CHAPTER ONE

INTRODUCTION

          The use of herbs to cure illness is as old as  man. This is because the existence of man is not without one form of ill health or the other. The evolution of man through pre historic, neolithic, medieval, and colonial and postcolonial times has been attached to one form of medical facility or the other. 

          In Africa, plants and herbs play major roles in addressing health challenges before the advent of the Arabs, Europeans, Christian missionaries and the eventual colonialization of the continent. The case of malaria, which saw to the death of many European visitors to Africa, did little harm to the people of Africa. The coming of quinine as drug for malaria was in actual sense not the first break through in addressing malaria. For example, dogoyaro, paw-paw leaf, lemon grass are used in preparing drugs for malaria before the discovery of quinine.

          Unfortunately, the coming of colonialism altered people’s health practices. The colonialist in their racial superiority created the impression that presented orthodox medicine as superior to African medicinal sciences. During the colonial period, missionaries and colonial authorities worked hand-in-hands in the introduction of medical treatment e.g the construction of lyienu Hospital Ogidi, Mile 4 Hospital Abakaliki and RCM Hospital in Afikpo. This development provided a platform for people to seek medical attention in western built hospitals.

          Inspite of the efforts to establish western medical care, no genuine effort was put in place to develop traditional medicine alongside the modern hospital. For example, Elizabeth Isichei captured the feelings of an Igbo native doctor turned Christian as follow:

In Igboland, as in other parts of the world, the history of disease and its treatment, and of epidemics, is an important and neglected variable in social history. The real achievements of pre-colonial African societies in the sphere of medicine are now generally recognized. Even today, traditional dibia include some superbly successful bone-setters, and pharmacologists in Nigeria (and elsewhere in West and East Africa) are conducting a scientific analysis of traditional herbal remedies.1

Furthermore, she continued:

In this connection we might well remember a certain Chive of Igbariam. Chive was a former dibia who had become a Christian, and suggested to the local missionary in 1921 that a university of medicine should be established, where Dibia could hand on their medical knowledge, in isolation from the corpus of traditional religious beliefs. The missionary snubbed the proposal, telling Chive how organized society regarded quacks.2

The reply of the missionaries is not different from that of the colonial administration since they are both propagators of western ideologies. For example, the recent increase in bone related cases calls for a revistation of the need for a synergy between orthodox and traditional medicine. This is because of the increase in modern transportation system such as vehicles, aero plane, motorbike, popularly called “Okada” have lead to increase in victims of bone related fractures. As will be discussed in this research, the traditional bone setting have proved itself viable more than western orthodox medicine in this regard. This is evident of few testimonies of peoples who got healed from the traditional hone setters. Unfortunately, in spite of its efficacy, the Federal, State and Local governments have not deemed it appropriate to integrate the bone setting industry into the orthodox medicine. However, throughout colonial rule, A report recorded as follow:

A closer examination of the Nigerian healthcare system sheds some light on why it has been particularly difficult to integrate contemporary western orthopedics with indigenous practices. The first hospital in Nigeria was established in 1873. However, the hospital was established primarily by the European colonials with the intent to primarily treat “their own”. It took another 40 years until Nigerians could actually use that hospital and even then only select elite Nigerians were welcomed. Similarly, when the National Orthopadedic Hospital were established, they were intended solely for Europeans. Nigerian physicians only began to receive training in orthopedic after the country’s independence from Great Britain in 1960.3  

Traditional bone setting methods are systematic. First step is to identify whether a fracture is opened or closed. For closed fractures, the bonesetters identify the fracture using palpation and clinical signs.4

This study is divided into five chapters namely introduction, the second chapter deals on the land and people of Enugu, the third chapter is traditional bone setting centers in Enugu, the fourth chapter is on the development of the health sector in Enugu and the fifth chapter is the summary and conclusion.

Scope of the Study

This  study covers the period between 1975-2015. The take off date of 1975 is remarkable because it was on 4 April 1975 that Government of East Central state named after Emperor Haile Selassie of Ethopia as Haile Selassie Institute of Orthopedic, plastic and ophthalmic surgery.

The terminal date 2015 was selected to re-examine forth years of the administration of the Orthopedic Hospital Enugu and its service to the people. Furthermore, the dominant role played by the Goodluck Jonathan administration which came to an end in 2015 is worth examining by historians.

This study covers the geographical space of the Enugu urban, which accommodates many patients and practitioners in bone related challenges both orthodox and traditional.

