report internship 2 jan willem knibbe 1473735

The opinion of traditional healers in Ethiopia towards cosmopolitan medicine

Jan Willem Knibbe

1473735

Supervisors

External

Prof. Damen Haile Mariam, PhD; College of Health Sciences, Addis Ababa University

Henk van den Heuvel, PhD; Centre of International Cooperation, VU University Amsterdam

Internal

Fiona Budge, MSc; Athena Institute, Faculty of Earth and Life Sciences, VU University Amsterdam

Barbara Regeer, PhD; Athena Institute, Faculty of Earth and Life Sciences, VU University Amsterdam

Internship 2 (30 ECTS) at College of Health Sciences, Addis Ababa, Ethiopia

VU University Amsterdam, Facultity of Earth and Life Sciences, Management, Policy Analysis and

Entrepreneurship in the Health and Life Sciences

Amsterdam, May 2012

Table of Contents

2

Table of Contents

Table of Contents ............................................................................................................................................................... 2

Summary ............................................................................................................................................................................... 7

1 Introduction ................................................................................................................................................................ 8

1.1 Problem definition ............................................................................................................................................ 8

1.2 Traditional healing in Ethiopia ....................................................................................................................... 8

1.3 Objective of the research .............................................................................................................................. 10

1.4 Central research question .............................................................................................................................. 10

2 Conceptual framework ............................................................................................................................................ 12

2.1 Social Learning Theory .................................................................................................................................. 12

2.2 Actant-Network Theory ................................................................................................................................ 14

2.3 Concepts .......................................................................................................................................................... 15

2.3.1 Beliefs about diseases ................................................................................................................................ 16

2.3.2 Practices ....................................................................................................................................................... 16

2.3.3 Curing .......................................................................................................................................................... 16

2.3.4 Social status ................................................................................................................................................. 16

2.3.5 Benefits ........................................................................................................................................................ 17

2.3.6 Patients......................................................................................................................................................... 17

2.3.7 Knowledge of cosmopolitan medicine ................................................................................................... 17

2.3.8 Payment ....................................................................................................................................................... 17

2.4 Sub questions .................................................................................................................................................. 18

3 Methodology ............................................................................................................................................................. 20

3.1 Analysis............................................................................................................................................................. 21

3.2 Interviewees ..................................................................................................................................................... 22

4 Results ........................................................................................................................................................................ 24

4.1 Beliefs about diseases ..................................................................................................................................... 24

Table of Contents

3

4.2 Practices ........................................................................................................................................................... 24

4.3 Curing ............................................................................................................................................................... 25

4.4 Social status...................................................................................................................................................... 25

4.5 Benefits ............................................................................................................................................................. 26

4.6 Patients ............................................................................................................................................................. 26

4.7 Knowledge of cosmopolitan medicine ....................................................................................................... 27

4.8 Payment ............................................................................................................................................................ 27

5 Discussion ................................................................................................................................................................. 29

5.1 Results .............................................................................................................................................................. 29

5.1.1 Groups ......................................................................................................................................................... 29

5.1.2 Actions ......................................................................................................................................................... 29

5.1.3 Objects ......................................................................................................................................................... 30

5.1.4 Facts ............................................................................................................................................................. 30

5.2 Location healers .............................................................................................................................................. 30

5.2.1 Layout .......................................................................................................................................................... 31

5.2.2 Objects ......................................................................................................................................................... 31

5.2.3 People........................................................................................................................................................... 31

5.3 Limitations of the study ................................................................................................................................. 32

5.4 Further research .............................................................................................................................................. 32

6 Conclusions............................................................................................................................................................... 34

7 References ................................................................................................................................................................. 35

Appendix I Interview design ........................................................................................................................................... 38

Personal information ................................................................................................................................................... 38

Illness & curing ............................................................................................................................................................. 38

Patients ........................................................................................................................................................................... 38

Social status ................................................................................................................................................................... 39

Payment ......................................................................................................................................................................... 39

Table of Contents

4

Knowledge ..................................................................................................................................................................... 39

Benefits .......................................................................................................................................................................... 39

Appendix II Interviewees ................................................................................................................................................ 40

Appendix III Interview transcripts ................................................................................................................................ 41

Interview 1 ..................................................................................................................................................................... 41

Interview 2 ..................................................................................................................................................................... 44

Interview 3 ..................................................................................................................................................................... 46

Interview 4 ..................................................................................................................................................................... 50

Interview 5 ..................................................................................................................................................................... 53

Interview 6 ..................................................................................................................................................................... 55

Interview 7 ..................................................................................................................................................................... 56

Interview 8 ..................................................................................................................................................................... 58

Interview 9 ..................................................................................................................................................................... 60

Interview 10 ................................................................................................................................................................... 62

Appendix IV Analysis ...................................................................................................................................................... 64

Beliefs about diseases ................................................................................................................................................... 64

Practices ......................................................................................................................................................................... 65

Curing ............................................................................................................................................................................. 67

Social status ................................................................................................................................................................... 69

Benefits .......................................................................................................................................................................... 69

Patients ........................................................................................................................................................................... 72

Knowledge of cosmopolitan medicine ..................................................................................................................... 74

Payment ......................................................................................................................................................................... 78

Appendix V Article ........................................................................................................................................................... 80

Summary ............................................................................................................................................................................. 80

Introduction ....................................................................................................................................................................... 81

Traditional healing in Ethiopia ................................................................................................................................... 81

Table of Contents

5

Methodology ...................................................................................................................................................................... 83

Conceptual framework ................................................................................................................................................ 83

Beliefs about diseases .............................................................................................................................................. 84

Practices ..................................................................................................................................................................... 84

Curing ........................................................................................................................................................................ 84

Social status ............................................................................................................................................................... 84

Benefits ...................................................................................................................................................................... 85

Patients ...................................................................................................................................................................... 85

Knowledge of cosmopolitan medicine ................................................................................................................. 85

Payment ..................................................................................................................................................................... 85

Sub questions ................................................................................................................................................................ 86

Interviews ...................................................................................................................................................................... 86

Analysis .......................................................................................................................................................................... 88

Results ................................................................................................................................................................................. 89

Beliefs about diseases ................................................................................................................................................... 89

Practices ......................................................................................................................................................................... 89

Social status ................................................................................................................................................................... 90

Benefits .......................................................................................................................................................................... 90

Patients ........................................................................................................................................................................... 90

Knowledge of cosmopolitan medicine ..................................................................................................................... 91

Payment ......................................................................................................................................................................... 91

Discussion .......................................................................................................................................................................... 92

Results ............................................................................................................................................................................ 92

Groups ....................................................................................................................................................................... 92

Actions ....................................................................................................................................................................... 92

Objects ....................................................................................................................................................................... 93

Facts ........................................................................................................................................................................... 93

6

Location healers ............................................................................................................................................................ 93

Layout ........................................................................................................................................................................ 94

Objects ....................................................................................................................................................................... 94

People ........................................................................................................................................................................ 94

Limitations of the study .............................................................................................................................................. 95

Further research ............................................................................................................................................................ 95

Conclusions ........................................................................................................................................................................ 97

References .......................................................................................................................................................................... 98

Interviewees ..................................................................................................................................................................... 101

Summary

7

Summary

This research investigates the opinions and beliefs towards cosmopolitan health care of traditional herbalist

healers in Ethiopia. A theoretical framework based on Social Learning Theory and Actor-Network Theory is

used to derive the eight concepts that are investigated in this research.

To investigate these eight concepts, ten traditional herbalist healers were interviewed, using semi-structured

interviews with the aid of translator. The interviewed healers all lived and worked in the Addis Ababa area. Five

of them were Ethiopian Orthodox, and the other five were Muslims; their ages varied between 28 and 95.

The main finding is that traditional healers are, in principle, positive towards more cooperation with

cosmopolitan health care. They see a great benefit in treatments they cannot deliver, such as operations or in-

patient care. However, differences are seen in the way medicines are prepared. The interviewees stated the

importance of using fresh ingredients, which is not case with medicines used in cosmopolitan care.

The most important hampering factor in cooperation with cosmopolitan care is the perception of traditional

healers that there is a lack of respect and recognition of their role. Cooperation between cosmopolitan and

traditional health care should be a two-way interaction.

Introduction

8

1 Introduction

This chapter introduces the subject of the research. First the problem will be defined, followed by a short

literature review of the various practices of traditional health care in Ethiopia. Finally, the objective of the

research is stated and the central research question is formulated.

1.1 Problem definition

About 80% of the population in Ethiopia uses traditional medicine (Kassaye, Amberbir, Getachew, &

Mussema, 2007). Therefore, the Ethiopian government has formulated in its health policy, the desire to have a

cooperation between modern Cosmopolitan medicine and traditional healing (Ethiopian Health Policy, 2009).

Understanding the beliefs of the traditional healers towards modern cosmopolitan healthcare, in order to find

common grounds for cooperation between these two health systems, will make an important contribution

towards the process of realizing the policy objectives.

1.2 Traditional healing in Ethiopia

This section gives a short overview of the practices of various traditional healers that can be found in Ethiopia.

It should be stressed that Ethiopia is an ethnic and culturally diverse country (Abbink, 2006; Bishaw, 1991).

This section will focus on the most common traditional health systems as they are practiced in Ethiopia (Bishaw,

1991; Kloos, 1998; Young, 1976), which includes professionals that were interviewed for this research.

The definition of traditional medicine as used by the WHO is “the sum total of the knowledge, skills and

practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or

not, used in the maintenance of health, as well as in the prevention, diagnosis, improvement or treatment of

physical and mental illnesses” (Zhang, 2000).

Cosmopolitan medicine is understood to be health care that is delivered by hospitals and medical clinics, based

on a biomedical approach that has originated from a Western perspective (Taylor & Leslie, 1973). People who

practice this kind of health care should have a formal training in a medical faculty of a university or health

college. Synonyms often used for this health system include Western, scientific or modern healthcare.

This research only focuses on traditional healers working in Addis Ababa. Therefore for the purpose of this

research, a traditional healer will be defined as someone who lives in Addis Ababa, works with herbal

treatments, and who has not received any formal training from the cosmopolitan health system. Nevertheless,

there are many types of traditional healers that operate within Ethiopia. These will be explained in this literature

section, to give an impression of the various types of health systems that exist.

Traditional healing has a long tradition in Ethiopia (Slikkerveer, 1982). The practices are as diverse as the various

cultures within Ethiopia (Bishaw, 1991; Kassaye et al., 2007). For this research, the focus will be on the

Introduction

9

traditional healers in Addis Ababa, where the traditional healing methods are strongly influenced by the

Ethiopian Orthodox Church (Slikkerveer, 1982). Health is seen as a gift from God, and religion plays an

important role in order to stay healthy (Bishaw, 1991; Kassaye et al., 2007). Furthermore, health is seen as a

state of equilibrium within the body and between the body and the environment (Bishaw, 1991). Some

comparisons with the cosmopolitan biomedical approach are possible. For example, it is believed that ill making

spirits live in unhygienic places that should be avoided (Bishaw, 1991). Nevertheless, the link with biomedical

tradition is not made explicit.

Traditional medicine in Ethiopia is generally practiced by members of the elite groups of the dabtara, the

Orthodox Christian literate healer; the meshaf-gelach, the Orthodox astrologer; the Zar doctor, the mystic spiritual

healer of the Zar cult; the woggesha, the pragmatic healer and bonesetter; and the tanqway, the diviner-wizard (S

D Messing, 1972; Young, 1976). These various types of healers have different kind of treatments and specialties.

The woggesha for example, treat broken and painful limbs, while the dabtara can treat people by removing the

spirit or poison that is causing a disease (Young, 1976). The sections below will discuss the various healers in

more detail.

Dabtara. The dabtara has strong ties with the Ethiopian Orthodox Church, and is sometimes referred to as a

lay-priest. The healing process has therefore a strong religious meaning, with both physical and psychological

illness being treated by amulets, sacrificial offerings or religious pilgrimage. Also treatment with traditional

medicine can be prescribed (Slikkerveer, 1990).

Meshaf-gelach. The meshaf-gelach has an important role in predicting the prognosis of patients by astrology.

Comparing the constellations of the name of the patient with the stars, he determines the best remedy for the

patient in the form of amulets, medicine or pilgrimage. He is like the dabtara usually a member of the elite of

the Ethiopian Orthodox Church (Slikkerveer, 1990).

Zar doctor. The zar doctor is most frequently described as a mystical spirit exorcist. Many people believe that

he possesses a powerful spirit (zar in Amharic) that is able to manipulate the spirits in the body of patients.

Symptoms patients suffer from can range from apathy, hysteria, paralysis to miscarriage. To cure patients, the

zar doctor and patients go into a trance in an esoteric environment, where the spirits are driven out by repeating

oaths (Simon D Messing, 1958). The zar doctor does not have official ties with the Ethiopian Church; however,

he is well respected by the members of the church and belongs to the local elite, like the dabtara and meshaf-

gelach (Slikkerveer, 1990).

Tanqway. Like the Zar doctor, the tanqway tries to treat patients by driving out evil spirits. People visit the

tanqway with symptoms like epilepsy or leprosy, but also in case of crop failure, theft or apathy. Unlike the

Introduction

10

above mentioned healer, the tanqway is usually avoided by more educated healers and is often regarded as a

quack by them (Slikkerveer, 1990).

Woggesha. The woggesha is a usually illiterate pragmatic healer. He uses simple instruments, like scissors or

cow horns, to relieve somatic complaints like fractures, wounds or abscesses. Furthermore, the woggesha has

great knowledge on the use of natural products, such as plants or oils, for preparing traditional medicines

(Bishaw, 1991). This is the type of healer that this research focuses on.

As causes of a disease can be seen as a combination of natural and supernatural influences, the practices can be

characterized by a combination of mystical and pragmatic concepts and beliefs (Bishaw, 1991; Slikkerveer,

1982).

Interesting to note is that most traditional healers have a kind of ‘no cure, no pay’ system. Patients have to pay

an initial sum, but further payments depend on the effectiveness of the treatment (Leonard, 2003). This is one

of the possible explanations why the use of traditional healers is still very common in Ethiopia, where the,

sometimes even cheaper, cosmopolitan healthcare is expanding (Leonard, 2003; Slikkerveer, 1982).

The Ethiopian government has recognized the important role that traditional healthcare plays in Ethiopian

society (Kloos, 1998). Therefore, the Ministry of Health has indicated traditional medicine as one of the eight

priorities of the current health policy (Kassaye et al., 2007): “due attention shall be given to the development

of the beneficial aspects of Traditional Medicine including related research and its gradual integration into

Modern Medicine” (Ethiopian Health Policy, 2009).

However, it should be noted that already in the 1970s action was undertaken to integrate traditional medicine

in the cosmopolitan health system. This was not accomplished due to conceptual disagreement and deep-rooted

antagonism (Kloos, 1998; Kloos, Getahun, Teferi, Gebre Tsadik, & Belay, 1988). Furthermore, these new

policies are not yet implemented into practice (Kassaye et al., 2007).

1.3 Objective of the research

The discussion above leads to the following objective:

The objective of this research is to find out what the opinion and beliefs are of traditional herbalist healers towards cosmopolitan

medicine in order to find common ground for cooperation between these two types of health systems.

1.4 Central research question

In order to be able to reach the objective stated above, the following two central research questions are

formulated.

Introduction

11

What are the opinions and beliefs of traditional herbalist healers, in Addis Ababa, towards cosmopolitan health care?

and

Do they see possibilities to cooperate with the cosmopolitan health system?

Conceptual framework

12

2 Conceptual framework

In order to be able to answer the central research question stated above, a conceptual framework was developed.

This section describes the framework that was used and the various concepts that emerged when answering the

research question. The framework is based on Social Learning Theory (SLT) and Actor-Network Theory

(ANT).

These two theories were chosen because of the two main objectives of this research. One is the investigation

of the beliefs of traditional healers, while the second one is the investigation for possible common ground in

order to be able to have more cooperation between traditional and cosmopolitan medicine.

The basis of this research is that in Ethiopia a new government policy has emerged that states there should be

more cooperation between traditional healers and cosmopolitan medicine (Health Sector Development Program IV

Woreda Based Annual Core Plan, 2010). The overall objective is to explore the opinion of traditional healers toward

Cosmopolitan medicine to see if there is any common ground for cooperation. For this to happen, it will

require behavior change efforts for both cosmopolitan practitioners and traditional healers. This research

however, will focus only on the behavioral change required of traditional healers.

To understand what is necessary for this behavior change the model of Social Learning Theory is used as a tool

to find out what the factors are that could determine whether the healers are able to cooperate with

Cosmopolitan health care. Furthermore, it will be investigated what the relations are between the various

concepts. The different interactions with actants, human and non-human agencies interacting with each other,

will be mapped in order to increase understanding of the way the opinion of the traditional healers is formed.

