STATUS OF TRADITIONAL MEDICINE DEVELOPMENT IN GHANA

STATUS OF TRADITIONAL MEDICINE DEVELOPMENT IN GHANA
PRESENTED BY E.N MENSAH (DR). CHAIRMAN, TMPC. AT THE SGWMDP MEETING, GMA HALL, ACCRA-ON 27TH APRIL, 2011
1. INTRODUCTION The art and the science of treating body malfunction or diseases have been practiced by all human societies since time immemorial. Traditional healing in all cultures all over the world involves the use herbs, minerals, animal parts and other physical and spiritual techniques in various combinations. Several systems have evolved and are still being used. The well known ones are those documented in writing from India, China and some of the countries in the Americas.

In Ghana, the Ministry of Health uses three broad classifications of,
(i). Traditional,
(ii). Complementary and
(iii) Allopathic medicines, to differentiate the various health care systems available to us.

Traditional medicine here refers to our indigenous African health care and healing modalities. Traditional health care and healing modalities are components of our African traditional health care systems, cosmology and cosmogony. The advent of colonization, foreign religions and cultures, secular education, the introduction of modern/allopathic medicine and the pressures of socio-economic development have adversely affected the image and the practice of indigenous African health care systems and the use of traditional healing modalities. Foreign religions tend to demonize our cultural and traditional medicine practices. The negative perceptions still persist, especially among the educated African elite. The attitude and behaviour of ignorant or unscrupulous and/or self conceited traditional medicine practitioners further aggravate the situation.

All these have contributed to the loss of a lot of some of the knowledge base and skills in African traditional medicine practice and health care systems. The extent of what is already lost, we may never know.

The various ethnic groups in Ghana, and for that matter in West Africa and other parts of Africa, have well defined etymology, cosmogony, signs and symbols. The meaning and significance of some of these are no longer clearly understood by many who currently use them.

However, there is evidence to suggest that a lot of the knowledge of African traditional philosophies, esoteric systems, cosmogony, health care systems and healing modalities still exit. There is now a wave of renaissance in traditional medicine and the less known complementary therapeutic/healing modalities all over the world.

Attitudes towards traditional or indigenous medicine and health care practices are changing for the better all over the world due to the work of modern anthropologists and scientists who believe in evidence rather than mere impressions by heavily biased and casual observers. I dare say Ghana is no exception.

Fortunately for us in Ghana, many individuals, groups and various successive governments have recognized the potentials and the importance of traditional medicine in holistic health care.

Several international resolutions for the promotion and development of traditional medicine have been passed by the World Health Organization (WHO), the Commonwealth Science Council and the African Union. These resolutions provide wider international context for the development of traditional medicine in Ghana.

It stands to reason that traditional health care practices and complementary medicine have survived, in spite of the challenges, because of the value the people have found in them. It is usually estimated that about 60-80% of our people, especially those in the rural areas, use traditional remedies regularly. What is it that the people see in them?

A lot of research in plant medicine is currently being done in universities and research institutions in Ghana, West African and other African countries. I do not know of any scientific research institution which has mounted the facility to investigate all aspects of traditional medicine in this country. Very few, if any, take interest in the complementary healing modalities. The research institutions and individual researchers work on herbal or plant remedies and all tend to carefully avoid the esoteric or psychic component. This paper has not discussed researches and findings in Ghana on Traditional Health care systems.

