Foster and Anderson have noted in their classic Medical Anthropology how few cognitive frameworks among non-Western peoples are necessary to “explain” the presence of disease.[1]They found that a dual division is sufficient to distinguish major categories, or systems, and suggested that these be called personalistic and naturalistic.

A personalistic system is one in which illness is believed to be caused by the active, purposeful intervention of a sensate agent who may be a supernatural being (a deity or god), a nonhuman being (such as a ghost, ancestor, or evil spirit), or a human being (a witch or sorcerer). The sick person is literally a victim, the object of aggression or punishment directed specifically against him, for reasons that concern him alone.

In naturalistic systems illness is explained in impersonal, systemic terms. Naturalistic systems conform above all to an equilibrium model; health prevails when the insensate elements in the body, the heat, the cold, the humors, etc., are in balance. When this equilibrium is disturbed, illness results.

 It is not our intention here to follow any of the models set by anthropologists for studying systems of traditional medicine, neither do we indulge in any detailed discussion of these systems. There is no such pattern, as books would describe in the mind of the layman—healer or patient. This is why we concentrate instead on describing the different parts of the system of popular health, give as many examples and refer to as many case studies as possible, and leave the rest of the field to the labour and ingenuity of future researchers.

Lay health beliefs in the Sudan are similar to those in other parts of the world, and especially to those in the Arabian Peninsula. They are part of the cultural matrix of society, arising as they do from the general experience of everyday people. Witchcraft, magic, religion, systems of taboos, customs, traditions and values, all feature to a greater or lesser extent in the different regional practices. They have naturalistic and personalistic causes, to follow Foster’s categories.

People seek and find natural causes for minor daily injuries and trivial disorders. They manage these ailments rationally. One knows that one may sustain an injury if one is not careful in play, in handling sharp objects, and in personal or tribal feuds. The cause is clear, and to avoid any unnecessary harm, one should only stay clear of combat or take care in whatever one does..

They do not attribute all diseases to unforeseen causes. The example of dracunculiasis[2], guinea worm infestation, illustrates this down-to-earth wisdom well. This is a disease endemic in the southern Kordofan Region, and is caused by a worm that penetrates the exposed skin. The Nuba of western Sudan noted that wading in pond water could result in infestation, and hence they thought they should protect themselves. They invented a special type of patten with very high heels and leather strapping. They wear them in their daily water crossing.

The natural causes were dominated by the four humors theory, which was propounded by the Greco-Roman Ionian philosophers (8th-6th century B.C.) to explain the patho-physiology of health and disease. The theory has its roots in the Greek theory of the four elements (earth, air, fire, and water), and the four qualities—hot, cold, dry and moist. The elements and qualities were integrated in one theory to produce the four “humours” with their associated qualities: blood (hot and moist), phlegm (cold and moist), black bile also called “melancholy” (cold and dry), and yellow bile, or “choler” (hot and dry).[3] The theory maintained that human health depends on the equilibrium of these humours or body fluids, and as a corollary, their preponderance determines the personality, temperament, and general health of the individual. For example, an excess of choler was believed to cause anger and bad temper (the choleric temperament).

To correct the imbalance of these fluids, whether it is excess or a deficiency, physicians should first know the constitution of the normal healthy body in the different seasons according to age. They should then treat the disease by the principle of opposition to reestablish the balance. This is achieved by diet, drugs, vomiting, purging, diuresis, bleeding, or cupping.

The four humours theory influenced European and Arabian medicine in the Middle Ages, and formed the basis of a rigid classification of disease, drugs, and diet. There is evidence to suggest that the Sudanese had working knowledge of this theory as early as the 10^th Century. Ever since, the theory has had strong effect on popular medical remedies and herbal prescriptions.

