Durham E-Theses An Auto-Ethnographical Study of Integration of Kanuri Traditional Health Practices into the Borno State Health Care Stystem El-Yakub, Kaka How to cite: El-Yakub, Kaka (2009) An Auto-Ethnographical Study of Integration of Kanuri Traditional Health Practices into the Borno State Health Care Stystem, Durham theses, Durham University. Available at Durham E-Theses Online: http://etheses.dur.ac.uk/171/ Use policy The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that: • a full bibliographic reference is made to the original source • a link is made to the metadata record in Durham E-Theses • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders. Please consult the full Durham E-Theses policy for further details. Academic Support Oce, Durham University, University Oce, Old Elvet, Durham DH1 3HP e-mail: [email protected] Tel: +44 0191 334 6107 http://etheses.dur.ac.uk 2 AN AUTO-ETHNOGRAPHIC STUDY OF INTEGRATION OF KANURI TRADITIONAL HEALTH PRACTICES INTO THE BORNO STATE HEALTH CARE SYSTEM by Hajja Kaka El-Yakub a thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy School of Applied Social Sciences Durham University November 2009 Supervisors: Prof. David Byrne and Dr Andrew Russell Contents Declaration i Abstract ii Acknowledgements iii Dedication v Chapter One Introduction 1 Chapter Two Borno State and Kanuri Society: The Context of Social Change 27 Chapter Three Methods 51 Chapter Four The Formal Healthcare Delivery System in Nigeria and in Borno State 73 Chapter Five Traditional Healthcare in Borno State 97 Chapter Six Traditional and Biomedical Healthcare Practices in Their Social Context in Borno and Beyond 128 Chapter Seven Views of Biomedical Professionals on Some of the Kanuri Traditional Health Practices 159 Chapter Eight Views of Lay People and Traditional Practitioners on Some of the Kanuri Traditional Health Practices 178 Chapter Nine Conclusion and Recommendations 192 Appendix I Rites of Passage 202 Appendix II The Formal Organization of Healthcare in Borno State 215 Appendix III Interview Schedule/Questionnaire Design 221 Bibliography 224 DECLARATION The copyright of this thesis rests with the author. No quotation from it should be published in any format, including electronic and the Internet, without the author’s prior written consent. All information derived from this thesis must be acknowledged appropriately. Hajja Kaka El-Yakub i ABSTRACT AN AUTO-ETHNOGRAPHIC STUDY OF INTEGRATION OF KANURI TRADITIONAL HEALTH PRACTICES INTO THE BORNO STATE HEALTH CARE SYSTEM Hajja Kaka A. El-Yakub, November 2009 There are many forms of traditional health practices in Nigeria, many of which are at odds or conflict with orthodox western biomedical practices. Yet they are hightly patronized, especially by rural dwellers who make up about 80 percent of the country’s population. The objective of this thesis is to consider the traditional health practices of the Kanuri people of Borno, NE Nigeria, and the extent to which they may harm and endanger the lives of people especially mothers and children. The context of the study is the high rates of maternal and infant mortality in the state. I occupy a dual role as both an upholder of the traditions of the Kanuri people (including their health traditions) and a public health professional. The dissonance and paradox inherent in this dual role is illustrated with first- hand examples throughout the thesis. It gave me the motivation to undertake this piece of research with a view to reducing the rhetorical gap between theory and practice which pertains in the state in regard to integrating the two systems, the co-existence and integration of which is promoted by the health policy of the country as a whole. Formal ethnographic research was conducted during a five year period from 1999 to 2005. The philosophy of reflexivity was adopted, drawing on my earlier experiences in an auto-ethnographic manner. Data triangulation was employed due to the complex nature of the research. Focus group discussions, interviews and questionnaire administration were employed with different categories of research subjects – traditional and orthodox health workers, urban and rural mothers. The results show that western-trained health professionals in the state stand between their own culture, which is of course changing, and the global professional identities they have acquired through professional development and training. At the same time the traditional healers can no longer operate in a context separate from official western-based systems which co-exist with the traditional practices and are widely known to the general public in Borno. Historically, the systems have been in opposition. Now there is supposed to be collaboration and overlap. ii ACKNOWLEDGEMENTS I am indebeted to the Almighty Allah for making me