Official ambivalence

Traditional medicine is a system of beliefs derived from an accepted theory of cosmology, and which prescribes the best methods of managing health. Healers are the caretakers of this system, and the repository of its knowledge. In recent years, this system has faced the rivalry of the powerful biomedical establishment with its arsenal of institutions, regulations, and supporting laws, backed up by a new set of organizations, new precepts and an intolerant and powerful authority. This rival system has asserted itself and enforced its practices through institutions that are regularly funded. The traditional system, on the other hand, has suffered neglect, contempt, and, frequently, outright hostility. When its presence was acknowledged, the system was described as one of superstitions, charlatanry or quackery. This system is forced to exist outside the mainstream of biomedicine, and it is sometimes actively opposed by legislation.

Traditional medicine is a present-day reality; it is practised by a major sector of the community. If some of its recipes have been found useful, one would have expected that this would be officially acknowledged, and practitioners trained, licensed, registered, and their activities recognized[1] and made lawful.[2] None of this has happened so far.

Healers’ approaches

	Sustained by the encouragement of continuing popular demand, and strengthened by mutual support, traditional healers tried different approaches. Some asserted their presence and tried to snatch recognition and legitimacy by forging an organization that was officially and socially accepted. The official system either responded with hostility, or remained silent or indifferent. As in many African countries, healers in the Sudan did not opt to form organizations, and the only one formed recently should be closely studied. Bannerman et al noted some of the important reasons for the difficulty of organizing national healers’ associations in most African countries:
	1.        In pre-colonial times there were no national states as we know today but ethnic entities, and indigenous healers therefore grouped themselves along ethnic geographical lines, into district and local level associations.
	2.        There were various healing sub-systems, each one forming one occupational group.
	3.        Language difficulties hindered the formation of any umbrella national organization.
	4.        Distance was another factor which made it difficult for indigenous healers to form one body, and thus only those healers within a certain geographical ethnic area were able to form occupation groupings.[3]