For this the theory of ANT is used.

The next two sections explain these two theories. This is followed by a section that describes the concepts

emerging from these theories.

2.1 Social Learning Theory

In order to increase understanding of how the beliefs of the traditional healers are formed, the model of Social

Learning Theory will be used. This theory is used to identify some different aspects that may determine the

view of traditional healers toward cosmopolitan medicine. These concepts will be clustered according to the

categories of SLT, which are explained below.

Behavior is believed to be determined by its consequences, SLT is derived from this belief (Bandura, 1977;

Rosenstock, Strecher, & Becker, 1988). This theory states that behavior is determined by expectancies and

incentives. Expectancies are usually divided into three categories (Rosenstock et al., 1988):


13

Environmental cues - how events are connected. For this research this has to do with the beliefs of

the healers on diseases. For example, the causes that lead to a disease and what kind of treatment is

needed to cure a patient. These are concepts that the healers take as granted, and are not able to

influence.

Consequences of one’s own action - how individual behavior is expected to influence an outcome.

This links to the practices of the healers; what kind of treatment can be given. This is thus not

necessarily something the individual can do himself.

Expectation about self-efficacy - beliefs about one’s own competence to influence an outcome. In the

frame of this research, this has to do what the healers can do themselves. It is what they are able to

themselves in order to treat the patient.

Incentive (or reinforcement) is defined as the value of a particular object or outcome (Rosenstock et al., 1988).

According to this theory, it is necessary to find out various beliefs of the subjects being investigated. This can

give a good description on how behavior with respect to health can be explained (Rosenstock et al., 1988).

SLT thus provides a tool to be able to understand what concepts may lead to behavior of healers towards the

cosmopolitan health system. It is possible the think as a hierarchical structure, with environmental on top going

down to incentive.

This makes it possible to focus on the important aspects. In Figure 1 the concepts of SLT are linked with the

concepts used in this research.

Figure 1 Link between the categories of SLT and the concepts studied in this research.

Incentive Social status Benefit

Expectactation about self-efficacyCuring

Consequences of one's own actionPractices

Environmental cuesBeliefs about diseases


14

2.2 Actant-Network Theory

Furthermore, to be able to find out possible hampering factors and common ground for cooperation with

cosmopolitan health care, the relations between several concepts need to be investigated. A tool that gives a

description to find these, is Actant-Network Theory (Latour, 2005). ANT treats human and non-human objects

of equal importance and tries to find out what the relation between them is, in order to give a description how

these interact (Dolwick, 2009).

In literature, this model is called both Actor-Network Theory and Actant, but to emphasize that actors can also

be non-humans, Latour preferred to use the word ‘actant’ instead (Powell & Owen, 2011). Therefore, I will

use the term ‘actant’ will be used instead of ‘actor’ in the remainder of this report.

In ANT, several concepts are important to describe reality: actant, agency and interaction, translation and

actant-network. These concepts will be explained below:

Actants are the humans and objects that interact with each other. In principle, objects and humans are treated

as equal (Dolwick, 2009). Thus, a person can be actant, but also a written text or an organization. In this

research, actants are, for example, the healers, the objects they use in treatment, or a hospital.

An actant network itself can be actant as well (Dolwick, 2009), for example a university can be seen as an actant

in the context of a country, but can be described as an actant network when one tries to describe the way it

internally functions. Examples of actants are then students, the library and faculties.

For this research it is important to identify the various actants and explore their role in the forming the opinion

of the traditional healers. Figure 2 shows the links between the various concepts that are identified with the

explanatory theory of ANT.


15

Figure 2 Interaction between various concepts according to ANT

2.3 Concepts

From a first literature scan and consideration of SLT and ANT, several concepts or actants were already

identified. These are used as a starting point to investigate the actant-network and are shown in Figure 3. In

this section, these concepts are explained as well as their relation to this research. These concepts provided the

basis for the interview design.

Because this is an explorative study and very little is known about the opinion of traditional healers towards

cosmopolitan health care, this framework is not firmly based on existing theories. Instead, it draws on relating

the concepts that are considered important and were identified in the first literature research in order to increase

understanding of the way the opinion of the traditional healers are formed.


16

2.3.1 Beliefs about diseases

The most important ‘environmental cue’ for the traditional healers is the way they believe diseases are caused.

These beliefs will influence greatly how they perceive cosmopolitan health care, because these are the lenses

the healers use when they think about curing (Young, 1983). Knowing their beliefs about diseases will help

explain the methods they use to cure patients and will help to explain their opinion toward cosmopolitan health

care.

2.3.2 Practices

The research aims to explore feelings of outcome expectancy among traditional healers. Specifically, how firmly

they believe in their treatment methods and their perceptions about the efficacy of cosmopolitan medicine, and

again, exploring options to establish common ground for cooperation. It is therefore necessary to know the

expectation of the healer about his capability of treating the patient (Good, Hunter, Katz, & Katz, 1979; Young,

1976). Therefore, one has to look at the practices of the healers and how they believe that this practice is useful

in curing the patient.

The investigation of practices serves two goals: (1) to find out what the perceived self-efficacy of the healers is

and (2) how this relates to the cooperation with cosmopolitan health care.

2.3.3 Curing

A healer needs to have the belief he is able to cure a patient. It is therefore important to investigate the self-

efficacy of healers regarding the way patients are cured. This gives an impression on the way healers look at

cosmopolitan healthcare, which is likely to be very different in the way of curing patients than traditional care

(Mokaila, 2001; Young, 1983). For that reason, it will be investigated (1) what traditional healers see as necessary

for curing and (2) how they think about the way of curing by cosmopolitan health care.

To be able to understand the differences in curing between traditional and cosmopolitan medicine, there is a

need to investigate what kind of objects are used and what the role of these objects are. This will give a clue as

to how treatment is given and how this relates to the beliefs and opinions of the healers (Pelto & Pelto, 1997).

This will give information on possible common ground in the way patients are cured.

2.3.4 Social status

There is also the aspect of social status. Traditional healers have a role within their local society that determines

how they look toward cosmopolitan medicine: it can be possible that they see it as threat to their status and it

could create a negative opinion toward it (Harkness, Edwards, & Super, 1981). On the other hand, when they

feel that they have a strong position in the community it is easier for them to cooperate on an equal footing

with cosmopolitan care. Furthermore, their social status will influence the way the interviewees act, because the

community has certain expectancies on their behavior and role.


17

Within the framework of SLT, the social status has to do with incentive. Therefore, the role the healers have

within the local communities and societies will be investigated and related to their opinion on cosmopolitan

medicine. Furthermore, it will be questioned whether they expect to see a different role emerge when the

relations with cosmopolitan care changes.

2.3.5 Benefits

For traditional healers to cooperate with cosmopolitan medicine, according to SLT, there needs to be some

incentive. Therefore, this study will investigate what benefit they believe could result from cooperation.

Therefore, it is useful to investigate whether traditional healers see if people can benefit from cosmopolitan

health care, and if so in what manner. When the healers see benefits for their patients, it more likely that they

will cooperate with the cosmopolitan care.

2.3.6 Patients

Patients are included as an actant, because it is important to understand preconceptions of traditional healers

regarding treatment of patients, as these expectations will influence their opinion towards the practices in

cosmopolitan healthcare (Slikkerveer, 1982). The way this differs from that of the perceived cosmopolitan

perspective, will have an influence on the way they see the complete cosmopolitan health system.

2.3.7 Knowledge of cosmopolitan medicine

An important concept that determines the view on cosmopolitan medicine is the knowledge of cosmopolitan

care of the traditional healers. This has to do with what healers expect from cosmopolitan medicine. Knowledge

can be on the way treatment is done is hospitals or the way patients are treated by cosmopolitan physicians.

This knowledge will influence their opinion of this system. Their own experience with cosmopolitan health

care can have a great influence on the way they see it, either positively or negatively (Young, 1983). Therefore,

it was be investigated what kind of contacts and interactions, if any, had occurred between healers and actants

of cosmopolitan health care, such as health clinics or medical doctors.

2.3.8 Payment

From the literature scan, the concept of payment emerged as important for this research, because of the clear

differences between the way traditional healers are paid and how payments are made in cosmopolitan

healthcare. Therefore, payment is included as an actant within this research. If income from the patients are

lost, traditional healers might be reluctant to cooperate with modern Cosmopolitan health care and will possibly

have a negative opinion towards Cosmopolitan medicine (Green, Makhubu, & Bag, 1984). Therefore, one has

to investigate the way and in what forms payments are made (e.g. money or other forms of payment).


18

Figure 3 Schematic overview of the conceptual framework. (TH stands for traditional healer, while CM stands for cosmopolitan medicine.)

2.4 Sub questions

Several sub questions emerged from the research framework that needed answering to be able to give an answer

the research question. This section states these questions.

What are the beliefs of traditional healers toward curing patients and how does this compare with their

beliefs about cosmopolitan curing of patients?

What is the social status of tradition healers in the research area?

What is the between the role traditional healers have within the community and their view on

cosmopolitan medicine?

What is the opinion of

THs towards CM?

TH practices

Payments

Opinion towards patients

Knowledge of CM

practices

Social status

Curing

Benfits

Beliefs about

diseases


19

What are the experiences and knowledge of traditional healers with cosmopolitan healthcare, with

regard to treating patients?

What similarities, if any, do traditional healers see between cosmopolitan and traditional beliefs about

treatment?

Do traditional healers see benefits from cosmopolitan healthcare for patients?

Methodology

20

3 Methodology

This chapter described the methods that were used for this research. First, a description will be given on the

interview procedure. Then the analysis is explained.

Ten semi-structured interviews were conducted to find answers to some predetermined concepts. This number

of interviews gave sufficient in-depth information and it made it possible to compare the various answers.

Furthermore, it is a realistic number as one can expect difficulties reaching the healers (Flick, Von Kardorff,

Steinke, Kardorff, & Jenner, 2004). The selection was made by convenient selection, with the help of

researchers from the College of Health Sciences. The researchers at the College of Health Sciences were in

contact with mediators, who in turn had good contacts with the interviewed traditional healers.

Furthermore, there was a snowball effect as participating healers were asked to introduce other possible

interviewees. It has been reported that response rates are lower when selection criteria are stricter (Ross,

Vaughan, & Patrick, 2011). Because there was limited time for this research, I opted for this method.

The interviewees were contacted by a contact person who is familiar with the healers and is trusted by them.

This was done to make sure that the response rate was adequate and the healers were willing to cooperate with

this research. They were provided with the aim of the study, so it was clear for them what to expect from the

interviews.

Because the traditional healers do not speak, or have very limited, English the service of a translator was

required. Two different translators were used, who both were instructed about the objectives of this research.

Before the start of the interview, the interviewees were asked whether they agreed for me to record the

interview. None of the interviewees had any objection about this recording. After the interviews were

performed, they were transcribed in Amharic. This transcript was translated back to English by an independent

translation office. This, so called, back translation was done to ensure that the translations were adequate and

gave reliable results (Brislin, 1970). Every attempt was made to minimize the taking of notes as much as

possible, because taking notes may distract from the interviewing process resulting in information being missed

(Flick et al., 2004).

Interviews took place at the location of the healer, as this was most comfortable for him, and increased

likelihood of getting reliable results. Furthermore, it was easier to see the various objects and interactions of a

healer when at his location. When it was not possible to conduct the interview at the healer’s place, the interview

was done at a hotel or restaurant near the place of the healer. The length of the interviews was between 30 and

45 minutes.

Methodology

21

Only male practitioners were interviewed for this research. Nevertheless, traditional medicine is practiced by

females as well (Yineger, Kelbessa, & Bekele, 2008). Therefore, the role that gender of the healer might play is

not investigated in this research.

In order to check the comprehensiveness of the topic list and the estimated timing, the interview design was

discussed with several people who were familiar with traditional healers. The interview design can be found in

appendix I.

It was chosen not to use participative observations due to limits of time

3.1 Analysis

The analysis of the interviews was done by means of structured analysis. The interviews were carefully examined

and structured according the various concepts that were identified in the conceptual framework. These concepts

were placed in a matrix, which made it possible to see the different links between them. For this, the computer

program WeftQDA was used a tool.

Within ANT one can identify five different concepts, or “uncertainties”, that need investigation to find out

what the relations are between the various actants (Latour, 2005). These five uncertainties that served as a

starting point of the research are the nature of: (1) groups, (2) actions, (3) objects, (4) facts, and (5) how to write

research accounts. These will be explained in the following paragraphs. The analysis of the interviews will be

done according to these five uncertainties in order to be able to identify the relations between the actants.

Groups. The concept of groups is about how actants came together. What needs to be investigated here is

“group making and unmaking” (Latour, 2005). In the context of this research this is, for example, the relation

between traditional healers and the cosmopolitan health system. Another aspect is the relation between patients

and how their social status is developed. This is related to how agency is used to make the translation by the

actants. Translation is the process where actants shape concepts to fit within a particular argument (Holtorf,

2003). It is here that the beliefs of the healers are transferred into practice.

Actions. This uncertainty deals with the concept of agency and one has to question how actants are influenced

to act by other actants (Oppenheim, 2007). For this research, it is important to ask how healers think about

cooperation with cosmopolitan health care. This topic also includes questions about their beliefs on causes of

disease and how treatment can be achieved. Furthermore, this is about how the relation with other actants is

established.

Objects. This deals with the recognizing of nonhuman objects that participate in the actions taking place

(Dolwick, 2009). It is here that one has to look at objects that influence and have a relation with the opinion

Methodology

22

the healers. Objects one can think of include medicines or instruments and the role they play in treatment, or

whether there is a health clinic near the village and how this will influence the opinion of the healers.

Questions one can ask include the role of payment of the healers and the policy the government has developed

with regards to traditional medicine. At this stage is important to find out from the healers what objects are

important for the healers and how this influences their opinion.

Facts. This concerns how to tell the difference between a ‘matter of fact’ and a ‘matter of concern’ (Dolwick,

2009). This deals with how strong the healers believe in their methods and how they see the cosmopolitan

beliefs of medicine. It is closely related to the concept of translation, as it deals with how strong the concepts

fit within the reality of the actant network.

How to write research accounts. This is the final step in the research, where the relations between the found

actants are described. It describes “who was doing what (and ‘what’ was doing what), how they were doing it,

where and when all of this was going on, and why” (Dolwick, 2009). It is about linking the actants and describing

how these links are made. This is the final step in the research, where all identified actants will be linked with

each other in order to represent the actant-network.

3.2 Interviewees

This section gives a description of the interviewees that participated in this research. An overview of all the

interviewees can be found in Appendix II.

Five Muslim and five Orthodox healers were interviewed for this research. This makes it possible to investigate

if religion plays a role in the opinion of the healers, and if there are differences in the healing process between

different religions.

The education level varied from 8th till 12th grade, thus all the interviewees had at least completed primary

school1. Usually they were trained by another traditional healer before they started their own profession. This

could be a family member, such as father, but one interviewee told that he received his training in Sudan. Some

healers stated that they also received religious training; this was the case with Muslims as well as Christians.

The healers usually started in their late twenties or early thirties with their own practice.

Furthermore, there was a broad age range, with ages varying between 27 and 95 years. This gives thus a good

mix of ages, which makes it possible to see whether there are differences in opinion due to age differences.

1 The Ethiopian school system consist of 8 years primary school, followed by 2 years lower secondary school and 2 years of higher secondary school (Teferra & Altbach, 2003).

Methodology

23

This also implies that there was a great range in experience: some healers were only working for a couple of

years, while others had more than 30 years of experience in the occupation of traditional healer.

One of the interviewees is the chairman of the association of traditional healers2. This gave the opportunity to

question the role that organization could play in coordination the cooperation of the traditional healers and

cosmopolitan health care.

2 The Ethiopian National Traditional Medicine Formulation and Treatment Organization, in the rest of this report it will referred to as the Association.

Results

24

4 Results

This chapter describes the results that are found in this research. These were clustered according to the concepts

that were identified in the conceptual framework. In the next chapter, the discussion, these points will be linked

with the five uncertainties that come from ANT.

