

of indigenous healing practices through exchange of programmes, knowledge and experiences

between indigenous healthcare system and Western health care system,

Another challenge against integration of African indigenous medicine and Western

medicine as Krah et al., (2018) observes, is that many young people interviewed during their

study, expressed unwillingness to become indigenous healers. The reasons being that the

indigenous healers are poorly remunerated, hence they take up other professions to meet up the

daily demands of life. Another reason is the unattractiveness of African indigenous medicine

as a profession and the advocacy of the superiority of Western medicine (159). Finally, in most

African countries, despite the huge funds that go to the public healthcare system, the indigenous

health care system is always overlooked in the health budget, with little or no funds at all.

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Though the challenges of declining interest of young people in African indigenous medicine

and poor or lack of governmental funding of African indigenous health care system represent

a few of the present difficulties facing African indigenous healing medicine and practitioners,

these challenges and others can be addressed if the preconditions for integration as highlighted

in section 4.4 are implemented by African governments at national level.

5.3 OPPORTUNITIES FOR AND BENEFITS OF INTEGRATING AFRICAN

INDIGENOUS HEALING PRACTICES AND WESTERN MEDICINE

Despite all the concerns and challenges against integrating African indigenous healing

practices and Western medicine, there are some promising opportunities or potentials that

promote the possibility and feasibility of integrating both healing systems. First, the high per

capita distribution of indigenous health practitioners compared to that of Western health

practitioners in most sub-Saharan African countries offers great potential for incorporation of

African indigenous health practitioners into the mainstream healthcare system. Also, the

increasing demand for African indigenous healing practices and herbal medicines for primary

health care needs (as shown in section 3.2 of chapter one) provides an opportunity for

integration of African indigenous medicine into national healthcare systems alongside Western

medicine, in order to tackle the shortage of Western medicines and healthcare personnel in the

primary healthcare systems in Africa. The increase in production and commercialization of

African indigenous herbal medicines, as a result of the efficacy of increasing number of

medicinal herbs use for treatment and management of a broad spectrum of diseases, is an

opportunity that necessitates the incorporation of African indigenous medicine in the

therapeutic regimen used for treating diseases in the conventional healthcare systems in Africa.

It is important to note that the cultural and religious footings, the affordability and accessibility

of African indigenous medicine, as well as its holistic approach to health, are some of the values

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or reasons why it is widely patronized by a good number of African population (estimated

around 80%), hence the high patronage which indigenous healers enjoy offers opportunity for

improving the clientele of Western medicine through integration.

However, whereas some researchers (Mbih, 2019; Cambell-Hall, et al. 2010) indicated

their disapproval of integration and the attitude of indifference among Western medical

practitioners in any arrangement for integration, other researchers have shown that many of the

indigenous healers and Western healthcare workers are willing and ready to collaborate and

work together in areas like knowledge and skills development and exchange, developmental

training programmes, documentation and protection of indigenous medical knowledge, and

production and commercialization of indigenous medicines. Other areas they are willing to

collaborate include; development of inventories and monographs on indigenous medicines and

herbal pharmacopeias, development and utilization of researches for integrative African

indigenous and Western medicine (Kayombo et al., 2007; UNAIDS, 2006; Krah, E. et al., 2018;

Nyame et al., 2021) . The optimistic disposition of many of the indigenous healers and Western

medical practitioners towards collaboration and cooperation increases the feasibility of any

possible integrative plans or strategy. Furthermore, some of the promising national strategies

and plans for development of African indigenous healing practices which have been

implemented in some African countries, offer opportunities for future and systematic

integration of relevant indigenous healing practices into the mainstream healthcare system. For

instance, according to the WHO report in The African Health Monitor (of 31 August 2010), 36

sovereign states out of 55 member-states that make up the African Union, have formulated

national policies to promote the practice of indigenous medicine, whereas about 21 countries

have developed legal frameworks for indigenous medicine practice. Also, about 18 countries

have adopted National Codes of Ethics for indigenous health practitioners to enhance the

safety, efficacy and quality of services they render to patients, and about 20 countries have

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established indigenous healing programmes in their ministries of health, while 36 countries

have also established National offices for indigenous medicine (9).