Wad Hulla case

	One example illustrating the difficulties involved, is that of Wad Hulla, a notable zar practitioner. Wad Hulla adopted several approaches to bring about the legalization of zar practice, because of the obstacles he, as well as other practitioners, found standing in the way. Like all zar practitioners, he was harassed by Muslim fundamentalist groups and by Ansar Al-Sunna Al-Muhammadiyya (the followers of the Prophet Muhammad’s deeds and sayings). These groups saw, in practices such as zar, a clear divergence from the straight path of orthodox Islam, and were convinced that it was incumbent on them to fight these deviations as being munkar (abominations), and bid’as (novelties). He announced on several occasions that he was particularly careful to see that his practice was godly and law-abiding. He did not allow alcohol or blood to be drunk in his zar ceremonies. He went even further; he modernized the music of zar by introducing brass instruments. Then he organized a society, of which he became the president, and, instead of holding ceremonies at the clients’ houses, made his enormous house a centre for zar public performance. Unlike many zar practitioners, Wad Hulla takes an interest in and, indeed, welcomes being interviewed by the media and researchers, and would always take the initiative of inviting his zar ensemble and followers to take part.
	He befriended almost all the personalities whom he thought would support his practice.[4] Sometimes he would ask earnestly for a certificate of good-standing or one that stated that he was cooperative and helpful to researchers.[5] The drawing room in his mansion-house in Kalakla Sanqa’at is full of framed paper testimonials from psychiatrists, researchers in traditional medicine, Ministry of Health officials, etc.
	Wad Hulla is an imaginative man, and he and his group are making an impression on women of Khartoum and other major cities. What is more important, he is taking zar out of its traditional environment and into newer spheres. The year 1987 witnessed his campaign to establish a society under which zar practitioners could pursue their activities free from harassment, one that ensured social and official sanction, and that provided protection against litigation.
	In Port Sudan, where his fellowship is large and particularly intimate, Wad Hulla started a quiet campaign to found The Society of Zar and Folklore Shaikhs. Television actress and a graduate of the Institute of Music and Drama, Khartoum, Ni’mat Hammad joined him and led the campaign of enlisting the minimum number of persons required to register a new society. She accompanied him in 1987 and 1988 in all his zar tours and interviews, obviously acting as his public relations officer.
	The society was registered on 27 October 1987 at the Office of the Registrar of Societies, Department of Social Affairs, under a registration certificate number 253. Wad Hulla was the founding president and Ni’mat Hammad was his deputy. This development was both important and interesting.
	Researchers read this innovative step in different ways. Professor Sayyid Hamid Hureiz, a renowned scholar and folklorist, was quick to sense the new trend. He saw the bylaws of the society as important sociological data providing information about the nature and contemporary state of zar. Moreover, it contains a clear vision of how zar shaikhs (or at least those who have joined the association) see themselves and how they are seen by others. Professor Hureiz went through the society’s bylaws and reported on them in the International Symposium on the Spiritual Dimension of Traditional African Medicine held in Khartoum in 11-13 January 1988. [6]
	The list of members included in the founding document contains 64 names; 40 males and 24 females. The executive committee of the association consists of 19 members, about two-thirds of whom are males. The president of this committee is the notable zar practitioner Shaikh Muhammad Wad Hulla and his deputy is a woman, whereas the secretary of the committee is a university student at Cairo University, Khartoum branch. Members of the association come from different professional backgrounds, e.g., drivers, housewives, clerks, carpenters, students, businessmen, etc.
	Two of the six objectives of the association lay stress on entertainment and the release of tension through music, acting and singing (article 11: Objectives 3 and 5). The Society of Zar and Folklore Shaikhs sought affiliation to the National Council for Arts and Letters. Of notable significance, however, is that the council granted the Association affiliation in accordance with article (b) of the council’s constitution of 1976: ‘The promotion of theatrical activities, music and folk arts’. It is, thus, legitimate to conclude that the zar shaikhs referred to above considered themselves, and were considered by the official authorities at the council, as an artistic dramatic society.
	Article 3: membership of the Association is also relevant. It specifies that any person who is 18 years old or above may join the Association, provided that he [or she] applies for membership while fully aware of the Association’s objectives, and that the application should be endorsed by two members.
	Professor Hureiz clearly saw the new divergence in the approach and practice of zar as far as this group is concerned. He concluded that, compared with the Wad Hulla group, traditional zar groups in the Sudan are closed societies, almost like secret societies. Members of such groups are zar practitioners and patients. All of them are fellow sufferers, and if a single individual is the focus of a zar ritual performance, other members will act as auxiliary egos. It is important that the individual seeking treatment behaves as a patient among patients. This is rather different from what we see in Shaikh Muhammad Wad Hulla’s Association. Its founders are evidently also seeking respectability in the modern idiom of drama and psychodrama.[7]

The orthodoxy

	Traditional medicine has been looked upon suspiciously and some of its practices criticized by the ruling authorities since the time of the Mahdi, who described as sacrilegious and banned several social activities including healing practices. The Mahdi, and later several other preachers, invoked religious reasons to condemn and outlaw certain healing activities. In addition, the Ansar Al-Sunna alluded to earlier, were particularly intolerant of many forms of traditional medicine and preached strongly against them, frequently following violent words with violent action.
	Several men of religion also contributed to the campaign against certain healing practices. Al-Zubair Abd Al-Mahmoud wrote Irshad Al-Badawi lil Din Al-Nabawi in 1392 A.H.[8] The book started with basic instructions on the Islamic faith directed mainly at illiterate nomad and rural communities. Later in the book, the author identified the practices that people commit out of ignorance, which, he argued, were against orthodox Islam. He first defined a wali (holy man), and denounced people’s conviction that the offspring of this man should be thought of as infallible, and entitled by right of birth to commit mistakes even if against Islamic teaching. He gave himself as an example of a person who accepted and indulged early in life in many unorthodox practices on this pretext, until he repented, and God accepted his return, he said. The practices he condemned included: beliefs in the powers of holy men granting children to infertile women, the rituals of mushahara (pregnancy taboos), nadr (conditional vow) to a holy man, facial scarring, zar, certain food taboos—especially the Marghomab tribe’s custom of eating animals’ hearts, naming children with slave names and inflicting un-recognized pattern of facial scars to elude evil spirits (a practice frequently resorted to by women whose children die young), shaving the child’s head at a holy man’s shrine, belief in good and bad omens, beliefs in auspicious days, birds or animals and astrology. He also denounced all divination practices except istikhara (God’s invocation) as described by the Prophet Muhammad.
	Al-Munqiz min Al-Mahalik (undated) is a small booklet containing the Tiganiyya Sufi order’s views on various popular traditional practices.[9] The author of this work, Muhammad Al-Tahir ibn Yusuf Al-Tigani, denounced the magical practices resorted to by faqirs and fakis. He also condemned all divination procedures and beliefs in auspicious days. He supported his argument with reference to the works of several Muslim scholars including Muhi Al-Din Ibn Al-Arabi, Al-Futuhat Al-Makkiya, Al-Arabi Ibn Al-Sayyih, Bughiat Al-Mustafid, Abd Al-Wahab Al-Sha’rani, Al-Anwar Al-Ghudsiya, and Al-Nazhifi Al-Tigani, Mawahib Al-Latif later, critics of a different type appeared: expatriate colonial officers and anthropologists studying the local practices that might have some political potential, and those interested in animist customs from a Christian viewpoint. Some closed societies for the practice of magic were described early this century among some tribes in southern Sudan. The most important were the Mani, Bili, and Bir societies in Zandeland, and the Yielde in the Banda country which is an exclusively women’s organization.