2. DEFINITIONS
2.1. Traditional medicine is defined as all knowledge and practices used in the diagnosis, prevention and treatment of physical, mental or social imbalance which rely on practical ancestral experience and observation handed down verbally or in writing. (WHO, 1978).
This earlier WHO definition presupposes that traditional medicine is based only on empiricism. This definition also does not explicitly recognize the spiritual or esoteric component of traditional medicine and health care practices.
2.2. Traditional medicine, by the new definition from WHO, refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose, and prevent illnesses or maintain well-being. (WHO. Fact Sheet, No.134, 2003).
2.3. In Ghana the working definition for traditional medicine is that it is the diverse health practices of the people based on the traditional knowledge and beliefs incorporating plant, animal, mineral based medicines, spiritual therapies, manual techniques and exercises applied singularly or combination to maintain well-being, diagnose, treat or prevent illness or physical, mental, social and spiritual imbalances. (MOH Documents).
2.4. Herbal medicine is a product obtained from plant, animal, naturally occurring inorganic substances and may be in the form of concoctions, decoctions, powders, infusions, lotions, ointments, suppositories, inhalations and which does not contain any active substances used in allopathic medicine. Herbal medicine involves more than plant medicine. (Ministry of Health Documents).
2.5. Plant Medicine is a preparation from plant sources only.
2.6. ‘Spiritual’ or ‘faith’ healing which refers to healing through prayer, with or without the use of holy oils, water or laying on of hands on the patient, as practiced by the very many religious (mainly Christian) charismatic groups is not accepted as part of traditional or complementary medicine healing modality.

3. PHILOSOPHY, PRINCIPLES AND PRACTICE
3.1 AFRICAN TRADITIONAL MEDICINE In Ghana, and for that matter in Africa, we believe that the human being is a tripartite entity consisting of mind (soul), body and spirit. Our well being therefore requires the fostering of harmony between the body, mind and spirit. Also that, the rhythm of biological activity in life is influenced by the rhythm of activity within our planet and the larger cosmos. It is strongly believed that the health of the human being has a link with the Creator, divinities and ancestral spirits (the metaphysical world). The causation of disease therefore, has both spiritual and physical dimensions (i.e. psychosomatic). Ill-health or disease is therefore the result of failure of humankind to maintain a well balanced relationship with the physical as well as the ancestral world. Deviant behaviour, what goes contrary to accepted social norms can lead to imbalance and cause disease. Also that, disease no matter its cause appears on the spiritual body (bio-energetic body) long before it manifests on the physical body.

Dr Gbodossou who is an Obstetrician and Gynaecologist and also a trained traditional medicine practitioner stated in his book “The African Concept From God to Man” that,

“In the African conception, man as a whole, is related to all that is terrestrial, extra-terrestrial and cosmological. Man is a living organism made up of integral elements having the nature as those of the social, cosmic and spiritual worlds. Some of man’s elements are perishable, others imperishable. Man’s biological cycle begins with the integration of the component elements around a principle of personalization. It ends with the breaking up of the human component, offering the possibility of reincarnation and a new fate. In fact, all the constituent elements of man are gathered before birth and persist beyond death. Life is only a benefit of death, the first creation of God” (Gbodossou, 2004).

Our people believe that the bio-energetic or bioluminescent body does create a sensitive and permanent energy contact between human being and the immediate environment. This bio-luminescent body can be augmented through external phenomena to restore health or disturb health and cause disease to manifest on the physical body. Health is equilibrium and disease disequilibrium. What affects the bio-energetic or ethereal body will almost instantly affect the physical body and what affects the physical body will eventually affect the energy body. The traditional medicine practitioners say that it is necessary to perform esoteric rituals in certain cases of ill-health to heal the ethereal body before the disease condition of the physical body can also heal.

Traditional Medicine Practitioners say that they must first determine through divination the causes of ill-health and ascertain the remedies to use for a given patient before starting the healing process. Some of them admit that it is not always that they know before hand which remedies to apply in given cases. It means that different people with similar symptoms and signs may need different items to effect healing. Constant divination is said to be central to successful healing and maintenance of good health. There are many methods of divination. Divination may take the form of reading the palms of the client, looking into mirrors or water, casting of special objects or direct communication with the soul of the client and spirit entities. Some of the information on what is needed to treat an ailment is said be obtained through dreams and clairvoyant observance of the human aura.

