Introduction to Common Ethiopian Traditional Medicine Practices (November 2024)

Introduction to common Ethiopian Traditional Medicine practices for year II medical students By: Tezera Jemere MSc in Pharmacology, Assistant Professor in Pharmacology CMHSs, School of Pharmacy, Depart...

Introduction to common Ethiopian Traditional Medicine practices for year II medical students By: Tezera Jemere MSc in Pharmacology, Assistant Professor in Pharmacology CMHSs, School of Pharmacy, Department of Pharmacology November, 2024 12/14/2024 10:31 AM TJA 1  Ethiopian Traditional Medicine Traditional medicine (TM): Diverse health practices, approaches, knowledge and beliefs incorporating plant, animal &/or mineral based medicines, spiritual therapies, manual techniques and exercises applied singularly or in combination to maintain well- being, as well as to treat, diagnose or prevent illness Complementary medicine (Nonconventional) Used in addition (complementary) to conventional medicine prescribed by a physician Example: using acupuncture to help with side effects of cancer treatment 12/14/2024 10:31:02 AM TJA 2  Ethiopian TM Cont’d Alternative medicine: It is "very valuable approach to healing that does not fall within the realm of conventional medicine" – is used in place of standard medical treatments. – eg. using a special diet to treat cancer instead of a method that a cancer specialist (an oncologist) suggests Herbal Medicines: Herbal Medicines include herbs, herbal materials, herbal preparations and finished herbal products: Herbs include crude plant material: leaves, flowers, fruit, seed, stems, wood, bark, roots, rhizomes or other plant parts, which may be entire, fragmented or powdered 12/14/2024 10:31:02 AM TJA 3  Ethiopian TM Cont’d T&CM is widely used around the world and valued for a number of reasons: A. traditional medicines, of proven quality, safety, and efficacy, contribute to the goal of ensuring that all people have access to care B. For many millions of people, herbal medicines, traditional treatments, and traditional practitioners are the main source of health care, and sometimes the only source of care C. This is care that is close to homes, accessible and affordable. 12/14/2024 10:31:02 AM TJA 4  Ethiopian TM Cont’d D.It is also culturally acceptable and trusted by large numbers of people E. The affordability of most traditional medicines makes them all the more attractive at a time of soaring health-care costs and nearly universal austerity F. Traditional medicine also stands out as a way of coping with the relentless rise of chronic non-communicable diseases 12/14/2024 10:31:02 AM TJA 5  Ethiopian TM Cont’d Advantages of TM/CAM:  Effective for chronic and debilitating diseases  Diversity and flexibility  Availability and affordability in many parts of the world  Widespread acceptance in low- and middle- income countries Comparatively low cost:  Relatively low level of technological input required  TM/CAM therapies have the potential to contribute to a better health care system in many countries  may cause fewer adverse events than conventional 12/14/2024 10:31:02 AM TJA 6 therapies  Ethiopian TM Cont’d Risks involved in the use of TM/CAM: I. Risks for consumers relate to the safety and quality of TM/ CAM medicinal products as they are:  Self- care treatments and unregulated in many countries  Sales of incorrect plant species and the contamination and adulteration of TM/CAM medication therapies  TM/CAM medication therapies may contain toxic concentrations of heavy metals, fumigating agents, microbial toxins and pharmaceutical substances 12/14/2024 10:31:02 AM TJA 7  Ethiopian TM Cont’d II. adverse events following substandard practices or the misuse of TM/CAM by unqualified practitioners III. Interactions may pose a risk to patients who use TM/CAM medication therapies in conjunction with conventional drugs IV. Unqualified practitioners V. Misdiagnosis, delayed diagnosis, or failure to use effective conventional treatments VI. Exposure to misleading or unreliable information 12/14/2024 10:31:02 AM TJA 8  Ethiopian TM Cont’d The majority of Ethiopians, up to 80% in some estimates, continue to rely on traditional healers and remedies for their health care needs Among those seeking modern medical care for chronic non-curable illnesses, a significant proportion simultaneously uses non- prescribed medications and herbs, and/or religious rituals like “Tebel” (holy water) and communal prayers Traditional and spiritual practitioners, like Debteras, who practice their craft through prayers (degemit), holy water (Tebel) and Kitab, an amulet worn to ward off evil spirits, are widely sought after TJA 12/14/2024 10:31:02 AM 9  Ethiopian TM Cont’d There is evidence that traditional medicine remains popular among Ethiopian migrant populations all over the world, indicating that it is not necessarily practiced as a last resort but rather as the preferred alternative in some cases Ethiopian traditional medicine is concerned not only with the curing of diseases but also with the protection and promotion of physical, spiritual, social, mental and material well-being 12/14/2024 10:31:02 AM TJA 10  Ethiopian TM Cont’d