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Utilization of indigenous healers in national health delivery systems
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Sot. Sci. Med. Vol. 16. pp. 1815 to 1816. 1982 Printed m Great Britain
Pergamon Press Ltd
INTRODUCTION UTILIZATION
OF INDIGENOUS HEALERS IN NATIONAL HEALTH DELIVERY SYSTEMS UNA MACLEAN’ and ROBERTH. BANNERMAN~
‘Department
Traditional somewhat
medicine
and
Medicine, Usher Institute, Warrender Park Road, Edinburgh EH9 1DW, Scotland and *Geneva, Switzerland of Community
indigenous
medicine
are
vague terms, loosely used to designate ancient. culture-bound health care practices which predated the application of allopathy or scientific biomedicine. There are a number of other frequently used synonyms. such as alternative, unorthodox, folk, fringe or ethno-medicine. Some writers even refer to unofficial healing, thereby indicating that the normative and legal type of medicine is the Western or modern model. None of the words or phrases in common use is completely satisfactory because they seem to imply a central body of principles. knowledge and skills which is shared by the vast variety of forms of indigenous or traditional medicine. In reality there is a significant difference between all-embracing and complex systems of health care such as Ayurveda and traditional Chinese medicine and the simple, home remedies to which most people turn as their first resource in sickness. The adjective traditional conveys a sense of the treatments and practitioners in question being now out of date, inappropriate and inadequate for present day health needs. The papers on the utilisation of indigenous healers presented at the Edinburgh Conference of the Society for Applied Anthropology in 1981 all highlighted the fact that traditional medicine is still an established and lively manifestation of culture. Although in certain countries the indigenous systems for health care and for the prevention of illness and personal misfortune may not be as well developed as in China and other Asian countries. some kind of local medicine is still practised everywhere. Even in technologically advanced countries of Europe. evidence of the persistence of different kinds of lay medicine is to be found. It must. moreover. not be forgotten that Western style bio-medicine is itself a reflection of the prevailing culture and an expression of a particular world view. However. the subject of traditional medicine is no longer merely academic. on the contrary. it has lately become a vital area of concern for national health planners who are now well advised to take account of the findings and applications of medical anthropolog>. Most Third World countries already lack the resources to develop health care on the costly Western or modern model. As inflation mounts. the economic situation of the non-oil producing countries is steadily u-orsening. making it impossible to expand health services if these are based on expensively staffed and equipped hospitals and health centres. Effective low-cost deliver) systems urgently need to be devised.
The World Health Organisation has of late put forward the ideal aim of ‘Health for all by the year 2000’. Primary health care, at the local community level should take priority. At the same time, questions of the present maldistribution of appropriate modern medical care facilities should not be evaded. For the majority of people in the developing countries. traditional medicine in fact remains the main or only source of care. For such patients ‘primary health care’ is necessarily synonymous with traditional medicine. Those who do have some choice commonly consult both Western orientated and indigenous healers in the event of sickness. The paucity of the funding available for orthodox medical care is starkly illustrated by the situation in Ghana, where 3% of the total governmental budget is allocated to Health, as compared with 25.5% for Agriculture, 21.6% for Transport and Communication and 12.6% for Education. Only 1% of the population is covered by the hospital based specialist services which, nonetheless, consume 40% of the health budget. Nine percent of the population are able to utilise the other hospital and clinic services. for which a further 457; of the available health funds are allocated. The remaining 90”/, of the population have to make do with the remaining 15% of health expenditure, on primary health care. These people are mainly living in rural areas, dispersed amongst 46,000 villages. African traditional medicine begins at the household level. where family members possess a great deal of information on the diagnosis and treatment of common symptoms. Beyond the family there exist a whole range of specialists, herbalists, diviners. bone setters and accredited experts in different conditions, such as psychiatric illness and women and children’s ailments. Traditional birth attendants are the ubiquitous. taken for granted. midwives. Many practitioners of traditional medicine, in Africa and elsewhere, are deeply involved in the maintenance of social order and in preserving cultural institutions. They help the patient to live at peace with his or her family. clan. village. tribe and himself. Such healers have a broader social role to play and are more community orientated than the typical modern. Western style clinician. The therapy purveyed by traditional practitioners is not always limited to drugs or herbs. it frequently involves spiritual rituals and the regulation of diet and behaviour. We are now beyond the stage of theorising about the co.ntributions which traditional and bio-medicine
1815
1816
Introduction
can make to one another. Already a number of experiments in integration are in progress and many of the implications of these are reported here. Prior to the recent interest in the activities of African practitioners, however, there has been the Indian experience, which supplies a fascinating case history of the hazards, conflicts and possibilities inherent in the development of a pluralist medical system. One
paper provides a broad overview of attempts at links across countries and continents. The case of Annang traditional birth attendants is. by way of contrast. a detailed examination of the neglected and invisible health work of women in one specific place, labouring for one another. Finally, Finland illustrates the universality and persistence of traditional therapy in the ancient art of cupping.
