By S. K. Adesina
Traditional medicine, as is well known, is a cul tural gem of various communities around the world and encompasses all kinds of folk med icine, unconventional medicine and indeed any kind of therapeutical method that had been handed down by the tradition of a community or ethnic group.
By the World Health Organisation (W.H.O 1976) definition, traditional medicine is the sum total of all knowledge and practices, whether expli cable or not, used in diagnosis, prevention and elimination of physical, mental or social imbalance and relying exclusively on practical experience and observations handed down from generation to generation, whether verbally or in writing. With these descriptions, various forms of medicines and thera pies such as herbal medicine, massage, homeopa thy, mud bath, music therapy, wax bath, reflexology, dance therapy, hydrotherapy, mind and spirit thera pies, self-exercise therapies radiation and vibration, osteopathy, chiropractice, aromatherapy, preventive medicine, radiant heat therapy, therapeutic fast ing and dieting spinal manipulation, psychotherapy, etc. are a few elements of traditional medicine. It does show that a large country of the size of Nigeria, with diverse cultures and traditions, should be rich in traditional medicine and should have emi nent and respected traditional healers to take care of the teeming population.
The traditional healer, as defined by the W.H.O (1976), is a person who is recognised by the com munity in which he 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, attributes and beliefs that are prevalent in the community, regarding physical, mental and social well-being and the causation of disease and disability.
For most countries of the world, just as we have in Nigeria, a traditional healer may be able to per form many functions thereby becoming more versa tile as a healer. The various categories of tradition al healers, perhaps specialists known in traditional medicine today include (A. Tella, 1986; M. M. lwu, 1986).
Such herbal preparations may be offered in the form of (i) powder, which could be swallowed or taken with pap (cold or hot) or any drink, (ii) powder, rubbed into cuts made on any part of the body with a sharp knife, (iii) preparation, soaked for some time in water or local gin, decanted as required before drinking; the materials could also be boiled in water, cooled and strained (iv) preparation pounded with native soap and used for bathing; such "medicated soaps" are commonly used for skin diseases, (v)pastes, pomades or ointments, in a medium of palm oil or shea butter, or (vi) soup which is consumed by the patient. Herbal prepara tions may also be administered as enema.
The herbalist cures mainly with plants which he gathers fresh. When seasonal plants have to be used, these plants are collected when available and are preserved usually by drying to eliminate mois ture. Herbs were the first medicines used by pre historic man. They are, therefore, part of every cul tural tradition and have helped the development and growth of herbalism in Nigeria.
Traditional Birth Attendants (TBAs):
The World Health Organisation defines a traditional birth attendant (TBA) as a person who assists the moth er at childbirth and who initially acquired her skills delivering babies by herself or by working with other birth attendants. In the northern parts of the coun try, TBAs are of the female sex only, whereas in some other parts both males and females are involved.
TBAs occupy a prominent position in Nigeria today as between 60-85 per cent of births delivered in the country and especially in the rural communi ties are by the TBAs. They know how to diagnose pregnancy, confirm it and determine the position of the growing foetus. They have been seen to pro vide pre-natal and post-natal care and so combine successfully the duties of the modern-day mid-wife. Highly experienced TBAs have been recognised to assist in obstetric and paediatric care, as they man age simple maternal and babyhood illnesses.
Because of their exposure and experience, and more particularly the TBA's concept of human reproduction, as exemplified by pregnancy and childbirth being normal biological functions of human life linked holistically to cultural/social prac tices, TBAs have been trained to assist in orthodox medicine practices at the primary health care level. With their extra hands, a greater coverage of pri mary health care leading to improved material or child health and the lowering of maternal and child mortality and morbidity, have been achieved.
TBAs are usually old and experienced women who see their assignments primarily as contributing their skill for the good of the community. With expe rienced TBAs, child delivery by Caesarean section is not common since it is hardly necessary to seek surgical help during child birth. If tHere is a difficult labour, for example, the TBA will massage and press on the abdomen and work on the foetus. It may be necessary to wash the womb or the vulva a few days before delivery, using some plant prepa rations now known to have muscle relaxant proper ties. The use of words according to different reli gious and social or cultural beliefs have helped in many cases. For example, to deliver a bridged baby, a TBA said these words (Adesina, 1988).
"A kii t'Ori su, a kit fidi bi ibi ti Oluwa ni ko 0 gba way ni ko 0 gba'
These words may be translated:
We don't normally defaecate through the head, We don't normally vomit through the anus The route of delivery ordained by God should be followed.
Such efforts by the TBA have, for most times, ensured safe and Caesarean-free deliveries.
