|Year : 2019 | Volume
| Issue : 4 | Page : 115-120
Traditional healers in Senegal: Characteristics and beliefs about treatment of diabetes
Nicole Hammond1, Rhonda Belue2, Bilikisu Elewonibi3, Rhoda Moise4, Laura Leuenberger1, Gail Hughes5
1 Medical and Graduate Education, Pennsylvania State University, College of Medicine, Hersey, PA, USA
2 Department of Health Management and Policy, St. Louis University, St. Louis, MO, USA
3 Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
4 Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
5 Department of Medical Biosciences, University of Western Cape, Faculty of Natural Sciences, Bellville, South Africa
|Date of Submission||30-Jan-2019|
|Date of Decision||03-Sep-2019|
|Date of Acceptance||03-Dec-2019|
|Date of Web Publication||31-Dec-2019|
Dr. Rhonda Belue
Salus Center, 3545 Lafayette Ave., St. Louis, MO 63103
Source of Support: None, Conflict of Interest: None
Background: It is known that patients with noncommunicable diseases utilize traditional healers (THs) regardless of their ability to access biomedical treatment facilities. However, information regarding the practices of THs and how they treat in Sub-Saharan African (SSA) is limited. This study examines the sociodemographic characteristics of Senegalese THs, how they treat diabetes, and how they interact with both patients and the larger health-care system.
Materials and Methods: THs were identified in M'bour, Senegal, who practice alongside a government hospital and several health outposts. Twenty THs agreed to participate in recorded interviews. A standardized questionnaire was used to investigate general practices and management of diabetes.
Results: Eighteen of the THs were male, ages 22–70 years. Thirteen were trained through family members, while five never received training, citing that they were born with or received their gift in a dream. All THs treated physical illnesses, including diabetes. Plants were used by all THs and were usually dispensed in the form of powder. Nine THs stated that they could lower blood sugar levels, while five said they were able to cure diabetes completely. Many THs cited referring patients to biomedical treatment centers if unable to manage their conditions either initially or after treatments were unsuccessful.
Conclusions: This study provides insight into the practice of THs in rural Senegal. Findings suggest the need for collaboration among THs, health professionals, and patients, given the increasing burden of diabetes in SSA.
Keywords: Diabetes, noncommunicable diseases, SSA, traditional healers
|How to cite this article:|
Hammond N, Belue R, Elewonibi B, Moise R, Leuenberger L, Hughes G. Traditional healers in Senegal: Characteristics and beliefs about treatment of diabetes. Int J Non-Commun Dis 2019;4:115-20
|How to cite this URL:|
Hammond N, Belue R, Elewonibi B, Moise R, Leuenberger L, Hughes G. Traditional healers in Senegal: Characteristics and beliefs about treatment of diabetes. Int J Non-Commun Dis [serial online] 2019 [cited 2020 Jan 20];4:115-20. Available from: http://www.ijncd.org/text.asp?2019/4/4/115/274461
| Introduction|| |
Globally, rates of noncommunicable diseases (NCD) continue to rise, with low-and-middle-income countries bearing a disproportionate burden of related morbidity and mortality. African countries are projected to experience the largest growth of NCD. Many Sub-Saharan African (SSA) countries have already reported increased stress on their underresourced health-care systems. The International Diabetes Foundation (2017) estimates over 15 million people in SSA have diabetes, one of the leading causes of NCD mortality. The majority of deaths from diabetes in SSA (79%) occur people <60 years of age., Preventable and premature mortality from diabetes not only poses a threat to the socioecological function of SSA countries, it also directly costs several billion US dollars in expenditures, further stressing these developing countries.
In Senegal, the prevalence of diabetes has been documented to be as high as 8.1% in urban areas. In rural areas, the prevalence has been noted as high as 4.6%. Of the limited literature on diabetes management and treatment in Senegal, studies highlight poor outcomes due to several factors including lack of detection services, insurance, and affordable medication., Notably, traditional healers (THs) are a frequent feature of African society. Established literature suggests that THs may be the only source, or even the preferred source, of health care for many people living in SSA.,,
It has been estimated that there is one TH for every 200 people in SSA; these healers are the primary caregivers for 80% of the population throughout the continent. In Senegal, THs are common and sought out for a variety of health and spiritual concerns.,, For instance, a cross-sectional survey implemented in Dakar, Senegal, found patients reported common use of herbal medicine such as Moringa to treat diabetes due to cultural values, efficacy, and cost-effectiveness. Further, studies have advocated for the legitimacy of traditional medicine to be acknowledged and integrated into the continuum of care to provide a culturally sensitive and comprehensive approach to wellness.,
The purpose of this study was to examine the sociodemographic characteristics of Senegalese THs, practice structure and treatment modalities, how they treat NCDs, specifically diabetes, and how they interact with larger health-care system.
