Bridging Africa’s Healthcare Gaps with Ethnomedicine

A photo of mother and child from the
indigenous Himba Community in Namibia

Photo:William Matews 2011 

African ways of life are highly characterized by communities’ relationship with nature. Their mostly agricultural economies are also dependent on their natural environment for primary health care, in the form of Ethnomedicine.

Although healthcare is modernizing on a global scale, a significant number of African economies have limited resources to carry out decentralized responsibilities such as revenue collection, leading to limited funds for delivery of social services such as healthcare, particularly in rural areas.  Lack of resources also results in poor enforcement of health standards and codes, leading to limited compliance.

Statistics show that approximately 60-80% of people in Africa still rely on traditional remedies for primary health care, to treat themselves for various conditions. This is because of limited access to modern health care facilities due to distance and high costs.

As a Development Studies student at Makerere University, I researched how indigenous knowledge has contributed to socio-economic development in Uganda, and wrote a paper on a case study in Masaka District. I interviewed traditional herbalists who use indigenous medicine to treat people, as well as farm owners, who use it to treat animals, and also use indigenous knowledge to control pests using animal urine, among other things.
My maternal grandmother, with a herbal tea spice "omujaaja",
aka "African Basil," that helps with flatulence and constipation
"Omujaaja" Plant
Photo: Africa2U
Of course, we know that medicinal plants date back to the Stone Age, making them the oldest form of primary health care, and various ancient cultures discovered medicinal plant usage through a process we could now call “botanical research.”

It is important to note that 30%-40% of allopathic drugs used to treat or suppress symptoms are derived from plant-based compounds, and many are synthetic analogues built on prototype compounds similar to those from plant species.  Also, 11% of the World Health Organization’s essential medicines, 340 or more drugs considered as basic and essential to "satisfy the priority health care needs of the population," originate from flowering plants.

Unfortunately, indigenous remedies have been inconsistently documented, and this knowledge is transferred orally, thus creating a large possibility of error. Due to the nature of medicinal plants and herbal medicine, doses vary depending on the person administering them, and are usually given until symptoms disappear. However, that does not make a treatment itself ineffective unless it is wrongly administered, just as with any modern medicine.

Indeed, indigenous medicines contain more medicine and less packaging.  Wikipedia reports that only 5 to 10 percent of a tablet or pill is the active substance, with another 10 percent being compounds for easy digestion and 80 percent being inactive fillers, binders, et cetera.  So 90% of a pill is not even medicine, but packaging.

This takes me back to the primary health care practices of communities in Africa. 

Regardless of modern challenges of cost and access, one cannot ignore that African communities had specialists in various medical procedures and health care in general.  The question is, why have Africans lost these specialized indigenous skills?

One might argue the promotion of formal education and employment has drawn young people to urban areas, where they are less likely to perpetuate indigenous practices. Another factor is that many poor people are losing their land to commercial investors or government.  

These factors disrupt the socio-economic and political stability of African communities, and threaten the livelihood of practitioners in indigenous medicine.

In addition, human activity threatens the habitat of medicinal plants.  To produce indigenous medicine and offer treatment to the large populations that need it but cannot access or afford modern medicine, we must maintain ecosystems to sustain renewable natural resources for herbal medicine.

At a regional level, I know the African Union’s NEPAD Declaration is closely linked to the attainment of the Millennium Development Goals (MDGs), including human rights, combating HIV/AIDS, malaria and other diseases.  

It should be reiterated, though, that these Health-related goals are only feasible when attention is given to key socio-economic indicators such as improving health outcomes and sustainable management of the environment. And these are not tenable without affected communities meaningfully participating in decision-making at all levels.

The state of healthcare and health financing in many African countries is lacking. Healthcare budgets are often donor-funded, which makes them unreliable for creating and sustaining affordable modern healthcare systems.  There are also very long periods between censuses and other demographic or health surveys, which impacts the timeliness of information that could be used to improve healthcare.

Finally, in addition to high domestic birth rates and growing populations, some African Union member countries in sub-Saharan Africa have fulfilled their international obligations and taken in refugees from areas of conflict, who have few resources and require care from health care systems that are already spread thin.  

So, what should African countries do to bridge the health care gaps? This takes me back to our theme, “Preserving Ethnomedicine.” I recognize that there are challenges that come with the undocumented herbal medicines used in the past, but African leaders can and should place emphasis on anthropological and agro-research in the health sector, and include the indigenous communities who are already heavily relying on this type of health care.  This could help serve more people in a timely and cost-effective manner.

I will leave you with a thought exercise, to try to get a feel for the scope of accessibility and affordability of modern health care in sub-Saharan Africa.

