Middle East Journal of Family Medicine

Correspondence to:
Dr. E. E. Enwereji
College of Medicine,
Abia State University
Uturu, Abia State
Nigeria
Email: hersng@yahoo.com
Phone: 2348036045884

ABSTRACT

Background and objective: There are medicinal plants of interest, which herbal medical practitioners claim are useful in treating infections including HIV/AIDS opportunistic infections like tuberculosis, diarrhoea, and others. The study aimed to highlight important herbs used in treating and/or preventing infections including HIV/AIDS opportunistic infections in Nigeria. The study identified limitations to the advancement of traditional medicine and ways forward. This was necessary now that most countries are encouraging acceptable and affordable local technologies in the prevention and/or treatment of diseases including HIV opportunistic infections.

Methods: To prepare this document, the author underwent six months apprenticeship on the use of herbs from three renowned traditional healers. Data were gathered through literature review, interviews and observations made during participation in treatment of patients. Ways forward in practice of traditional medicine were emphasized during the study.

Findings: Knowledge of mode of transmission of infections including HIV was poor. Out of 56 patients studied, only 6 (10.7%) mentioned two modes of HIV transmission, the rest 50 (89.3%), including the three traditional healers, had wrong knowledge of HIV transmission.
Patronage for traditional medicine especially among youths was low. Out of 56 cases treated 18 (32.1%) persons were youths, the rest were middle age and elderly persons.

Conclusion: Though patronage for traditional treatment was low, traditional medicine proved effective for augmenting unaffordable and inaccessible orthodox medicines in Abia State, Nigeria.

Key words: opportunistic infections, orthodox, medicinal plants, rituals, Nigeria

Nigeria is a large country with numerous rich natural medicinal plants and human resources[1]. Nigeria has immense potential in the area of using preparations from these plants to complement what the western world offers in treatment and/or prevention of infections including HIV/AIDS opportunistic infections.

About 15 percent of flowering plants in Nigeria have some medicinal properties. In Abia State of Nigeria, there are about 3,000 medicinal plant species for treating different diseases including opportunistic infections[2]. Over 70 million Nigerians depend on preparations from them in the cure of diseases[3]. Though treatment of HIV/AIDS opportunistic infections like pneumonia, diarrhoea, tuberculosis, and others \, was targeted, treatment of other health problems of interest was also included.

Currently, there is a very high demand for traditional treatment for infections among the middle aged and the elderly in developing countries including Nigeria[4, 5]. It is now an important component of health care services in the rural areas, and will continue to be because of the inaccessibility and un-affordability of health care services including anti-retroviral drugs[6]. It is clear that not many people, including those living positively with HIV/AIDS can afford drugs[7,8]. Therefore, to move indigenous treatment forward, there is need to incorporate new knowledge, technologies and techniques in the effective treatment of opportunistic infections[9, 10,11]. One problem of herbal medicine is lack of documentation[12]. This lack of documentation has been shown to be the main cause of poor patronage and practice of traditional medicine[13,14,15] yet studies have identified medicinal plants as the main stay of pharmacotherapy[16,17,18] and basic drugs like aspirin, reserpine and others are all derived from plants[19,20 21,22]. The question is, to what extent is traditional medicine used in treating and/or preventing infections including HIV opportunistic infections?

Objectives of the study include:

In preparing materials for this work, the author underwent six months of apprenticeship in herbal medicine under three renowned traditional healers. As a result of some initiations, she participated in the treatment of patients and skills for clairvoyance and clairaudience with medicinal plants were developed. This orientation enhanced skills to identify specific curative properties of some plant species. From this perspective, much of the information contained in this paper has not been documented elsewhere. As such, only information, which an initiate can reveal without committing serious indiscretion, has been provided.

Data was collected through review of relevant literature, interview guide and observations made during the study. Interview guides for collecting information from patients and traditional healers contained structured and unstructured questions.

During the study, the author participated in treatment of 56 patients comprising 38 (67.9%) males and 18 (32.1%) females who came down with various ailments including malaria, typhoid, diarrhoea, boils, productive cough and others. Most of these cases were treated with assorted herbs suspected to prevent or treat such ailments.

Limitations observed during study:
The study noted technical, social, logistic and financial limitations that affected setting up, practice, diagnosis and management of cases. Some of the limitations observed are discussed below:

Lack of proper documentation:
A major problem of traditional medicine noted during the fieldwork was lack of documentation. Elderly persons were mainly the practitioners of this knowledge. They passed on knowledge through word of mouth and rituals in accordance with their ethical codes. Specifically, the study noted poor scientific research and/or documentation of the taxonomy of medicinal plants used in treating and/or preventing diseases.

