1. The opinion of traditional healers in
Ethiopia towards cosmopolitan medicine
Jan Willem Knibbe
1473735
Supervisors
External
Prof. Damen Haile Mariam, PhD; College of Health Sciences, Addis Ababa University
Henk van den Heuvel, PhD; Centre of International Cooperation, VU University Amsterdam
Internal
Fiona Budge, MSc; Athena Institute, Faculty of Earth and Life Sciences, VU University Amsterdam
Barbara Regeer, PhD; Athena Institute, Faculty of Earth and Life Sciences, VU University Amsterdam
Internship 2 (30 ECTS) at College of Health Sciences, Addis Ababa, Ethiopia
VU University Amsterdam, Facultity of Earth and Life Sciences, Management, Policy Analysis and
Entrepreneurship in the Health and Life Sciences
Amsterdam, May 2012
2. Table of Contents
2
Table of Contents
Table of Contents ...............................................................................................................................................................2
Summary...............................................................................................................................................................................7
1 Introduction................................................................................................................................................................8
1.1 Problem definition............................................................................................................................................8
1.2 Traditional healing in Ethiopia.......................................................................................................................8
1.3 Objective of the research ..............................................................................................................................10
1.4 Central research question..............................................................................................................................10
2 Conceptual framework............................................................................................................................................12
2.1 Social Learning Theory..................................................................................................................................12
2.2 Actant-Network Theory................................................................................................................................14
2.3 Concepts ..........................................................................................................................................................15
2.3.1 Beliefs about diseases ................................................................................................................................16
2.3.2 Practices.......................................................................................................................................................16
2.3.3 Curing ..........................................................................................................................................................16
2.3.4 Social status.................................................................................................................................................16
2.3.5 Benefits........................................................................................................................................................17
2.3.6 Patients.........................................................................................................................................................17
2.3.7 Knowledge of cosmopolitan medicine...................................................................................................17
2.3.8 Payment.......................................................................................................................................................17
2.4 Sub questions ..................................................................................................................................................18
3 Methodology.............................................................................................................................................................20
3.1 Analysis.............................................................................................................................................................21
3.2 Interviewees.....................................................................................................................................................22
4 Results........................................................................................................................................................................24
4.1 Beliefs about diseases.....................................................................................................................................24
3. Table of Contents
3
4.2 Practices ...........................................................................................................................................................24
4.3 Curing...............................................................................................................................................................25
4.4 Social status......................................................................................................................................................25
4.5 Benefits.............................................................................................................................................................26
4.6 Patients.............................................................................................................................................................26
4.7 Knowledge of cosmopolitan medicine .......................................................................................................27
4.8 Payment............................................................................................................................................................27
5 Discussion.................................................................................................................................................................29
5.1 Results ..............................................................................................................................................................29
5.1.1 Groups.........................................................................................................................................................29
5.1.2 Actions.........................................................................................................................................................29
5.1.3 Objects.........................................................................................................................................................30
5.1.4 Facts .............................................................................................................................................................30
5.2 Location healers..............................................................................................................................................30
5.2.1 Layout ..........................................................................................................................................................31
5.2.2 Objects.........................................................................................................................................................31
5.2.3 People...........................................................................................................................................................31
5.3 Limitations of the study.................................................................................................................................32
5.4 Further research..............................................................................................................................................32
6 Conclusions...............................................................................................................................................................34
7 References.................................................................................................................................................................35
Appendix I Interview design...........................................................................................................................................38
Personal information ...................................................................................................................................................38
Illness & curing.............................................................................................................................................................38
Patients...........................................................................................................................................................................38
Social status ...................................................................................................................................................................39
Payment .........................................................................................................................................................................39
4. Table of Contents
4
Knowledge.....................................................................................................................................................................39
Benefits ..........................................................................................................................................................................39
Appendix II Interviewees................................................................................................................................................40
Appendix III Interview transcripts ................................................................................................................................41
Interview 1.....................................................................................................................................................................41
Interview 2.....................................................................................................................................................................44
Interview 3.....................................................................................................................................................................46
Interview 4.....................................................................................................................................................................50
Interview 5.....................................................................................................................................................................53
Interview 6.....................................................................................................................................................................55
Interview 7.....................................................................................................................................................................56
Interview 8.....................................................................................................................................................................58
Interview 9.....................................................................................................................................................................60
Interview 10...................................................................................................................................................................62
Appendix IV Analysis ......................................................................................................................................................64
Beliefs about diseases...................................................................................................................................................64
Practices.........................................................................................................................................................................65
Curing.............................................................................................................................................................................67
Social status ...................................................................................................................................................................69
Benefits ..........................................................................................................................................................................69
Patients...........................................................................................................................................................................72
Knowledge of cosmopolitan medicine .....................................................................................................................74
Payment .........................................................................................................................................................................78
Appendix V Article...........................................................................................................................................................80
Summary.............................................................................................................................................................................80
Introduction.......................................................................................................................................................................81
Traditional healing in Ethiopia...................................................................................................................................81
5. Table of Contents
5
Methodology......................................................................................................................................................................83
Conceptual framework................................................................................................................................................83
Beliefs about diseases..............................................................................................................................................84
Practices.....................................................................................................................................................................84
Curing ........................................................................................................................................................................84
Social status...............................................................................................................................................................84
Benefits......................................................................................................................................................................85
Patients ......................................................................................................................................................................85
Knowledge of cosmopolitan medicine.................................................................................................................85
Payment.....................................................................................................................................................................85
Sub questions................................................................................................................................................................86
Interviews ......................................................................................................................................................................86
Analysis ..........................................................................................................................................................................88
Results.................................................................................................................................................................................89
Beliefs about diseases...................................................................................................................................................89
Practices.........................................................................................................................................................................89
Social status ...................................................................................................................................................................90
Benefits ..........................................................................................................................................................................90
Patients...........................................................................................................................................................................90
Knowledge of cosmopolitan medicine .....................................................................................................................91
Payment .........................................................................................................................................................................91
Discussion..........................................................................................................................................................................92
Results............................................................................................................................................................................92
Groups.......................................................................................................................................................................92
Actions.......................................................................................................................................................................92
Objects.......................................................................................................................................................................93
Facts...........................................................................................................................................................................93
7. Summary
7
Summary
This research investigates the opinions and beliefs towards cosmopolitan health care of traditional herbalist
healers in Ethiopia. A theoretical framework based on Social Learning Theory and Actor-Network Theory is
used to derive the eight concepts that are investigated in this research.
To investigate these eight concepts, ten traditional herbalist healers were interviewed, using semi-structured
interviews with the aid of translator. The interviewed healers all lived and worked in the Addis Ababa area. Five
of them were Ethiopian Orthodox, and the other five were Muslims; their ages varied between 28 and 95.
The main finding is that traditional healers are, in principle, positive towards more cooperation with
cosmopolitan health care. They see a great benefit in treatments they cannot deliver, such as operations or in-
patient care. However, differences are seen in the way medicines are prepared. The interviewees stated the
importance of using fresh ingredients, which is not case with medicines used in cosmopolitan care.
The most important hampering factor in cooperation with cosmopolitan care is the perception of traditional
healers that there is a lack of respect and recognition of their role. Cooperation between cosmopolitan and
traditional health care should be a two-way interaction.
8. Introduction
8
1 Introduction
This chapter introduces the subject of the research. First the problem will be defined, followed by a short
literature review of the various practices of traditional health care in Ethiopia. Finally, the objective of the
research is stated and the central research question is formulated.
1.1 Problem definition
About 80% of the population in Ethiopia uses traditional medicine (Kassaye, Amberbir, Getachew, &
Mussema, 2007). Therefore, the Ethiopian government has formulated in its health policy, the desire to have a
cooperation between modern Cosmopolitan medicine and traditional healing (Ethiopian Health Policy, 2009).
