Moïse Mvetumbo et al.

The persistence of spleen sickness culture in Cameroon:
A comparison between a remote village in the Eastern Region
and an urban area of the Central RegionMoïse Mvetumboa, Takanori Oishib, Paschal Kum Awaha, Marlène Toukam Ngansopc,
and Léonelle Touyou AkeptadabDepartment of Anthropology, University of Yaoundé I, Cameroon

African Studies Center – Tokyo University of Foreign Studies, Japanc

Department of Plant Biology, University of Yaoundé I, CameroondCatholic Health Centre Holy Mary of Soa (Yaoundé), Cameroon

Abstract:‘Spleen sickness’ is a pathology characterised by a set of abnormal abdominal swelling and pains
affecting the human body that is uniquely recognised by traditional medicine. This sickness continues
to affect diverse categories of the country’s population. Our objective is to describe the varied ways ofperception and management of ‘spleen sickness’ by local peoples in the different contexts of health caredevelopment and urbanisation. Of the informants, only two living in Yaoundé (1.7%) replied that they
had found a solution to their problem by receiving care in biomedical health facilities. The others(98.3%) stated that their health had been restored by receiving care from traditional healers. Whereas
the rural population tended to use more diverse plants for management than urban populations, they
commonly depended on medicinal plants. However local knowledge related to ‘spleen sickness’ tends
to be closed within each community of hunter-gatherers and farmers in Ndongo, it is more open in
Yaoundé. Ethnomedicinal recipes are exchanged and hybridised between different cultures in the urban
area. The commonalities and differences identified between the two sites illuminate the common
patterns of a culturally constructed disease, but also the dynamics of therapeutic knowledge under theurbanisation.

Keywords: cultural diversity, ethnomedicine, health care development, urbanisation, Cameroon― 279 ―
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The persistence of spleen sickness culture in Cameroon

1. Introduction
Conventional medicine conceives of disease as an exogenous entity breaking into the patient’s body andof medicine as the healing of that health problem. Major causes include genetic factors; infectious agents(viruses, bacteria, or parasites); poisons and drugs; pollution in its various forms (e.g. atmospheric,habitat-related), and immunological factors. To cope with these health problems, it is recommended that
local ‘healers’, ‘herbalists’, and ‘birth attendants’ compensate for the shortcomings of national healthsystems (WHO 1978). According to the World Health Organisation (WHO), 80% of the population ofdeveloping countries are dependent on traditional medicine, mainly using extracts of plants to meet theirneeds. This situation can be explained by the poverty of the populations, their socio-cultural habits, theisolation of rural areas, the absence of sanitation or rudimentary infrastructure, the high cost ofpharmaceutical remedies, and low incomes (Dibong et al. 2011), and is experienced differently in urban
and rural areas. In this respect, the city of Yaoundé has a large number of health facilities and qualified
personnel (ONU-HABITA 2007), while the populations of rural areas have enormous difficulty
accessing health care. Indeed, the Ndongo locality, for example, has an Integrated Health Centre with ahealth staff that for various reasons is not always on site. The local population sometimes spends one or
two weeks without access to quality health services.
This situation increases the health vulnerability of these populations, who can suffer from common
diseases falling within the expertise of conventional medicine. In reference to biomedicine, Boltanski(1971) makes it clear that familiarisation with morbid and symptomatic taxonomies, as well as theacquisition of new categories of perception of the body, are essentially the result of attendance ofprofessional health services by the population. In South-East Cameroon, for example, several studies
have shown that migration from the forest and increased contact with nearby ethnic groups havecontributed to poor Baka health and increased disease prevalence in general (Froment 2014, Ndembi etal. 2003) and newfound illness in particular (Carson et al. 2019). According to Mbonji (2009), newdiseases are born while others disappear; new drugs are being manufactured to replace those lesseffective or less available. As regards the asymmetric relationships between diseases and drugs, it should
be noted that they are not always due to the emergence of new pathologies, resistance of old ones, orincompleteness of the care offered. In Africa, these relationships are explained in particular by theexistence of a certain number of morbid cases that do not necessarily fall within the official
categorisation of the disease, a categorisation based more on a biomedical and institutional vision thanthe ethnographic conception of health or disease.
‘Spleen sickness’ in this regard is not a pathology recognised by scholarly medicine, while the local
populations consider biomedicine incompetent to find effective solutions. According to Eloundou(2009), ‘spleen sickness’, known as tsite among the Ewondo population, is a health problem that theyhold can only be solved at the level of traditional medicine. In daily life, any society develops methods
to cope with a disease, a set of means to stop it and explain its appearance (Meziane 2003: 65). By― 280 ―

Moïse Mvetumbo et al.

consulting literature on the most recurrent diseases in our contemporary society, we realised that what
rural and urban populations in Cameroon call ‘spleen sickness’ has not been the subject of much researchin social science. At this stage, some studies have focused on plants used against this health problem in
Cameroon (Adjanohoun et al. 1996), among the Baka of Cameroon (Brisson 2011) and Gabon(UNESCO 2009), and among the Baboua population of the Central African Republic (Jacqueline 1959).
Our objective in this work is not necessarily to justify the relevance of social practices, but to explain
how people live and express this reality. In this movement, Fainzang (2000) considers that what is
important from the anthropological point of view is not whether such a practice is effective, but why itis thought to be so by the society studied, what its meaning and social significance are and how this isconstructed in practice. The main question at the centre of this research is: What are the socioculturalconsiderations that the population has regarding ‘spleen sickness’ and its management practices in ruraland urban Cameroon? To achieve this goal, we aim in this work to describe multiple ways of perception
and management practices of ‘spleen sickness’ by local peoples in the different contexts of health caredevelopment and urbanisation.
2. Material and methods
2.1. Study area
We conducted this research in two localities of Cameroon: Ndongo in the Eastern region and Yaoundé
in the Central region.

