Health care forms an integral part of human lives as it help keep the body in good condition to serve other purposes of life. The World Health Organization (W.H.O, 1948) defines Health as “the state of complete physical, mental, and social wellbeing of an individual and not merely the absence of diseases or infirmity”, and so theattitudes displayed by health care practitioners in carrying out their functions may affect the state of health of individuals positively or negatively. The commonest attitude is seen with Orthodox and Herbal medicine as the two are the main forms of health care practices in Ghana.
The misunderstanding that exists between Orthodox and Herbal practitioners is so intense that the former believes the latter is unprofessional and several medical complications arise from its actions, whiles the latter believes the former “kills” people through medications and are incompetent as they sometimes treat cases the latter finds difficult to attend to/manage. This claim of superiority by both Orthodox and Herbal medicine practices has fueled lots of wrong attitudes both in the training of these practitioners and in their practices.
The first of such wrong attitudes is seen with patient consultation and diagnosis. Consultation and diagnosis is an important component of healthcare delivery as it offers patients the opportunity to “open up” to practitioners on issues requiring medical attention and in turn help practitioners arrive at concrete diagnosis. The orthodox medical training offers the best means of diagnostic procedures and includes history taking, physical examination, investigations (e.g labs). Professional herbal medicine practice by Medical Herbalist trained at the Kwame Nkrumah University of Science and Technology (KNUST) borrows this aspect of orthodox medicine in offering their services.
History taking for instance is characterized with; Demographics, Presenting complains (PC), history of presenting complains (HPC), On-direct questioning (ODQ), Past medical history (PMH), drug and allergy history (DH), family history (FH), Social and Occupational history, and last menstrual period(LMP) for female patients. The demographics as part of history taking is made up of vital information about the patient such as Name, Age, Sex, Occupation, Residence, Marital status, etc. The symptoms the patient has, becomes the Presenting complains (PC) and the medical summary of the PC becomes the History of presenting complains (HPC). The PC or noted symptoms may be related to more than one body system therefore series of questions is asked by the physician or Medical Herbalist to rule out some suspected conditions or systems and this is called On-direct Questioning(ODQ).
At this stage the physician still has some differentials in mind and so he/she will proceed to the patient’s past medical history (PMH), drug history (DH), family history (FH), to arrive at a diagnosis. General examination of the body is then performed as part of the Physical examination and when the need arises, systemic examination. The major steps in physical examination include: Inspection, Palpation, Percussion and Auscultation which simply denotes “looking with the eyes”, “touching with the arm”, “kicking with the middle finger”, and “listening with the stethoscope”. The physician or Medical Herbalist may come to a diagnosis after physical examination or request for investigations such as imaging, labs, etc to confirm a diagnosis after which medications are then prescribed.
Whiles Physicians or Medical herbalists sometimes do not make time to conduct proper consultations; others find it difficult to utilize components of patients’ history taking like Drug and allergies history. Drug history (DH) informs the Physician or Medical herbalist about the medicines (prescribed or not) a patient for instance has been on since the onset of his/her symptoms/illness.
The medical training in Ghana does not cover knowledge on herbal medicines and so Medical doctors/physicians struggle in the case where patients have drug histories of herbal medicine usage (prescribed or not). Some consult appropriate sources for help, whiles others rather blame the existing medical condition in these patients on the herbal medicines used or being used. Medical doctors and others like nurses have feelings like every other human beings and since most of the complications associated with the wrong attitudes of patients like delay in seeking medical care early, self-medication among other, come to them directly, they are made to believe that herbal medicine use in general are the causes of these complications in the case where the patient involved had drug history of self-medication with herbal medicines (like herbs, herbal material, and herbal preparations) purchased from buses, market places or he/she had visited a herbal centre who failed to either refer or monitor the referred patient to specialists at the secondary and tertiary levels of medical care.
These experiences influence patient counseling most a times by nurses at the Out Patient Departments (OPD) who tend to condemn herbal medicine use in general instead of condemning herbal medicines like decoctions, herbs, and herbal products not sourced from appropriate licensed centres like herbal clinics/hospitals, herbal shops and pharmacies. This misinformation on herbal medicines has led to herbal medicines being listed as causes of some disease conditions in the Standard Treatment Guidelines (STG) used by medical doctors and other practitioners of orthodox medicine. Self-medication (With both pharmaceuticals and herbals) especially when diagnosis isn’t known is dangerous and may cause health complications in general.
This results in declining health states as consumers take wrong medications for the right conditions although the medications may treat some associated symptoms experienced and as such the underlining disease “takes over” the body and with time other complications arise. Biological variation exist with the use of medicines, that is why it is advisable to seek medical care if no improvement is seen with the use of any certified medicine/drug after a period time (usually after 48hrs for analgesics or antimalarial) as stipulated by the manufacturers therefore there is no need to look down on any medicine (be it herbal or pharmaceuticals) in cases where they do not “work” in some people. Forms of herbal medicines like herbs, herbal preparations and herbal materials are well utilized in places like herbal clinics/hospitals, and in some instances licensed herbal shops, so when they fall in wrong hands, the health states of people may be affected.
People who sell them in vehicles tend to convince travellers by way of testimonies from people they claim have had success stories using their herbs, herbal materials or preparations instead of using FDA registration and certification details as basis for marketing. Even with FDA certification, means like buses is not the right place to sell medicines but rather licensed herbal shops, chemical shops and pharmacies. In an attempt to make profit, these people end up mentioning lots of symptoms and diseases that at least someone on board in the vehicle or at the market center may be experiencing. The plants used may have been proven to be safe and effective but the standard operating procedures may not have been observed by the manufacturer/producer and since they are not registered the safety of their medicines isn’t guaranteed.