The healers say that all trees have spirits that nurture them and that the healing potential of each plant depends on the hierarchy and power of the spirit that nurtures it. These spirits are what are seen by some people and referred to as fairies or dwarfs. This is said to be the reason why these spirits (dwarfs) are more frequently seen in forests.

The afa ( efa or fa ) system of divination is practiced in parts of Ghana, Togo, Benin and Nigeria. Afa is believed to be a direct contact with all beings of the spiritual realm and the soul of the client and through it information on the remedies to apply are obtained. Afa is one of the components of the Hu-Yehweh system which is the ancient African teaching on God, the Creator, and His relationship with humankind and the cosmos as a whole. The Hu-Yehweh system is still very much alive but is shrouded in strict secrecy and practiced by initiates in Shrines in Ghana, Togo, Benin and Nigeria. According to the tenets of this system the planets, animals and all things on the earth, and the whole cosmos came into existence through the universal creative substance composed of a spectrum of 16x16x16 light/colour and sound vibrations that emanated from God. It is the female aspect of the universal creative substance that is involved in healing.

There is evidence that our people traditionally distinguish clearly between good and evil. They talk of evil spirits, benevolent spirits and evil or beneficial spiritual practices. They talk about good or accepted morality and do have codes of acceptable socio-cultural norms and religious/spiritual practices. We know of the rather severe punishment which is still imposed by banishing those accused of practicing cannibalistic witchcraft to “witches colonies”. There is still the now degraded “trokosi” system where young girls are placed in shrines in atonement for past wrong doings by their family members. Ill-health or disease may be prevented using scarification, taking preparations orally, spiritual baths, amulets, spiritual sacrifices with various objects and animals, observance of moral codes and injunctions, none eating of certain food items and environmental cleanliness.

4. LEVELS OF HEALING SKILLS

In ancient Chinese Medical Science, there are five levels of healing skills.
1ST Level: massage and acupressure.
2ND Level: herbs, animal products, minerals etc.
3RD Level: acupuncture and moxibustion -kankua
4TH Level: acupuncture with projection of chi energy into needles, meridians and internal Organs.
5TH Level: projection of chi energy without needles or physical contact. -Various forms of sacrifices, psychic and spiritual practices to effect healing have evolved using this type of skill.

The projection of chi energy into the body to heal is called Medical chi kung. There is the internal and the external schools. In the internal school the healer uses his/her own internal chi energy to heal. The external school uses life energy from the air, healing spiritual entities and the earth and directs it to the patient for healing.

