By Rukia Nabbanja

In the scorching heat of a sunny afternoon in Uganda’s Northern region, Arach Concy received an unexpected guest at her sacred sanctuary nestled under a magnificent mango tree in Layiibi, Gulu District. For fear of the negative stereotypes that are associated with consulting traditional healers in her community, the woman, Lamunu (pseudonym) asked to remain anonymous. 

Lamunu’s weariness was evident as she appeared visibly tired, her complexion pale with a subtle yellowish tinge, indicating potential signs of iron deficiency or anaemia.

Lamunu, now five months pregnant, has been anaemic all her life. In the past 18 weeks, her condition has worsened despite being consistent with her Fefol tablets (iron and folic acid capsule), which she obtained during her previous prenatal visit. She has come to Concy for her blood-retaining treatment.

“Lamunu’s mother brought her here and at the time, she was worse,” says Concy as she mixes a concoction of a rough powder and water for the patient.

Reluctantly, Lamunu drinks the mixture. She says she has experienced significant improvement since her last visit, with her charts now showing haemoglobin levels of 11g/dL, which is within the recommended concentration level during the first and third trimesters of pregnancy. Her mother, too, has consulted Concy, a traditional medicine woman for over three decades.

Concy then gives her a mixture of dried papaya and avocado leaves, hibiscus with herbs for bathing, and tea to aid her recovery and promote relaxation, citing benefits for both the mother and baby. Before bidding her farewell, Concy recommends that Lamunu undergo blood tests before her next visit.

Concy surrounded her home and shrine with herbal plants and trees, which she calls “emergency herbs” for a patient who needs urgent care for food poisoning, deep cuts, solid headaches and more. She attributes her knowledge to guidance from the spirits.

Previously, traditional healers travelled long distances to collect herbs and harvested them in bulk every time they went out. But in 2015, Concy was introduced to Wise Women Uganda, which supplied her with herbal tree seedlings and taught her how to extract medicines without endangering the trees. Concy now owns a two-acre farm of herbal and fruit tree species.

Arach Concy (left) and Juliet Adoch the Wise Women Director (right) standing under an eight-year-old Afzelia Africana tree, one of Concy’s medicinal trees from the Wise Women Uganda.

“We didn’t know that we were contributing to the problem. Herbs were hard to come by, so when we went to get them, we harvested them in bulk. In herbal medicine, every part is important, so we would uproot the whole plant,” says Concy.

‘Mon Ma Ryek,’ an Acholi word that means Wise Women, is the name given to the community-based organisation of women healers in Gulu, a district in Northern Uganda. Wise Women Uganda started in 2013 with only seven Traditional Medicine Practitioners (TMPs) and later grew to 150 comprising herbalists, bonesetters, psychic healers, traditional birth attendants, faith healers, diviners, and spiritualists. The women in the group use their indigenous knowledge as a catalyst for plant conservation and restoration.

For the last eight years, Herbalist women like Arach Concy under the leadership of Juliet Adoch the proprietor of Wise Women Uganda have been planting trees across eight districts in the Northern Region, ensuring that it remains a biodiverse habitat for an array of endangered tree species. 

The healers have specialised in planting indigenous tree species such as Afzelia Africana, Prunus Africana, Combretum Molle and Fragrans, Shea, Caya Afzelia, Mangifera Indica, Vertex Donania, Grewia Bicolor, Ghanaians Gardenia, Moringa Oleifera, Balinse Ejetica, Cassia Occidentalis, Violet Tree, Sausage Tree- Kigelia Africana, Imperialis and more.

The trees are crucial to the traditions, culture and health of Uganda’s Northern region. According to Adoch, trees are the resting place of the gods and the dead ancestors. 

“The gods and ancestors like warm and cool places and so they strive to restore them. In return, they help protect the region from natural disasters like floods and other calamities,” Adoch says.

Cultural traditions and community leadership are playing a critical role in boosting conservation efforts and increasing green cover in Uganda, which is losing forests at an alarming rate.

Dr George William Lubega, a senior research fellow at the National Agricultural Research Organization (NARO) in Uganda, highlights the importance of conserving and promoting the cultivation of indigenous trees in his research.

