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for instruction in traditional medicine as a distinct academic
Medical Education
TRADITIONAL MEDICINE AND THE MODERN
MEDICAL CURRICULUM
FARHANG TAHZIB S. O. DANIEL
College of Health Sciences, University of Sokoto, Sokoto, Nigeria
Summary Experience in Sokoto suggests that
traditional medicine can be successfully
introduced as a distinct academic discipline into the
curriculum of a modern African medical school. The
importance of such a step lies in two facts. Firstly, for the
foreseeable future most people in developing countries will
turn to traditional medicine at times of sickness, so modern
doctors should be acquainted with its principles and
methods. Secondly, within traditional medicine there is a
body of important knowledge that needs to be explored and
studied. If exposed early and gradually to the subject,
medical students are likely to become more effective both as
health workers and as contributors to medical science.
INTRODUCTION
A ROOT cause of inadequacies of health care in the less
developed countries is that their patterns of medical care and
education of health personnel are copied closely from
Western countries. Making this point, Bryantl criticised the
widespread reluctance to deviate from these patterns, even
though they are often seriously irrelevant for the less
developed countries and may not even be well suited to the
countries where they originated. Similarly, the Director-
general of the World Health Organisation has remarked that
"any thoughtful observer of medical schools will be troubled
by the regularity with which the educational system of these
schools is isolated from the health service systems of the
countries concerned". Medical schools, he notes, "prepare
their students for certain high, obscure, ill defmed, and
allegedly international ’academic standards’ and for dimly
perceived requirements of the twenty-first century, largely
forgetting or even ignoring the pressing health needs of
today’s and tomorrow’s society".2 It is also unfortunate that
an average medical student in a developing country ends his
undergraduate or postgraduate medical education by
knowing more about the pathology and technology of the
Western world than about the health care system and
conditions of his own country.
At times of sickness, most people in developing countries
turn to traditional medicine and traditional medical
practitioners.3 As more medical schools are established and
encounters with the rural populations (we hope) increase
with the production of more trained manpower, it is
important to examine the relationships between the various
systems of health care. According to an early stereotype,
largely developed by anthropologists, physicians practising
in traditional settings are frequently ignorant of traditional
medicine, do not understand its vocabulary and rationale,
and so have difficulties in communicating with patients.
Foster,4 however, contests this notion, arguing that it is
based on an outdated image of Western missionary doctors
and upper-class physicians: today, medical education is no
longer the monopoly of upper-class youth, and doctors in
growing numbers do understand the concepts of disease to
which their patients subscribe. In this paper we put the case
discipline.
EXPERIENCES ELSEWHERE
In India, traditional medical systems such as Ayurvedic and
Unani Tibb have developed their own medical schools where
traditional medicine is taught, researched, and practised to a high
level. Subjects such as anatomy, physiology, and radiology are
taught alongside herbal therapy and the Ayurveda. The Western-
style medical schools, however, do not reciprocate and pay little or
no attention to traditional medicine. In China traditional medicine
and Western medicine have been taught and developed side by side,
with one or the other preponderating as the political and
socioeconomic climate has fluctuated.
In most developing countries the medical curriculum is based
closely on Western models, particularly British, French, and North
American, and until recently traditional medicine has been
considered unscientific, unhygienic, inferior, and unworthy to be
taught at medical schools in any form. This picture is changing. For
example, in the University of Lagon, in Ghana, medical students
spend some 4-6weeks in a rural area where they are attached to a
traditional medical practitioner. In the University in Bamako, Mali,
students are required to show knowledge of some herbs and
well-known medicinal plants. Numerous schools have research
programmes for investigation and development of medicinal plants,
and students are often given brief instruction in the relevant
research methods. During courses in community health, traditional
medical practitioners are commonly discussed as a possible means
of spreading primary health care-though the focus tends to be
exclusively on the training of traditional birth attendants.
The China Medical College in Taichung, Taiwan, provides a
good example of how up-to-date teaching methods in traditional =
and modem medicine can be practised side by side. It is also
noteworthy that medical schools in developed countries such as
France and Sweden are introducing some elements of traditional
medicine (eg, acupuncture) into their curricula,while there is
widespread interest in various forms of complementary and
alternative medicine.
SOKOTO
The College of Health Sciences of the University of
Sokoto in Northern Nigeria was founded in 1980. The
medical school is the only one in Sokoto State, which has an
estimated population of over 8 million people. There is one
doctor for over 100 000 people in the rural areas; the
maternal mortality rate is 30 per 1000 deliveries; and the
perinatal mortality rate is 200 per 1000. Some 85-90% of
the people turn to traditional medical practitioners for
medical advice, and for most of them it is the only option.
In devising our programme-the first attempt in Africa to
examine traditional medicine as a distinct academic
discipline in the medical curriculum-we began by noting
certain traditional principles, practices, and methods during
existing courses. For example, in pharmacology particular
mention would be made of some traditional methods of
dispensing and some aspects of medicinal plants; in
community health mention would be made of the
epidemiology, use, and development of traditional medical
practitioners and their role in primary health care
programmes; in orthopaedics there would be reference to
the traditional bonesetters; and in obstetrics and
gynaecology there would be discussion of traditional
childbirth techniques, beliefs, and practices. This method
proved rather fragmentary and we felt that traditional
medicine should have its own specific courses, to run
through the 6-year undergraduate curriculum.