5. LAND MARKS IN DEVELOPMENT OF TRADITIONAL MEDICINES IN GHANA


(1). Traditional medicine practice had been established in our part of the world since time unknown. The practice came under severe pressure with colonization and the introduction of foreign secular education and religions and western modern/allopathic medicine into the Gold Coast colony by the colonial administration.
(2). In 1878, the Native Customs Regulation Ordinance was passed to prohibit many customary practices which offended the sensitivity of the Europeans.
(3). In 1930, the Soceity of African Herbalists was formed and based in Sekondi.
(4). In 1950, the Ga Medical Association was formed in Accra as part of the political struggle in defiance of the colonial legislation.
(5). In about 1940-42, Dr Oku Ampofo left the colonial medical system to set up a private practice in Akwapim-Mampong. He invited herbalists to practice in his clinic. That was the first known practical relationship to be established between an allopathic medical set up and traditional medical practice in this country. Dr Ampofo single handedly compiled a list of over 300 medicinal plants, herbal remedies and names of the healers he came into contact with. He later transferred the clinic and the documents to the Center for Scientific Research into Plant Medicine.
(6). In 1960, Osagyefo Dr Kwame Nkrumah initiated the formation of the Ghana Psychic and Traditional Healing Association. The Association was charged, among others, to promote and encourage the study of herbalism and psychicism in Ghana. Very little was achieved by this association. Meanwhile several other associations and groups emerged, each struggling for recognition.
(7). In 1971, a group of researchers came together and submitted a memorandum to the then government recommending that a center to facilitate the co-ordination of all research work into plant medicine be established.
(8). NRC Decree 344 legally established the Center for Scientific Research into Plant Medicine in 1975.
(9). The Danfa Comprehensive Rural Health and Family Planning Project of the Community Health Department of the University of Ghana Medical School was started in 1969/70 with support by USAID. This project studied some service delivery aspects of traditional medicine and trained a lot of practitioners to ensure their safe service delivery.
(10). The Brong Ahafo Rural Integrated Development Programme of the Ministry of Health supported by WHO and UNICEF started in 1976 and trained a large number of practitioners in an area now covered by the Techiman, Nkoranza and Wenchi districts.
(11). The Alma Ata Declaration of Primary Health Care in 1978 provided the basis for WHO support for the development and use traditional and complementary medicines as integral component of holistic health care systems.
(12). 1985. UNICEF support to Training of TMPs on ORS use in Brong Ahafo.
(13). 1985. UNIDO support to review the pharmaceutical industry with special reference to the herbal industry.
(14). A Traditional Medicine Directorate was established in the Ministry of Health in 1991. The directorate is now known as the Traditional and Alternative Medicines Directorate (TAMD).
(15). In 1992, the Ghana Herbal Pharmacopoeia was prepared.
(16). 1992, The Food and Drugs Law, PNDCL 305B and amended as FDB Act 523 is to regulate the introduction of traditional medicine preparations on to the commercial market.
(17). 1999 saw the inauguration of the Ghana Federation of Traditional Medicine Practitioners’ Associations (GHAFTRAM).
(18). 1999-2004, The First MOH Strategic Plan for TM development with focus on reorganization of TMPs under MOH support.
(19). 1999. Formation and inauguration of GHAFTRAM. An umbrella body and spokes agency for all TM associations
(20). 1999. TAM Directorate was set up by MOH.
(21). 2000 to Date. PROMETRA International (NGO) has been working with the MOH for TM development and promotion.
(22). In 2000, the Traditional Medicine Practice Act, (Act 575) was enacted.
(23). 2000, was the First National Strategic Plan for Traditional and Alternative Medicine (2000 – 2004) was launched.
(24). The TAMD did a land mark baseline study in 2001into traditional medicine practice in Ghana with the support of DANIDA.
(25). The Kwame Nkrumah University of Science and Technology started a degree course in herbal medicine in 2001/2002.
(26). In 2001, the Traditional and Alternative Medicine Directorate (TAMD) did another study to assess the institutional capacity of 21 institutions for research and testing of plant medicinal products.
(27). 2002-2004. Second MOH Strategy with focus on training of TMPs. Within this period , the National Traditional Medicine Week and WHO African TM Day launched.
(28). 2002-2004 WHO: Strategy for Traditional Medicine development launched.
(29). 2001 – 2010. African Union Decade of Traditional Medicine development.
(30). In 2004, the Code of Ethics and Standards of Traditional Medicine Practitioners document was finalized and launched.
(31). The first batch of students successfully graduated from the Herbal course at Faculty of Pharmacy of the Kwame Nkrumah University of Science and Technology in 2005.
(32). 2005, The Second National Strategic Plan of TAMD started.
(33) 2008. The Ouagadougou declaration on PHC and Health System.
(34) 2002-2010. Project (NSBCP) Support by MDAs and Northern Savanna Biodiversity Conservation for cultivation of herbal medicine plantations in the northern region.
(35). 2005- 2010. The Third Strategy focused in development tools training, accreditation, standardization, safety and control for TM products development
(36). 2010-2014. The Fourth MoH Strategy with focus on institutionalization of TM practice in the National Health care delivery system.

Protocols to guide the institutionalization have been developed. About 14 Ghana Health Service facilities have targeted for the initial phase about 160 herbal medicine preparations have been selected into the essential herbal medicine list. The base line study conducted by TAMD revealed that there are about 20,000 traditional medicine practitioners in Ghana. However there are indications that the actual number may be about twice this figure.

