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In Ghana, conflict and complementarity.

In Ghana, Conflict and Complementarity

A people's approach to health care is based on their understanding of human being, life, and consequently health.[1] In Ghana, as well as other non-Western nations, the interplay of traditional modes of health care and imported "Western" medicine creates tensions for the allocation and utilization of health care resources. In a climate of increasingly scarce medical resources and cultural transition, how are these tensions to be resolved? Searching out the ways in which the indigenous and Western medical systems can complement one another offers some hope.

Life, Being, and Health In indigenous Ghanaian society, being is understood basically as "force." Thus human being is the immediate manifestation of spiritual force or power (God and the spirits being the ultimate sources). Human being manifests the power of both male (ntoro) and female (mogya) spirits--being brave and fierce, generative and peaceful, respectively. These male and female spirits are in fact dimensions of God. Thus, God is the ultimate source of all powers of good because they are dimensions of His being, while human being is the vehicle through which the divine manifests Himself in the universe. Accordingly, an offense against a fellow human being is regarded ultimately as an offence against his or her spirit, which requires pacification.

Ghanaians see life as a total integrated, contemporaneous experience of existence in all dimensions--spiritual and physical, social and personal. Physical being is simply the physical manifestation of the spiritual force that a human being fundamentally is--a mystery even to him or herself. As L. Senghor notes: an extension of the

image of God, and at the centre

of created forces, lives in a

community of a psycho-physical world

whose solidarity and morality are

upheld by the powers around

him that rule the entire universe.

This concept tends to enlarge the

sense of community to overstep

the social boundaries of a clan or

tribe or even nation.[2]

The individual is linked both to the material world, and through the ntoro, mogya, and their union in the person's okra ("spirit" or "temperament"), to the world of the spirit. These not only make it possible for a person to enter this world, but also guide him or her throughout life until he or she returns to the world of the spirit in death and becomes an ancestor for his or her descendants. Deviant behavior is subject to sanctions from the spiritual world, including ill-health.[3]

Thus the physical state of the individual is the external manifestation of his or her spiritual-moral state. Illness is an indication of a bad spiritual-moral state, the result of moral fault of the sufferer or someone related to him or her in various ways. Unless the culprit confesses, pays for expiatory or reconciliatory ritual, and makes amends, the performance of an evil act sets in motion a progressive deterioration of the well-being of the individual and society, leading to disaster--even death--as an automatic and inescapable punishment.

Certain evil acts are believed to have their corresponding types of disease. For instance, incest or adultery results in adzim, disease generally connected with all types of chest troubles and frequent coughing. The culprit is not punished by God or man; rather adzim follows directly from the individual's wrongdoing itself.[4] To restore a person's health, his or her spiritual-moral integrity must be restored by confession and rituals.

This conception of health also reflects an understanding of the individual as truly human only as an integral member of the community--the mystical union of spirits, ancestors, and the living. Good health, then, is well-being as a result of personal and communal integrity.[5] Illness, correlatively, threatens not only the individual, but also the community's solidarity and security. Therefore, every effort must be made to discover the cause of the individual's suffering, often through divination, to forestall disaster for the community.

Indeed, some evil acts are believed to cause epidemics. Murder, rape, abortion, or laughing at those suffering from contagious diseases, for instance, are believed to desecrate the sacredness of life, causing general infertility of nature and thus starvation and related outbreaks of disease. The whole community must be ritually cleansed to avert such disaster.[6]

Agents of Indigenous Health Care The agents of traditional health care in Ghana are the members of the community themselves. They are responsible for promoting and preserving the life of the individual and the survival of the community through their various roles--the guardian spirits as spiritual protectors, the ancestors as guarantors of the survival of their lineages, living lineage heads at all levels of the household, family, clan, and tribe as immediate guardians of their respective lineage units. Others function more specifically in the service of health--diviners who reveal the causes of illness, cultic officials who perform healing rituals, and medicine men who are the actual practitioners responsible for treating illnesses by traditional methods. Mbiti has described the role of the last of these:

[T]he medicine man applies both

physical and "spiritual" (or

psychological) treatment, which

assures the sufferer that all is and

will be well. The medicine man is

in effect both doctor and pastor

to the sick person. His medicines

are made from plants, herbs,

powders, bones, seeds, roots,

juices, leaves, liquids, minerals,

charcoal and the like. And in dealing

with a patient he may apply

massages, needles or thorns, and he

may bleed the patient; he may

jump over the patient, he may use

incantations and ventriloquism,

and he may ask the patient to

perform various things like

sacrificing a chiken or goat,

observing some taboos or avoiding

certain foods and persons....[7]

Religious rituals are used as a means of cleansing, healing, and reconciling the individual with the community and the neighbor who might have been offended. Exorcism is practiced to drive away evil spirits believed to be the probable causes of ailments. And herbs or other substances with natural healing properties are used in treatment. But probably the most important source of healing is the concern, care, and solidarity of the other members of the community.[8] For example, the family head pools all available resources for the cure, and others visit to reconcile, encourage, to massage or bathe the patient, or to clean clothes and the house.