Figure 1. Study areas
2.1.1. Ndongo village
Ndongo is a village situated in the Moloundou subdivision of the Eastern region. It is located along the
Dja River, which forms the international border between Cameroon and the Republic of the Congo.
Ndongo is located at 650km southeast of Yaoundé, the capital of Cameroon. The Ndongo villagers
belong to more than 10 ethnic groups, including the Baka, Bakwele, Djem, Bangando, Konabembe,― 281 ―

The persistence of spleen sickness culture in Cameroon

Hausa, Fulbe, Kotoko, and Bamileke. Ndongo inhabitants can be classified into three categories basedon lifestyle and ethnic identity: the Baka are hunter-gatherers, the Bakwele are farmers, and the Hausa,
Bamileke, and Bamoun are merchants. Their respective populations number around 300, 250, and 50
persons, giving a total population of approximately 600 (Oishi 2016a). We focused only on the Baka
and Bakwele, who constitute the majority of the population. This situation afforded us the opportunity
to meet the maximum number of informants, and also allowed us to cross check the names of plant
specimens before leaving the field.
2.1.2. Yaoundé city
Yaoundé is the capital of the Mfoundi Division in the Central Region and the political capital of
Cameroon. The city is located at latitude 3°90 North and longitude 11°50 East (Aimé et al., 2015). This
area is a little larger because as there are few ‘spleen sickness’ traditional therapists, this allowed us toobtain the same number of practitioners as at the rural site. It is also a multi-faceted town with a strong
diversification of activities and a high concentration of populations originating from various localitiesof the country (Hirano 2014, Porto 2012). The average density of the population in relation to theterritory of the CUY is 45.25 hab/ha, and that relative to the urbanised area is about 153 hab/ha (CUY2008).
2.2. Data collection method
2.2.1. Focused population
The focused population for this research consisted of persons who have experienced ‘spleen sickness’.
Regarding the first category, the choice focused on the victims and their relatives (patients, parents,
accompanying persons). When a case of illness occurs in the community, the patient’s entourage
mobilises itself to help the patient through this delicate moment of life. This means that in many cases,
the victim does not follow the pattern they lay down. The second category comprises health practitioners
who recognise this reality as a health problem. These are traditional healers, and any member of thecommunity may master the therapeutic knowledge and apply it to ‘spleen sickness’ patients. This study
was conducted with 120 informants, 40 in Ndongo and 80 in Yaoundé. The difference in number is due
to Yaoundé being larger and more populous than Ndongo. Thus, in Ndongo we consulted 20 Baka and
20 Bakwele, while in Yaoundé the 80 respondents interviewed consisted of 29 Ewondo and 51 allogens(i.e. 17 Bagam from the Grass Field region, 17 Mabi from the coastal region, and 17 Toupouri from the
Sahelian region of Cameroon). Given the cosmopolitan character of the city of Yaoundé, we tried to do
this to take into the population waves of the great cultural changes of Cameroon. This justifies the useof the concept of ‘allogen’ used to designate inhabitants not living in their birthplace. The respondents
in our sample voluntarily agreed to take part in the study. Apart from the general population, four
anthropological criteria borrowed from De Rosny (1981: 164) by which populations identify true healers― 282 ―

Moïse Mvetumbo et al.

guided the inclusion of that category of informants in our sample: their stability in the community where
they were born; the origin of their power/healing knowledge (the inhabitants of their respective villages
must be able to testify to the reality of their vocation); the duration of the cures they have made; andgood knowledge of medicinal plants and the proper use of therapeutic rites (Wamba et al. 2017: 168).
2.2.2. Data collection and processing
We organised home interviews with the holders of knowledge on their conception of ‘spleen sickness’
and the medicinal species their therapies use. We then went with them into the forest or the gardens
around their houses, where we identified with them the species they used, the privileged parts as well as
the instructions for use. In this context, we started by collecting specimens, which were well preservedin the Plank and protected from moisture. After the fieldwork, the different species collected wereidentified at the National Herbarium of Yaoundé. We subsequently constructed an Excel database withsuch items as family names; scientific names; biological types; parts used; modes of care administration;and sources of therapeutic knowledge. These different elements afforded us a global idea of the
management strategies of this disease in traditional societies and the dissemination of related therapeutic
knowledge. Data interpretation was based on cultural ecology theory, which has the aims of ‘the studyof dynamics, active human behaviour in the context of a changing environment, [and] interconnections
among the dynamic components of our system’ (Jochim 1981: 5). This perspective allows us todemonstrate how populations use their environmental resources to solve human health problems.
3. Results
3.1. Contrast between the sociocultural conception of ‘spleen sickness’ and biomedical
considerations
3.1.1. The sociocultural conception of ‘spleen sickness’
In Ndongo, ‘spleen sickness’ is conceived mainly as the result of the consumption of the animal's liver,a part of the wild animal, which is considered harmful to children’s bodies among the local populations(both Baka and Bakwele). We illustrate our remarks through a consideration of the expression kò na
ngέndὲ-so, which means the ‘disease of the animal’s liver’ in the Baka language. We also have theexpressions ɛpial-ɛ-tsite and ɛpial-ɛ-zock, meaning ‘animal’s liver’ and ‘elephant’s liver’, respectively,in the Bakwele language. What is important to observe here is that these populations sincerely believethat the consumption of the ‘animal’s liver’ is one of the main causes of ‘spleen sickness’. According tothem, this organ contains toxic agents responsible for the appearance of this health problem once thisnutriment enters children’s bodies or their mothers’. In this area, while all meat (liver) species suitablefor consumption are incriminated among the Bakwele community, the Baka focus only on the doe andthe hare, whose livers they consider harmful to children and to pregnant and lactating women.
In Yaoundé, several populations gave us an understanding of the local meaning of this health― 283 ―

