Dr. Lisa Esposito
Chair of Philosophy & Religion Department
Associate Professor of Philosophy & Religion
Phone: (417) 873-7229
Fax: (417) 873-7435
lesposit@drury.edu
Traditional vs. Western Medicine - African Context
Aone Mokaila, MacMurray College, 2001
In many parts of Africa, traditional healers are the most easily accessible health resource available to the community. In addition, they are most often the preferred option for the patients. For most of these people, traditional healers offer information, counseling and treatment to patients and their families in a personal manner as well as having an understanding of their client’s environment. Despite this, "traditional healers have rarely been included in key decision making, action agendas and community programs in HIV/AIDS prevention and care" (National Council for International Health). Does it make sense to ignore traditional healers when trying to tackle epidemics such as HIV/AIDS, one of the most critical global issues of our century? What are the fears and difference in opinion of Western medicine and traditional healers that create barriers to forming equitable working relationships? What needs to happen in order for Western Medicine and traditional healers to bring together their unique resources to solve problems such as HIV/AIDS prevention and care?The basic philosophic approach to disease is different for Western medicine and traditional medicine. Zimmerman, in his article "Western and Eastern Medicine Compared", explained "Western medicine is a sort of crisis intervention medicine, with its strength lying in its trauma care and therapies for acute problems." In contrast, in traditional medicine, there has been a long-standing viewpoint of wellness as "stability, using things around you, you mind, your body [and] your spirit" (Montaocean). According to Montaocean, co-director of the Center for Natural and Traditional Medicines, the traditional medical practitioner uses all of these in a systematic fashion to build a specific health system. Centering on meta-physical causes such as discontented gods or ancestors spirits and apparent disease, healers practice a holistic approach -- the ultimate goal being to reinstate the individual to a harmonious relationship with the social order (Outreach Services Newsletter). In this way, every aspect of an individual’s well being is taken into consideration and treated. Because of such an approach, traditional medicine is much broader because it includes recognizing disturbances in the environment outside the individual as being involved in the illness, whereas the Western concept strictly restricts the locality of the disease to the body of the individual. With regard to the Western medical systems, a different approach in treating the patient as well as the particular ailment is taken. Healing strategies are focused more on the individual and on a "more rigorous and scientific standard of understanding disease". In this way, the physical condition of the patient becomes the primary focus, with little or no consideration of the social and spiritual state of the patient (Outreach Services Newsletter). Because of such a difference in approach to medicine, both groups have difficulty in accepting the others' method. Therefore, there is a clash of methods and worldviews.
The history of medicine and health care in Africa has been a long and hectic one. Created by complicated social, political and economic processes, health care has come to take many forms. Africans "developed their own health and healing traditions, including ways of recognizing, classifying and treating disease and illness" (Outreach Services Newsletter). According to Dennis Ityavyar, author of "Health in Precolonial Africa", healers drew upon extensive knowledge of healing methods and materials, collected and passed down from one generation to another and based upon complex social, cultural and religious beliefs.
As Western missionaries and later colonial power began to proliferate on the African continent, so too did Western modes of dealing with disease and illness. In fact, Montaocean, a medical doctor in Tanzania states that because of this proliferation, "the knowledge of traditional medicine [had to be] preserved through much sacrifice". This was because when Western philosophy and science came to Africa, it came about through aggression and with the purpose of "stamping out the indigenous peoples’ thought and perception of medicine" (Montaocean). As a result, the fundamental role of the community, natural to the indigenous people's health and healing systems, was largely reduced. Because of this diminished role of the community especially in matters regarding healing systems, John M. Janzen describes the consequences it had on these indigenous medical practices in Africa especially in Zaire and states that, " the effect on concrete consultations was that diagnosing and divination with a prophet-seer was seen as conflict arousing, [and] thus dangerous. Open consideration of witchcraft was punishable". Because of such hostility and force imposed on the indigenous people's beliefs but the Western philosophy, it became inevitable that traditional healers would view Western medicine with some cynicism. Western philosophy came with the good intent of "helping" the indigenous people, but unfortunately, the indigenous people did not see it the same way.