| Materials and Methods|| |
THs were interviewed in June 2015 in M'bour, Senegal, a town of 973,000 people about 80 km from the capital city of Dakar. Roughly half of the population of M'bour lives in the rural areas surrounding the town, while the other half of the population lives in the urban area of the city. The area is serviced by one main government hospital, the Hospital of M'bour. There are a number of ethnicities present in the greater M'bour area. The population is 72% Serer, 15% Wolof, 8% Mandinka, and 5% other. Islam is the dominant religion, but Christianity and Animism are also present.
THs were identified through various means, including radio, television, and signs advertising their practices. Snowball sampling was used to identify additional TH practices. THs referred us to their colleagues, and customers referred us to other healers whom they frequent. All 20 of the healers approached for interview agreed to participate. A research assistant who is also a resident of M'bour completed immediate interpretation between Wolof and English for most of the TH interviews. On two occasions, immediate interpretation of Wolof and English was not used. One TH was proficient in English and preferred to communicate with the research team in English. Another TH was originally from Spain and preferred to speak Spanish with a member of the research team who was fluent in Spanish. Each of the interviews was audio recorded with the permission of the TH and was later transcribed in English and back-translated. Each TH was compensated for his or her time.
Ethics approval was received from the lead authors' institution. In addition, colleagues from the hospital of M'bour who work in community outreach reviewed the protocol for cultural relevance and provided a letter of support.
The interview instrument was designed to elicit the following pieces of information in the order listed: demographics, practice information, treatment modalities, treatment of diabetes, plant collection, and relationship with allopathic medical providers. The interview was conducted in an open-ended question format and concluded with an opportunity for the THs to ask questions of the interviewers. The instrument was adapted from a previous study conducted in Southern Africa. The full list of questions is included in Appendix A.
The demographic data obtained from the THs were quantified using descriptive statistics. Qualitative data were analyzed with familiarization, a process during which the researcher becomes immersed in the details of the data to gain a general understanding of the content and to document initial impressions. Content analysis identified emergent themes from the interview questions. All analyses were conducted by hand. Transcripts were analyzed by two members of the research team and corroborated by a third. Themes related to each survey question as well as emergent themes are presented and discussed.
Interview results highlight information on how TH build their practices, including ways of knowledge acquisition, practice management, specialties, and treatment modalities. The following themes emerged related to beliefs about Western medicine and specific ways to treat diabetes were identified from the content analysis: including the relationship with Western medicine and knowledge and treatment of diabetes.
| Results|| |
Sociodemographic characteristics of traditional healers
Twenty total interviews were conducted regarding the practice of 21 THs in M'bour, Senegal. One of the practices was run by a husband and wife team, for a total of twenty practices investigated in total. Therefore, when discussing the healers themselves versus the practices, 21 healers will be discussed. Nineteen of the THs were male; two were female. The healers ranged in age from 22 to 70 years, with a mean age of 49.76 years. They represented seven different ethnicities: Wolof 7 (33%), Serer 4 (19%), Toucouleur 3 (14%), Spanish 2 (9.5%), Peulh 2 (9.5%), Soce 1 (5%), Lebou 1 (5%), and Diola 1 (5%). The THs spoke a combined total of 14 languages: Wolof (20), French (9), Serer (5), Arabic (5), Toucouleur (3), Peulh (2), Soce (2), Spanish (2), Catalan (2), Creole (2), Bambara (1), Pular (1), English (1), and Diola (1). 85% of the healers identified as Muslim. Their formal education ranged from no schooling to completion of medical school.
The 21 THs learned their trade in different ways. The majority (61%) were trained through family members, usually grandfathers and fathers. Some noted that healing was a trade of their ancestors. However, five healers noted that they never received training, citing that they were born with the gift or that the information “just came to them,” usually in a dream. Seven healers cited that they spent time training with THs outside of their family or through more formal apprenticeships. Two learned their trade while in Quranic School. In addition, two healers were medically trained in Spain and specialized in Traditional Chinese Medicine. They were a husband and wife team practicing acupuncture in M'bour. Others noted that they had used the internet to research treatment modalities and had also traded or purchased information from others. Twelve of the healers (57%) learned through multiple means. For example, one healer was trained by his father and also completed an apprenticeship.