what I am today, so also to my parents Ahmed and Habiba Khadi, especially to my mother who took the pains of staying with my children any time I travelled to England for the programme. She did not survive to see its completion. I must thank sincerely the Borno State government and Governor Dr Ali Modu Sheriff, and his wife Mrs Fatima Ali Sheriff, for giving me both moral and financial support that contributed greatly to the success of the programme. I acknowledge with gratitude my supervisors Professor David Byrne in the School of Applied Social Sciences and Dr Andrew Russell of the Department of Anthropology, both at Durham University, England. I have been inspired by their encouragement, giving of expert technical advice as well as showing keen interest towards the success of this ethnography. I am short of words to express my gratitude to both of them who, in spite of their tight schedules, were able to give me attention as desired. I acknowledge with thanks the concern of Sarah Dawson, without whose help the programme would not have taken off and matured. She assisted in no small way from the beginning until the maturation of the programme. Also in this category Mrs Yabawa Wobi highly deserves my appreciation as her assistance contributed to the maturation of the programme in a big way. My special acknowledgement goes to Professor B.A. Omotara (who is my mentor) whose encouragement motivated my academic pursuit to this level. I should be ungrateful if I did not acknowledge with gratitude M. Iargema Bukar who assisten in the collection and collation of the triangulated data and Baba Gana Allamin who assisted in the packaging. And to the following people who participated as respondents – Fati Alkali, M. Aja Zannah Yerima, M. Bukar, Dr Alphous, Dr Gajere, Mrs Ashe Barde, Hajja Kanumbu Kachalla, Bawa Gana Tijani, Ya Mali Baba Shehu, Zara Maaji, Baa Wanzama and others to numerous to mention and those who wishes to remain anonymous even at the point of acknowledgement. Lastly but by no means least are the members of my family, friends and well- wishhers who are too numerous to mention individually but include the following: iii My husband Alhaji Mohammed El-Yakub, my daughter Fatima, niece Fati, sons Yakub and Ahmed, Mustafa Shehu and Yafati my house help. Among my friends, the Bukar Wobis highly deserve my acknowledgement for their assistance at the beginning of the programme. I must thank Ms M.K. McCarthy whose encouragement gave me some sense of belonging in a faraway home. Her encouragement contributed in no small way in making the programme a success. I also thank with gratitude Yagan Jibrin my niece, whose concern has given me a sense of belonging in faraway England and to Fariba and family for the nice lunches at weekends in Durham that bridged my nostalgis for home and home foods. I thank the Honourable Commissioner of Health Dr. Asabe V. Bashir and all my Director colleagues in the Ministry of Health, Borno State, for the cooperation and understanding. I am sincerely grateful to Dr. Alhavi Bulama Mali Gubio without whose assistance and intervention the programme could have been a failure when he was the Permanent Secretary for Scholarships, and to Alhaji Maina Wadai the Secretary of Scholarships. And lastly but by no means the least to Dr Antia Bassy who took the pains of editing this thesis in spite of the tight schedules of his work. My PhD examiners, Dr. Dorothy Hannis and Dr. Gina Porter, commented on an earlier version and made inestimably useful suggestions for its improvement. Any errors and omissions remain my own. iv DEDICATION To my mother and father Hajja Habiba and M. Ahmed Khadi v CHAPTER ONE INTRODUCTION 1.0 INTRODUCTION Paradoxically I am in a situation of dialectics, not of materialism as Marx puts it, but rather a paradox of roles. My role as horn to the traditional royal family of the Mainin Kinandi of Borno comes with the expectation that I will preserve Kanuri culture. At the opposite end, the expectation that comes with my technical professional role as a highly trained Nurse, Midwife, Midwife tutor, Health and Social Worker, and Public and Health Administrator requires that I uphold proper biomedical standards. These simultaneous roles create a dilemma, given the opposition between the two. Sometimes I feel I am a deviant when I fail to get the two opposite ends to meet in the middle. Dialectics, whether of materialism or roles, is chaotic. What a paradox! The issue of the relationship between traditional health practices and bio-medical health care systems is one that is very relevant in Nigeria. The country has two systems of health care, namely, the western orthodox type that came with colonialism in 1900, and the traditional African type (which is as old as African tradition) that was well established before colonialism.