The various forms of sur gery recognised in traditional medical care include:
(i) the cutting of tribal marks: traditional surgeons usually cut tribal marks into the cheeks, bellies, etc. and charred herbal products are usually rubbed into these bleeding marks to effect healing,
(II) male and female circumcision (Clitori dectomy): traditional surgeons carry out these simple surgical operations with special knives and scissors; blood-let ting operations and wounds that result from these operations are usually treat ed with snail body fluid or pastes pre pared from plants. These practices are, however, fast dvino out in urban areas.
(ili) removal of whitlow: diseased toes or fingers are usually cut open and treated. Piercing of ear lobes: particularly in the youth to allow the fixing of ear rings. Extraction of tooth: infected teeth or teeth with holes that bring pain to the mouth are removed and treated with herbal medicines prepared in local gin. Performance of amputations: occasionally and very rarely too, there are amputations per formed with 'anaesthesia'; usually, the patient is sent to sleep with a strong narcotic concoction and the amputation done with a very sharp knife. The excision has to be achieved with the very first stroke. The stump is packed with a suitable herbal preparation and healing usually occurs within some four or five weeks
Cutting of the uvula (uvulectomy); the cut ting of the uvula is widely practised. It is believed that uvulectomy can protect the patient from various infections of the pharynx and the respiratory sys tem. Traditional surgeons in the northern part of Nigeria are versed in cutting off the upper end of the throat flap commonly referred to as epiglottis for the treatment of many illnesses.
The traditional surgeon performs his skill with out the aid of X-rays and with only a little knowledge of anatomy. While he may still be respected in some local communities, complicated surgery is better achieved with modern facilities and better trained hands these days.
Bone Setters: Bone setting or orthopaedic sur gery is the art of pairing fractures and other orthopaedic injuries. It is recognised to have attained a level of success comparable to that in orthodox medicine in Nigeria. Traditional bone setters are those knowledgeable in the art and skill of setting broken bones in the traditional way, using their skill to see that bones unite and heal properly.
There have been reported cases of fractures resulting from motor accidents or falls from trees. Such fractures may be simple, compound or com plicated. Wounds resulting from such fractures are usually cleaned, the bones are set making sure that the ends of the bones unite properly to prevent any deformity. Bleeding is usually stopped on applica tion of plant extracts, basil or cassava leaf extracts or the giant snail's body fluid. It is common to use banana leaves as lint. Wooden splints made from bamboo plants are used to immobilise the fractures while fresh or dry banana stem fibre (a fibrous plant), have served as bandage. Various methods are known for applying traction to fractured legs. Patients are usually also subjected to radiant heat treatment or hot applications of peppers to reduce inflammation and swelling. The occurrence of deformities or abnormal shapes of post-treatment limbs is very rare.
An interesting aspect of the bone setter's approach is the selection of a chicken whose leg would be broken and re-set. The fracture caused on the chicken is treated alongside that of the patent at the same time and in the same way. This is usually used to determine the time the patient's fracture would heal, and the time to remove the wrapped splints and clay caste.
It is particularly note-worthy that bone setters are often capable of arresting the deterioration of gangrenous limbs that may lead to amputation. This feat makes amputation rare. Situations have arisen when patients have had to be withdrawn from hospital for treatment in the bone setters clinics.
Traditional Medicinal Ingredient Dealers:
These dealers, more often women, are involved in buying and selling of plants, animals and insects, and minerals used in making herbal preparations. Some of them who indulge in preparing herbal con coctions or decoctions for the management or cure of febrile conditions in children or some other dis eases of women and children, may qualify to be referred to as traditional healers.
Traditional Psychiatrists: The traditional psy chiatrist specialises mainly in the treatment of lunatics and those with mental disorders. Lunatics are usually restrained from going violent by chain ing them with iron or by clamping them down with wooden shackles. People with mental disorders who are violent, particularly those that are demon possessed, are usually caned or beaten to submis sion and then given herbal hypnotics or highly sedative herbal potions to calm them. Such herbal preparations include extracts of the African Hauwolfia. Treatment and rehabilitation of people with mental disorders usually take long periods.
Practitioners of Therapeutic Occultism:These practitioners include diviners or fortune tellers, who may be seers, alfas and priests, and use supernatural or mysterious forces, incantations, may prescribe rituals associated with the communi ty's religious worship and adopt all sorts of inexpli cable things to treat various diseases.
The practitioners are usually consulted for diag nosis of diseases, their causes and treatment. With their ability to deal with the unseen, the supernatu ral, they are usually held in high esteem in the com munity. They are believed to have extra-sensory perception and can see beyond the ordinary man.