Source and Methodology

In historical study, two major sources exist. They are the primary and secondary sources. The primary study includes oral interviews, news papers and the internet google search engine. The research will adopt the descriptive style of historical analysis by conducting interviews on health personnel’s both in the orthodox hospitals selected for this study. On the other way round, there will be visit of the traditional bone setting attendants in selected places in Enugu State.

Furthermore, the views expressed by medical experts will be collaborated into the frame work of analysis in this research. This will exist in objective assessment of the development relating to the traditional bone setting. There are specialized hospitals in Enugu Urban that deserve the attention of this research. The National Orthopedic  Hospital as well as the university of Nigeria Teaching Hospital Ituku –Ozalla will serve useful purpose  for this research the writer intends to interrogate medical experts of bone related developments.

Literature Review

Alternative medicine has been part of the people’s culture before the arrival of the Europeans. As part of its civilizing mission, Lawal observed that the Christian missionaries  saw traditional medicine as superstition belonging to witch doctors and charlatans. In spite of the efforts of the nationalists to kick against westernization, no remarkable achievement was put in place in regards to improving traditional medicine. Colonial medical schools succeeded in training nurses doctors, dentist with western orientations. Furthermore, scholars who published works on health and medicine did not provide basis for the reading public to accept anything from the traditional medicine as useful. Furthermore, government budgets allocations on health focuses more on training of medical personnel at home and oversees building more hospitals with utter neglect of the traditional medicine research.5

In an empirical research, A.M Udosem, O.O. Ote,  O. Onuba wrote on the role of traditional bone setters in Africa: Experience  in Calabar. The authors are medical experts of the department of surgery, university of Calabar. They studied eight centers of bone settings in Calabar and administered questionnaires to about ninety two persons. They observed that there is erroneous belief that the only available option. For the treatment of fractures in hospitals is amputation. The  authors observed that ignorance was a factor in the patronage of people in traditional bone setting as majority of the patients were illiterate motorcyclists they argued that traditional bone setting use the same method of herbal cream application, native bamboo splinting frequent pulling and massage and complications such as tetanus, gangrene and germs are usually attributed to charms and withcrafts they accused traditional bone setters of lacking basic knowledge of anatomy and physiology, as a result of this, they suggested an outright legislation against patronizing traditional bone setters.6

Mathew O. Egwu, Vincent CB. Nwuga and Mathew O.B Olagun’s paper on therapeutic philosophy of some Bonesetters, argues differently from A.M Udosen and others already reviewed. They observed that python fat; shear butter, palm oil, herbs and roots were used as medium for massage and healing. The success of the traditional bone setters include in their stretching of posterior longitudinal ligament causing pain relief. They observe that traditional Bonesetters manages various orthopedic conditions through conventional technique, uses incantations and other psychological support to get healing. They concluded that traditional Bonesetters are ignorant of basic physiology of inflammation and arterial supply. However, they expresses confidence that  traditional Bonesetters enjoy immense training in the physical and mental healing and thus, if trained be a great asset since there is absence of most qualified orthopedics compared to the ration of patients who need their assistance.7

Relevant to this study, Nnamdi Emmanuel Omeire’s “Indigenous Orthopedic medicine: A case study of the buckets”. Using a traditional           bonesetting center in Emiyi Owerri, author interacted with patients receiving treatment during the period of his research and they continued that they were already penciled down for amputation if not for the Iweke healing home. In all, the author asserts that the Iweke traditional medicine has exposed the qualitative level of ignorance that pervades the orthodox medicine. According to him, orthopedic sugeries in the hospital were unnecessary if doctors have knowledge of how to hand pick and set bones.8

V.R Adebimpe wrote on the ambivalence of westernized professional towards traditional medicine. He concluded that for western-trained practioners to continue to cover importance of traditional medicine, is for them to operate with a false sense of self-sufficiency and to love with complete self  knowledge.9 Next to Adebimpe’s work is M.M Iwu’s Igbo Ethromedicine, he outlined the various typologies of Igbo medicine men to include Dibia Afa (Diviners) Dibia Ngboro-ogwu (Herbalists), Dibia Ogbanje (in charge of evil spirits and paediatic diseases). Dibia owu Nmiri (in charge of river goddesses), Dibia Ogba- Okpukpu (Orthopaedic injuries) Eze mmuo (witch sacrifices). Of particular interest to this  study, is the author’s  analysis on Igbo Orthopaedic medicine. After examining 84 cases of clinically rated major fractures, the writer informs us that the art of preparing fractures and other orthopaedic injures is almost parallel to  the European or western method of   orthopaedic treatment. The author noted that apart from the use of wooden splints to immobilize the fractures the herbs used and the incantations are not customary with European medicine. A fundamental difference is the use of hot applications of pepper and other spices in bonesetting in situations where the European doctors would prescribe cold compressions.10