Understanding the beliefs of the traditional healers towards modern cosmopolitan healthcare, in order to find
common grounds for cooperation between these two health systems, will make an important contribution
towards the process of realizing the policy objectives.
1.2 Traditional healing in Ethiopia
This section gives a short overview of the practices of various traditional healers that can be found in Ethiopia.
It should be stressed that Ethiopia is an ethnic and culturally diverse country (Abbink, 2006; Bishaw, 1991).
This section will focus on the most common traditional health systems as they are practiced in Ethiopia (Bishaw,
1991; Kloos, 1998; Young, 1976), which includes professionals that were interviewed for this research.
The definition of traditional medicine as used by the WHO is “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 mental illnesses” (Zhang, 2000).
Cosmopolitan medicine is understood to be health care that is delivered by hospitals and medical clinics, based
on a biomedical approach that has originated from a Western perspective (Taylor & Leslie, 1973). People who
practice this kind of health care should have a formal training in a medical faculty of a university or health
college. Synonyms often used for this health system include Western, scientific or modern healthcare.
This research only focuses on traditional healers working in Addis Ababa. Therefore for the purpose of this
research, a traditional healer will be defined as someone who lives in Addis Ababa, works with herbal
treatments, and who has not received any formal training from the cosmopolitan health system. Nevertheless,
there are many types of traditional healers that operate within Ethiopia. These will be explained in this literature
section, to give an impression of the various types of health systems that exist.
Traditional healing has a long tradition in Ethiopia (Slikkerveer, 1982). The practices are as diverse as the various
cultures within Ethiopia (Bishaw, 1991; Kassaye et al., 2007). For this research, the focus will be on the
9. Introduction
9
traditional healers in Addis Ababa, where the traditional healing methods are strongly influenced by the
Ethiopian Orthodox Church (Slikkerveer, 1982). Health is seen as a gift from God, and religion plays an
important role in order to stay healthy (Bishaw, 1991; Kassaye et al., 2007). Furthermore, health is seen as a
state of equilibrium within the body and between the body and the environment (Bishaw, 1991). Some
comparisons with the cosmopolitan biomedical approach are possible. For example, it is believed that ill making
spirits live in unhygienic places that should be avoided (Bishaw, 1991). Nevertheless, the link with biomedical
tradition is not made explicit.
Traditional medicine in Ethiopia is generally practiced by members of the elite groups of the dabtara, the
Orthodox Christian literate healer; the meshaf-gelach, the Orthodox astrologer; the Zar doctor, the mystic spiritual
healer of the Zar cult; the woggesha, the pragmatic healer and bonesetter; and the tanqway, the diviner-wizard (S
D Messing, 1972; Young, 1976). These various types of healers have different kind of treatments and specialties.
The woggesha for example, treat broken and painful limbs, while the dabtara can treat people by removing the
spirit or poison that is causing a disease (Young, 1976). The sections below will discuss the various healers in
more detail.
Dabtara. The dabtara has strong ties with the Ethiopian Orthodox Church, and is sometimes referred to as a
lay-priest. The healing process has therefore a strong religious meaning, with both physical and psychological
illness being treated by amulets, sacrificial offerings or religious pilgrimage. Also treatment with traditional
medicine can be prescribed (Slikkerveer, 1990).
Meshaf-gelach. The meshaf-gelach has an important role in predicting the prognosis of patients by astrology.
Comparing the constellations of the name of the patient with the stars, he determines the best remedy for the
patient in the form of amulets, medicine or pilgrimage. He is like the dabtara usually a member of the elite of
the Ethiopian Orthodox Church (Slikkerveer, 1990).
Zar doctor. The zar doctor is most frequently described as a mystical spirit exorcist. Many people believe that
he possesses a powerful spirit (zar in Amharic) that is able to manipulate the spirits in the body of patients.
Symptoms patients suffer from can range from apathy, hysteria, paralysis to miscarriage. To cure patients, the
zar doctor and patients go into a trance in an esoteric environment, where the spirits are driven out by repeating
oaths (Simon D Messing, 1958). The zar doctor does not have official ties with the Ethiopian Church; however,
he is well respected by the members of the church and belongs to the local elite, like the dabtara and meshaf-
gelach (Slikkerveer, 1990).
Tanqway. Like the Zar doctor, the tanqway tries to treat patients by driving out evil spirits. People visit the
tanqway with symptoms like epilepsy or leprosy, but also in case of crop failure, theft or apathy. Unlike the
10. Introduction
10
above mentioned healer, the tanqway is usually avoided by more educated healers and is often regarded as a
quack by them (Slikkerveer, 1990).
Woggesha. The woggesha is a usually illiterate pragmatic healer. He uses simple instruments, like scissors or
cow horns, to relieve somatic complaints like fractures, wounds or abscesses. Furthermore, the woggesha has
great knowledge on the use of natural products, such as plants or oils, for preparing traditional medicines
(Bishaw, 1991). This is the type of healer that this research focuses on.
As causes of a disease can be seen as a combination of natural and supernatural influences, the practices can be
characterized by a combination of mystical and pragmatic concepts and beliefs (Bishaw, 1991; Slikkerveer,
1982).
Interesting to note is that most traditional healers have a kind of ‘no cure, no pay’ system. Patients have to pay
an initial sum, but further payments depend on the effectiveness of the treatment (Leonard, 2003). This is one
of the possible explanations why the use of traditional healers is still very common in Ethiopia, where the,
sometimes even cheaper, cosmopolitan healthcare is expanding (Leonard, 2003; Slikkerveer, 1982).
The Ethiopian government has recognized the important role that traditional healthcare plays in Ethiopian
society (Kloos, 1998). Therefore, the Ministry of Health has indicated traditional medicine as one of the eight
priorities of the current health policy (Kassaye et al., 2007): “due attention shall be given to the development
of the beneficial aspects of Traditional Medicine including related research and its gradual integration into
Modern Medicine” (Ethiopian Health Policy, 2009).
However, it should be noted that already in the 1970s action was undertaken to integrate traditional medicine
in the cosmopolitan health system. This was not accomplished due to conceptual disagreement and deep-rooted
antagonism (Kloos, 1998; Kloos, Getahun, Teferi, Gebre Tsadik, & Belay, 1988). Furthermore, these new
policies are not yet implemented into practice (Kassaye et al., 2007).
1.3 Objective of the research
The discussion above leads to the following objective:
The objective of this research is to find out what the opinion and beliefs are of traditional herbalist healers towards cosmopolitan
medicine in order to find common ground for cooperation between these two types of health systems.
1.4 Central research question
In order to be able to reach the objective stated above, the following two central research questions are
formulated.
11. Introduction
11
What are the opinions and beliefs of traditional herbalist healers, in Addis Ababa, towards cosmopolitan health care?
and
Do they see possibilities to cooperate with the cosmopolitan health system?
12. Conceptual framework
12
2 Conceptual framework
In order to be able to answer the central research question stated above, a conceptual framework was developed.
This section describes the framework that was used and the various concepts that emerged when answering the
research question. The framework is based on Social Learning Theory (SLT) and Actor-Network Theory
(ANT).
These two theories were chosen because of the two main objectives of this research. One is the investigation
of the beliefs of traditional healers, while the second one is the investigation for possible common ground in
order to be able to have more cooperation between traditional and cosmopolitan medicine.