6. TYPES OF TM PRACTICES IN GHANA

There are five main types of practices and practitioners/healers, namely,
(i). Herbalists (including bonesetters and circumcisers),
(ii). Herbalist-spiritualists,
(iii). Diviners/Soothsayers (including mallams or Islamic healers),
(iv). Shrine Devotees and
(v). Herbalist-Traditional Birth Attendants (TBAs).

It was found that the practitioners are generally illiterate and quite advanced in age and live mainly in the rural areas. There are some fairly literate Christians and Muslims among them. The tendency of Traditional medicine practitioners isolating themselves from formal education is partly self-imposed to ward off the onslaught of foreign religions and foreign secular education that condemn our traditional values and heritage. In practical terms, nothing much has been achieved in the promotion, development, practice and control of traditional medicine in this country.

7. THE CURRENT SITUATION OF TRADITIONAL AND COMPLEMENTARY MEDICINE

The passing on of the knowledge and skills of traditional medicine is still done in Ghana mainly through oral communication, including songs, and informal apprenticeship. A few countries in Africa, eg Egypt, Uganda and La Cote d’Ivoire have recently established courses in traditional medicine at tertiary levels. Ghana has started a degree programme in Herbal Medicine. Most of the traditional medicine practitioners encountered in study done by TAMD live in the rural areas and do not belong to any healers’ association. Commercial production and sale of traditional medicine products on market are on the increase. Foreign plant preparations are also widely available on the local market as food supplements. About 415 of such food supplements and 449 of herbal preparations have been registered by the Food and Drugs Board between January 2002 and December2004. In 2005 the Board set up a special Unit to handle the registration of herbal preparations to be marketed in Ghana.

There are 6 major and about 19 minor Traditional Medicine Practitioners associations in Ghana. The efforts by the Food and Drugs Board are not yet yielding the desired coverage and control. Over 1000 herbal medicine products, both foreign and local, have been registered with FDB to date. However, as at the close of 2010, only 184 local and 208 foreign are in good standing in respect of renewal of registration. The Council for Traditional Medicine Practice was finally established in April 2010. TAMD, TMPC and FDB have been organizing training in safe patient care and clinic management for practitioners. There are WHO guidelines on research into and the use of traditional medicine products. A lot of primary research has been done and is being done on herbal medicines or natural products. Very few quality clinical trails have done to date. Much more is waiting to be done.

The Researchers from Ghanaian universities and research institutions and their colleagues from the other West African Countries have formed the “West African Network of Natural Products Research Scientists (WANPRES). The major aim of the network is to organize their members so that all the various aspects of a given product can be researched upon concurrently so that as complete as possible information can be obtained on the product within the shortest possible time. The clinical research component of the programme of activities of WANPRES is not very much visible.