4.1 Beliefs about diseases

There are two main points that the healers identify within this topic. The first aspect identified, is that diseases

are caused by something that resides inside the body of the patients. In order to be able to heal the patient, this

has to be removed from the body. Therefore, a common practice is to prescribe a drug that causes the patient

to throw up or to have diarrhea. “When he feels sick, there must be something inside his stomach” (Interview 1) and “As to

the very nature of the disease it simply intermingled with blood and other parts of our body, the medicine we provide helps to totally

remove such problems.” (Interview 3)

The second, related, concept that came forward from the interviews was that a disease often cannot be removed

by surgery only. It is believed that the cause of the disease is inside the body and with surgery one only removes

the exterior parts. It is therefore that a disease should be cured with a medicine from plants or roots. This is

will result in the disease being removed from the body and therefore curing the patient permanently. “(…) the

modern medicine removes the problem that is emerged around the anus through surgical treatment, but steel does not heal the

problem. Therefore, due to this short coming most of the patients frequently visit hospitals as it is emerging again and again through

time. This happens because it is difficult to remove the problem totally with its roots as they cut its uppers parts to remove the

inflammation only.” (Interview 3)

4.2 Practices

All the interviewees use herbals to make medicines for specific diseases. These drugs are prepared for use in

different forms, namely ointments, pills and syrups. They find it very important that these drugs are made from

fresh ingredients. Here they identify a difference with cosmopolitan care, which uses non-fresh ingredients to

prepare drugs. The traditional healers feel that this method will decrease the effectiveness of a drug. “There are

drugs in ointment, syrup and tablet forms (...) most of the drugs are prepared from various herbals and roots (...).” (Interview 5)

and “in the modern facilities, many patients are provided with the necessary service and follow up as in-patient. But this is not

possible in the traditional service provider” (Interview 10)

Apart from giving injections, there is very little use of instruments. Both examination and treatment is done

without the use of instruments. The healers that use injections indicate that they use it in cases of hemorrhoid.

It was never mentioned outside that context. All the interviewed healers name the little use of instrumentation

as an important difference with cosmopolitan health care, where the use of instruments is ubiquitous. “I believe

Results

25

that the first difference is the medical equipments that are used to examine patients, the drug formulation and the way it is given.”

(Interview 5)

Most of the interviewed healers are specialized in a certain type of disease. This can be for example skin disease

or respiratory problems like asthma. This implies that they only make drugs for a limited number of diseases in

which they are specialized. “It is common for any traditional medicine facility to specialize and become famous in any one of

disease treatment.” (Interview 3)

4.3 Curing

All the interviewees agreed that the cooperation of the patient is very important in the healing process. That is,

not only (herbal) medicines are needed, but also the attitude of the patient is needed. This means often that

patients need to change their lifestyle, for example by stopping the eating of raw meat or exercise more. “Beside

our treatment, we observe the change prohibiting patients not to take things such as fat, alcohol, serve kinds of food, etc.” (Interview

10)

Another important aspect of curing mentioned by the healers is that always a diagnosis is made before the

treatment starts. The resulting treatment depends on the diagnosis made. Furthermore, when a disease is

diagnosed and the healer is unable to cure, the patient will be referred to another healer or to a hospital.

“Whatever the case it might be, we do not give drugs guessing the case.” (Interview 5)

Furthermore, all interviewees indicated that they do not possess any special gifts, other than their knowledge

on diseases and plants. This knowledge is learnt from other healers. As one healer states: “Regardless of knowledge

and experience, the knowledge of our forefathers has played significant role for us to be engaged in this work. I think there cannot

be any other skill except these ones.” (Interview 6)

4.4 Social status

Most of the interviewees indicate that they feel well respected by the local community. This respect comes with

age, one of the younger healers indicated that he did not have the respect that his father had. However, some

indicate that there are some people who do have a bad attitude towards them. One indicates that this is caused

by beliefs that he uses witchcraft to cure people. Nevertheless, it is always a minority who has a bad attitude

towards them. One interviewee indicated that the trust increased because he was participating actively with the

community. “However, as they see patients getting recovered and healed and we participate actively in social life now their attitude

is totally changed to good through time.” (Interview 5) and “Though there is some bad attitude, some people with good understanding

and attitude encourage us to work. As we are also providing our service broadly, I think most of the society have good attitude.”

(Interview 10)

Results

26

On the other hand, it is felt that the cosmopolitan health care has a very negative attitude towards their

profession. This is identified as a great hampering factor towards cooperation with the cosmopolitan health

care. “However, due to the attitude and opinion that the modern medical science professionals towards us, the traditional ones are

demeaning and looking downwards therefore they do not like to work with us. This is not a good condition to create and establish

healthy relationships between us.” (Interview 3)

Another important aspect that came up often during this topic is that they would like to be more accepted by

the government and cosmopolitan medicine. They see this as a very important hampering factor that should be

changed before there can be effective cooperation between traditional and cosmopolitan health care. For

example, the organization that represents the traditional healers is not officially recognized by the Ethiopian

government. “Again, the association was denied its license in 2007/08, still various efforts have been undertaken with the

cooperation of the practitioners.” (Interview 7)

4.5 Benefits

All except the oldest interviewed healer saw benefits from cosmopolitan health care. The most important

benefit seen is the use of instruments for diagnosis and the possibility of performing operations, both

unavailable to traditional healers. Another aspect they identify is that there are certain diseases that they are

unable to cure, while these can be cured in a hospital. Furthermore, for hospitals it is possible to provide in-

patient service, which is not possible for traditional health providers. “The modern medicine can simply heal complicated

diseases like cancer, gangrene, etc. They also do operational treatments. As there are various professionals who have well developed

knowledge obtained through education, I say without reservation that it is good. (… ) if the type of disease is beyond our capacity

or it can be treated simply with the modern medicine, we advice the patient to go to there for service.” (Interview 4) and “In addition,

as we see the treatment service for patients, in the modern facilities, many patients are provided with the necessary service and follow

up as in-patient. But this is not possible in the traditional service provider” (Interview 10)

4.6 Patients

All interviewees emphasized that they treat all the patients equally. There is no difference made between the

patients’ religion, sex, background. Anyone who needs curing is welcome by the interviewed healers.

Furthermore, they see it as very important for their profession that there is no discrimination of patients. “This

is not work that you can do with discrimination. Since we are concerned for the life of our peoples, it makes us to do it carefully.”

(Interview 5)

With regard the treatment of patients by cosmopolitan health care, there is no difference identified by the

interviewees. They all believe that their mutual goal is to cure patients, and it does not matter what the

background of the patient is. “Beyond everything, our mutual goal is to help patients, and we can raise things related with

this.” (Interview 5)

Results

27

4.7 Knowledge of cosmopolitan medicine

All the interviewed traditional healers have been in contact with cosmopolitan medicine. It is very common for

them to refer patients to a hospital in case of disease they are unable to cure. This seems to be a relatively new

development, because in the literature it is never mentioned that patients are referred the cosmopolitan

hospitals. “If we are for the first time that we come across with the disease or there is no drug to heal, we refer patients to the

modern hospital. We do this even where the disease remains with the patients for longer periods of time.” (Interview 3)

As stated above, the interviewed healers recognize the more advanced use of instruments. Furthermore, it is

seen that hospitals have great benefit in being able to provide in-patient care; something that the traditional

care is unable to perform. “What I consider as a difference, in most of the traditional healers, there is no in-patient service,

maybe some of them can do it. Most of the patients receive the service as out-patient.” (Interview 6)

One of the suggestions made to overcome this barrier is that the government should create a kind of platform

where there can be an exchange of ideas between the cosmopolitan and the traditional medicine. It is felt that

if there is more mutual understanding, both the traditional and the cosmopolitan health care can benefit from

it. “I believe it will be great if we got acknowledgment from the government to strengthen our unity and conduct practice of showing

experience with local and international works and with donor organizations working on health research.” (Interview 6)

It was suggested to form an independent board that coordinates exchange of knowledge between traditional

and cosmopolitan health care. Furthermore, it was suggested that there should be more research on the working

of traditional curing methods. By doing so, the healers believe this will lead to increased mutual understanding

which will increase their acceptance by cosmopolitan health. This might result in more governmental support

for the traditional health care, from which also patients can benefit. .

4.8 Payment

Payment is usually done after the treatment is finished. It is also customary that the payment depends on the

financial capabilities of patients; poor individuals usually have to pay much less or can even get treatment free.

The payment in general is made in money, however, it might be that people after treatment return with gifts in

kind, like food. This is seen as an extra sign of respect and gratefulness paid by the cured patient. The

interviewees told this often to show the respect in community that they earned with their profession, as it not

obligatory for the patient to do so. “We first do not talk about payment. We tell patients about payment after they are healed

and have received our service. Then the patient pays us the amount he can afford. We also provide the service for free for needy

persons.” (Interview 6)

The opinions are divided on whether traditional treatment is more expensive or cheaper than cosmopolitan

health care. Both opinions were equally voiced by the interviewees. It should be noted, however, that healers

who indicate that cosmopolitan health is more expensive argue that this is caused by the in-patient care. The

Results

28

in-patient care is a function that the traditional healers cannot offer for their patients. This is seen as an

important difference between traditional and cosmopolitan health care. “Still it is cheap, because patients may pay in

different ways in the modern facility. For example, there is payment for the card exam (lab, ultrasound, endoscopy) and finally for

drugs. Therefore, there is a big difference in terms of payment.” (Interview 10)

Discussion

29

5 Discussion

This chapter discusses the results and places them in a broader context. The various concepts will be integrated

in the uncertainties of ANT that are indentified in the conceptual framework. Furthermore, the locations where

the healers practice and the methods used will be discussed. The chapter concludes with suggestion for further

research.

5.1 Results

The discussion of the results is clustered according to the uncertainties that were identified by ANT. This is

done to give the discussion structure and it will make it easier to see how the actants interact.

5.1.1 Groups

There is an association of traditional healers; however, this organization is not recognized by the government

as an official partner. This is felt by the healers that that they are not accepted by the government. This is clearly

an important hampering factor regarding cooperation with cosmopolitan health care. The association plays an

important role in organizing the healers and giving trainings and is therefore an important actant.

Patients are seen as important by the healers. According to the healers, they do not discriminate against their

patients. Everybody is welcome for treatment, regardless of religion, ethnicity, gender or age. They also identify

that treating patients is a mutual goal of both traditional and cosmopolitan health care. This is thus an important

common ground for cooperation.

The healers are in general well respected by the community. This might also depend on their age, as one the

interviewees indicates. This has probably to do with a broader cultural aspect where older people are more

respected due their age. Another explanation for this is that the older healers have a longer experience and

therefore more known in the community. When looking for cooperation, it might therefore be good to start

first with contacting older and more experienced healers as peers. Another argument for this is that young

healers are often trained by experienced healers, before they start their own practice.

5.1.2 Actions

The use of medical invasive instruments is very limited by traditional healers. This is partly caused by beliefs

about disease (“steel doesn’t cure”) but is also seen a benefit that cosmopolitan has above traditional care. The

curing of the patient by traditional methods is done by giving the patient drugs made from fresh ingredients.

Furthermore, advice on lifestyle is sometimes given, e.g. that the patient should not eat raw meat anymore or

should exercise more.

The cause of a disease is usually identified as something that resides inside the body, and has to be removed in

order to cure the patient. A difference with cosmopolitan care is that in traditional care this cause should be

Discussion

30

removed with medicines, and operations alone are not enough. Nevertheless, operations are seen as an

important benefit from cosmopolitan care. Nevertheless, this might be a common on ground on which

cooperation between the two health systems can be improved.

In general, there is not a negative attitude towards cosmopolitan health care. The interviewed healers see

potential benefits in cooperation with cosmopolitan health care for their patients. Nevertheless, they feel that

their profession deserves official recognition by the government and the cosmopolitan health care system.

5.1.3 Objects

There is very little use of instruments by traditional healers. They see this as one of the key differences in

comparison with cosmopolitan health care. Diagnoses are made by questioning the patient on the symptoms

and examining external factors such wounds and heartbeat by hand, while the interviewees indicate that in

cosmopolitan care equipment is often used to make a diagnosis. Furthermore, in the treatment the only use of

instrumentation is that of injections or medicines. There are no operations or any other direct interaction on

the body of the patient. All the interviewees highlight this as a key difference between their profession and the

cosmopolitan one.

The payment is done after the treatment, and depending of the financial situation of the patient. There is not

clear a vision on whether cosmopolitan care is more or less expensive than traditional care. Nevertheless, it

looks like traditional care takes the income of the patients more into account than cosmopolitan care does.

Medicines are arguably the most important object used by the healers. In general, these are local plants, but

some healers import them from countries like Sudan. This is identified as an important difference compared

with cosmopolitan care, where medicines are made from prepared non-fresh ingredients. This method is seen

as inferior by the healers and therefore an important aspect to keep in mind regarding cooperation.

5.1.4 Facts

A key result of this research is that healers do believe in their methods of curing, but they do not see this as the

only way to help patients. For some cases, their methods are insufficient and it would be better for the patient

to go to the hospital. In such cases, the healers do indeed refer the patient to a hospital. This finding was seen

in all the age groups; there was no difference in age, both the younger and the older ones would refer to

cosmopolitan hospitals.

5.2 Location healers

This section describes the healers’ places that I visited for the interviews. Not all the interviews were held at a

healer’s place, because these were seen as inappropriate for the interviews, for example due to lack of a quiet

place. Therefore, these places might differ significant from places described in this section.

Discussion

31

5.2.1 Layout

Most places I visited had a waiting room where the patients could sit before being called by the healer. This

waiting room generally had some benches to sit on and sometimes a TV was broadcasting. Patients were called

one by one to visit the healer in another room for the consult.

The patients were usually accompanied by a family member, for example husband or mother. These were also

present during the consult with the healer.

The medicines were sometimes stored in the treatment room and sometimes in a separate room. In a couple

of cases, the medicines were sold by assistants of the healer. People could return when they needed more

medicines.

The places were in general well maintained and clean. All the places visited had electricity and thus electric

lightning. This was also necessary, as there was no daylight inside because of the lack of windows. Nevertheless,

the rooms were still only dimly lit.

5.2.2 Objects

A couple of healers used printed leaflets to promote their activities. These flyers stated for example the diseases

they were able to cure and experiences the healer had. I only found these flyers at the older healers; none of

the healers under 50 years seemed to advertise this way.

One of the healers had a handwritten book with different treatment methods and recipes for medicines. None

of the other interviewees seemed to use a book in determining the diagnosis. However, some had a certificate

hanging on the wall that showed certain courses they had conducted at the association of traditional healers.

They seemed proud of this and always mentioned it during the interview.

The Orthodox healers had various religious symbols placed in their rooms. These included images from saints

or crosses. In general, the places of the Muslims were much more sober in decoration. It seemed, however, that

religion did not play an important role for the way patients were treated. For example, none mentioned religion

as being important to cure patients and all healers indicated that they helped people regardless of religion.

5.2.3 People

When first contacting the healers, they seemed a bit reluctant to cooperate with the research, but once agreed

they were quite cooperative to work with me. The only restriction they often made was that they would not tell

how they prepared their medicines. This was a result of bad experience in the past when people were using

their recipes and methods without their permission.

Discussion

32

During the interview, the interviewees were quite relaxed and came up with subjects themselves. They seemed

to be quite happy to participate with the research. I did not have the impression that they were afraid to answer

questions or to speak out.

5.3 Limitations of the study

For this research, ten traditional healers were interviewed. It is therefore impossible to draw quantitative

conclusions. On the other hand, the number of interviewees is enough to draw qualitative conclusions that can

give a good starting point for further research.

Furthermore, all the interviewees practice in the capital Addis Ababa. Therefore, the conclusions will only be

applicable to this group of traditional healers. From the literature, it is clear that there are various other groups

of practitioners with different beliefs. Therefore, these different groups might have quite different views

towards cosmopolitan health care and the results of this research can therefore not be generalized towards

other types traditional healing. For example, it is likely that healers living in rural areas have much less relations

with cosmopolitan health care, simply because cosmopolitan health care is much more lacking in rural areas.

Two different translators were used during the interviews. This might lead to a slightly different interpretation

of the questions. I tried to minimize this effect by translating the transcripts in Amharic by a translation office.

In addition, both the translators were instructed on the objective of this research.

The method of selecting the interviewees with help from the College of Health Sciences might impose a bias

among the respondents, as they likely have a positive attitude towards cosmopolitan health care. It is also

possible that people who are positive towards cosmopolitan health care are more likely to participate with this

research than healers who have negative experiences or attitude.

5.4 Further research

Several points are interesting for further research. It might be very interesting to compare the finding of this

study with other groups of traditional healers. Ethiopia is a country with a very diverse population, so the

opinions in other ethnic groups might be very different from that in the capital (Abbink, 2009). Furthermore,

for this research only male practitioners were interviewed. It might be interesting to explore the opinions of

female healers as well and see if there are any differences in gender roles.

The interviewees indicated that they found it important to have more recognition from cosmopolitan care

professionals. It would therefore be interesting to investigate whether practitioners of cosmopolitan care are

willing to cooperate and see possibilities for cooperation. A good start would be to repeat this study with

participants from the cosmopolitan health.

Discussion

33

It might be interesting to visit the healers when they interact with patients and compare this with the way the

patients are treated in a clinic of the cosmopolitan health care. This might lead to a better insight into the way

patients are treated. The comparison can provide insight in possible hampering factors and common ground

for cooperation.