According to Boon et al., the benefits accruing from integrating indigenous healthcare

system and Western healthcare system exceed the collective benefits accruing from individual

healthcare practice (55). Contrary to the assumed challenges or concerns against the idea of

integration, there are thoughts that integration can help to reduce the Western doctor-patient

ratio, which is very high in sub-Saharan African countries. In some sub-Saharan African

countries, the Western doctor-patient ratio is 1:20,000, while in others it is as high as 1:100,000.

However, in indigenous health care system, the indigenous healer-patient ratio is as low as

1:200 in most sub-Saharan African countries (Krah et al., 157; Cook, 261). Integrating both

healthcare systems can increase the number and availability of health care practitioners and

workers in both the rural and urban areas in sub-Saharan African countries. Also, integration

can lead to a better mutual understanding between African indigenous healers and Western

healthcare practitioners, as well as dispel distrust and enhance trust and respect, as well as

mutual understanding and collaboration in healthcare management and cross-referral of

patients. Research by Nyame et al. (2021) among indigenous health practitioners, Western

health care practitioners and caregivers, and service users in Ghana, shows that they are

optimistic that collaboration between indigenous healing system and Western health care

system, would make it possible for people to utilize the beneficial aspects of both healing

systems (4). Integration will not only make the beneficial aspects of both healing systems

readily available and accessible, but also affordable and widely acceptable. It brings about a

more holistic and improved approach to primary healthcare through the merging of healing

knowledges of both healing system. Furthermore, integration of African indigenous medicine

and Western medicine will enable health care consumers to have a wider choice of healing

therapies. Also, through integration, effective clinical evidence on the safety, quality and

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efficacy of African indigenous medicine and improved healthcare delivery for all Africans can

be realized.

These opportunities for and benefits of integrating African indigenous healing practices

and Western medicine, as highlighted in section, serve as influential bioprospecting tools in

developing national policy for the integration of relevant African indigenous healing practices

into national healthcare systems in Africa, alongside the Western medicine for an improved,

holistic and approach to curative and preventive medicine.

5.4 TOWARDS INTEGRATIVE AFRICAN INDIGENOUS AND WESTERN

HEALTHCARE SYSTEM

In their conceptual framework for different models of team-oriented health care

practice, Boon et al. (2004), identified seven models of healthcare practice which have evolved

over the past few decades, and they are; parallel model, consultative model, collaborative

model, coordinated model, multidisciplinary model, interdisciplinary model and integrative

model (3-4). The last and evolving model in the continuum which is called integrative medicine

or healthcare is what this academic work advocates, given that it is more holistic, cost effective

and yields more outcomes than other models; it entail the combination of the treatment

therapies and services of indigenous medicine and conventional healthcare system to achieve

a holistic approach to health and wellbeing, through a shared vision or objectives, a shared

philosophy or values, a common health care structure or management and a collective

evaluation of healthcare practice (Boon et al., 2).

Maize et al. (2002), define integrative medicine (IM) or integrative healthcare (IHC) as

“medicine that reemphasizes the relationship between patient and physician, and integrates the

best of complementary and alternative medicine with the best of conventional medicine” (851).

The defining features and scope of an integrative medicine or healthcare is often reflected in

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philosophy or values that guide its emergence, the type of structure that links both healthcare

systems, the process or the internal dynamics of integration and the expected outcomes when

the integrative healthcare is operational (Boon et al., 54; Boon et al. 2). In a more expansive

form, integrative healthcare is defined by Boon et al. as;

“an interdisciplinary, non-hierarchical blending of both conventional medicine and

complementary or alternative healthcare that provides a seamless continuum of

decision-making and patient-centered care and support, and employs a collaborative

team approach guided by consensus building, mutual respect, and a shared vision of

health through a partnership of patient and practitioners to treat the whole person by

synergistically combining therapies and services in a manner that exceeds the

collective effect of the individual practice” (55).

Integration requires the synergistic cooperation and collaboration of all the health practitioners

(both indigenous and Western) in exchange of medical knowledge and services or care

provision. It involves shared management of the patients, shared patient care, shared practice

guidelines and shared common values and goal” to ensure the total wellbeing of the whole

person (the bio-psycho-socio-spiritual dimensions) (Khorsan et al., 2). By synergistically

combining therapies and services of both indigenous and Western medicine, integrative

medicine is geared towards treating the whole person, supporting the innate healing properties

of each person, enhancing health and wellness and preventing diseases (Boon et al., 3; Boon et

al., 55). In Integrative healthcare, both empirical evidence and experience-based evidence of

the health practitioners are recognized, valued and infused (Templeman and Robinson, 85).