The secret societies

	A Mani is a typical closed society reported from the Yei River district, the Tumbura in Bahr Al-Ghazal and the Belgian Congo;[10] these Mani societies are spread all over but are chiefly found in the Azande district, Evans-Pritchard thought that these organizations are most probably foreign in origin, and that (at the time of the report) they were not incorporated into Zande social organization, and were regarded as underground subversive movements. Its membership must have numbered thousands; it certainly included people of all ages, except the elderly and the very young. A Mani is a society of commoners in which authority is derived from the medicines that are unique to each society, and which have the attributes of good Magic.
	Some magicians in southern Sudan have set up their own secret societies. Harm or even death by magic agencies and medicines or poisons is alleged to befall those who do not obey their orders, comply with their rules, or who betray their secrets. These societies are not all healing in function. Some of them harbour fugitives and impostors to the extent that they have become a source of growing concern and complaint to their fellow witch doctors, Christian Missionaries, administrators and Sultans.
	A Bir or Bili is a typical society of this type that prevailed in the Yambio, Meridi and Tumbura districts. The votaries of these societies were skilled in the preparation of poisons which they used for criminal purposes. Police raids on their premises often discovered large quantities of hashish. Bir was also rampant in Belgian Congo among the Azande. The chief of this cult is supposed to have been able to cause and cure diseases, ensure good crops or cause them to be destroyed by elephants and to kill people by means of lightening, etc.[11]
	Father J. Zugnoni, a Christian missionary of Deim Zubeir Mission, described the Yielde society among the Gbaya, Aja and Banda tribes of the western district of Equatoria, showing its harmful influences on people.[12] The Yilede is a women’s closed society centred in the Banda country and most probably of Banda origin. The chief aims of women in this society are to be independent from their husbands, free from motherhood responsibilities, to enjoy feasts and dances, help each other in need, and gratify private revenge.[13]
	The society is a well-organized group rebelling against subjugation by men. Every group has a chief, subchief and officers. There may be a group in every village. Every group has its own membership, meetings, dances, initiation rites, laws, referral system, bylaws and oath of allegiance. The society sometimes helps non-members, by providing medicine, or providing assistance against an enemy. Men are only allowed to enter the society if they are influential, or in order to perform duties that women are unable or unwilling to do. Yilede is invoked in different occasions mostly in vengeance against husbands. The society is believed to use poison for criminal purposes. One such poison is prepared from the juice of mbuga (Euphorbia sp.), which is believed to cause swelling of the belly. People under its effect drink a lot of water and death probably results in ten to fifteen days. Father Zugnoni considers that the society is the main cause of the low Banda birth rate. After careful enquiry in the four localities of Sopo river, Mbuu, Gule and Birdi, he has ascertained that out of 555 married women, 320 (57%) are childless. In addition to the fact that women deny their husbands their marital rights, the society supplies its members with abortifacient items such as gun powder and paw-paw seeds. He thinks that the genital excision which Banda girls undergo at puberty is one of the reasons for their aversion to motherhood, for it renders childbearing extremely painful.
	Deaths and illnesses have frequently been attributed to the activities of this society, and for this reason and for the veil of mystery that surrounds it, people fear it greatly. They are even afraid to mention the name of the spirit Yilede. In this it differs from other secret societies such as those of the spirits Yanda and Kudu.
	Also, the Editor of the Sudan Notes and Records reported in 1920 on secret witchcraft societies in the southern Sudan as described by the journal’s correspondents in the region. These organizations were alleged to have an increasingly baneful influence, and the Government consequently found it advisable to pass special legislation[14] to suppress their ‘dangerous and obscene’ rites.[15]
	The British Government also faced several reports from organizations such as the British Medical Association, concerned figures,[16] and the Church,[17] describing the brutal nature of female circumcision as practised in the Sudan, and asking for its abolition; their accounts were discussed in the House of Commons in Britain. The Government discussed the matter in its highest legislative assembly,[18] set up a high-powered committee of inquiry,[19] and finally after some vacillation, passed the 1946 laws making female circumcision unlawful.[20] However, enforcement of the law was sporadic, because at that time the national movement for liberation of the country was very active and the Sudanese were skeptical of any legislation passed by the colonial Government and its Advisory Council. The late Mahmoud Muhammad Taha spearheaded protest against this law in the city of Rufa’a, and was consequently imprisoned.[21] Nevertheless, his movement aroused so much sensitivity over the issue that the law was suspended, (and has been ever since).