The basis of this research is that in Ethiopia a new government policy has emerged that states there should be
more cooperation between traditional healers and cosmopolitan medicine (Health Sector Development Program IV
Woreda Based Annual Core Plan, 2010). The overall objective is to explore the opinion of traditional healers toward
Cosmopolitan medicine to see if there is any common ground for cooperation. For this to happen, it will
require behavior change efforts for both cosmopolitan practitioners and traditional healers. This research
however, will focus only on the behavioral change required of traditional healers.
To understand what is necessary for this behavior change the model of Social Learning Theory is used as a tool
to find out what the factors are that could determine whether the healers are able to cooperate with
Cosmopolitan health care. Furthermore, it will be investigated what the relations are between the various
concepts. The different interactions with actants, human and non-human agencies interacting with each other,
will be mapped in order to increase understanding of the way the opinion of the traditional healers is formed.
For this the theory of ANT is used.
The next two sections explain these two theories. This is followed by a section that describes the concepts
emerging from these theories.
2.1 Social Learning Theory
In order to increase understanding of how the beliefs of the traditional healers are formed, the model of Social
Learning Theory will be used. This theory is used to identify some different aspects that may determine the
view of traditional healers toward cosmopolitan medicine. These concepts will be clustered according to the
categories of SLT, which are explained below.
Behavior is believed to be determined by its consequences, SLT is derived from this belief (Bandura, 1977;
Rosenstock, Strecher, & Becker, 1988). This theory states that behavior is determined by expectancies and
incentives. Expectancies are usually divided into three categories (Rosenstock et al., 1988):
13. Conceptual framework
13
Environmental cues - how events are connected. For this research this has to do with the beliefs of
the healers on diseases. For example, the causes that lead to a disease and what kind of treatment is
needed to cure a patient. These are concepts that the healers take as granted, and are not able to
influence.
Consequences of one’s own action - how individual behavior is expected to influence an outcome.
This links to the practices of the healers; what kind of treatment can be given. This is thus not
necessarily something the individual can do himself.
Expectation about self-efficacy - beliefs about one’s own competence to influence an outcome. In the
frame of this research, this has to do what the healers can do themselves. It is what they are able to
themselves in order to treat the patient.
Incentive (or reinforcement) is defined as the value of a particular object or outcome (Rosenstock et al., 1988).
According to this theory, it is necessary to find out various beliefs of the subjects being investigated. This can
give a good description on how behavior with respect to health can be explained (Rosenstock et al., 1988).
SLT thus provides a tool to be able to understand what concepts may lead to behavior of healers towards the
cosmopolitan health system. It is possible the think as a hierarchical structure, with environmental on top going
down to incentive.
This makes it possible to focus on the important aspects. In Figure 1 the concepts of SLT are linked with the
concepts used in this research.
Figure 1 Link between the categories of SLT and the concepts studied in this research.
Incentive
Social status Benefit
Expectactation about self-efficacy
Curing
Consequences of one's own action
Practices
Environmental cues
Beliefs about diseases
14. Conceptual framework
14
2.2 Actant-Network Theory
Furthermore, to be able to find out possible hampering factors and common ground for cooperation with
cosmopolitan health care, the relations between several concepts need to be investigated. A tool that gives a
description to find these, is Actant-Network Theory (Latour, 2005). ANT treats human and non-human objects
of equal importance and tries to find out what the relation between them is, in order to give a description how
these interact (Dolwick, 2009).
In literature, this model is called both Actor-Network Theory and Actant, but to emphasize that actors can also
be non-humans, Latour preferred to use the word ‘actant’ instead (Powell & Owen, 2011). Therefore, I will
use the term ‘actant’ will be used instead of ‘actor’ in the remainder of this report.
In ANT, several concepts are important to describe reality: actant, agency and interaction, translation and
actant-network. These concepts will be explained below:
Actants are the humans and objects that interact with each other. In principle, objects and humans are treated
as equal (Dolwick, 2009). Thus, a person can be actant, but also a written text or an organization. In this
research, actants are, for example, the healers, the objects they use in treatment, or a hospital.
An actant network itself can be actant as well (Dolwick, 2009), for example a university can be seen as an actant
in the context of a country, but can be described as an actant network when one tries to describe the way it
internally functions. Examples of actants are then students, the library and faculties.
For this research it is important to identify the various actants and explore their role in the forming the opinion
of the traditional healers. Figure 2 shows the links between the various concepts that are identified with the
explanatory theory of ANT.
15. Conceptual framework
15
Figure 2 Interaction between various concepts according to ANT
2.3 Concepts
From a first literature scan and consideration of SLT and ANT, several concepts or actants were already
identified. These are used as a starting point to investigate the actant-network and are shown in Figure 3. In
this section, these concepts are explained as well as their relation to this research. These concepts provided the
basis for the interview design.
Because this is an explorative study and very little is known about the opinion of traditional healers towards
cosmopolitan health care, this framework is not firmly based on existing theories. Instead, it draws on relating
the concepts that are considered important and were identified in the first literature research in order to increase
understanding of the way the opinion of the traditional healers are formed.
16. Conceptual framework
16
2.3.1 Beliefs about diseases
The most important ‘environmental cue’ for the traditional healers is the way they believe diseases are caused.
These beliefs will influence greatly how they perceive cosmopolitan health care, because these are the lenses
the healers use when they think about curing (Young, 1983). Knowing their beliefs about diseases will help
explain the methods they use to cure patients and will help to explain their opinion toward cosmopolitan health
care.
2.3.2 Practices
The research aims to explore feelings of outcome expectancy among traditional healers. Specifically, how firmly
they believe in their treatment methods and their perceptions about the efficacy of cosmopolitan medicine, and
again, exploring options to establish common ground for cooperation. It is therefore necessary to know the
expectation of the healer about his capability of treating the patient (Good, Hunter, Katz, & Katz, 1979; Young,
1976). Therefore, one has to look at the practices of the healers and how they believe that this practice is useful
in curing the patient.
The investigation of practices serves two goals: (1) to find out what the perceived self-efficacy of the healers is
and (2) how this relates to the cooperation with cosmopolitan health care.
2.3.3 Curing
A healer needs to have the belief he is able to cure a patient. It is therefore important to investigate the self-
efficacy of healers regarding the way patients are cured. This gives an impression on the way healers look at
cosmopolitan healthcare, which is likely to be very different in the way of curing patients than traditional care
(Mokaila, 2001; Young, 1983). For that reason, it will be investigated (1) what traditional healers see as necessary
for curing and (2) how they think about the way of curing by cosmopolitan health care.
To be able to understand the differences in curing between traditional and cosmopolitan medicine, there is a
need to investigate what kind of objects are used and what the role of these objects are. This will give a clue as
to how treatment is given and how this relates to the beliefs and opinions of the healers (Pelto & Pelto, 1997).
This will give information on possible common ground in the way patients are cured.
2.3.4 Social status
There is also the aspect of social status. Traditional healers have a role within their local society that determines
how they look toward cosmopolitan medicine: it can be possible that they see it as threat to their status and it
could create a negative opinion toward it (Harkness, Edwards, & Super, 1981). On the other hand, when they
feel that they have a strong position in the community it is easier for them to cooperate on an equal footing
with cosmopolitan care. Furthermore, their social status will influence the way the interviewees act, because the
community has certain expectancies on their behavior and role.
17. Conceptual framework
17
Within the framework of SLT, the social status has to do with incentive. Therefore, the role the healers have
within the local communities and societies will be investigated and related to their opinion on cosmopolitan
medicine. Furthermore, it will be questioned whether they expect to see a different role emerge when the
relations with cosmopolitan care changes.
2.3.5 Benefits
For traditional healers to cooperate with cosmopolitan medicine, according to SLT, there needs to be some
incentive. Therefore, this study will investigate what benefit they believe could result from cooperation.