In the integrative health care system, the two healing systems, for instance, the African

indigenous healing system and Western medical system need not to clash against each other;

they can be blended in a way that is non-hierarchical, mutual and beneficial with each

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maintaining its own epistemic foundation, and using the best features of each system to make

up for the weaknesses in each. Integrative medicine is successfully practiced in countries like

China and South Korea. According to the National Bureau of Statistics of China, in China

Statistical Yearbook 2011, both indigenous Chinese medicine and Western medicine is

integrated in the Chinese National healthcare system, and both medicines are practiced

alongside each other at all levels of national health care service with public and private

insurance cover for both indigenous Chinese medicine and Western medicine. There are about

440-700 healthcare institutions in China providing indigenous Chinese medicine services, with

520-600 beds for patients, including all levels of traditional hospitals and general hospitals,

clinics and health stations in urban and rural areas. About 90% of general hospitals have an

indigenous Chinese medicine department which provides indigenous Chinese medicine

services for all patients (both inpatients and outpatients). Indigenous medical institutions are

governed by the same national legislation on medical institutions as Western medical

institutions. Indigenous health practitioners are allowed to practice in both public and private

clinics and hospitals. Government and private insurance fully cover Chinese indigenous

medicine including Tibetan, Mongolian, Uygur and Dai indigenous medicine. Patients are free

to choose Chinese indigenous medicine after being provided with advice on which therapies

may be better suited to their health problems (Qtd. in WHO Traditional Medicine Strategy

(2014-2023), 37). In the Republic of Korea, indigenous healers provide Korean indigenous

medicine in both public and private hospitals and clinics. A national medical insurance

programme has covered Korea indigenous medicine services since 1987 and currently private

insurance also cover indigenous medicine services ((Qtd. in WHO Traditional Medicine

Strategy (2014-2023), 37-38)

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5.5 PROPOSED CONCEPTUAL FRAMEWORK FOR INTEGRATIVE AFRICAN

INDIGENOUS AND WESTERN HEALTHCARE MODEL

The integrationist project termed; Integrative African Indigenous and Western

Healthcare Model, as envisaged in this academic work, consists of an integrative healthcare

model wherein relevant African indigenous healing practices is practiced alongside Western

medicine at all levels of national healthcare systems (i.e., primary, secondary, tertiary and

quaternary or experimental health care). While adopting any national policy on the proposed

Integrative African Indigenous and Western Healthcare Model, there are six important

organizational strategies or schemes that should be considered, namely; (i) the dimensions of

integration, (ii) the guiding principles and/or values (iii) the structure of management (iv) the

process or the internal dynamics of integration, (v) planning of patient care, and (vi) the process

of evaluation and assessment of care services. These organizational strategies or schemes are

important because they give direction and guidelines on how the Integrative African

Indigenous and Western Healthcare Model should be designed in any national policy that

would be adopted and implemented.

5.5.1 The Dimensions of Integration

The dimension of the Integrative African Indigenous and Western Healthcare Model as

envisioned in this academic work is a kind of functional and normative integration which

supports and links together the policies, practices and functions, as well as the values, culture,

goals and outcomes of both African indigenous and Western medicine, at different four levels

of integration: (i) system integration, (ii) organizational integration, (iii) professional

integration, and (iv) clinical integration (as depicted in Figure 1).

The system integration of Integrative African Indigenous and Western Healthcare

Model involves the combination of structures, healing values, healing processes or techniques

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and policies of both African indigenous healing system and Western healthcare system to fit

the healthcare needs of Africans and cope with the challenges of present and emerging health

problems. To enhance the quantity, quality and efficiency of care and consumer satisfaction,

the model system integration involves both vertical and horizontal system integration

incorporated together to achieve both disease-focused and patient-focused care. In vertical

system integration, all the different levels of care of both African indigenous and Western

medicine are linked together, for instance; healthcare practitioners of both healing systems at

both primary and secondary healthcare levels should be able to collaborate together and

exchange information. While in horizontal system integration, all the similar levels of care of

both healthcare systems are linked together. For instance, the healthcare practitioners of both

healing systems at primary healthcare levels should be able to collaborate together and

exchange information. This type of holistic system integration requires the collaboration and

partnership of both African indigenous and Western healthcare practitioners and workers in

primary and secondary healthcare services, most especially in areas of curative and preventive

medicine. The facility of integrative healthcare model should be more like separate healthcare

facilities within the same public healthcare institution, for both African indigenous and Western

health practitioners to practice according to their healing beliefs and knowledge systems, even

though they may differ from each other. For this to be possible, there should be tolerance of

each other’s healing beliefs and knowledge system. Also, patients should be alloweed to choose

the type of healing they prefer. However, there should cross-referable services between both

healing systems, if deemed necessary for the wellbeing of the patient with his or her consent.