Practice structure and treatment modalities
The 21 THs have been in practice from 3 to 46 years, with a mean of 20.4 years. Fifteen healers worked full time as THs, while six worked part-time. Those that worked part-time had other jobs including managing a corner store, working at the market, teaching the Quran, and working as an artist. Many of the healers that worked full time spoke about their professions prior to practicing full time but said that demand became so high for their healing practices that they had to abandon their other profession. Most TH accepted cash payments, and less often bartered their services for items such as food items; in some specific cases, they offered their services gratis.
The most commonly cited specialties of treatment were diabetes (6), headache (5), asthma (4), infertility/erectile dysfunction (4), gastrointestinal upset (4), and hypertension (4). Other specialties including cancer, pregnancy complications, and muscular/skeletal pain were also mentioned. All of the practices treated ailments that were also treated by the modern medicine health system. In addition, 20% of the TH practices also cited practicing nonmedical specialties including spiritual problems, jealousy, examinations, travel visas, and jail time.
All 20 TH practices used plants in some form for treatment. Fourteen used powder from different parts of a plant – either leaves, branches, or roots – thus making it the most commonly used form of herbal medication. The use of powder and other portions of the plants could be consumed orally or made into a liquid form to drink as a tea, to bathe in, or to put directly on the skin. The leaves could also be burned, smelled, or boiled for medicinal purposes. In addition, one healer noted that powders could also be administered in the form of suppositories. The second most common form of herbal medication was tea, utilized by six of the TH practices.
Prayer was another significant component of treatment, with 12 healers citing the use of this form of healing. Many healers incorporated prayer in the initial assessment of the patient. Through prayer, the TH could determine if he/she would be able to help the patient and what methods to use. In addition, three healers also spoke of writing verses of the Quran on paper and then washing the paper with water. The water was either consumed orally by the patient or mixed with powder for treatment. The Quran was also used by four healers in their practices. Animal sacrifice was performed as a healing methodology by five of the THs interviewed. Other modalities discussed included: acupuncture, mysticism, laying hands on patient, sand fortune-telling, use of feathers and animal skin, and use of genital stimulation.
Knowledge and treatment of diabetes and other conditions
The treatment of diabetes varied significantly among the THs of M'bour. Nine practices (45%) noted they could not cure diabetes but are able to treat it. Five practices (25%) noted they could cure diabetes completely, while six practices (30%) do not treat diabetes at all.
Three of the healers that treat, but do not cure diabetes, believe that patients should still be seen by modern medicine. One healer, in particular, believed that modern medicine can cure diabetes. TH do not treat diabetes for a variety of reasons. One healer noted that he knows how to cure diabetes but is unable to treat patients as he is unable to access the required plants. Another healer reported that he had cured diabetes in the past, but patients do not seek his care because they do not have faith in his ability to cure diabetes. Another healer spoke very matter-of-factly about diabetes, stating, “I cannot do anything for diabetes, and anyone that tells you that they can is lying.” Furthermore, the healers that specialize in traditional Chinese medicine do not treat diabetes.
The utility of checking blood sugar levels was brought up by four THs. Two healers had glucometers that they used to check their patients' blood sugars. Another healer informed the research team of his plan to buy a glucometer, as he wished to verify the efficacy of his treatments. Another healer encourages patients to check their blood sugars both before and after consuming his traditional medicine to ensure their treatments are effective.
Treatment modalities for diabetes always included plants; however, some healers also utilized the Quran. The plants were made into tea or other liquid forms and consumed or placed directly on food before it was consumed. One healer who informed us that he is able to cure diabetes discussed his treatment modality in detail. He encouraged patients to boil chicken with roots that he provides to patients. The patient is then instructed to consume the boiled water as treatment for diabetes. He also presented another curative option for diabetes, which included boiling bark from a specific tree and drinking the boiled water for 3 days.
One healer discussed the challenges of working with diabetic patients. He reported that he must travel outside of the city of M'bour to obtain plants to treat diabetes. The plants cost the TH 4000 CFA, but the patient for whom he obtained the leaves only compensated him 500 CFA for the treatment. One healer mentioned that he has diabetes and seeks biomedical services for treatment. He noted that he cannot seek the help of another TH because people would believe he is incompetent. He believes that he does not have the ability to heal himself, which is why he seeks outside treatment.
