The Role of God/Allah
All the participants articulated that their health and well-being are under the direct control of the will of the almighty God/Allah. Many rituals appealed directly to the power of God/Allah and interestingly were celebrated by the entire community regardless of their religious affiliations (Christian or Muslim). The use of amulets, tsebel/holy water/and other religious symbols was widespread by participants, and use of symbols commonly had little to do with stated religious affinity and more to do with honoring God/Allah in a general sense.
Almost all of the interviewees made a specific point of thanking God/Allah for their health and well-being throughout the interviews. For example, Fatima, a 56-year-old participant, said:
Many thanks to Allah! I believe in “Allah” and I would pray to Him all day and all night to make our country peaceful and rich, and me and my family healthy … It’s according to Allah, you might be Christian and may not be the same as my beliefs but there is only one Allah, so if He wants you to stay healthy, you stay healthy. So far I have not gone to modern medicine, with the help of Allah I’m healthy, He is my police, my Law, my justice and my court He is everything for me and I can’t say this heals and this doesn’t because everything is in His hands.
This faith was articulated even in situations where it was evident from the physical appearance of the discussants that they were not doing very well. A similar finding was reported in a study of New York City’s Muslim community which highlighted the belief that health was bestowed by God/Allah (Abu-Ras et al.
2008).
People within the study communities widely believe that by observing the laws recommended by God/Allah, every individual could protect himself/herself from possible misfortune. Irreverence to God or Allah is believed across religions and belief systems to cause illnesses, absence of peace and lack of food.
An interesting feature of the study community was that most people celebrated religious ceremonies and followed traditions designed to honor God/Allah that were not based in their stated religions. When the issue of ill-health is raised, there were no religious barriers to seeking healing and prevention from a wide range of religious sources. For example, during our field visit on March, 20, 2014, we observed the “Tsadiku”/lit. The saint/festivities. We were invited to one of the villagers’ homes, and the head of the household, 59-year-old Mohammed, explained: “there are beliefs shared by both Christians and Muslims. For example, ‘tsadiku’ is celebrated by both the Christians and Muslims although this saint is actually a Christian saint. There are people that get cured by the ‘tsadiku’. That is their belief. We don’t work on that day.”
Many other participants confirmed this widespread example of “borrowing” beliefs, traditions and rituals from a wide range of religions:
We are Muslims, but my husband doesn’t work on St. George’s day (he doesn’t even cut grass for cattle) [Worke, Female, 60)
In our village, there are Muslims who celebrate tsadeku (on March 20th) and teklehaimanot (on the 24th) every year. We make tela and bukre [local drinks], we bake injera [flat bread] and bread. Thus we have these kinds of traditions that are not just for Christians or Muslims, but for both [Mufti, Male, 65).
Alvarez, the writer in the early sixteenth century, indicated that there was a good relationship between the Christian and Islamic communities in
Wollo. He was likely referring to the area near present-day
Tehuledere, in the region previously known as
Ambassel. His writings describe how those living in the area celebrated all Muslim and Orthodox Christianity religion rituals thought to enhance health, regardless from which religion they belong (Alvarez
1961). This cross-religious relationship appears to have been maintained in the contemporary
Tehuledere community (Hussien
2001).
During our observation, it was noted that amulets and other symbols (bottle of holy water, religious or prayer books or a cross) from a wide range of religious influences were used for protection from a very diverse range of illnesses. They were believed to ward off illnesses ranging from those supposedly caused by spirits to physical ailments including infections. The belief in the prophylactic and curative power of amulets was very strong. One such example was the cross (traditionally a Christian symbol), which was found widely used within the study population for the healing and prevention of ailments and social health problems, despite the fact that most did not identify as Christians. For instance, we observed Muslim women in
Tehuledere who adorned themselves with cross-shaped necklaces or tattoos which seem to have no religious connotation to them. Similarly, Assefa (
2015) reported that the Cross was generally considered as an amulet and talisman par excellence in Ethiopia.
Tsebel or holy water is also found to be one of the most popular healing systems in the study area. Again, although technically based in a Christian belief system, use of holy water was widespread among the entire community.