In order to meet up with health care demands of African (affordable, accessible and

quality healthcare) organizational integration of African indigenous and Western medicine

requires collective responsibilities and actions of all organizations across the entire levels of

care both healthcare systems towards a holistic health and wellbeing. In order to avoid the

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complexity of health care decision-making, the management of the integrative African

indigenous and Western healthcare system is a kind of autonomous dual management

mechanism, wherein health care decisions are independently made by the management of each

healthcare system. However, there should be a joint management, drawn from both African

indigenous healing and Western health practitioners, that oversees the general affairs and

evaluates the collective outcomes of the integrative healthcare system. In the inter-

organizational integration, exchange of medical information and knowledge, inter-

organizational interactions and cross-referral services between African indigenous healers and

Western health practitioners are strongly encouraged.

Another dimension of Integrative African Indigenous and Western Healthcare Model

is professional integration which involves a partnership or collaboration between professionals

from both healthcare systems with shared responsibilities, roles and accountabilities of

providing a comprehensive and coordinated continuum of both therapeutic and preventive

health care to patients. The last level of dimension of integration of African indigenous and

Western medicine is clinical integration which entails coherence in the primary health care

delivery process, policies and decisions of both African indigenous and Western medicine.

Here, the primary patient-care services are coordinated across various professional and

institutional boundaries of both healthcare systems.

5.5.2 The Guiding Principles and/or Values

Another defining feature of the Integrative African Indigenous and Western Healthcare

Model is the guiding principles and/values that underlie its approach to patient care, since they

determine the quality and type of care services rendered. The adoption of national policy on

Integrative African Indigenous and Western Healthcare Model as proposed here, should be

guided by the art, science and principles of each healing system. Although the art and science

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of African indigenous healing practices are distinctly different from that of Western medicine,

there are some core principles or values that should guide the practice of the healthcare model.

They are as follows;

1. Patient-centered, as well as community-centered; allows patient consent, participation

and preferences when designing any treatment plan.

2. Holistic approach to health, wellness and wellbeing of all Africans; considers the

physical, psychological, spiritual, social, and even ecological dimensions of life.

3. Helps to restore the balance or harmony between a patient and his or her inner

environment (homoeostasis) or external environment (community)

4. Supports the body's innate healing ability or vital energy.

5. Alleviate suffering.

6. Affordable, accessible and readily available to all.

7. Focuses on preventive healthcare.

8. Commitment to evidence-based practice (both empirical evidence and experience-

based evidence)

9. Promotes core medical values such as compassion, dignity and respect.

10. Ecosystem friendly.

These principles are important in the practice of integrative African indigenous and Western

medicine, as they tend to inform clinical decision making, particularly decisions relating to

treatment of individual patients and assessment of care services.

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Figure 1: The Guiding Principles and/ or Values for the Integrative African Indigenous and

Western Healthcare Model.

5.5.3 The Structure of Management

The structure management of the Integrative African Indigenous and Western

Healthcare Model should be a balanced and non-hierarchical integration of relevant African

indigenous healing practices and Western medicine in order to arrive at the best and holistic

approach to health and treatment. The structural approach should be a holistic collaborative

team approach involving both African indigenous and Western health practitioners; that is,

horizontal collaboration between both African indigenous and Western health practitioners at

the same level of care and vertical collaboration between African indigenous and Western

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health practitioners at different levels of care. For instance, in horizontal collaboration, both

African indigenous and Western general health practitioners at the same level of primary health

care can work together in areas of routine healthcare services and preventive medicine. In

routine healthcare services, African indigenous healers should be allowed to practice alongside