The persistence of spleen sickness culture in Cameroon

problem in relation to their environmental resources. For the Ewondo, the indigenous population of thecity, for example, tsite ‘meat’ is the denomination used to express ‘spleen sickness’. According to them,this health problem is caused by the consumption of banned meat and is manifested by an inflammationof the abdomen that resembles a piece of meat to the touch. The Bagam informants (from the Westernregion) used the term bagyec ‘cricket’ to describe this reality, these populations explaining that the
movements of the chest of a person suffering from ‘spleen sickness’ is like the normal movements of acricket’s chest. Also, when the disease gets worse, the patient loses weight and becomes skinny like alocust, often described as meat without flesh. Mabi (coastal populations) used the expression tchiri‘animal’ and tchiri da'a ‘crab spleen’ to describe the same pathology. In substance, within these various
communities mentioned, the populations explained the disease with reference to the behaviour ofanimals and insects and their similarities with the characteristics or forms of ‘spleen sickness’ that may
justify the name at the local level. Here as elsewhere, the natural environment has always been a sourceof inspiration for people in their daily lives (Table 1).
Table 1. Summary of local denomination of ‘spleen sickness’

Baka

BakweleEwondoLocal

Meaning in

denomination

Englishkò na ngέndὲ-so‘disease of meat

The consumption of the liver of animal by the baby, mother, or aliver ‘pregnant woman predisposes children to ‘spleen sickness’ɛpial-ɛ-tsite‘disease of

The consumption of the liver of an animal by the baby, mother, orɛpial-ɛ-zock

animal liver’pregnant women predisposes the child to ‘spleen sickness’. Also,‘disease of

the two denominations are used to indicate the size of the sickness

elephant liver’as small (or simple) or large (or dangerous)‘animal’ or

The ‘spleen sickness’ is manifested by the presence of a ball at the‘meat’

level of the patient’s ribs; said ball is compared to a piece of meat

Tsite

Link of causality

buried in the body. It may have been the result of consuming asnail or the liver of the animal.
Mabitchiri‘Animal’The movement of the patient is compared to that of an animal in a
trap (fighting death). This disease can be the result of theconsumption of a snail.

Bagam

Bagyec‘Cricket’

The movement of the infected side is comparable to that of acricket. Although crickets are not implicated in the genesis of thedisease, they are nevertheless a well-known therapeutic element in
the community.

― 284 ―

Moïse Mvetumbo et al.

3.1.2. Contrast with the biomedical conception
From the biomedical perspective, the spleen is an organ located on the left side of the abdomen thatplays the special role of ‘cleanser’ of the blood. It is the main site of the destruction of red and whiteblood cells at the end of their lives (Orphanet 2010), which increases the volume of this organ (spleen)
as a consequence of the intensification of its work. In the literature, several researchers have provided
explanations of spleen pain, a situation that can create confusion in the mind of the population. Thus, alink between malaria, schistosomiasis, and inflammation of the spleen has been clearly established(Gentilini 1995). In the same direction, Greenwood et al. (1987) conducted research on ethnic
differences in the prevalence of splenomegaly and malaria in three populations (Mandinka, Wolofs, andFulas) in the Gambia, where they identified a high prevalence among Fulas, suggesting that thiscommunity is predisposed to this health problem. We have also noted an abundant literature on thepathological ‘wandering’ spleen, which is a rare malformation due to hyperlaxity or agenesis of thesuspensory ligaments of the spleen arising from a congenital or acquired anomaly (Germain et al. 2018,
Dème et al. 2016). In Cameroon, Mbanya et al. (2008) observed in a study carried out in Yaoundé thatan imbalance in the level of haemoglobin in a patient is a risk factor that promotes splenomegaly cases.
Bernard et al. (2001) highlighted the relationship between the existence of splenomegaly, a marker of astate of chronic parasitism, and the saturo-weight growth of a population of young children in southern
Cameroon.
Globally, ‘spleen pain’ is perceived by health professionals as a symptom of a variety of pathologies(malaria, cancer, sickle cell anaemia, various infections). Based on this clinical reality, biomedical
practitioners believe that the good management of these causes can generate the disappearance of pain
and inflammation. In the context of our study we observed that the choice of treatment of the population,
as indicated above, is traditional medicine. Of the 120 respondents at both sites, only 2 informants in
Yaoundé (1.7%) reported that they had found a solution to ‘spleen sickness’ by receiving care in healthfacilities. Almost all of the informants estimate that their state of health has been restored thanks to thecare received from traditional healers (98.3%). This information is more significant because therespondents belong to all social classes (rich and poor, children and adults, men and women, religious
and nonreligious)
3.2. Species used for treatment
In this work, 88 species have been identified from the two research sites, with 63.6% from Ndongo and36.4% from Yaoundé. From the Ndongo informants, 35 plants were found among the Baka and 21
among the Bantu population. In this locality the most commonly used species are Cylicodiscus
gabunense (8.9%), followed by Schumanniophyton magnificum and Anchomanes difformis (7.1% each).
Among the least common, 16 species were mentioned once, among which are Ceiba pentandra (1.8%)
and Afzelia bipindensis (1.8%). From Yaoundé, 32 species were cited by the informants, 15 species by― 285 ―