Therefore, it is useful to investigate whether traditional healers see if people can benefit from cosmopolitan
health care, and if so in what manner. When the healers see benefits for their patients, it more likely that they
will cooperate with the cosmopolitan care.
2.3.6 Patients
Patients are included as an actant, because it is important to understand preconceptions of traditional healers
regarding treatment of patients, as these expectations will influence their opinion towards the practices in
cosmopolitan healthcare (Slikkerveer, 1982). The way this differs from that of the perceived cosmopolitan
perspective, will have an influence on the way they see the complete cosmopolitan health system.
2.3.7 Knowledge of cosmopolitan medicine
An important concept that determines the view on cosmopolitan medicine is the knowledge of cosmopolitan
care of the traditional healers. This has to do with what healers expect from cosmopolitan medicine. Knowledge
can be on the way treatment is done is hospitals or the way patients are treated by cosmopolitan physicians.
This knowledge will influence their opinion of this system. Their own experience with cosmopolitan health
care can have a great influence on the way they see it, either positively or negatively (Young, 1983). Therefore,
it was be investigated what kind of contacts and interactions, if any, had occurred between healers and actants
of cosmopolitan health care, such as health clinics or medical doctors.
2.3.8 Payment
From the literature scan, the concept of payment emerged as important for this research, because of the clear
differences between the way traditional healers are paid and how payments are made in cosmopolitan
healthcare. Therefore, payment is included as an actant within this research. If income from the patients are
lost, traditional healers might be reluctant to cooperate with modern Cosmopolitan health care and will possibly
have a negative opinion towards Cosmopolitan medicine (Green, Makhubu, & Bag, 1984). Therefore, one has
to investigate the way and in what forms payments are made (e.g. money or other forms of payment).
18. Conceptual framework
18
Figure 3 Schematic overview of the conceptual framework. (TH stands for traditional healer, while CM stands for
cosmopolitan medicine.)
2.4 Sub questions
Several sub questions emerged from the research framework that needed answering to be able to give an answer
the research question. This section states these questions.
What are the beliefs of traditional healers toward curing patients and how does this compare with their
beliefs about cosmopolitan curing of patients?
What is the social status of tradition healers in the research area?
What is the between the role traditional healers have within the community and their view on
cosmopolitan medicine?
What is the
opinion of
THs towards
CM?
TH
practices
Payments
Opinion
towards
patients
Knowledge
of CM
practices
Social
status
Curing
Benfits
Beliefs
about
diseases
19. Conceptual framework
19
What are the experiences and knowledge of traditional healers with cosmopolitan healthcare, with
regard to treating patients?
What similarities, if any, do traditional healers see between cosmopolitan and traditional beliefs about
treatment?
Do traditional healers see benefits from cosmopolitan healthcare for patients?
20. Methodology
20
3 Methodology
This chapter described the methods that were used for this research. First, a description will be given on the
interview procedure. Then the analysis is explained.
Ten semi-structured interviews were conducted to find answers to some predetermined concepts. This number
of interviews gave sufficient in-depth information and it made it possible to compare the various answers.
Furthermore, it is a realistic number as one can expect difficulties reaching the healers (Flick, Von Kardorff,
Steinke, Kardorff, & Jenner, 2004). The selection was made by convenient selection, with the help of
researchers from the College of Health Sciences. The researchers at the College of Health Sciences were in
contact with mediators, who in turn had good contacts with the interviewed traditional healers.
Furthermore, there was a snowball effect as participating healers were asked to introduce other possible
interviewees. It has been reported that response rates are lower when selection criteria are stricter (Ross,
Vaughan, & Patrick, 2011). Because there was limited time for this research, I opted for this method.
The interviewees were contacted by a contact person who is familiar with the healers and is trusted by them.
This was done to make sure that the response rate was adequate and the healers were willing to cooperate with
this research. They were provided with the aim of the study, so it was clear for them what to expect from the
interviews.
Because the traditional healers do not speak, or have very limited, English the service of a translator was
required. Two different translators were used, who both were instructed about the objectives of this research.
Before the start of the interview, the interviewees were asked whether they agreed for me to record the
interview. None of the interviewees had any objection about this recording. After the interviews were
performed, they were transcribed in Amharic. This transcript was translated back to English by an independent
translation office. This, so called, back translation was done to ensure that the translations were adequate and
gave reliable results (Brislin, 1970). Every attempt was made to minimize the taking of notes as much as
possible, because taking notes may distract from the interviewing process resulting in information being missed
(Flick et al., 2004).
Interviews took place at the location of the healer, as this was most comfortable for him, and increased
likelihood of getting reliable results. Furthermore, it was easier to see the various objects and interactions of a
healer when at his location. When it was not possible to conduct the interview at the healer’s place, the interview
was done at a hotel or restaurant near the place of the healer. The length of the interviews was between 30 and
45 minutes.
21. Methodology
21
Only male practitioners were interviewed for this research. Nevertheless, traditional medicine is practiced by
females as well (Yineger, Kelbessa, & Bekele, 2008). Therefore, the role that gender of the healer might play is
not investigated in this research.
In order to check the comprehensiveness of the topic list and the estimated timing, the interview design was
discussed with several people who were familiar with traditional healers. The interview design can be found in
appendix I.
It was chosen not to use participative observations due to limits of time
3.1 Analysis
The analysis of the interviews was done by means of structured analysis. The interviews were carefully examined
and structured according the various concepts that were identified in the conceptual framework. These concepts
were placed in a matrix, which made it possible to see the different links between them. For this, the computer
program WeftQDA was used a tool.
Within ANT one can identify five different concepts, or “uncertainties”, that need investigation to find out
what the relations are between the various actants (Latour, 2005). These five uncertainties that served as a
starting point of the research are the nature of: (1) groups, (2) actions, (3) objects, (4) facts, and (5) how to write
research accounts. These will be explained in the following paragraphs. The analysis of the interviews will be
done according to these five uncertainties in order to be able to identify the relations between the actants.
Groups. The concept of groups is about how actants came together. What needs to be investigated here is
“group making and unmaking” (Latour, 2005). In the context of this research this is, for example, the relation
between traditional healers and the cosmopolitan health system. Another aspect is the relation between patients
and how their social status is developed. This is related to how agency is used to make the translation by the
actants. Translation is the process where actants shape concepts to fit within a particular argument (Holtorf,
2003). It is here that the beliefs of the healers are transferred into practice.
Actions. This uncertainty deals with the concept of agency and one has to question how actants are influenced
to act by other actants (Oppenheim, 2007). For this research, it is important to ask how healers think about
cooperation with cosmopolitan health care. This topic also includes questions about their beliefs on causes of
disease and how treatment can be achieved. Furthermore, this is about how the relation with other actants is
established.
Objects. This deals with the recognizing of nonhuman objects that participate in the actions taking place
(Dolwick, 2009). It is here that one has to look at objects that influence and have a relation with the opinion
22. Methodology
22
the healers. Objects one can think of include medicines or instruments and the role they play in treatment, or
whether there is a health clinic near the village and how this will influence the opinion of the healers.
Questions one can ask include the role of payment of the healers and the policy the government has developed
with regards to traditional medicine. At this stage is important to find out from the healers what objects are
important for the healers and how this influences their opinion.
Facts. This concerns how to tell the difference between a ‘matter of fact’ and a ‘matter of concern’ (Dolwick,
2009). This deals with how strong the healers believe in their methods and how they see the cosmopolitan
beliefs of medicine. It is closely related to the concept of translation, as it deals with how strong the concepts
fit within the reality of the actant network.
