Anthropological studies indicate the existence of diverse understandings of health, illness and healing. The diversities include variations on the theory of etiology, a system of diagnosis and techniques of appropriate therapy (Levinson 1997:137). The World Health Organization for instance defines traditional medicine as "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" (WHO, 2000:1).
In this regard, diverse medical lore and local traditional pharmacopeia have been in place for a long time in Ethiopia. The people used and are still using this medical lore and local pharmacopeia to prevent treat and cure ranges of illnesses (Pankhurst, 1965; 1990). (1) Medical historians indicate the existence of literatures of traditional medicine in the local languages of Geez and Amharic that dates back to at least the second half of eighteen century. These literatures contain thousands of prescriptions for a wide range of diseases. However, the medico-religious manuscript of traditional medicine did not make clear distinctions between the medical and extra medical aspects of disease in the eyes of western ontology. Disease is not treated in any different manner from other problems of human beings. The literature for instance contains prescriptions not only for the treatment of epilepsy, syphilis, rabies, kidney trouble, hemorrhoid, sterility , snoring but also magic formula to assist in dealing with various concerns such as averting the evil eye and overcoming demons (Pankhurst, 1990:113).
Recently, the Ethiopian government has interested to standardize/regulate the practice of traditional medicine in the country. The major focus of this quest for standardization is to ensure "the safety, efficacy and quality" of traditional medical services. To this end, the government enacted a proclamation entitled "Food, Medicine and Health Care Administration and Control Proclamation No.661/2009" on January 13, 2010. The proclamation clearly stipulates while traditional medication means "a medical service using plant, animal or mineral product or physical means out of indigenous and customary knowledge which is accepted by the society;" traditional practitioner is defined as "a person who is licensed by the appropriate body to provide traditional medication." (Federal Negarit Gazeta No. 9, 2010:5162-5163).
However, the issue of regulating traditional medicine is often fraught with diverse at times conflicting views. While health care professionals trained in biomedicine underscore the need for stringent scientific procedures to ensure the safety, efficacy and quality of traditional medicine others for instance (Waldron,2010; Nyamnjoh,2004) situate the issue in broader context of the power relation between the West and Africa at epistemological level. In other word, what has been established as a bench mark to classify something as scientific and the process of knowledge production specifically in medicine is challenged for its blindness to and the marginalization of African indigenous health knowledge.
The expansion of biomedicine was the aspirations of consecutive rulers throughout Ethiopian history although the fate of traditional medicine was not so clearly fallen in the hands of professionals trained in biomedicine. Hence, this article attempts to analyze whether the recent proclamation is conductive to foster traditional medical knowledge, the attitudes of healers towards the policy and the extent to which the policy has been effective since it came into force first in 1948 and recently in 2010.
Methods and Setting
The study area is the capital city of Ethiopia and the seat of many international organizations including the African Union. The city covers an area of 530km (2) and divided into ten sub cities. Addis Ababa is home to an estimated population of about 3 million in July, 2011 (CSA, 2010:30). The annual population growth rate in Addis Ababa is 2.1% which entertains diverse socio-economic and cultural conditions.
The study is based on an ethnographic design. The data for the research came from primary sources through fieldwork between January and May 2014 in Addis Ababa. Participants were traditional healers and their patients that were willing to share their views. Accordingly, the data for this came from eight healers, ten assistant healers, twenty patients, three pharmacists and one botanist. Observation, unstructured and semi structured interviews as well as discussions were conducted to collect primary data from these participants. Also data was collected two years earlier for another project were used to augment this study.
While scholars (Jurg, 1993 in Steklenburg, 2005:68) classify traditional healers into four categories as traditional birth attendants, faith healers, spiritualists and traditional herbalists, my research in Addis Ababa focuses on one of these categories, i.e., traditional herbalists. The major reason behind this decision was that traditional birth attendant work in rural areas mainly in collaboration with primary health care clinic where there is shortage of health personnel. They don't have separate organized offices from which they deliver health care service in Addis Ababa. Thus, this research targets the medical practices in organized forms at the study area. Secondly, the spiritualist category involves a few individual healers who operate not openly, especially after a spiritual healer was sentenced to life imprisonment four years ago. The government accused the spiritual healer of fraud and homicide in the healing process. Moreover, the inclusion of faith healing widely observed in the study area at religious congregations would make the study too feasible to manage given the time and financial hurdles.
Therefore, the remaining category of traditional herbalists is the focus of this study regarding traditional medicine in Addis Ababa. However, the boundary between traditional herbalists and faith healing becomes fluid on some aspects. Since the herbalists have backgrounds in religious education, they base some aspect of their healing on religious ideas although their pharmacopeia which comes from plants, animals and mineral products. In addition, the very term herbalist is at times too narrow to represent the broad ranges of their services. Therefore, it is in this context that the terms herbalist, traditional medicine and traditional healer are used in this study.
The Situation of Traditional Medicine in Addis Ababa
Traditional healers operate without formal recognition by the government in different parts of Addis Ababa. However, the government office responsible for the study of traditional medicine (from biomedical perspective) does not have concrete data on the number of service providers since there is no traditional healer licensed by this office to provide the healing service. Hence, one could observe and make rough estimates that the number of service providers has been raising even without the required license. This could be identified from the increasing number of new traditional medicine service centers in the city and the growing advertisement of different healers in private newspapers and magazines. The oldest healer had died just months before my fieldwork for this research. But he was willing to share his views two years before his death during my fieldwork for another research project. He had seventy three years of traditional health care service experience. And within this, new traditional medicine service centers are also mushrooming from time to time, given the demand for traditional medicine and the lucrative financial return from the practice.
Healer key informants reported that they acquired their knowledge and skill acquired informally. The training and apprenticeship is usually a long...