New York Academy of Medicine
Traditional Medicine in Africa: Colonial Transformations
Steven Feierman, Ph.D.
March 13, 2002

Report by George M. Carter

Traditional healers in Africa treat not only individual diseases, but also, historically, have played important roles in healing the body politic. Dr. Feierman presented a fascinating analysis of how the arrival of Europeans had a severe impact on the network of traditional healers that is having repercussions to this day.

He began by noting the "passionate ambivalence" of many in Africa today toward the arts of the traditional healers and toward botanical medicine and sought to understand its origins. While more and more individuals in the West are embracing healing traditions from around the world, many of the elite in Africa reject it. This is fairly commonly seen in certain sectors. Among religious institutions, for example, pastors refer to traditional healing as the devil's work. Practitioners of western "biomedicine" (also sometimes referred to as "allopathic" medicine) in Africa may also look askance at methods of traditional healing, although they will give sometimes grudging acknowledgement to some botanical interventions and the need to study them.

As Dr. Gerald Bodeker had pointed out in a recent conference held at Columbia University and as Dr. Feierman reiterated, traditional healing remains for many the only source of healthcare for many, particularly those in rural areas. And for some diseases, such as malaria, for which widely available treatment (chloroquine) is no longer efficacious due to resistance, an upsurge in the use of certain botanicals, such as various species of Artemisia, has been widely observed in cultures ranging from Africa to Asia.

During the colonial period, traditional healers in many areas were allowed to practice their craft, at least under the law. Yet the law was written in ways that, as is not uncommon, assured that power would remain in the hands of the colonial governors. This was achieved through the issuance of anti-witchcraft ordinances. He reviewed some of the texts of these as developed in the early part of the 20th century in places like Tanganyika (now Tanzania), Rhodesia (Zimbabwe) and Uganda.

Of course, as is too often the case, the application of the law was arbitrary and horrifically punitive. Virtually any practice of traditional healers could fall under the vague rubric of witchcraft.

On the up-side, few practitioners were actually prosecuted. Nearly all Africans were unable to access modern medicine before 1950 and thus some traditional healing practices persisted. Nonetheless, the focused persecution made such practices increasingly difficult, even in remote areas.

Some healers were very selectively targeted--largely because of their activities in endeavoring to heal the body politic. Indeed, the colony administrators and governors were quite clear about whom to prosecute. Those decisions being driven in part by the oppressive nature of the regimes which sought to mold the local populace into the European image, with little regard to the wisdom and insights the local peoples could provide.

One exquisite example of this was in the role traditional healers played in the environment. For example, trypanosomiasis (sleeping sickness) is caused by the tse-tse fly. An effective traditional healer would proscribe certain areas for cultivation or cattle grazing that were rife with the insects. Other only modestly infested areas would be used sparingly--which had the consequence of allowing cattle to develop immunity. Thus, they acted as healers for the very environment in which they lived.

Colonialists, directly or indirectly through driving the traditional healer practices underground, halted these practices. As a consequence, incidence of the disease expanded. Currently, according to a conference held by Doctors Without Borders on Neglected Diseases held March 14, 2002 in New York City, the disease afflicts 500,000 people and another 60 million are at risk in Africa.

Some colonists made attempts at providing modern biomedical facilities, clinics and hospitals to Africa. Primarily, this came from missionaries and other religious-based organizations that were also very hostile to non-christian practices. International government efforts were, to be kind about it, very modest and had virtually no penetration into rural areas.

Hindsight is 20-20, but even at the time, a little thought may have averted a great deal of trouble. As it was, the colonialists usually came to take lands from the locals by force. War ensued. These ghastly efforts were then often followed by famines. Diseases would spread. Under less horrific circumstances, the traditional healers would be called upon to heal the body politic. Normally, that would have meant a challenge to the local chief.

By the time the local chief was the colonial governor, such challenges were at risk of more dire consequences. One instance was the Maji Maji rebellion of 1905-07 in Tanzania. As a result of the upheavals caused by colonials, traditional healers began to intervene. Ultimately, the rebellion was violently suppressed, and two of the most important leaders were hanged at the end of the rebellion. While there is much to be lauded about the contributions African traditional healing can still make, there were certain aspects of magical thinking that do not necessarily translate into reality. One was the notion that a certain type of water washing the skin of rebel forces would protect them from enemy fire. Sadly, this effect was not realized in "field trials."