Both Western medicine and traditional medicine make many claims about their side of the argument, but there are three values that clearly conflict. These two sides in the conflict value knowledge concerning nature, but their methods of obtaining this knowledge are in conflict. In Western thinking, nature is viewed as empirically knowable whereas in traditional thinking it is viewed as a mystery.
Western science, a method well renowned for its orderliness and control, uses empiricism as a basis for knowledge believing that observational experience is essential to understand the physical world. The fundamental idea behind empiricism is that knowledge can be derived through careful observation, classification of phenomena, and formulating laws and principles from these observations. Empiricism is knowledge derived through the senses. As John Locke proposed in his " Essay Concerning Human Understanding" it enables one to know and understand things around him or her. Locke stated that, "experience, [is what] all our knowledge is founded; and from that it is ultimately derived" (61). According to Locke, when humans were born, the mind was like a blank tablet or "tabula rasa", but as one grew, this tablet was furnished with information via the senses. This was to say, the script of this tablet was experience. It is this first hand experience that enabled humans to manipulate and understand the things around them better.
This concept of empiricism has enabled Western medicine to advance. Beginning with Hippocrates, who used observation and simple deduction, and Galen who dissected human cadavers, Western medicine used this early form of empiricism to better understand the anatomy and physiology of their bodies (Mayeaux). Through careful observations, systematic ways of cataloging facts and the testing of phenomena, humans' were able to understand things about themselves and the nature around them.
Another way of knowing nature in Western thinking is via rationalism. Rationalists had immense faith in the logical power of the human mind. To them, humans understood or just knew some things because they were so clear mathematically and logically and because of the manner in which they followed the laws of nature. For rationalists, nature was no longer viewed as abstract and incomprehensible. Rather, it was believed that nature functioned according to a set of laws and rules and that it never strayed away from these laws and rules. This made nature more predictable and therefore empirically knowable. Thomas Paine, a believer in the capacity of human knowledge and a strong advocate of the use of reason, believed that people should base their search for truth on the use of reason. Paine strongly emphasized reason as the only trustworthy source of knowledge and understanding: "take away reason, and [humans] would be incapable of understanding anything" (Paine 78). As a consequence of this reason and knowledge, Western medicine could be trusted because it could be tested and the results cataloged. Therefore, in Western medicine, doctors and researchers, in exploring the unknown, try to establish a cause and effect relationship between phenomena. In sum, according to Western medicine, reason has enabled humans to explain things more accurately and has enabled people to follow a cause and effect path when trying to explain the workings of nature.
In contrast to this smooth running machine-like and predictable Western notion about nature, there is the more mysterious and incomprehensible traditional view about nature. In this view, there is no systematic way of observing phenomena or any form of testing and as a result, traditional medicine is a "system of medicine based on cultural beliefs and practices handed down from generation to generation"(Covington). In fact, Oniang'o of the foundation of African Philosophy stated that "the African culture does not assume that reality can be perceived through reason alone. There are other modes of knowing such as imagination and intuitive experience and personal feelings. That is why the deepest expression of the African culture has been through art, myths and music, rather than through logical analysis" (Oniang'o). Therefore, in judging the cause disease or illness, traditional healers will first attempt to single out whom —not what -- is responsible for the disease. They often believe — but do not prove -- that the patient has been bewitched. Subsequently the traditional healer will then execute some sort of supernatural divination — not experiments -- to establish if the patient has gone against any pre-established order. If the patient has, then the patient has to seek ancestor’s pardon through sacrifice and rituals to appease the angry dead. Finally, the traditional healer will prescribe "muti", which is basically a secret concoction that may include human body parts. Now if the patient dies after taking this muti, it is believed that his or her death was due to ancestral anger. If improvement does not occur, it is assumed that the patient did not to take the muti in the proper kneeling position, or was maybe facing the wrong direction. Traditional practitioners use intuition and therefore, this medicine sometimes works, and other times it does not. Therefore, the "patient’s improvement or recovery after treatment might be incidental" (Covington). Because of such unpredictability, nothing follows a set of rule or laws in traditional medicine; it is all a matter of chance, which plays little or no role in the process of the scientific method. No one can ever be sure or definite about the out come of anything. Therefore, traditional medicine believes that nature is not empirically knowable. Because of this lack of empiricism in traditional medicine, the idea of using science to derive one’s truth is defeated.