Support

	Dr. Tigani Al-Mahi (1911-1970) was a refined Sudanese intellectual and a psychiatrist of vision. Early in life, he developed an interest in traditional medicine and became ever afterwards an avowed advocate. He saw traditional medicine as a national heritage worthy of being studied and made use of. After specializing in psychiatry in the United Kingdom, he came back to the Sudan, started psychiatric practice and established the first mental health clinic in Khartoum North in 1958. He thought it was imperative to study the local culture in general, and the healing system in particular. To do that, he preached, researchers should befriend the healers; this he did, and he did so for yet another more important reason. He believed that if the system of traditional medicine is to be acknowledged and recognized by the authorities, the gap between the two systems—medical and traditional—should be bridged. He started and maintained dialogue with and befriended several notable religious healers in several parts of the country. He used to refer psychiatric patients to their care, and they reciprocated courteously. The late Al-Mikashfi of Shikeiniba, and Khalifa Yusuf Wad Badr of Um-Dubban village, east of Khartoum North, both renowned holy men, were among his best friends. Religious healers, unlike all others, organized themselves in strict hierarchies of religious fraternities or Sufi orders, established codes of ethics, initiation rites, wrote litanies, founded schools of thought, and most importantly, healing centres and asylums for the mentally-ill.[22]
	Tigani Al-Mahi contributed significantly to the inception and promotion of an African model of psychiatric health delivery that came to be known as the “village system” as typified by that of the village of Aro in Abeokota in western Nigeria. The system permitted treatment of the mentally-ill by utilization of the inherent dynamic resources of the social environment as the principal therapeutic technique.[23] Earlier, T, Adeoyo Lambo (a Nigerian pioneer psychiatrist) and Tigani Al-Mahi postulated that under stress—emotional or otherwise—newly-acquired and highly-differentiated social attitudes and ideologies are more susceptible to ‘damage,’ leaving the basic traditional beliefs and indigenous moral philosophy functionally overactive. This insight lead them to recognize the part played by indigenous psychotherapeutic approaches in the total management of patients, without any lowering of standards of medical practice. They also found, through long practice in Africa, that a multi-disciplinary approach and collaboration with traditional healers is necessary for better scientific understanding of man and his environment. Lambo wrote:
	“For example, Dr. El Mahi and I have for a number of years made use of the services of African ‘witch doctors,’ especially selected for epidemiological work and other aspects of social psychiatry (for example, a community attitude survey), a procedure that is indefensible by Western standards. Through their participation we have enriched our scientific knowledge of the psychopathology and psychodynamics of the major psychiatric disorders occurring in these exotic societies. We have also been able to accumulate a mass of data on the natural history and prevalence of many psychiatric disorders, in terms of cultural and social variables that are ill-defined and remain resistant to Western forms of categorization. Without the help of the ‘witch doctors,’ we would not have known how and where to look and what obstacles to skirt in searching for simple disorders like obsessional neurosis in the indigenous population of Africa. Most of these traditional healers who are employed by us and are participating in this scheme have considerable experience in the management of African patients. They supervise and direct the social and group activities of our patients in the villages under our guidance.”[24]
	Tigani’s endeavours to study and apply the traditional health systems were genuine and far-sighted, but were not sufficiently supported to establish a "Sudanese model,’ and the Sudanese experiment he initiated did not progress to fruition. The next generation of psychiatrists maintained links with traditional healers with little enthusiasm and possibly with little conviction. The exemplary project that he started dwindled into a makeshift clinic run by a psychiatric nurse and visited occasionally by a psychiatrist. The clinic experiment did not succeed, though often quoted as illustrating healthy integration and collaboration with traditional healers. There is no documentation of this experience available, though it is known that it was established within the maseed of Um-Dubban. Tigani’s contemporaries were genuinely concerned and committed. They believed in the worth of traditional mental health systems in patient care. However, Taha Baasher, Tigani’s successor as Senior Psychiatrist in the Ministry of Health, who was equally interested in traditional medicine, proposed his reasons for the failure of this experiment, and probably the whole model. He said:
	“A pertinent question may be raised here, i.e. if the village system has been traditionally well-established for centuries in the Sudan and is still generally popular, why has it not been further developed as an integral part of psychiatric services? The reasons for this seem to be historical, social and geographic. Historical, because the traditional village system has its roots in rural communities, while modern psychiatric services have been developed in urban centres. Social, for the village system fitted rather well with an agrarian and nomadic population. Geographic, for the traditional and modern institutions were at such a distance apart, that it was not feasible to establish an effective relationship and efficient cooperation. However, the channel of communication between the two systems continued to be usefully active. Some of the traditional healers having been oriented towards modern psychiatric thinking and practices, proved helpful in early referral of patients, in providing support and guidance to patients where no other alternative medical care was available, in public education and in enhancement of community resources.”[25]
	Apart from these early efforts, contacts with traditional healers have been unofficial, informal, and maintained through personal interest in culture and in cross-cultural psychiatric approaches. Muhammad Al-Hasan Al-Qaddal, a psychiatrist in Atbara Civil Hospital, established friendly relations with the religious healers in the Kadabas maseed. Tigani Adam Hammad, at the Faculty of Medicine of the Gezira University, maintained similar links with Wad Al-Ubiyyid in Wad Al-Ubiyyid village on the outskirts of Wad Medani city in Gezira, central Sudan. These trials and probably others, were, no doubt, genuine, but since they were personal, they remained sporadic academic experiments. For these reasons, and in spite of the resources available for the support of such research, almost all of them withered.
	Taking note of these experiments and other experiences, the traditional medicine programme that has been sponsored by the Ministry of Health and the National Council for Research, as embodied in the Traditional Medicine Research Institute objectives stressed the need for making use of the resources of all available traditional health practitioners through recruitment and training.[26] As yet, apart from the teaching and training of habl midwives as part of the domiciliary midwives’ training scheme in the Ministry of Health, no other category of healers has received any type of instruction in the basic techniques of modern medicine. On the other hand, no allopathic health worker—medical or paramedical—has received any introduction in traditional medicine. Brief interactions have occurred sporadically between researchers including psychiatrists and religious healers. The Department of Community Medicine in the Faculty of Medicine, Khartoum, encouraged under-graduate research in traditional medicine, but only as partial fulfillment for qualifying in community medicine examinations. The Faculty of Medicine, Gezira University, with its emphasis on community orientation, is encouraging more field work and contact with healers. The departments of psychology and social anthropology in the University of Khartoum and the Ahfad College for Women, are encouraging undergraduate projects in traditional medicine, but very little postgraduate research is pursued.
	Village midwives have attracted special attention in the Ministry of Health since its inception as the Sudan Medical Service early this century. A programme to train village midwives including traditional birth attendants, was launched as early as 1921 in Omdurman.[27] Dr Sobhi El Hakim summed this experience up, saying:
	“Among all the countries of the world, the Sudan is one of those with the longest experience in the formal training of TBAs [Traditional Birth Attendants]. Although the programme started as an effort to train women who were known to be practising traditional midwifery, it gradually evolved and by the early 1960s it included those who had no experience in this regard. It now focuses almost exclusively on the latter, who are trained to assume higher and broader functions than the TBAs. For this reason, the training programme is now referred to as one for village midwives.”[28]
	Training started with the realistic approach of persuading illiterate women, including habl midwives, to attend a four-months-course in modern midwifery. Tuition was entirely practical, using simple language and techniques adaptable to the Sudanese house. The candidates were taught to recognize powders, tablets, and other forms of medicines by feel, taste and smell. The course eventually increased to eight and then 12 months, and after starting with basic midwifery, it later included infant welfare, hygiene, antenatal care, home visiting, participation in immunization programmes, health education and reporting of infectious diseases. More importantly, midwives were taught the harmful effects of female circumcision and instructed not to perform it. Midwives were neither employed nor paid by the government, and were satisfied and happy with this arrangement. However, the socio-psychological and economic climate in which they used to work and which gave them relevance and enhanced their role in society, changed. The payment they get is no longer enough to cover the increasing cost of living, and, hence, they sought other sources of supplementing their income. Circumcising young girls and recircumcising women as a plastic operation, were the first activities they turned to, in order to earn more money.