George .E. Simpson offers an insight into Yoruba Religion and medicine in Ibadan. Beginning from the Native Doctors Association. According to his revelations their exist remarkable difference between herbalists, babalawo and other diviners. Herbalists according to him uses medical history and symptoms for diagnosis. The common methods of preparations made of mixtures of roots, leaves, barks, fruits, parts of animal and so forth, and rituals involving offering to the Orisa or the witches. However, one of the remarkable revelations of the study shows that trained medical experts at Ibadan in most cases accept that plants are capable of curing ill-health.”11

All the texts reviewed add to our knowledge of the topic in so many ways. However, there are basic gaps that our study of traditional bone  medicine practice in Enugu state attempts to address. Enugu is reputable for hosting two teaching hospitals, many private hospitals and a national orthopedic hospital. The relationship between the aforementioned hospitals and the traditional bone setting centers have not received the attention it deserves from historians. Historians  appear to address more of political and economic issues and pay little attention to evaluating the commitment of the traditional bonesetting in the development of the health sector.

ENDNOTES

1.     Elizabeth Isichei, A History of The Igbo People, London, Macmillan Press 1976,p.223

2.     Isichei,p.223

3.     Benedict U. Nwachukwu, ‘Traditional Bonesetters and Contemporary Orthopaedic Fracture Care in a Developing Nation: Historical Aspects, Contemporary Status and Future Directions, Open Orthop Journal 2011,p.4

4.     Nwachukwu,p.3

5.     Adebayo A. Lawal, Nigeria Culture, Economy and External Relations, Ibadan, Connel Publications 2015, PP 91-116

6.     A.M Udosen, O.O Otei and O. Onuba, “Role of Traditional Bone Setters in Africa: Experience in Calabar, Nigeria” Annals of African Medicine  vol. 5 No. 4 2006, PP 17-173

7.     Michael O. Egwu, Vincent C. B Nwuga, and Mathew O.B Olaogun, “Skills, Materials, procedures and the Therapeutic Philosophy of some Bone. Setters in Nigeria” Journal of the Nigerian Medical Rehabilitation therapists (JNMR) Vol. 3 No. 6 June 1998 pp. 37-40.

8.      Nnamadi Emmanuel Omeire, “Indigenous Orthopedic Medicine: A case study of the Iweke’s in T.I Okere and Levi Nkwocha ed. Harvesting and Sharing Indigenous knowledge, Owerri, Assumpta press 2004, PP 193 -216

9.      V.R. Adebimpe, “ Ambivalence of westernized Professionals in Africa Towards Traditional Medicine” in O.A. Erinosho and N.W Bell ed. Mental Health in Africa, Ibadan, Ibadan University Press 1982, pp 215-219

10.                         M.M Iwu, “Igbo Enthomedicine” in G.E.K Ofomata ed. The Igbo Nation, Onitsha, Africana first publishers ltd  2002) PP 583-605

11.                        George E. Simpson, Yoruba Religion and Medicine in Ibadan, Ibadan, Ibadan, University Press, 1980.

CHAPTER TWO

LAND AND PEOPLE OF ENUGU

Geography and People of Enugu

          The land and people of Enugu in Enugu State Nigeria is the focus of this chapter. Literally, Enugu, among the Igbo of Nigeria, means a hill top. It derives the name from its position among the Udi Hills in the South-Eastern heartland situated 689.8 feet above sea level. In Igbo, the world “enu” (elu) means top, while Ugwu (anglicised as Ugu) means hill. Thus, the two words: Enu and Ugwu/Ugu join to produce Enugwu (anglicised as Enugu) meaning hilltop.1

          Enugu connote city located on the top of a hill. Enugu is bounded on the north by the Ekulu River; on the south by the Idaw River and a litany of clans and communities such as Amechi, Obiagu, Ugwuaji, Akegbe Ugwu, Obuoffa, and Akwuke; on the east by Nike town; and on the West by Ngwo.2

          It has been noted that what is known today as Enugu only existed as a group of farmlands owned by indigenous peoples from the adjoining communities particularly the Nike and Awkunanaw.3 The name Enugu was not the name of any community until the coming of colonialism in the early twentieth century and hence Enugu was used to describe the topography of an area.4