Conclusions

34

6 Conclusions

The most important belief identified is that to cure a patient the ‘object’ that causes the disease has to be

removed from the patient. This has to be done the inside, and with the aid of medicines. A surgical operation

alone is not seen as sufficient. Another important aspect is that the medicines used should be prepared from

fresh ingredients.

All the interviewed traditional healers indicated that it is important for them to treat all patients equally,

irrespective of religions, age, and sex.

The interviewed healers feel well respected by the local communities. They do not see this to be changing due

the arrival of cosmopolitan health care. However, their social status might be depending on age. Younger

interviewees indicate that they do not have as much earned respect as older healers.

The interviewed traditional healers have a quite clear vision on what cosmopolitan care is. They do have contact

with and even refer patients to hospitals. However, they would like be respected as well for the work they do.

Here lays, according to the interviewees, an important role for the government to facilitate this, probably in

cooperation with NGOs. Another important actant is the organization of traditional healers, that can play a

mediation role in the process of increased cooperation.

The most important similarity identified is that the goal of both traditional and cosmopolitan health care is to

cure patients. This is therefore an important aspect to focus on to improve cooperation between cosmopolitan

and traditional health care.

The interviewed traditional healers believe that it is possible to cooperate with cosmopolitan health care. They

especially see opportunities in cases that they are unable to cure, for example because an operation is necessary

or the patient needs in-patient facilities. They do not see cosmopolitan health care as a threat for their own

profession.

There are differences regarding treatment methods, but it seems that these are not too big that it should hamper

the cooperation between traditional and cosmopolitan health care. The most important difference is the lack

of trust of traditional healers in medicines prepared from non-fresh ingredients.

The most important hampering factor is the lack of recognition of traditional medicine that is given by the

government and cosmopolitan health care. Furthermore, a lack of respect is felt from the cosmopolitan health

care. In order to create a successful cooperation between cosmopolitan and traditional healthcare, it is important

that these two factors should improve.

References

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Appendix I Interview design

38


I am a student from a Dutch university and for my doing my final research in association with the College of

Health Science from Addis Ababa University. For this research, I am interested in the way traditional healers

perceive western medicine. In order to investigate this, I will ask you some questions. Your answers will kept

strictly anonymous. If you do not want to answer a question please feel free do so. This research will only be

used within the university.

Personal information

First, I would like to know to some person information.

Age

Religion

Formal education

Illness & curing

When people are coming to visit you, what kind of symptoms do they have.

What is causing these symptoms?

What is possible for this person to be treated?

Would you be able to treat him?

What should the patient do himself to be cured?

If we now move on to the Western care, can you maybe describe how this is different from your own approach?

How do see what they are doing?

Are they doing things different than you would do?

Do you think the patient is helped in this kind of curing?

May be add a general open question about their feelings toward CM

Patients

Now I would like to get some insight in your relation with patients.

How do they see their relation with patients?

How is this different the cosmopolitan medicine?


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Social status

Next, I would like to know something about the way people in the community see you.

What is your role in the community?

How can this change due different health care available? Do you expect this to be changing?

Do you feel rewarded by you patients? Would this change when they go to health clinic, referred either

by you or by when they go by themselves?

Payment

How do patient pay you?

Do you see differences with health clinics in this?

Knowledge

For this topic, I am interested in your knowledge about Western care.

Have you ever been in contact with a Western care?

Can you tell something about your experience?

Did you ever refer patients to a Western health clinic? Why was that, or why haven’t you done that?

Benefits

Do they see possible benefits from cosmopolitan health care, e.g. treatments you are unable to give?

Would you see it possible to cooperate with cosmopolitan health care? If so, on what kind of topics?

If not, why not?

Thank you very much for your time.

Are there any questions left or you have some remarks you would like to make?

Appendix II Interviewees

40

Appendix II Interviewees

Interview

number

Date of

interview

Age Religion Formal

education

Comments

1 November 19 28 Islam 8th grade He is working together with

his brother. Their father was a

healer as well.

2 December 9 95 Orthodox Unknown He is a former officer in the

imperial army. He has two

assistants who help him.

3 December 19 27 Orthodox Unknown Trained by Sudanese in herbal

medicine

4 January 1 61 Islam 8th grade Working for 30 years as a

traditional healer

5 January 3 Unknown,

around 40

Islam 12th grade


around 50

Islam 8th grade Has also received religious

education

7 January 23 58 Orthodox 8th grade Chairman of the traditional

healers association

8 January 23 51 Orthodox 8th grade

9 January 24 54 Islam 10th grade Working for 23 years up as a

traditional healer


traditional healer

Appendix III Interview transcripts

41


Interview 1

If people come to visit, what kind of sickness do they have?

When they see symptoms, people come here. Usually one person tells to another so that they can use this one

to be treated here.

So people don't come directly

They come they come. To who is the best traditional practitioner. They ask for different places and finally they

come.

And what is the reason that they come to this place?

His friend was sick and finally he was frustrated he was drinking alcohol and finally brought him a

malfunctioning stomach. And then finally he brought him here and they gave him medicine and finally he is

treated. This is witness.

And what kind of medicine did he receive?

This type of medicine is oneowd but I think it is plant. It is a plant.

And why does this plant work?

When he feels sick, there must be something inside his stomach. So when we give this medicine so finally with

diarrhea and different working he will be finally be cured.

So it is something that should go out of the body.

Do you think that also in a Western hospital such treatment could be given?

They say they claim they went to the scientific western hospital, but they say the were not cured so that is why

we come here.

So that is what the patients say.

If it is bone cancer, if they go the western hospital the leg will be amputated. But here we don't mutilate. When

it starts bleeding or we wash properly and collect all the broken bones and we put medicine inside so that they

will be cured without mutilation. So they prefer our place above the hospital, because if they go to the hospital


42

they say it should be mutilated. If he is referred to hospital, most of the time hospital make an operation. But

here without an operation but my taking medicine only they will be cured.

How do you see the relation with the patient?

For the purpose of our profession we see all equally. No discrimination.

Everybody can come here. And do you think that is different in a hospital?

We see the patient and if it is beyond our capacity and knowledge we refer to a hospital.

So there is kind of a relation between them and the hospital?

We don't refer to a hospital directly, but to specific hospital. But we say go to a western. But nowadays the

attitude is changing, it was not like that. The government now recognizes us now. Now, the last time they gave

us training on how to treat patients. It gives recognition for the traditional medicine. So nowadays, if you can't

treat you can refer to the hospital. But we don't write and say go to this hospital. Only we say go to a hospital.

But they feel happy about, they feel good, they like it?

The government at that time, all traditional practitioners were called for a meeting and asked to bring all their

medicines and this was taken to the laboratories all were tested and finally they gave permission for that

medicines that treat. The others that doesn't give cure... That was in the military government.

What is your role within the community?

Now we are young, but our father was doing this work because he was older and respected so people come

with their quarrel. So he was a very respected guy.

And they think that will come with time with them too?

Yes off course. Within our age group we also do this thing, even today. If our friends quarrel with each other

or somebody took money and doesn't give back. We deal and conceal it.

And do they think this will change when people go more often to hospitals?

We treat people properly, and not only that we treat according to their financial resources. So we treat them for

15 days or week or so and then if you couldn't we will refer them to the hospital.

And people also have to pay when they are not successful?


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Even at the beginning we don't start treatment if we could not treat and cure the patient. So once we start we

are dead sure to treat him.

Only when they know they can treat the patient, they will do so. Otherwise they will referred to a

hospital

Exactly.

And payment is done by money?

Yes. And once a patient is treated he also brings us bread and tea and other items.

And how do they think about the Western type of payment? That you always have to pay regardless of

outcome?

He is not sure but it seems to him they have pay for the bed and for the medicine and for the treatment. They

pay for all this. The payment is too high compared with this one. Once you they (=interviewee) treat they give

2 years guarantee.

If you get ill again you can come back within that 2 years range for free.

Do they see benefits from the hospital?

There are people that prefer traditional medicine than the western treatment. People come even from Israel,

black Falasha come here. They come here.

And do hospitals also refer people to here?

Sometimes they say it is better that you go to the traditional healer. There is relation.

Do they think this should happen more often?

It is good for the patients, it nice.


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Interview 2

What kind of symptoms do patients have when they come here?

Skin disease, when you're bitten by a fly you're whole body will become a wound. [almas balay], it is caused by

a fly. When it bites you, it spreads all throughout of all of your skin.

And for all these different kind of disease there are different plants?

Yes yes. It started with treatment when I was a small boy with treating smallpox. Look this is from the stomach

of the people when it went out. I gave medicine and this came out. Look. This is it, it came out of the stomach.

You give medicine and then it could out with diarrhea. Sometimes they vomit and sometimes

Is that also possible in a hospital?

Most of the patients came from to the hospital because they are not treated there. There is also type of worm

in the river. When the animals drink it. So a patient says I went in different specialties and did not cure, so this

in my last time. So he came from hospital.

So he can treat people than in a hospital

Yes.

So he would never refer to a hospital?

Yes, he refers to hospitals. And the hospital also sent people to him.

So depending on the disease?

Yes

How does he see the relation with his patients?

I see all equal. But according to the disease. If it is very harmful I treat very carefully and talk to them. S I treat

all my patients equally. He has also a medicine for grasshopper. Not only for human beings. He also gives for

animals for nature and other things

So also people can come with their animals?

I give them. It is free. I never charge for rabies. I have also for grasshopper. They know the value it. I am the

one who give service for all Ethiopians. But they do not recognize me. They sent their wives to be treated here.


45

But the so called doctors and intellectuals they don't recognize me. I took certificates, from Israel and Greece

and from Italy and then from England.

But not from Ethiopia?

He got license to treat people.

He doesn't feel recognized by the government?

If you bring you letter from your university or from the Ministry of Health I can give you medicine from rabies

so that you will take it and you make in your lab. And I can give you certification. Because from Black Lion

Hospital they sent people to me, from Addis Ababa Health Office they sent people to me to treat. So if you

bring letter, I can give you that.

How does he feel with the relation with the hospitals?

I have a good relation with the hospital.

Does he see benefits from the hospital?

Nothing, no benefits.

So it is not good that there are hospitals?

They asked me to give training. Went there and gave training to them. Finally, they took my medicine and sent

it to other counties laboratories and then finally stopped giving the medicines.

So he is not very happy with

No no

How is payment done, how do patient pay?

He asks pay this much. They willing pay me. It is free to the patients what they pay.

What is role in the community?

I am the one that is respected by the community.

Does he feel less respected because there are now western hospitals?

I am respected by the people.


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Interview 3

Can you please describe me most of the patients who receive your service in the facility and kind of

medicinal service you provide?

Most of the patients who come to our for medication are those basically suffering from hemorrhoid. That is

because we administer the drug, which is highly quality through injection and change is seen immediately after

the administration. It is common for any traditional medicine facility to specialize and become famous in any

one of disease treatment.

How do you prescribe or provide drug for patients after they came here and their health problem is

diagnosed?

Every disease has its own manifistaiton. For example, if we see problem to be happened on our eyes we will

see the problem from different perspective like if it is due deficieny of vitamin or cell deterioration or viral of

bacterial. As we all know in our sector we don’t use any modern equipment that can simply tell us or show us

the character or nature of the health problem, we use different mechanisms and finally come to know many

complicated health problems but in a simple way.

If we come to the nature and behavior observed on hemorrhoid, in most cases it comes to emerge in three

different ways or directions. If it is worst of all appears around nails, but most of the time it appears through

anus. There are different symptoms to be observes physically like burning, inflammation and pain in and around

backbones. But this does not mean that all diseases have one and the same nature or behavior. It is possible to

identify the type of disease based on the kinds and nature of pains that the patient is feeling.

Therefore it is not possible to give or prescribe drugs before diagnosing the disease and identifying its nature.

In addition to this in our side we have to aware patients about the treatment and make them know well.

Regarding working hours, we provide medical treatment service in the normal working hours and days.

Is there any other way in which patients can help themselves and do things to heal or treat the disease

in addition to the drug or injection you administer to them? In your side, what do you use to make

patients to do so?

If we see the case and treatment of hemorrhoid, after the patients have received the injection service we will

inform them what to eat, to drink within 15 days after the treatment and sometimes, as to the case a month.

Patients will be instructed the kind of things to use by writing until the time the change required is to immerged

or made.


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Can you please tell me what you think is the difference between the treatment you provide which

means the traditional healing treatment and the modern medicine which is famous worldwide?

It the basic and the primary difference between the two treating methods are the tools and equipments that we

use for the diagnosis and provide the treatment service. The modern medicine uses and applies and is supported

with equipments that are produced with modern technology in different kind of factories. In our side always

use the conditions, observations and basically our broad and deepest experience. As we know the symptoms of

each disease, we will identify the disease based on what we hear from patients and compare the basic symptoms

and pains. The basic difference is the use of equipments to diagnose and provide the treatment. In case of

cancer, for example we observe the symptoms on the patient based on our experience then we will proceed to

the cause and the characters of TB and administer the drug/injection.

Do you believe that the traditional following up treatment and the drug you provide have the power to

heal patients from the disease they are suffering from?

In our procedure as we are following up patients in different schedule and provide the different kinds of

medicines and services that are directly related to the disease, but not effective; in most cases most of our

patients receive high quality service to return back to their home fully rehabilitated and healed. Therefore, I can

say that it has the power and the quality to heal from diseases.

What do you think about the cases that cannot be healed and unconditionally changed by the modern

medical science in your traditional medicine service? Is there any condition to refer patients to the

modern medical service?

For instance, in case of hemorrhoid, the modern medicine removes the problem that is emerged around the

anus through surgical treatment, but steal does not heal the problem. Therefore, due to this short coming most

of the patients frequently visit hospitals as it is emerging again and again through time. This happens because

it is difficult to remove the problem totally with its roots as they cut its uppers parts to remove the inflammation

only.

Thus most patients who receive the modern medicine service come to us to get our service and to be healed

for once and for all. That is because the modern medical service cannot provide long lasting service. As to the

very nature of the disease it simply intermingled with blood and other parts of our body, the medicine we

provide helps to totally remove such problems.

As we come to the second question, if we are for the first time that we come across with the disease or there is

no drug to heal, we refer patients to the modern hospital. We do this even where the disease remains with the

patients for longer periods of time.


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How do describe the way you treat and handle patients?

We always accept patients as per the code of conduct of the profession and try to hospitalize as much as

possible. Sometimes as there is bad attitude towards our service among the community and believe that we do

some magic. They believe we are doing something that they don’t know and consider us as we are discriminating

our service recipients. Contrary to that we are working and providing the healing service considering every

patient equally. This is the only way that we can make the society in large and particularly our patients that their

attitude and awareness towards the service providers is untrue. We do not discriminate our service recipients

based on their gender, educational status and any other factors. Whatever the status of the patient might be, we

provide our service equally and fairly.

Most the time people believe that the good service is only the modern one. What do you think about

this attitude?

This is dependent on our conception and awareness that we have towards the subject. This is common in

everything for all of us. The people who receive our medical service always come to us whenever they encounter

any health problem. Similarly, others always believe and visit modern medical service providers. Whatever the

case it might be, we need the people to have the appropriate and the right attitude and awareness towards both

medical services specially the goodness of the traditional one. This is because the traditional healing service is

provided using natural plants and the combination thereof that cannot expose patients for any other side effect

of related or opportunistic diseases. With this, everyone has to know that, all our patients or at least most of

our patients get back to home healed.

If we compare the cost that users pay for the modern and traditional medical services, which one do

you think is expensive?

As far as my opinion is concerned, the traditional treatment is more expensive than the modern one, because

the types of drugs that we administer for our patients has the sufficient power to heal and with the great standard

quality. In addition to that, I import the drugs I use for my patients from Sudan, India, France, etcetera. It

requires foreign currency therefore in effect it maximizes the cost. In addition to that since the cost considers

and includes the transportation cost and any other various related costs, there will be the condition to raise up

the value to pay by the patients.

In case of outpatients, what kind of payment strategy is there? Is it in advance or after the service?


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First of all we do not talk about payments, we always first consider the awareness and the way to heal the patient

from the disease. Patients themselves ask about the payment. Sometimes we go to the level of providing the

service for free for patients who cannot afford for the service provided for them.

Is there any condition introducing with the modern medical science professionals and working

together?

By the way we want to work closely with them. It is better to come together and share knowledge and experience

in medical practice like diagnosis of causes for diseases and the way to use medical equipments and materials.

However, due to the attitude and opinion that the modern medical science professionals towards us, the

traditional ones are demeaning and looking downwards therefore they do not like to work with us. This is not

a good condition to create and establish healthy relationships between us. I think the government has to play a

role to make us come together for work to develop the science together.