Aspects of Modern Health Care in Ghana Into this context have come Western technological medical practices that draw on very different concepts of health. Based on natural rather than religio-moral causation, modern health care systems seek to diagnose and cure ill-health "scientifically" using the technology available in well-equipped institutions.

In general, people seek care at modern facilities, both private and public. Relatively well-equipped regional and district hospitals serve the urban population, while health centers and health posts, along with facilities associated with religious and other non-governmental bodies, provide primary health care in rural areas. Mobile teams of doctors, midwives, and (community) nurses supplement these localized facilities.

Nonetheless, many continue to rely on traditional treatment as well. This is particularly the case when an illness has been diagnosed as psychosomatic or when patients perceive the scientific treatment they receive to be "inadequate."[9] And, of course, those who lack the financial means or who must travel great distances--or over rough terrain--to avail themselves of modern care turn to traditional practitioners.

Conflicts Between Traditional and Modern Medicine Where traditional health care is an integral aspect of Ghanaian culture, modern medicine tends to introduce elements that do not conform to the cultural life of the people. Thus, whereas the focus of indigenous health care is on the person as a whole, the increasing specialization of modern health care systems tends to disintegrate the person, resulting in a "conveyor belt" system of health care delivery. Often, the possibilities of referrals seem virtually unlimited.[10] And whereas traditional care treats the patient in the context of his or her social relations, modern medicine tends to view the patient as an individual, or even as just another "case" on which to try a new technique.[11]

This may result in conflicts, as when modern medical treatment ignores the religious dimension. After "scientific treatment" a patient may return home unsatisfied, unconvinced, and therefore not fully healed until the religious aspect of his or her illness is addressed in sacrifice or ritual.[12]

When a modern health care unit declares a particular illness beyond any hope of cure, this may be interpreted as advice to seek traditional treatment. Thus one physician reported restoring a patient's health with traditional herbal treatment after hospital treatment for his paralysis had failed. So also, where scientific medicine only suppresses hypertension, traditional herbs seem actually to cure it.[13]

At other times, it is also true that families delay seeking treatment at a modern facility and continue visiting one shrine after another until the patient's condition deteriorates beyond remedy before he or she is rushed to the hospital.

Lastly, indigenous health resources, both human and material, are found where people live, and care can be provided at minimal cost. But modern medical care depends on personnel trained in expensive institutions--whether in Ghana's major cities or abroad--and on increasingly expensive means. Sophisticated equipment, for the most part, must be imported (or produced by imported machinery). Since the tools and amenities these physicians are accustomed to are not readily available, especially outside the cities, many prefer not to work in rural areas.

Pragmatics of Allocation In the face of increasingly scarce medical resources, the greatest challenge is to help people exploit the positive elements of indigenous health resources. There is, for example, need for serious research into indigenous methods of diagnosis and treatment of disease, not only by institutions of health science, but by all organizations involved in health care. For instance, it would be useful for those trained in Western medicine to learn how medicine men combine both physiological and religious-moral diagnosis to effect holistic treatment.

This is being done in some research centers in Ghana.[14] Privately, Dr. G.K. Noamesi heads a laboratory researching medicinal plants and plant medicines. In addition to scientific clinical diagnosis, Dr. Noamesi treats patients with plant medicines and often questions them about their relationships to help identify and correct stressful situations underlying such conditions as hypertension.[15] Publicly, the government-sponsored Centre for Scientific Research into Plant Medicine in Mampong-Akwapim conducts research toward improving herbal medicine in cooperation with traditional healers. Equally important, the Centre promotes better understanding of traditional medicine, and maintains production facilities and a dispensary.

Apart from studying the medicinal properties of materials used in traditional medicine, it is also important to rediscover the rich nutritional properties of native plants that are now being replaced by imported food.[16] Quite aside from the actual medicinal benefits of some traditional foods, efforts to improve general nutritional standards are an important aspect of preventive health care.