Ibn Daif Allah, in Al-Tabaqat, which contained biographies of notable Sudanese scholars, jurists, poets and holy men who lived during the Funj Kingdom (1505-1820), draws a vivid picture of the Muslim scholars of the 10^th century discussing the pros and cons of coffee and tobacco as novelties. Finally, after consulting with Egypt’s scholars, they reached a consensus; they prohibited tobacco and approved coffee for individuals with a ‘phlegmatic temperament’ but not for those with a ‘choleric’ temperament, because they believed that coffee increases choler.[4]

Also, the faki prescribes amulets only after identifying the tabi’a (nature) of the patient. If the faki, or other healer, diagnoses joint pain (rutuba ‘moisture’ or buruda ‘coldness’) they prescribe their opposites for a cure. This was not the only inherited misconception.

In the Sudan, sniffing of samin (liquid butter) mixed with black cumin, known as tas’it, is occasionally practised, as in the treatment of mental illnesses. It was believed, as it was in the ancient theories of pathology, that the nostrils were continuous with the brain. Therefore, nasal secretions come from the base of the brain down the nose in nazla (coryza). These are seen as signs of health, and it is often said jokingly that ‘al-zukma marad al-‘afia’ (literally coryza is a disease of health).

Purging the body of excessive, stagnant or simply harmful fluids is seen as a health-promoting procedure that should be carried out periodically using various plant recipes. Joints pain is considered either due to sas (syphilis) or to buruda (coolness). If it is due to buruda, efforts are directed to reverse it by fumigation, exposure to direct heat or with a ‘sand cure’ (see page 241).

People throughout the Sudan believe in the presence of supreme powers, Gods and their cognates, who control all aspects of human life. These powers either punish or reward human activities on earth. When enraged, they inflict disease on human beings and injure their livestock, crops and property. When content, they induce happiness and promote wealth and health.

Other occult powers exist; these are the powers of supernatural beings, those of the spirits. They also influence human beings and affect their health, causing disease, infirmity and death. They possess individuals or influence them from afar. When they are provoked, they do harm either through the machination of a faqir, a holy man, or a magic-monger, using these spirits as jinns subject to their command.

Muslim Sudanese have identified and named many spirits. Many of them have been labeled evil, malicious or envious, few harmless or calm. The Azande tribe in southern Sudan finds in witchcraft and magic an explanation for most abnormal incidents. Edwards Evans-Pritchard describes the social system of this group, in Witchcraft, oracles and Magic among the Azande, and confirms that the Azande, like other tribes we will describe later, attribute disease to the Supreme Being, to the magic of a sorcerer, a breach of a taboo or to witchcraft[5].

The Dinka and Nuer tribes believe firmly in the omnipotence of a Supreme Being, and attribute most incidents of misfortune to its will. The Lotuko, reported Somerset, believe in an invisible power called naijok, a neuter form. It is conceived chiefly as bringing death and disease. Everything not understood, however, is ascribed to naijok.[6] The Mesakin tribes of the Nuba Mountains in western Sudan are literally obsessed by fears of witchcraft (known as torogo). Among these tribes, accusations of witchcraft are frequent, and entail violent quarrels, assaults, and even blood revenge. The Mesakin believe that witchcraft itself is a mysterious, malignant, and often deadly power, emanating directly from evil wishes, though it is subject to two significant restrictions. Mesakin witchcraft is believed to operate only between maternal kin, especially between a mother’s brother and a sister’s son, the older relative assailing the younger. Also, it operates only if there is a reason, some legitimate cause for resentment or anger.[7] Among, the Acholi writes Grove, misfortune may come from many causes. Firstly it may be the ancestors. A person may have neglected too long to sacrifice at the Kac and his dead father may be hungry. Secondly the trouble may be due to the evil influence of some other man. The unfortunate one may have eaten Awola; or a lajok may have looked at him; or a wua auaua may have pointed to him; or a latal[8] may have danced in his doorway at night. Lastly the man’s fellow villagers may be envious of him or evil disposed towards him and their ill will has brought him bad luck.[9]

People bring harm upon themselves in several situations; if one does not conform to certain personal or social standards, misbehaves or breaches set taboos, customs and traditions, one exposes oneself to all sorts of diseases. Neglect of a totemic spirit or the duties of blood brotherhood, are equally dangerous.

Human beings can harm each other through black magic, witchcraft, or through an envious, jealous, or malicious evil eye. A young infant may harm its nursing mother through its constant gaze. This, women believe, is a common cause of hair loss.