If the government has ordered of facilitated the way for us to present and demonstrate the types of herbals and

plants we use in the medical service, it may contribute grate for experience sharing. It also helps to teach and

aware both sides.


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Interview 4

Which is the most common case for which patients come to you for treatment?

Hemorrhoid, gonorrhea, syphilis and cancer.

How do you diagnose the case when patients come to you?

It fills stomach with air, constipation, burning during diarrhea, etc. All diseases have their own unique, regular

and common characters. (He shows photos of patients with hemorrhoid, and how he treats them with

injections). There are different kinds of hemorrhoid. They are classified as internal and external, famine,

masculine etc. It can occur in different parts of the body. It is more about knowing the type and dosage to be

taken after case is diagnosed. There is no any witchcraft or anything else. Sometimes there is difference in the

treatment and procedure for similar case between modern and traditional medicine. In order to see the case, if

we take … in the modern medicine the only treatment is to remove through operation, but in our case we have

medicine to subscribe that totally heals and doesn’t allow it to regenerate again. The only thing that modern

medicine can do is to cut it out, but the disease in its rosy nature occurs or regenerates again and again since its

roots are down there inside the body. Therefore, it happens again and again after it is cut out.

Is there anything that should be done besides the treatment follow up?

After the case is diagnosed, we always identify causes or aggravating factors to the disease and inform patients

what to do or not in advance. The patient himself has to follow up the treatment voiding such prohibited things.

How do you explain the modern medicine in relation with your profession and experience?

The modern medicine can simply heal complicated diseases like cancer, gangrene, etc. They also do operational

treatments. As there are various professionals who have well developed knowledge obtained through education,

I say without reservation that it is good.

What do you think is the biggest difference between the modern and traditional medicine?

The basic difference is the use of appliances with which diseases can be diagnosed and the other parent is the

difference in drug preparation and prescription.

Do you believe the medical treatment service that you are providing can exactly treat or fully heal

patients from their pains?


51

Once the disease and its cause are diagnosed, as we give the type of drug we believe works out or improve for

the disease we exactly know with the appropriate dosage considering the age, sex, physical resistance capacity;

it helps patients without any doubt. It is reliable as there are various follow-up procedures in addition to the

drug. However, if the type of disease is beyond our capacity or it can be treated simply with the modern

medicine, we advice the patient to go to there for service.

How do you see patients in terms of their sex, religion, age, etc?

Since the basic objective of the service is to reserve the person from suffering, there is no discrimination on

any ground. However, as I have already said, if two patients, for example old and child patients, there are

procedural differences from diagnosis steps to drug provision.

What differences your medication service from the modern medicine, especially in relation with

treatment and healing patients?

The modern facilities have great capacity in treating and caring for patients. They have well facilitated and

adequate caring space, but in our case what we can do is to give the drug and to make him follow up basically

staying in their house. However, if the case is difficult and the patient plan to properly follow up we follow him

up making him stay with us and we see things during the time we think enough to see changes and improvement

prohibiting not take aggravating things.

What perception do the local public and private health facilities, local community have towards you

in terms of your profession?

I always try to aware patients who came even from areas far away for treatment about the service to be provided

to the people who returned back to their home after enjoying the service tell to others what they saw and

received. I don’t think there are people who perceive me badly.

What do you feel when you advice patients with complicated cases that is beyond your capacity to do

to modern medical service after they came to you?

The basic fact is that the fundamental objective of both the modern and traditional medicines is to heal patients.

Therefore, we feel happy when we do so because they can get healing service that we cannot provide them or

remove problems by operation.

How much do you charge patients for the treatment service you provide?


52

It is based on the capacity of patients. If patients who cannot afford for the service present the certificate

received from authorized body, we even provide them with required service for free. As far as my information

is concerned, traditional medicine is too cheap and affordable for everybody. For instance, in the modern

facilities there are various payments for the same medical case. If we consider that, of course the payment for

the traditional one is affordable and reasonable.

Can you please tell me you application towards the modern medicine briefly?

I believe that if we work in cooperation, an experience-sharing forum is conducted by the government and

study is made on preparation and formulation on drugs, I am sure we can provide great medical service.

Do you refer patients or advice patients to visit modern medical facilities?

Of course, yes, I do. It is impossible to heal all diseases in traditional medication. Therefore, for some cases,

we immediately make patients to go t clinics and hospitals/

What do you think is that makes the modern medicine the most advantageous?

As I have already said, some complicated, challenging and urgent diseases can be simply and immediately treated

by the modern medicine, I think this is its adventitious side.


53

Interview 5

Which disease is the most common case in most of the patients who come for treatment to you?

Hemorrhoid, gonorrhea, impotency.

After the cause of the patients’ case is diagnosed, how do you give them drugs?

Whatever the case it might be, we do not give drugs guessing the case. That is because some diseases cannot

be identified simply and other diseases though simply identifiable the dosage of their drugs should not be more.

What kind of drugs do you give?

There are drugs in ointment, syrup and tablet forms. However, as most of the drugs are prepared from various

herbals and roots, they are prepared in syrup or [inaudible] form.

As you compare the modern and the traditional medicine, what do you think is the difference?

The traditional one was started since old age by our forefathers. They didn’t know about the modern medicine.

They were healing those wounded in war with herbals and other illnesses with natural roots. As we come to the

modern one, I believe that the first difference is the medical equipments that are used to examine patients, the

drug formulation and the way it is given.

Besides the service you provide to heal patients, do you advise patients to care for themselves and not

to take things that should be avoided?

Beyond our relationship to give treatment, there can be other thing things that aggravate or not to be treated

like dose or food. This can be understood for instance, when we give drugs that should be taken at home with

tea, we advise the patient not to take unboiled milk. We also advise most of our patients not to eat raw meat

for most of the diseases. If it is allergy or white spots on skin, we advise patients to use unperformed soap while

taking a shower or washing their hands.

Do you see your patients equally? Is there any difference based on their sex, religion, ethnic identity?

This is not work that you can do with discrimination. Since we are concerned for the life of our peoples, it

makes us to do it carefully.

How do you compare the modern medicine with the traditional one in the way they care for patients?


54

We are doing with the limited capacity and man power we have to make patients change their attitude towards

their illness, because some patients can be seen hopeless. In addition to this if their family is dependent to the

patients’ income; we always advise and help them not to be stressed for their family.

What perception do you think the society has towards you?

Primarily there was bad perception among society, because they thought we are engaged in witchcraft. However,

as they see patients getting recovered and healed and we actively participate in social life now their attitude is

totally changed to good through time.

Can you explain me the good sides you think about the modern medicine?

In our side, we cannot do surgical treatment. Thus if the case is beyond our capacity, we advise patients to go

to the modern medical facility. It is great in many sides.

Have you ever thought to work in cooperation with the modern medicine or anything you wish to do

be done in such regards?

Beyond everything, our mutual goal is to help patients, and we can raise things related with this. For example,

it will be good if it is possible to formulate drugs doing broad study and research on plants and we have good

skill on it. Besides that, it will be good if we get various equipments as aid and do things that help traditional

healers opening a certain institute.


55

Interview 6

Do you have any skill other than your profession like using any spirit or influence to heal the patient?

Regardless of knowledge and experience, the knowledge of our forefathers has played significant role for us to

be engaged in this work. I think there cannot be any other skill except this ones.

D0 you see your patients at one time? Is there any difference based on their sex, religion, ethnic

identity?

We see all our patients equal. We treat both the priest and the sheik, teacher, etc.

How do you compare the modern medicine with the traditional one in the way they care for patients?

What I consider as a difference, in most of the traditional healers, there is no in patient service, may be some

of them can do it. Most of the patients receive the service as out-patient.

How much money do you charge patients?

We first do not talk about payment. We tell patients about payment after they are healed and have received our

service. Then the patient pays us the amount he can afford. We also provide the service for free for needy

persons.

Have you ever thought to work in cooperation with the modern medicine or anything you wish to be

done in such regards?

I believe it will be great if we got acknowledgment from the government to strengthen our unity and conduct

practice of showing experience with local and international works and with donor organizations working on

health research.


56

Interview 7

Can you please tell me about the Association of Herbalists and you work and responsibility?

The association, the Ethiopian National Traditional Medicine Formulation and Treatment Organization was

officially established in 1959. After its establishment, there were activities to promote the association at the

times. As the Derg regime came to power, it has cancelled the licence of the association and prohibition was

proclaimed not to do anything in the name of the association. During these periods all the activities planned to

accomplish both its objective and mission were remained unperformed.

After the Derg regime was over and EPRDF came to power in 1991, the association's acknowledgement was

granted again and various good activities were being done.

Again, the association was denied its licence in 2007/08, still various efforts have been undertaken with the

cooperation of the practitioners.

I am also serving for the association as chairperson.

Have you ever had any opportunity to be introduced with health professionals?

Yes, of course. As I have participated in various awareness raising forums both personally and representing the

association. I have got the opportunity to meet and be introduced with the modern medical practitioners during

such discussions.

Is there anything that you think is useful in the modern medical service?

Of course the modern medical medicine is the most successful one and it is the one and basic thing that ensure

the hope of human being to live.

The modern medicine is working day and night to come up with best solutions for the newly emerging diseases

from time to time.

In addition to that, it is producing highly helpful findings in examining and researching on micro organisms

that cause diseases and creating better conditions that significant help patients. There are also a lot of other

vital uses.

Is there something you wish to work on in cooperation with the modern medicine?

It is a good question. Among other things, I wish if there is the condition we can work together in formulating

and preparing medicines to be given for patients.

Continuous study is to be done on plants and roots that is internationally acceptable with their medical values.


57

The relationship that lay the foundation and help to share experience between the traditional and the modern

medicine.

What is the role of the association to create bilateral relationship?

Basically and primary awareness raising activity will be organized to aware all the traditional healer members of

the association about the goodness and importance of the modern medicine. Then in order to enable the

association to work in coordination with the modern medicine the favorable condition will be created to share

experience and take trainings on various cases and health.

What makes the traditional medicine different from the modern in following-up disease?

We don't use any kind of equipment to treat patients, but I don't mean that we don't use any equipment totally.

While providing treatment for patients, the modern facility treats patients as impatient and through surgery, but

there is no such operational treatment in the traditional one except taking them to stay in temporary basis.

Patients go the modern medical facility that is located in a certain area. The basic objective of any health facility

is to heal patients. The practitioner in any facility, either in the modern or traditional one should bot have bad

attitude when patients go to the traditional or modern health service provider. For example, if we see the

traditional one, whenever a patient appeared with highly complicated case which is beyond our capacity of the

provider, the patient will be made to got to the modern health facility. On the other hand, there are patients

who don't need to visit traditional health facility though the required capacity and service out there for their

case. Therefore, there should not be the feeling of every of such things, because such feeling or related attitudes

can't have any space in this profession. Whatever the choice consequences to the traditional service whether it

results pressure or not. I believe in providing the service for patients who come to get it with the ethics and

positive attitude.


58

Interview 8

How do you identify the type and cause of diseases when patients come to you?

Currently I am not doing any examination of disease. What we do is that I am doing on cases common to me

and I can identify the type of disease by asking patients about their feeling and symptoms.

How do you prepare the medicines you give to patients?

In ointment, table and syrup form.

What makes the traditional medicine different from the modern one?

There is no doubt that the modern medicine had abundant equipments of examination, but we don have such

things. There is a difference in drug storage and formulation. There is also broad difference in disease diagnosis.

Do you treat patients equally in your facility?

We always do whatever we can regardless of their race, religion, ethnicity, sex, etc.

Do you have acceptability in your local areas?

The documents that I have shown you are received from governmental institutes and testify that I have

acceptance to and acknowledgement of such institutes which I think is based on the attitude of the local society

towards me that helps me do what I can do.

Have you ever had the chance to meet and share experience with other health professionals?

I have got such chances even beyond the local practitioner. I have shared experiences even abroad. We have a

great knowledge while giving broad professional explanation on newspapers, radios, magazines with other

professionals.

How do you charge patients with your service?

It is too cheap. Even we provide the service for free if they have sufficient evidence of neediness.

Which one is expensive if you compare with the modern health service?

There is no doubt that the modern provider is highly expensive.

Is there anything that you think is useful from the modern medicine?


59

As I refer patients to the modern facility, they simply manage and administer the treatment which is highly

complicated and difficult for me. They do surgical treatments fast. They provide good care for patients. They

use various equipments to find out the most complicated cases and serve human beings with their drugs.

Is there something that you wish to work on together with the modern medical practitioners?

Of course there is. I wish we could make good a relationship leaving aside look down one another to commonly

server people. It is also good if governmental institutes do something to develop both of us.


60

Interview 9

How do you identify the cause of diseases of your patients as they come to you to get treatment?

Which cases are common in most of your patients?

The most common cases in the place where I am working are skin problems, hemorrhoid, spider, Almaz

Balechira and various internal problems such as worms. The least common cases are impotency and gastric.

The method that we commonly use to identify the causes or nature of the disease is our experience and based

on the symptoms or the condition being sustained as patients show and tell and based on our assessment to

know what we should do to relief patients.

How do you give drugs?

We prepare the drug in ointment, powder or syrup forms. In most cases we produce in powder form. We do

it that way because it is easier to keep it for longer periods without being spoiled.

Most of the time we produce drugs in table form for few types of disease.

Do you advise patients on what to do to care for or heal themselves beside the treatment you provide

them?

Of course, as there are some diseases that can be cured without drug. We prohibit our patients not to use or

take things that we believe they may hide or aggravate the disease.

What do you think is the difference between the traditional and modern medicine?

The first difference is the important medical equipment that the modern medicine uses. The second one is the

treatment done in surgery which is not done in the traditional medicine. The modern one has higher capacity

such as ray, ultra sound, detail etc. They broadly use the equipments to simply diagnose diseases.

How do you consider the variety of patients in you service?

We give drugs for patients older than 16 years in different way considering the type of disease, health status of

the patient, etc. We don’t give drugs that should be taken orally to children.

Can you tell how the society accepts and perceives you?

I can say it is good. We have good respect even out of our service area.


61

What do you tell when other health facilities are established or refer/advise your patients to see

modern facilities?

We don’t have any bad attitude towards it. I also think that it may cause any bad spirit in the life of a human

being.

What do you say about the amount of money you charge your patients for the service you provide. Is

it expensive or cheap?

It is too cheap. As we can see it, there is no expensive price for our service.

Do you want to work in cooperation with the modern medical practitioner and things they facilitate?

In order to more develop our profession, it will be better if we support each other and the necessary platform

is created for that effect. The other point I want to tell you is that there should be an effort to be done to

conserve the most important types of plants and herbs that are being extinct. It think it is good if legal

acknowledgment is given to the traditional medical society.


62

Interview 10

How do you identify the disease when patients come to you to get treatment?

Some patients tell us where they feel pain and other conditions they experience and others come to us in

modern medical facilities and got no change there. Beyond this, most of the diseases have their own uniform

system of behavior such as if we put the urine sample of diabetes patients in sun light, flies will be on it within

minutes. In addition we use observations. We use our observations to identify different kinds of hemorrhoid,

and other skin problems. However, as we can identify the complicated cases we refer to the modern health

facilities.

Do you advise your patients to heal the disease or care for themselves?

Beside our treatment, we observe the change prohibiting patients not to take things such as fat, alcohol, serve

kinds of food, etc.

What do you think is the basic difference between the modern and the traditional medicine?

There is difference from drug formulation to prescription and use of medical equipments. In addition, as we

see the treatment service for patients, in the modern facilities, many patients are provided with the necessary

service and follow up as in-patient. But this is not possible in the traditional service provider.

Do you treat patients equally? Or is there anything different in such regards?

Yes, we always try to do everything we can.

Do you have acceptability in the local community?

Though there is some bad attitude, some people with good understanding and attitude encourage us to work.

As we are also providing our service broadly, I think most of the society have good attitude.

How do you charge your patients for the service you provide?

As far as my experience is concerned, it is cheap and affordable. That is because we are using local herbs and

roots for which we are not paying too much.

How do you compare with that of the modern one?

Still it is cheap, because patients may pay in different ways in the modern facility. For example, there is payment

for the card exam (lab, ultrasound, endoscopy) and finally for drugs. Therefore, there is a big difference in terms

of payment.


63

Have you ever had the change to share experience with modern medical practitioners?

We have relatives and there is also some opportunity to get introduced to each other.

If you can't cure the case, do you refer patients to modern medical facilities?

Of course, yes. If it is beyond our capacity, needs surgery, the case is not diagnoses; we just refer them to the

modern facility.

Do you have any plan to do something with the modern medical practitioners if you can work together

or the condition is facilitated?

It will be good, if there is the condition to share experience and study is conducted. As it is confirmed that

modern medicine helps and cures, and even the drugs in modern medicine are formulated from roots and

plants; it will be great if special attention is given.

