In contrast to the crowds outside the gates of the Central Hospital in Yaound茅, the wards inside seem disconcertingly quiet and serene. There is, of course, an explanation. It is not that Yaound茅鈥檚 population is remarkably healthy, but simply that most of the sick and the dying cannot afford to be here.
After a drive through the city with Jacob Ngu, a professor of medicine at the University of Yaound茅 I, who practises at the hospital, the reasons start to make sense. Cameroon鈥檚 economic slump and the policies imposed by the World Bank mean that people must now pay for treatments that were once free. No one, not even the desperately ill, is exempt. 鈥淚 used to pay for drugs for people who were unconscious, but my wages have been cut by two-thirds,鈥� says Ngu. He recounts the case of a mother unable to pay for emergency rehydration treatment for her child, who later died. 鈥淪he offered to give a pint of her own blood and her sandals. It鈥檚 pathetic.鈥�
This chaos, however, has placed one group of medical practitioners in great demand. With modern treatments beyond the financial reach of most, traditional healers with their array of herbal remedies are now medicine鈥檚 frontline. A simple X-ray, for example, will cost ten times as much as a consultation with a traditional healer and a herbal remedy. 鈥淎t least 80 per cent of people are dependent on plants for their treatment,鈥� says Christiana Mbi, a former director of the government-run Centre for Studies on Medicinal Plants in Yaound茅, who now runs a pharmacy in the shadow of the city鈥檚 football stadium.
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But this frontline is also riddled with mines. Vincent Titanji, who studies river blindness at the University of Buea, says that in the villages, where traditional medicine was always dominant and the healers are part of the fabric of local society, the system mostly works well. But in the city, spiralling demand has created tensions between the old guard and the less scrupulous newcomers for whom the collapse of Cameroon鈥檚 healthcare system represents a chance to make a fast buck. The streets are full of placards announcing a healer鈥檚 ability to treat a long list of diseases 鈥� often including AIDS and cancer.
But what about the genuine healers? Finding one who will reveal his secrets to an outsider is not easy. The office of Daniel Lantum seems a reasonable place to start. Lantum is a professor of public health at the University of Yaound茅 I, who styles himself as an intermediary between the worlds of modern and traditional medicine. Since the early 1980s, Lantum has been compiling a register of Cameroonian traditional healers. The project has scant funding, and is still far from complete, but Lantum estimates there must be at least 8000 healers in the country. Lantum describes this work with gusto, but becomes markedly less enthusiastic when asked to name some of the plants used, and whether any of the active ingredients have been isolated. 鈥淚鈥檓 not interested in chemistry,鈥� he says. 鈥淲e know very well the plants and the dosages that work.鈥� Peter Miachop, a healer collaborating with Lantum, is similarly uninformative. Lantum translates Miachop鈥檚 answer: 鈥淚f you want to know, you will have to come and be my apprentice.鈥�
Other healers will talk 鈥� at a price. A meeting with two, who describe Lantum as their 鈥渃oordinator鈥�, turns out to be a discussion of the terms under which they will talk. Saturday will be a good day to visit their clinics, in exchange for two large cockerels, or an equivalent sum in cash. It soon becomes obvious that an extended interview with this duo could result in an improbable-looking expenses claim.
But at last, a healer appears who will talk for nothing. Adam Fokounang (a.k.a. Papa Bamenda) explains why others are reticent. Many healers have been quizzed by biomedical researchers, both foreign and Cameroonian, about the plants they use, and most are convinced that these scientists have profited from their knowledge. Fokounang complains that he has received no compensation for the information. 鈥淲e have been so duped,鈥� he says. But there is no evidence that anyone has ever made a fortune on the back of the knowledge of the healers. And in any case, Fokounang鈥檚 displeasure with modern biomedical scientists is more than matched by his anger at some of the shady practitioners who claim to be traditional healers. 鈥淨uacks and charlatans,鈥� he fumes. 鈥淎 charlatan comes to you as a patient. He observes the substance you are giving. Tomorrow, he is giving the same substance for other diseases.鈥�
Fokounang is famed for his success in treating mental illness, an area in which traditional medicine has always been dominant. A survey in the early 1990s could identify only four psychiatrists in the whole country. Fokounang entered the field in 1972, after a dream in which he found himself treating insane patients. A practising Muslim, he was fasting for Ramadan at the time. In the dream, his father revealed a plant called Polyscias fulva, a member of the ivy family that forms the basis of one of Fokounang鈥檚 main remedies.
