Indigenous Ill-health Perception and Healing Practices: Socio- Cultural Study in North-Eastern Ethiopia
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Date
2017-06
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Addis Ababa University
Abstract
Introduction: When integrated with ‘modern’ medicine, well developed indigenous
medicinal knowledge and practices have the potential advantage of reducing
overcrowding of primary care services. However this aspect is not well studied in the
Ethiopian setting. Therefore, this study explored the indigenous medicinal beliefs and
practices used by communities in North Eastern Ethiopia in the management of health
problems in their homes using a conceptual framework adopted from Kleinman’s Cultural
Systems Model, the Murdock illness causation model, and the Padela God-centeric healing
model.
Methods: Ethnographic methods were used for this study. Participant observation was
supplemented by ten focus group discussions (FGDs) (n=96) and 20 in-depth interviews
conducted with the key informant community members. The analysis and interpretation
was informed by thematic and narratives strategies.
Findings: The findings indicated that the Tehuledere people’s worldview of health, health
problems and healing systems is closely linked to their day-to-day cultural lives. They had
widespread perceptions about causes of illness. They perceived that illnesses might be
caused by the wrath of God or gods, ‘qolle or quteb (spirit possessions); natural causes
(e.g., environmental sanitation and personal hygiene, poverty, biological such as organic
deterioration and accident and psychological factors such as stress) and societal causes
(e.g., social trust, experiences of family support and harmony; and violation of social
taboos). Therefore, the explanatory model of illness causation in this community was very
similar to that of the Murdock model with one key difference: social elements need to be
added to the model. The major factors associated with use of indigenous medicine
included: the perceived etiology of illnesses; the availability and acceptability of healthcare
services; the relationship between the health-care practitioners and the patients; socioeconomic
factors (cost of health care expenditure); and the influence of social networks
and/or social relationships. It was found that in Tehuledere pluralistic health-care
resources were used either independently or concurrently with biomedicine. The study
identified that religious and spiritual healing, bio-medicine, ‘folk’ or indigenous healing
systems, and popular or home-based medicine, were the major types of health-care options.
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Many of the Tehuledere people attribute illness to the wrath of supernatural forces. Thus,
healing is thought to be mitigated by divine assistance obtained through supplication and
rituals and through the healing interventions of nature spirit actors such as Woliy (Muslim
saints) and Kalicha (Muslim voodoo). Also seeking God/Allah/ and nature-spirit
forgiveness with ritual ‘Dua (Prayer), Tsebel/holy water/, ‘wodaja’ (harmonizing the spirit
to heal evil), ‘Chelle’/ goddess of fecundity/ were practiced for certain ailments such as
jinn and Buda. Moreover, Traditional health practitioners (kitel betash or herbalists,
‘awalaj’ or birth attendants and ‘wogesha’ or bone setters) were consulted for preventive,
protective and remedial care of the participants and their families. Instances of selfmedication
were also encountered in the participants. The participants apply home
remedies for prevention and remedial purposes. Treatment is meant for those apparent
ailments such as Nedad (malaria), Mich (acute febrile illness) and Gunfan (flu) and other
relatively common health problems. Otherwise the popular agents refer to the biomedical
experts if no progress was seen subsequent to treating with home remedies. The findings
further demonstrated that bridge of caring was built between the traditional healers and the
primary health service (i.e. the health posts) in the management of perceived common
ailments, such as yewof beshita (jaundice) and yelig tilat (herpes zoster) in the village.
Another bridge of care was also built between the health posts and the health center for the
management of the other health problems, such as HIV/ AIDS and tuberculosis, which the
study communities experience as critical incidents. The role of health extension workers
was very important for this integration. The increased accessibility in the modern health
care appears to have been both a blessing and curse to the area, as the indigenous
communities competed to find a place for their healing system within the new health
system. The findings also identified communication and attitudinal problems that exist
between the communities and modern health care providers.
Conclusion: The indigenous health care mechanisms of the study community address basic
elements of primary health care such as fostering self-care and self-reliance, community
participation and the use of indigenous medical practices for the maintenance of good
health. It is within this area that the study communities appear to express the greatest
concern related to the ‘natural’, ‘spiritual` and `societal` health of their homes and villages.
Since people in the study communities believe that spiritual , indigenous healer and home
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remedial healings are health care options among multiple health-care resources, successful
rural primary health care strategy would give due attention to such local resources. This
will help to ensure the optimal utilization of Ethiopia’s limited resources. This study
suggests that there should be a clear plan as to how indigenous medicinal practices can be
supported within a health care systems approach.
Key Words: Indigenous health knowledge, primary health care, Illnesses, health,
Religion, Spirit, home remedies, qualitative, Beliefs, Tehuledere, Ethiopia.
Description
Keywords
Indigenous health knowledge; Primary health care; Illnesses;Health, Religion, Spirit, home remedies, qualitative, Beliefs, Tehuledere