The purpose of the courses was not to produce traditional
medical practitioners but rather to educate medical students
in some broad general concepts, principles, practices, and
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methods; we wished them to emerge with a grasp of the
alternative strategies and philosophies of traditional
medicine and a knowledge of how it may be evaluated, used,
and developed for the benefit of the communities within
which they will be working. The teachers include
conventional academic staff who are knowledgeable about
traditional medicine, visiting experts, scholars from other
universities in the country, and certain carefully selected
traditional medical practitioners (two of whom have been
appointed as honorary consultant traditional medical
practitioners for research and teaching purposes). Apart
from lectures, tutorials, and seminars, the course includes
demonstrations of techniques such as acupuncture and
bonesetting, practical exercises in analysing medicinal
plants, and supervised field visits to high-grade traditional
medical practitioners. The course can be summarised as
follows:
Year 2-30 hours
Definition of terms
Concepts, aim, scope, and background
Major traditional medical systems including African,
Ayurvedic, Chinese, and Unani Tibb
Summary of some basic traditional therapeutic and diagnostic
techniques including homoeopathy, iridology, osteopathy,
herbalism, naturopathy, acupuncture, and yoga
Classification of traditional medical practitioners and practices
in Nigeria, with particular reference to bonesetters, traditional
midwives, surgeons, and herbalists.
Year 3 and 4-30 hours
Evaluation of principles, practices, and diagnostic and
therapeutic tools and techniques including scientific basis and
validation. Review of current trends and research methods
Traditional home remedies and some basic herbal
remedies. Scientific investigation, use, and development of
medicinal plants and other traditional remedies and methods
Role of traditional medicine and traditional medical
practitioners in primary health care programmes with
particular reference to traditional psychiatry, birth attendant
training programmes, herbalists, and bone-setters
Relationships between Western and traditional medical
systems.
’
Year 5 and 6-30 hours
Supervised field visits to recognised high-grade traditional
medical practitioners.
IMPACT
The orthodox faculty members and also the students were
at first resistant to the introduction of traditional medicine
into a modem medical curriculum, partly because they
associated traditional medicine with witch doctors, magic,
and superstition. But once the programme had been
outlined and anxieties about its academic and scientific level
had been allayed, there was general agreement that students
and community would benefit. Even those students who
were most resistant to the idea of "unscientific backward
medicine" soon dropped their sophisticated guard and
became content to learn about the medicine of their
forefathers, and eager to evaluate it by scientific methods.
The programme has stimulated other academic staff to
select individual traditional therapeutic tools and methods
for scientific scrutiny and development; and the local
community has felt itself closer now that the medical college
has accepted traditional medicine as part of the culture of the
area.
We acknowledge the personal interest and support of Prof Mahdi Adamu,
Vice-chancellor of the University.
Preventive Medicine
BED-NETS (MOSQUITO-NETS) AND
MORBIDITY FROM MALARIA
A. K. BRADLEY B. M. GREENWOOD
A. M. GREENWOOD K. MARSH
P. BYASS S. TULLOCH
R.HAYES
Medical Research Council Laboratories, The Gambia;
Tropical Epidemiology Unit, London School of Hygiene and
Tropical Medicine, London
Summary A undertaken in the Farafenni
study was
area of The Gambia to determine the
relation between morbidity from malaria in children and the
use of bed-nets (mosquito-nets). From comparisons of
parasite and spleen rates in bed-net users and in non-users it
seemed that bed-nets had a strong protective effect.
However, the prevalence of malaria in the study population
was also influenced by ethnic group and place of residence,
and the association of bed-net use with these two confound-
ing factors accounted for some of the differences observed
between bed-net users and non-users. Nevertheless, a
significant inverse correlation between splenomegaly and
the use of bed-nets remained. This suggests that bed-nets
give Gambian children some protection against malaria and
that the use of bed-nets, either untreated or treated with an
insecticide such as permethrin, should be investigated
further as a means of malaria control in Africa.
INTRODUCTION
IN parts of Africa bed-nets (mosquito-nets) are used
widely to protect against biting insects. It is possible that in
such communities bed-nets give some protection against
malaria, but bed-nets as a means of malaria control seem to
have been little investigated in Africa. In a rural area of
Guinea-Bissau a lower level of malaria parasitaemia was
reported among users of bed-nets than among non-users (H.
Carlsson, unpublished observation). In The Gambia it was
shown that bed-nets, even when defective, reduced biting
by Anopheles gambiae but no parasitological measurements
were reported. Interest has increased lately in the idea of
using fabrics impregnated with insecticides as a method of
malaria controland there has been a preliminary report
from Mali of a reduction in spleen rate among subjects
sleeping under bed-nets impregnated with deltameduin.1
During a malaria survey in the Farafenni area of The
Gambia before the introduction of a primary health care
programme we found significant differences in the preva-
lence of malaria parasitaemia and of splenomegaly between
members of three ethnic groups (unpublished). In children
both parasitaemia and splenomegaly were less frequent
among Mandinkas than among Wollofs or Fulas: one
possible explanation is that bed-nets were used more often
by the Mandinkas. We report here a survey of the use of
1. Bryant J. Health and the developing world. Ithaca: Comell University Press, 1969: xi.
2. Mahler H. The meaning of Health for All by the Year 2000. World Health Forum 1981,
2 (1): 5-22.
3. Bannerman RH. Traditional medicine in modern health care. World Health Forum
1982; 3 (1): 8-26.
4. Foster GM. An introduction to ethnomedicine. In: Bannerman RH, Burton J,
Wenchieh C, eds. Traditional medicine and health care coverage. Geneva: WHO,
1983: 17-24.
5. Akerele O. WHO’s traditional medicine programme: progress and perspectives
WHO Chron 1984; 38 (2): 76-81.