A similar tragedy occurred earlier in Zimbabwe in 1896, partly spurred by a rinderpest outbreak which killed 80% of the cattle. (Rinderpest is caused by a member of the Morbillivirus family.) Rebellions also occurred in what is today northern Rwanda and Uganda after similar outbreaks of rinderpest, 3 smallpox epidemics, one of jigger and five famines. The practice of praying to Yabingi by spirit healers soon was suppressed.

While praying to a fertility goddess may seem quaint to western thinking, it was rooted in certain practical realities. For example, in Malawi, the fertility of streams was under the jurisdiction of a good healer. If the healer saw that the stream was being over-fished and the supply diminishing, an edict would be issued to cease fishing in that stream. Once the fertility of the stream was restored, fishing would once again be allowed, It was in this and myriad other ways that the traditional healer was expected to heal both the body and the body politic. And indeed, even argue with the chief if they felt the policies were unwise.

[As an aside, I cannot help but draw parallels between these members of society and the effect of organizations like ACT UP has had in both the treatment of the individual and the recognition of the disease of the body politic.]

As a result, the "anti-witchcraft" laws were enacted. They were designed quite intentionally to enable governors to "maintain order," otherwise known as assuring that their power over local populations and wealth was secured.

It became so dangerous that most healers abandoned the trappings of their practice, including amulets, bags, hair locks and went underground. Another fascinating practice to which Dr. Feierman pointed was the practice of "cloning" of traditional healers.

Dr. Feierman cited the example of Ngoja bin Kimeta. In the 1920s, he was a practitioner of wide-reknown and greatly respected. He also challenged the local authorities. It was with the Maji Maji rebellion in mind that the threat of individuals like Ngoja to write anti-witchcraft laws in Dar es Salaam, Tanganyika and pass them in 1928.

But fascinatingly, it may be difficult to determine who did what as there were a number of healers who went by this name. Another case was a fellow named Ulilo [LAST NAME?]

However, another consequence of these draconian laws and the destruction of the network of healers was the difficulty in training new apprentices. As a result, many individuals with little experience could simply "hang out their shingle" and begin to practice. This was in stark contrast to pre-colonial training and apprenticeship. The graduation was for the young practitioner to go to another land (and recall that there were many languages spoken in Africa.) Travelling around, the healer would be engaged by local communities to offer his help. Eventually, it was to be hoped, he would return home. Successful practitioners were identified by the number of cattle (wealth) with which they returned and this served as a means to evaluate their worthiness. Today, no such means of separating the wheat from the chaff is at hand.

Yet with the burgeoning AIDS epidemic in Africa, many are returning to at least some of the old ways. (This, of course, is in part due to the interference by transnational pharmaceutical companies in preventing nations from acquiring generically-priced antiretrovirals. For more information on this aspect, please review some of the links below.)

As a result of this renewed interest, it may be that at least some aspects of the traditions may return. For example, there is increasing interest in botanical medicines. Such an interest may satisfy a more "scientifically" rooted rationale. It is an easier matter to assess the benefit, risks and limitations of a botanical intervention than one rooted in any spiritual belief.

Yet, ultimately, some of the benefits that traditional healers' roles would have held may yet be realized and the spirit that they embodied. For example, wise use of lands will allow better protection of both the environment. This is true both on a local and a global scale. A rationale will exist to sustain local ecosystems which in turn will preserve valuable botanical interventions, for example. "Fair trade" associations may develop to assure that the local wealth remains in local hands, particularly when a more international commercialization may arise. The needs of the people and the environment may return to a great consonance in a way that can heal the blundering and bloodshed of European colonization.

Dr. Zena Stein noted that in South Africa, traditional healers are being recruited to help in a number of ways. Directly observed therapy (DOTs) is a very successful way to assure that patients take a full course of medication to prevent the development of resistance. Routine PAP smears for women are important. In both cases, traditional healers have helped to facilitate access to these services for local population. In Uganda, the THETA program recruits traditional healers as purveyors of safer sex and other messages to help stem the spread of HIV disease.

As alluded to earlier, due to a lack of effective and available treatments for malaria, many will use local herbs. Others, in managing AIDS, will go from hospital to an herbalist to a spiritualist to a muslim healer and back again. Partly driven by what is affordable, the family becomes the local caretaker. And indeed, families and people living with HIV/AIDS are seeking to establish means of identifying which aspects of these interventions are most successful in helping people to survive and thrive. This is the example being set by groups of people with HIV/AIDS and their families in Tanzania.

Some websites:
AIDS and orphans
Asian Human Rights Commission
Consumer Project on Technology
Doctors Without Borders: at www.accessmed-msf.org or www.msf.org.
Fair Trade: What is it?
ICASO
World Policy Institute

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