Legislation

	Traditional medicine in the Sudan has never been condemned or prohibited in total. At times, however, the government has enacted and enforced a ban on some forms, and adopted an attitude of tolerance and turned a blind eye to most traditional medical practices as long as no disturbance is officially reported. The practices that were specifically prohibited by legislation, were pharaonic circumcision in the Muslim Sudan, and the secret witchcraft societies in the south. Other legislations suppressed traditional medicine indirectly.
	The Ministry of Health has produced several pieces of legislation and regulations for the proper practice of modern medicine. The Sudan Medical Council’s terms of reference, rules, orders and regulations were set to achieve a high standard of professional medical practice, and to maintain moral and ethical codes. There has been no clauses, now or in the past, in the Sudan Medical Council’s ordinance or the Ministry of Health’s Public Health Acts, or any legislature in any other institution that identify or recognize traditional medicine or acknowledge any alternative system of health care. On the contrary, there are definite clauses that could be interpreted to the detriment of traditional medicine and its practitioners and sometimes to their customers.
	As they did in many former colonies, the British introduced several concepts of health care. Amongst these were the need to promulgate laws to regulate the practice of medicine, to ensure a high standard of professional competence, and implement ethical and disciplinary codes. Other laws were devised to keep the profession a prerogative of the licensed professionals. Since its inception in 1955, the Sudan Medical Council[29] has followed in the footsteps of the British Medical Council. This was expected, since the Sudan was a former British colony. The systems of medical education and training followed the British tradition. In fact, Gordon Memorial College[30] (the predecessor of the University of Khartoum), when it was upgraded to higher education level in 1947, was affiliated to the University of London. Kitchener School of Medicine[31] (the predecessor of the Faculty of Medicine, University of Khartoum), was founded in 1924, and was intended to be a part of the international medical community.
	Systems of control of the profession were envisaged,[32] and two bodies were designated to carry out these tasks:[33] the Sudan Medical Council, and the Ministry of Health’s Public Health Board. The first is an autonomous body concerned with the medical profession (doctors, pharmacists and dentists). The second, a department of the Ministry of Health, regulates the paramedical profession, personnel, health facilities and public health measures. Jan Stepan summed this up in the following:
	“Legislation was designed to regulate the delivery of health care as a monopoly of formally educated physicians and a few other professions. Subsequently, even the practice of the allied and auxiliary health professions was limited to licensed persons.”[34]
	The Sudan Medical Council has made the practice of the profession of medicine (medicine, pharmacy and dentistry) unlawful to anybody but those registered in the Council’s roll. It states clearly that any person who practises medicine while not registered on the permanent or temporary roll, or any person who employs such a person, shall be sentenced before the court concerned to a term of imprisonment not exceeding two years, or a fine not exceeding five thousands pounds, or with both penalties together.
	The Council defined the various specialties and the practitioners eligible for registration on its roll. Later, it provided The Regulations for Registration of Specialists, 1405 AH (1985), whereby any physician [and dentist and pharmacist] who practises as a specialist without registration under these regulations shall be punished by imprisonment for a period not exceeding a month or a fine not exceeding 100 pounds.
	The Ministry of Health, which is responsible for health care delivery in the Sudan, limited the practice of medicine to certified and registered persons. It stipulated in the Public Health Act, 1975[35] that nobody other than certified persons should assume any of the functions of a human medical doctor. Any person who practises medicine while not registered on the permanent or temporary roll; … or who prescribes any medicines to any patient with the intention of treating disease or infirmity; or who performs any surgical intervention or causes any cut or amputation on the body of any person with the intention of treatment of disease or disability, shall be sentenced to imprisonment for a period of 6 months and not exceeding 3 years and with a fine not exceeding 200 pounds.
	The Act also restricted the practice of midwifery. It states that midwifery should only be practised by Government certified and registered midwives. Any person who does not abide by this law will be subject to imprisonment for a period not exceeding one month or with a fine not exceeding 30 pounds or with both penalties together.
	In line with the Medical Council’s Medical Acts, the Pharmacy and Poison Act 1963 (1963 Act No. 37)[36] was just as restrictive to traditional healers. It tightened the monopoly of pharmacy to licensed and registered pharmacists, and restricted drug dispensation to accredited places. Traditional medicines were completely unacknowledged.
	The Act has the following provisions:
	4 (1) Except as may be specifically provided by and of the provisions of sections 20 or 21, no person other than a person duly registered as a pharmacist under the provisions of this part shall:
	a. carry on business or practise as a pharmacist;
	b. in the course of any trade or business prepare, mix, compound, dispense or supply wholesale or by retail any drug except under the immediate supervision of a registered pharmacist;
	c. describe himself as a pharmaceutical chemist, chemist, pharmacist or druggist or otherwise assume, take, exhibit or in any way make use of any title, emblem, description or addition reasonably calculated to suggest that he is a registered pharmacist.
	The Act provided for the licensing of pharmaceutical premises and businesses and for the registration of drugs. It was no longer lawful to practise pharmacy outside accredited places and without a license. It was also made unlawful to manufacture, import, export, distribute, sell, offer for sale, receive for resale, purchase, administer, transport or possess any brand of drugs including, dangerous drugs and their plant precursors which has not been registered in the Board. Contravention of any of these items subjected any individual found guilty to imprisonment and fine.
	Section 4 (3) gave the Board some leeway. It stipulated that ‘notwithstanding subsection 1 of this section, the Board may, by order published in the Gazette, authorize any person, on such terms and conditions as it may think fit, to sell drugs or any class of drugs either by wholesale or retail.’ Based on this Act, the Drug Registration Regulations of 1974, were enacted. In it, the Public Health Board was entrusted with regulating the type, and establishing a register of drugs in circulation in the country.[37] Though the drugs here were well-defined, the exemption yet provided some hope that a similar proviso could be granted to some items of the Sudanese materia medica in the future.