Interaction with health-care system and health professionals
Seventeen of the 20 practices noted that they had referred patients to the local hospital, the main point of care for both inpatient and outpatient needs in M'bour. Conditions in which THs elected to refer patients to the hospital include diabetes, stomach pain, open wounds, infection, need for X-rays, and blood transfusions. One TH specifically stated that he prefers patients seek biomedical treatment first, and only seek traditional practices if biomedical treatment is unsuccessful. In contrast, one healer commonly reported receiving referrals from the local hospital, but never sends patients for biomedical treatment. Eight (40%) of the THs have treated patients who were referred to them from the hospital. Half of those that receive referrals note that they work directly with the hospitals to treat patients. Two healers mentioned that biomedical facilities will call them to assist in patient care; one treats burns and the other repositions breech babies prior to delivery.
In some cases, THs commented on the combination of traditional and modern medicines. Four believed that it was inappropriate to mix traditional medicine with modern medicine, with the majority of those suggesting that patients complete their prescribed dosage of modern medicine before starting traditional medicine. The other recommends that modern medicine be stopped, and traditional medicine be initiated upon seeking out his recommendation. In contrast, another healer sees no problem with combining biomedical medicine and traditional medicine as long as the patient is benefitting from both.
| Discussion|| |
The male predominance of THs in Mbour, Senegal, and the familial training of most THs in this study (61%) are consistent with THs throughout SSA. THs in Tanzania, Kenya, and Ethiopia were also found to be mostly male and often trained in a combination of ways, with family-based apprenticeships the most common.,, An additional 25% of the THs interviewed in Mbour stated that they had no formal training, and that the information just “came to them,” often in the form of a dream. The acquisition of knowledge through dreams is a commonly reported fact; THs in Tanzania and Cameroon also noted their knowledge came to them from God, or that spirits spoke to them through dreams.,
Numerous aspects of the TH characteristics and practices of Senegal impacted accessibility to patients. Typically, the biomedical health system in Senegal operates predominately in French and one or two other languages. The 20 TH practices interviewed for this study, however, were multiple ethnicities and religions, spoke a multitude of languages, and offered numerous and variegated selection of services. They also represented seven different ethnicities as well as faith-based (Christian, Muslim, and Mystic) and nonfaith-based practices. In addition, traditional health practices of Senegal offered services for both medical and nonmedical concerns, as well as acupuncture. While this fact undoubtedly increases their accessibility, it also provides insight into the health concerns of the people of Senegal. The most commonly reported specialties among THs in M'bour are chronic conditions, suggesting that they have responded to the increase in NCD in the region. Senegalese THs are not alone in this response, as the specialization in NCDs was also seen in Tanzania, where infertility, headache, and abdominal problems are most frequently treated by THs. The treatment of nonmedical concerns is also well documented in Cameroon, where THs treat mental health problems and witchcraft.
The complex relationship between THs of Senegal and biomedical treatment facilities concordant with literature outlining the traditional healing practices throughout the continent. The referral system to biomedical facilities discussed among Senegalese THs is similarly described in Cameroon, where an informal referral system exists; and in Tanzania, where most healers referred their patients to modern medical facilities either because their treatment failure or there existed the perception of better treatment., This information, however, differs from a study in Ethiopia, where only one healer referred patients to a modern medical facility. This lack of referral in Ethiopia is theorized to be due to a mutual distrust of practices between THs and biomedical treatment facilities.
While the practices of the THs varied, their differing views on diabetes are perhaps the most striking. Twenty-five percent of THs in this study believed diabetes could be cured, which is in direct contrast to the current scientific data. The belief that diabetes can be cured is shared by THs in South Africa, Cameroon, Kenya, and Uganda.,,,,, This is likely attributable to the fact that traditional health practices in Africa often believe that all ailments have a cure.
The use of modern medicine and biomedical practices among THs in Senegal has also been reported in other SSA nations. The use of glucometers was also seen in Kenya, where THs used both glucometers and hospital laboratories to confirm the diagnosis of diabetes. Similarly, in Cameroon, the majority of healers said they refer cases of diabetes to biomedical treatment facilities. Furthermore, the combination of traditional medicine and modern medicine is shared among THs in Northern Tanzania.
