Archive | March 28, 2011

Traditional Medicine in Malawi

Herbal medicines

In Africa, western medicine often has to compete with it’s indigenous counterpart. Traditional herbalists have long offered medical services to the ill, treating a variety of physical ailments and offering help to the injured and sick. Some merely offer herbal services, but others offer assist in the treatment of spiritual illnesses. Diagnosis of disease however, is a holistic matter, where practitioners look into the spiritual nature of the patient to discover answers to the type of ailment and the strategy of treatment. If ones looks hard enough, one can find herbalists on the outskirts of public markets. Often though, they wait by the entrance to standard hospitals, offering there products to anyone who passes by. Where western medicine fails, herbalists readily provide.

Many readily discredit herbalists and traditional medicine, but its my view that the characterization of fraudsters and hacks are undeserved. Herbalists often come from a long blood line of traditional doctors, and recipes are handed down and modified from father to son. Both of the herbalists I spoke with indicated that they first learned their trades from their parents or relatives.

Herbalists in Malawi are licensed to practice by the Malawian government and their legitimacy formally preserved. The Malawi Medical Practitioners and Dentists Act of 1987 protects the rights of traditional healers and herbalists to practice their trades in Malawi, assuming that life is not threatened:

“Nothing contained in this act will be construed to prohibit or prevent the practice of any African system of therapeutics by such persons in Malawi, provided that nothing in this section shall be construed to authorize performance by a person practising any African system of therapeutics of any act which is dangerous to life.”

Herbalist outside Machinga Hospital

Medications are intended for a variety of conditions, a few of which I list here. These were the medications which appeared in the short video I shot below:

1. Kuthenta Mapadzi – Medication for aching joints and feet

2. Mauka – for pain in urination, likely due to urinary tract infections or sexually transmitted infections

3. Konjzela Mphamvu – an aphrodisiac and sexual enhancement medication

4. High blood pressure medication

Back pain

6. Burns on the hands or body

7. Any type of problems at all, it appears to be an aspirin like medication

8. Chibayo – for kidney problems

9. Kudya Kanzanza – medication for diarrhea

10. Eye problems

11. Njohka – for cases of intestinal worms

Herbalist license

Not surprisingly, most of these medications are for chronic conditions associated with aging. Medical service in Malawi, being as rudimentary as it is, likely cannot accommodate more serious chronic diseases. Thus, herbalists provide some level of relief for desperate patients. I asked the gentleman if he treats malaria, a disease readily treatable with western pharmaceuticals. He readily said no, that when patients come to him with malaria, he sends them to the local health facility. With the exception of basic pain killers and some anti-helminthic meds, none of his treatments were for commonly treatable conditions.

This is not to say that herbalist medications do not work. In fact, I am positive that at least some of them do. In contrast to more ambiguous forms of care, such as spiritual healing, traditional medicines cannot be completley ineffective. The ingredients in at least some of the medications are likely the same ingredients of more expensive factory produced meds. Studies of traditional medicines have been performed in the past, but it has only been recently that western practitioners have begun to take them seriously. The anit-helminthic and anti-diarrheal meds likely work to some level. I know that marijuana is commonly used throughout Malawi as a means of controlling nasuea during malaria episodes in adults. By probably no coincidence at all, traditional herbal meds to treat malaria in Tanzania contain cannabis.

Herbalist in Limbe Market

My conversations with both of these men revealed immensely proud and professional medical practitioners. Both of them readily and openly discussed their craft with me as clinicians and not as charlatans. Neither one attempted to sell me any type of medication. Perhaps if I had gone to one complaining of some physical ailment, one might have. As with western doctors, there is no sense in treating those who are not ill.

Interesting to me was the method of packaging and sales, which follows a western paradigm. Medications are packed at pills, given at particular dosages from clearly marked containers. While the methods of pharmaceautical creation and diagnostic strategies may be as they were before Colonialization, the practice has clearly been absorbed into a standard western paradigm of licenses and packaging. In my experience, most things in Africa, from medicine to music to religion, are a fascinating reinvented mix of indigenous and western, producing something new and old at the same time in contrast to merely adapting new ideas to sell to a local population. Malawians, while in some ways very conservative, are in other ways a very curious and inquisitive people, eager to explore and integrate new ideas into everyday life.