They can receive telepathic messages, can consult oracles, spirit guides etc. and perform well where other traditional healers and orthodox doctors fail. Their activities include making prayers, citing and singing of incantations, making invocations and preparing fetish materials to appease unknown gods. It is believed that diseases which are caused by supernatural forces will be readily diagnosed and treated by these practitioners.
This, in itself, sterns from the belief that certain medical ingredients — unusually large trees that are believed to house spirits, astronomic herbs, grave-yard plants like the physic nut, protective plants such as the wild colocynth or Sodom apple or even some reproductive herbs like the sausage tree or the tree of life itself — have occultic powers and can be effectively utilised by these practitioners for the good of all.
The instructions which these practitioners use include magic stones which are usually thrown to the ground. Sounds so produced are read and interpreted. Some take replies of messages in a pool or glass of water. Others depend on the throw ing of cowries, coins, kola-nut seeds, divining rods, keys or sticks, etc.
Divination has come of age, its various func tions linked with religion, creation myths, cosmolo gy et cetera. Its use as communication and for sto chastic processes makes it unique and beyond the reach of most traditional healers.
Specialists exist in the various categories of tra ditional medicine identified earlier.
TRADITIONAL MEDICINE IN CONTEMPORARY NIGERIA
Health is the most precious of all things and it is the foundation of all happiness. Traditional medi cine has developed in various communities in Nigeria in response to the health needs of the peo ple. There is the common saying that "what the toad will eat, God will not put on a tree." Even if such needs of the tojff develop or grow in space, they will surely come to the ground if they are to sat isfy the needs of the toad. Many communities have, therefore, since creation, developed various tradi tional systems using locally-available resources for the alleviation of their health problems. As once noted some 13 years ago (Tella, 1986), traditional medicine is as old as the hills in Nigeria. The devel opment of traditional medicine in Nigeria has led to various categories of healers, the various healing methods, strategies and medicines or remedies now known. The British colonial masters brought in orthodox medicine and, today, both systems of medicine exist in the country; both have the primary objective to cure, manage or prevent diseases and maintain good health.
It is important to stress the relevance of tradi tional medicine to the majority of Nigerians. Most Nigerians, especially those living in rural communi ties don't have access to orthodox medicine and it is estimated that about 75 per cent of the populace still prefer to solve their health problems consulting traditional healers. Where such access exists, the rising cost of imported medications and other com modities used for medicines have posed a big prob lern. Besides, many rural communities have great faith in traditional medicine, particularly the inexpli cable aspects as they believe that it is the wisdom of their fore-fathers which also recognises their socio-cultural and religious background which orthodox medicine seems to neglect. Recent reports show that more people in the world embrace traditional medicine. In 1996, the WHO published (WHO Policy and Activities in the Field of Traditional Medicine) that in China, the ratio of med ical doctors to the population stood at 1:20,000 compared with traditional practitioners ratio of 1:2000, and in Swaziland, these figures are respec tively 1:10,000 and 1:100.
There is abundant justification for the use of herbs by the various traditional healers identified. Disease conditions identified in traditional medicine include (1) cardiovascular disease - hypertension, stroke etc. for which the antihypertensive herbs, the African Rauwolfia and the Negro coffee have been used (2) diseases of the nervous system-convul sions, insomnia etc. for which the parrot's beak and the African Rauwolfia also offer a good remedy, (3) diseases of the alimentary system-diarrhoea, dysentery etc. for which basil is useful (4) diseases of the endocrine system-diabetes etc. for which the leaves of the common Roused periwinkle or Mormodica are valuable (5) diseases of the respira tory system - asthma, cough etc. for which the lemon grass is of value (6) diseases of the genito urinary system-gonorrhoea, haematuria, etc. for which the bush banana is useful (7) diseases of the skin-wounds, dermatonycosis etc. for which the craw-craw plant is very useful (8) diseases associ ated with the ear, nose and throat ache, sinusitis etc. for which the resurrection plant is usually rec ommended and (9) diseases caused by microbes, viruses, insects etc. - infections, malaria etc. for which garlic, clove, the African mahogany etc. have been found useful.
Numerous other diseases or complaints of a special nature such as hernia, snake bite, arthritis, gout etc. have been treated using herbs alone or in admixture with animal parts and minerals. Today, plant medicines include vincristine and vinblastine isolated from the Rose periwinkle and used to treat childhood leukaemiaand Hodgkin's disease, reser pine extracted from the African or Indian Rauwolfia and used in tranquillisers, diogenin extracted from the yam and used in the treatment of rheumatism and to produce oral contraceptives and the shea butter which showed nasal decongestant activity etc. Non-plant medicines include the bee venom which is used in the treatment of arthritis and the civet cat exudate which has shown anticonvulsant effects. Plant extracts and chemicals with muscle relaxant properties have been used by the TBAs to assist in child deliveries. All these facts point to the values of medicinal plants and their importance in traditional medicine in present day Nigeria. (Adesina, 1995, Gbile, 1987).