Throughout SSA, diabetic patients are seeking the treatment of THs. Diabetic patients in Guinea note the use of THs because of lower cost, easier access to treatment and belief in its efficacy. Similarly, in Ethiopia patients selected THs first, perceiving them to be more efficacious. Conversely, most diabetic patients surveyed in Ghana sought biomedical care first due to their confidence in the practical knowledge and expertise of providers and publication of solutions to causes of diabetes through drug and dietary management. For those who chose to seek traditional medicine first, they believed their disease to be a result of witchcraft. Many of these people later turned to biomedical care.
| Conclusions|| |
This initial investigation provides insight into the practice of THs in rural Senegal and their relationship with biomedical treatment centers. It is known that patients throughout SSA seek the treatment of THs for a variety of reasons, medical and nonmedical. While THs care for a majority of the population, little standardization among the training and treatment among THs has been found. Furthermore, the efficacy of many herbal medications is unknown or not yet studied. Thus, much more research into the practices and treatment is required.
However, many opportunities to collaborate exist. The informal relationship between biomedical providers and THs suggests a mutual respect between providers. If present, this relationship could be used to help incorporate THs into the health-care system. This would be congruent with the World Health Organization Traditional Medicine Strategy 2014–2023, which aims to “promote the safe and effective use of traditional medicine by regulating, researching and integrating traditional medical products, practitioners and practice into health systems where appropriate.”
Studies completed in other African countries have demonstrated some success in training THs on the biologic basis of disease, in order to expand their public health capacities as health educators.,, This model could be explored in M'bour to increase the prevalence of knowledgeable providers who assist in the treatment and education of patients, given the increasing burden of diabetes and other NCDs in SSA.
Travel support was provided in part from the National Research Foundation in South Africa, and University of Western Cape Research Office.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| Appendix A|| |
The interview questions have been designed to obtain information from traditional health practitioner who uses traditional herbal medicines and other treatment modalities for treatment of diseases. Specifically, this study would like to determine which traditional herbal medicines and approaches are being used for the treatment of noncommunicable diseases such as diabetes. The research findings of this study will help in understanding the usage pattern of traditional herbal medicines, plants used and in documentation for future use. Participation is voluntary and withdrawal from the study is allowed without penalty at any time. Your confidentiality and anonymity will be kept at all times.
Participant Name: _____________
Participant ID Number: _____________
Date of interview: ______________
Name of interviewer: ______________
Study title: Approaches to Treating Diabetes among Traditional Healers in Senegal West Africa
The interview will take 30 min to 1 h of your time. Feel free to ask questions if you do not understand the questions.
Participant demographic profile
- Gender: Male [ ] Female [ ]
- Age (completed years only):………………….
- Ethnic group [ ] Wolof [ ] Serer [ ] Pular [other]
- Place of origin
- Languages Spoken (specify)………………………….
- Marital Status: [ ] Never Married [ ] Married [ ] Divorced
- How long have you been staying in M'bour, Senegal?
- Highest level of formal education completed: [ ] No education [ ] Primary school [ ] Secondary School [ ] Tertiary [ ] Other (Specify)………….
- Employment status: [ ] Working full-time [ ] Working part-time [ ] Unemployed
- How do you receive payment for services?
Part A: Practice information
- Tel me about your experience as a traditional healer? In terms of
- Length of practice (how long have you been a traditional healer?)
- Your specialty if there is any (i.e., specialize with chronic diseases/HIV/AIDS)
- Do you work with diabetics?
Tell me about your knowledge of plants? In terms of
- How do you know which plants to use,
Part B: Traditional herbal medicines in use for the treatment of diabetes and hypertension and other related illnesses (e.g., stroke)
- Which traditional herbal medicines do you use to treat/manage Diabetes?
- Which parts of the plant are you using when treating Diabetes patients?
- In what form do you dispense your medicines?
- In what form are your patients taking this traditional herbal medicine?
- How do you prepare your medication?
- In what quantity or dose is the medicine administered?
- In which way is the medication administered?
- How long is the patient supposed to take the medication?
- What other healing modalities do you use for Diabetes?
- Forms of prayer
- Topical herbs (e.g., to shower with)
- Use of animals?
Part C: Plant collection
- Tell me, where do you get your plants and how do you harvest them?
- Is there anything you would like to add?
Part D: Collaboration with Allopathic Providers?
- Do you ever work with Doctors or Nurses at a Hospital?
- Do you discuss other types of Medical Care with your clients? Why/Why not?
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