Western physicians in all the public primary healthcare hospitals and clinics, in providing

routine therapies to patients who prefer indigenous medicine. However, there should be cross-

referral between African indigenous healers and Western physicians, in cases that need further

expert assessment or specialized investigation by relevant specialists of secondary or tertiary

health care (vertical collaboration). Referral services should be in the general interest of the

patient, rather for financial gain of the physician. In aspect of preventive medicine, there should

be collective or synergic measures (both primary and secondary) to prevent, halt or avert the

occurrence of diseases, most especially communicable diseases like malaria, HIV, cholera,

smallpox, yellow fever, tuberculosis, trypanosomiasis etc., as well emerging infectious

diseases like Ebola, Lassa fever, Chikungunya and Crimean-Congo hemorrhagic fever, with

very high mortality rate in Africa. Also, there is a dire need for partnership between African

indigenous midwives or birth attendants and Western maternal healthcare practitioners in

curbing the high rate of maternal and infant mortality.

In the aspect of the structure of management, there should be a joint management that

oversees and evaluates the independent separate managements and professional bodies of the

integrative healthcare system. For instance, the management of each healing system should be

allowed to coordinate key managerial functions such as, financial management, strategic

planning, quality improvement, information management, human resources, health insurance,

consumer assurance, and healthcare services. However, a board of directors drawn from

different care levels of both African indigenous and Western medicine should be saddled with

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the responsibility of making national health policies and evaluating the implementation by the

management and professional body of each healthcare system.

5.5.4 The Process or Internal Dynamics of Integration

Another important feature of the Integrative African Indigenous and Western

Healthcare Model is the process or internal dynamics of integration, which entails how the

integrative healthcare system should work or function to achieve optimized health care that

exceeds the overall impact of the individual healthcare practices. The internal dynamics of

integration envisioned in this academic work is a kind of interprofessional or interdisciplinary

model or process of working, communication and decision-making that would enable the

separated and shared knowledge, skills and practices of both African indigenous and Western

care providers to synergistically meet the complex and emerging healthcare demands or needs

of Africans.

For an effective and efficient working process, care providers of each healing system

should work or function independently but collaboratively with trust and mutual respect, and

with considerable understanding of each other’s medical perspective and abilities. Each healing

system should share in the responsibility, burden and rewards of providing affordable,

accessible and quality healthcare services to patients. And to achieve this, the competence,

confidence, knowledge and insights of care providers of any healing system should not be

underrated or denigrated. In aspect of decision-making, care providers or practitioners of each

healing system though should be allowed to make decision that pertains to them, however, they

should interact, collaborate and consult with those of other healing system, as a way of ensuring

that the services of each healing system are tailored to the objectives, values and expected

outcomes of the whole integrative healthcare system. For instance, African indigenous

orthopedic surgeons or bone setters should be allowed to practice autonomously with their own

space in the public hospitals and make care decisions in line with their own ethics of profession.

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However, it is important that they collaborate with Western orthopedic surgeons in exchange

of information, knowledge and skills that may be helpful to them in their decision making.

Also, since the conceptions of health, illness and healing, and epistemic foundation of African

indigenous healing system differs from that of Western paradigm, care providers or health

practitioners of African indigenous medicine should be governed by their own ethics of

profession and regulated by an independent professional body or medical council, and the same

applies to the care providers or health practitioners of Western medicine. However, there

should be a joint-professional body that supervises the activities and adherence to professional

ethics of these two independent professional bodies.

5.5.5 The Process of Planning of Patient Care

One of the factors that is crucial to healthcare delivery and in achieving a successful

Integrative African Indigenous and Western Healthcare Model is the process of planning for

patient care. A key component of healthcare planning is goals setting, which is fundamental in

achieving a successful integrative healthcare, as well as in assisting health practitioners or care

providers of both African indigenous and Western medicine in identifying and prioritizing

strategies of resolving, ameliorating or preventing patients’ health problems. An efficient

planning of patient care entails having a well-defined and documented strategy of goals or

expected outcomes of achieving an effective healthcare delivery through an individualized,

participative and coordinated patient-centered treatment. In other words, the best way of

achieving a patient-focused care is by having a goal-centered model of care. Planning and

setting healthcare goals

Having well-defined common goals, expected outcomes or treatment objectives for

integrative African indigenous and Western medicine is important in enabling continuity of

improved and consistent approach to care and effective evaluation of clinical outcomes or

performance, by harmonizing care services, providing measurable endpoints towards which