Utilization

The availability of traditional recipes for people to use in modern forms goes hand-in-hand with the official recognition of the system, with political ideology and will. In spite of validated research in the Sudan and abroad, the use of medicines that have been proven to be valuable is limited. Various reasons have been given in justification. The commercial availability of plants in their purified or crude forms, depends on heavy investment in research, pilot production and manufacturing. Also, poor countries have different priorities, addressing urgent and basic needs, and supporting their basic infrastructures.

In spite of reported and unreported complications in traditional practice, people seek traditional healers regularly and confide in them. They respect them, and revere and worship many. Healers throughout the country have given people continuous social and psychological support, and offered them help in different spheres of life. People also know the system’s limitations very clearly, and often choose intelligently which healer to consult, and, whenever there is a modern facility—a clinic or hospital -around, they could well go to it first in acute or urgent cases. As a general rule, people continue to be committed and faithful to their traditional recipes and practices, though aware that healers make mistakes, some of which are fatal and unpardonable. However, in the local mind, these mistakes are part of life’s eventualities. Complications of varying degrees have followed surgical interventions, and bone-setters have set bones wrongly. Non-union, and mal-union of fractures have been reported, and gangrene of limbs has occurred after tight bandaging, rendering amputation necessary. Several bone-setters have been ignorant of the relative positions of nerves and arteries, and have caused, in the process of setting bones, contractures of hand muscles with subsequent deformity and loss of function. Habl midwives have failed repeatedly to deliver babies safely, or retrieve the placenta, with often fatal results. Ignorance or neglect of basic rules of hygiene, have frequently resulted in mother and newborn tetanus. Unequipped as they have been, midwives have met all the complications a qualified medical practitioner is ever likely to meet. Many girls have lost their lives during circumcision, due to bleeding when the midwife either failed to catch a bleeding blood vessel. The rule still holds; the bereaved family of the unlucky child never disclose the identity of the midwife who performed the operation no matter how persistently the police pursue their inquiry.