Abstract

This exploratory ethnobotanical study took place in Kumasi, the capital city of the Asante, one of the Akan tribes. Data was collected using the multi-method approach of descriptive review, semi-structured interviews with traditional medical practitioners, and brief scientific review. Traditional Akan medicine is holistic and does not separate the physical world from the supernatural world. It is deeply rooted in traditional religion, with illness seen as a departure from the natural equilibrium. Traditional healers are either spiritually based or non-spiritually based.

This study found the traditional knowledge of healing and use of medicinal plants is disseminated through generations by family members. However, the acquisition of academic qualifications is now a priority, and formal training is taking place in the workplace and a university. Techniques used in diagnosis and treatment consist of a fusion of traditional and biomedical methods. Treatment of hypertension was used as an example, with all practitioners recognizing hypertension's clinical signs and symptoms. Medicinal plants are predominantly wildcrafted and dispensed mainly by decoction, although prepared formulas are given. To prevent self-medication, patients are seen frequently. Scientific evidence validates the pharmacological actions of the medicinal plants. Public health care in Ghana is accessed by a "cash and carry" system that is only available to those who can afford it. Approximately 75 percent of the population depends on traditional medicine for primary health care. A national health insurance scheme was introduced in 2004, and it has been proposed that traditional medicine will be integrated into this new system.

Introduction

The use of plants as medicines to treat illness has a long and venerable history. Over the centuries the indigenous peoples of the world have developed sophisticated social systems and their traditional healers, through oral tradition and empirical means, have acquired and compiled detailed knowledge regarding the use of medicinal plants, which has been disseminated from generation to generation.

In an attempt to explore how the biopsychosocial relationship between cultural belief systems and health interact to shape the etiology of illness, diagnosis, and treatment, a multi-method, exploratory ethnobotanical study was undertaken in Kumasi, Ghana. Ghana was chosen primarily for its rich historical and valued tradition of herbal medicine and for ease of access to practicing herbalists. This study focuses on traditional Akan herbalists living in the area surrounding the urban town of Kumasi. It also investigates the scientific validation of the pharmacological actions of medicinal plants used by Akan healers in treatment.

The Akan is a collective name for a number of tribes in Ghana who occupy the region bounded by the Black Volta River in the north, the Gulf of Guinea in the south, the Camoe River in the west, and the Volta River in the east. They constitute the largest ethnic group in Ghana, with Twi being the most commonly spoken language. (1) The Akans are considered to be one of the most traditionally well-cultured, indigenous inhabitants of Africa (2) with an established social system.

The Asante (Ashanti) are the most predominant group of Akans and have a matrilineal society. The town of Kumasi is their capital city and home to the Asantehene (King of Asante).

Traditional Akan Beliefs

Akan ontology is conceptually complex and much debated; therefore, only very brief details are discussed below. These focus on the construct of the individual's relationship with the natural world forming the basis for health.

According to Opoku (cited in Ephirim-Donkor: (3) "The human being is a composite of okra (soul), the sunsum (intangible element) necessary for character, ntoro (inherited characteristics) and mogya (blood)." Thus, the individual is seen as the product of the male spirit (ntoro-sumsum) and female blood (mogya), the union of which gives rise to the okra. Danquah (cited in Minkus) (4) defines sunsum as, "the power that sustains a person's character or individuality" and Owoahene-Acheampong (1) describes okra as, "a life principle; it is a small indestructible part of God," and on death returns to join the creator and the ancestors. Therefore, there is a triad of ntoro-sunsum (spirit), okra (divine), and mogya (blood), which forms a basis for holistic health and healing.

Mother Earth holds great reverence for the Akan; nature is believed to be a living thing. Within the natural world, the Akan see the earth, plants, stones, and bodies of water as containing their own individual sunsum, giving each a unique essence; (4) natural phenomena can also be inhabited by spirit-powers (obosom).

Traditional Akan Medicine

Traditional Akan medicine has its roots in a cosmology where there is no clear conceptual distinction between the physical world and the supernatural world. Health, illness, and healing are part of this integrated worldview, wherein the Akan traditional religion plays a major determinant. Onyame (God) permeates and resonates throughout Akan culture.

To be healthy is broadly described as implying health of mind, body, and spirit, and calls for "living in harmony with one's neighbors, with the environment, and with oneself--a total harmony that encompasses physical, social, spiritual, natural, and supernatural realities." (5)

Illness is a departure from this natural equilibrium. The Akan term for illness is yadee--ya meaning pain, and adee meaning painful thing. A painful thing can be physical, psychological, emotional, spiritual, social, or environmental, and can be naturally or supernaturally caused. Agyapong (6) described five main sicknesses that can affect a person as follows:

* Sunsum mu yadee--spiritual sickness. This can be caused by witchcraft and destructive powers purchased or acquired from a spiritualist.

* Dua bo--curse from the gods. An enemy has consulted a deity to bring ill health upon some one who has offended him.

* Erie yadee--"home sickness" caused by bad feelings arising within a family.

* Ho nam mu yadee--diseases of the body. These are conceptualized as originating and emanating from the belly or the center of the body.

* Mogya mu yadee--sickness of the blood.

Traditional Medical Practitioners (TMP) of Ghana

Traditional medicine (TM) is defined by the World Health Organization (WHO) as, "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 social imbalance, and relying exclusively on practical experience and observation handed down from generation to generation, whether verbally or in writing." (7)

The WHO also defines a TMP as, "a person who is recognized by the community where he or she lives as someone competent to provide health care by using plant, animal and mineral substances and other methods based on social, cultural and religious practices." (7)

Writing on TMPs in Ghana, Evans-Anfom (8) noted that, "TMPs acquired their knowledge through a) instruction, b) dreams and visions and c) a 'voice' heard in the bush." Ampofo (9) indicated that herbalists undergo a period of tutelage under an experienced TMP for up to 10 years, trainees being chosen because they have an interest in healing.

The training of a traditional Asante healer takes three years. They are called to the profession by "hearing a voice" or through spiritual possession. Men and women are trained separately at different shrines and live in the house of the trainer. Training includes communication with deities and spirits, divination, and a thorough knowledge of medicinal plants and their uses. (10)

The various categories of TMPs are subject to the interpretation of the researcher. For instance, Appiah-Kubi (11) recognized five groups; whereas, Twumasi (12) identified four. The difficulty in categorization is apparently because TMPs combine specializations. For example, some have expertise in snakebite or eye disease, (12) while others treat psychosocial and mental health problems. (13) Nevertheless, whatever the specialty, TMPs are divided into spiritually based and non-spiritually based practitioners, (1,10,14) both groups using plant and animal products for treatment.

Tsey (14) noted the main difference between the two divisions is their belief system. The non-spiritually based practitioner tends to look at medicinal plants with an increasingly biomedical approach, while the spiritually based practitioner believes that illness cannot be treated without dealing with the spiritual factors.

Spiritually Based TMPs

Spiritually based TMPs include: