Sharing the Burden of Sickness

A History of Healing and Medicine in Accra

Jonathan Roberts

• Publisher: Indiana University Press
• Year: 2021
• ISBN:
  9780253057921
• Topic: Medicine
• Subtopic: Diseases & Allergies

In Sharing the Burden of Sickness, Jonathan Roberts examines the history of the healing cultures in Accra, Ghana. When people are sick in Accra, they can pursue a variety of therapeutic options. West African traditional healers, spiritual healers from the Islamic and Christian traditions, Western clinical medicine, and an open marketplace of over-the-counter medicine provide ample means to promote healing and preventing sickness. Each of these healing cultures had a historical point of arrival in the city of Accra, and Roberts tells the story of how they intertwined and how patients and healers worked together in their struggle against disease.

By focusing on the medical history of one place, Roberts details how urban development, colonization, decolonization, and independence brought new populations to the city, where they shared their ideas about sickness and health.

Sharing the Burden of Sickness explores medical history during important periods in Accra's history. Roberts not only introduces readers to a wide range of ideas about health but also charts a course for a thoroughly pluralistic culture of healing in the future, especially with the spread of new epidemics of HIV/AIDS and ebola.

ONE

THE ROOTS OF THERAPEUTIC PLURALISM IN ACCRA, 1677 TO THE MID-1800s

IN 1680, JEAN BARBOT, THE agent-general of the French Royal African Company, noted that “it . . . often happens that one doctor is discharged with a good regard, and another called in his place, knowing well how to manage the superstitious simplicity of his patient. His first act is to condemn all the former physician has done, whereupon new offerings are made, cost what they will, to get what may be had, for fear of being also turned away very shortly, as his predecessor was, and another again brought in, in his stead. For this change of doctors, or physicians, will happen twenty times or more successively.”¹ At first glance, this passage may seem like just another racist account of Africans by a chauvinistic European merchant. It is lazy reportage in the sense that it uses a derisive and exaggerated tone, portraying the West African healer as a cynical charlatan and the African patient as a credulous fool without any details for proof. However, as objectionable as this quip from Barbot may be, it offers two key insights into the history of healing in Accra. The first is the basic fact that a plurality of African healers worked in the towns and villages of the West Coast of Africa, each offering different types of therapies. Barbot’s mistake was to assume that the succession of doctors was a band of fraudulent quacks, lining up to deceive credulous patients. Within the context of therapeutic pluralism, such an assertion is clearly a mistake. If Barbot had bothered to distinguish between the different types of healers he described, he would have more carefully enumerated the diversity of herbal remedies, consecrated medicines, and spiritual therapies circulating around West Africa.

Barbot’s second insight is that patients had the power to choose between practitioners and healing systems. In an era of therapeutic pluralism, patients had the luxury to patronize healers who promised to cure and dismiss healers who failed to do so. They did not “change doctors” because they were capricious, as Barbot wants us to believe, but because they had the power to choose. West Africa, it seems, was an open arena for therapeutic services. It was a patient’s market, and if Barbot had bothered to ask patients why they kept dismissing their healers, they might have told him they were “selling” their sickness.

Jean Barbot failed to recognize this diversity of therapies because, like other Europeans during the transatlantic slave trade, he believed that Africans lived in a world beholden to so-called “fetish.” Derived from the Portuguese feitiço, the word fetish became a pejorative term that associated idol worship with diabolism and malificium.² The use of the term was a mistake, of course, because West Africans did not worship idols per se, but rather sought guidance from innumerable lesser deities, spiritual forces and consecrated objects. Ideas about fetish worship pose a discursive barrier that still impedes an understanding of the history of therapeutic pluralism in West Africa today, but European travelers’ obsession with African religious practices and material cultures has, fortunately, also left behind rich archival material about healing traditions.³ In fact, when European travel accounts are correlated with data derived from linguistics, archaeology, and botany, their discussion of so-called fetish practices shows that the healing culture of West Africa was both dynamic and pluralistic.

This chapter sketches out an early era of therapeutic pluralism, evident within the language, practices, and material cultures of the Ga people. As the city grew, it became a polyglot capital, and the Ga healing lexicon became an aggregation of core Ga-Dangme terms and Akan, Ewe, and Hausa loanwords. Accra also became home to multiple healing practices, including deity worship, spirit possession, dancing, drumming, animal sacrifice, libation, and ritual surgery, which took hold in the city as different ethnic groups carved out distinct neighborhoods within the Ga capital. Material culture also played a crucial role in making Accra a hub of therapeutic pluralism, as the city became a clearinghouse for herbal ingredients and consecrated medicines from around West Africa and a marketplace for medicinal flora from Asia and the Americas. Diversity reigned within the African healing culture of Accra. When European surgeons first appeared in Accra, they did little to alter the context of pluralism. Far from being agents of change, European healing traditions survived only as a marginal component of the larger pluralistic network of Accra, one choice among many for patients in the city, and not a very good choice at that. Even European sailors were quick to abandon their shipboard surgeons to conduct their own quests for therapy among the African healers of the city.