People are however cautioned that conditions like High blood pressure, Diabetes mellitus, Stroke, and other chronic conditions require close monitoring by qualified health care providers and so herbal or orthodox medicines for such conditions should not be purchased anyhow both at authorized and unauthorized places irrespective of their Food and Drugs Authority (FDA) endorsement. Same said about Medical doctors and nurses earlier can also be said about Medical herbalists with weak foundation in orthodox medicines/pharmaceuticals in a different context. Patients on orthodox medicines especially for chronic conditions sometimes visit herbal clinics or hospitals when they feel they have not seen significant improvements in their health states, therefore careful attention is to be paid on the drug history which some medical herbalists take for granted. Herbal medicines prescribed to such patients for instance may be well spaced to prevent systemic overdose.
They should not interact with/prevent the orthodox medicines the patient is already on from working. Previous history of such patient/medical records, periodic review, among others is required in instances where patients already on pharmaceuticals/ orthodox medicines are to be totally taken off those medications by medical herbalists or other practitioners of herbal medicine. Other practitioners of herbal medicine trained by way of apprenticeship most of the time totally have no knowledge about orthodox medicines/pharmaceuticals which is not the best. Their training does not involve knowledge on the orthodox practice/medicine and so to some of such practitioners, pharmaceuticals are poisons manufactured to kill people.
Again, while some people who only have licenses to manufacture/produce herbal products take advantage of the system to operate herbal clinics or pose as herbal doctors (Medical Herbalists), Others with license to operate herbal hospitals/clinics most of the times do not employ professionals like Medical Herbalists, to oversee medical aspects like diagnosis in addition to the usual herbal medicine roles. They rather prefer to work themselves (Even though they lack the medical training) and in addition employ few professionals like Sonographers, Medical Laboratory technicians to oversee the ultrasound, and lab respectively.
These practitioners find it difficult interpreting X-rays, Lab results, Ultrasound results etc, they sometimes even find it difficult understanding the medical reports and investigations of already diagnosed patients that visit their facilities seeking for alternative care in the case where these patients themselves are not well informed about their conditions, all because they fail to employ trained people/medical professionals like Medical Herbalists. These practitioners are most of the time successful in treating patients due to the nature of well-prepared herbal medicines in general despite their shortcomings. Here a plant or groups of plants for example may treat more than one respiratory tract infections as now backed with scientific findings/researches and so the plants are generally indicated for respiratory infections at particular herbal centres, same with nervous system, reproductive systems etc, so if the practitioner mistakes a disease relating to a particular body system for another, the formular/formulation used may treat the conditions with very reduced side effects unlike in orthodox medicine where the medicines are very specific to a disease/condition with a more severe side effects compared to herbal medicines. This explains why people with potent herbal medicines trained by way of apprenticeship go ahead to establish herbal clinics with the feeling that no Medical Herbalists/professionals are needed.
Another wrong attitude put up by both orthodox and herbal medicine practitioners is with patient referrals and collaborative treatments. Referrals are transfers of patient care by primary health care physicians (PCP) to secondary or tertiary health care practitioners. For instance a patient treated with skin conditions repeatedly may be referred to a dermatologist (secondary/tertiary care) for a specialist skin care or to a plastic surgeon (tertiary care) for a more specialized care. Practitioners of herbal medicine fall within the primary healthcare practitioners although they can work with specialists at the secondary and tertiary level of medical care.
In ideal situations, a medical doctor/physician may recommend alternative medical care by way of herbal medicine for a recurring fibroid in a patient after surgery by a general surgeon. The physician is then supposed to work with the herbal clinic/hospital in provision of quality healthcare by making sure the herbal medicines are either able to completely treat the fibroid or prevent it from increasing to a size that will require surgery again, this is collaborative care. In the same way an emergency room doctor may through the hospital work with herbal centers with specialties in certain areas of care like bone settings for accident victims instead of always recommending amputations to be carried out by orthopedic surgeons. There is however a bad relationship in terms of referrals between the two health care practices and this has affected the quality of lives of many people. Complications sometimes result from the actions of herbal medicine and orthodox practitioners as they fail to respect their limits of healthcare due to over confidence and greed.
Lastly another wrong attitude seen with healthcare practitioners is with natural mineral/food supplements. Influx of these supplements into the Ghanaian market is on the rise in recent times. These “natural” products/supplements most of the time is sold to people through network marketing with nice financial benefits and other attractive packages for individuals involved as long as the people registered continue to register new clients. For some companies, a registered client is required to directly register four to five members under him/her. He/she is then task with helping each member register additional five clients to continue the network chain, with the preceding clients enjoying a percentage of the profit from the activities of the succeeding clients.
Registered clients in some instances are required to purchase products from the company involved on monthly basis to make profits from the company in addition to the individual profits made on the sale of each product purchased from the company. Other companies only require people to purchase a package of their product usually at a huge cost to become registered, after which monthly purchases of products becomes optional provided persons involved continue to register new clients to climb up the success ladder set by the company to earn more money and packages like holiday trips around the world, cars, etc. Network marketing although currently the best method for marketing goods and services, has influenced healthcare providers’ attitudes negatively in recent times. Medical doctors and Medical Herbalists in attempts to make more money and enjoy other flashy benefits quickly are now overburdening patients with natural supplement products (which usually come at high costs) which are not included in the essential list of medicines to be prescribed to patients even when their use is not necessary. This often causes people to self-medicate as they prefer not to seek medical care as a result of the high cost of supplements (due to dollar exchange rates) prescribed instead of the required medicines for their illnesses. This attitude has shifted the priority from patients care to quick wealth and now put people’s health at risk.
Emmanuel Bentil Asare Adusei
BSC HERBAL MEDICINE, KNUST
C.E.O, ADUBEN HERBAL CONSULT
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