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Advances in Social Sciences Research Journal – Vol. 9, No. 9
Publication Date: September 25, 2022
DOI:10.14738/assrj.99.12995. Adiko, A. F., N’Goran, K. G., & Koua, K. A. (2022). Perceptions of "Incurable" Diseases and Therapeutic Responses among Traditional
Healers in the District of Abidjan. Advances in Social Sciences Research Journal, 9(9). 46-57.
Services for Science and Education – United Kingdom
Perceptions of "Incurable" Diseases and Therapeutic Responses
among Traditional Healers in the District of Abidjan
Adiko Francis Adiko
Centre Ivoirien de Recherches Economiques et Sociales (CIRES)
08 BP 1295 Abidjan 08, Université Félix Houphouët-Boigny
Côte d’Ivoire / Centre Suisse de Recherches Scientifiques en
Côte d’Ivoire (CSRS), 01 BP 1303 Abidjan 01, Côte d’Ivoire
Kouakou Gérard N’Goran
Institut des Sciences Anthropologiques de Développement (ISAD)
01 BP V 34 Abidjan 01, Université Félix Houphouët-Boigny, Côte d’Ivoire
Kouakou Adrien Koua
Institut des Sciences Anthropologiques de Développement (ISAD)
01 BP V 34 Abidjan 01, Université Félix Houphouët-Boigny, Côte d’Ivoire
ABSTRACT
In Africa and particularly in Côte d'Ivoire, traditional medicine highlights the
consideration of the association between biological, psychological and social
factors within the framework of public health policies. But in reality, it is clear that
there is a neglect of the psychosocial dimension in favor of the biomedical aspects,
even on the part of traditional healers in the management of incurable diseases.
Indeed, traditional medicine seems to be part of a process of reduction to
phytotherapy drugs while ignoring its cultural basis. The question is to know which
posture and which approach appear to be the most appropriate in the evaluation,
prevention and treatment of complex diseases. The objective of this research is to
describe and analyze the perceptions of the causes of so-called "incurable" diseases
and the therapeutic responses proposed by traditional healers. The methodology
was based on documentary research and semi-structured interviews with 30
traditional healers in the district of Abidjan. The results show that the perception
of causes and therapeutic responses are surrounded by complexity. This research
has therefore highlighted the fact that people with an incurable disease are
considered by traditional healers as people in need of psychosocial care. Ultimately,
it should be noted that traditional medicine offers an alternative response to the
management of so-called incurable diseases in the district of Abidjan. These
characteristics of the perception of causes and therapeutic responses are
parameters to be considered in the management of so-called incurable diseases in
African society.
Keywords: Perception, Incurable Diseases, Therapeutic Responses, traditional healers.
INTRODUCTION
According to the WHO, health is “a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity” (WHO, 1946). There are therefore two
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Adiko, A. F., N’Goran, K. G., & Koua, K. A. (2022). Perceptions of "Incurable" Diseases and Therapeutic Responses among Traditional Healers in the
District of Abidjan. Advances in Social Sciences Research Journal, 9(9). 46-57.
URL: http://dx.doi.org/10.14738/assrj.99.12995
dimensions of health (biological and psychosocial) in the management of incurable diseases.
Consideration of this dual dimension of health supports how biological, psychological, and
social factors intervene in the assessment, prevention, and treatment of disease (Havelka et al.,
2009, pp. 306-307). The interest of the biopsychosocial approach lies in the valuation of the
relevant determinants of health and disease, which are biological, psychological and social
factors. Because the evaluations of these characteristics during life courses contribute to a
better understanding of the well-being and health of populations (Harris & McDade, 2018).
