I Disagree with the Gambia Journal on Traditional Medicine

Dear Editors, 

Please allow me to have this letter published in your widely respected online publication. It is a respect you well deserve due to the quality of journalism and intellectual discourse displayed in the journal. I have been a keen reader for over three years and my continued interest is kindled on by the diversity of the topics and issues treated. I am aware of some of the criticisms that have in the past sprung up against your journal but I take distance from most of them. For example there were some voices raised over your publication of interviews and articles by rebel leader Koukoie Samba Sanyang. People who want to deprive others the right to have their views published are themselves fascists, no better than Jammeh. If one has anything written or said by Mr. Sanyang, he/she should write and counter what Sanyang says but not attack a medium for publishing Sanyang’s views. This is what I think but this does not mean I agree with the Gambia Journal on everything. In fact my purpose for writing and sending this letter is to express my profound but respectable disagreement with some points I consider salient.

Sirs,  for a long time now and in dozens of articles and reports published on the journal you have manifested a very prejudiced position as regards traditional medicine which you on whole  sale condemn as “superstition and backwardness,” in my view. It shows you choose to look at an African phenomenon with European spectacles, I dare say. Your recent articles criticizing President Jammeh’s treatment program demonstrate this more clearly. While I agree with you that Jammeh’s lies, pretensions and charlatanism are dangerous to the health of many people and therefore need to be exposed and condemn, I think you have been throwing the baby with bathwater. Jammeh’s exhibitionist practices, more akin to witchcraft than traditional African medicine, should not be confused for the system of treatment of the sick which is as old as the people of the continent itself. The thousands of years of existence in the face of very adverse conditions, like in an environment endemic to the growth and rapid mutation of innumerable disease organisms and hash climatic conditions is sufficient proof that Africans must have had effective system of treatment long before the encounter with Western civilization. Must this system, still to be properly surveyed and researched, be thrown away just because, as you would say, one mercurial African head of state has laid claims on being able to treat a host of diseases?   

But first, let me remind you that  in Africa, everywhere on the continent, access to Western medicine and treatment is neither accessible nor affordable to the vast majority of the poor and the disadvantaged. There are other types of therapeutic remedies that are accessible to most inhabitants in the continent and that, at the same time, give answer to the deepest needs of the African spirit.

Most African countries find themselves forced to import almost all conventional medicines, which makes the selling price to the public excessively high for the average person. On the other hand, financial difficulties have brought most national health systems to the point of collapse, when not to the total breakdown. Many health posts, clinics and hospitals, especially in the rural areas, have been obliged to close or greatly limit their services due to the scarcity of basic medicines and medical personnel. For example, in the past years the Government of The Gambia has only been able to budget about 1.15 dollars per person a year for the purchase of medicines; and counts with only one doctor for every 10,000 people in the urban areas and for 50,000 in the rural areas.

The HIV/AIDS pandemic has contributed further to the deterioration of sanitary structures in the African continent. Wealthy patients have always the possibility of resorting to private clinics and hospitals or fly abroad to get this treatment.

What are the options for the majority of Africans who do not receive the necessary medical attention in the public institutions and cannot afford the high prices demanded by private or overseas institutions? The answer is to turn to traditional medicine, like their ancestors did for generations before the introduction of modern remedies by the colonial administrators. 

According to a study by the World Health Organization approximately 70 per cent of Africans consult habitually experts on traditional medicine, like marabouts, healers, herbalists, fetishists or so called witch doctors – to treat their sicknesses. Curiously enough, in these last years, and in part as a consequence of the explosion of AIDS, even those who have easy access to modern medicine and can afford it, prefer to put themselves in the hands of traditional doctors.  The number of patients who abandon conventional hospitals where they are hospitalized in search of help among traditional healers is constantly growing. It is seldom that one sees even Western-trained doctors, engineers, scholars, intellectual and other members of the modern professional classes resorting to the humble “clinics” of traditional specialists to seek treatment. Those visits are often surrounded by an atmosphere of secrecy because the official position, inherited from colonial times, still maintains an attitude of mistrust and contempt towards the traditional practices, which the western mentality stigmatized as superstitions. Editors, Sir, your articles do the same to African medicine and it is over this that I disagree with you most profoundly.  

Africans continue to resort to the medical legacies of the ancestors even centuries after the encounter with the West and ample exposure to Western medicine. But few critics of African traditional medicine stop to ask themselves why this has been so. The ones who care to ask this question often answer it only superficially, downgrading it into “ignorance and backwardness.” But behind this persistence and vitality of traditional medicine is the vision that African culture has of sickness. Modern medical science is based on the dualistic approach that separates the mind and body, and its principal objective is to eliminate physical suffering. However, most African societies understand sickness primarily as the physical or mental manifestation of the breaking down of the personal equilibrium or the social relationships.  Both Fr. Pierre Temple and other anthropologists and Africanists have suggested that the African self is like a dynamic vessel containing various gravitating forces. As the self grows it achieves a certain equilibrium. It is a break in this equilibrium that causes sickness, from foot-sores, malaria to anxiety, paranoia and mental illness. Break in the equilibrium does not come about only out of the relations among the contained forces but also in their interaction with outside social factors  and even the cosmos.    

According to traditional culture, a person’s ailment could be caused by the action of evil spirits, due to his/her failure to abide by the social rules, to his/her lack of respect for the ancestors, or to contamination by objects considered taboo.