A second argument on this issue pertains to the concept of progress and change. Western medicine believes in progress and change, while traditional medicine does not. Western medicine relies heavily on progress and change through the means of technology. This is because Western medicine is having to continuously come up with new drugs for the many different diseases. New technologies are needed to keep up with these diseases. In fact it is noted that because of the rapidly expanding technologies spawned by modern science, advances are occurring that were unimaginable a short time ago (for example, deciphering the human genetic code with computers). In fact, the World Health Organization (WHO) estimates that even though about 80% of the world’s people use traditional medicines as their primary health care, "almost all the funding and scientific attention go to the very expensive corporate or academic medicine form which the majority of the world is excluded" (James). With the explosion in research, and the rush to produce new breakthroughs, new drugs are continually flooding the market.
This commitment to change and bettering ourselves has been a long standing one, one that is also supported by Pico’s view on the potential of humans. For example, in his work "Oration on the Dignity of Man", Pico talks of the ability of humans. Pico believed in the potential of humans and stated that humans had the capability and freedom "to be whatever [they] will" (Pico 255). Isaac Newton was also strongly committed to progress. Newton had an amazing impact since he had offered ways that led one to obtaining indisputable proof, which was mathematical proof. He believed that nature had order and meaning, order and meaning that were not based on faith for he stated that, "we are certainly not to relinquish the evidence of experiments for the sake of dreams and vain fictions" (Newton 63). This order and meaning was based on human reason. Because of this idea, Newton had a solid belief in western intellectual tradition, especially with regards to the idea of human progress. He believed that human history was one of the progressive unfolding of human capacity for perfectibility. This is further reiterated by Newton's claim that "[we are not] furnished with that sufficiency of experiments which is required to an accurate determination and demonstration of the laws by which this electric and elastic spirit operates" (67). What Newton was basically saying was that through the use of experiments and mathematical equations, humans were potentially now empowered with the ability to know and understand everything. In this sense, Newton was calling on humans to strive to know the world through experimentation. In medical terms, the Western world is committed to this kind of progress and change because it is only through it that new drugs can be discovered. It is through this change that people are able to accumulate and pass on knowledge from generation to generation and apply it to produce new knowledge, new knowledge about medicine. Indeed Fontaine stated that the priority of intervention was opposing illness and this approach was evident in the many medications available.
The view of traditional people on progress and change contrasts with that of Western medicine. To them, the knowledge that they possess about their medicine is a complicated concept that reflects an even more complex set of social and spiritual factors that make up their culture. This knowledge refers to the "integrated expression of collective values and customs that guide interactions between people and nature" (Moralez-Gomez). Unlike the Western concept of nature that can be isolated and understood, Traditional healers could not isolate nature and study let alone manipulate and understand it as an entity. Nature was part and parcel of who indigenous people were. Therefore, it became imperative that information or knowledge that was known about nature was passed on untainted because it was a guide for the people. It was a way to inform them on how to live their lives as well as practice their medicine. Traditional people therefore went through great pains to preserve this information or knowledge. As Montaocean states, "what they preserved for their knowledge . . . they kept at a high price". This was because as stated earlier, when Western philosophy was first introduced, it came with the idea of stamping out these peoples' perception on medicine. Western philosophy wanted the indigenous people to change and progress but they could not because this idea of progress and change would mean that they would have to change their whole culture.
As a result, traditional people probably had to come up with simple ways of keeping this knowledge and passing it down to the next generation. These ways may have included such things as music, dance and stories. Indeed LaoTsu's idea of simplicity would support the traditional medicine view. Everything is kept simple so that it is easier to transfer to the next generation. Lao Tsu stated that one should "give up ingenuity, renounce profit . . to see simplicity" (19). Traditional medicine must remain unchanged for it to survive and this is in contrast to western medicine that is committed to change.
The third conflict on this matter relates to the issue of the value of life. Although both sides would tend to agree that life is valuable, their view on this value is different. In fact one would have to wonder how much at odds these two sides are. Traditional medical people have fought so hard to preserve their medicines in order to save lives. Why did they have to live under persecution in order to do so? Why has western medicine tried to impose its views about medicine on other cultures? Although this is not the place to analyze all attitudes about life, it is quite clear that these are difficult questions to answer.