How to write research accounts. This is the final step in the research, where the relations between the found
actants are described. It describes “who was doing what (and ‘what’ was doing what), how they were doing it,
where and when all of this was going on, and why” (Dolwick, 2009). It is about linking the actants and describing
how these links are made. This is the final step in the research, where all identified actants will be linked with
each other in order to represent the actant-network.
3.2 Interviewees
This section gives a description of the interviewees that participated in this research. An overview of all the
interviewees can be found in Appendix II.
Five Muslim and five Orthodox healers were interviewed for this research. This makes it possible to investigate
if religion plays a role in the opinion of the healers, and if there are differences in the healing process between
different religions.
The education level varied from 8th till 12th grade, thus all the interviewees had at least completed primary
school1. Usually they were trained by another traditional healer before they started their own profession. This
could be a family member, such as father, but one interviewee told that he received his training in Sudan. Some
healers stated that they also received religious training; this was the case with Muslims as well as Christians.
The healers usually started in their late twenties or early thirties with their own practice.
Furthermore, there was a broad age range, with ages varying between 27 and 95 years. This gives thus a good
mix of ages, which makes it possible to see whether there are differences in opinion due to age differences.
1 The Ethiopian school system consist of 8 years primary school, followed by 2 years lower secondary school and 2 years
of higher secondary school (Teferra & Altbach, 2003).
23. Methodology
23
This also implies that there was a great range in experience: some healers were only working for a couple of
years, while others had more than 30 years of experience in the occupation of traditional healer.
One of the interviewees is the chairman of the association of traditional healers2. This gave the opportunity to
question the role that organization could play in coordination the cooperation of the traditional healers and
cosmopolitan health care.
2
The Ethiopian National Traditional Medicine Formulation and Treatment Organization, in the rest of this report it will
referred to as the Association.
24. Results
24
4 Results
This chapter describes the results that are found in this research. These were clustered according to the concepts
that were identified in the conceptual framework. In the next chapter, the discussion, these points will be linked
with the five uncertainties that come from ANT.
4.1 Beliefs about diseases
There are two main points that the healers identify within this topic. The first aspect identified, is that diseases
are caused by something that resides inside the body of the patients. In order to be able to heal the patient, this
has to be removed from the body. Therefore, a common practice is to prescribe a drug that causes the patient
to throw up or to have diarrhea. “When he feels sick, there must be something inside his stomach” (Interview 1) and “As to
the very nature of the disease it simply intermingled with blood and other parts of our body, the medicine we provide helps to totally
remove such problems.” (Interview 3)
The second, related, concept that came forward from the interviews was that a disease often cannot be removed
by surgery only. It is believed that the cause of the disease is inside the body and with surgery one only removes
the exterior parts. It is therefore that a disease should be cured with a medicine from plants or roots. This is
will result in the disease being removed from the body and therefore curing the patient permanently. “(…) the
modern medicine removes the problem that is emerged around the anus through surgical treatment, but steel does not heal the
problem. Therefore, due to this short coming most of the patients frequently visit hospitals as it is emerging again and again through
time. This happens because it is difficult to remove the problem totally with its roots as they cut its uppers parts to remove the
inflammation only.” (Interview 3)
4.2 Practices
All the interviewees use herbals to make medicines for specific diseases. These drugs are prepared for use in
different forms, namely ointments, pills and syrups. They find it very important that these drugs are made from
fresh ingredients. Here they identify a difference with cosmopolitan care, which uses non-fresh ingredients to
prepare drugs. The traditional healers feel that this method will decrease the effectiveness of a drug. “There are
drugs in ointment, syrup and tablet forms (...) most of the drugs are prepared from various herbals and roots (...).” (Interview 5)
and “in the modern facilities, many patients are provided with the necessary service and follow up as in-patient. But this is not
possible in the traditional service provider” (Interview 10)
Apart from giving injections, there is very little use of instruments. Both examination and treatment is done
without the use of instruments. The healers that use injections indicate that they use it in cases of hemorrhoid.
It was never mentioned outside that context. All the interviewed healers name the little use of instrumentation
as an important difference with cosmopolitan health care, where the use of instruments is ubiquitous. “I believe
25. Results
25
that the first difference is the medical equipments that are used to examine patients, the drug formulation and the way it is given.”
(Interview 5)
Most of the interviewed healers are specialized in a certain type of disease. This can be for example skin disease
or respiratory problems like asthma. This implies that they only make drugs for a limited number of diseases in
which they are specialized. “It is common for any traditional medicine facility to specialize and become famous in any one of
disease treatment.” (Interview 3)
4.3 Curing
All the interviewees agreed that the cooperation of the patient is very important in the healing process. That is,
not only (herbal) medicines are needed, but also the attitude of the patient is needed. This means often that
patients need to change their lifestyle, for example by stopping the eating of raw meat or exercise more. “Beside
our treatment, we observe the change prohibiting patients not to take things such as fat, alcohol, serve kinds of food, etc.” (Interview
10)
Another important aspect of curing mentioned by the healers is that always a diagnosis is made before the
treatment starts. The resulting treatment depends on the diagnosis made. Furthermore, when a disease is
diagnosed and the healer is unable to cure, the patient will be referred to another healer or to a hospital.
“Whatever the case it might be, we do not give drugs guessing the case.” (Interview 5)
Furthermore, all interviewees indicated that they do not possess any special gifts, other than their knowledge
on diseases and plants. This knowledge is learnt from other healers. As one healer states: “Regardless of knowledge
and experience, the knowledge of our forefathers has played significant role for us to be engaged in this work. I think there cannot
be any other skill except these ones.” (Interview 6)
4.4 Social status
Most of the interviewees indicate that they feel well respected by the local community. This respect comes with
age, one of the younger healers indicated that he did not have the respect that his father had. However, some
indicate that there are some people who do have a bad attitude towards them. One indicates that this is caused
by beliefs that he uses witchcraft to cure people. Nevertheless, it is always a minority who has a bad attitude
towards them. One interviewee indicated that the trust increased because he was participating actively with the
community. “However, as they see patients getting recovered and healed and we participate actively in social life now their attitude
is totally changed to good through time.” (Interview 5) and “Though there is some bad attitude, some people with good understanding
and attitude encourage us to work. As we are also providing our service broadly, I think most of the society have good attitude.”
(Interview 10)
26. Results
26
On the other hand, it is felt that the cosmopolitan health care has a very negative attitude towards their
profession. This is identified as a great hampering factor towards cooperation with the cosmopolitan health
care. “However, due to the attitude and opinion that the modern medical science professionals towards us, the traditional ones are
demeaning and looking downwards therefore they do not like to work with us. This is not a good condition to create and establish
healthy relationships between us.” (Interview 3)
Another important aspect that came up often during this topic is that they would like to be more accepted by
the government and cosmopolitan medicine. They see this as a very important hampering factor that should be
changed before there can be effective cooperation between traditional and cosmopolitan health care. For
example, the organization that represents the traditional healers is not officially recognized by the Ethiopian
government. “Again, the association was denied its license in 2007/08, still various efforts have been undertaken with the
cooperation of the practitioners.” (Interview 7)
4.5 Benefits
All except the oldest interviewed healer saw benefits from cosmopolitan health care. The most important
benefit seen is the use of instruments for diagnosis and the possibility of performing operations, both
unavailable to traditional healers. Another aspect they identify is that there are certain diseases that they are
unable to cure, while these can be cured in a hospital. Furthermore, for hospitals it is possible to provide in-
patient service, which is not possible for traditional health providers. “The modern medicine can simply heal complicated
diseases like cancer, gangrene, etc. They also do operational treatments. As there are various professionals who have well developed
knowledge obtained through education, I say without reservation that it is good. (… ) if the type of disease is beyond our capacity
or it can be treated simply with the modern medicine, we advice the patient to go to there for service.” (Interview 4) and “In addition,
as we see the treatment service for patients, in the modern facilities, many patients are provided with the necessary service and follow
up as in-patient. But this is not possible in the traditional service provider” (Interview 10)
4.6 Patients
All interviewees emphasized that they treat all the patients equally. There is no difference made between the
patients’ religion, sex, background. Anyone who needs curing is welcome by the interviewed healers.