….. So the holy water heals everyone who uses it. In the eyes of God everyone is equal. Because of our differences in our beliefs, language, and so on, we call ourselves Muslims or Christians. But God did not create us separately. We conspired to bring too many religions. … Because the holy water is given from God, it heals Muslims and the Christians alike. God sees every one with one eye, he does not say black, white, red, bent, straight, tall, short [Priest Admasu, Male, 69].
In our field visit, we observed two, very different, holy water sites: Bededo and St. Stephen. The Bededo holy water healing site is situated at the extreme southwest part of Haiq Town. It encompasses two separate springs. The first spring is slightly modified whereby a wall was constructed with two hollow tubes for the holy water to pour down. There is a small wall dividing the space for males and females. Here, the females are more protected by the wall while washing their bodies with the holy water, whereas the males are exposed to the sight of any passerby or observer. People, with different health problems, take off their clothes and sit under the flush of water coming down from the pipes channeling water from the spring.
Ahmed, 59, who brought his sickly wife to Bededo holy water site, said that such health problems as itching, swelling of legs and other body parts, headache and Jinn attack are resolved through the application of this holy water. Similarly, Kedir, 45-year-old who lives in Haiq, said: “Washing with this holy water means securing health.” According to Ahmed, both Muslims and Christians come from the various regions of Ethiopia and use Bededo holy water, and they claim that they are cured from their illnesses. As the water hits the holy water users, one can hear a lot of screaming. According to Ahmed, this is an indication of the fact that the evil spirits or any other disease-causing agents are going away, and the individuals are getting relief and refreshment. There is no specific or group to supervise or control the holy water site or to explain the healing procedures. People use the holy water turn-by turn based on mutual understanding and respect for others.
The healing practices of
St. Stephen were quite different from that of
Bededo. The holy water is in the compound of St. Stephen Church which is located at the island of Lake Haiq. We observed two categories of clients who needed the holy water healing service at St. Stephen Church: the first category consisted of those people who had minor health problems and who entered the “healing room” by themselves; the second category comprised of those people who had serious or major illnesses and were carried in by relatives and/or friends into the room and then held by force under the flush of the holy water. In both cases, the holy water healer utters words both in Amharic and
Ge’
ez1 languages, while repeatedly touching the head of the sick with a wooden cross. In the case of the very sick clients, the healer applies both the holy water and the symbolic blow with the holy cross more intensively, and he shouts a lot so that the Satan,
Jinn or Buda possessing the sick would be gone. The holy water healer asked the disease-causing agent whether it was a Satan,
Jinn,
or Buda, and “it replies to his question.” Increasing the intensity, the blow with holy water and the cross, the priest warned the disease-causing agent to dispossess the sick person and disappear. Finally, “the spirit declares that the sick person is free.”
According to one informant, both Christians and Muslims come to the St. Stephen holy water ritual despite the fact that this is technically Christian-based holy water and it is a Christian priest who serves a lead role in the healing practice. Last year, more than 600 patients (Christians and Muslims) were registered in the archive of the church; their religions, places of residence, and their illnesses had been recorded. But according to the deacon, about 10,000 people received the St. Stephen holy water healing services (within a 2-year period, i.e., 2012 and 2013), and they were able to resolve their health problems.
During our field observations, we learnt that health extension workers recognize religious practices such as holy water as helpful in healing Satan, Jinn or Buda. In view of such recognition, health extension workers provided religious cleric healers with training on environmental hygiene and medical supplies such as examination gloves. Religious cleric healers on the other hand assist health extension workers to mobilize community members on various community-based health activities including campaigns for vaccinations.
Human and Nature Spirit Agents: “Woliy,” “Wadaja” and Healing
In addition to participating in religious rituals from a range of religions, deeply entrenched beliefs in the supernatural world impacted participants’ beliefs about health and illness, regardless of their professed religion. The “evil eye” of the Buda person was a very powerful and widespread example of this. Another example was the Wadaja, which is a group ritual ceremony carried out in many houses of Muslim and Christian community members, whereby a person or group with health or any other problems is helped through prayers and songs.