The persistence of spleen sickness culture in Cameroon

the Ewondo and 17 by members of the other cultural groups interviewed. The most important species
are Ageratum conyzoides (12.5%), Carica paya (9.4%), and Aframomum melegueta (9.4%), while 16
species were mentioned once (see Table in appendix section). Of the 88 plants identified in this work,
only 3 appeared in the lists from both Yaoundé and Ndongo (Aframomum melegueta, Elaeis guineensis,
and Carica papaya).
3.2.1. Biological type and part used
3.2.1.1. Biological type
Generally, the main species used by populations come from trees (58%), grasses (36.4%), and liana(5.7%). In the Ndongo locality, trees made up a high proportion (70.9%) of the responses, followed
respectively by herbs (21.8%) and liana (7.3%). On the other hand, there was a preponderance of herbs(62.5%) among the informants in Yaoundé, followed by trees (34.4%) and liana (3.1%). This situation
can be explained by the adaptation of populations to their immediate environment in the city as in the
countryside.

90%
80%
70%

70,9%
63%

60%
50%
40%

34,4%

30%

21,8%

20%

7,3%

10%
0%

Trees

Herbs
NdongoYaoundeFigure 2. Biological types― 286 ―

3,1%
Liana

Moïse Mvetumbo et al.

3.2.1.2. Parts used
Globally, the main parts used by population to treat ‘spleen sickness’ are bark (47.1%) and leaves(26.4%), while the least common are fruit/seed (8.1%) and stalk (3.4%). According to Ndongo
respondents, the most popular parts are bark (58.2%), followed by roots/tubers (21.8%). For informants
in Yaoundé, we noted the use of leaves (59.4%) followed by bark (28.1%). These different parts arechosen for their virtues backed by the experience accumulated by the population regarding their use.
The bark and the leaves are the most popular parts among the Ndongo and the Yaoundé, respectively,
which also reflects the predominance of trees and leaves in the primary choices of informants in theirrespective localities.

90%
80%
70%
60%

59,4%

58,2%

50%
40%
30%

28,1%

20%

7,3%

10%
0%

21,8%

Bark

3,1%

Leave

Root/tuber
NdongoYaoundeFigure 3. Parts used

― 287 ―

7,3%

9,4%

Fruit/seed

5,4%

0%

Stem

The persistence of spleen sickness culture in Cameroon

4. Modes of care administration
Globally, the main methods of care administration revealed by our informants from both sites arescarification-massage combination (39.8%), bleeding (25%), single massage (18.2%), and oral
administration (10.2%). In Ndongo specifically, the most commonly used modes are scarificationmassage (47.3%) and bleeding (23.6%), while in the city of Yaoundé, the major modes of administration
are scarification-massage (25%) and bleeding (25%). According to these populations, scarification andmassage can easily destroy the ‘spleen sickness’ from the outside while purging and oral intake areresponsible for the destruction of the disease from the inside. The high demand of care applying
scarification at both sites (47.3% for Ndongo and 25% for Yaoundé), for example, is justified by the
belief shared by the populations that contact between the remedy and the patient’s blood is a directmeans of counteracting an affection. According to them, through this method the medication can treat
the illness both at that moment and in the future by affording direct access to the deep pain of the patient.
Whether in Yaoundé or in Ndongo, the management of ‘spleen sickness’ involving scarification
associated with massage has proved to be a sure and lasting solution, according to the testimony of many
informants. It offers the opportunity to access the ‘root of the evil’ in the body for some, but also andespecially in the blood.

90%
80%
70%
60%
50%
40%
30%

43,3%
25%
20%

20%

12,5%

10%
0%

18,7%

23,6%

25%
9,1%

12,5%

0%
Scarificationmassage

Bite

0%
Massage

Bleeding

NdongoYaoundeOraladministration

Figure 4. Modes of care administration― 288 ―

3%

Inhalation

0%

3,1%

Bleedingmassage

Moïse Mvetumbo et al.