Behavioural lapses, likewise, do harm and cause disease. They not only affect a person’s health, but they threaten social relations, disrupt peace and unity, and may even endanger the environment. A disease such as leprosy is closely linked with clan offenses among the Nuba among whom it is endemic. Nadel observed that the disease was regarded as dangerous and infectious only within the clan. He said he once attended a clan feast in Heiban at which the people were drinking beer happily in the company of a leprous woman who, it appeared, had taken a holiday from the local leper colony. His informants explained that they were not afraid of drinking with her (as they usually are of eating or drinking with lepers), since she belonged to a different clan.[10]

In a country like the Sudan with over three hundred and fifty tribes and over a hundred languages and dialects, it would be futile, if not well-nigh impossible, to describe the health systems of all ethnic groups, or to generalize with any degree of safety after studying only a few.

For example, tribes like the Korongo of the Nuba Mountains, who have no witchcraft, possess a full and explicit mythology concerned with explaining all the things in the world: the creation of man and animals, the origin of death and disease, the invention of fire, and so forth.[11] Yet other tribes dream of having magical cures for all ills and a means of transmuting base metal, or even water, into gold, They believe that an Elixir Tree exists somewhere, and that they will find it one day. This tree is peculiar; it has only two branches, and each branch has two leaves. A branch of this Tree would change silver into gold, and also provide a panacea for all diseases. Some people believe that the Tree grew upon Jebel Kadugli, or on top of Jebel Kasala, in western and eastern Sudan respectively.

The Hawazma Arabs who camp near Jebel Kadugli believe that if a man can find and reach the Tree, break off one branch, and descend to the plain again without having called on the name of Allah for protection when attacked by the ‘afrits who guard the Tree, then he will be able to turn water into gold by striking it with the branch; but only he could perform this miracle, and then once only.[12] Wherever this Tree grows, and whether it exists at all or not, it remains a symbol of the dreaming human being everywhere.

Northern Sudanese society has accepted death as an inevitable end to life, as do all Muslims. According to Islamic teaching, death is the beginning of a better eternal life for good believers, and have prepared their dead with due respect according to Muslim teaching. The Dinka of Bahr Al-Ghazal, among other tribes of the southern Sudan, who are mainly animist, also accept natural death and mourn lost members. They are also reported to have practised, in the old days, mercy killing of their dignitaries.

Sudanese health culture abounds in observances and taboos that are well-knit in the social system: activities of tribes, clans, kindred, family life, and inseparable from every activity and occasion be it in marriage, adulthood or adolescence. Many of these can affect health and may cause disease if broken or ignored.[13] Although Muslim shari’a law governs social and family life in northern Sudan, indigenous rites, customs, and practices still influence and modify these laws, and dictate some taboos. Those concerning food, pregnancy, personal and social conduct, and sex matters, will be discussed in the relevant chapters.

Taboos that should be strictly obeyed include those concerning mistakes of conduct and behaviour that the society considers as deviant. These deviations harm man and his possessions. Mistakes include nonobservance of auspicious days, breaches of social norms, or of the obligations of blood-brotherhood. Some of these taboos might be minor personal non-observances. Even bathing water is surrounded with taboos that should be observed. If one jumps over or crosses the bath-water, one exposes oneself to harm.

For example, spitting on urine causes a sore throat of one kind or another, and trotting inadvertently over a wali‘s (holy man) burial place leads to ferendeet (guinea-worm infestation). Other mistakes could be serious. If one ridicules a holy man intentionally, one may become lunatic. And, as Evans-Pritchard has noted, among the Azande:

“A breach of the obligations of blood-brotherhood may sweep away whole groups of kin, and when one after another of brothers and cousins die it is the blood and not witchcraft to which their deaths are attributed by outsiders, though the relatives of the dead will seek to avenge them on witches.”[14]

In the following sections we identify the roles attributed to supreme and supernatural powers in influencing human health. We also study the part played by witches and sorcerers, as well as ordinary people when moved by envy or jealousy. We highlight the beliefs and practices of some cultural groups, and describe how they are applied to matters of health, disease, death, and related aspects of everyday life.