COLUMN ONE : Herbalism Casts Spell on Ghana : Folk medicine is gaining in popularity in the West African nation. As much as 75% of the population turns to traditional healers for primary health care.

MAMPONG, Ghana —  After three years of taking Western drugs, the patient explained, her ulcer was as bad as ever. There had also been three surgical operations, she said, lifting her shirt to display a midriff that looked like the scarred landscape of some medical knife fight.

Dr. Aoku Asabre nodded sympathetically. Then he drew up his pad and prescribed a preparation of tree bark, certified effective against ulcers by the clinic on whose staff he serves: Ghana’s Center for Scientific Research Into Plant Medicine.

The center, built into a hillside about 150 miles inland from Ghana’s Atlantic coast, is the oldest institution in Africa devoted to establishing whether the thousands of folk preparations derived from herbs and other plants found around the continent are truly effective against illness.

Under the leadership of its founder, Dr. Oku Ampofo, the institute has identified more than 300 plants as having genuine therapeutic effects, with the greatest success claimed on treatments for arthritis, diabetes, sickle-cell anemia and malaria.

It is not surprising that so many herbs indigenous to Africa should be found to have beneficial use; after all, many if not most accepted Western medicines, ranging from penicillin to quinine and aspirin, have a botanical pedigree.

But Africa’s distinct brand of traditional medicine, a melange of herbalism and mysticism, appears to be enjoying a surge in popularity. In Ghana and elsewhere along the West African coast, as much as 75% of the population relies on “traditional” healers for their primary health care.

Although this reliance is more pronounced in rural areas, where orthodox medical personnel may be scarce, it extends throughout all social and economic strata.

In Accra, Ghana’s capital and largest city, scarcely a street corner is unadorned by hand-painted billboards offering herbal treatment for everything from venereal disease and impotence (“You will recover within 5 to 10 minutes. . . . You try me and see.”) to lumbago, blindness, cancer and AIDS.

”. . . And lots and lots of sickness you can consult me for help,” concludes a typical sign.

Government-supported clinics and laboratories like the center at Mampong have been built in Nigeria, Mali, Kenya and Tanzania, partly with financial and technical assistance from the U.N. World Health Organization, which has established a traditional medicine program, headed by a Nigerian doctor, in its Geneva headquarters.

Some reasons for the popularity of traditional medicine are obvious. One is its very familiarity.

“Traditional medicine has been the backbone of health care system in this country for generations,” says G. L. Boye, chairman of the pharmacology department at the Ghana Medical School and the recently appointed director of the Mampong institute. “And before the white man set foot here it was the only medicine.”

Herbal treatments are considerably cheaper than Western medicines, which almost always have to be imported using scarce foreign currency.

Further, herbalism has great allure as an indigenous African art triumphing over the animus of European colonialists. When the Europeans arrived with their Western notions of hygiene and medicine they suppressed the less systematic herbalists. Missionaries also frowned on many aspects of traditional medicine.

“They thought it was black magic,” says Boye.

Even today, the atmospherics employed by many traditional healers discomfit some of their supporters.

“In this country you see a lot of tricksters, the casting of spells, and so on,” says Ampofo. “All the rigmarole of magic and so forth is just to convince the patient there’s something happening.”

But he sees that as not so dissimilar from some of the devices that Western doctors employ to inspire identical feelings of awe and confidence among their patients.

“It’s just like the gadgets of Western medicine, stethoscopes and blood-pressure machines, the urine samples, the taking of the pulse,” he says, chuckling. “There’s very little you can learn from a man’s pulse, you know.”

It is here in Ghana that herbal medicine may be poised to take more of a leap into the medical mainstream than anywhere else in Africa. For the government has been pressuring hospitals to make herbal treatments developed at Mampong more accessible to their patients.

It is also undertaking to register the country’s estimated 30,000 healers, most of whom are members of the Psychic and Traditional Healers Assn. of Ghana. (Association officials contend that the licensing program is only an ill-disguised attempt to extract revenue from the practitioners.)

But many orthodox doctors are less than delighted at steps they believe will lend credence to unproven practices and give status to a group they regard as sloppy, unhygienic, and illiterate.

“The main problem is they won’t be satisfied until they are working side by side with doctors in the hospital,” complains Dr. Samuel N. Otoo, the medical director of Accra’s Korlebu Teaching Hospital, an arm of the University of Ghana Medical School. “But a lot of what they say is bravado. We have no way of saying whether they are correct or wrong, because you need a lot of scientific research to make a judicious assessment.”

Even Ampofo’s work is less than conclusive, Otoo argues. “Dr. Ampofo has not been able to identify the active ingredient in the herbs he finds,” he says.

In truth, the Mampong research has never been subjected to the kind of peer review and oversight that would lead to publication in, say, a European medical journal. (Ampofo has published several reports in the Ghana Medical Journal and a non-technical article, entitled “Plants That Heal,” in a WHO journal.)

Because so much of the herbalists’ reputation is based on anecdotal evidence and word-of-mouth, doctors like Otoo are doubly suspicious. Much of the healers’ apparent success involves conditions, such as non-specific aches and pains that, in any event, tend to be transient.