5. Influence of the natural environment on ‘spleen sickness’ management
During our stay in the field, informants of both sites allowed us through their narration to understandthe close relationship they have with their natural environment. Among the 88 plant species identified
for medicinal use for ‘spleen sickness’ treatments, 56 were collected from rural informants and 32 fromurban informants, as mentioned above. Apart from the diversity of the vegetal therapeutic resources
revealed in the field, we also observed the regular solicitation of some animal species for the same
purpose. Within the Bakwele community for example, we noted that snails and the liver of the hare areused by populations as therapeutic element to neutralise ‘spleen sickness’. The Baka informants for theirpart used the nails and skin of the elephant to solve this health problem. In Yaoundé, cows’ hooves,crickets, and dragonflies were recorded among the Bagam, lizards, frogs, and snails among the Ewondo,
and snail slime among the Mabi and Ewondo informants. All these elements of the animal world aretaken from the daily environment of the populations (Table 2).
Table 2. Animal resources used to cure ‘spleen sickness’ in the population
Locality

NdongoTherapeutic elements

Synthesis

Community

Snail

Burial of the living snail at the end of thepatient’s massage

BakweleHare liver

Scarify and embalm the chest of thevictim with the powder of the liver of the
hare

BakweleNail of elephantMassage of the patient’s rib by pressure
from the elephant’s nail

Baka

Skin of elephantMassage with charred skin, associatedwith bark

Baka

Gyrinus natator is returned to the water atthe end of the bite care.

Bagam

Beef hoof

Massage of the patient’s rib using powder
from a charred cow’s hoof.

Bagam

Shell of the snail

Massage of the patient with powder fromthe charred shell

EwondoFrog

Burial of the living frog at the end of thepatient massage

EwondoSnail slime

Scarify and embalm with snail slime

Ewondo,Mabi

An aquatic insect(Gyrinus natator)

Yaoundé― 289 ―

The persistence of spleen sickness culture in Cameroon

6. Cultural transmission of local knowledge at both sites
Therapeutic knowledge is transmitted through (1) dreams, (2) from parents to children, and (3) between
members of the community at both sites. Here we describe how each knowledge transmission process
occurs.
6.1. Dreams
Dreams emerge as an essential means of access to the therapeutic knowledge regularly mobilised for the
management of this health problem. The populations explain that during sleep, a spirit presents itself toreveal to a family member a recipe that will enable him to neutralise ‘spleen disease’. Generally, thisspirit explains the composition and the mode of administration. At both research sites, 10 people
admitted to have acquired some therapeutic knowledge via this channel. This was much more common
among the eight Ndongo respondents (six Baka and two Bakwele) who attested to this, while in Yaoundé,
only two people gave the same testimony. Several studies have highlighted this means of access totherapeutic knowledge (Nkonmeneck 2007, Mbonji 2006). On the whole, the density of know-how
acquired through this channel testifies to the nature of the relationship between the living and theirancestors. According to Mbonji (2006) for example, those who contributed during their lifetime to thewell-being of their fellow man have the responsibility to continue their good works in the afterlife. Baseon this consideration, some informant from Grass Field region of Cameroon believed that it is therefore
necessary for the living to remain in harmony with this higher entity in order to arouse its awakening
and sympathy when passing through difficult times. Through this harmony, this entity looks after thehealth and destiny of family members and society in general.
6.2. Transmission from parents to children
To achieve this, elders are accompanied in their activity by the youngest to gradually instil knowledge
and therapeutic practices. In fact, 18 out of 20 caregivers in Ndongo stated that they received therapeutic
knowledge from their parents. Here we note a strong connection, with 100% among the Baka and 80%
among their neighbours, the Bakwele. In Yaoundé, this trend is generally maintained, with 13 of 20
carers interviewed reporting having benefited from their parents’ know-how, 7 among the Ewondo(35%) and 6 among the non-indigenous groups (30%). This means of transmission has been mentioned
in several studies (Nyeyambe 2017, Mve Belinga 2011). For parents, not all children have the samepotential at birth that can promote their cooptation into the circle of traditional healers. Indeed, somechildren have a more open mind and the skills to master the herbs, barks, and objects that can heal a
victim of this pathology. On a day-to-day basis, the caregiver looking for a successor starts by observing
his children or his family closely in order to identify the one who has the most aptitude to serve hisfamily and perpetuate his therapeutic knowledge in the long term. Whatever the community and practice,
the responsibility of adults in this case is to channel young children and aspirants ‘endowed with gifts’― 290 ―

Moïse Mvetumbo et al.

