The Pharmaceutical Journal
Vol 271 No 7258 p93-94
19 July 2003

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Herbal practitioners and pharmacists in Ghana

By Peter J. Houghton, FRPharmS, and Abraham Y. Mensah

In this article, the authors describe a visit to Ghana and the interface between pharmacy and herbal practice in the country

Ghana is a comparatively small West African country but has some considerable influence in the wider world, not least in the realms of international pharmacy. Kofi Annan, secretary general of the United Nations, is Ghanaian, as are many people in the professions in the United Kingdom. In the world of pharmacy Oscar Bruce, president of the Pharmaceutical Society of Ghana, is the only vice-president of the International Pharmaceutical Federation from a developing country, and Ghanaian pharmacists enjoy a considerable reputation as scientists and practising pharmacists.

We obtained an International Research Development Award in Tropical Medicine from the Wellcome Trust for investigation into the wound-healing properties of some plants used in traditional medicine by the Ashantis, one of the largest ethnic groups in Ghana. Part of this grant enabled me (PJH) to visit the school of pharmacy at Kumasi in Ghana for the first time in over 25 years. Not surprisingly, many things had changed, but there were still the smiling faces and welcomes that were so attractive on my first visit, as well as, more specifically, the efforts to carry out and to move the subject of pharmacy forward in tune with wider international developments.

Driving along the roads, it was impossible to miss the multitude of signs advertising clinics and places where people could buy or be treated with herbal medicines. These had a much higher profile than a generation ago and I was intrigued to find out why this should be the case. I asked several groups in different places and affordability appeared to be the major factor. Although, due to aid from Cuba, "Western" medical facilities are not uncommon even outside the major towns, prices are too high for many of the local people. The general increased interest in complementary therapy worldwide has also affected Ghana and several practitioners of Chinese medicine were apparent on the streets of Accra, the capital city.

Degree course in herbal medicine

There are several aspects of herbal practice, as well as its interface with pharmacy, which we consider of interest to pharmacists in the UK. For example, the school of pharmacy recently started a degree course in herbal medicine. This is the first such course to be offered anywhere in West Africa and is in contrast to such courses in the UK, which have been started by professional herbalists rather than pharmacists. The members of the faculty of pharmacy have developed a positive collaboration with Ghanaian herbal practitioners and companies who market extracts of Ghanaian plants. A major aim of the degree is to give training in rational diagnosis as well as knowledge of the botanical, chemical and pharmacological characteristics of the local plants, which are so necessary for ensuring that the correct plant is given. The Ghana Herbal Pharmacopoeia has been produced as an aid in this direction. Although at present it gives little more than botanical and some chemical information, it is planned to include more details on features such as chromatographic and pharmacological information in future editions.

Staff in the pharmacy faculty also help those who wish to market herbal products with quality control and formulation and, most days, someone connected with the production of herbal medicinal products is to be found in the university, an admirable example of interface between a university and the community. The staff are also on the boards of various companies and research institutes that have an interest in the promotion of herbal medicines. Much more remains to be done, particularly on the analytical aspects, in testing for safety and in clinical studies to determine the value of the products on sale — but much the same can be said for the situation in the UK.

Some other academic centres are also addressing these issues and a King's PhD graduate Dr Alex Dodoo, in Korle Bu, the main university teaching hospital for Accra, is heading a research unit concerned with the safety of herbal medicines.

Local herbal practitioners

Of particular interest were the visits we made to herbal practitioners. This was real old-fashioned pharmacognosy, with piles of roots, barks and leaves waiting for extraction by heating in water or soaking with alcohol before being dispensed to patients. A variety of diseases which could be treated was often displayed, some of which could easily be identified under conventional categories but for others, eg, waist pains, it was not possible to find out if this would be due to hernia, kidney problems or back strain. Malaria, fever, infertility and problems of sexual potency were the conditions for which many came to be treated. An extract of a local plant Cryptolepis sanguinolenta, which is known as Ghana quinine, is extensively used for the treatment of malaria, and several commercial brands are marketed. A considerable amount of scientific study has been conducted on this species by various European research groups, and has given some support to the claims made, but good clinical trials are needed before it can be promoted as a serious alternative to conventional antimalarial treatment.

Packaged extracts sold in shops

As well as the local herbal practitioners, often trained through the transmission of knowledge through family members, there are shops and stalls selling packaged extracts, usually containing a mixture of plants. The quality of the packaging is generally good but claims are made on labels which would not be permitted in the UK. Some of these claims raise matters of serious concern, especially since they encompass the "cure" of diseases like HIV infection. The immediate symptoms may be reduced due to the herbal extract, giving the patient the impression that they are no longer HIV-positive and so he or she might resume sexual activities which could cause spread of the disease. HIV is not such a problem in Ghana as it is in some countries in Africa but extensive advertising of its dangers and the need for preventive measures show that the medical authorities are not complacent.

A special treat was a visit to the long-established clinic at Mampong-Akwapim in the hills north-west of Accra, which is a collaborative centre for the World Health Organization traditional medicines project. As well as treating patients, the centre also runs a laboratory that oversees the granting of rights to public sale of all herbal products sold commercially. Although standards of analysis are not as sophisticated as would be required in countries with better equipment and facilities, this is a positive aspect and takes the first steps in protecting the public from harmful or ineffective products.

Sustainability

The huge increase in use of local medicinal plants, coupled with deforestation and other losses of habitat, is a cause of concern to conservationists. Indeed, some of the herbalists whom we visited mentioned that some plants were much more difficult to obtain than previously. It was encouraging to see that several of them had realised the need for sustainability and were growing species of interest in their own gardens, but this is impractical for those species that are large rainforest trees. In the beautiful, but somewhat undervalued, botanical gardens at Aburi near Accra, there is a nursery that grows and supplies medicinal plants for herbalists, and similar projects are in existence in university agriculture departments.

We are convinced of the value of medicinal plants to complement more orthodox medicines and it has to be accepted that there is little alternative for many people in countries like Ghana. The academic pharmacists in Ghana are a good model of how scientific training can help provide products with some assurance of quality and safety. No one would deny that much more could be done, and needs to be done, before such products can be handled in the same way as scientifically proven medicines, but moves are being made in the right direction, slowed down more by lack of resources than a lack of willingness on the part of all concerned parties.

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