THE LINGUISTIC INFLUENCES ON HEALING IN ACCRA

The roots of therapeutic pluralism are embedded within the Ga language. At the core is a set of terms drawn from early iterations of Ga, known to linguists as Proto-Ga-Dangme (PGD). Within this core word list is a group of foundational sounds and shapes identified as uniquely Ga and labeled with a system of starred forms. At the heart of this healing lexicon is hewalε, a word that contains the PGD starred form of *wā, a basic component of many terms relating to a normative state of health, strength, and hardness.⁴ As Ga speakers understand it, hewalε flows through the body as a type of essential vigor, but it can be diminished by blockages, which may result in illness.⁵ The goal of the healer is to remove these blockages by treating the body and, if necessary, by purifying the spirit of the patient.⁶

Within the Ga language, common illnesses fall into the category of hela folo, or ordinary illness. A case of indigestion, for example, might be read as a common illness caused by putrid food or intestinal worms, and so a patient suffering from stomach trouble would not need to theorize about the deeper causes of the illness.⁷ But the Ga understanding of the corporeal self has always gone beyond bodily illness. The definition of the word for body, gbomotso, exemplifies the intertwining of the physical and the spiritual. As a concatenation of mo (PGD: *mє-), the term for person, and tso (PGD: *tse-), the word for tree, the gbomotso operates as a mask covering the spiritual essences of the individual.⁸ The implication here is that the outward body is a surface that can be read and interpreted. If a patient suffered from a chronic illness, for instance, a Ga healer would be obliged to inquire about the deeper causes of the malady. After investigating, they might suggest that the disease is a spiritual illness caused by rogue spirits known as woji or by named deities known as jemawoji, words derived from core Ga terminology (PGD: *wode).⁹ If a healer has divined that a person is being attacked by spirits, they might resort to the use of ritual and consecrated medicines to combat the assault.

Whether a disease has been deemed natural or spiritual, the primary weapon used to fight it has always been herbal medicine, known in Ga as tsofa (PGD: *tse-). Speakers of Bantu languages will note that the core sound within this word matches the Bantu starred form of *ti, which suggests a deep continuity within the medical lexicon of sub-Saharan Africa.¹⁰ The most common form of tsofa was derived from the leaves, twigs, roots, and bark of local plants. Patients consumed plant medicines as herbal drafts and poultices, usually without any deep contemplation of the source of their healing power. Lingering illnesses required additional therapies, containing both material and ritual elements. A common example of this sort of aggregate medicine is ti, a collection of charred herbs mixed into poultices, suspended in potions, or rubbed into cuts in the skin. The production of ti differed from the preparation of individual herbs because it was made by specialists who conducted rituals as part of the fabrication process. Ga speakers have traditionally regarded ti as an elevated form of tsofa because it includes both herbal ingredients common to the scrublands of the Accra Plains (such as hiiatso and nyanyara, two medicinal plants that have been used by herbalists for centuries) and ground-up minerals and animal parts.¹¹

Consecrated ritual objects make up another category of medicine used in Accra. Europeans referred to these items as fetishes and were confounded by their spectacular diversity. As European records show, Ga healers have been producing amulets, charms, and figurines as devices of healing for several hundred years at least. Pieter de Marees, a Dutch traveler who visited Accra several times during the late seventeenth century, recorded seeing consecrated devices used to prevent ailments such as insomnia and indigestion, and Danish botanist Paul Isert noted in the late eighteenth century that all members of society wore amulets made of leather, gourds, beads, and shells as protection against illness and misfortune.¹² The owners of these amulets often rubbed...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contents
• List of Key Terms
• Acknowledgments
• Note on Sources
• Introduction: Historicizing Therapeutic Pluralism
• 1. The Roots of Therapeutic Pluralism in Accra, 1677 to the Mid-1800s
• 2. The Convergence of Five Healing Traditions in the “Healthy” Capital of the Gold Coast: Mid-1800s to 1908
• 3. Therapeutic Pluralism during the Cocoa Boom, 1908–1930s
• 4. Colonial Medical Culture at Korle Bu, 1923–1945
• 5. The Creation of an African “Bloodstream”: Malaria Control during the Hitler War, 1942–1945
• 6. The Resilience of Therapeutic Pluralism on the Eve of Ghanaian Independence
• Epilogue: Therapeutic Pluralism in Postcolonial Accra
• Bibliography
• Index
• About the Author