so that they can better express their genius.
6.3. Acquisition from a third party who is not automatically a member of the family
The study also revealed a significant openness of therapeutic knowledge to learners of all backgrounds
who meet the basic requirements instituted by the ancestors. In Ndongo, 2 ‘spleen’ caregivers out of 20
interviewed (10%) mentioned having received additional training from a third party with whom they are
not related, though this was only noted by Bakwele informants. In Yaoundé, 7 out of 20 ‘spleen’
caregivers (35%) reported having received training from a person to whom they were not related. The
fact that this type of knowledge transmission is less common among the Baka is explained by thediversity of knowledge within this community. On the other hand, the significant proportion observedin Yaoundé reflects the adaptive dynamics of people in search of effective therapeutic formulas
applicable to victims of the ‘spleen sickness’ in a multicultural context.
7. Discussion
7.1. Biological types and parts used
Our results revealed a preponderance of trees as the source of the therapeutic elements used in Ndongo,
unlike Yaoundé, where herbs are most common among the populations. This variation can be explainedby the judicious exploitation of environmental resources by the rural and urban populations. In this sense,
the large equatorial forest that predominates in southeastern Cameroon has a significant influence on
the way of life of local populations. It has been shown that the Baka, for example, are still highly
dependent on forest resources despite having been sedentarised fairly recently, starting in the 1950s(Lueong 2016, Hewlett 2014). Similarly, the majority of the Bantu for their part depend on agriculture
for sustenance (Hattori 2014, Neumann et al. 2012). This may explain the orientation of their therapeutic
knowledge centred on the abundance of herbs in the fields. All this happened in the context where morethan two-thirds of the world’s plant species have medicinal value (Sofowora 2010). Among these species,
some studies have found a strong preponderance of woody species in traditional pharmacopoeia (Nana
2005, Olivier and Sanou 2003).
Regarding the plant parts used in the management of ‘spleen sickness’, the populations explain thateach part of the plant contains specific therapeutic substances that effectively counteract this healthproblem. The choices by the population are guided by the experience acquired by the ancestors regarding
the effectiveness of each specimen targeted by the therapists in the locality of Ndongo (among the Baka
and Bakwele) or Yaoundé (among the Ewondo, Bagam, Mabi, and Toupouri). From this perspective,
some studies have demonstrated that certain plant organs such as leaves, barks, and roots are used in
traditional medicine in the treatment of common diseases in many African societies (Mbonji 2009,
N’Guessan et al. 2009). In general, herbal medicines include whole plants, parts of plants, plant-basedmaterials, herbal preparations, and herbal finished products, which contain as active ingredients parts of― 291 ―

The persistence of spleen sickness culture in Cameroon

plants, other materials, or their combination (Nacoulma 1996). ‘Spleen sickness’ is a health problem
that affects mostly young children and requires the rapid response of parents, but also the mobilisationof appropriate therapeutic resources adapted for their age. In this perspective, Flahaut (1999) observedthat leaves are more widely used in the treatment of childhood diseases, while Burgund (2002) foundthat the peripheral organs (leaves and roots) play a protective role and are consequently used in theprevention of childhood diseases. The strong preponderance of barks among Ndongo informants andleaves in Yaoundé are also explained by the initial choices recorded among biological types, with apreference for trees in rural areas and herbs in urban areas. Regarding the reasons for theses choice,Betti (2001) highlighted that leaves are easily accessible and contain metabolites responsible for their
therapeutic properties. The preponderance of this peripheral part of plant has been noted in many recent
studies in Cameroon (Etame et al. 2018, Ngoule et al. 2015).
7.2. Hybridisation of ‘spleen sickness’ cultures
The hybridisation of the therapeutic practices used to cope with ‘spleen disease’ can be observed at twolevels, the patient and the caregiver, though we only observed this phenomenon in the urban area. Its
absence in Ndongo can be explained by the diversity and density of therapeutic knowledge within thelocal communities (among the Baka and the Bakwele), a situation that has so far given satisfaction totheir respective members. As regards the manifestation of hybridisation in Yaoundé level, we found astrong commitment on the ground on the part of the population to seek care with the nearest therapist
regardless of their socio-cultural background. Here what matters for the patient without a family member
entitled to perform treatment is the search for an effective solution. This can be understood in that when
the populations migrate towards urban centres like Yaoundé, they do not move systematically with theirlocal healers, and those practitioners who do settle in the city are faced with the difficulty of accessing
certain species they need. Given their instinct for survival, all the patients who thought that they were
suffering from ‘spleen disease’ struggled to find a solution to this crisis. It is thus possible to see an
Ewondo patient from the Central Region being treated by a Mabi therapist from the Southern Region, aBagam from the Western Region by a Toupouri from the Far-North Region, a Mabi by a Bagam or a
Toupouri by an Ewondo, and vice versa. According to the testimonies recorded in the field, it iscustomary to observe the same patient soliciting the services of several practitioners in succession before
finding the cure. This itinerary is explained by the belief shared by the people about the omnipotence oftraditional medicine, whatever the origin of its practitioner.
The second dimension is that of the caregivers of ‘spleen sickness’ themselves. At this level, there
is also the circulation of a category of therapeutic knowledge between the different existing culturalcommunities. Our research reveals that 35% of ‘spleen sickness’ caregivers working in Yaoundé
reported to have received training from people from the same socioculture. Their local know-how, now
shared by the community, contributes to strengthening the capacity of certain practitioners, but also and― 292 ―

Moïse Mvetumbo et al.

