PROFESSIONAL ASSOCIATIONS, ETHICS AND. DISCIPLINE AMONG YORUBA TRADITIONAL HEALERS OF NIGERIA D.D. 0. OvepoLa Department of Physiology, University of Ibadan, Ibadan, Nigeria Abstract—Four Yoruba traditional healers were interviewed on their professional associations and the objectives of such association. A semi-structured questionnaire was administered to 165 traditional healers on the ethics of traditional medicine and the discipline of erring members. Photographs were rade of sign-posts related to the practice of traditional medicine found in strategic locations in and around Yoadan city. The results of the study showed 2 proliferation of Yoruba herbalist associations ‘These associations serve as mecting points for healers for social purposes, and to share their professional experiences. There are rules and regulations (mostly unwritten) that guide the practice of traditional healers, Disciplinary bodies also exist to deal with offending members. The misleading nature of one herbalis’s sign post is highlighted. The disadvantage of not having a central professional body to control its activities, and the dangers of unsubstantiated claim of proficiency in the treatment of certain diseases by herbalists is emphasized. ‘The invited comments on this paper have stressed the growing interest in traditional medicine and ‘have touched on some of the problems confronting researchers and health planners in matters relating to traditional healers ‘The author is ip agreement with many of these comments and has attempted {Gapyus' T9A1 Pergamon Pres Li iving answers to some of the questions raised by the discussants. INTRODUCTION Jn Nigeria and many developing countries, scientific medicine and traditional medicine co-exist and the Wo systems are well-patronized by health consumers. ‘The practice of scientific medicine in Africa is along the lines found in Europe and America, although available facilities in terms of human and material resources for practice is less adequate in the develop- ing countries. The practice of scientific medicine is controlled by accredited professional associations in all countries. Such associations keep a register of members of the profession. and claim to ensure that medical ethics are adhered to by all practitioners by the associations’ punishment in cases of professional misconduct, For cach country, there is usually a par- ‘ent professional body. with regional or state branches. Activities of such professional associations are docu- ‘mented through notices/preceedings of meetings, and the publication of articles on medical science in various journals. The traditional healers are often the only source from which 40-90% of the population of many devel- ‘oping countries can receive health care [1]. Their im- portanee in health care delivery in Nigeria had been stressed [2-5], In spite of this high utilization of trae ditional healers, there has been no account in the literature about the professional body/bodies con- ‘rolling the practice of traditional medicine. At the preliminary stage of a recent study of Yoruba tra- ditional healers in Nigeria [6], 1 found that the tra- ditional healers also have professional associations Indeed. the support of one of the main professional associations facilitated the study. The ethics. which guide the practice of the Nigerian traditional healers have not been previously reported. Information on whether they have ways of protecting the interest of the public by way of punishment andor other forms 7 of deterrent for infamous acts amongst their members should be of interest. The present communication is ‘on professional associations, ethies and discipline among Yoruba traditional healers. MATERIALS AND METHODS The study was carried out in three parts, The first part was on professional associations. Four tra- ditional healers were interviewed. Two of them could read and write the vernacular (Yoruba) and two were iiterate, The four healers were asked the names of Yonuba herbalist associations known to them. the year of formation of cach association, and to indicate whether the associations were still functioning. The healers were requested to give a brief historical back- ‘round of the associations. if this was known, and to Outline their objectives. The two literate herbalists were allowed to refer to the scanty written records available from a few traditional healers. The second part involved 163 traditional healers randomly selected from 31 towns and villages in the Yoruba speaking areas of Nigeria. A semi-structured questionnaire was administered to these healers. The Scope of the questionnaire is reflected in Tables 2 and 3. The details of the selection of towns and villages for study, the selection of herbalists interviewed. the prep- aration, pretesting and administration of the ques- tionnaire as well as the analysis of results were pub- lished in an earlier communication [7] The third part of the research involved taking photographs of sign-posts related to the professional life of the traditional healers (Figs 1-3) The practi- tioner whose sign-post is shown in Fig. 2 was inter- viewed about how he diagnoses hypertension, a symp- tomless condition. and the drugs he uses for treating it. A sample of the drug for gonorthoca advertised in8 D.D.O. Ovtnora win nT: Leann Cea Fig. 1. Secretariat and training center sign-post of the Amalgamation of Nigeria Medical Herbalists on ‘Oyo Road, Ibadan. T FOF T NAIL. | Th FEO ide N6/ 843 @. SANUSI eT IBADAN. IN THE Fig. 2A traditional