Indigenous views on causation of diseases Ethiopian indigenous cosmology regarding the causes and prevention of diseases has been the result of mixed beliefs of Christian, Islamic, and indigenous beliefs and practices The wraths of these spiritual entities were often considered as causative agents of a whole range of human misfortune: illness, deaths, drought and famine Every kind of assistance was also sought from almost all the endowments of nature In short, spirits were held responsible for the mishaps and/or the well-being of the society 12/14/2024 10:31:02 AM TJA 11  Ethiopian TM Cont’d The folk knowledge and traditions of Ethiopia utilize the herbal resources available in nature The knowledge is transferred from generation to generation orally It is more diverse based on the ecosystem and the household level health practices. The health practices that start from home remedies for primary health care to specialized healing traditions like bone setting, poison healers, delivery, and veterinary healers are found among various communities The treatment system involves plants, animal derivatives and mineral resources that are available in the nature 12/14/2024 10:31:02 AM TJA 12  Ethiopian TM Cont’d Traditional medicine practitioners and practices: Traditional practitioners: bonesetters ('Wogesha‘), birth attendants (‘yelimd awalaj‘), tooth extractors, herbalists, as well as 'debtera', 'tenquay' (witch doctors), and spiritual healers ('kalicha‘) Religious practices: Play a large part in the healing by praying and going to church Holy water for Orthodox Christians ('tsebel') or 'zemzem' in Moslems are frequently used for a wide varity of illnesses Ethiopians believe that holy water cures when it is drunk10:31:02 12/14/2024 or bathed AM in TJA 13  Ethiopian TM Cont’d Characteristics of traditional medicine in Ethiopia: Ethiopia has a long history of TM to combat disease Ethiopian TM is concerned with curing of diseases and protection, promotion of human physical, spiritual, social, mental and material wellbeing It is widely believed in Ethiopia that the skill of traditional health practitioners is 'given by God' and knowledge on TM is passed orally from father to a favorite child, usually a son or is acquired 12/14/2024 10:31:02 by AM some spiritual TJA procedures 14  Ethiopian TM Cont’d Healers obtain their drugs in descending order of frequency plants, animals and minerals Drugs are prepared in various dosage forms: liquids, ointments, powders and pills Drugs are also prescribed in a nonformulated form and additives are usually incorporated and more than one drug is used in a single dosage form Drugs were administered topical, oral and respiratory When side effects became severe, antidotes were claimed to be used 12/14/2024 10:31:02 AM TJA 15  Ethiopian TM Cont’d The healers imposed restriction when certain types of drugs were taken by patients Drugs are stored usually in bottles, papers, pieces of cloth, leaves and horns, and kept anywhere at home In addition to professional healers, there is also an old tradition of self care in the home In Ethiopian TM, health is seen holistically as physical, mental & spiritual wellbeing Many Ethiopians generally believe that their religion helps keep them healthy & health is seen as a 'gift of God' or 'the will 12/14/2024 10:31:02 AM TJA of God' 16  Ethiopian TM Cont’d Church-based healers (dabtara) Debteras are members of the Orthodox Christian clergy Kalichas are members of the Muslim community They possess the widest array of medical knowledge Debteras began their education in church schools and were viewed as particularly skilled in treating a broad range of medical and socio- cultural problems involved a rich complex of practices based on the use of esoteric medical texts and the manipulation of letters and numbers, as well as an invocation of spirits and the use of herbal remedies 12/14/2024 10:31:02 AM TJA 17  Ethiopian TM Cont’d They had to undergo the most rigorous training – involving years of education from a range of teachers located over wide areas of the country After long period of textually based and practical training they command the religious, linguistic and medical/magical subjects needed to practice their craft Debteras usually look upon mental disorders as possession by evil spirits, which are thus treated mostly by praying and using holy water or eventually exorcising the evil spirit Debteras are renowned for their prayer (degmit) and prepare holy water (tsebel) and kitab amulets containing a written script 12/14/2024 10:31:02 AM TJA 18  Ethiopian TM Cont’d By means of the degmit, the debteras claim to have the ability to perform miracles, which are believed to be manifested by the reactions of their patients Tsebel is commonly used to ward off evil spirits from patients who are believed to be possessed by the devil Kitabs are worn for the purpose of protecting oneself against evil eye or ‘buda’, snake & scorpion bites Kalichas through an ecstatic ritual, can investigate the causes of a disorder and advise the patient on what to do Mental disorders are generally explained as resulting from disturbances in the relationship between 12/14/2024 people 10:31:02 