In general, it can be said that African traditional mentality considers sickness a kind of punishment by the spirits of the ancestors to those who do not observe the rules of good behavior of the society to which they belong. The ancestors withdraw their protection from the transgressors of the social norms and leave them exposed to the whims of the evil spirits who cause physical dysfunctions. In the context of this perception of sickness, which is deeply rooted in many inhabitants of the continent, it is as important to find and eliminate the “supernatural” causes of the ailment as to heal its somatic manifestations, which are only symptoms by and large 

Many African patients feel frustrated with the merely rational approach of modern medicine which, according to their perception, does not attack the root of their disease. For this reason, when sick, they turn to those they know will treat both the hidden causes and the physical effects of their affections.

 Therefore traditional African medicine is the set of knowledge and practices, rationally explicable or not, used in the diagnosis, prevention and elimination of physical, mental, and social disequilibrium. This collection of knowledge and practices comes from experiences and observation that are transmitted from one generation to the next. Some relatives of President Jammeh have been long known to be specialist on bone and muscle treatment. Many patients who visit modern hospitals in Banjul, Bansang, Basse or Farrafenni are often asked to some of these traditional specialists by doctors, nurses or other hospital workers.  

The traditional medicine-men, healers, herbalists, etc. are persons recognized in their communities as specialists in the treatment of sickness through the use of plants, minerals, and animal parts and through other methods based on the social, cultural and religious traditions of the population. They are an integral part of the local culture and quite appreciated as healthcare agents, due to their knowledge of the sicknesses and of the appropriate remedies for each one of them.

The practitioners of African traditional medicine are quite numerous and live among the people, in such a way that the sick persons have easy access to them. An estimate, in a 2005 health survey for instance, has a medicine-man per 281 inhabitants; while Senegal, a country with approximately 12 million people, has registered more than 30,000 healers. Many of the traditional doctors frequently mention a “calling” from the spirits of the ancestors as the origin of their dedication to the healing activities, as Jammeh in January 2007 also did with his claim of a “mandate.” Others acknowledge that they simply continue with a family tradition that passes from fathers to their children.

But all of them had to undergo between two and five years of training, under the supervision of an experimented traditional healer, to learn the trade before establishing their own practice. Jammeh himself claimed he had practicing his type of medicine even before he took power in 1994. The traditional doctor develops his activities on two complementary levels, derived from the African concept of sickness: the supernatural or spiritual, and the corporal or physical level.

The healer - as an expert on the feelings, beliefs and the dominant norms of conduct norms of the community to which the patient belongs - tries first to establish the “spiritual” cause of the ailment. Listening to the sick person or to his/her relatives, using divinatory techniques and putting himself in contact with the spirits of the ancestors, he will decide on what has broken the equilibrium of the person or the group and which evil forces are causing the sickness.

Once the deep cause has been established, the traditional doctor will prescribe the actions to follow – reparation of an injustice, reconciliation between antagonized persons, performance of the rites due to the ancestors, etc. – to restore the equilibrium within the individual or the social group. He also resorts to prayers and invocations destined to recover the favor of the ancestors and to send away the evil spirits. Jammeh’s chanting that you mentioned in your articles, may be this.   

It was this somehow “mysterious” aspect of the activities of the traditional healers that made you and your western way of seeing thing,  dismiss them as ‘witchcraft’ and superstition.  But African traditional medicine maintains a strong connection between healing and spirituality because Africans live deeply the psycho-religious values of the human person.

Once the primary causes of the ailment are determined and treated, the traditional practitioners moves on to eliminate the corporal manifestation of the sickness. To do this, they make use of their vast knowledge of medicinal plants and of the therapeutic properties of certain animal parts and minerals. Their own experience, added to the accumulated experience of their predecessors for generations, allow the healers to offer effective and cheap remedies for the main ailments afflicting the population of the continent, like malaria, stomach infections, respiratory problems, rheumatism, arthritis, sexual dysfunctions, anaemia, parasite infections, mental problems, bone fractures, etc.

After diagnosis of the type of sickness the patient suffers from, the traditional medicine-man selects the plant or collection of plants – leaves, roots, barks, stem…. – adequate to the treatment of the  ailment. Sometimes, he will also use parts of animals or minerals whose curative properties complement those of the plants.  With all those ingredients, the healer prepares a cooked paste or an infusion that the patients take orally or are applied to them topically. He may also incinerate those ingredients and apply the resulting powder on the small incisions done in the skin. Much more averse to your views, the medicine man may decide to get the hair of one animal stuffed into the horn of another type, and the claw of yet another into a package, sewn into a necklace or a belt to help cure the disease.

Most traditional doctors treat all kinds of diseases, but some of them stand out for their success in curing a concrete sickness and attract patients from all parts of the country where they practice and even from neighboring countries. Everyday in The Gambia, one can hear over the radio, medicine men from Guinea or Mali, advertising their services of curing all from blindness, tuberculosis, impotence, skin diseases, etc. Some of these may be only some hustlers, seeing the possibilities of cashing on the widespread belief in the medical system, but there are also many counterfeit modern medical tablets in circulation and that is no reason why Western medicine should be condemned wholesale.

True, some healers, like Yahya Jammeh have  claim to have identified medicinal plants which kill the AIDS virus and affected persons flock to them in the thousands searching for a miraculous remedy. If they actually do not have the remedy they are then doing a great disservice to the fight against the epidemic and I agree that such people must be exposed and condemned outright. But this does not mean we must condemn all African medicine out of hand.

Even the World Health Organization (WHO) has recommended since the 1970s the inclusion of traditional practitioners in the national systems of health because of their knowledge of medicinal plants, their closeness to the local populations and their knowledge of all the elements that intervene in a sickness. According to WHO, the uncertain health situation of the African continent does not allow wasting the medical and pharmaceutical experience of the local healers; it would be a serious mistake to ignore the fact that they are the ones who provide medical attention to most Africans, especially in the rural areas.

You, Editors, Sirs, should be even more mindful of this. Anyway, thanks for the space.