Ignorance and cultural attitudes:
There was a general lack of knowledge on mode of transmission of infections including HIV. Out of the 56 patients studied, only 6 (10.7%) mentioned two modes of HIV transmission (sexual intercourse and blood transfusion) the rest 50 (89.3%), as well as the three traditional healers, viewed HIV infection as a curse from God for violating sexual norm and also as witchcraft from enemies. This lack of knowledge influenced the healers' attitude and method of treatment. Most healers used bloodletting as an essential method of treating most acute infections including HIV/AIDS. As a result, no treatment was termed complete without bloodletting, a practice that could expose individuals to blood transmitted infections.

During treatment of any disease, objects such as dry bones, stones, shells, and other items believed to boost potency of herbs were freely displayed. The belief is that the more the number of objects displayed, the more acute the illness and the more several methods are employed during treatment.
Further finding showed that culturally, individuals treated for acute infections including opportunistic infections were not allowed to consume items like alcohol, sugar, coffee, tobacco, crab, snail, refrigerated fish and milk. Consuming these items was believed to delay recovery.
Rather, consumption of items like pepper, ginger, and others, which acted as bio-assimilating agents, was encouraged because of the assumption that eating them would speed up digestion and assimilation of food for quicker recovery.

Literacy level of healers:
None of the healers studied had formal education. The study noted poor hygienic conditions of environments under which most treatments took place. Animal blood, feathers, cloth, and other items, characterized the environments. Also rainwater stored in partially closed clay pots was mainly used to prepare most herbs. This practice is capable of exposing users to water borne diseases.

Inadequate amenities and technical skill:
Three methods, fermentation, boiling and burning of herbs were commonly used for preparation and preservation of herbs. Most concoctions used for treating infections were fermented in partially closed clay pots. Fermentation method was used more than other methods because it was considered cheaper and easier to practice.

Further findings showed that healers lacked scientific techniques for diagnosing most diseases before treatment. The common practice was that healers diagnosed diseases mainly by physical examination and consultation of oracles. The study observed that diseases with similar symptoms were treated with common herbs. This formed the basis for mixing assorted herbs during treatment. In effect, a single plant was used for treating several diseases.

The most widespread technique for diagnosis is the 'Njagbu Aja' (bare foot method), where patients, irrespective of their health conditions, must be barefooted during treatment to enable healers to receive inspiration from oracles on the right diagnosis and treatment. Healers claimed that 'Njagbu Aja' technique, assisted them in providing.

Further observation showed that traditional medicine is still practiced in a generalist form. A healer specializes in several techniques including bandaging, fracture management, treatment of infectious diseases and others.

Scarcity of medicinal plants:
Medicinal plants were harvested from nearby bushes. As a result, some herbs were extremely rare or even extinct and the few available ones were excessively exploited. Also noted were frequent disturbances of most bushes where medicinal plants were grown because they were also used as farmlands.

Insufficient patronage:
Patronage to traditional medicine was low, especially among youths. Throughout the period of study, only 18 (32.1%) persons below the age of 30 years out of the 56 cases treated were youths. The rest were elderly persons 30 years and above.

Reasons for poor patronage were explored from patients and the three traditional healers. Reasons they proffered are contained in Table 1.

Perceived properties of medicinal plants and/or herbs:
Findings showed that most medicinal plants served dual purposes, as food items and as medicinal plants for treating diseases. For example, the study noted that paw-paw, banana, mango, bush cane, guava, lime, and others, which are food items, were also used in treating diseases like typhoid, malaria and others.

Findings showed that herbs were used for two purpose;, rituals and medications. Herbs for rituals were mostly used during sacrifices and initiations. Their inclusion was believed to ward off evil spirits and accelerate a patient's recovery rate.

Code of conduct:
One advantage of traditional medicine in Abia State is that its codes of conduct encouraged positive behavior change for initiates. Initiates are expected to be temperate in eating, drinking, dressing, and also in controlling passions as well as free from anger, envy, bitter feelings and similar vices. It is to this end that during initiations, initiates must swallow the heart of a lamb, as a symbol of meekness. This practice of being meek contributes to the difficulty an initiate has in carelessly releasing certain classes of information on herbal medicine to the uninitiated.

Medicinal plants used for treating diseases:
Findings showed that for most treatments, several medicinal plants were mixed for treatment. Scarcely was a single plant used for any treatment. Healers had uniform dosages for treatment. Most herbs for treatment were usually boiled with water except for serious infections like venereal diseases that were boiled with palm wine. In each case, mixtures were taken half a glass three times a day until the problem is relieved.

However, dosage for medicinal plants, whose method of processing is either by squeezing or grinding, is a full glass twice a day, preferably, morning and evening.
For storage and preservation problems, some medicinal plants, especially roots and leaves were dried, ground and then mixed with cold water before use.

The number of herbs used in treating an infection determines its severity. Highest numbers of herbs were used to treat diseases like malaria, typhoid fever, tuberculosis, diarrhea and infertility because they constitute common health problems of people living positively with HIV/AIDS. Table 2 contains a list of medicinal plants, the ailments they prevent and their methods of preparation.