In Africa and especially in Côte d’Ivoire, the consideration of the association between biological,
psychological and social factors and health, makes it possible to realize the possibility of
improving the management of increased disability by acting on psychological targets within the
framework of public policies. It is highlighted by traditional medicine in African health (Ataudo,
1985; Naidoo et al., 2017; Okonji et al., 2022). But in the face of facts, one could say that there
is here a neglect of the psychosocial dimension which could be perceived as the reduction of
the management of this disease to its biological dimension by the traditional healer. This
approach of the traditional healer thus poses the problem of the management of the disease by
the biomedical world. Indeed, in the biomedical world, the person with a so-called incurable
disease, as a “patient”, has a passive role which is limited to answering the professional's
questions and applying his recommendations". This way of working in the relationship with the
patient does not make it possible to identify the psychosocial dimension of the therapeutic
response. However, we note that the perceptions of traditional healers could reveal the
psychological and social levels of the disease, therefore in addition to the medical intervention
which deals more with the somatic aspect. This work focuses on so-called "incurable" diseases
treated by traditional healers. At the start of this research, it was observed that categories of
so-called incurable diseases in modern medicine are treated in the district of Abidjan by
traditional healers using medicinal plants. Indeed, according to biomedicine, an incurable
disease is a disease that the individual must adapt to live with. By considering this theoretical
approach, we propose to describe and analyze the perceptions of the causes of incurable
diseases and the therapeutic responses that traditional healers offer.
THEORETICAL AND METHODOLOGICAL FRAMEWORKS
Theoretical and conceptual references
To better understand the perceptions of traditional healers, this work calls on the theory of
social representation which includes the fundamental ideas about the world and the rules of
the social structure of the community and gives the religious and moral justification of what is
right or wrong, and they understand (Moscovici, 2000; Wagner, 2012). Supported by
anthropology which gives a "total and encompassing sense par excellence of health as an object
of the contemporary world brought to consider the habits and customs of our time with an
interest equal to that deployed yesterday for the tribes and ethnic groups of the planet, today
exposed to a process of globalization of which the collective quest for health is an essential part”
(Hours, 2001; Murray & Flick, 2002). There are two elements that show how the anthropology
of health can be useful in the analysis of perceptions of incurable diseases (Mino et al., 2008, p.
186). First of all, we note that the anthropology of health is not only an anthropology of illness
or a medical anthropology which examines illness and its representations, it is also, and at the
same time, an anthropology of the health of societies, which is interested in collective health,
public health, health systems” (Hours, 2001, p. 124; Flick, 1998; Fischer et al., 2021; Hours,
2001, p. 126; Murray & Flick, 2002). With regard to the contributions of anthropology, it is now
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a question of knowing which posture and which approach could be the most appropriate in this
type of analysis. Indeed, public health appears as a crossroads of knowledge and knowledge,
which are located in the field of health and disease and come from other disciplines, while
waiting to constitute themselves into specific knowledge with its concepts, its achievements
theory and its application (Gruénais & Dozon, 1992). From all the above, this work is part of the
social representation theory of (Moscovici, 1969). Indeed, according to this author, social
representation is a form of knowledge, socially developed and shared, having a practical aim
and contributing to the construction of a reality common to a social whole (Jodelet, 1984, pp.
211-238; Jodelet, 1991; Moscovici, 2000). Thus defined, social representation is a construction
that traditional healers make of a reality, an object or a situation. It is a set of opinions, beliefs,
individual or collective information that is shared on the reality or the situation in question. It
is therefore not only a question of proposing remedies for the medical aspect of incurable
diseases. This research therefore focused on the perceptions of incurable diseases treated by
traditional healers in order to know to what extent these traditional healers could limit the
impact of the disease at the biological level or not. It is a question of knowing which posture
and which approach could be the most appropriate in this type of situation. We then sought to
know if these traditional healers considered people with incurable diseases as people in need
of psychosocial care. Thus, in order to circumscribe the perceptions of traditional healers in the
consideration of these two other dimensions of health, this work calls on the concept of
"therapeutic responses", which integrates these bio-psycho-social notions (Harris & McDade,
2018; Havelka et al., 2009). It seems essential to use the concept of "therapeutic responses"
because perceptions have an impact on the management of incurable diseases.