“There are lots of conditions that will burn themselves out no matter what you give,” Otoo says.

Still, researchers have found some consistency in preparations administered for specific complaints by herbalists all over West Africa, suggesting that people have independently stumbled across the same efficacious plants.

Ampofo, in semi-retirement at 81 and the grand old man of serious herbal research in Africa, says he first approached herbalism as a skeptic himself nearly 50 years ago. The Edinburgh-trained doctor was newly assigned to the Mampong region as health officer in 1940 when a patient arrived suffering from tetanus, for which serum was simply unavailable.

“Someone told me there was a man in town who could halt the disease,” he recalled. “I monitored the case, and within two to three weeks my patient went back to work.”

Ampofo decided to investigate the claims more systematically.

“At the beginning, I thought most of it was guesswork. But I adopted their methods of preparation, and I found that in most cases they were right. They were using herbs as common laxatives, or to treat skin diseases, measles, chicken pox. . . . “

In 1973, he persuaded the Ghanaian government to finance the center at Mampong to collect herbs, test them for efficacy and toxicity and eventually subject them to clinical tests on patients.

For all that, there are few healers in Ghana whose claims don’t extend well beyond the physical. Typical of the breed is the vice chairman of the Psychic and Traditional Healers Assn., Julius Aikins.

Aikins’ office is on the top floor of a rickety building on the edge of Accra’s biggest market. There is no sign to direct patients up a wooden stairway eroded by years of traffic to a creaky thinness; they just have to know.

Inside, Aikins, a tiny man of 76 with a pencil-thin mustache, is settled deep within the recesses of an ancient armchair. His eyes are nearly invisible behind a pair of glasses worn almost to opacity. Gathering dust atop piles of yellowed paper are various dry and browning nosegays of herbs, some with withered flowers.

“Herbal medicine is a common practice all over the world,” he says, “but very often the orthodox practitioners feel envious. There are so many cases they cannot handle.”

Aikins specializes in gynecology. The previous night, he says, he was visited by a woman who was having trouble getting pregnant. The vice chairman cheerfully demonstrates his diagnostic technique, displaying a slip of paper on which Mrs. Justina Kabuki Caesar had written her name and left an invisible fingerprint.

Over it he suspends a cheap wooden pendulum on a string. “Is there a problem with the uterus?” he asks aloud. The pendulum, moving almost but not quite independently of Aikins’ flexing wrist, ceases its counterclockwise motion and moves to and fro.

“Ah,” he says.

“Ninety percent of our sickness emanates from the etheric and astral planes,” he confides. “I get in touch not only with the physical body but the etheric and astral body.”

Later, he says, the pendulum will help him select an appropriate herb for treatment, and will eventually even tell him if his patient “will bring forth a boy child or a girl child.”

Is it accurate? he is asked.

“To the letter,” he says emphatically.

Even putting aside such cabalism as innocuous, many argue that herbal medicine should be subjected to modern appraisal if only to rescue its patients from their healers’ looser instincts. Many orthodox doctors in West Africa can relate stories of having to undo some rural healer’s handiwork--if possible.

“Most people won’t admit if they used country medicine,” says a Western doctor working in a hospital in Monrovia, Liberia. “Whenever a child comes in comatose and jaundiced, you wonder whether it’s something he was given. Every child I’ve had in here for toxic hepatitis has died.”

Boye, the Ghana institute’s new director, acknowledges that such cases are common.

“We see quite a few complications, ranging from children in coma to adults vomiting and passing blood. The patient comes in unconscious and nobody knows what happened, except that he went to a herbalist,” he says. “These cases just endorse the fact that it’s necessary to conduct research.”

Another mark against traditional healers is the reluctance of many of them to be bound by what modern medicine considers proven. Perhaps the most widespread claim among them today is that they can cure AIDS, or acquired immune deficiency syndrome. One herbalist in western Ghana recently had three men arrested because they were questioning his patients about their AIDS treatment; he contends they were out to steal the formula, evidently “at the instigation of foreign interests.”

Orthodox doctors wrinkle their noses at herbalists’ claims of AIDS and cancer cures, not least because those diseases are so much harder to diagnose than the diabetes, anemia, malaria and arthritis that are their more common province.

“First of all, I ask is their diagnosis correct,” says Korlebu Hospital’s Dr. Otoo. “When I see these statements I just wonder if what they call AIDS is the same thing we do.”

Health officials in many countries are also concerned that AIDS patients will be financially exploited or will turn complacent after taking a herbal treatment, thus continuing dangerous habits or avoiding counseling.

The sternest reaction has so far come from Kenya, where Minister of Health Mwai Kibaki warned his country’s herbalists that he “will not tolerate irresponsible statements regarding the cure of AIDS from traditional healers.”

For all that, there is little question that herbal treatments are destined to enter mainstream medical practice in Africa. As much as they abhor the theatricality of herbalists, many orthodox doctors acknowledge the usefulness of some of their knowledge.

Concedes Dr. Boye of the Ghana institute: “We’ve come a long way in acceptance from 10 years ago.”