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patient care is directed, directing attention towards to relevant healthcare programmes, and

channeling greater efforts and resources towards the set up goals. The goals of the Integrative

African Indigenous and Western Healthcare Model should be aligned to the core principles that

should guide the practice of the healthcare model as highlighted in sub-section 5.5.2. This is

important in developing mutually derived goals that motivate care providers or health

practitioners of both towards the achievement of the common goals and drive interprofessional

or interdisciplinary healthcare practice. The formulation of a systematic plan of care for the

Integrative African Indigenous and Western Healthcare Model should involve stakeholders of

both African indigenous medicine and Western medicine. The planning process and goals to

be adopted should be specific, measurable, achievable, realistic, time-bound, patient-centered,

mutually derived and well outlined and documented. Also, it is important that the prioritization

of goals takes into consideration the preferences of patients and care consumers.

5.5.6 The Process of Evaluation and Assessment of Care Services

In order to improve the planning process and outcomes of care in the Integrative African

Indigenous and Western Healthcare Model, there should be a systematic process of evaluating

and assessing healthcare services in the integrative healthcare model. And this entails gathering

reliable and valid data or information about the care services of the healthcare model in a

systematic way, and making comparison to previously identified standards (or making

comparison of actual outcomes or progress against expected outcomes or progress) for the

purpose of making informed health care decisions and adequate understanding of the working

mechanisms or progress of the healthcare model. The management of each healing system in

the integrative healthcare model can adopt relevant clinical evaluation instruments, through

sources like patients and care providers interviews, questionnaires, pertinent documentation,

cross-sectional research, professional observations, objective measures and clinical

assessments and tests, to monitor the effectiveness of any healing treatment and the progress

100
in achievement of identified goals or to improve the efficiency of the integrative healthcare

model. While the method of sourcing accurate and reliable data is indispensable to the process

of evaluation, an effective evaluation of care services requires that the managements and

practitioners of the integrative African indigenous and Western healthcare system should be

mindful of the factors that affect the attainment of expected outcomes or goals, since they can

also influence the rate of progress towards the defined clinical endpoints. These factors include;

clinical factors, social factors, patient-derived factors, practitioner-derived factors, structural

factors, patient-practitioner relationship, and methods of treatment. It is therefore important

that these factors are taken into consideration when evaluating the services of the integrative

healthcare model. An annual evaluation of care services of the integrative African indigenous

and Western healthcare system could help in determining whether or not to improve the quality

of healthcare services, clinical outcomes and professional standards of the integrative

healthcare model or create new benchmarks for best integrative healthcare practice or in

determining whether or not clinical outcomes have been achieved in a more efficient, cost-

effective and beneficial manner. However, before adopting any national policy for

implementation of the Integrative African Indigenous and Western Healthcare Model, there is

need for some pre-developmental strategies that are pertinent for successful implementation.

5.6 PRE-DEVELOPMENTAL STRATEGIES FOR A SUCCESSFUL

IMPLEMENTATION OF THE INTEGRATIVE AFRICAN INDIGENOUS AND

WESTERN HEALTHCARE MODEL

For a successful implementation of the Integrative African Indigenous and Western

Healthcare Model, it is important that the following preparatory and developmental strategies

be implemented by African leaders at national level. The importance of these pre-

developmental strategies is to develop and harness the potentials of indigenous healthcare

101
systems for an effective integration and institutionalization into national healthcare systems of

African countries. Some of these strategies are formulated from the WHO Traditional Medicine

Strategy (2002-2005 and 2014-2023), as a way of seeing to it that African indigenous medicine

meets up with the demands and challenges of indigenous medicine in contemporary society,

with better resources for effective integration into national healthcare systems. It is important

to note that some of these pre-developmental strategies for a successful integration of African

indigenous healing practices and Western medicine have been implemented at national level

in some African countries, while others are yet to be implemented. They are as follows:

I. First all, there should be a statutory regulation framework to regulate, promote, develop

and standardize African indigenous healing practices in African countries.

II. There should be a well-developed code of ethics that guides indigenous health practices

to enhance safety, efficiency, efficacy and quality of services rendered to patients.

III. There is a need to include indigenous health programmes in the mainstream ministries

of health of African countries for awareness-building and promotion of indigenous

health practices.

IV. There should be a professional body that is responsible for regulation, accreditation,

and evaluation of training, activities and services of indigenous health practitioners.