Methodological considerations
This research was carried out in the district of Abidjan which is one of the important health
regions of Côte d'Ivoire. The district of Abidjan abounds the capital of the Ivory Coast. It is a
major socio-cultural and economic crossroads where people from different backgrounds rub
shoulders. It houses all the central health institutions in the country. Abidjan also has three
University Hospital Centers (CHU) responsible for the management of various diseases
considered incurable. This choice aims to capture the importance given to traditional healers
in the management of diseases considered "incurable". The study population is considered to
be traditional healers only. It is made up of thirty (30) traditional healers chosen from among
those who receive and care for individuals with incurable diseases. This work is based on an
essentially qualitative methodology. The choice of this methodological option is explained by
its importance in the assessment of the data to be collected. This methodology is based on two
main techniques, documentary research and semi-structured interviews. To achieve the
objective, two data collection techniques were used, namely the semi-structured interview and
documentary research. With regard to the duration of the interviews, it is indefinite because
each fact encountered can be the subject of an in-depth interview. These interviews took place
in a more or less formal way. After introduction and explanation of the purpose of the interview
to the patient and after the latter has signed the consent form, the interview is approached as a
conversation or discussion. This kind of interview within the framework of this work allowed
to collect richer data because the patient does not have the impression to be interrogated but
to converse with someone while he is active. At the end of the interviews, the content analysis
methods made it possible to analyze the data. The interpretation of the results mobilized
systemic and dialectical analysis.
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Adiko, A. F., N’Goran, K. G., & Koua, K. A. (2022). Perceptions of "Incurable" Diseases and Therapeutic Responses among Traditional Healers in the
District of Abidjan. Advances in Social Sciences Research Journal, 9(9). 46-57.
URL: http://dx.doi.org/10.14738/assrj.99.12995
RESULTS
Diseases caused by anthropomorphic powers and by the power of the human spirit
The perception relating to the causes of incurable diseases treated by traditional healers are
compiled in the Table 1.
Table 1: Perceptions of the causes of "incurable" diseases and therapeutic responses
Incurable
diseases
Perceptions of the
causes of
"incurable" diseases
Therapeutic responses
Herbal Solutions Spiritual and Mystical
Solutions
Diabetes
- Excess blood sugar
-Work of wizards
-mystical origin
-Work of bad people
-Evil spirits
- Guitosin
- Sarenta
- Sucaro were
- Glycum
- hemony
- Protection against
witchcraft
-delivery
- Protection against any
attack
- Washed the sick with
water from a sacred
forest
- Protection ring against
bad people
- herbal healing and
prayers
kidney failure
-Work of wizards
-mystical origin
-Work of bad people
- evil spirits
-Poor food hygiene
- Nadieco
- Herbal tea made from
plants and barks from a
neighboring country
- Protection against
witchcraft
-delivery
- Protection against any
attack
- Washed the sick with
water from a sacred
forest
herbal healing and
prayers
AIDS
- evil spirits
-mystical origin
-Work of wizards
-Work of bad people
-Unprotected sex
- Charcoal to cure hair
loss
-‘’Toro Yoman’’
-Association of Sarenta
and Guitosine
-Protection against
wizards and evil people
- Protection against
witchcraft
-delivery
- Protection against any
attack
-Preparation of canary
- herbal healing and
prayers
Source: 2015 Survey data
Table 1 reveals that the incurable diseases treated by traditional healers are either caused by
anthropogenic powers or by supernatural or spiritual human powers. These diseases are
among the three so-called "incurable" diseases treated by traditional healers in the district of
Abidjan (diabetes, kidney failure and AIDS). This perception takes into account two dimensions
of illness in traditional medicine. The origin of the disease is either spiritual or mystical. It is
thus noted that the traditional healers met have an original perception of the causes of so-called
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incurable diseases (diabetes, kidney failure and AIDS). In this regard, a traditional healer says
this:
“I would like to point out that in Africa most of the so-called incurable diseases are
the results of spells that bad people cast on people, peaceful citizens. For example,
diabetes is known to be caused by excess sugar in the blood. But more and more, we
see that sorcerers cast spells and cause diseases including diabetes and AIDS’’ (D,
Tradipracticians).