Sot. Sci. Med. Vol. 16. pp. 1815 to 1816. 1982 Printed m Great Britain
Pergamon Press Ltd
INTRODUCTION UTILIZATION
OF INDIGENOUS HEALERS IN NATIONAL HEALTH DELIVERY SYSTEMS UNA MACLEAN’ and ROBERTH. BANNERMAN~
‘Department
Traditional somewhat
medicine
and
Medicine, Usher Institute, Warrender Park Road, Edinburgh EH9 1DW, Scotland and *Geneva, Switzerland of Community
indigenous
medicine
are
vague terms, loosely used to designate ancient. culture-bound health care practices which predated the application of allopathy or scientific biomedicine. There are a number of other frequently used synonyms. such as alternative, unorthodox, folk, fringe or ethno-medicine. Some writers even refer to unofficial healing, thereby indicating that the normative and legal type of medicine is the Western or modern model. None of the words or phrases in common use is completely satisfactory because they seem to imply a central body of principles. knowledge and skills which is shared by the vast variety of forms of indigenous or traditional medicine. In reality there is a significant difference between all-embracing and complex systems of health care such as Ayurveda and traditional Chinese medicine and the simple, home remedies to which most people turn as their first resource in sickness. The adjective traditional conveys a sense of the treatments and practitioners in question being now out of date, inappropriate and inadequate for present day health needs. The papers on the utilisation of indigenous healers presented at the Edinburgh Conference of the Society for Applied Anthropology in 1981 all highlighted the fact that traditional medicine is still an established and lively manifestation of culture. Although in certain countries the indigenous systems for health care and for the prevention of illness and personal misfortune may not be as well developed as in China and other Asian countries. some kind of local medicine is still practised everywhere. Even in technologically advanced countries of Europe. evidence of the persistence of different kinds of lay medicine is to be found. It must. moreover. not be forgotten that Western style bio-medicine is itself a reflection of the prevailing culture and an expression of a particular world view. However. the subject of traditional medicine is no longer merely academic. on the contrary. it has lately become a vital area of concern for national health planners who are now well advised to take account of the findings and applications of medical anthropolog>. Most Third World countries already lack the resources to develop health care on the costly Western or modern model. As inflation mounts. the economic situation of the non-oil producing countries is steadily u-orsening. making it impossible to expand health services if these are based on expensively staffed and equipped hospitals and health centres. Effective low-cost deliver) systems urgently need to be devised.
The World Health Organisation has of late put forward the ideal aim of ‘Health for all by the year 2000’. Primary health care, at the local community level should take priority. At the same time, questions of the present maldistribution of appropriate modern medical care facilities should not be evaded. For the majority of people in the developing countries. traditional medicine in fact remains the main or only source of care. For such patients ‘primary health care’ is necessarily synonymous with traditional medicine. Those who do have some choice commonly consult both Western orientated and indigenous healers in the event of sickness. The paucity of the funding available for orthodox medical care is starkly illustrated by the situation in Ghana, where 3% of the total governmental budget is allocated to Health, as compared with 25.5% for Agriculture, 21.6% for Transport and Communication and 12.6% for Education. Only 1% of the population is covered by the hospital based specialist services which, nonetheless, consume 40% of the health budget. Nine percent of the population are able to utilise the other hospital and clinic services. for which a further 457; of the available health funds are allocated. The remaining 90”/, of the population have to make do with the remaining 15% of health expenditure, on primary health care. These people are mainly living in rural areas, dispersed amongst 46,000 villages. African traditional medicine begins at the household level. where family members possess a great deal of information on the diagnosis and treatment of common symptoms. Beyond the family there exist a whole range of specialists, herbalists, diviners. bone setters and accredited experts in different conditions, such as psychiatric illness and women and children’s ailments. Traditional birth attendants are the ubiquitous. taken for granted. midwives. Many practitioners of traditional medicine, in Africa and elsewhere, are deeply involved in the maintenance of social order and in preserving cultural institutions. They help the patient to live at peace with his or her family. clan. village. tribe and himself. Such healers have a broader social role to play and are more community orientated than the typical modern. Western style clinician. The therapy purveyed by traditional practitioners is not always limited to drugs or herbs. it frequently involves spiritual rituals and the regulation of diet and behaviour. We are now beyond the stage of theorising about the co.ntributions which traditional and bio-medicine
1815
1816
Introduction
can make to one another. Already a number of experiments in integration are in progress and many of the implications of these are reported here. Prior to the recent interest in the activities of African practitioners, however, there has been the Indian experience, which supplies a fascinating case history of the hazards, conflicts and possibilities inherent in the development of a pluralist medical system. One
paper provides a broad overview of attempts at links across countries and continents. The case of Annang traditional birth attendants is. by way of contrast. a detailed examination of the neglected and invisible health work of women in one specific place, labouring for one another. Finally, Finland illustrates the universality and persistence of traditional therapy in the ancient art of cupping.