healer’s sign-post. He is a specialist in hypertension, stroke and cardiovascular diseases but he admitted that he does not know how to measure blood pressure!Yoruba traditional healers of Nigeria 9 Fi advertise the availubility of medicine for "gonorthoea and hernia”. Note the “Important not patuki") on the lelt corner Its tile is “L ABODE ELEML GBAJUMO OGUN ase i yay pea enat in) yest ‘that is. “LABODE ELEMU. the renowned medicine-mman” THE FEDERATION OF NIGERIA THE COMPANIES ACT (CAP. 37) COMPANY LDWTED OY sNanES MEMORANDUM AND SUBSTITUTED ARTICLES @F association OF ‘THE WEST AFRICAN (SIVEDERO) HERBAL MOSPITAL LD. wa canaaressamgassssararamas@asaesss5 Fig. 4 An attempt at founding a herbal hospital, This is ‘the cover of the hospitals constitution (the venture failed). Fig. 3 was purchased and tested in titro for effects on isolated cultures of Neisseria gonorrhoea organisms. ‘Of the 165 herbalists involved in the questionnaire aspect of the study. only 156 filled the questionnaire sufficiently well 10 be included in the analysis of results. The results of the study are shown below and in Tables 1, 2 and 3 and Figs 1-5. RESULTS Professional associations Herbalist or traditional healers’ associations have existed among Yoruba since the 19th century. In the early stages. such associations were confined to indi- vidual communities. The “Oloriawo” or “Babasegun”. “the head of those who keep secrets” or “father of the healers”, was the designation for the head of such associations. Since most of the people are iliterates very scanty records of their activities are available. Towards the end of the 19th century the herbalists became aware of the need to form regional associ- ations. Hence. about 1886 (Table 1) the Ekiti-parapo Herbalist Association and the Beje Medical Herba- lists Association were formed in Ekiti and Tjebu-lebo areas. Although these associations served primarily the interests of communities in their arcas, herbalists from other towns and villages in the Yoruba speaking. areas subscribed to them, Other associations were later formed. The objectives of these associations in those early days were: (2) To afford herbalists the opportunity of meeting and knowing themselv (b) To provide a forum for members to cooperate in their practice by identifying specialists in. specific problems and referring relevant difficult cases to such persons:D.D. 0. Ovenors Bator stron re Br se, oar Hee TAS yes FE setts seraey gate ste or oan Fig. 5. A certificate issued to registered members of a herbalist association. Table |, Herbalist associations among the Name of associa Akoko United Herbalist Association ‘Association of Nigeria Medical Herbalists Beje Medical Herbalists Association. Hiebu Eghe Aiyegunle Herbalist Association Fkiti-parupo Herbalist Association Ewedatyepo Nigeria Herbalist Association Federation of Herbal Indigenous Practitioners Ghegbesele Aiyelola Herbalist Association General African Medical Herbal Organisation ‘of Nigeria (GAMHON; also called Amalgamation cof Nigeria Medical Herbalists] Ijebu-Mure Herbalists Association unmun-parapo Herbalists Association Lagos Aftican School of Herbalist Association Nig. Herbalist Research Association (Ogo-Oluwa Herbalist Association Taivese Herbalist Association Union of Nig. Medical Herbalists United Nig. Medical Herbalist Western Herbalists College These dates were those given by my informants and were not there were no written records in. most Eases Probable year of formation® 1985 1908 Iss 1950 8x6 1988 1930 94s 138 9M 193s 1950 1958 950 930 1930 1930 Yorubs ruthenticated since Comments Functioning Functioning Functioning. Defunct Functioning Functioning Funetioning Functioning Eunetioning, Functioning, Defuner Defunct Defunct Funetionmg Defuner Fonctiosing Defunct DefunetYoruba traditional healers of Nigeria a1 ‘Table 2. Professional ethics of the traditional healers/midwives Number of No. Questions Possible options respondents (a) Is public advertisement allowed Yes 74 No 8 No response 4 tb) Can a herbalist traditional midwife actively canvass for patients? Yes 2” No ns No response 2 © ith a Patient who is of the opposite sex? Yes — No 148 No response 8 (i) Is there any disciplinary body {or cases of misconduct? Yes BS No 15 No response 6 (6) To provide a forum for the continuous improve- ment in the knowledge of the herbalists through exchange of ideas on herbal remedies. (d) To preserve and ensure the growth of traditional medicine. With the passage of time, the herbalists became politically conscious and few of their associations were registered along the lines laid down by the government for trade unions. Among other functions, these associations became media for agitation for government recognition and support. Table 1 shows the more important regional herbalist associations among the Yoruba. Apart from achieving the above aims, these associ- 18 were charged with the responsibility of draw- ing-up guidelines and codes of conduct to discipline erring members. Many of these associations published pamphlets containing their constitution (Fig 4) Abortive attempts were also made to establish herbal hospitals. It was also the duty of herbalist associ- ations to assess the quality of the knowledge of herba- lists who wished to become their member through interviews, Certificates of proficiency were issued by some associations to successful applicants. Figure $ shows the certificate issued by one of the herbalist associations. Professional ethics, cupable acts and discipline