According to many focus groups participants, belief in the
Buda person, someone who has the power of the ‘evil eye’ and cause illnesses was very common. Buda-caused illnesses were thought to be diagnosed and cured both by indigenous methods often led by
Woliy.2 Christianity and Islam could not disentangle themselves from these highly entrenched ancient beliefs, and thus, rituals spanning both religious traditions, and beyond, have evolved within the study communities to protect against and treat illnesses caused by these forces.
Human agents, such as the
Woliy, managed some ailments in the study community, perhaps most commonly the
Buda or Ede Tibebat or Evil eye attack. Regarding Buda management, one male participant stated:
The people that mostly do this are the ones that know ‘kitab’ (Islamic Holy scriptures). They break the egg on the head of patient and read the Asma’aa (Islamic scripture magic). Let alone a child, even an adult with an evil spirit (buda yebelaw) gets cured with this [Ali, male, 62].
Despite the fact that the Woliy are not recognized as part of any specific religious establishment in the doctrine, the Woliy incorporate reciting Islamic Holy Scriptures in front of people as part of their traditional approach to effect healing.
Many
qolle or
quteb, nature spirits,
3 acknowledged in the study community, were believed to exact tributes in return for physical and emotional security and to deal out punishments for failure to recognize them. Similar to the evil eye, venerating
qolle or quteb,
wuqabi,
awlia, zar and
jinn spirits were not considered part of either Christian or Islamic religious practices. According to Christian and Muslim teachings, all the supposedly spirit-afflicted illnesses should belong to the family of the Devil. But the Christians and Muslims in the study communities turned to these ancient animistic beliefs without being concerned that I did not appear to fit with their dominant faith.
The idea that the “Wadaja” could ward off illnesses and restore health seems to have been the major reason for the persistence and popularity of the ritual among the local population. The Wadaja seemed compulsory when a community was affected with communicable diseases (human or animal) and natural calamities such as drought, heavy rain and locust invasion. The ritual was also used for healing purposes when, for example, the family of the sick would summon Wadaja experts to conduct a healing session to free the sick from physical or sociopsychological illness and help the patient regain his/her health.
Ahmed, a 55-year-old male participant, had to say:
They [wadajas] say “let’s pray (du’a) with this color of sheep, with this color of goat [to be sacrificed], with this tree, at a particular place”…. if a disease comes, a lot of its bela (bad things) would vanish due to these prayers. God through nature spirit like qolle and qutib would come for us and give us rahemet (economical blessing). Through these prayers [wadaja or dua]) on the said place, with the sacrifices of the said sheep or goat, and the rains come…
In all but one of the focus group, participants noted that the health centers had difficulty assisting with spirit-related ailments like:
qolle or quteb,
wuqabi,
mewokel,
zar,
buda and jinn, and that people preferred to visit the cleric healers for this. A participant explained:
If it is jinn /mafatet’, it is believed that the doctor can not cure it thus we take him to the holy water or wadaja will be called. Then the jinn will ‘shout’ and say “I am out” [Kemal, Male, 55]
Another participant added:
There are times when ‘modern’ medicine cannot cure the disease properly. Injections and surgery do not take out the root of the problem. For example, in case a person gets ‘Ebidet’ (madness or Emotional problem) [Kedir, Male, 52]
At times, modern medicine is undermined by the participants’ beliefs. For example, some participants described how they believed some symptoms were wrongly associated with organ failure by the biomedical health workers in the health centers. A male participant said:
What is common in our area is Jinn; but when we go to health centers, they call the condition kidney failure looking at the swell of the victim’s body. We, however, believe that the devil caused the swelling [Kedir, male, 59].
Continuing the description of Jinn attack and its management strategies, Kedir noted,
The major symptom for Jinn attack is swelling. Another thing is that it could lead to a mental illness, making the patient speak out loud. The indigenous treatment is ‘Wadaja’. When you do Wadaja there are things you call out for. The leader of the ritual, usually a sheik, says words from holly Islamic scriptures and calls for the spirit to leave the victim. After that there will be applause …If it is Jinn, the victim sees it in a dream as a human and a monster. At that time, you can see the victim’s body shake. In our culture, there are things you should say in these situations; you say ‘Be’ Muslim’ (In the name of Islam) and sing ‘yaheya keyo’/ritual sing/. Then it will leave the body through the door and scream outside the house. But if it’s not Jinn, the patient won’t be able to see anything so he will be taken to the hospital.