8. THE CHALLENGES FOR GHANA


(1). Ghanaian traditional medicine and health care practice systems are not well documented and characterized in writing.
(2). Traditional medicine practitioners are mainly illiterate and practice in the general community or in secret shrines which are mostly in rural areas.
(3). The mutual suspicion between Traditional Medicine Practitioners on one hand, and allopathic medicine practitioners, academics and the educated elite on the other hand, is still rather strong.
(4). Traditional secrecy and the absence of effective specific protection of intellectual property rights are barriers to making knowledge easily available by the practitioners. However there are indications that some of the healers are prepared to divulge some the secrets.
(5). Lack of adequate financial support through out the system limits rapid progress in developing traditional medicine.
(6). The systems for legal control and management of traditional medicine in Ghana are still weak.
(7). There is no legal or administrative instrument to control complementary medicine practice in this country.
(8). Although there is a growing interest in phyto-medicine research, there is no known organization or individuals in Ghana that conduct scientific research into the esoteric component of traditional medicine and the other healing modalities.
(9). Efficacy tests have not been done on virtually all of the traditional and complementary medicine products on the commercial market.
(10). There are no formal schools in Ghana for Traditional Medicine and any of the types of complementary medicine.
(11). Modalities for establishing useful working relationship between allopathic and Traditional and other medicine practitioners are yet to be clearly defined.
(12). There is no national standard research protocol and no national ethical committee on TM.
(13). Poor agricultural practices, indiscriminate bush burning and uncontrolled harvesting are threatening the easy availability of some medicinal plants.
(14). There are many quacks and opportunists in the field of traditional and complementary medicine practice in this country.
(15). There has not been any formal or any real research, to the best of my knowledge, in any of the types of complementary medicine in Ghana.
(16). One still hears of professionals in allopathic/modern medicine who openly and severely rebuke patients and/or their relations for visiting a traditional medicine practitioner(s) during the course of an illness. Because of fear of rebuke patients normally deny that they ever visited a traditional medicine practitioner(s).
(17). There is a very widespread use of the title “Doctor” by traditional and complementary medicine practitioners in Ghana. This is unethical and very deceptive to the unsuspecting public.
(18). Herbal Medicine grade has now been establishment in the Ministry of Health. But it is taking much too long to establish the facilities in the various chosen institutions for them to start any meaningful work.

9. ROLE OF THE ALLOPATHIC MEDICINE PRACTITIONER

The Allopathic Medicine Practitioner by virtue of his/her training is in the best position to play a leading role in the team work for the development and practice of the Traditional and Complementary medicines in a holistic health care system. I know some specialists in allopathic medicine in the United Kingdom who offering complementary medicine care facilities in their clinic. The Centre in Mampong runs purely herbal medicine clinic. The Allopathic Medicine Practitioner must have a leading role in: (1). The wider question of continuing clinical research and documentation in all aspects of traditional and complementary medicines, especially for common diseases of public health importance. (2). Understanding traditional cosmogony, philosophy and the concepts of health and ill health in the African context. (3). Production of protocols and modalities for clinical evaluation of the efficacy of herbal and other products and healing modalities. (4). Developing working relationships between allopathic, traditional and complementary/alternative medicine practitioners (5). Establishing comparisons of the various aspects of African traditional and complementary medicines with those of the modern medical sciences and practices. (6). Defining and comparing the causes, signs, symptoms and diagnosis of diseases in traditional, complementary and allopathic medicines, especially, for common diseases of public health interest. (7). Examining traditional names as compared with allopathic medicine ones for diseases. (8). Production of essential drug list for traditional and complementary medicines. (9). The development of formal education and training for traditional as well as complementary medicine practitioners and their establishment in the public health services delivery system. (10). Development of modalities for holistic health care system in the country. (11). Development of regulatory mechanisms for all categories of practitioners. (12). Monitoring, supervision and evaluation of practices (both ethical and technical) and the efficacy of remedies.