Furthermore, they see it as very important for their profession that there is no discrimination of patients. “This
is not work that you can do with discrimination. Since we are concerned for the life of our peoples, it makes us to do it carefully.”
(Interview 5)
With regard the treatment of patients by cosmopolitan health care, there is no difference identified by the
interviewees. They all believe that their mutual goal is to cure patients, and it does not matter what the
background of the patient is. “Beyond everything, our mutual goal is to help patients, and we can raise things related with
this.” (Interview 5)
27. Results
27
4.7 Knowledge of cosmopolitan medicine
All the interviewed traditional healers have been in contact with cosmopolitan medicine. It is very common for
them to refer patients to a hospital in case of disease they are unable to cure. This seems to be a relatively new
development, because in the literature it is never mentioned that patients are referred the cosmopolitan
hospitals. “If we are for the first time that we come across with the disease or there is no drug to heal, we refer patients to the
modern hospital. We do this even where the disease remains with the patients for longer periods of time.” (Interview 3)
As stated above, the interviewed healers recognize the more advanced use of instruments. Furthermore, it is
seen that hospitals have great benefit in being able to provide in-patient care; something that the traditional
care is unable to perform. “What I consider as a difference, in most of the traditional healers, there is no in-patient service,
maybe some of them can do it. Most of the patients receive the service as out-patient.” (Interview 6)
One of the suggestions made to overcome this barrier is that the government should create a kind of platform
where there can be an exchange of ideas between the cosmopolitan and the traditional medicine. It is felt that
if there is more mutual understanding, both the traditional and the cosmopolitan health care can benefit from
it. “I believe it will be great if we got acknowledgment from the government to strengthen our unity and conduct practice of showing
experience with local and international works and with donor organizations working on health research.” (Interview 6)
It was suggested to form an independent board that coordinates exchange of knowledge between traditional
and cosmopolitan health care. Furthermore, it was suggested that there should be more research on the working
of traditional curing methods. By doing so, the healers believe this will lead to increased mutual understanding
which will increase their acceptance by cosmopolitan health. This might result in more governmental support
for the traditional health care, from which also patients can benefit. .
4.8 Payment
Payment is usually done after the treatment is finished. It is also customary that the payment depends on the
financial capabilities of patients; poor individuals usually have to pay much less or can even get treatment free.
The payment in general is made in money, however, it might be that people after treatment return with gifts in
kind, like food. This is seen as an extra sign of respect and gratefulness paid by the cured patient. The
interviewees told this often to show the respect in community that they earned with their profession, as it not
obligatory for the patient to do so. “We first do not talk about payment. We tell patients about payment after they are healed
and have received our service. Then the patient pays us the amount he can afford. We also provide the service for free for needy
persons.” (Interview 6)
The opinions are divided on whether traditional treatment is more expensive or cheaper than cosmopolitan
health care. Both opinions were equally voiced by the interviewees. It should be noted, however, that healers
who indicate that cosmopolitan health is more expensive argue that this is caused by the in-patient care. The
28. Results
28
in-patient care is a function that the traditional healers cannot offer for their patients. This is seen as an
important difference between traditional and cosmopolitan health care. “Still it is cheap, because patients may pay in
different ways in the modern facility. For example, there is payment for the card exam (lab, ultrasound, endoscopy) and finally for
drugs. Therefore, there is a big difference in terms of payment.” (Interview 10)
29. Discussion
29
5 Discussion
This chapter discusses the results and places them in a broader context. The various concepts will be integrated
in the uncertainties of ANT that are indentified in the conceptual framework. Furthermore, the locations where
the healers practice and the methods used will be discussed. The chapter concludes with suggestion for further
research.
5.1 Results
The discussion of the results is clustered according to the uncertainties that were identified by ANT. This is
done to give the discussion structure and it will make it easier to see how the actants interact.
5.1.1 Groups
There is an association of traditional healers; however, this organization is not recognized by the government
as an official partner. This is felt by the healers that that they are not accepted by the government. This is clearly
an important hampering factor regarding cooperation with cosmopolitan health care. The association plays an
important role in organizing the healers and giving trainings and is therefore an important actant.
Patients are seen as important by the healers. According to the healers, they do not discriminate against their
patients. Everybody is welcome for treatment, regardless of religion, ethnicity, gender or age. They also identify
that treating patients is a mutual goal of both traditional and cosmopolitan health care. This is thus an important
common ground for cooperation.
The healers are in general well respected by the community. This might also depend on their age, as one the
interviewees indicates. This has probably to do with a broader cultural aspect where older people are more
respected due their age. Another explanation for this is that the older healers have a longer experience and
therefore more known in the community. When looking for cooperation, it might therefore be good to start
first with contacting older and more experienced healers as peers. Another argument for this is that young
healers are often trained by experienced healers, before they start their own practice.
5.1.2 Actions
The use of medical invasive instruments is very limited by traditional healers. This is partly caused by beliefs
about disease (“steel doesn’t cure”) but is also seen a benefit that cosmopolitan has above traditional care. The
curing of the patient by traditional methods is done by giving the patient drugs made from fresh ingredients.
Furthermore, advice on lifestyle is sometimes given, e.g. that the patient should not eat raw meat anymore or
should exercise more.
The cause of a disease is usually identified as something that resides inside the body, and has to be removed in
order to cure the patient. A difference with cosmopolitan care is that in traditional care this cause should be
30. Discussion
30
removed with medicines, and operations alone are not enough. Nevertheless, operations are seen as an
important benefit from cosmopolitan care. Nevertheless, this might be a common on ground on which
cooperation between the two health systems can be improved.
In general, there is not a negative attitude towards cosmopolitan health care. The interviewed healers see
potential benefits in cooperation with cosmopolitan health care for their patients. Nevertheless, they feel that
their profession deserves official recognition by the government and the cosmopolitan health care system.
5.1.3 Objects
There is very little use of instruments by traditional healers. They see this as one of the key differences in
comparison with cosmopolitan health care. Diagnoses are made by questioning the patient on the symptoms
and examining external factors such wounds and heartbeat by hand, while the interviewees indicate that in
cosmopolitan care equipment is often used to make a diagnosis. Furthermore, in the treatment the only use of
instrumentation is that of injections or medicines. There are no operations or any other direct interaction on
the body of the patient. All the interviewees highlight this as a key difference between their profession and the
cosmopolitan one.
The payment is done after the treatment, and depending of the financial situation of the patient. There is not
clear a vision on whether cosmopolitan care is more or less expensive than traditional care. Nevertheless, it
looks like traditional care takes the income of the patients more into account than cosmopolitan care does.
Medicines are arguably the most important object used by the healers. In general, these are local plants, but
some healers import them from countries like Sudan. This is identified as an important difference compared
with cosmopolitan care, where medicines are made from prepared non-fresh ingredients. This method is seen
as inferior by the healers and therefore an important aspect to keep in mind regarding cooperation.
5.1.4 Facts
A key result of this research is that healers do believe in their methods of curing, but they do not see this as the
only way to help patients. For some cases, their methods are insufficient and it would be better for the patient
to go to the hospital. In such cases, the healers do indeed refer the patient to a hospital. This finding was seen
in all the age groups; there was no difference in age, both the younger and the older ones would refer to
cosmopolitan hospitals.