It emerges from these comments that there are two levels of perception of incurable diseases
treated by traditional healers. On the one hand, the disease is due to the action of a foreign agent
(sorcerers and bad people) to the patient who, from outside, comes to swoop down on the
latter. According to these perceptions, the disease has its origin in the will of an
anthropomorphic power: sorcerer, evil spirit, mystical practices, bad person. In this regard, a
traditional healer admits this:
“They want us to believe that there are incurable diseases. I rebel against all those
people who, because they are incompetent to treat "so-called incurable" diseases
such as AIDS, kidney failure, diabetes, etc., qualify them as incurable diseases. These
diseases I say that in their great majority they are mystical diseases” (P,
Tradipractitioner).
According to these perceptions of traditional healers who consider the causality of the disease
as a mystical event is the result of a spell launched by a human being, a sorcerer, a genius or
even a ghost of a living being. It can also result in a bewitchment. In this regard, a traditional
healer says this:
“Another disease that is the work of sorcerers is AIDS. It is a disease that has existed
for a very long time in Africa. At home in the village, it was my father who treated
him, already in the 1970s. Another disease which is the work of sorcerers is
Diabetes” (G, Tradipractitioner).
On the other hand, the disease comes from the individual itself (food hygiene, excess sugar,
unprotected sexual intercourse). In a second step, we also perceive that the disease has its
origin in a harmful agent conceived as natural: the relationship of the human being to food and
the relationship of man to sexuality. This consideration of disease as the result of human
behavior is close to that of biomedicine. In this regard, a traditional healer admits this:
“I myself detect these different pathologies with certainty (AIDS, Diabetes, kidney
failure). For example, it is enough simply to look at the eyes, the urine, the appetite
etc. Some patients come with medical documents and I feel comfortable caring for
them. It cannot be said that all illnesses are mystical illnesses. That's why I don't do
fetishes and I don't wear amulets” (J, Tradipractitioner).
We note here that the cause of the so-called incurable disease in the traditional practitioner is
not far removed from that of modern medicine. This cause of the incurable disease calls for an
objective type diagnosis. In this regard, a traditional healer says this:
“I find that diabetes is more a matter of dietary education issues. A lot of people
manage badly. We do not manage to be satiated all the time, but to heal ourselves,
in truth. Otherwise as soon as I am diagnosed with diabetes. I recommend stopping
the consumption of sugar or food that contains sugar’’ (N, Tradipractitioner).
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Adiko, A. F., N’Goran, K. G., & Koua, K. A. (2022). Perceptions of "Incurable" Diseases and Therapeutic Responses among Traditional Healers in the
District of Abidjan. Advances in Social Sciences Research Journal, 9(9). 46-57.
URL: http://dx.doi.org/10.14738/assrj.99.12995
These different referent perceptions of incurable diseases are at the origin of the therapeutic
responses proposed by traditional healers in the face of the disease.
Therapeutic responses proposed by traditional healers regarding so-called incurable
diseases
As a whole, the therapeutic responses proposed by traditional healers take into account the
natural and supernatural dimension of the disease. Indeed, when the disease comes from the
individual himself (food hygiene, excess sugar, unprotected sexual intercourse), the traditional
healer offers medicines or herbal teas made from medicinal plants. In the case where the
incurable disease comes from the patient himself, the harvest of the plant and the preparation
of the medicine appear simpler. We note here that the effectiveness of these plants is praised
by traditional healers as a whole. It is in this sense that a traditional healer admits this:
“If you use my medicines, you can no longer be sick, since no disease could resist in
your body which is prepared to fight disease effectively and ensure your health. The
combination of Seranta and Guitosine is recommended for the treatment of certain
diseases, namely HIV 1, 2, and 3. This combination completely cures kidney failure”
(L, Tradipractitioner).
According to traditional healers, these medicines are made from plants harvested either in Côte
d'Ivoire or in neighboring countries The drugs obtained make it possible to effectively treat
these diseases. In this regard, a traditional healer says this:
"I don't give deadlines to a sick person. I effectively heal the subjects that come to
me in time, but if they have reached a terminal stage, I take longer to heal them.