Everyone has a right to live and that right must be respected. Everyone should be given the right to live, and one way of accomplishing this is by the elimination of disease or illness. One reason why life may be considered precious is in the way life and death is viewed. Western culture perceives life and death as two separate realities. For example, Rene Descartes in the 17th century stated that the mind and body were separate. Newton also spoke about separation. Newton’s view of the world and nature as operating in a linear and sequential form suggested a mechanistic view of nature and this view could also be used when dealing with the human body. The body could be viewed as a series of body parts. This was a kind of reductionist approach in which a person was reduced from a system to just a few cells. Hence, the human body could be viewed as a machine, and disease as the culprit that prevented the machine from working smoothly. Doctors were in turn trained to fix or repair broken parts through the use of drugs, surgery or even replacement of body parts. Because of such a belief, the "approach [to healing] is aggressive and militant, with physicians being in war against disease"(Fontaine). Consequently, because of such an approach to disease, Western medicine perceived humans as individuals who interacted with nature, and science as the tool they used to manipulate nature. All this really meant was that humans used science to manipulate nature in order to combat any disruption in the order of things. Humans used science within the medical field to combat disease and thus prevent death.
In contrast, from a traditional medical standpoint, death is seen as part of the harmony of nature. In African culture, death is not seen as the destruction of a person, but merely "a passing away into another state of existence (Oniang’o). It is a cruel and painful parting, but a necessary one. From the African perspective, "man and nature are not two independent realities, but an inseparable continuum of a hierarchical order by making the visible world continuous with the invisible world" (Oniang’o). Therefore, because of these two conflicting beliefs, the approach to saving life would be different. Western medicine would see death as an obstruction to living a long life and therefore use "surgical procedures and drugs to rid the body of sickness" which was the cause of death (Outreach Service Newsletter). In contrast, Traditional medicine would prescribe herbal remedies "for equalizing unbalanced relationships within the social or spiritual order" (Outreach Service Newsletter).
On April 10, 2000, a regional task force on traditional medicine and AIDS in east and southern Africa was inaugurated in Uganda. This task force was set up to "coordinate activity related to the widespread use of traditional medicine by people with HIV/AIDS and the role of traditional healers in the prevention of HIV/AIDS" (Bodeker). The reason for this task force was to try to promote alliance between traditional healers and western practitioners in the fight against AIDS. The task force believed that "the widespread use of traditional medicine was in a real sense carrying the burden of clinical care for the AIDS epidemic in Africa" (Bodeker). Why was this the case? Why does it seem that there are people out there trying to bridge this wide gap, but the gap still continues to grow larger?
There are two basic reasons patients continue to choose traditional healers. First, for traditional societies, culture puts a large divide between Western science and traditional medicine. Traditional medicine lacks of scientific mentality and training, with traditional healers believing that "ill health and misfortune are more often based on social factors than on epidemiology." In contrast, Western medicine believes that success or cure "should be based on clinical success". (Bodeker). Another reason supporting this continued use of traditional healers is that the traditional people, when in need, believe that the healers are dealing with their misfortunes within a shared pattern of understanding. In the Western world, doctors hope that their patients will trust them just because they are doctors. The second reason for the continued use of traditional healers is that traditional healers are participants in the culture. Traditional healers can be found almost everywhere at any time. They do not have working hours and their services can be sought out on a Sunday, holidays and in the evenings. In addition, payment for traditional healers often occurs after treatment and depends much on the results, whereas in Western medicine, payment is due before the patient has judged its results.
All these reasons are sufficient to convince one why people often choose to go to traditional healers, but there are also good reasons why people should go to Western doctors. For example, Western hospitals are often funded, fully staffed, and provide a personal service to the patient. The doctors are also fully trained and understand exactly what they are doing and why. This is to say that the doctors have undergone professional training and have received licensing authorizing them to treat patients. Most, if not all traditional healers, have not received any form of professional training or licensing. Unlike the traditional way of doing things, in Western hospitals there is proper documentation and a standardized or a regulatory mechanism of doing things. There is also a wide range of drugs that can be used if one drug fails to do its job. (Bodeker).