Appendix IV Analysis

64


Beliefs about diseases

01 interview 19 november 2011 [913-975]

When he feels sick, there must be something inside his stomach

02 interview 9 december 2011 [73-256]

Skin disease, when you're bitten by a fly you're whole body will become a wound. [almas balay], it is caused by

a fly. When it bites you, it spreads all throughout of all of your skin

03 interivew 19 december 2011 [1087-1625]

If we come to the nature and behavior observed on hemorrhoid, in most cases it comes to emerge in three

different ways or directions. If it is worst of all appears around nails, but most of the time it appears through

anus. There are different symptoms to be observes physically like burning, inflammation and pain in and around

backbones. But this does not mean that all diseases have one and the same nature or behavior. It is possible to

identify the type of disease based on the kinds and nature of pains that the patient is feeling.


For instance, in case of hemorrhoid, the modern medicine removes the problem that is emerged around the

anus through surgical treatment, but steal does not heal the problem. Therefore, due to this short coming most

of the patients frequently visit hospitals as it is emerging again and again through time. This happens because

it is difficult to remove the problem totally with its roots as they cut its uppers parts to remove the inflammation

only.


As to the very nature of the disease it simply intermingled with blood and other parts of our body, the medicine

we provide helps to totally remove such problems.

04 interview 01 januari 2012 [179-1266]

It fills stomach with air, constipation, burning during diarrhea, etc. All diseases have their own unique, regular

and common characters. (He shows photos of patients with hemorrhoid, and how he treats them with

injections). There are different kinds of hemorrhoid. They are classified as internal and external, famine,

masculine etc. It can occur in different parts of the body. It is more about knowing the type and dosage to be

taken after case is diagnosed. There is no any witchcraft or anything else. Sometimes there is difference in the


65

treatment and procedure for similar case between modern and traditional medicine. In order to see the case, if

we take … in the modern medicine the only treatment is to remove through operation, but in our case we have

medicine to subscribe that totally heals and doesn’t allow it to regenerate again. The only thing that modern

medicine can do is to cut it out, but the disease in its rosy nature occurs or regenerates again and again since its

roots are down there inside the body. Therefore, it happens again and again after it is cut out.


They were healing those wounded in war with herbals and other illnesses with natural roots. As we come to the

modern one.


The most common cases in the place where I am working are skin problems, hemorrhoid, spider, Almaz

Balechira and various internal problems such as worms. The least common cases are impotency and gastric.

The method that we commonly use to identify the causes or nature of the disease is our experience and based

on the symptoms or the condition being sustained as patients show and tell us and based on our assessment to

know what we should do to relief patient.


Beyond this, most of the diseases have their own uniform system of behavior such as if we put the urine sample

of diabetes patients in sun light, flies will be on it within minutes. In addition we use observations.

Practices


This is it, it came out of the stomach. You give medicine and then it could out with diarrhea. Sometimes they

vomit and sometimes


That is because we administer the drug, which is highly quality through injection and change is seen

immediately after the administration. It is common for any traditional medicine facility to specialize and become

famous in any one of disease treatment.


Regarding working hours, we provide medical treatment service in the normal working hours and days.


66


If we see the case and treatment of hemorrhoid, after the patients have received the injection service we will

inform them what to eat, to drink within 15 days after the treatment and sometimes, as to the case a month.

Patients will be instructed the kind of things to use by writing until the time the change required is to immerged

or made


There are drugs in ointment, syrup and tablet forms. However, as most of the drugs are prepared from various

herbals and roots, they are prepared in syrup or … form.


I believe that the first difference is the medical equipments that are used to examine patients, the drug

formulation and the way it is given.


Beyond our relationship to give treatment, there can be other thing things that aggravate or not to be treated

like dose or food. This can be understood for instance, when we give drugs that should be taken at home with

tea, we advise the patient not to take unboiled milk. We also advise most of our patients not to eat raw meat

for most of the diseases. If it is allergy or white spots on skin, we advise patients to use unperformed soap while

taking a shower or washing their hands.


We don't use any kind of equipment to treat patients, but I don't mean that we don't use any equipment totally


The basic objective of any health facility is to heal patient


In ointment, table and syrup for


We prepare the drug in ointment, powder or syrup forms. In most cases we produce in powder form. We do

it that way because it is easier to keep it for longer periods without being spoiled.


67

Most of the time we produce drugs in table form for few types of diseases.


Some patients tell us where they feel pain and other conditions they experience and others come to us in

modern medical facilities and got no change the


We use our observations to identify different kinds of hemorrhoid, and other skin problems. However, as we

can identify the complicated cases we refer to the modern health facilities

Curing


This type of medicine is oneowd but I think it is plant. It is a plant


So nowadays, if you can't treat you can refer to the hospital. But we don't write and say go to this hospital


Even at the beginning we don't start treatment if we could not treat and cure the patient. So once we start we

are dead sure to treat him.


Therefore, it is not possible to give or prescribe drugs before diagnosing the disease and identifying its nature.

In addition to this in our side we have to aware patients about the treatment and make them know well


In case of cancer, for example we observe the symptoms on the patient based on our experience then we will

proceed to the cause and the characters of TB and administer the drug/injection.


In most cases, most of our patients receive high quality service to return back to their home fully rehabilitated

and healed. Therefore, I can say that it has the power and the quality to heal from diseases.


68


This is because the traditional healing service is provided using natural plants and the combination thereof that

cannot expose patients for any other side effect of related or opportunistic diseases.


After the case is diagnosed, we always identify causes or aggravating factors to the disease and inform patients

what to do or not in advance. The patient himself has to follow up the treatment voiding such prohibited things.


Once the disease and its cause are diagnosed, as we give the type of drug we believe works out or improve for

the disease we exactly know with the appropriate dosage considering the age, sex, physical resistance capacity;

it helps patients without any doubt. It is reliable as there are various follow-up procedures in addition to the

drug.


Whatever the case it might be, we do not give drugs guessing the case. That is because some diseases cannot

be identified simply and other diseases though simply identifiable the dosage of their drugs should not be more.


Regardless of knowledge and experience, the knowledge of our forefathers has played significant role for us to

be engaged in this work. I think there cannot be any other skill except this ones.


While providing treatment for patients, the modern facility treats patients as impatient and through surgery, but

there is no such operational treatment in the traditional one except taking them to stay in temporary basis


Of course, as there are some diseases that can be cured without drug. We prohibit our patients not to use or

take things that we believe they may hide or aggravate the disease



69

Beside our treatment, we observe the change prohibiting patients not to take things such as fat, alcohol, serve

kinds of food, etc.

Social status


Now we are young, but our father was doing this work because he was older and respected so people come

with their quarrel . So he was a very respected guy


I am the one that is respected by the community.


I always try to aware patients who came even from areas far away for treatment about the service to be provided

to the people who returned back to their home after enjoying the service tell to others what they saw and

received. I don’t think there are people who perceive me badly.


Primarily there was bad perception among society, because they thought we are engaged in witchcraft. However,

as they see patients getting recovered and healed and we participate actively in social life now their attitude is

totally changed to good through time.


I have acceptance to and acknowledgement of such institutes which I think is based on the attitude of the local

society towards me that helps me do what I can d


I can say it is good. We have good respect even out of our service area


Though there is some bad attitude, some people with good understanding and attitude encourage us to work.

As we are also providing our service broadly, I think most of the society have good attitude

Benefits



70

There are people that prefer traditional medicine than the western treatment. People come even from Israel,

black Falasha come here. They come here. 00:26:23-7


Yes, he refers to hospitals. And the hospital also sent people to him


Nothing, no benefits


As we come to the second question, if we are for the first time that we come across with the disease or there is

no drug to heal, we refer patients to the modern hospital. We do this even where the disease remains with the

patients for longer periods of time.


By the way we want to work closely with them. It is better to come together and share knowledge and experience

in medical practice like diagnosis of causes for diseases and the way to use medical equipments and materials


I think the government has to play a role to make us come together for work to develop the science together.

If the government has ordered of facilitated the way for us to present and demonstrate the types of herbals and

plants we use in the medical service, it may contribute grate for experience sharing. It also helps to teach and

aware both sides.


The modern medicine can simply heal complicated diseases like cancer, gangrene, etc. They also do operational

treatments. As there are various professionals who have well developed knowledge obtained through education,

I say without reservation that it is good.


However, if the type of disease is beyond our capacity or it can be treated simply with the modern medicine,

we advice the patient to go to there for service.


71


The modern facilities have great capacity in treating and caring for patients. They have well facilitated and

adequate caring space, but in our case what we can do is to give the drug and to make him follow up basically

staying in their house. However, if the case is difficult and the patient plan to properly follow up we follow him

up making him stay with us and we see things during the time we think enough to see changes and improvement

prohibiting not take aggravating things.


As I have already said, some complicated, challenging and urgent diseases can be simply and immediately treated

by the modern medicine, I think this is its adventitious side.


In our side, we cannot do surgical treatment. Thus if the case is beyond our capacity, we advise patients to go

to the modern medical facility. It is great in many sides.


Whenever a patient appeared with highly complicated case which is beyond our capacity of the provider, the

patient will be made to go to the modern health facility.


they simply manage and administer the treatment which is highly complicated and difficult for me. They do

surgical treatments fast. They provide good care for patients. They use various equipments to find out the most

complicated cases and serve human beings with their drugs


Of course there is. I wish we could make good a relationship leaving aside look down one another to commonly

server people. It is also good if governmental institutes do something to develop both of u


In order to more develop our profession, it will be better if we support each other and the necessary platform

is created for that effect. The other point I want to tell you is that there should be an effort to be done to

conserve the most important types of plants and herbs that are being extinct. It think it is good if legal

acknowledgment is given to the traditional medical socie


72


Of course, yes. If it is beyond our capacity, needs surgery, the case is not diagnoses; we just refer them to the

modern facility


It will be good, if there is the condition to share experience and study is conducted. As it is confirmed that

modern medicine helps and cures, and even the drugs in modern medicine are formulated from roots and

plants; it will be great if special attention is given

Patients


For the purpose of our profession we see all equally. No discrimination.


Sometimes they say it is better that you go to the traditional healer. There is relation. 00:26:58-3

It is good for the patients, it nice. 00:27:24-7


I see all equal. But according to the disease. If it is very harmful I treat very carefully and talk to them. S I treat

all my patients equally.


Thus most patients who receive the modern medicine service come to us to get our service and to be healed

for once and for all.


We always accept patients as per the code of conduct of the profession and try to hospitalize as much as

possible. Sometimes as there is bad attitude towards our service among the community and believe that we do

some magic. They believe we are doing something that they don’t know and consider us as we are discriminating

our service recipients. Contrary to that we are working and providing the healing service considering every

patient equally. This is the only way that we can make the society in large and particularly our patients that their

attitude and awareness towards the service providers is untrue. We do not discriminate our service recipients


73

based on their gender, educational status and any other factors. Whatever the status of the patient might be, we

provide our service equally and fairly.


This is common in everything for all of us. The people who receive our medical service always come to us

whenever they encounter any health problem. Similarly, others always believe and visit modern medical service

providers. Whatever the case it might be, we need the people to have the appropriate and the right attitude and

awareness towards both medical services specially the goodness of the traditional one


Since the basic objective of the service is to reserve the person from suffering, there is no discrimination on

any ground. However, as I have already said, if two patients, for example old and child patients, there are

procedural differences from diagnosis steps to drug provision.


This is not work that you can do with discrimination. Since we are concerned for the life of our peoples, it

makes us to do it carefully.


We see all our patients equal. We treat both the priest and the sheik, teacher, etc.


What I consider as a difference, in most of the traditional healers, there is no in patient service, maybe some of

them can do it. Most of the patients receive the service as out-patient.


We always do whatever we can regardless of their race, religion, ethnicity, sex, et


We give drugs for patients older than 16 years in different way considering the type of disease, health status of

the patient, etc. We don’t give drugs that should be taken orally to children


Yes, we always try to do everything we can


74

Knowledge of cosmopolitan medicine


If he is referred to hospital, most of the time hospital make an operation. But here without an operation but by

taking medicine only they will be cured


We see the patient and if it is beyond our capacity and knowledge we refer to a hospital.


The government now recognizes us now. Now, the last time they gave us training on how to treat patients. It

gives recognition for the traditional medicine. So nowadays, if you can't treat you can refer to the hospital. But

we don't write and say go to this hospital. Only we say say go to a hospital.


The government gives training because they know people go the traditional healers, so that unti people become

very conscience. So he has to treat like this


This is for example the license (officieel papier dat ingelijst aan de muur van de wachtkamer hangt) that is given

to his father.


Most of the patients came from to the hospital because they are not treated there. There is also type of worm

in the river. When the animals drink it. So a patient says I went in different specialties and and did not cure, so

this in my last time. So he came from hospital.


But they do not recognize me. They sent their wives to be treated here. But the so called doctors and

intellectuals they don't recognize me



75

It the basic and the primary difference between the two treating methods are the tools and equipments that we

use for the diagnosis and provide the treatment service. The modern medicine uses and applies and is supported

with equipments that are produced with modern technology in different kind of factories. In our side always

use the conditions, observations and basically our broad and deepest experience. As we know the symptoms of

each disease, we will identify the disease based on what we hear from patients and compare the basic symptoms

and pains. The basic difference is the use of equipments to diagnose and provide the treatment. In case of

cancer, for example we observe the symptoms on the patient based on our experience then we will proceed to

the cause and the characters of TB and administer the drug/injection.


That is because the modern medical service cannot provide long lasting service.


However, due to the attitude and opinion that the modern medical science professionals towards us, the

traditional ones are demeaning and looking downwards therefore they do not like to work with us. This is not

a good condition to create and establish healthy relationships between us


The basic difference is the use of appliances with which diseases can be diagnosed and the other parent is the

difference in drug preparation and prescription.


The basic fact is that the fundamental objective of both the modern and traditional medicines is to heal patients.

Therefore, we feel happy when we do so because they can get healing service that we cannot provide them or

remove problems by operation.



76

I believe that if we work in cooperation, an experience-sharing forum is conducted by the government and

study is made on preparation and formulation on drugs, I am sure we can provide great medical service.


Of course, yes, I do. It is impossible to heal all diseases in traditional medication. Therefore, for some cases,

we immediately make patients to go t clinics and hospitals/


Beyond everything, our mutual goal is to help patients, and we can raise things related with this. For example,

it will be good if it is possible to formulate drugs doing broad study and research on plants and we have good

skill on it. Besides that, it will be good if we get various equipments as aid and do things that help traditional

healers opening a certain institute.


I believe it will be great if we got acknowledgment from the government to strengthen our unity and conduct

practice of showing experience with local and international works and with donor organizations working on

health research.


Yes, of course. As I have participated in various awareness raising forums both personally and representing the

association. I have got the opportunity to meet and be introduced with the modern medical practitioners during

such discussion.


Of course the modern medical medicine is the most successful one and it is the one and basic thing that ensure

the hope of human being to live.


77

The modern medicine is working day and night to come up with best solutions for the newly emerging diseases

from time to time.

In addition to that, it is producing highly helpful findings in examining and researching on micro organisms

that cause diseases and creating better conditions that significant help patients. There are also a lot of other

vital us.


There is no doubt that the modern medicine had abundant equipments of examination, but we don’t have such

things. There is a difference in drug storage and formulation. There is also broad difference in disease

diagnostics.


I have got such chances even beyond the local practitioner. I have shared experiences even abroad. We have a

great knowledge while giving broad professional explanation on newspapers, radios, magazines with other

professional


The first difference is the important medical equipment that the modern medicine uses. The second one is the

treatment done in surgery which is not done in the traditional medicine. The modern one has higher capacity

such as ray, ultra sound, detail etc. They broadly use the equipments to simply diagnose disease


There is difference from drug formulation to prescription and use of medical equipments. In addition, as we

see the treatment service for patients, in the modern facilities, many patients are provided with the necessary

service and follow up as in-patient. But this is not possible in the traditional service provider


We have relatives and there is also some opportunity to get introduced to each other


78

Payment


We treat people properly, and not only that we treat according to their financial resource


And payment is done by money? 00:22:36-9

Yes. An once a patient is treated he also brings us bread and tea and other items


He is not sure but it seems to him they have pay for the bed and for the medicine and for the treatment. They

pay for all this. The payment is too high compared with this one. Once you they (=interviewee) treat they give

2 years guarantee


If you get ill again you can come back within that 2 years range for free. 00:25:17-0


He asks pay this much. They willing pay me. It is free to the patients what they pay


As far as my opinion is concerned, the traditional treatment is more expensive than the modern one, because

the types of drugs that we administer for our patients has the sufficient power to heal and with the great standard

quality. In addition to that, I import the drugs I use for my patients from Sudan, India, France, etcetera. It

requires foreign currency therefore in effect it maximizes the cost. In addition to that since the cost considers

and includes the transportation cost and any other various related costs, there will be the condition to raise up

the value to pay by the patients.