AM and divinity TJA 19  Ethiopian TM Cont’d They conduct special ceremonies to effectively perform their practices with the use of excessive smoke by burning incense such as myrrh, and frankincense (etan) Kalichas also prepare kitabs of their own kind to be worn by their clients Besides its healing, ETM is also helpful to prevent the evil eye, overcoming demons, defeating human enemies, obtaining long life, clear eye sight, a good memory, as well as a large family and a faithful wife 12/14/2024 10:31:02 AM TJA 20  Ethiopian TM Cont’d Preventive practices ETM prevent the spread of highly infectious diseases (smallpox) by deserting places where the epidemics occurred Moreover, people were inoculated by taking pus from a sick person during special rituals Sweeping or covering floors with particular plants to prevent disease Isolating people with contagious diseases, prohibition or controlling movement and taking children away from the affected areas 12/14/2024 10:31:02 AM TJA 21  Ethiopian TM Cont’d The conditions that claim to be treated: GI disturbances, respiratory disorders – STIs, TB, Impotency, hemorrhoids, rabies, intestinal parasites, skin problems, liver diseases, mental disorders, hypertension, diabetes, gynecological conditions, Rheumatism, malaria and others Herbalist-healers: Medhanit awakis (kitel betashs) herbalists using plants as their primary means of providing treatment 12/14/2024 10:31:02 AM TJA 22  Ethiopian TM Cont’d The art of herbal therapy was the oldest medical tradition in Ethiopia A large number of plant medicines are used Minerals and animal-derived substances are additional items For the purpose of references, most medhanit awakis possess pharmacopoeias Medhanit awakis diagnose disease conditions mostly by physical examination and questioning patients Sometimes they prescribe medicines based on descriptions from informants They prepare their medicines in various dosages and forms and administer medicines via different routes10:31:02 AM 12/14/2024 TJA 23  Ethiopian TM Cont’d After preparations, many of the medicines are stored in containers anywhere at home without special requirements Although the medhanit awakis make efforts to modernize their practices, they do not normally employ any of the equipment and techniques used in conventional medical or pharmaceutical practices Surgical practice Traditional practices considered to be related to surgery include bone-setting, uvulectomy, circumcisions, bleeding and cupping, cautery, scarification and tooth extraction The setting of bones is regarded as an important surgical procedure which requires a certain degree of skill and experience on the part of the healer 12/14/2024 10:31:02 AM TJA 24  Ethiopian TM Cont’d In many situations, wogesha practices his/her skills without aseptic conditions, with or without application of medicines Other procedures are indicated for more specific conditions: rheumatism, bleedings, swelling, wounds, headache, localized infections, snake & scorpion bites “surgeon-herbologist-empiricist” cured through the physical manipulation of the human body They are mostly nonliterate and professed to no esoteric or mystic knowledge They acquired their craft through a long period of apprenticeship 12/14/2024 10:31:02 AM TJA 25  Ethiopian TM Cont’d They served as bone-setters (or orthopedists) and performed other surgical operations – such as cauterization, bleeding, cupping, circumcision, cutting the uvula, scarification, opening abscesses, removing tumors and bullets, and extracting carious tooth possessed a limited amount of herbal knowledge Traditional midwives commonly known in Amharic as “yelmid awalaj”, (traditional birth attendants) and most yelmid awalajs are women 12/14/2024 10:31:02 AM TJA 26  Ethiopian TM Cont’d Traditional professionals are consulted, it is often for their specialized traditional knowledge and skills pertaining to a relatively limited range of health Most families grow or gather plants in their vicinities Problems associated with traditional medicine Blindness and changes in CNS function have repeatedly been found in people who took over dosage of Hagenia abyssinica Traditional healers may cause create delays in the treatment of communicable diseases such as TB if they fail to refer patients to modern health services Moreover, a number of harmful practices have been traced to healers: female genital mutilation, uvulectomy, and milk tooth extraction 12/14/2024 10:31:02 AM TJA 27  Ethiopian TM Cont’d Ethiopia is rich in medical lore The use of plants in religious ceremonies as well as for magic and medicinal purposes is very commonplace and widespread The art of native medicine is still widely practiced While much of this lore is indigenous, yet there are strong indications of Hebrew and Egyptian as well as Greek and other Arabic influences 12/14/2024 10:31:02 AM TJA 28  Ethiopian TM Cont’d Artemisia abyssinica “Chikugn” Is a species of wormwood that is traditionally used for:  intestinal problems, for infectious diseases, and acts against Leishmania parasites  The whole herb can be used to address tonsillitis, and an infusion is traditionally drunk as a remedy for colds, and sickness in children 