Indigenous Ill-health Perception And Healing Practices Socio- Cultural Study In North-eastern Ethiopia

Introduction: When integrated with ‘modern’ medicine, well developed indigenousrnmedicinal knowledge and practices have the potential advantage of reducingrnovercrowding of primary care services. However this aspect is not well studied in thernEthiopian setting. Therefore, this study explored the indigenous medicinal beliefs andrnpractices used by communities in North Eastern Ethiopia in the management of healthrnproblems in their homes using a conceptual framework adopted from Kleinman’s CulturalrnSystems Model, the Murdock illness causation model, and the Padela God-centeric healingrnmodel.rnMethods: Ethnographic methods were used for this study. Participant observation wasrnsupplemented by ten focus group discussions (FGDs) (n=96) and 20 in-depth interviewsrnconducted with the key informant community members. The analysis and interpretationrnwas informed by thematic and narratives strategies.rnFindings: The findings indicated that the Tehuledere people’s worldview of health, healthrnproblems and healing systems is closely linked to their day-to-day cultural lives. They hadrnwidespread perceptions about causes of illness. They perceived that illnesses might berncaused by the wrath of God or gods, ‘qolle or quteb (spirit possessions); natural causesrn(e.g., environmental sanitation and personal hygiene, poverty, biological such as organicrndeterioration and accident and psychological factors such as stress) and societal causesrn(e.g., social trust, experiences of family support and harmony; and violation of socialrntaboos). Therefore, the explanatory model of illness causation in this community was veryrnsimilar to that of the Murdock model with one key difference: social elements need to bernadded to the model. The major factors associated with use of indigenous medicinernincluded: the perceived etiology of illnesses; the availability and acceptability of healthcarernservices; the relationship between the health-care practitioners and the patients; socioeconomicrnfactors (cost of health care expenditure); and the influence of social networksrnand/or social relationships. It was found that in Tehuledere pluralistic health-carernresources were used either independently or concurrently with biomedicine. The studyrnidentified that religious and spiritual healing, bio-medicine, ‘folk’ or indigenous healingrnsystems, and popular or home-based medicine, were the major types of health-care options.rnVrnMany of the Tehuledere people attribute illness to the wrath of supernatural forces. Thus,rnhealing is thought to be mitigated by divine assistance obtained through supplication andrnrituals and through the healing interventions of nature spirit actors such as Woliy (Muslimrnsaints) and Kalicha (Muslim voodoo). Also seeking God/Allah/ and nature-spiritrnforgiveness with ritual ‘Dua (Prayer), Tsebel/holy water/, ‘wodaja’ (harmonizing the spiritrnto heal evil), ‘Chelle’/ goddess of fecundity/ were practiced for certain ailments such asrnjinn and Buda. Moreover, Traditional health practitioners (kitel betash or herbalists,rn‘awalaj’ or birth attendants and ‘wogesha’ or bone setters) were consulted for preventive,rnprotective and remedial care of the participants and their families. Instances of selfmedicationrnwere also encountered in the participants. The participants apply homernremedies for prevention and remedial purposes. Treatment is meant for those apparentrnailments such as Nedad (malaria), Mich (acute febrile illness) and Gunfan (flu) and otherrnrelatively common health problems. Otherwise the popular agents refer to the biomedicalrnexperts if no progress was seen subsequent to treating with home remedies. The findingsrnfurther demonstrated that bridge of caring was built between the traditional healers and thernprimary health service (i.e. the health posts) in the management of perceived commonrnailments, such as yewof beshita (jaundice) and yelig tilat (herpes zoster) in the village.rnAnother bridge of care was also built between the health posts and the health center for thernmanagement of the other health problems, such as HIV/ AIDS and tuberculosis, which thernstudy communities experience as critical incidents. The role of health extension workersrnwas very important for this integration. The increased accessibility in the modern healthrncare appears to have been both a blessing and curse to the area, as the indigenousrncommunities competed to find a place for their healing system within the new healthrnsystem. The findings also identified communication and attitudinal problems that existrnbetween the communities and modern health care providers.rnConclusion: The indigenous health care mechanisms of the study community address basicrnelements of primary health care such as fostering self-care and self-reliance, communityrnparticipation and the use of indigenous medical practices for the maintenance of goodrnhealth. It is within this area that the study communities appear to express the greatestrnconcern related to the ‘natural’, ‘spiritual` and `societal` health of their homes and villages.rnSince people in the study communities believe that spiritual , indigenous healer and homernVIrnremedial healings are health care options among multiple health-care resources, successfulrnrural primary health care strategy would give due attention to such local resources. Thisrnwill help to ensure the optimal utilization of Ethiopia’s limited resources. This studyrnsuggests that there should be a clear plan as to how indigenous medicinal practices can bernsupported within a health care systems approach.rnKey Words: Indigenous health knowledge, primary health care, Illnesses, health,rnReligion, Spirit, home remedies, qualitative, Beliefs, Tehuledere, Ethiopia.

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