above all the cultural proliferation of care for this condition. Indeed, each technique and medication isbacked by a cultural base of design that gives it meaning and coherence and is the trademark of acommunity of practitioners who at one time in history integrated a practice into their repertoire of tricks
to remedy health problems. With reference to the substantial questions inherent in human communities,
Sigaut asserts that learning transmits effective knowledge, meaning, and identity together (Sigaut
1988:24). What usually happens in the case of ‘spleen sickness’ is that when an insider meets a personof good character and believes that the latter can use it as a ‘gift’, to support his fellow citizens, hetransmits some of his knowledge to him. Some access conditions are the disbursement of material andfinancial resources, so that any person who satisfies this request is eligible to benefit from knowledgeof ‘spleen sickness’ care practices. What is common and constant in this process is the favourable social
context of transmission marked by the good relationship between the holder of the knowledge and those
who desire. Sabinot (2008: 307) notes that intimacy and social proximity between learners and teachers
is an essential dimension of learning.
7.3 Influence of the natural environment on ‘spleen sickness’ management
The disease is first of all indicative of the sense of the world of a given human society that is at thesymbolic or ideological level meditated by language (Meziane 2003: 66). On the subject of ‘spleen
sickness’, the Cameroonian people adopt various denominations to qualify it by putting a particularemphasis on the environmental reality. In this context, the informants of our two sites explicitly adduce
connections between this ‘evil’ and the elements of nature. We have therefore collected the names kòna ngέndὲ-so ‘animal liver disease’ in the Baka language, ɛpial-ɛ-tsite and ɛpial-ɛ-zock ‘disease of theliver of the animal’ and/or ‘Elephant liver disease’ among the Bakwele, tsite ‘meat’ among the Ewondo,‘tchiri’ ‘animal’ among the Mabi, and bagyec’ ‘cricket’ among the Bagam. The adoption of theseconcepts to describe the ‘disease of the spleen’ raises a part of the veil covering the relations that thesedifferent peoples maintained in the past with the fauna around them.
The multiple names recorded for ‘spleen sickness’ both in urban and rural areas reflects the historyof populations, but also express the context within which this health problem occurs. In this perspective,
Mebenga (1988: 19) observed that verbal symbols constitute the sources of knowledge, the screens ofpeople’s lives, and the retrospective knowledge of their civilisations. If the historical proximity between
humans and animals is unmistakable in the south-east in the heart of the equatorial forest, several works
have highlighted that the denominations of many quarters of Yaoundé city have direct links with animals
or environment (Essono 2016, Pondi 2012). The relationship with wildlife is not limited only to the levelof denomination, and the conception of the origin of this health problem also indicates the people’sviews of therapeutic potentialities. We noted in this context in Ndongo the use of nails and elephant skinby the Baka and hare liver and snails by the Bakwele to cope with this disorder of the ‘spleen’. The sameobservation holds in Yaoundé, notably the use of snail slime by the Mabi and Ewondo, dragonflies,― 293 ―

The persistence of spleen sickness culture in Cameroon

locusts, and cows’ hooves by the Bagam, and frogs by the Ewondo. Each cultural group applies its fundof knowledge to its members but also to all outsiders who seek their health services. These are traditional
practices that have been perpetuated from generation to generation since they were first invented. Thisrapprochement between the animal kingdom and the field of health is a current issue for many
researchers. Indeed, the use of fish or animal resources to treat current health problems has been studied
among the Bakwele population (Oishi 2016b), the Baka of Central Africa (Brisson 2011, Sato 1998),
the coastal populations of central and western Africa (Mvetumbo 2013, Sabinot 2008), and by other
African peoples (Maindo et al. 2017).
Other recipes (the majority) are concocted from materials from trees, herbs, and lianas, all essential
components of the plant cover. The Rubiaceae appeared to be the most representative with 12
occurrences, followed by Asteraceae with 6 appearances. Concerning the first group, Lachenaud (2017)
revealed that Rubiaceae family is one of the largest families of flowering plants and it is very diverse in
the tropics, where the vast majority of its representatives are trees or shrubs. Several studies conducted
in Benin revealed the preponderance of the Rubiaceae family (Adjakpa et al. 2013, Sangare 2012). On
the other hand, the predominance of the Asteraceae family has been reported by Betti et al. (2013) in asurvey of plants used in the treatment of malaria in the Dja Reserve and by Etame et al. (2018) in a studyof medicinal plants and their traditional uses in Lom and Djerem (Eastern Region-Cameroon). The
density of these families supports their importance to the population for medical purposes. Several
researches have investigated the medicinal plants used against ‘spleen sickness’ by populations in
Cameroon (Brisson 2011, Adjanohoun et al. 1996), in Gabon (UNESCO 2009), and in Central African
Republic (Jacqueline, 1959). This indicates the extent of this health problem both inside and outside
Cameroon and the necessity of carefully understanding the dynamism of ‘spleen sickness’ culture.
8. Conclusion‘Spleen sickness’ is a social disease rather than a clinical health problem in many Cameroonian and
African societies, while biomedical practitioners consider this health situation a symptom that candisappear if the disease in which it originates is fully treated, as mentioned above. The populations
attribute its source to heredity, mysticism, or violations of dietary prohibitions. They also believe that
this health problem can be solved only at the level of traditional medicine. Of the 120 respondents in
our two sites, only 2 informants in Yaoundé stated that their problem had been treated by receiving carein health facilities. Almost all of the informants consider their state of health to have been restored thanks
to the care they received from traditional healers. Overall, therapeutic practices are denser and morediverse in Ndongo than Yaoundé. This situation is due to the proximity of local populations to the forest,
which is their main source of supply of therapeutic resources, while the city is marked by a coexistence
between hospitals and culturally diverse local therapists. In the city and in the countryside, the strong
cultural anchoring of health perceptions and practices related to ‘spleen sickness’ is an ambient reality.