V. There is a need to establish research institutes responsible for improving the safety,

efficacy and quality of indigenous medicines, as well as regulating their

commercialization.

VI. There is a need to develop a knowledge-based system (KBS) on African indigenous

medicine (ATM), for example in the form of ontology-based ATM Clinical Decision

Support System, in order to store, harmonize, maintain and facilitate sharing and

transfer of indigenous healing knowledge.

102
VII. There should be institutes or colleges that offer training programmes for those that want

to become indigenous health practitioners, as well continuing education programmes

for improving the skills of practicing indigenous health workers.

VIII. There should be a well-formulated and inclusive policy for protection and preservation

of African indigenous medical knowledge and intellectual property rights. In order to

accommodate the peculiar features of indigenous healing knowledge, skills, practices

and innovation, Sui-generis Intellectual Property System (IPS) can be adopted.

IX. Finally, there should be adequate financial resources allocated for implementation of

African indigenous medicine activities and programmes.

The implementation of these pre-developmental requirements or preconditions should be

adopted and implemented in consultation and collaboration with all stakeholders of indigenous

health care system. There should be town hall meetings with all indigenous health care

practitioners to hear their views and contributions towards implementing these strategies, since

their experiential knowledge of indigenous healing practices can be a valuable tool in the

process of adoption and implementation of these strategies. These pre-developmental

strategies, if effectively implemented, can help to mitigate the challenges or resolve the

concerns raised against integration of African indigenous healing practices and Western

medicine.

103
5.7 CONCLUSION

In chapter five, I have discussed some of challenges and concerns of the anti-

integrationists against integration of African indigenous medicine and Western medicine, as

well as some of the promising opportunities that promote the possibility and feasibility of

integrating both healing systems, namely; the growing demand and use of African indigenous

medicine for healthcare needs and the high per capita distribution of indigenous health

practitioners compared to that of Western health practitioners. I have also highlighted some of

the benefits of integrating African indigenous medicine and Western medicine such as; a more

holistic approach to primary healthcare, more effective and affordable healthcare and better

mutual understanding and collaboration between African indigenous healers and Western

healthcare workers, and improved healthcare delivery for all Africans. I argued that the

opportunities for and benefits of integrating African indigenous healing practices and Western

medicine serve as influential bioprospecting tools in developing national policy for the

integration of relevant African indigenous healing practices into national healthcare systems in

Africa alongside Western medicine. I proposed an integrationist project termed; Integrative

African Indigenous and Western Healthcare Model, which should be implemented at national

level. I developed six important organizational strategies or schemes for the proposed

conceptual Integrative Healthcare Model, namely; (i) the dimensions of integration, (ii) the

guiding principles and/or values (iii) the structure of management (iv) the process or the

internal dynamics of integration, (v) planning of patient care, and (vi) the process of evaluation

and assessment of care services. Finally, I highlighted some of the pre-developmental

requirements for a successful implementation of the Integrative African Indigenous and

Western Healthcare Model.

104
 GENERAL CONCLUSION

This dissertation which was an integrationist project that sought to promote the idea

that African indigenous medicine and health practitioners possess what it takes to make them

an integral part of national healthcare systems in Africa alongside Western medicine and health

practitioners, namely; a holistic approach to health, illness and healing, a holistic understanding

of etiology of illness and perception of human nature, as well as embodiment of social, moral,

religious, professional and economic or commercial values embedded in African culture such

as affordability, accessibility, acceptability, cultural compatibility and suitability for the

treatment of broad spectrum illnesses, particularly the chronic illnesses.

To realize its aim, this integrationist project was divided into five chapters. In chapter

one, I discussed the African conception of health, illness and healing vis-à-vis Western

concepts of health, illness and healing. And through the discussions, I showed that Africans

have a more holistic concept of health, illness and healing that permeates all aspects of life

(physical, physiological, emotional, spiritual, economic, social, cultural and ecological) than

the Westerners. This holistic understanding of health, illness and healing in African indigenous

healing context, explained why some patients whose illness cannot be unraveled or cured in

Western medicine are usually referred to indigenous healers for holistic treatment. It also

explained why a patient feels relieved from the burden of moral guilt, the anxiety of being sick

and fears of dying, after undergoing the indigenous healing rituals and practices.