These spiritual beliefs may also contribute to reasons why a patient might avoid using biomedical interventions. For example, some believed that diseases caused by the action of certain spirits like Jinn might be made worse by medication injection. This was because the needle could hurt the disease-causing spirit, causing it to endanger the life of the patient by making him or her unresponsive to other therapeutic or exorcizing procedures. Similar to our findings, Dein et al. (
2008) found that the belief in
Jinn possession was associated with symptoms of mental illness among East London Bangladeshi community particularly when encountering unexplained physical side effects.
The widespread nature of these beliefs and the impact they may have on health-seeking behavior and adherence to biomedical treatments suggests that primary healthcare health service interventions need to incorporate a full understanding of the indigenous beliefs of the community. Biomedical clinicians may need to work closely with religious figures and other indigenous healers, especially when working to support patients with mental illness. Religious clergy may be the first-line emotional healthcare suppliers, especially in areas with active and rich indigenous cures for mental health conditions exist. Rather than ignore or denigrate these traditions, it may be much more effective to identify ways these clergy healers can work with mental health workers to help fulfill the health and spiritual needs of the patient (Osman et al.
2005; Al-Habeeb
2003; Cinnirella and Loewenthal
1999).
Further research should explore the prevalence of mental health issues in individuals who ascribe mental health challenges to suffering by Jinn, qolle or quteb, wuqabi, mewokel, zar and buda specifically among the individuals who look for treatment from faith healers. Creating ways to work synergistically with religious figures and other nature spirit reverence merits further consideration, specifically in connection to distinguishing models of good primary care practice.
Practical Implications
Biomedical service providers in the
Tehuledere communities will only be effective if they can earn the trust of the community which involves developing strong relationships with both the patients and the traditional healers within the community. Some study participants bemoaned that biomedical providers sometimes did not meet their religious and cultural needs, and voiced worries about their distant interaction style. Such inadequacies in the patient–provider relationship have important ramifications for healthcare utilization and medical services quality. Patient–provider interaction challenges resulting from lack of understanding of patients’ beliefs and values have been found to lead to a poorer quality of care in general including delays in seeking biomedical care, lack of full disclosure of symptoms and concurrent therapies and decreased adherence to treatments (Lee and Lin
2008; Williams and Mohammed
2009). Basic understanding of the culture traditions of the indigenous people, and where possible accommodating and/or integrating care by including indigenous clergy healers in care plans, appears necessary to implementing successful primary care services in the study communities (Chao et al.
2008).
One way to provide a bridge between the religious cleric healers and modern healthcare providers appears to be the health extension workers. Among the roles of health extension workers facilitating integration of the beneficial aspects of religious and spiritual practices and modern healthcare resources is critical for improved health of the local community and optimal use of limited resources in the primary care. It was found that this cooperation of health extension workers, religious cleric healers and modern healthcare practitioners was working well in Tehuledere communities.
Our findings suggest that there is a need to improve cultural sensitivity within the biomedical healthcare providers serving the study communities. By understanding the significant actors in health care in these communities for example, God/Allah,
Tsadiqu,
Tsebel clergy,
Woliy,
Qallicha, we distinguish points of indigenous medicinal services that can be harnessed to improve the well-being of people in the study communities. Given the God-driven perspective of health and healing within this cultural setting, working together with these caregivers can help to spread positive healthcare services messages in ways that are congruent with the religious and spiritual system. Other studies propose that imams and mosques can enhance well-being in a range of different way. For instance, training of imams about tuberculosis brought about mosque sermons prompting expanded location and treatment in Bangladesh (Rifat et al.
2008). In Afghanistan, similar interventions with imams helped to decrease maternal death rates (Mason
2010).
The current Ethiopian indigenous health strategy (the National health strategies with regard to Indigenous Solution reported in March 2015) recognizes the importance of advancing of the useful parts of indigenous medicine including related enquiry and specialized backing. The end goal is to amplify the advantages of indigenous medicine, build new biomedical practices on the foundation of religious and spiritual healing practices. In order for this to be successful, the plans for implementing new essential medicinal services need to be re-evaluated to ensure they fit with the beliefs, needs and interests of the local people (FMOH
2015).