― 294 ―

Moïse Mvetumbo et al.

It is therefore imperative to perpetuate the transmission of the therapeutic knowledge employed by
African populations and to foster better collaboration between traditional and conventional medicine inorder to limit both juvenile and adult mortality risks. Also, concerns about the harmful effects ofchemical drugs and the high costs of care in hospitals are in favor of the growing success of
traditional medicine (Dibong et al. 2011, Mpondo and Dibong 2012).

Acknowledgments
The fieldwork of this study was conducted with financial support from MEXT Grants-in-Aids for
Scientific Research: KAKENHI Nos. 16H02716; 18H03439; 17H06342. Our sincere gratitude goes toall informants from Ndongo and Yaoundé. We are also grateful to the Millennium Ecological Museumof Cameroon. We especially wish to express our gratitude to Dr. Denis Sonwa, Dr. Evariste Fongnzossie
Fedoung, Mr. Forbi Preasious Funwi, and Mr. Justin Djondandi Koue.

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Appendix 1.
Table 3. List of plant
Scientific name

FamilyVernacularname/commercial
name
NdongoBaka

Afzelia bipindensis

Leguminosae-Caesalpinioideae

Timi

Alstonia boonei

Apocynaceae

Guga

Anonidium mannii

Annonaceae

Mbe

Ceiba pentandra

Bombacaceae

Coulo'oCordia platythyrsa

Boraginaceae

Mbwabi

Cylicodiscus gabunense

Leguminosae-Mimosoideae

Bolouma

Desplatsia dewevrei

Tiliaceae

LiambaDracaena sp.

Dracaenaceae

Bingi

Erythrococca sp.

Euphorbiaceae

Ndoukou

Erythrococca sp.

Euphorbiaceae

Ndoukou

Milletia sanagana

Leguminoseae-Papilionoideae

Ngada

Myrianthus arboreus

Cecropiaceae

Ngata

Persea americana

Lauraceae

AvocadoPicralima nitida

Apocynaceae

Motokotoko

Pycnanthus africana

Myristicaceae

Tombè

Rourea obliquifoliolata

Connaraceae

Toukoussa

Schumanniophyton magnificum

Rubiaceae

Gogologo

Strombosiopsis tetrandra

Olacaceae

BobongoBakweleAframomum melegueta

Zingiberaceae

Anchomanes difformis

Araceae

Deuleuzock

Boerrhavia cf. coccinea

Nyctaginaceae

NalekeCarica papaya

Caricaceae

PapayaCitrus reticulate

Rubiaceae

Mandarin

Citrus sinensis

Rutaceae

OrangeElaeis guineensis

Arécaceae

Palm oil

Mangifera indica

Anacardiaceae

Mango

musa paradisiaca

Musaceae

Banana― 300 ―

Moïse Mvetumbo et al.

Pausinystalia johimbe

Rubiaceae

Ngorgue

Persea amer

Lauraceae

Avocado

Theobroma cacao

Sterculiaceae

Cocoa

Uncaria sp.

Rubiaceae

Becoline

YaoundéEwondoAframomum melegueta

Zingiberaceae

MvonloAgeratum conyzoides

Asteraceae

King grass

Annickia chlorantha

Anacardiaceae

NfouolCarica papaya

Caricaceae

PapayeChenopodium ambroides

Chenopodiaceae

Combretum micranthum

Combretaceae

GometaneDichrocehala Integrifolia

Asteraceae

MidzalaErythropheleum suaveolens

Ceaesalpiniaceae

Tali

Gnetum africanum

Gnetaceae

Morinda lucida

Rubiaceae

Akeng

Vernonia amigdalina

Asteraceae

Bitter leaf

Voacanga africana

Apocynaceae

Etoam

Allogen population (Bagam, Mabi and Toupouri)
Aframomum melegueta

Zingiberaceae

so'o

Ageratum conyzoides

Asteraceae

King grass

Azandirachta indica

Azandirachta indica

Gaillé

Canarium schweinfurthii

Burcéraceae

Bé

Carica papaya

Caricaceae

PapayeClerodendron aff. Anomala

Lamiaceae

Queen of herbs

Elaeis guineensis

Arécaceae

Palm oil

Euphorbia hirta

Euphorbiacea

BoungmonHarungana madagascariensis

Hypericaceae

Ntounyé

Khaya senegalensis

Meliaceae

Bagué

Palisota ambigua

Commelinaceae

Mbolimbo

Rauvolvia vomitoria

Apocynaceae

Touna

Triumfertta cordifolia

Malvaceae

Chimbelè― 301 ―

The persistence of spleen sickness culture in Cameroon

Appendix 2. Photographs

Figure 5. (A)Massage of a ‘spleen sickness’ patient (Yaoundé, 2017), (B)Care administration byinhalation (Yaoundé, 2017), (C)Care administration by scarification (Ndongo, 2017), (D)Care
administration by scarification (Ndongo, 2018)― 302 ―