Below is a short video I made while conversing with an herbalist in the Limbe Market last month.

Movie of the Week: Congo in Four Acts (2009)

The Democratic Republic of Congo, despite having a fertile landmass the size of Western Europe and a trove of natural resources that dwarf giants like the United States, ranks as one of the poorest countries on the planet and has been the home of one of largest conflicts in human history. The DRC (formerly Zaire) rarely makes more than a passing mention in the Western press, an afterthought in a world of wealth which is indifferent to the plight of poor countries.

Congo in Four Acts” is a series of four short documentary features about the DRC, made by Congolese artists and writers. Teams traveled to the DRC in 2008 and provided training and support so that Congolese could express that which directly concerns the citizens of the DRC.

Western filmmakers will always see the problems of Sub-Saharan Africa through western eyes, a filter of amazement and disgust, informed by culturally entrenched attitudes and western modes of thought. The result often overlooks the very real concerns of the African citizens themselves, which are often much more immediate than the larger issues of weather conditions and international politics.

“Congo in Four Acts” takes the viewer through the devastation of the DRC health “system,” an unfunded series of health providers providing basic health care and maternity services. Patients must pay for services rendered or be confined to the hospital until someone can pay for them or collateral produced. “Ladies in Waiting,” directed by Dieudo Hamadi, follows the hospital staff as they attempt to extract payment from impoverished patients, many of whom are the spouses of civil servants whose salaries have not been paid for months. Even a woman who bore a child of rape is confined in the hospital until she can locate the man who raped her so that he can pay. It’s a heartbreaking picture of a bankrupted government and the failure of a fee-for-service system (a system promoted by the Western powers in Africa) where most people have no means of earning cash.

“Zero Tolerance,” also by Dieudo Hamadi, tells the story of victims of rape, an endemic problem in the DRC. For years, the DRC military and other militant groups have used rape as a weapon of war. Militant groups routinely recruited young boys as soldiers and acclimated them to a culture that viewed sex as a tool of power and military strength and women as mere objects to be had. “Zero Tolerance” follows two boys who gang raped an older woman and sexually mutilated her, their arrest and an interview with desperate parents hoping to spare their children the horrors of a DRC prison. Also featured, is an older man, who rapes and brutally beats a local woman, who later dies of her injuries. Telling is the inability of the perpetrators to recognize their crimes and extent to which they attempt to manipulate the power structure to discredit their victims and assure their innocence.

Kiripi Katembo Siku directs two features, one on the rotting infrastructure of Kinshasa and the other on women forced to work daily breaking rocks in the open sun for a mere $.25 a day. Kinshasa routinely floods during the rainy seasons, exposing underground power lines and dissolving ancient rubber wire encasements. Exposed wires traverse the landscape. Brave local residents daily repair exposed wires by hand, risking their lives in order to provide power to local merchants who depend on it for their livelihoods. Children play around hot wires laying in pools of water and local residents complain about the unwillingness of the local government to provide even basic services.

Poverty forces women to work in the rock quarries to support their children, as husbands have long ago left or died in warfare or of HIV. They are poorly paid, yet their labors keep the DRC elite wealthy through sales to Western mineral dealers. It could be said that the western powers encourage the desperation and chaos of the DRC. Chaos allows business to dictate the terms of mineral commerce in the DRC, minus the annoyance of a strong government which regulates prices and working conditions.

Hamadi and Siku goes where no western journalist could ever go. At first, I was unaware that the film was made by Congolese and kept wondering how the filmmakers were able to easily shoot on the street. It is often risky for a Westerner to even take a simple photograph in Africa, and even if one does take one, the stares of the surrounding people change the dynamic of the photograph itself. It becomes less a photograph of Africans, and more a photograph of Africans staring at wealthy white people. What was more impressive, was the level of access that Hamadi had to her subjects. It is clear from the film that her subjects feel comfortable opening up regarding their plights, hiding nothing in their heart wrenching stories of violence and pain. A western filmmaker could never get this level of honesty in interviews.

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