His research focused on identifying and conserving indigenous fruit trees by involving local communities in the processes, as they are often the custodians of traditional knowledge and use of the trees.

According to the World Health Organization (WHO), 88 per cent of countries are estimated to use traditional medicine, such as herbal medicines, acupuncture, yoga, indigenous therapies and others. With inequities in access to conventional medicine, it is still a mainstay for some.

The majority of the population in Uganda has greater access to traditional medicine than to Western health care. This is largely linked to many Ugandans living in rural areas, where modern medicine is inaccessible to communities. 

Traditional healers are an integral part of the local culture and are appreciated as key and sustainable sources of care and knowledge on disease and illness. 

According to a 2002 World Bank report on traditional medical practice in Uganda, there was at least one traditional healer for nearly every 290 people, compared to one medically trained health professional for every 10,000 people in urban areas and 50,000 people in rural areas respectively. More recent studies have not yet been conducted.

Re-growing seeds to aid reforestation

Northern Uganda, also known as the Acholi sub-region, has forest cover that ranges from dry to humid and is home to many animals and endangered tree species. These forests are culturally and spiritually valuable to the Acholi people.

But after 20 years of civil war, internal displacement and poverty, the return of nearly 1.8 million internally displaced people in the region has left large landscapes bare, obliterating many of the native tree covers.

In areas where forests, shrubs and bushes remain, charcoal burning, timber harvesting, agriculture, and Uganda’s increasing refugee populations caused by the wars in South Sudan, Ethiopia and other neighbouring countries, threaten the remaining native woodlands. 

The disappearance of these plants is detrimental to both the environment and its local ecology, as well as the well-being of the local population. 

Wise Women Uganda runs the largest native tree nursery in Uganda sitting on approximately seven acres of land. Since 2013, the traditional women herbalists under Mon Ma Ryek have worked with 1,476 communities in the Gulu district and the refugee settlement of Palorinya and the host communities in Moyo District, to disperse and replant endangered trees used in medicines and other works such as wood for gun making, food, home fencing and more. 

Originally consisting of seven individuals united by a shared purpose, the group embarked on an expansion initiative. Each of the original seven pioneering members undertook the task of training an addition of twelve women from different districts in tree conservation, and the cycle continues as each of the trainees is supposed to train more from where they come from.

Furthermore, they provide the women with seedlings and the necessary assistance to establish their own fruit and medicinal tree nurseries.

In Gulu alone, the organisation has worked with women in the Owoo, Unyama, Bungatira and Laliya sub-counties. 

“Last year alone, we trained 18 women in the Omoro district to replicate what we have here in the Wise Women’s Garden. Through their Village Savings, they acquired a two-acre piece of land to make a nursery bed to plant 1,800 tree seedlings,” Adoch says.

Ann Dokotho, a former participant in a native tree project and a resident of Bungatira, in Gulu District, has recently established a fruit nursery garden. The garden primarily consists of Mangifera indices, a mango species commonly found in various regions of northern Uganda. Dokotho occasionally sells the mango seedlings to buyers outside her local area. Over the past two years, she has also been distributing free seedlings to the residents as a way for trainees to contribute to the community and promote the conservation of native trees.

According to Dokotho, “There is a prevailing perception that mangoes are the primary export of Gulu. However, this may be due to the fact that it is now difficult to find a household in our communities without a mango tree. During the fruits season, we consume some of the mangoes and sell the remainder to generate income for our families and fulfil the needs of our children.”

During a recent interview, Dokotho further revealed that in the current year alone, she has distributed around 150 free Mangifera seedlings within the Bungatira community, specifically during their savings group meetings.

The TMP community also practices on-farm conservation, which involves the maintenance of traditional crops such as Boo (Amaranthus), Awaca (Searsia) and more, by farmers within traditional agricultural systems especially on a subsistence basis, to ensure the maintenance of ancient landraces (the plants that are sown and harvested) and those wild species dependent on traditional agriculture.

“Each season, the farmer keeps a proportion of harvested seed for re-growing, and seedlings may be exchanged locally between villages and communities,” Adoch explains.