          Enugu derives its name from its position among the Udi hills on the altitude of 689.8 feet above sea level an area of 28.27 square miles.5 Enugu owes its existence to the discovery of a rich seam of coast east of Ngwo village in 1909 by a geological exploration team lead by a British mining Engineer, Mr. Kitson. In 1914, another British mining Engineer, Mr. W.J. Leck arrived in Enugu with a group of larbourers from Onitsha led by Mr. Alfred Inoma. Mr. Leck and his white assistants made their first home in temporary mud houses on top of the Milliken Hill ridge in what is known as the Hill Top, while the indigenous labourers established their own settlement on a spur 200 feet up the ridge and hillside of the camp was named after the head labourer, Mr. Alfred Inoma.6

          By 1914, construction work started on a railway line to link the Udi coal fields with the coast of Port Harcourt for the purpose of export. In 1915, the first coal mine was opened at Udi. In that year, the District prison, formerly at Udi was moved to Enugu and the prisoners were set to work on the mines. In 1917, the second coal mine, Iva mine was opened. In that year too, Enugu attained township status under the name Enugu Ngwo. In 1928, Ngwo was dropped to distinguish the town from Ngwo village.

          It should be noted that coal exploration and exploitation could not start in 1915 in Enugu without signatories from the landlords. Among the signatories to the treaties were Chief Ozo Eze (Ngwo), Chief Nnadi (Ngwo), Chief Afo (Ngwo), Chief UKwuani (Ngwo) and Chief Ahim (Ogui Nike). The treaty was said to have been signed byefore Mr. N.C. Duncan (the District Officer for Udi), Mr. J.S. Heys (Colliery manager).8

          The development of Enugu was anchored on two major factors namely the colliery and the Railway Corporation. These two development strides  saw to the influx of people into Enugu from the earliest times. Available records shows that Enugu grew in importance as an administrative, industrial and commercial town. By the early 1930s saw the expansion  of the tow on an unprecidendent scale and Ogui, Asata and the G.R.A now Ekulu were developed. With time, more residential layouts were established namely Thinkers Corner, New Era Layout, Republic Layout, Independence Layout and the development of about 729.2 acres of land known as Trans Ekulu.

          Beginning from a population estimation of about 138,457 in 1963 census, Enugu by the data provided in 2006 census has a population of about 722,664.10 Enugu occupies the heart of Igbo land as the capital of old Eastern region then to old Anambra State created in 1976 and the capital of the present day Enugu state created in 1991.11

Traditional Bone Setting During Colonial Times

Traditional bone setting records during the colonial period in Enugu are not yet readily available in written literature. This makes it difficult for the historian trying to work in the field of health history.

          With the arrival of Christian Missionaries and British colonial officials, it marked the opening of Western medical facilities as well. The level of modernity ushered in by Christianity and western education affected greatly people’s patronage towards traditional medicine in general.

          An informant insist that in as much as the traditional bone setters were on ground during the colonial period, their level of acceptance reduced because of the various colonial policies on health especially the classification of the activities of the traditional medicine under what he described as juju ordinance.12 Beginning from 1925 to 1930, there was widespread of the establishment of colonial hospital in Nigeria. In his book on the History of the Nigerian Health Services, Ralph Schram recorded as follow:

Several other town witnessed progress. Hospital building included the reconstruction of Lagos General Hospital from 1925-1930, the building of new government hospital at Enugu, Jos, Aba, Mubi, Ijebu-Ode, Oshogbo, government nursing homes at Ibadan, Jos, Kano, Enugu and new missionary hospitals at Vom, Ogbomosho, Itinam, Huk Mbang, and Wusasa (Zaria) as well as a few missionary leprosy settlements (Itu, Garkida and Kafanchan).13

The widespread of western hospital, contributed in no small measure to increasing ideas and neglect of the traditional bonesetting. This new hospitals address ill-health challenges from the western point of view. 