THE PRACTICE OF TRADITIONAL MEDICINE
Unlike the bone setter, the traditional psychia trist and the traditional birth attendant whose duties are well defined and specialised, the herbalist is the general practitioner in traditional medicine. He is expected to be knowledgeable in all the various aspects ol healing and in the functioning of the var ious organs of the body. Much is expected of him, as by his wealth of experience and knowledge he is expected to determine the nature of the patient's ill ness, treat him and also predict the course of his treatment. In a typical traditional setting, he com bines the role of the present day doctor with that of the pharmacist and the nurse.
Treatment of an ailment or a disease usually follows the following heads (A. Tella, 1986):
Diagnosis/aetiology: Common ailments or problems are easily recognised and treated suc cessfully, based on the symptomatology of the dis ease.
If the illness persists, recourse is made to the practitioner of occultism/the diviner who, in his efforts to discover the real cause of the disease, may consult various spirits including his oracle, pre scribe appropriate rituals and make sacrifices to solicit the right answer. This is because she believes that diseases can be caused by sorcery, ghosts, breach of taboo, spirit intrusion and acts of God. It has also been found that public opinion and rumours may help the diviner to trace the cause of a disease.
Diagnosis may also be achieved by visual examination of eyes, skin, urine, faeces etc.; taste, for example, of urine for sugar in the diabetic, use of ants to detect sugar in the urine of the diabetic, palpation, that is through the sense of touch using palms, fingers or the analysis of a patient's dreams. Proper diagnosis is needed in the treatment of psy chosomatic and psychiatric cases just as in the cases of bone fractures and other traumatic injuries. Generally, proper diagnosis is the key to most traditional treatments.
Symptom: The patient describes the symptoms as much as practicable. The healer also watches out for these. For the various diseases, symptoms that are usually watched out for include behavioural changes; fever or abnormal rise in body temperature; jaundiced state, yellow colour in the eyes, urine, palm and fingers suggesting possi ble liver problems; seizures as often experienced in convulsions, diarrhoea in cases of poisoning; fre quent stooling and vomiting; bleeding which may be from the nose, mouth, gums, teeth, from private parts, anus; blood in the urine; coughing and vom iting blood; breathing difficulty; sneezing; swelling which may be minor and localised; general weakness of the body; and development of rashes and even pain. Experienced herbalists can readily dif ferentiate constant or intermittent pains from sharp or dull ones and link them with specific diseases. Signs: These are usually observed by experi enced healers. Modern-day healers are being encouraged to use stethoscopes and other simple instruments to determine signs.
Treatment: As was mentioned earlier, the herbalist treats with medicines made up of plants, animals and minerals. He may also use any of the therapeutic systems described earlier-therapeutic fasting and dieting massage, therapeutic occultism et cetera.
Modern-day technology, innovations and edu cation, have however, made a lot of impact on the herbalist and on the practice of traditional medicine in Nigeria. The general populace now wants to compare the herbalist with the orthodox medicine general practitioner. Herbalists are now being encouraged to improve on the quality of their out put and practice. Herbalists are being encouraged to identify correctly the medicinal plants and other ingredients used in the preparation of herbal prod ucts. They should be mindful of the sources of theirraw materials and avoid adulteration, all in the bid to ensure safe medicines.
Herbalists who normally would rely on the collection of plants from the wild are being encouraged to have their own medicinal gardens and farms and grow some plants especial ly those facing extinction due to over-use, bush burning, drought, urban development et cetera. Herbalists are being encouraged to undertake toxi city studies on their products, in collaboration with scientists and recognised institutions.
As micro organisms and parasites abound in the environ ment, herbalists are being reminded of the need to work in clean hygienic environment and the need for good manufacturing practices to prevent con tamination of raw materials and finished herbal products, to ensure stable and well-preserved proucts, to ensure properly-labelled herbal medicines and, probably most important, to ensure standards as well as also uniform and accurate dosing. Herbalists are also being encouraged to register their proven and efficacious standardised herbal preparations with the National Agency for Food and Drug Administration and Control (NAFDAC).
It is an interesting development that some states of the federation have established traditional medicine boards to monitor the activities of its prac titioners, This development should be encouraged throughout the country.