That said for diabetes it must be said that I make decoctions in a small canary. As
soon as the patient considers himself cured, I stop the treatment” (T,
Tradipractitioner).
We note that even if traditional healers say they claim to cure these various diseases declared
by modern medicine to be incurable, they sometimes have limits. In this regard, a traditional
healer says this:
“I couldn't give you a time frame, because among these diseases there are those that
we contract from birth and others that we neglect and drag on for a long time
before seeking treatment. There are also among these diseases those which are
declared very quickly. For example, when it is several years after the diabetic
realizes that he has the disease, the treatment will depend. So the duration of
treatment absolutely varies. We must not lie by saying that we can make miracle
treatments. To be honest, there are diabetic patients I couldn't help. In life, you can't
know everything and you have to have the courage to recognize these limits’’ (G,
Tradipractitioner).
In this regard, another traditional healer added by saying this:
“We are not God. We do not pretend to deny our limits. But in everything, we say
that we believe in the healing of all our patients in the healing of all the patients
who come to us. And based on that faith and our science, we always satisfy our
patients” (M, Tradipractitioner).
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Adiko, A. F., N’Goran, K. G., & Koua, K. A. (2022). Perceptions of "Incurable" Diseases and Therapeutic Responses among Traditional Healers in the
District of Abidjan. Advances in Social Sciences Research Journal, 9(9). 46-57.
URL: http://dx.doi.org/10.14738/assrj.99.12995
sectional study. Also, the method used is the individual interview face to face and after the
traditional healers. Although this method reduces the rate of non-response and missing data.
Subsequently, it has the disadvantage of not respecting the anonymity of the traditional healer
and thus expose to a risk of social desirability, the traditional healer expressing his opinion less
easily. Also, almost all of the interviews took place in French and it took interpreters for
traditional healers who do not speak French, this could lead to discrepancies or modify the
meaning of certain terms. As seen in the results, there are two levels of perception of incurable
diseases treated by traditional healers. On the one hand, the disease is due to the action of a
foreign agent (sorcerers, evil spirits, mystics and bad people) to the patient who, from outside,
comes to swoop down on the latter (Kate et al., 2012; Singh, 2021; Workneh et al., 2018, pp. 4-
6). On the other hand, the disease comes from the deviant behaviors of the individual himself
(poor food hygiene, excess of sugar, unprotected sexual intercourse) (Angrist et al., 2018, p. 6).
From the first level flow two categories of meanings. At first, we perceive that the disease has
its origin in the will of an anthropomorphic power: sorcerer, evil spirit, mystical practices and
bad people. We note that the biomedical vagueness around the causes of so-called incurable
diseases and the possibilities of remission further accentuates this perception in the
imagination of traditional healers (Mokgobi, 2014, p. 7). This is why in Africa, the institutions
which deal with the disease are all at the same time religious, political and therapeutic; they
cover a field of skills and functions (diviner, clairvoyant, anti-sorcerer, witch doctor, cult priest)
which gives rise to the overall effectiveness emanating from multifaceted powers than to the
singular expression of therapeutic aspects (Dozon, 1987, p. 14; Pordié, 2011; Modic & Žvelc,
2015, pp. 17-20). The same observation by emphasizing that the search for the causes of disease
in the traditional healer involves the search for unnatural causes of the disease and requires
capacities that allow the therapist to communicate with elements of the invisible world (Yoro,
2010, p. 59). It appears that the perceptions associated with a pathology as well as the
importance given to them in the public and social space, result from the combination of many
influences (Fischer et al., 2021, pp. 813-814; Dunkel et al., 2017, pp. 848-857; Koffi et al., 2018,
pp. 8-9). If the influence of the traditional healer and his practices on the construction of
diseases is undoubtedly the most obvious, it is interesting to note that it is in fact exercised
through various functions of the healers (Broutelle & Le Morvan, 2009, p. 61). Among
traditional healers, illnesses considered ordinary are perceived as normal, but persistent
illnesses, such as chronic or incurable illnesses, are perceived as not pertaining to biomedicine,
but rather the result of a cosmological dysfunction, curse or bad luck (Parkhurst, 2018). From
these perceptions of the causes of incurable diseases, the traditional healer proposes
therapeutic responses according to the cause of the so-called "incurable" disease.