5.2 Location healers
This section describes the healers’ places that I visited for the interviews. Not all the interviews were held at a
healer’s place, because these were seen as inappropriate for the interviews, for example due to lack of a quiet
place. Therefore, these places might differ significant from places described in this section.
31. Discussion
31
5.2.1 Layout
Most places I visited had a waiting room where the patients could sit before being called by the healer. This
waiting room generally had some benches to sit on and sometimes a TV was broadcasting. Patients were called
one by one to visit the healer in another room for the consult.
The patients were usually accompanied by a family member, for example husband or mother. These were also
present during the consult with the healer.
The medicines were sometimes stored in the treatment room and sometimes in a separate room. In a couple
of cases, the medicines were sold by assistants of the healer. People could return when they needed more
medicines.
The places were in general well maintained and clean. All the places visited had electricity and thus electric
lightning. This was also necessary, as there was no daylight inside because of the lack of windows. Nevertheless,
the rooms were still only dimly lit.
5.2.2 Objects
A couple of healers used printed leaflets to promote their activities. These flyers stated for example the diseases
they were able to cure and experiences the healer had. I only found these flyers at the older healers; none of
the healers under 50 years seemed to advertise this way.
One of the healers had a handwritten book with different treatment methods and recipes for medicines. None
of the other interviewees seemed to use a book in determining the diagnosis. However, some had a certificate
hanging on the wall that showed certain courses they had conducted at the association of traditional healers.
They seemed proud of this and always mentioned it during the interview.
The Orthodox healers had various religious symbols placed in their rooms. These included images from saints
or crosses. In general, the places of the Muslims were much more sober in decoration. It seemed, however, that
religion did not play an important role for the way patients were treated. For example, none mentioned religion
as being important to cure patients and all healers indicated that they helped people regardless of religion.
5.2.3 People
When first contacting the healers, they seemed a bit reluctant to cooperate with the research, but once agreed
they were quite cooperative to work with me. The only restriction they often made was that they would not tell
how they prepared their medicines. This was a result of bad experience in the past when people were using
their recipes and methods without their permission.
32. Discussion
32
During the interview, the interviewees were quite relaxed and came up with subjects themselves. They seemed
to be quite happy to participate with the research. I did not have the impression that they were afraid to answer
questions or to speak out.
5.3 Limitations of the study
For this research, ten traditional healers were interviewed. It is therefore impossible to draw quantitative
conclusions. On the other hand, the number of interviewees is enough to draw qualitative conclusions that can
give a good starting point for further research.
Furthermore, all the interviewees practice in the capital Addis Ababa. Therefore, the conclusions will only be
applicable to this group of traditional healers. From the literature, it is clear that there are various other groups
of practitioners with different beliefs. Therefore, these different groups might have quite different views
towards cosmopolitan health care and the results of this research can therefore not be generalized towards
other types traditional healing. For example, it is likely that healers living in rural areas have much less relations
with cosmopolitan health care, simply because cosmopolitan health care is much more lacking in rural areas.
Two different translators were used during the interviews. This might lead to a slightly different interpretation
of the questions. I tried to minimize this effect by translating the transcripts in Amharic by a translation office.
In addition, both the translators were instructed on the objective of this research.
The method of selecting the interviewees with help from the College of Health Sciences might impose a bias
among the respondents, as they likely have a positive attitude towards cosmopolitan health care. It is also
possible that people who are positive towards cosmopolitan health care are more likely to participate with this
research than healers who have negative experiences or attitude.
5.4 Further research
Several points are interesting for further research. It might be very interesting to compare the finding of this
study with other groups of traditional healers. Ethiopia is a country with a very diverse population, so the
opinions in other ethnic groups might be very different from that in the capital (Abbink, 2009). Furthermore,
for this research only male practitioners were interviewed. It might be interesting to explore the opinions of
female healers as well and see if there are any differences in gender roles.
The interviewees indicated that they found it important to have more recognition from cosmopolitan care
professionals. It would therefore be interesting to investigate whether practitioners of cosmopolitan care are
willing to cooperate and see possibilities for cooperation. A good start would be to repeat this study with
participants from the cosmopolitan health.
33. Discussion
33
It might be interesting to visit the healers when they interact with patients and compare this with the way the
patients are treated in a clinic of the cosmopolitan health care. This might lead to a better insight into the way
patients are treated. The comparison can provide insight in possible hampering factors and common ground
for cooperation.
34. Conclusions
34
6 Conclusions
The most important belief identified is that to cure a patient the ‘object’ that causes the disease has to be
removed from the patient. This has to be done the inside, and with the aid of medicines. A surgical operation
alone is not seen as sufficient. Another important aspect is that the medicines used should be prepared from
fresh ingredients.
All the interviewed traditional healers indicated that it is important for them to treat all patients equally,
irrespective of religions, age, and sex.
The interviewed healers feel well respected by the local communities. They do not see this to be changing due
the arrival of cosmopolitan health care. However, their social status might be depending on age. Younger
interviewees indicate that they do not have as much earned respect as older healers.
The interviewed traditional healers have a quite clear vision on what cosmopolitan care is. They do have contact
with and even refer patients to hospitals. However, they would like be respected as well for the work they do.
Here lays, according to the interviewees, an important role for the government to facilitate this, probably in
cooperation with NGOs. Another important actant is the organization of traditional healers, that can play a
mediation role in the process of increased cooperation.
The most important similarity identified is that the goal of both traditional and cosmopolitan health care is to
cure patients. This is therefore an important aspect to focus on to improve cooperation between cosmopolitan
and traditional health care.
The interviewed traditional healers believe that it is possible to cooperate with cosmopolitan health care. They
especially see opportunities in cases that they are unable to cure, for example because an operation is necessary
or the patient needs in-patient facilities. They do not see cosmopolitan health care as a threat for their own
profession.
There are differences regarding treatment methods, but it seems that these are not too big that it should hamper
the cooperation between traditional and cosmopolitan health care. The most important difference is the lack
of trust of traditional healers in medicines prepared from non-fresh ingredients.
The most important hampering factor is the lack of recognition of traditional medicine that is given by the
government and cosmopolitan health care. Furthermore, a lack of respect is felt from the cosmopolitan health
care. In order to create a successful cooperation between cosmopolitan and traditional healthcare, it is important
that these two factors should improve.
35. References
35
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38. Appendix I Interview design
38
Appendix I Interview design
I am a student from a Dutch university and for my doing my final research in association with the College of
Health Science from Addis Ababa University. For this research, I am interested in the way traditional healers
perceive western medicine. In order to investigate this, I will ask you some questions. Your answers will kept
strictly anonymous. If you do not want to answer a question please feel free do so. This research will only be
used within the university.
Personal information
First, I would like to know to some person information.
Age
Religion
Formal education
Illness & curing
When people are coming to visit you, what kind of symptoms do they have.
What is causing these symptoms?
What is possible for this person to be treated?
Would you be able to treat him?
What should the patient do himself to be cured?
If we now move on to the Western care, can you maybe describe how this is different from your own approach?
How do see what they are doing?
Are they doing things different than you would do?
Do you think the patient is helped in this kind of curing?
May be add a general open question about their feelings toward CM
Patients
Now I would like to get some insight in your relation with patients.
How do they see their relation with patients?
How is this different the cosmopolitan medicine?
39. Appendix I Interview design
39
Social status
Next, I would like to know something about the way people in the community see you.
What is your role in the community?
How can this change due different health care available? Do you expect this to be changing?
Do you feel rewarded by you patients? Would this change when they go to health clinic, referred either
by you or by when they go by themselves?
Payment
How do patient pay you?
Do you see differences with health clinics in this?
Knowledge
For this topic, I am interested in your knowledge about Western care.