10. THE WAY FOREWARD


(1). A permanent forum or entity needs to be established for the co-ordination of the activities of all stakeholders in traditional and complementary medicine. The Traditional and Alternative Medicine Directorate of the Ministry of Health should be charged with the responsibility to initiate this. This should be backed by law or an administrative instrument or directives.
(2). The Centre for Scientific Research into Plant Medicine should be charged with additional responsibilities to enable the Centre play a lead role in research into other aspects of traditional medicine.
(3). Quality and suitably qualified Allopathic medicine clinical researchers need to be attached to the Centre for Scientific Research into Plant Medicine to make sure that clinical observations on the use of the herbal remedies prescribed at the Centre are scientifically documented. These records are requirements for the patent and protection of intellectual property rights and also for the registration of the products with the Food and Drugs Board.
(4). A special institute for scientific research into the esoteric aspect of traditional and complementary medicines needs to be established. I believe there are well educated people who will like to get involved.
(5). The specific legal framework and the modalities for the protection of intellectual property rights of traditional medicine practitioners needs to be put in place as soon as practicable.
(6). The five categories of traditional medicine practitioners identified in the country need to be studied in greater detail and the beliefs and procedures documented for use in the preparation of training manuals for traditional as well as allopathic medicine practitioners.
(7). To me, there is an urgent need for our traditional rulers and the highest political authorities to dialogue with the keepers of the shrines and cults to reveal at lest some the ancient esoteric and all of the exoteric knowledge base of their practices.
(8). The etymology of our languages and the cosmogony of our forefathers are to be found in these shrines and cults. Individual researchers have made some progress talking to individual practitioners. There is need for more and better coordinated sociological research in the field of traditional medicine.
(9). If there are any real defects in the existing laws these must be discussed with all stakeholders so that the necessary amendments can be made by parliament. In-action and inertia are contributing to the slowing down of the development of traditional medicine in the country.
(10). Not much of the activities planned in the previous Strategic Plans were implemented. This needs to be evaluated to determine the reasons for this so as to make sure that there is greater success with the fourth plan.
(11). The Traditional and Alternative Medicine Directorate should take the initiative to discuss the degree course in herbal medicine with the authorities in KNUST with the view of determining how the products are to be placed in the health delivery system. The course is an innovation in Ghana and deserves commendation and not condemnation.
(12). The herbal medicine graduates constitute the best link for development, practice and control of traditional medicine practice in this country.
(13). KNUST should consider developing the herbal medicine course into a traditional medicine course within the shortest possible time.
(14). There is the need to look into the possibility of development of traditional and complementary courses at polytechnic level.
(15). There are research protocols for plant and natural products. A team of researchers made up of allopathic, complementary and traditional medicine practitioners and various research scientists needs to be put together to produce a Standard national protocol(s) to be made available to the institutions.
(16). The MOH/Ghana Health Service should officially authorize all health institutions to conduct, at lest the preliminary, clinical trails on traditional and complementary healing remedies in the cases of selected diseases of public health and social importance.
(17). The Government needs to seriously support the development of facilities for large scale cultivation of raw materials and for large scale commercial manufacture and constant supply of traditional remedies for diseases of public health interest.
(18). In order to foster closer cooperation and collaboration between allopathic, complementary and traditional medicine practice, patients must be encouraged to disclose the fact they did visit a traditional or complementary medicine practitioner during the course of a particular illness. Patients should be told that they have the choice to visit traditional or complementary healers but they must visit allopathic clinics very early in the course their illness to enable early diagnosis and treatment so as to prevent possible severe complications and avoidable death.
(19). A permanent body needs to be put in place and charged to review the Ghana Herbal Pharmacopoeia on regular periodic basis.
(20). Traditional and complementary medicine practitioners must be impressed upon to device a mechanism(s) to control quackery among their ranks.
(21). Much more money needs to be made available by Government for the development of traditional medicine than is currently given. This must be given the national priority that it deserves.
(22). I fully support the call by the Ghana Federation of Traditional Medicine Practitioners Associations that traditional medicine development must be made one of the Special Presidential Initiative Programmes.
(23). The Ghana College of Physicians and Surgeons may consider sourcing special funds to support clinical and basic research in designated aspects of traditional and complementary medicine products as one of the core prerequisites for fellowship qualifications. The College may need to dialogue with the West African Network of Natural Products Research Scientists. This also implies a lot of issues to be resolved with the owners of the products, research institutions and service provider agencies.
(24). It time that basic information on traditional and the other health care systems are introduced into the curriculum of the medical schools, the School of Public Health and the training institutions for the other allied health professions. Unless people are tasked to get that done within a time frame it is likely that we shall talk a lot about it but nothing will happen any time soon.

