Amy Lamprecht and Dr. William C. Olsen, Anthropology
The medical system extant in Ghana today is a complex one made up of many different health care delivery sectors. As is often the case wherever competing systems of medicine exist, the traditional and Western medical systems that participate in health care in Ghana are not effectively integrated and do not cooperate at a level where efficacious communication between the two groups can be facilitated. In a nation where most of the government focus and funding for health care is directed towards Western medicine but where seventy percent of the population relies on traditional medicine, the need for an effective system of collaboration between the two medical systems is readily apparent. The Ghanaian Ministry of Health and the Ghana Health Service have made important strides in this effort in the past twenty years, primarily through the establishment of training for traditional birth attendants and a center for research regarding traditional medicinal herbs, and are planning new projects to further this effort. From research I have gathered from traditional medical practitioners (TMPs) and Ghanaian medical doctors, I have discovered that there is much more to be done to promote effective collaboration and integration between Western and traditional medicine, and that members of both groups are anxious to participate in these efforts.
The primary focus of my research changed over the course of my three-month field study in the Ashanti region of Ghana, West Africa. The original project that I established with the assistance of my faculty mentor consisted of a plan to create a small-scale training program for traditional medical practitioners in Ghana where they would meet weekly in a central location with Ghanaian doctors and other public health professionals. There the two groups would converse regarding a different public health problem facing the people of Ghana each week, and each would theoretically offer his or her own suggestions for how they currently treat or approach each problem. Ideally, both groups of medical practitioners would gain valuable information from the other on how to treat specific diseases and public health issues, and a system of collaboration between the two groups would be facilitated.
As I explained previously, the focus of my research shifted away from wanting to set up this training program once I actually got to my research site in Ghana. After meeting with a Ghana Health Service professional and interviewing a few TMPs, I realized that my project was neither very feasible nor very ethical in the context of the culture. I quickly learned that Ghanaian culture devotes high esteem to the TMPs in each society, and so while these health professionals were generally very friendly and willing to speak to me, they also were very conscious of their superiority. Through the course of my interviews, I found that, generally, the Ghanaian TMPs were quite interested in participating in a program similar to the one that I had hoped to set up, but I also found out that I should not be the one to establish it, with my limited credentials, young age, and outsider status. To do so could have been an affront to the high cultural standing of these esteemed health professionals and could have been viewed as an attempt on my part to exert some kind of false Western superiority over the people in Ghana.
This information, while somewhat disappointing, actually provided a valuable impetus to the new focus of my research. Once I had decided to not go forward with the project I had outlined, I was able to instead examine the feasibility of such a project in the context of Ghana, as well as determine the reasons why it would or would not be beneficial to the medical system there and the reasons why it has not been done so far. These quickly became the new foci of my research, and allowed me to examine the Ghanaian medical system as an outsider who has the ability to look through the eyes of insiders occasionally, via interpreter-facilitated interviews with health professionals. I completed a large number of interviews, primarily with TMPs such as traditional birth attendants (TBAs), faith healers, and okomfos (Ashanti spiritualist healers), but also with Ghanaian medical doctors, nurses, public health nurses, and public health administrators. I was able to infer from the information I gathered from these interviews that the TMPs, doctors, and public health officials were generally all quite interested in establishing a system of collaboration between the two health sectors (traditional and Western/biomedical), but that there were certain barriers that were keeping effective training and cooperative programs from being established.
Despite extensive worthwhile attempts to create programs for the training and incorporation into the national public health care system of TMPs that have been and are currently being made, there is much work to be done. The projects that have been established have been limited in their geographical location (such as the training project established in the Brong-Ahafo region of Ghana by Dr. Edward Green, which I modeled my program after), the type of TMPs that have been involved (like the TBA training programs established in the early 1990’s by the Ministry of Health), and/or the proportion of TMPs that have been reached by their effects (like the herbalist licensing and Ministry of Health training programs for TMP Association chairmen). In order for a TMP training program to be effective in educating TMPs nationwide and in creating a system of collaboration and a feeling of mutual respect for TMPs and Western medical professionals, it must be available and accessible all members of both groups throughout the nation, and must span a broad range of public health topics of interest to the varied types of health practitioners involved as well as topics of national health care interest. In addition, an effective TMP training program must also engage the interest of both the TMPs and the doctors and must convince them that participation in such a program would be valuable to them by improving their knowledge and their ability to heal their patients. This was one important issue that I noted in numerous interviews; both TMPs and doctors said they would be willing to participate in this kind of program, but they were skeptical of its ability to teach them anything valuable that they didn’t already know.
After gathering the information I did regarding the barriers to cooperation and the limitations of current training programs, I established some possible guidelines for the creation of a successful TMP training program. First, the local volunteer public health workers in each area could be employed to publicize (and popularize) the training program to the TMPs that they are aware of in their town in order to get the word out to each TMP quickly and easily. Secondly, the training sessions could be held in centralized locations, with the transportation fare to and from each session paid by the group funding the program. Thirdly, interviews should be held with each participant to ensure that they feel that what they are learning is valuable to them, and to gather information on how to improve the program. The topics focused on should be tailored to the responses of the program participants. Finally, hands-on and visual learning strategies should be employed to avoid the problem of widespread illiteracy among the TMPs.