At Adoch’s residence is a huge and rare species of Moringa Oliefera, with relatively bigger leaves and big dry pods that she breaks to collect the moringa beans. She winnows them while blowing out the white polythene-like residues in preparation for good seedlings that she can share with the locals. 

“This species is environmentally resistant and crucial to our communities during the dry season. The leaves shed off every two weeks; then new ones grow. People eat them as vegetables and the seeds are edible; all parts of it are highly nutritious,” she expounds. 

Under this model, the women transplant seedlings from the Wise Women Uganda seedbed to their gardens at zero cost for replanting under the native seed project. More than 900 women have been provided with seedlings from 2015-2021 with support and in partnership with Wild Forest and Fauna across the region, including those living in camps for the internally displaced.

Limitations to the work

While traditional healers restore the Northern Region forest cover, they are still associated with dark magic, and with sorcery and witchcraft. 

The majority – 82 percent – of the population in Uganda is Christian with 14 percent Muslim. Even though many of these people still appreciate herbal medicine, Adoch observes, most would rather buy it from vendors and not Traditional Medicine Practitioners due to their religious affiliations. This affects the income that the women’s groups can source to sustain their nurseries and farms.

Herbal trade is not yet as lucrative as the so-called ‘big pharma.’ For many women, transporting seedlings presents a challenge to them, because their farms are in distant locations and seedlings are obtained from a stretch of about 470 kilometres from Gulu to South Sudan, which costs between $45-$70 (UGX 165,000 -256,000).

According to Atube Martin, a herbalist and community member of Owoo village, despite the existence of the laws, people still cut down trees from his two-acre farm located 42 kilometres away from Gulu city, especially those planted along the roadside. 

“The appreciation for indigenous tree species on our farms is not universally shared among the locals,” says Martin.

Even as the trees are still growing, people see them as a waste of space or weeds that need to be used for firewood and charcoal burning and this threatens Martin’s efforts to restore the indigenous medicinal trees.

Improper harvesting and extraction methods among herbalists have been identified as major challenges, leading to significant wastage of herbs, according to Adoch. 

The herbalists interviewed for this story stated that low-income earnings among women contribute to the problem, as they are unable to afford the necessary machinery for better processing. The lack of access to proper grinders results in the wastage of medicinal plant parts such as roots, despite their importance in herbal medicine preparation, and community support and collaborations amongst the herbalists are encouraged until each one of them is able to own machinery.

Integrating traditional and modern medicine

Traditional and conventional medical practices are based on different principles. For conventional medical scientists, evidence that the medicine has undergone research and animal tests and has been proven to be effective before administering it to humans is important. But for traditional medical practitioners, knowledge is passed on from one generation to another through cultural beliefs and ancient practices, as in the case of Concy.

Some conventional medical practitioners recognize that for many Ugandans, traditional medicine is usually the first stop before they consider visiting conventional medical facilities.

“Many of our patients begin with kitchen remedies; they only run to our hospitals when their first treatment fails,” says Dr Beatrice Odongkara, a paediatrician and diabetologist at Gulu National Referral Hospital and proprietor of St. Veronica Clinic of integrated medicine in Gulu.

For a long time, there have been suspicions related to administering medicine, health competencies and work ethic among local healers, conventional medical doctors and scientists. 

“We are all contributing to improving the health of our communities; the challenge that we are lately trying to address is the mistrust between them [traditional healers] and us [doctors],” Dr Odongkara says.

According to Dr Boniface Adeka, a pharmacist and pharmacognosy (a study of medicines of crude drugs produced from natural sources such as plants, microbes, and animals) specialist at the Mulago Cancer Institute, herbal medicine use complicates their relationship with patients.

“Patients conceal prior use of herbal medicine from medical doctors who need to do clear analysis, diagnosis and prescriptions. They fear being judged and perhaps angering the doctor,” observes Adeka.

At least 25 percent of all modern medicines are derived, either directly or indirectly, from medicinal plants. Several drugs – including those used to treat grave ailments like cancers – to mild cases such as flu, are derived from plants. Scientists agree that the medicinal benefits of herbs are real, as has been in the case of the Arogyapacha herb, trichopus zeylanicus, which works as an aphrodisiac and treats liver disease, and stomach ulcers, among other ailments. 