11. DISCUSSION

Religion, morality, social norms and behaviour and even political commitment depend to a very large extent on individual conviction. Acceptance and practice of any religion or discipline depends on faith and/or direct practical experience.
It is unlikely that any researcher who is not an initiate in traditional medicine or of the shrines will come out with any profound finding about African cosmogony, etymology of languages, health care and esoteric information and practices. The practitioners for reasons of occult injunctions, loss of intellectual property rights and mere suspicion will and do keep hold back critical information.

Some of the most profound and thought provoking information about the human being, material mature, the cosmos, spirit world and relationship with God, the Creator, came from those who had been intimately involved in these cultures. They were initiates and practitioners. They lived in it and got the practical experience and hence the confidence in and the conviction about what they said and wrote.

We are where we are in regards to traditional medicine and health care information and practices because the greater numbers of the practitioners are illiterate and dwell in the rural areas. If some of the most knowledgeable ones were to have been well educated even to the tertiary levels and became familiar with scientific investigative methods, comparative religion, other cultural values and philosophy the storey would have been different.

The well educated in allopathic medicine and in the sciences will make a big difference in the development of traditional medicine and the other less known healing modalities by getting directly involved in the practice of these therapeutic modalities.

It is better to record all research findings in the original languages in which these information were found. The information can then be translated into English or any other language. This is to avoid the loss of actual meanings through inaccurate or wrong interpretation or translations. The originals will then be available to refer to.

I believe that methods of scientific investigation can be applied to any phenomenon that lends itself to independent investigation. The explanation to findings may not be immediately known. The most logic way for any true scientist or open minded independent observer is to investigate the phenomena (physical/exoteric or spiritual/esoteric) of the universe using replicable methods. Drawing conclusions, condemning or demonizing or unreserved praises, by the virtue of mere reasoning or conjecture has never really promoted the development of valid scientific evidence, socio-cultural progress and development.

To me, any phenomenon that is independently verifiable and replicable is scientific. Be it physical or esoteric (spiritual). Poverty of thought naturally results in poverty of right action, material poverty and tight poverty cycle. It is the poverty of action of those who know but fail to act that makes the deprivation very biting. Words are fine indeed but one must not let rich thoughts flow out mostly only in words. Thoughts can only be of material benefit when they are transformed into planed effective actions.

12. CONCLUSION

Everyone wishes for good health, happiness, long life and prosperity. They are desiderata. We know the effect of good health on life expectance at birth and human productivity. There is ample evidence that people can have the best of health and longevity through healthy life styles coupled with the availability of facilities for proper methods and services for prevention of disease, protection of health, disease management and rehabilitation.

I believe that there is remedy for every malfunctioning that occurs in this world. If it were not so then this world is not complete and is not the microcosm of the universe as some people will like us to believe. But the indications are that this world is complete and that there is still a lot to be discovered.

Some of us have kept the interest in our traditional remedies because of the potential that we believe they hold. I share the belief that we in Africa will certainly get better and attain faster development when we, as a people, begin to get to know and practice aspects of the now hidden or ignored ancient wisdoms of our forefathers. What has been coming from other parts of the world supports this position.

There is the pressing need for the development and promotion of the use of African traditional remedies as our contribution to the expansion of the horizon of scientific knowledge and for the social and economic benefits that will accrue if we succeed. We need to distinguish between esoteric injunctions and mundane or social beliefs and practices. We need those who will improve upon what they have learnt and subtract and discard what is obsolete, of no value or are decidedly dangerous.

I do think that God and our ancestors will be very disappointed in us for not using the intellect they have endowed us if we fail to make our environment a better to live in but instead blindly keep beliefs, religion and practices in the mere name of traditions, culture and unexamined educational values.

The time has come, although a little late for Africa, for planed, purposeful and productive actions. Fortunately, there are many who are genuinely committed to the development and promotion of traditional medicine and its use in the public health care delivery system. Adequate financial support is a very essential prerequisite for the development of other resources and facilities for traditional medicine practice.

What is expected to be achieved is a holistic health and medical care system based on the best available scientific, human and material resources.

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