Coming from Africa myself, I believe that no one way is the best. Both sides have their merits, but I see no room for cooperative effort. As long as Western medical practices are considered the "standard cure", it will be very hard for traditional medicine to become recognized. In fact, one could infer that because they [traditional medicine] differ from the "standard of care", the traditional practices and practitioners are incompetent. It therefore becomes important that the communication gap between the two groups is bridged, but, as stated by Engela Pretorius, "there is still a long, difficult road ahead". It is also interesting to read Covington’s article that mentioned that "much of the pharmacology of scientific medicine was derived from the herbal lore". He goes on further to explain that in fact, "one fourth of the prescription drugs used today are of herbal origin". Therefore, it becomes clear that although people might think that these two forms of medicine are incompatible, they really are not.
There is little realistic hope for cooperation even though some doctors are reaching out to traditional healers. Ruben Mowszowski reports that, "scientists have struck up a 50-50 deal with traditional healer [in South Africa] to test local herbal cures in the laboratory". According to Mowszowski, a collaborative organization, which calls itself the South African Traditional Medicines Research Group, has spoken to various traditional healers’ organizations with the intention to receive any information on plants that they believe might be effectual against some illnesses. Although this seems as a good idea, there is still distrust. Traditional healers "fear that their remedies will be expropriated and land up under the label of a multinational pharmaceutical company" (Matabisa). While the traditional doctors' fears may be warranted, Sonia, a character in Mindwalk argues that the world is interconnected and that we all need each other. In spite of this view, she recognizes that Western science, which is the foundation of western medicine, encourages intervention and not prevention. As an example, Sonia uses Francis Bacon’s claim that scientists had to torture nature in order to get out her secrets. This is in contrast to traditional people who would probably claim that their culture, which is also a part of their medicine, prevents any violence to the environment. This is a complex issue and one cannot hope to resolve it easily.
In addition to distrust, there is also a certain amount of pride at work here. During the past summer, I attended a seminar in my country Botswana. The idea behind this seminar was to try to get traditional and Western doctors talking with the goal of reaching some middle ground. Throughout the whole seminar, I sensed that traditional doctors felt that the western doctors were only now coming to them because these doctors had run into a wall. These traditional doctors made it seem as if the western doctors wanted to steal their excellent medicines because their western medicine was not working. At the end of this three-day seminar, nothing was accomplished. The traditional doctors refused to cooperate and the western doctors ran out of reasons to convince them that they were not trying to steal their medicine.
It is really hard for me to pick sides in this issue, but I feel that Western society's understanding of traditional medicine still has far to go to master the deeply rooted values beneath the culture. Too often, traditional culture is perceived as an early form of science. In fact, when strictly perceived in a time line dimension, traditional medicine becomes a collection of facts and practices frozen in the past. Its significance in the modern world becomes reduced to an effort to bring clusters of information forward to resolve diverse problems of the present (Moralez-Gomez). Rather than addressing traditional medicine with curiosity, it should be approached as a source of learning.
On the other hand, having grown up in a culture heavily influenced by Western practices, I also feel that Western medicine is also viewed with some degree of curiosity by traditional healers. They don’t understand it and, rather than trying to understand it, they totally disregard it. They view it as a modern day, instant solution. I personally feel that in such a matter, the choice should be left up to the individual. This past summer, while working in Botswana with cancer patients and patients with full blown AIDS, I encountered a young woman with advanced breast cancer who was struggling between the care of a traditional healer and surgery provided by a Western-style oncologist. She changed her mind several times, ultimately rejecting the recommended mastectomy in favor of the more familiar traditional care. Although I felt personally saddened when she left our clinic, I support her right to make that decision. In other words, as this example demonstrated to me, if one chooses to go to a traditional healer, let them go, and on the other hand, if one chooses to go to a Western doctor, let them go. I feel that it is sad that many Western skeptics accuse traditional medicine of fraud and quackery, and that the traditional healers accuse Western doctors of being profit driven and cold. Indeed there might be some truth on both these positions, but my feelings are that at the end of the day, the doctors and the healers are good people trying to offer safe and effective services. The question that still remains unanswered is that if the professionals on both sides cannot get along, how can we expect the patients to be cooperative?
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