Have you ever been in contact with a Western care?
Can you tell something about your experience?
Did you ever refer patients to a Western health clinic? Why was that, or why haven’t you done that?
Benefits
Do they see possible benefits from cosmopolitan health care, e.g. treatments you are unable to give?
Would you see it possible to cooperate with cosmopolitan health care? If so, on what kind of topics?
If not, why not?
Thank you very much for your time.
Are there any questions left or you have some remarks you would like to make?
40. Appendix II Interviewees
40
Appendix II Interviewees
Interview
number
Date of
interview
Age Religion Formal
education
Comments
1 November 19 28 Islam 8th grade He is working together with
his brother. Their father was a
healer as well.
2 December 9 95 Orthodox Unknown He is a former officer in the
imperial army. He has two
assistants who help him.
3 December 19 27 Orthodox Unknown Trained by Sudanese in herbal
medicine
4 January 1 61 Islam 8th grade Working for 30 years as a
traditional healer
5 January 3 Unknown,
around 40
Islam 12th grade
6 January 3 Unknown,
around 50
Islam 8th grade Has also received religious
education
7 January 23 58 Orthodox 8th grade Chairman of the traditional
healers association
8 January 23 51 Orthodox 8th grade
9 January 24 54 Islam 10th grade Working for 23 years up as a
traditional healer
10 January 24 51 Islam 9th grade Working for 20 years as a
traditional healer
41. Appendix III Interview transcripts
41
Appendix III Interview transcripts
Interview 1
If people come to visit, what kind of sickness do they have?
When they see symptoms, people come here. Usually one person tells to another so that they can use this one
to be treated here.
So people don't come directly
They come they come. To who is the best traditional practitioner. They ask for different places and finally they
come.
And what is the reason that they come to this place?
His friend was sick and finally he was frustrated he was drinking alcohol and finally brought him a
malfunctioning stomach. And then finally he brought him here and they gave him medicine and finally he is
treated. This is witness.
And what kind of medicine did he receive?
This type of medicine is oneowd but I think it is plant. It is a plant.
And why does this plant work?
When he feels sick, there must be something inside his stomach. So when we give this medicine so finally with
diarrhea and different working he will be finally be cured.
So it is something that should go out of the body.
Do you think that also in a Western hospital such treatment could be given?
They say they claim they went to the scientific western hospital, but they say the were not cured so that is why
we come here.
So that is what the patients say.
If it is bone cancer, if they go the western hospital the leg will be amputated. But here we don't mutilate. When
it starts bleeding or we wash properly and collect all the broken bones and we put medicine inside so that they
will be cured without mutilation. So they prefer our place above the hospital, because if they go to the hospital
42. Appendix III Interview transcripts
42
they say it should be mutilated. If he is referred to hospital, most of the time hospital make an operation. But
here without an operation but my taking medicine only they will be cured.
How do you see the relation with the patient?
For the purpose of our profession we see all equally. No discrimination.
Everybody can come here. And do you think that is different in a hospital?
We see the patient and if it is beyond our capacity and knowledge we refer to a hospital.
So there is kind of a relation between them and the hospital?
We don't refer to a hospital directly, but to specific hospital. But we say go to a western. But nowadays the
attitude is changing, it was not like that. The government now recognizes us now. Now, the last time they gave
us training on how to treat patients. It gives recognition for the traditional medicine. So nowadays, if you can't
treat you can refer to the hospital. But we don't write and say go to this hospital. Only we say go to a hospital.
But they feel happy about, they feel good, they like it?
The government at that time, all traditional practitioners were called for a meeting and asked to bring all their
medicines and this was taken to the laboratories all were tested and finally they gave permission for that
medicines that treat. The others that doesn't give cure... That was in the military government.
What is your role within the community?
Now we are young, but our father was doing this work because he was older and respected so people come
with their quarrel. So he was a very respected guy.
And they think that will come with time with them too?
Yes off course. Within our age group we also do this thing, even today. If our friends quarrel with each other
or somebody took money and doesn't give back. We deal and conceal it.
And do they think this will change when people go more often to hospitals?
We treat people properly, and not only that we treat according to their financial resources. So we treat them for
15 days or week or so and then if you couldn't we will refer them to the hospital.
And people also have to pay when they are not successful?
43. Appendix III Interview transcripts
43
Even at the beginning we don't start treatment if we could not treat and cure the patient. So once we start we
are dead sure to treat him.
Only when they know they can treat the patient, they will do so. Otherwise they will referred to a
hospital
Exactly.
And payment is done by money?
Yes. And once a patient is treated he also brings us bread and tea and other items.
And how do they think about the Western type of payment? That you always have to pay regardless of
outcome?
He is not sure but it seems to him they have pay for the bed and for the medicine and for the treatment. They
pay for all this. The payment is too high compared with this one. Once you they (=interviewee) treat they give
2 years guarantee.
If you get ill again you can come back within that 2 years range for free.
Do they see benefits from the hospital?
There are people that prefer traditional medicine than the western treatment. People come even from Israel,
black Falasha come here. They come here.
And do hospitals also refer people to here?
Sometimes they say it is better that you go to the traditional healer. There is relation.
Do they think this should happen more often?
It is good for the patients, it nice.
44. Appendix III Interview transcripts
44
Interview 2
What kind of symptoms do patients have when they come here?
Skin disease, when you're bitten by a fly you're whole body will become a wound. [almas balay], it is caused by
a fly. When it bites you, it spreads all throughout of all of your skin.
And for all these different kind of disease there are different plants?
Yes yes. It started with treatment when I was a small boy with treating smallpox. Look this is from the stomach
of the people when it went out. I gave medicine and this came out. Look. This is it, it came out of the stomach.
You give medicine and then it could out with diarrhea. Sometimes they vomit and sometimes
Is that also possible in a hospital?
Most of the patients came from to the hospital because they are not treated there. There is also type of worm
in the river. When the animals drink it. So a patient says I went in different specialties and did not cure, so this
in my last time. So he came from hospital.
So he can treat people than in a hospital
Yes.
So he would never refer to a hospital?
Yes, he refers to hospitals. And the hospital also sent people to him.
So depending on the disease?
Yes
How does he see the relation with his patients?
I see all equal. But according to the disease. If it is very harmful I treat very carefully and talk to them. S I treat
all my patients equally. He has also a medicine for grasshopper. Not only for human beings. He also gives for
animals for nature and other things
So also people can come with their animals?
I give them. It is free. I never charge for rabies. I have also for grasshopper. They know the value it. I am the
one who give service for all Ethiopians. But they do not recognize me. They sent their wives to be treated here.
45. Appendix III Interview transcripts
45
But the so called doctors and intellectuals they don't recognize me. I took certificates, from Israel and Greece
and from Italy and then from England.
But not from Ethiopia?
He got license to treat people.
He doesn't feel recognized by the government?
If you bring you letter from your university or from the Ministry of Health I can give you medicine from rabies
so that you will take it and you make in your lab. And I can give you certification. Because from Black Lion
Hospital they sent people to me, from Addis Ababa Health Office they sent people to me to treat. So if you
bring letter, I can give you that.
How does he feel with the relation with the hospitals?
I have a good relation with the hospital.
Does he see benefits from the hospital?
Nothing, no benefits.
So it is not good that there are hospitals?
They asked me to give training. Went there and gave training to them. Finally, they took my medicine and sent
it to other counties laboratories and then finally stopped giving the medicines.
So he is not very happy with
No no
How is payment done, how do patient pay?
He asks pay this much. They willing pay me. It is free to the patients what they pay.
What is role in the community?
I am the one that is respected by the community.
Does he feel less respected because there are now western hospitals?
I am respected by the people.