12/14/2024 10:31:02 AM TJA 29  Ethiopian TM Cont’d Ocimum lamifolium ‘ Demakese’ Used to treat coughs and colds, the fresh leaves are squeezed and the juice sniffed The juice can also be used as an eye rinse for eye infection Used for “mich”, an infection of fever with headache and mouth blisters Zingiber officinale ‘Zingibil’ The rhizome (root) of ginger is popularly used in Ethiopia for stomachache and respiratory problems It is chewed or masticated with Lepidium sativum ‘feto’ for stomach disorders 12/14/2024 10:31:02 AM TJA 30  Ethiopian TM Cont’d It is popularly used for its carminative (relieves gas) and anti-nausea activities It has demonstrated anti- inflammatory, anti- platelet, antioxidant, antitumour, antirhinoviral & antihepatoxic activities Withania somnifera ‘Gisewa’ Used for coughs, asthma, as a narcotic, anti- epileptic headache, malaria, fever, stomachache and as a diuretic in Ethiopia Burning of roots is commonly inhaled for ‘devil disease’ It has antifertility properties & traditionally used as a vaginal douche for its uterotonic and anti- implantation activity 12/14/2024 10:31:02 AM TJA 31  Ethiopian TM Cont’d Echinops kebericho ‘Kebercho’ It is endemic to Ethiopia It is used for fever and taenicidal herb (to expell tapeworm) Smoke from burning the plant is inhaled to relieve headache and also as a cure for “evil eye” The root is burned for smoke to ward off mosquitoes and as a snake repellant in the house The smoke is inhaled to fight typhus, fever, and used as a fumigant after childbirth The root is chewed to alleviate stomach ache 12/14/2024 10:31:02 AM TJA 32  Ethiopian TM Cont’d Verbena officinalis ’Atuch’ The roots are soaked in water and drunk to expel roundworm, help with snake bite, and relieve stomach ache and diarhoea It have is antimicrobial properties and is used for treating tropical ulcers Mixed with olive oil, the juice of the fruit is used as ear drops Juice made by crushing the fresh leaves, filtering and mixing with honey used to alleviate dry cough 12/14/2024 10:31:02 AM TJA 33  Ethiopian TM Cont’d Foeniculum vulgare ‘Ensilal’ Its roots are boiled or roasted for treatment of gonorrohoea, digestive disorders and infant colic The juice of fresh or dried leaves is used in stemnosebleeds & as an antifertility remedy Seed are used as a carminative and digestive Clinical trials also support the use of Fennel in combination with other herbs for dyspeptic conditions of the upper GIT, including pain, nausea, belching and heartburn; chronic non- specific colitis, diarrhoea or constipation 12/14/2024 10:31:02 AM TJA 34  Ethiopian TM Cont’d Aloe vera ‘Eret’ It has cooling and cathartic properties It is used for fever, spleen and liver troubles, as well as ‘knee troubles in old age’ and ‘eye treatment’ Juice is applied on the breast of nursing mothers to assist with weaning as its bitter taste would discourage the baby from suckling Leaves juice is given to a mother in childbirth to ease labour Fresh leaves’ juice is used as a topical application to cool burns and is taken orally for digestive disturbance 12/14/2024 10:31:02 AM TJA 35  Ethiopian TM Cont’d Artemisia africana ‘Ariti’ Juice of crushed leaves is mixed with water or honey and administered orally to address stomach pain Its essential oil has antimicrobial properties It is commonly used herbal medicine for treating coughs, colds, malaria and diabetes 12/14/2024 10:31:02 AM TJA 36  Ethiopian TM Cont’d Lepidium sativum ’fetto’ A. The ripe, dried seeds are ground into a fine flour and mixed with water to use as a drench for stomach disorders of livestock B. A paste is made of the seed-flour and water and used on chapped lips, sunburn, and other skin disorders C. The flour is mixed with honey and taken as a treatment for amoeba D. The paste is rubbed onto the skin to repel mosquitoes and other insects E. The paste was rubbed onto the skin by warriors for warmth during cold nights 12/14/2024 10:31:02 AM TJA 37  Ethiopian TM Cont’d F. ‘fetto’, ‘tukur-asmud’ (Nigella sativa) and salt are ground together to make a thick dough and allowed to ferment for seven days & One teaspoon of this is taken once a day for stomach cramps G. The ground flour of the seed is mixed with chopped injera and water to make a dish known as ‘fetto fitfit’ & is eaten early in the morning to help increase the appetite 12/14/2024 10:31:02 AM TJA 38  Ethiopian TM Cont’d Datura stramonium ‘astenagrt’ Dried, ground leaves are mixed with butter and used as a fungicide to treat scalp infections and sometimes on the face The vapor of boiled seed pods is inhaled to alleviated the pain of toothache 12/14/2024 10:31:02 AM TJA 39  Ethiopian TM Cont’d Leaves are crushed and made into a paste that is used to treat open sores of pack animals (animal carry loads) The black seeds are poisonous and a few seeds in a cup of tea or coffee are enough to produce instant death resulting from heart paralysis In smaller quantity of seeds powder mixed in local drinks (areke, tej & tella) causes temporary insanity, a practice often used to make the drink more strong All parts of the plant are considered poisonous 12/14/2024 10:31:02 AM TJA 40  Thank you 12/14/2024 10:31:02 AM TJA 41