All 156 herbalists in the second part of the study belonged to one or more professional associations. The response pattern to the questionnaire are shown in Tables 2 and 3. Disciplinary actions against ‘Table 3. Offences for which herbalists can be disciplined Type of offences ‘Number of respondents* Being intimate with a female patient 7% Procuring abortion 34 Seducing or committing adultery with the wife of a professional colleague 30 Fraud 19 Preparing hacmfil medicines 7 A male herbalist using his penis as applicator to push a drug Into a female patient's vagina eauidiki") 1s Stealing B Failure to attend association's meetings B Receiving money from patients under false pretence iw Sedueing or marrying @ patient 0 Social misconduct 9 Giving a useiess medicine to patients 9 Practising without joining the professional association 8 Treating a marcied feruale patient who is not accompanied by her husband or relation ? Aiging @ thief by giving him medicinal charms 5 Satching a colleague's patient 3 False advertisements by the healer about his competence 5 Leaking secrets 2 No idea 4 No response 8 ™ Several herbalists named two or more offences2 members could take the form of fines. suspension or dismissal from the association, or handing over to the police for prosecution if a criminat offense had been committed. The type of disciplinary action taken would depend on the gravity of the offense commit- ted, The associations set up disciplinary bodies from among their members. Figures 1-5 depict various features on matters related to advertisements, professional associations land the practice of traditional medicine. The healer ‘whose sign-post is in Fig. 2, who claims to treat hypertension and cardiovascular diseases, does not know how to measure blood pressure! He claimed to treat “hypertension” with herbal concoctions whose components were not disclosed. The drug advertised for treating gonorrhoea in Fig. 3 showed no pharm cological activity in in cttro tests on cultures of Neisseria gonorrhoea, DISCUSSION. ‘There are several herbalist associations among Yor- uba traditional healers. Efforts to make them form one professional body have so far been unsuccessful although some of the associations have combined to form G.AMHLOM. (Table 1). However, the latter is not an all-embracing association of Yoruba tra- ditional healers. This proliferation of professional as- sosiations makes a central control of the practice of traditional healers difficult and weakens their bar- gaining power with the government, Table | also shows that the herbalists have felt the need and have attempted to establish a herbal college and a herbal research unit. Figure | butresses the latter and Fig. 4 the former. The herbalists, like Western-trained doctors, have tried to protect the interest of the society they serve by having ethics that bound the practice of their pro- fession (Table 3), From Table 2. it will be noted that apart from public advertisement on which opinion is divided, most of the herbalists agreed that it is unpro- fessional to canvas for patients, have intimate re- lationship with a patient and it is possible to disci- pline erring members. Some of the culpable acts in ‘Table 3 are similar to what Would constitute an infa- mous act if committed by the present-day prac tioners of scientific medicine. itis difficult to imagine how the healer whose sign-postis in Fig, 2 could treat hypertension without a proper method of disgnosis of the disease. This casts serious doubts about his claim. His practice may be mere deceit of a gullible clien- telle. It is important to protect the public from this type of practitioner. Also. the much advertised gonorrhoea medicine (Fig. 3) had no effect on plates B.D. 0. Ovencca, of Neisseria organisms cultured in vitro. Although in rico tests were not done. the effects of anti-biotics can usually be demonstrated in citra. The absence of ac- Livity in in vitro tests puts the efficacy of this medicine jn doubt. Again, the dangers of patients with gonor- rhoea infection purchasing a worthless medicine for treating their condition cannot be over-emphasized. Ta the course of the larger study [6]. it was dis- covered that the professional associations wield tremendous influence over their members. Their co- operation and support will be needed if proposals 19 utilize traditional healers for health care delivery in the developing countries is to be successful. They are also indispensable in research ventures. into tra- ditional medical systems. It is important that further studies be carried out to identify the herbalist assoc; ations in the major ethnic groups in Nigeria and ther Aftican countries. The Western-trained doctors and government health policy makers should liaison with such associations to ensure success if and when the proposal of the W-H.O. [1,8] that traditional healers in Africa should be integrated or at least. should cooperate with scientific doctors in the deliv- ery of health care is implemented. Acknowledgements—I am grateful to Prince A. Adegboyega and all the other herbalists who participated in this study. The herbalists kindly gave permission to publish the photographs. Miss Monica fkekhua gave scerctarial assist- REFERENCES. L WHO. Health Manpower development. paper EB ST/21. Add. 2, p.3, W.H.O. S7th session, 1976 2. Maciean Catherine M. U. Traditional medicince and its practitioners in Ibadan. J. Trop. Med. Hy. 68. 237, 1965. 3. Ademuwagun Z. 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