Alternative response to the management of incurable diseases
The results of the study show a variety of therapeutic responses. When the origin of the so- called "incurable" disease (diabetes, kidney failure and AIDS) is therefore unnatural, the
traditional healer offers a herbal tea made from a medicinal plant (Niagia, 2002; Sapna & Ravi,
2007, p. 183; Konan, 2012). There are a variety of herbal medicines for diabetes, kidney failure
and AIDS. However, in the treatment of all these ailments, Ivorian therapists in particular
(traditional healers, healers, etc.) of traditional African medicine use different plants from the
flora, and resort to a lesser extent to fauna (Mokgobi, 2013; Kroa et al., 2014). Most often, the
plants, substances and other elements used in these treatments come from the immediate
environment of the populations. The same observation by emphasizing that the treatment is
based on traditional pharmacopoeia products through the use of a healer (Yao, 2004, p. 11;
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Moro, 2018, p. 183). When successive biological treatments become ineffective then diagnosis
by divination intervenes to detect non-empirical causes (Cantrelle & Locoh, 1990, pp. 16-17).
Thus, when the cause of the "so-called incurable" disease is non-empirical (anthropomorphic
power), the therapeutic solution is of a spiritual and mystical nature (protection of the
traditional healer, canaries, etc.) (Kind, 2008). As a result, the knowledge that the traditional
healer uses as a therapeutic response to incurable diseases is coupled with a power over
medicinal plants. This means that the rationality that makes therapy work in the management
of so-called incurable diseases by traditional healers is not classical rationality. It is based here
on both positive experience, empirical facts and the level that we do not see but which works
(Prasansuklab et al., 2020, p. 307; Ranjitha et al., 2018). Thus, the rationality that makes the
drug effective here is not reduced to medicinal plants. We therefore see that the ritual and its
result on the effectiveness of the plant, but its energy, we do not see it. But the effectiveness of
the therapeutic response also results, to a large extent, from the multiple psychological defense
mechanisms and strategies implemented by the traditional healer so that the patient is
reassured of his recovery (Macé, 2016, p. 156). It is all these perceptions of the traditional
practitioner's therapeutic response that must be taken into account in the quest for a solution
to the so-called "incurable diseases" as a global approach.
CONCLUSION
According to this research, it should be noted that so-called incurable diseases are subject to
several forms of perceptions of the causes of the disease in general. Together they are made up
of the work of sorcerers, mystics, evil people, evil spirits and poor food hygiene and unprotected
sex. These are causes that are characteristic of traditional African medicine and African
conceptions of therapist intervention. These perceptions of the causes of incurable diseases can
be grouped into two categories. On the one hand, there are natural incurable diseases and non- natural diseases. From these two perceptions, traditional healers offer two therapeutic
responses. There is a conception that highlights the biological power of plants and another that
makes supernatural intervention the essential part of therapy. We therefore distinguish in
traditional African medicine, two approaches to the therapeutic response of the traditional
practitioner. We note that one is of a somatic order in relation to the physical or psychosomatic
disease whose symptoms must be recognized. On the other hand, the other is of a metaphysical
order. To these two orders of therapeutic responses proposed by the traditional practitioner,
is added the psychosocial dimension proposed by the traditional practitioner. Ultimately, it
should be noted that traditional medicine offers an alternative response to so-called incurable
diseases. It is noted that the perception of causes and therapeutic responses are surrounded by
complexity. These characteristics of the perception of causes and therapeutic responses are
very evocative parameters that should not be overlooked when it comes to talking about so- called incurable disease in African society.
ACKNOWLEDGEMENT
The authors would like to express their deep gratitude to all the participants in the study, and
in particular the health care professionals who accepted the invitation to respond to the
interview guide.