Integration of both herbal and pharmaceutical medicinal knowledge has been appreciated with time, and according to Dr Adeka, “to integrate means to come to a common ground.”

In 2019, the Parliament of Uganda passed the Traditional and Complementary Medicines Act, which encourages the move to integrate traditional medicines into conventional practices. The Act “promotes collaboration and integration of traditional and complementary medicine with conventional medicine.”

Moreover, the strategies in place gear towards providing scientific evidence that the extracts from herbalists and TMK practitioners indeed have targeted medicinal elements.

Scientists are also pushing for this multidisciplinary approach to see that conventional practitioners have the skills to administer TMK. According to Dr. Adeka, Government policies are needed to ensure that conventional facilities like hospitals accept traditional medicine practices such as the use of herbal medication in some treatments such as in some cancers especially in the study of immunotherapy as a cancer treatment.

Interestingly, Adeka says they have proposed including TMK in the studies like they do in Pharmacognosy to prepare a safe ground for both the doctors and patients. 

“We have got to do laboratory work and see that it works,” Adeka says.

In practice, according to Dr Adeka, modern medicine is playing its part in conserving medicinal plants through gene preservation methods like biotechnology. Biotechnology involves extracting the genes of the plant and preserving them in a laboratory through a process known as cryopreservation, which can keep the genes viable for many years and allow them to be multiplied. 

Adoch and her team are keeping up with modern medicine under the regulatory watch of Natural Medicine Society of Uganda, under the leadership of Professor Patrick Ogwang. They use light and improved packaging to make sure the syrups, powders, capsules, and other types of medicine are safe and effective.

Working with conventional doctors like Dr Odongkara has also helped the Wise Women Uganda healers understand that unmonitored herbal medication can be toxic for humans.

“We have emphasised that herbal medicine can be dangerous; some of the plants are toxic and can be harmful to the body organs when administered poorly,” says Dr Odongkara at St Veronica Clinic, a centre for integrated medicine in Gulu.

The ongoing relationship between traditional healers in Gulu and Dr Odongkara, an advocate for integrated medicine, has improved the healers’ interaction with the plant biodiversity. Adoch says she carefully extracts the bark and other materials for her medicines while preserving the tree and its roots, giving it a chance to regrow and perhaps multiply compared to uprooting it. She has taught this strategy to other herbalists, who have found the method a more sustainable way of keeping their medicinal supply constant and convenient.

Government’s role in the conservation of medicinal plant biodiversity

Trees like shea nut, Afzelia Africana and many others are only found in the Northern and West Nile regions of Uganda. In 2018, the Government of Uganda through the Ministry of Water and Environment suspended any cutting, transportation and sale of these endangered tree species and their products in alignment with the National Forestry and Tree Planting Act of 2003.

The natives of Gulu say that every chiefdom decreed that for every native tree that one cuts down – most especially the endangered species- a cow or its equivalent of UGX 3.5 million ($1,000) is paid by the perpetrator irrespective of the size of the tree. 

Cultural leaders further put stringent rules on other perennial tree species in the district that are considered endangered and barred from being destroyed. They include tamarind, wild plum trees, mango trees, black plum, hard cedar mahogany, sausage tree –Kigelia Africana, and Afzelia Africana, commonly known as “Afzelia” or “Beyo,” among others.

These conservation laws have helped Wise Women Uganda replant and distribute seedlings all over the Gulu district and the neighbouring regions. 

As some other groups in Uganda exploit tree species for their timber and charcoal, the Wise Women Uganda sees the medicinal value. They regrow the trees to provide a resting space for their gods and protection from disasters such as heat waves, floods, wildfires and thunderstorms.

Although their practices are unconventional, culturally, the women believe they can fight against climate change and restore biodiversity the way they were taught by their predecessors.

 “We didn’t choose this; the spirits chose us, and we have to respect the spirits, plant the trees, give them a place to rest and when you do that, you won’t see any of those disasters that you see happening because of climate change,” Adoch concludes.

This story was produced with support from the Internews Earth Journalism Network, with editorial support from InfoNile.