Until last year, Fokounang ran a residential clinic in the town of Foumban in Cameroon鈥檚 West Province. His results certainly sound spectacular: of the 60 patients on his books when he was forced to shut down the clinic because of an injury, Fokounang claims that 56 were well on the road to recovery. Today, Fokounang is running a smaller clinic in Yaound茅 while he convalesces. He lifts up his skullcap to reveal the reason for his reduced circumstances: a dented scalp scarred by a machete wound inflicted by one of his patients.
So what is his secret? The precise treatment varies according to the underlying cause of madness. But many patients, he claims, are driven insane by an imbalance in their bile secretions. In these cases, the first step is to purge their digestive systems with a powder ground from a liana plant called Lavigeria macrocarpa. Then Fokounang squirts a solution containing an extract of P. fulva up his patients鈥� noses. 鈥淚t washes the brain,鈥� says Fokounang. 鈥淚t promotes the nerves to reform.鈥� A relative of heather, Agauria salicifolia, is taken like snuff to induce sneezing. 鈥淚t is like connecting an electric switch,鈥� says Fokounang. 鈥淭his helps to stabilise the memory.鈥�
Whether Fokounang鈥檚 remedies have any real pharmacological effects is impossible to judge 鈥� nobody has ever conducted a controlled clinical trial of them. But what is certain is that he and other traditional healers are the only people in Cameroon making a serious attempt to help mentally ill patients. And a large part of Fokounang鈥檚 treatment can be described as psychotherapy. He sees this 鈥渂rain building鈥� as vital.
鈥淟iving with a patient as a psychiatric doctor, I have to take him as my child.鈥� This means rewarding appropriate behaviour and punishing misdemeanours: those who abscond are recaptured, beaten and fed with vomit-inducing potions. The goal is to reshape patients鈥� behaviour so that they can return to their former lives. Where that is not possible, says Fokounang, 鈥測ou plan a supporting job, either as a houseboy, a waiter, or a cook鈥�.
Some patients are brought to Fokounang by their families. Most, however, are picked up off the street. 鈥淚 go out in my car with my boys 鈥� those who are already well 鈥� and we arrest them,鈥� says Fokounang. This means that his psychiatric practice is run more as a public service than a profit-making business. 鈥淚 heal many other types of disease which give me money,鈥� he says. 鈥淚f I have money, I go out and fetch people.鈥�
Many biomedical researchers in Cameroon recognise that healers like Fokounang are providing a vital service that no one else can offer. 鈥淭he traditional healers have a definite place,鈥� says Titanji at Buea.
But the relationship between modern and traditional doctors is at best an uneasy one. 鈥淚鈥檓 very interested in traditional medicine,鈥� says Andr茅 Mbakop, a pathologist at Yaound茅鈥檚 Central Hospital. 鈥淚 just want it to be exploited scientifically.鈥�
Lantum and others think the Ministry of Public Health should accept that traditional medicine is the dominant form of healthcare in Cameroon, and regulate it. That option, however, seems a long way off: the government shows no willingness to wade into these murky waters. And the gulf between the traditional healers and the modern doctors remains as great as ever. It seems that the crowd outside the hospital will be taking their chances for the foreseeable future.
鈥� 鈥楧evelopment is big business. Development aid, including loads, probably dwarfs in scale many multinational industries or the Mafia.鈥� Mark Hobart, School of Oriental and African Studies, University of London
鈥� 鈥楾he frustrating thing is when people you鈥檝e been to college with in the US or Europe start coming to Cameroon as paid advisers. You went to school with them, you beat them in school. But now they鈥檙e coming here as experts. It鈥檚 quite baffling. You鈥檝e been able to hold your own internationally, but in your own country, you鈥檙e still not considered good enough.鈥� Yunkap Kwankam, University of Yaound茅 1
鈥� 鈥楾here are 20 million people infected with the parasite that causes river blindness. But they are all poor people 鈥� the equivalent of 20 Americans.鈥� Jacob Ngu, University of Yaound茅 1(see Graph)