Experts also suggest that we must find ways to bring the community, the family, and other relations into the health care system as a support system for institutionalized treatment.[17] This would help create a loving, caring environment and allow the community to share in, and facilitate, the process of healing in a holistic way. This rediscovery of the positive elements of the indigenous link between treatment of the sick and social relations would also cut down costs. Nursing a relative at home, for example, would not only reduce costs of hospital care, but constant companionship would also prevent recurrent loneliness, depression, etc., and thus accelerate the healing process.

And since medicine is now coming to be appreciated as an integral element of peoples' cultural expressions in Ghana as elsewhere,[18] there is a need for gradual integration of traditional medicine men into the modern health system. They should be accorded professional standing, to preserve the cultural heritage of the art of indigenous medicine. As Mbiti notes,

Whatever abuses may be

apparent in [their] would

be extremely unjust to condemn

their profession [as] friends,

pastors, psychiatrists, and doctors of

traditional African villages and


Both traditional and modern (scientifically trained) physicians must build a trusting relationship with each other through humble dialogue and learning from one another. References [1]What follows is not exclusive to indigenous Ghanaian or African culture; the cultural history of all peoples would reveal similar beliefs and concepts. See, for example, David Landy, ed., Culture, Disease and Healing (New York: Macmillan, 1977); Lynn Payer, Medicine and Culture (New York: H. Holt & Co., 1988). [2]Quoted by Patrick Akoi, Religion in African Social Heritage (Rome: Urban University, 1970), at pp. 48-49; see also Edward Fashole-Lukes et al., eds., Christianity in Independent Africa (London: Rex Collings, 1978), 399. [3]P.A. Twumasi, Medical Systems in Ghana: A Study in Medical Sociology (Tema: Ghana Publishing, 1975), 22-23. [4]Noah Dzobo, Modes of Traditional Moral Education Among Anfoe-Ewes (Cape Coast: University of Cape Coast, 1971); Peter Sarpong, "Culture and Education," The Standard, 26 November 1978, 5-6. [5]Akoi, Religion, at 48. [6]Noah Dzobo, "Moral Behavior in Marriage among the Anfoe-Ewes of Ghana and Togo," unpublished paper presented at the University of Cape Coast, Cape Coast, Ghana, 1972. [7]John Mbiti, African Religions and Philosophy (London: Heinemann Educational Books, 1969), 169-70; see also Kofi Appiah-Kubi, Man Cures, God Heals: Religion and Medical Practice Among the Akans of Ghana (Totowa, NJ: Rowman & Littlefield, 1981). [8]Twumasi, Medical Systems. [9]Twumasi, Medical Systems, 84-88, 119-24; and Twumasi, ed., Survey Report: Catholic Health Services in Ghana, January-April 1982 (Accra: National Catholic Secretariat, Department of Health, 1982), 6-245. [10]See Peter Conrad, "The Experience of Illness: Recent and New Directions," Research in the Sociology of Health Care 6 (1987), 3-17. [11]See Benedict M. Ashley and Kevin O'Rourke, Ethics of Health Care (St. Louis: Catholic Health Association, 1986), 40-42. [12]See P.A. Twumasi, "Scientific Medicine: The Ghanaian Experience," Ghana Journal of Sociology 6:2 (1970), 63-64, and 7:1 (1971), 76-77; Twumasi, Medical Systems 106-110, 120-24. [13]For case studies see E. Evans-Anfom, Traditional Medicine in Ghana: Practice, Problems, and Prospects, The J.B. Danguah Memorial Lectures, Seventh Series, February 1984 (Accra: Academy of Arts and Sciences, 1986), 24-25. [14]See Council for Scientific and Industrial Research, Medical Research Centres in Ghana, Current Research Projects (Accra: Council for Scientific and Industrial Research, 1973). [15]Personal communication. [16]B.N. Okigbo, "Broadening the Food Base in Africa: The Potential of Traditional Food Plants," Food and Nutrition 12:1 (1986), 4-17. [17]Conrad, "The Experience of Illness." [18]Landy, Culture, Disease and Healing; Payer, Medicine and Culture. [19]Mbiti, African Religions, 170. Jacob Hevi is a lecturer in moral theology at St. Peter's Regional Seminary, Cape Coast, Ghana.
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Title Annotation:health care in Ghana
Author:Hevi, Jacob
Publication:The Hastings Center Report
Date:Jul 1, 1989
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