1. Think of the average income of an individual in a rural African community.
2. How many people are in their household?
3. How many of these people are employed?
4. What is the number of children in this average household? 
5. What is the approximate household income?
6. How many suffer from at least one condition requiring medicine in a month?
7. How much does it cost for a single treatment with an essential drug?
8. What are the percentage odds this household can afford modern medicine?
9. How many will die without access to modern health care?
10. How will that affect the productivity of the community?
11. How will this affect the general human development index of the country?
12. How does this affect the future of the country?
13. After healthcare, what percentage of income is left for other necessities?
14. Can you propose points for health care intervention in this scenario, to avoid the loss of life?

This presents us with the reality of the state of health care in Africa, and why it is necessary to bridge the health care gap by recognizing existing indigenous ethnomedicine and promoting its incorporation into healthcare.

Watch the Episode:

Vernonia Amygdalina
Photo: Dailymotion. com

Local  East and West African names 
Source: www.doktorsea. com

“mululuza”  –  Luganda (Uganda)
 “ewuro”  – Yoruba (Nigeria)
“onugbu” – Igbo (Nigeria)
 “shiwaka”  or  Chusar-doki – Hausa (across central and west Africa)bitter leaf 2
“ndole” –  Douala (Cameroon)
“figatil” or “necroton”  – Brazil
“grawa” – Amharic (Ethiopia)
“etidot” –  Ibibios (Nigeria)
“ityuna” –  Tiv  (Cameroon and Nigeria)
“oriwo” –  Edo (Nigeria)
“labwori”  – Acholi (North Uganda and South Sudan)
“olusia”  – Luo (Kenya and Tanzania)

The herb/plant is popular in these African communities. It has, historically been used to treat fevers related to Malaria, and as an anti-inflammation home remedy, among other things.

Vivian Birchall

African rhythm has no color

This video debunks the stereotype that caucasians cannot dance to the African rhythm.

The old Bakiga Tale of "Ruhondeza Mwene Busaasi"

African storytelling in New England

Ruhondeza Mwene Busasi is an old tale among the Bakiga of South Western Uganda.

According to the tale, Ruhondeza, was a mature man who loved to sleep a lot. He could use any opportunity to sleep, even if there was work to do, *Ruhondeza* would look for a hidden place and sleep.

One time Ruhondeza found a hidden place and slept, just like he had done many times. However, nobody woke him up.

The hills of Kigezi, the land of the Bakiga People
The sun set, rose and set again, the rains (Katumba) came and went, the dry season (ekyanda) came  and went, the grasshopper season came and went  and so many moons (months)  passed and Ruhondeza still slept. At the  place where he slept, the grass grew between his fingers and around him.

Apparently, Ruhondeza slept for 2 over years.

When he finally woke up, he could not see, because sleepy seeds were so large that they had sealed off his entire eyes. In Rukiga, sleepy seeds are called ebihonzi. His beard and hair had grown so long that his beard was touching his chest. The finger nails were too long. In short, Ruhondeza looked like a wild animal. Remember,  he could not see.

Due to his absence, his wife had gotten inherited by another man as was the culture among the bakiga. If a man died, his immediate brother or whoever the family of the man chose, would inherit the wife of the man who had passed on. So Ruhondeza's wife was inherited too.

So here was "Ruhondeza," homeless, blind, and helpless all because he preferred sleeping to working. It was from his name Ruhondeza that the word Okuhondeza meaning "to sleep soundly without the ability to know what is happening around you, was derived."

When you Kuhondeeza, You can be carried off your bed, put in water, and you still would not wake up*. A person who can Kuhondeza sleeps soundly and for long hours,  waking up normally to eat, due to hunger , and return to sleep.

                                                                                                      Watch the Episode
Ruhondeza, however, had managed to survive in his sleep mode without food for many years. (In science, this type of sleeping is called hibernation)
People from many villages heard  about a blind, homeless man, and how his life was full of pain. (Obusasi). Many came to see for themselves and behold, there he was , Ruhondeza looking and smelling like a wild beast. Stories about him spread far and wide among the Bakiga and beyond into Bufumbira and Ankole. The stories were about a man, Ruhondeza, who was living a life of suffering, (Obusasi), simply because he loved to sleep too much. People referred to him as Ruhondeza Mwene Busasi which means "Ruhondeza was an offspring of suffering".

This basically meant that the offspring of sleeping too much (as was the case with Ruhondeza), is pain and suffering, and this was the story that was passed on from generation to generation. Parents advised their children to learn to wake up early, start work early and avoid sleeping during working hours or hiding in the granary or anywhere else to sleep, lest they end up *blind, homeless and in pain like Ruhondeza Mwene Busasi

And that is the long story that my people (the Bakiga) used to tell, about a man, we now know as Ruhondeza Mwene Busasi

Note: This tale was originally compiled by:  Kazooba Ka' Nyamuhanga, Omukiga omuruganda rwa Basigyi,  omuzooba omu Bazooba  ba Mparo, abatanywa maizi kandi aba tanyata,  edited and adapted by Vivian Birchall for an Africa2U episode, on Acton TV

Acknowledgment:- Scovia Kyarisiima                        

Dancing Kizino with Anne Kansiime, a Ugandan Comedian