The Economic Impact of Traditional Bone Setting in Enugu

          The economic impact of traditional bone setting is of great importance. Some critical aspect of it has been discussed by scholars. For example, Professor Elizabeth Isichei gave a useful insight on the economic variations of the orthodox and western medicine. According to Ishichie, the availability of western medicine is, of course, quite a different matter from its use.14 She continued that many Igbo still consult herbalists, and faith healers, and patent medicine vendors, not because these are thought to be more efficacious, but because they cannot afford hospital bills.15

          Economically, it is expensive to treat bone related challenge at the orthodox hospitals but the traditional bone attendants are relatively cheap. During my research trip to the National Orthopaedic Hospital Enugu, I discovered that a patient with serious fracture challenge spent over N300,000 within two weeks at the hospital.16 This further deepened my thoughts on how an average civil servant domiciled in Enugu can be able to meet up with some of these challenges in terms of finance. Efforts to understand the high cost of bone related problems or orthopaedic challenges at the hospital shows that they have various consultants in various fields and the inflated cost of drugs is at the high side.17 This further deepens people’s interest to Alternative Medicine inspite of the advice being given by orthodox experts not to engage in traditional medicine.

          This development with regards to Igbo patients of Enugu listening to the advice of orthodox medical personnel has been addressed by U.D Anyanwu in his book, Christianity in Igbo and Nigerian Society as follows;

The people had greater faith in traditional healing than in the new medical system. Similar belief affected the people’s response to nervous related diseases, pregnancy problems or complications, convulsion, Oedema, dysentery and epilepsy. Since the Igbo were not aware of the scientific history which brought the western system into being, it is not surprising that it took some time before they could appreciate the claims made for the system by the Christian medical missionaries.18

The economy of traditional bone setting practitioners has really engaged scholars. For example, Omeire in his study of the Iwueke Orthopadic family group revealed that where the state or National Orthopaedic Hospitals had billed about N150,000 without eventually achieving a cure, the Iweke healing home has never taken up to N20,000 and achieved the desired result. Despite the fact that the Iweke’s charge very low bills, yet most of their discharged patients have been found to be unable to pay their token bills.19

Nevertheless, traditional bone setting practitioners were also responsible family people catering for their needs as well. It appears that protocols involved in consulting a traditional bone attendant  are not numerous when compared to an orthodox orthopaedic medical personnel.

          In an interesting interview with Anosike Moses, a traditional bone attendant in Nike Enugu had this to say:

By the Grace of God You can see am surviving. I have three children all in the university in Enugu here and I have noting doing except this traditional bone practice. I don’t pay house rent to anybody rather people do to me.20

This assertion properly places our vision about examining the income of bone attendants as capable of satisfying their immediate needs.

          In this chapter, we have attempted to show the formation of Enugu as a colonial city. Furthermore, we examined the impact of colonialism in situating the economy of the traditional bone setting.

ENDNOTES

1.     Dan, O. Chukwu, “Coal and the Rise of the City of Enugu, 1909-2008” in Onwuka Njoku, and Obi Iwuagwu, (ed.), Topics in Igbo Economic History, Lagos, First Academic Publishers,p.80

2.     Chukwu, p. 81

3.     Chukwu, p. 81

4.     Chukwu, p. 77

5.     National Archives Enugu (NAE) Dr. P.E.H. Hair Report on Enugu, File No. ENLA-1/7/4 Enugu Township Report July, 1915.

6.     NAE “Dr. P.E.H hair Report on Enugu”

7.     Enugu, https://en.wikipedia.org/wiki/Enugu. Accessed 20  August 2016

8.     Chukwu,p.82

9.     Enugu, https://en.wikipedia.org

10.                        Enugu, https://en.wikipedia.org

11.                        J. Odoh, Supplement on Igbo-Eze South Local Government in Enugu Township: A Social Survey, Enugu, Prince of Peace Volunteers, 1996, p.66.

12.                        Oral interview with Paul Okeke, 65, Nike Enugu, 11 September 2016.

13.                        R. Schram, A History of the Nigerian Health Services, Ibadan, Ibadan University Press, 1971, p. 195.

14.                        Elizabeth Isichei, A History of the Igbo People, London, Macmillan, 1976, p. 225.

15.                        Isichei, p. 225.

16.                        The patient’s uncle who narrated their plight gave the patient’s name as Ogechi Okafor, NOHE, 24 years, 14 September 2016.

17.                        Oral interview with Eze Joy, Pedeatric Orthopaedic Nurse, NOHE, 38, 14 September 2016.

18.                        U.D Anyanwu, Christianity in Igbo and  Nigerian Society, Owerri, Uzopietro, p245

19.                        Nnamdi, E. Omeire, “Indigenous Orthopaedic Medicine: A Case Study of the Iwekes” In T.I. Okere and Levi Nkwocha ed. Harvesting and Sharing Indigenous knowledge in Africa, Owerri, Assumpta press, 2003, p. 214.

20.                        Oral Interview with Anosike Moses, Traditional Bone Practioner, 13 September 2016.