First of all we do not talk about payments, we always first consider the awareness and the way to heal the patient

from the disease. Patients themselves ask about the payment. Sometimes we go to the level of providing the

service for free for patients who cannot afford for the service provided for them.


79


It is based on the capacity of patients. If patients who cannot afford for the service present the certificate

received from authorized body, we even provide them with required service for free. As far as my information

is concerned, traditional medicine is too cheap and affordable for everybody. For instance, in the modern

facilities there are various payments for the same medical case. If we consider that, of course the payment for

the traditional one is affordable and reasonable.


We first do not talk about payment. We tell patients about payment after they are healed and have received our

service. Then the patient pays us the amount he can afford. We also provide the service for free for needy

persons.


It is too cheap. Even we provide the service for free if they have sufficient evidence of needines


There is no doubt that the modern provider is highly expensive


It is too cheap. As we can see it, there is no expensive price for our service


As far as my experience is concerned, it is cheap and affordable. That is because we are using local herbs and

roots for which we are not paying too much


Still it is cheap, because patients may pay in different ways in the modern facility. For example, there is payment

for the card exam (lab, ultrasound, endoscopy) and finally for drugs. Therefore, there is a big difference in terms

of payment

Appendix V Article

80

Appendix V Article

Summary

This research investigates the opinions and beliefs towards cosmopolitan health care of traditional herbalist

healers in Ethiopia. A theoretical framework based on Social Learning Theory and Actor-Network Theory is

used to derive the eight concepts that are investigated in this research.

To investigate these eight concepts, ten traditional herbalist healers were interviewed, using semi-structured

interviews with the aid of translator. The interviewed healers all lived and worked in the Addis Ababa area. Five

of them were Ethiopian Orthodox, and the other five were Muslims; their ages varied between 28 and 95.

The main finding is that traditional healers are, in principle, positive towards more cooperation with

cosmopolitan health care. They see a great benefit in treatments they cannot deliver, such as operations or in-

patient care. However, differences are seen in the way medicines are prepared. The interviewees stated the

importance of using fresh ingredients, which is not case with medicines used in cosmopolitan care.

The most important hampering factor in cooperation with cosmopolitan care is the perception of traditional

healers that there is a lack of respect and recognition of their role. Cooperation between cosmopolitan and

traditional health care should be a two-way interaction.

Introduction

81

Introduction

About 80% of the population in Ethiopia uses traditional medicine (Kassaye et al., 2007). Therefore, the

Ethiopian government has formulated in its health policy, the desire to have a cooperation between modern

Cosmopolitan medicine and traditional healing (Ethiopian Health Policy, 2009). Understanding the beliefs of the

traditional healers towards modern cosmopolitan healthcare, in order to find common grounds for cooperation

between these two health systems, will make an important contribution towards the process of realizing the

policy objectives.

Traditional healing in Ethiopia

The definition of traditional medicine as used by the WHO is “the sum total of the knowledge, skills and

practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or

not, used in the maintenance of health, as well as in the prevention, diagnosis, improvement or treatment of

physical and mental illnesses” (Zhang, 2000).

Cosmopolitan medicine is understood to be health care that is delivered by hospitals and medical clinics, based

on a biomedical approach that has originated from a Western perspective (Taylor & Leslie, 1973). People who

practice this kind of health care should have a formal training in a medical faculty of a university or health

college. Synonyms often used for this health system include Western, scientific or modern healthcare.

This research only focuses on traditional healers working in Addis Ababa. Therefore for the purpose of this

research, a traditional healer will be defined as someone who lives in Addis Ababa, works with herbal

treatments, and who has not received any formal training from the cosmopolitan health system.

Traditional healing has a long tradition in Ethiopia (Slikkerveer, 1982). The practices are as diverse as the various

cultures within Ethiopia (Bishaw, 1991; Kassaye et al., 2007). For this research, the focus will be on the

traditional healers in Addis Ababa, where the traditional healing methods are strongly influenced by the

Ethiopian Orthodox Church (Slikkerveer, 1982). Health is seen as a gift from God, and religion plays an

important role in order to stay healthy (Bishaw, 1991; Kassaye et al., 2007). Furthermore, health is seen as a

state of equilibrium within the body and between the body and the environment (Bishaw, 1991). Some

comparisons with the cosmopolitan biomedical approach are possible. For example, it is believed that ill making

spirits live in unhygienic places that should be avoided (Bishaw, 1991). Nevertheless, the link with biomedical

tradition is not made explicit.

There are various types of traditional healers, each with their own characteristics (Young, 1976), for example

the meshaf-gelach, the Orthodox astrologer; the Zar doctor, the mystic spiritual healer of the Zar cult; the woggesha,

the pragmatic healer and bonesetter; and the tanqway, the diviner-wizard (S D Messing, 1972; Young, 1976).

Introduction

82

For this research, ten woggesha practicing in Addis Ababa are interviewed. The woggesha is a usually illiterate

pragmatic healer. He uses simple instruments, like scissors or cow horns, to relieve somatic complaints like

fractures, wounds or abscesses. Furthermore, the woggesha has great knowledge on the use of natural products,

such as plants or oils, for preparing traditional medicines (Bishaw, 1991). As causes of a disease can be seen as

a combination of natural and supernatural influences, the practices can be characterized by a combination of

mystical and pragmatic concepts and beliefs (Bishaw, 1991; Slikkerveer, 1982).

Interesting to note is that most traditional healers have a kind of ‘no cure, no pay’ system. Patients have to pay

an initial sum, but further payments depend on the effectiveness of the treatment (Leonard, 2003). This is one

of the possible explanations why the use of traditional healers is still very common in Ethiopia, where the,

sometimes even cheaper, cosmopolitan healthcare is expanding (Leonard, 2003; Slikkerveer, 1982).

The Ethiopian government has recognized the important role that traditional healthcare plays in Ethiopian

society (Kloos, 1998). Therefore, the Ministry of Health has indicated traditional medicine as one of the eight

priorities of the current health policy (Kassaye et al., 2007): “due attention shall be given to the development

of the beneficial aspects of Traditional Medicine including related research and its gradual integration into

Modern Medicine” (Ethiopian Health Policy, 2009).

However, it should be noted that already in the 1970s action was undertaken to integrate traditional medicine

in the cosmopolitan health system. This was not accomplished due to conceptual disagreement and deep-rooted

antagonism (Kloos, 1998; Kloos et al., 1988). Furthermore, these new policies are not yet implemented into

practice (Kassaye et al., 2007).

In order to be able to reach the objective stated above, the following two central research questions are

formulated.

What are the opinions and beliefs of traditional herbalist healers, in Addis Ababa, towards cosmopolitan health care?

and

Do they see possibilities to cooperate with the cosmopolitan health system?

Methodology

83

Methodology

This chapter describes the methods that were used in this research. First the framework is described that is

used for this research. From this framework several concepts are identified and it is explained why these are

important. The chapter is concluded with the description of the interviews and the interviewees.


In order to be able to answer the central research question stated above, a conceptual framework was developed.

This section describes the framework that was used and the various concepts that emerged when answering the

research question. The framework is based on Social Learning Theory (SLT) and Actor-Network Theory

(ANT).

These two theories were chosen because of the two main objectives of this research. One is the investigation

of the beliefs of traditional healers, while the second one is the investigation for possible common ground in

order to be able to have more cooperation between traditional and cosmopolitan medicine.

To understand what is necessary for this behavior change the model of Social Learning Theory is used as a tool

to find out what the factors are that could determine whether the healers are able to cooperate with

Cosmopolitan health care. Furthermore, it will be investigated what the relations are between the various

concepts. The different interactions with actants, human and non-human agencies interacting with each other,

will be mapped in order to increase understanding of the way the opinion of the traditional healers is formed.

For this the theory of ANT is used.

Furthermore, to be able to find out possible hampering factors and common ground for cooperation with

cosmopolitan health care, the relations between several concepts need to be investigated. A tool that gives a

description to find these, is Actant-Network Theory (Latour, 2005). ANT treats human and non-human objects

of equal importance and tries to find out what the relation between them is, in order to give a description how

these interact (Dolwick, 2009).

Within ANT one can identify five different concepts, or “uncertainties”, that need investigation to find out

what the relations are between the various actants (Latour, 2005). These five uncertainties that served as a

starting point of the research are the nature of: (1) groups, (2) actions, (3) objects, (4) facts, and (5) how to write

research accounts. These will be explained in the following paragraphs. The analysis of the interviews will be

done according to these five uncertainties in order to be able to identify the relations between the actants.

The next paragraphs explain the relations that are investigated in this research.

Methodology

84


The most important ‘environmental cue’ for the traditional healers is the way they believe diseases are caused.

These beliefs will influence greatly how they perceive cosmopolitan health care, because these are the lenses

the healers use when they think about curing (Young, 1983). Knowing their beliefs about diseases will help

explain the methods they use to cure patients and will help to explain their opinion toward cosmopolitan health

care.

Practices

The research aims to explore feelings of outcome expectancy among traditional healers. Specifically, how firmly

they believe in their treatment methods and their perceptions about the efficacy of cosmopolitan medicine, and

again, exploring options to establish common ground for cooperation. It is therefore necessary to know the

expectation of the healer about his capability of treating the patient (Good et al., 1979; Young, 1976). Therefore,

one has to look at the practices of the healers and how they believe that this practice is useful in curing the

patient.

The investigation of practices serves two goals: (1) to find out what the perceived self-efficacy of the healers is

and (2) how this relates to the cooperation with cosmopolitan health care.

Curing

A healer needs to have the belief he is able to cure a patient. It is therefore important to investigate the self-

efficacy of healers regarding the way patients are cured. This gives an impression on the way healers look at

cosmopolitan healthcare, which is likely to be very different in the way of curing patients than traditional care

(Mokaila, 2001; Young, 1983). For that reason, it will be investigated (1) what traditional healers see as necessary

for curing and (2) how they think about the way of curing by cosmopolitan health care.

To be able to understand the differences in curing between traditional and cosmopolitan medicine, there is a

need to investigate what kind of objects are used and what the role of these objects are. This will give a clue as

to how treatment is given and how this relates to the beliefs and opinions of the healers (Pelto & Pelto, 1997).

This will give information on possible common ground in the way patients are cured.

Social status

There is also the aspect of social status. Traditional healers have a role within their local society that determines

how they look toward cosmopolitan medicine: it can be possible that they see it as threat to their status and it

could create a negative opinion toward it (Harkness et al., 1981). On the other hand, when they feel that they

have a strong position in the community it is easier for them to cooperate on an equal footing with cosmopolitan

care. Furthermore, their social status will influence the way the interviewees act, because the community has

certain expectancies on their behavior and role.

Methodology

85

Within the framework of SLT, the social status has to do with incentive. Therefore, the role the healers have

within the local communities and societies will be investigated and related to their opinion on cosmopolitan

medicine. Furthermore, it will be questioned whether they expect to see a different role emerge when the

relations with cosmopolitan care changes.

Benefits

For traditional healers to cooperate with cosmopolitan medicine, according to SLT, there needs to be some

incentive. Therefore, this study will investigate what benefit they believe could result from cooperation.

Therefore, it is useful to investigate whether traditional healers see if people can benefit from cosmopolitan

health care, and if so in what manner. When the healers see benefits for their patients, it more likely that they

will cooperate with the cosmopolitan care.

Patients

Patients are included as an actant, because it is important to understand preconceptions of traditional healers

regarding treatment of patients, as these expectations will influence their opinion towards the practices in

cosmopolitan healthcare (Slikkerveer, 1982). The way this differs from that of the perceived cosmopolitan

perspective, will have an influence on the way they see the complete cosmopolitan health system.


An important concept that determines the view on cosmopolitan medicine is the knowledge of cosmopolitan

care of the traditional healers. This has to do with what healers expect from cosmopolitan medicine. Knowledge

can be on the way treatment is done is hospitals or the way patients are treated by cosmopolitan physicians.

This knowledge will influence their opinion of this system. Their own experience with cosmopolitan health

care can have a great influence on the way they see it, either positively or negatively (Young, 1983). Therefore,

it was be investigated what kind of contacts and interactions, if any, had occurred between healers and actants

of cosmopolitan health care, such as health clinics or medical doctors.

Payment

From the literature scan, the concept of payment emerged as important for this research, because of the clear

differences between the way traditional healers are paid and how payments are made in cosmopolitan

healthcare. Therefore, payment is included as an actant within this research. If income from the patients are

lost, traditional healers might be reluctant to cooperate with modern Cosmopolitan health care and will possibly

have a negative opinion towards Cosmopolitan medicine (Green et al., 1984). Therefore, one has to investigate

the way and in what forms payments are made (e.g. money or other forms of payment).

Methodology

86

Sub questions

Several sub questions emerged from the research framework that needed answering to be able to give an answer

the research question. This section states these questions.

What are the beliefs of traditional healers toward curing patients and how does this compare with their

beliefs about cosmopolitan curing of patients?

What is the social status of tradition healers in the research area?

What are the experiences and knowledge of traditional healers with cosmopolitan healthcare, with

regard to treating patients?

What similarities, if any, do traditional healers see between cosmopolitan and traditional beliefs about

treatment?

Do traditional healers see benefits from cosmopolitan healthcare for patients?

Interviews

Ten semi-structured interviews were conducted to find answers to some predetermined concepts. This number

of interviews gave sufficient in-depth information and it made it possible to compare the various answers.

Furthermore, it is a realistic number as one can expect difficulties reaching the healers (Flick et al., 2004). The

selection was made by convenient selection, with the help of researchers from the College of Health Sciences.

The researchers at the College of Health Sciences were in contact with mediators, who in turn had good contacts

with the interviewed traditional healers.

Furthermore, there was a snowball effect as participating healers were asked to introduce other possible

interviewees. It has been reported that response rates are lower when selection criteria are stricter (Ross et al.,

2011). Because there was limited time for this research, I opted for this method.

The interviewees were contacted by a contact person who is familiar with the healers and is trusted by them.

This was done to make sure that the response rate was adequate and the healers were willing to cooperate with

this research. They were provided with the aim of the study, so it was clear for them what to expect from the

interviews.

Because the traditional healers do not speak, or have very limited, English the service of a translator was

required. Two different translators were used, who both were instructed about the objectives of this research.

Before the start of the interview, the interviewees were asked whether they agreed for me to record the

interview. None of the interviewees had any objection about this recording. After the interviews were

Methodology

87

performed, they were transcribed in Amharic. This transcript was translated back to English by an independent

translation office. This, so called, back translation was done to ensure that the translations were adequate and

gave reliable results (Brislin, 1970). Every attempt was made to minimize the taking of notes as much as

possible, because taking notes may distract from the interviewing process resulting in information being missed

(Flick et al., 2004).

Interviews took place at the location of the healer, as this was most comfortable for him, and increased

likelihood of getting reliable results. Furthermore, it was easier to see the various objects and interactions of a

healer when at his location. When it was not possible to conduct the interview at the healer’s place, the interview

was done at a hotel or restaurant near the place of the healer. The length of the interviews was between 30 and

45 minutes.

Only male practitioners were interviewed for this research. Nevertheless, traditional medicine is practiced by

females as well (Yineger et al., 2008). Therefore, the role that gender of the healer might play is not investigated

in this research.

In order to check the comprehensiveness of the topic list and the estimated timing, the interview design was

discussed with several people who were familiar with traditional healers.

Five Muslim and five Orthodox healers were interviewed for this research. This makes it possible to investigate

if religion plays a role in the opinion of the healers, and if there are differences in the healing process between

different religions.

The education level varied from 8th till 12th grade, thus all the interviewees had at least completed primary

school3. Usually they were trained by another traditional healer before they started their own profession. This

could be a family member, such as father, but one interviewee told that he received his training in Sudan. Some

healers stated that they also received religious training; this was the case with Muslims as well as Christians.

The healers usually started in their late twenties or early thirties with their own practice.

Furthermore, there was a broad age range, with ages varying between 27 and 95 years. This gives thus a good

mix of ages, which makes it possible to see whether there are differences in opinion due to age differences.

This also implies that there was a great range in experience: some healers were only working for a couple of

years, while others had more than 30 years of experience in the occupation of traditional healer.

3 The Ethiopian school system consist of 8 years primary school, followed by 2 years lower secondary school and 2 years of higher secondary school (Teferra & Altbach, 2003).

Methodology

88

One of the interviewees is the chairman of the association of traditional healers4. This gave the opportunity to

question the role that organization could play in coordination the cooperation of the traditional healers and

cosmopolitan health care.

