An occasional health report from The Times' foreign bureaus
Ghanaian priest David Angamah stood over Efua Badu, resting a Bible on her head as she sat in an open courtyard, her eyes tightly closed. Angamah recited the Lord's Prayer and the Apostles' Creed in loud, heated tones, accompanied by a high-pitched chorus of responses from assistants adorned in red dresses and head scarves.
When the praying was over, Badu was bathed from head to foot with a mixture of blessed tap water and "Florida water" cologne, her eyes now wide-open and filled with gratitude and relief.
Badu had suffered weeks of severe hemorrhaging and turned to a traditional healer after a transfusion and 15 days at a local hospital failed to cure her. After seven weeks under Angamah's care, Badu maintains the bleeding has stopped.
"I believed that he could cure me," said Badu, 40, a resident of the Wassa West mining community in Ghana's rural Western Region. "I realized the bleeding was not normal, but it had something to do with the spiritual."
Frustrated with the poorly run national health system, more and more Ghanaians--possibly as many as a third of this West African nation's 18 million people--are seeking treatment from spiritualists, herbalists and prescribers of chemical concoctions.
But what is truly notable is that international aid workers and many in the Ghanaian government are now treating the traditional healers as a resource to be embraced rather than discredited.
The healers command a unique trust among many Ghanaian communities, their services are affordable, and sometimes their methods help alleviate pain--reason enough, many believe, to encourage the conventional health sector to collaborate with nonconventional practitioners.
"People in the community really listen to traditional healers," said Theodore Avotri, a local government health official. "If people have confidence in them and listen to them, then they are an asset in educating people."
And that education could help stem the spread of disease, particularly sexually transmitted ailments--caused by black magic, many believe--that have seen a recent upsurge here.
"If an herbalist tells a person that AIDS is real, then he is going to believe it," Avotri said. "The potential is there for these people to really help."
Bernard Boateng-Duah, a doctor at a local government hospital, concurs.
"Even if you had hospitals or clinics every five kilometers, people would still use traditional healers," he said. "They are more efficient, often more humane and less expensive."
That sentiment is not unanimous. Some Christian groups accuse traditional healers of doing the devil's work and of capitalizing on people's ignorance, fear and superstition.
Other detractors argue that the healers' presence allows the government to shirk its responsibility for providing Ghanaians with reliable and affordable health care.
And there is fear that traditionalists, who peddle homemade drugs, could distribute potentially deadly potions.
But the healers defend their methods.
"I feel my work is important because I'm saving lives and protecting people from diseases," said Malam Yakubu, an herbalist since 1977 who says he inherited his powers from his dead father, who appears in visions to advise him. "I've treated government officials, students, businessmen, diplomats, schoolchildren. People come to me from as far away as Ivory Coast, Benin and Nigeria."
Added Angamah, "I'm saving people, and I'm helping the government."
Problems Plague Health System
Ghana's health system is, indeed, in disarray. Its hospitals are plagued by shortages of drugs, medical supplies and equipment. Overburdened and poorly paid, many doctors and nurses lack incentive and are accused of being insensitive.
By Western standards, health care here is inexpensive--patients pay the equivalent of about $10 for a medical consultation and drugs. But many of the country's poor have problems footing the bill. Unemployment is high, the minimum daily wage is $1.20, and there is no system of medical insurance.
By contrast, traditional healers are well-regarded in their communities and often know their patients personally. They rarely demand payment upfront, instead allowing patients to pledge what they can.
Supporters claim that traditional healers can cure many ailments, including prostrate enlargement, infertility, epilepsy, malaria, even insanity.
The treatments typically include potions made from boiled tree bark, weeds and herbs, and homemade chemical brews. Tribal priests combine Christian prayers and sermons--introduced here by missionaries--with elaborate rituals of ancient African songs and dances. Alcoholic libations are normally offered to the spirits of ancestors, though many nonconventional spiritual leaders say they consider only the Christian God their savior.
To expel evil spirits, Angamah, 61, smears patients with white clay mixed with Florida water, a light perfume used in many of his potions. He uses nasal drops from blessed Florida water to cure madness.
Angamah stands by his methods--but when they fail, he says, he has no qualms about referring patients to the formal health sector.
And now the government is returning the favor.
One example of the newfound cooperation is a pilot program that links the Ghanaian Health Ministry, foreign relief workers and local healers in Wassa West, a community of about 80,000. Brought about by the spread of AIDS and sexually transmitted diseases in Ghana's mining areas, the program helps train healers in counseling techniques and gives them advice on when to refer patients to conventional doctors.
Supporters insist that such collaboration should be a formal part of national health policy and are keeping close watch on the Wassa West test case, which began in 1996 but went into full swing only last year.
The western region was particularly suitable for the project because of a recent influx of young men seeking their fortunes in gold mining--contributing to a flourishing sex industry and a rise in casual sex.
"The perception is that miners are very rich, and women get attracted to these people," said project manager Bernice Heloo. "Promiscuity is rampant."
In the last year, 40 men with sexually transmitted diseases have sought Angamah's help after finding no relief from conventional doctors. His treatment requires drinking a mixture of boiled herbs.
"They have been to hospitals before but come to me after all else has failed," he said.
But most laborers who contract social diseases turn to traditional healers first, local studies show.
"All unexplained illnesses are seen as juju, or a curse," said Heloo. "Many people believe [sexually transmitted diseases] are a curse, so they prefer to go to a spiritualist or an herbalist to remove the spell."
Is It a Disease or a Curse?
Fear of juju is widespread.
Emmanuel Kwaw believes a co-worker's curse caused his legs and other body parts to swell. Doctors told him there was nothing they could do, so he came to Angamah.
"This man has done everything for me," said Kwaw, 20, a truck driver who says his symptoms were relieved after a month in Angamah's care. "The hospital couldn't do anything for me because it's not a hospital disease. It's a curse."
Badu, the woman with the hemorrhaging problem, also suspected juju was the cause of her ailment--a diagnosis that was reinforced by Angamah. A deceased sister had cursed her for failing to take care of the children she left behind, Badu believes. After Angamah warned her that the sister's spirit would kill her if she underwent surgery, Badu decided against the procedure, which had been recommended by conventional doctors.
The merits of such a diagnosis are debatable, but Badu maintains that Angamah's methods cured her, while the hospital's did not.
"Some people are degrading the [traditional] practice because when they come to see us, we reveal the bad things that they have done and hence the reason they have fallen sick," said Angamah. "They become angry and say bad things about us."
Much of the criticism is directed at healers who make bold claims about their powers. Some even say they can reverse infection of HIV, the virus that causes AIDS.
Avotri, the district health director, said the program in Wassa West helps traditional healers understand their limitations. But he also acknowledged that many healers, particularly herbalists, can indeed help relieve the symptoms of the human immunodeficiency virus, including diarrhea, coughing and abdominal cramps. And spiritualists can offer much-needed psychological therapy when all hope seems lost, he says.
Boateng-Duah, the government doctor, believes his colleagues should abandon their condescending attitudes and work with traditional healers to provide complete health care for Ghanaians.
"For us in the formal sector, we tend to look down on some of these people," said Boateng-Duah. "But traditionally, before the advent of the white man, these were the people who were treating us. . . . These are methods that have been tried and tested for centuries. It's not fake."