The idea of healers mixing assorted herbs to cure diseases irrespective of their contraindications, and notwithstanding symptoms of diseases, implies that traditional medicine as it is currently practiced, lacks scientific backing and calls for research to investigate the toxic levels of herbs before mixing them for treatment. This is necessary to assist researchers to note medicinal properties of plants in preparation of drugs for treating common ailments.

The fact that blood letting was a common method of treating all diseases point to poor knowledge of mode of transmission of infections including HIV and suggests the extent to which individuals are exposed to HIV infection. Findings on poor knowledge of mode of transmission of infections was also confirmed by the studies by[10,11,15]. This poor knowledge calls for health education approaches on mode of infections, prevention and treatment. Non-print information systems such as radio, video, role-plays, story telling, town criers and television-based education could be useful.

The fact that factors such as lack of documentation, scarcity of medicinal plants, poor patronage, unhygienic environment, inadequate amenities and technical skills, ignorance and others constrained the practice of traditional medicine, suggest that traditional medicine lacks sustainability. Attempts to ensure sustainability of traditional medicine would be to adopt the strategy of empowering traditional healers themselves to form a strong force to impress on Government to include in National Health Policies, planting of medicinal plants. This might be addressed to some extent by integrating traditional medicine into the existing health care structure. This would make it easier to sustain this policy.

Indeed successful programmes appeared to be those whose sustainability is community driven and controlled by indigenous researchers. Also the fact that traditional medicine is not properly documented showed that it has not received the supposed attention it deserves and as such, available information on traditional medicine in this regard is less than what the demand should warrant. Findings on lack of documentation of traditional medicine agrees with that of [20]. Treating only 56 patients for the period of 6 months study, points to poor patronage of traditional medicine considering the fact that the population of Abia State is more than 17 million. Poor patronage of indigenous treatments was also confirmed by[8]. However, findings suggest further research is required on reasons for poor patronage especially now that most developing countries are resorting to local technologies due to high cost of orthodox drugs including anti-retroviral drugs.

Availability of basic amenities like potable water, electricity, good food, roads, and environment cannot be taken for granted during treatment of infections including opportunistic infections in the rural areas. These basic amenities are needed to improve the unhygienic conditions under which most infections were treated during the study. This is necessary because rainwater was used to ferment herbs in partially opened pots that were scarcely washed. These dirty pots could contain harmful microorganisms capable of exposing users to other infections.

Since a good number of individuals who are in contact with traditional medicine had poor knowledge of mode of transmission of infections, procedures should be instituted for the training and re-training of traditional healers to enhance their level of education, facilitate their professionalism and improve collaboration with other healthcare workers in the management and prevention of diseases including HIV/AIDS opportunistic infections.

There is lack of sustainability for traditional medical practice in Nigeria. This is because traditional medicine depended on medicinal plants harvested from frequently disturbed ecosystems that are used as farmland. More so, mode of harvesting medicinal plants is not calculated to ensure their sustainability. Little or no conscious effort is made to cultivate medicinal plants for future use.

Increasing scarcity of medicinal plants calls for efforts and strategies that would incorporate Ministry of Agriculture, Extension Agriculture Stations and others in the communities in planting of medicinal plants to ensure sustainability. It is felt that treatment/prevention programmes are not likely to yield greater results if planting of medicinal plants is handled in isolation. These Government offices could serve as information dissemination centers for anti-deforestation campaigns that would sensitize people at the grassroots level. This process would encourage community involvement in preservation of medicinal plants.

Therefore, for the next decade, the most important strategy to sustain traditional medicine in Nigeria including Abia State would be public awareness and education on preservation of medicinal plants and use of traditional medicine to control diseases.

Therefore, traditional medicine should be incorporated into the existing Primary Health Care system to ensure greater utilization and sustainability so as to reduce demand for unaffordable and inaccessible western treatments. Additionally, intellectual property rights of traditional healers should be recognized and compensated. This would motivate them to give out useful information to interested persons.

Finally, since lack of preservation facilities constituted drawbacks to advancement of traditional medicine it is therefore recommended that adequately equipped laboratories should process and preserve medicinal plants to ensure safe dosages are necessary.

The author is grateful to Professor A.E. Afigbo for his assistance in this study. He critiqued and made immeasurable inputs to this document. I also thank the three Traditional Medicine Practitioners, Ogbonna, James, Okorie, Benjamin and Okorie, Benedict for allowing the author to undergo the study under their guidance. I appreciate their interest in the study. I am grateful to the cases for volunteering to participate in this study. The information they provided gave insight to the study. I am particularly grateful to Abia State Ministry of Agriculture and Natural Resources for their willingness in making available vital documents that assisted during the study. I also thank the Nigerian Institute of Forestry Research, Umuahia for classification of the medicinal plants.