Analysis

The analysis of the interviews was done by means of structured analysis. The interviews were carefully examined

by categorizing the results according to the concepts identified above. These concepts were placed in a matrix,

which made it possible to see the different links between them. For this, the computer program WeftQDA was

used a tool.

This was done by making a code tree, and the main concepts are mentioned. From this tree, the various links

between the concepts are identified in order to see how the different actants influence each other.

4 The Ethiopian National Traditional Medicine Formulation and Treatment Organization, in the rest of this report it will referred to as the Association.

Results

89

Results


There are two main points that the healers identify within this topic. The first aspect identified, is that diseases

are caused by something that resides inside the body of the patients. In order to be able to heal the patient, this

has to be removed from the body. Therefore, a common practice is to prescribe a drug that causes the patient

to throw up or to have diarrhea.

The second, related, concept that came forward from the interviews was that a disease often cannot be removed

by surgery only. It is believed that the cause of the disease is inside the body and with surgery one only removes

the exterior parts. It is therefore that a disease should be cured with a medicine from plants or roots. This is

will result in the disease being removed from the body and therefore curing the patient permanently.

Practices

All the interviewees use herbs to make medicines for specific diseases. These drugs are prepared for use in

different forms, namely ointments, pills and syrups. They find it very important that these drugs are made from

fresh ingredients. Here they identify a difference with cosmopolitan care, which uses non-fresh ingredients to

prepare drugs. The traditional healers feel that this method will decrease the effectiveness of a drug.

Apart from giving injections, there is very little use of instruments. Both examination and treatment is done

without the use of instruments. The healers that use injections indicate that they use it in cases of hemorrhoid.

It was never mentioned outside that context. All the interviewed healers name the little use of instrumentation

as an important difference with cosmopolitan health care, where the use of instruments is ubiquitous. Most of

the interviewed healers are specialized in a certain type of disease. This can be for example skin disease or

respiratory problems like asthma. This implies that they only make drugs for a limited number of diseases in

which they are specialized. Curing

All the interviewees agreed that the cooperation of the patient is very important in the healing process. That is,

not only (herbal) medicines are needed, but also the attitude of the patient is needed. This means often that

patients need to change their lifestyle, for example by stopping the eating of raw meat or exercise more.

Another important aspect of curing mentioned by the healers is that always a diagnosis is made before the

treatment starts. The resulting treatment depends on the diagnosis made. Furthermore, when a disease is

diagnosed and the healer is unable to cure, the patient will be referred to another healer or to a hospital.

Furthermore, all interviewees indicated that they do not possess any special gifts, other than their knowledge

on diseases and plants. This knowledge is learnt from other healers. As one healer states: “Regardless of knowledge

Results

90

and experience, the knowledge of our forefathers has played significant role for us to be engaged in this work. I think there cannot

be any other skill except these ones.”

Social status

Most of the interviewees indicate that they feel well respected by the local community. This respect comes with

age, one of the younger healers indicated that he did not have the respect that his father had. However, some

indicate that there are some people who do have a bad attitude towards them. One indicates that this is caused

by beliefs that he uses witchcraft to cure people. Nevertheless, it is always a minority who has a bad attitude

towards them. One interviewee indicated that the trust increased because he was participating actively with the

community.

On the other hand, it is felt that the cosmopolitan health care has a very negative attitude towards their

profession. This is identified as a great hampering factor towards cooperation with the cosmopolitan health

care.

Another important aspect that came up often during this topic is that they would like to be more accepted by

the government and cosmopolitan medicine. They see this as a very important hampering factor that should be

changed before there can be effective cooperation between traditional and cosmopolitan health care. For

example, the organization that represents the traditional healers is not officially recognized by the Ethiopian

government.

Benefits

All except the oldest interviewed healer saw benefits from cosmopolitan health care. The most important

benefit seen is the use of instruments for diagnosis and the possibility of performing operations, both

unavailable to traditional healers. Another aspect they identify is that there are certain diseases that they are

unable to cure, while these can be cured in a hospital. Furthermore, for hospitals it is possible to provide in-

patient service, which is not possible for traditional health providers.

Patients

All interviewees emphasized that they treat all the patients equally. There is no difference made between the

patients’ religion, sex, background. Anyone who needs curing is welcome by the interviewed healers.

Furthermore, they see it as very important for their profession that there is no discrimination of patients.

With regard the treatment of patients by cosmopolitan health care, there is no difference identified by the

interviewees. They all believe that their mutual goal is to cure patients, and it does not matter what the

background of the patient is.

Results

91


All the interviewed traditional healers have been in contact with cosmopolitan medicine. It is very common for

them to refer patients to a hospital in case of disease they are unable to cure. This seems to be a relatively new

development, because in the literature it is never mentioned that patients are referred the cosmopolitan

hospitals.

As stated above, the interviewed healers recognize the more advanced use of instruments. Furthermore, it is

seen that hospitals have great benefit in being able to provide in-patient care; something that the traditional

care is unable to perform.

One of the suggestions made to overcome this barrier is that the government should create a kind of platform

where there can be an exchange of ideas between the cosmopolitan and the traditional medicine. It is felt that

if there is more mutual understanding, both the traditional and the cosmopolitan health care can benefit from

it.

It was suggested to form an independent board that coordinates exchange of knowledge between traditional

and cosmopolitan health care. Furthermore, it was suggested that there should be more research on the working

of traditional curing methods. By doing so, the healers believe this will lead to increased mutual understanding

which will increase their acceptance by cosmopolitan health. This might result in more governmental support

for the traditional health care, from which also patients can benefit. .

Payment

Payment is usually done after the treatment is finished. It is also customary that the payment depends on the

financial capabilities of patients; poor individuals usually have to pay much less or can even get treatment free.

The payment in general is made in money, however, it might be that people after treatment return with gifts in

kind, like food. This is seen as an extra sign of respect and gratefulness paid by the cured patient. The

interviewees told this often to show the respect in community that they earned with their profession, as it not

obligatory for the patient to do so.

The opinions are divided on whether traditional treatment is more expensive or cheaper than cosmopolitan

health care. Both opinions were equally voiced by the interviewees. It should be noted, however, that healers

who indicate that cosmopolitan health is more expensive argue that this is caused by the in-patient care. The

in-patient care is a function that the traditional healers cannot offer for their patients. This is seen as an

important difference between traditional and cosmopolitan health care.

Discussion

92

Discussion

This chapter discusses the results and places them in a broader context. The various concepts will be integrated

in the uncertainties of ANT that are indentified in the conceptual framework. Furthermore, the locations where

the healers practice and the methods used will be discussed. The chapter concludes with suggestion for further

research.

Results

The discussion of the results is clustered according to the uncertainties that were identified by ANT. This is

done to give the discussion structure and it will make it easier to see how the actants interact.

Groups

There is an association of traditional healers; however, this organization is not recognized by the government

as an official partner. This is felt by the healers that that they are not accepted by the government. This is clearly

an important hampering factor regarding cooperation with cosmopolitan health care. The association plays an

important role in organizing the healers and giving trainings and is therefore an important actant.

Patients are seen as important by the healers. According to the healers, they do not discriminate against their

patients. Everybody is welcome for treatment, regardless of religion, ethnicity, gender or age. They also identify

that treating patients is a mutual goal of both traditional and cosmopolitan health care. This is thus an important

common ground for cooperation.

The healers are in general well respected by the community. This might also depend on their age, as one the

interviewees indicates. This has probably to do with a broader cultural aspect where older people are more

respected due their age. Another explanation for this is that the older healers have a longer experience and

therefore more known in the community. When looking for cooperation, it might therefore be good to start

first with contacting older and more experienced healers as peers. Another argument for this is that young

healers are often trained by experienced healers, before they start their own practice.

Actions

The use of medical invasive instruments is very limited by traditional healers. This is partly caused by beliefs

about disease (“steel doesn’t cure”) but is also seen a benefit that cosmopolitan has above traditional care. The

curing of the patient by traditional methods is done by giving the patient drugs made from fresh ingredients.

Furthermore, advice on lifestyle is sometimes given, e.g. that the patient should not eat raw meat anymore or

should exercise more.

The cause of a disease is usually identified as something that resides inside the body, and has to be removed in

order to cure the patient. A difference with cosmopolitan care is that in traditional care this cause should be

Discussion

93

removed with medicines, and operations alone are not enough. Nevertheless, operations are seen as an

important benefit from cosmopolitan care. Nevertheless, this might be a common on ground on which

cooperation between the two health systems can be improved.

In general, there is not a negative attitude towards cosmopolitan health care. The interviewed healers see

potential benefits in cooperation with cosmopolitan health care for their patients. Nevertheless, they feel that

their profession deserves official recognition by the government and the cosmopolitan health care system.

Objects

There is very little use of instruments by traditional healers. They see this as one of the key differences in

comparison with cosmopolitan health care. Diagnoses are made by questioning the patient on the symptoms

and examining external factors such wounds and heartbeat by hand, while the interviewees indicate that in

cosmopolitan care equipment is often used to make a diagnosis. Furthermore, in the treatment the only use of

instrumentation is that of injections or medicines. There are no operations or any other direct interaction on

the body of the patient. All the interviewees highlight this as a key difference between their profession and the

cosmopolitan one.

The payment is done after the treatment, and depending of the financial situation of the patient. There is not

clear a vision on whether cosmopolitan care is more or less expensive than traditional care. Nevertheless, it

looks like traditional care takes the income of the patients more into account than cosmopolitan care does.

Medicines are arguably the most important object used by the healers. In general, these are local plants, but

some healers import them from countries like Sudan. This is identified as an important difference compared

with cosmopolitan care, where medicines are made from prepared non-fresh ingredients. This method is seen

as inferior by the healers and therefore an important aspect to keep in mind regarding cooperation.

Facts

A key result of this research is that healers do believe in their methods of curing, but they do not see this as the

only way to help patients. For some cases, their methods are insufficient and it would be better for the patient

to go to the hospital. In such cases, the healers do indeed refer the patient to a hospital. This finding was seen

in all the age groups; there was no difference in age, both the younger and the older ones would refer to

cosmopolitan hospitals.

Location healers

This section describes the healers’ places that I visited for the interviews. Not all the interviews were held at a

healer’s place, because these were seen as inappropriate for the interviews, for example due to lack of a quiet

place. Therefore, these places might differ significant from places described in this section.

Discussion

94

Layout

Most places I visited had a waiting room where the patients could sit before being called by the healer. This

waiting room generally had some benches to sit on and sometimes a TV was broadcasting. Patients were called

one by one to visit the healer in another room for the consult.

The patients were usually accompanied by a family member, for example husband or mother. These were also

present during the consult with the healer.

The medicines were sometimes stored in the treatment room and sometimes in a separate room. In a couple

of cases, the medicines were sold by assistants of the healer. People could return when they needed more

medicines.

The places were in general well maintained and clean. All the places visited had electricity and thus electric

lightning. This was also necessary, as there was no daylight inside because of the lack of windows. Nevertheless,

the rooms were still only dimly lit.

Objects

A couple of healers used printed leaflets to promote their activities. These flyers stated for example the diseases

they were able to cure and experiences the healer had. I only found these flyers at the older healers; none of

the healers under 50 years seemed to advertise this way.

One of the healers had a handwritten book with different treatment methods and recipes for medicines. None

of the other interviewees seemed to use a book in determining the diagnosis. However, some had a certificate

hanging on the wall that showed certain courses they had conducted at the association of traditional healers.

They seemed proud of this and always mentioned it during the interview.

The Orthodox healers had various religious symbols placed in their rooms. These included images from saints

or crosses. In general, the places of the Muslims were much more sober in decoration. It seemed, however, that

religion did not play an important role for the way patients were treated. For example, none mentioned religion

as being important to cure patients and all healers indicated that they helped people regardless of religion.

People

When first contacting the healers, they seemed a bit reluctant to cooperate with the research, but once agreed

they were quite cooperative to work with me. The only restriction they often made was that they would not tell

how they prepared their medicines. This was a result of bad experience in the past when people were using

their recipes and methods without their permission.

Discussion

95

During the interview, the interviewees were quite relaxed and came up with subjects themselves. They seemed

to be quite happy to participate with the research. I did not have the impression that they were afraid to answer

questions or to speak out.

Limitations of the study

For this research, ten traditional healers were interviewed. It is therefore impossible to draw quantitative

conclusions. On the other hand, the number of interviewees is enough to draw qualitative conclusions that can

give a good starting point for further research.

Furthermore, all the interviewees practice in the capital Addis Ababa. Therefore, the conclusions will only be

applicable to this group of traditional healers. From the literature, it is clear that there are various other groups

of practitioners with different beliefs. Therefore, these different groups might have quite different views

towards cosmopolitan health care and the results of this research can therefore not be generalized towards

other types traditional healing. For example, it is likely that healers living in rural areas have much less relations

with cosmopolitan health care, simply because cosmopolitan health care is much more lacking in rural areas.

Two different translators were used during the interviews. This might lead to a slightly different interpretation

of the questions. I tried to minimize this effect by translating the transcripts in Amharic by a translation office.

In addition, both the translators were instructed on the objective of this research.

The method of selecting the interviewees with help from the College of Health Sciences might impose a bias

among the respondents, as they likely have a positive attitude towards cosmopolitan health care. It is also

possible that people who are positive towards cosmopolitan health care are more likely to participate with this

research than healers who have negative experiences or attitude.

Further research

Several points are interesting for further research. It might be very interesting to compare the finding of this

study with other groups of traditional healers. Ethiopia is a country with a very diverse population, so the

opinions in other ethnic groups might be very different from that in the capital (Abbink, 2009). Furthermore,

for this research only male practitioners were interviewed. It might be interesting to explore the opinions of

female healers as well and see if there are any differences in gender roles.

The interviewees indicated that they found it important to have more recognition from cosmopolitan care

professionals. It would therefore be interesting to investigate whether practitioners of cosmopolitan care are

willing to cooperate and see possibilities for cooperation. A good start would be to repeat this study with

participants from the cosmopolitan health.

Discussion

96

It might be interesting to visit the healers when they interact with patients and compare this with the way the

patients are treated in a clinic of the cosmopolitan health care. This might lead to a better insight into the way

patients are treated. The comparison can provide insight in possible hampering factors and common ground

for cooperation.

Conclusions

97

Conclusions

The most important belief identified is that to cure a patient the ‘object’ that causes the disease has to be

removed from the patient. This has to be done the inside, and with the aid of medicines. A surgical operation

alone is not seen as sufficient. Another important aspect is that the medicines used should be prepared from

fresh ingredients.

All the interviewed traditional healers indicated that it is important for them to treat all patients equally,

irrespective of religions, age, and sex.

The interviewed healers feel well respected by the local communities. They do not see this to be changing due

the arrival of cosmopolitan health care. However, their social status might be depending on age. Younger

interviewees indicate that they do not have as much earned respect as older healers.

The interviewed traditional healers have a quite clear vision on what cosmopolitan care is. They do have contact

with and even refer patients to hospitals. However, they would like be respected as well for the work they do.

Here lays, according to the interviewees, an important role for the government to facilitate this, probably in

cooperation with NGOs. Another important actant is the organization of traditional healers, that can play a

mediation role in the process of increased cooperation.

The most important similarity identified is that the goal of both traditional and cosmopolitan health care is to

cure patients. This is therefore an important aspect to focus on to improve cooperation between cosmopolitan

and traditional health care.

The interviewed traditional healers believe that it is possible to cooperate with cosmopolitan health care. They

especially see opportunities in cases that they are unable to cure, for example because an operation is necessary

or the patient needs in-patient facilities. They do not see cosmopolitan health care as a threat for their own

profession.

There are differences regarding treatment methods, but it seems that these are not too big that it should hamper

the cooperation between traditional and cosmopolitan health care. The most important difference is the lack

of trust of traditional healers in medicines prepared from non-fresh ingredients.

The most important hampering factor is the lack of recognition of traditional medicine that is given by the

government and cosmopolitan health care. Furthermore, a lack of respect is felt from the cosmopolitan health

care. In order to create a successful cooperation between cosmopolitan and traditional healthcare, it is important

that these two factors should improve.

References

98

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Interviewees

101

Interviewees

Interview

number

Date of

interview

Age Religion Formal

education

Comments

1 November 19 28 Islam 8th grade He is working together with

his brother. Their father was a

healer as well.

2 December 9 95 Orthodox Unknown He is a former officer in the

imperial army. He has two

assistants who help him.

3 December 19 27 Orthodox Unknown Trained by Sudanese in herbal

medicine


traditional healer


around 40

Islam 12th grade


around 50

Islam 8th grade Has also received religious

education

7 January 23 58 Orthodox 8th grade Chairman of the traditional

healers association

8 January 23 51 Orthodox 8th grade

9 January 24 54 Islam 10th grade Working for 23 years up as a

traditional healer


traditional healer

report internship 2 jan willem knibbe 1473735

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