In chapter two, I discussed the epistemology of African indigenous healing vis-à-vis

Western paradigm. I was able to show through the discussions that Africans have their own

indigenous healing knowledge, since knowledge, in whatever definition, form and cultural

context it may exist, is found in all societies, and is affected by the way each society conceives,

105
understands and interprets reality. I dismissed the misconceptions of Western positivists

regarding non-Western indigenous knowledges, and then argued that African indigenous

healing knowledge is not inferior or unscientific as Western scientism framed it to be, rather

its scientific nature is embedded in African indigenous and cultural methods of acquiring,

categorizing, labeling, verifying and validating epistemic claims. With reference to the works

of indigenous African scholars like Ejikemeuwa Ndubisi, Elijah Okon, Barry Hallen, Disan

Kutesa, Usman Gbari, John Mbiti and Andrew Uduigwomen, I also argued that African

indigenous healing knowledge differs uniquely from the Western paradigm, hence they can

only be reasonably investigated or analyzed from the same lens through which African people

conceive, interpret and make sense of their reality, rather than through Western scientific

method.

In chapter three, I discussed the diagnostic methods in African indigenous medicine,

namely; divination, physical examination of the patient’s illness and questioning to know the

patient’s medical history or to uncover the cause(s) of his or her illness, as well as some of the

African indigenous healing methods and approaches (comprising of both natural and spiritual

healing methods) namely; spiritual cleansing, spiritual protection, sacrifices, exorcism,

appeasing the gods and pouring of libation, prescription of herbs, application of clay, surgery

and psychosocial counseling or reconciliation. Also, I discussed the African perception of

etiology of illness, as well as how this perception relates to African conception of the human

person and the relevance of some of the values of African indigenous healing practices.

Through these discussions I was able to show that African indigenous healing practices or

medicine is as holistic as the African view of reality and that it is still very relevant in

contemporary African society.

In chapter four, I discussed some of the major fields of specializations in African

indigenous healing practices, namely; the diviners, the herbalists, the indigenous midwives and

106
birth attendants, and the indigenous orthopedic surgeons/bonesetters, and their roles in curative

and preventive medicine in primary health care in Africa. Also, I discussed both the informal

and formal training of the African indigenous healers and the key challenges to use of African

indigenous medicine in primary health care in Africa. Through these discussions I argued that

African indigenous health practitioners play indispensable roles in primary healthcare in

Africa, hence they deserved to be given a better formal recognition (than they are currently

given) and practicing space in the national healthcare systems in African countries, alongside

Western medicine.

In chapter five, I discussed some of challenges and concerns of the anti-integrationists

against integration of African indigenous medicine and Western medicine, as well as some of

the promising opportunities that promote the possibility and feasibility of integrating both

healing systems, namely; the growing demand and use of African indigenous medicine for

healthcare needs and the high per capita distribution of indigenous health practitioners

compared to that of Western health practitioners. I also highlighted some of the benefits of

integrating African indigenous medicine and Western medicine such as; a more holistic

approach to primary healthcare, more effective and affordable healthcare and better mutual

understanding and collaboration between African indigenous healers and Western healthcare

workers, and improved healthcare delivery for all Africans. I argued that the opportunities for

and benefits of integrating African indigenous healing practices and Western medicine serve

as influential bioprospecting tools in developing national policy for the integration of relevant

African indigenous healing practices into national healthcare systems in Africa alongside

Western medicine. To achieve the vision of this dissertation, I proposed an integrationist

project termed Integrative African Indigenous and Western Healthcare Model, which should

be implemented at national level. I developed six important organizational strategies or

schemes for the proposed conceptual Integrative Healthcare Model, namely; (i) the dimensions

107
of integration, (ii) the guiding principles and/or values (iii) the structure of management (iv)

the process or the internal dynamics of integration, (v) planning of patient care, and (vi) the

process of evaluation and assessment of care services. Finally, I highlighted some pre-

developmental strategies for a successful implementation of any integrationist framework.

Through the whole discussions and articulation of ideas in all the chapters, this

dissertation has contributed to the ongoing academic discourses on African indigenous healing

knowledge and practices, as well as the discourses on integration of African Indigenous healing

practices or medicine and Western Medicine in the national healthcare system in Africa. It also

proposed and discussed the need for an integrationist project called Integrative African

Indigenous and Western Healthcare Model and how it can be realized through the proposed

conceptual organizational strategies or framework.

108
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