Ethiopian Highlands

Two lines of highland medicine

Highland medicine runs in a written line and a hand line

Ethiopian highland medicine has two streams, and they are not the same craft. One is written. Church-trained scholars copied prayer, remedy and protection into Geʽez manuscripts, and those manuscripts survive in Ethiopian monasteries and in European libraries with catalogue numbers attached.

The other stream is manual. The bonesetter and the herbalist learn from a teacher, work with their hands, and leave no books. Their knowledge moves from person to person, which is why it took field researchers rather than librarians to write it down.

The written stream is old enough to date by physical test. The Garima Gospels, kept at the Abuna Garima monastery in Tigray, were assigned by radiocarbon analysis to the late fifth to early seventh centuries. They are written in Geʽez, the classical language of the Ethiopian church, and they place a literate culture on the plateau at a fixed date.

Highland medicine did not descend from Greek medicine. Ted Erho of the Hill Museum and Manuscript Library puts it flatly: no ancient medical treatise by Galen or Hippocrates is known in Geʽez translation. The plateau traded across the Red Sea for centuries and still built its medical literature out of its own materials.

The däbtära

Who wrote the manuscripts, and why he is not a priest

The däbtära is an unordained cleric of the Ethiopian church, trained in Geʽez, in the liturgy and in sacred song, and he is the maker of the healing scrolls. The museums that hold his work identify him that way. Princeton catalogues its scroll as the work of a däbtära, and the University of Toronto exhibit of Ethiopian manuscripts describes scrolls tailor made by däbtära for a specific person and a specific illness.

A priest performs the sacraments. The däbtära carries the church's learning and the older healing knowledge alongside it, and that is what put manuscript medicine in his hands rather than in the hands of the altar clergy.

He is also not the bonesetter and not the herbalist. Those are separate crafts, learned separately, with their own terms and their own practitioners. Collapsing the three into one figure is the most common error made about Ethiopian healing.

The scroll and the church's medical books

A healing scroll is cut for one named person

A healing scroll is a strip of parchment written and painted for a single individual, and its length is set by that person's body. The Toronto exhibit describes scrolls sewn together to roughly the height of a human body. The Princeton scroll made between about 1770 and 1830 runs 246 centimeters by 12.

That scroll was made for a woman named Asädä Maryam, and its text appeals for protection in the name of Saint George so that she be healed of plague and malaria. Its imagery includes an eight-pointed star with eyes, a serpent consuming its own tail, and a fish. Scrolls were usually rolled into small leather tubes and worn on the body. This one has holes at both ends and probably hung from a post inside a house.

The written medicine reaches well beyond scrolls. The Maṣḥafa bāḥrey, the Book of the Pearl, was compiled around 1441 under Emperor Zarʼa Yāʼeqob, and it sets the prayers of priests beside anointing with olive oil. The Maṣḥafa qandil, the Book of the Lamp, is the Geʽez rite for anointing the sick.

Manuscript EMDA 00028 carries both texts in one volume. It was written in the late eighteenth or early nineteenth century at the monastery of Marṭula Māryām and belonged to a man named Śāhla Rufāʼēl. Its asmāt prayers work through the body one region at a time. Some name affliction of the liver, the rib and the heart. Others name the hand, the foot, the hip and the bone. Others name the head, the eye, the ear, the nose, the mouth, the throat, the tongue and the tooth.

Tsebel and holy water treatment

Holy water treatment is measured in months

Tsebel is holy water, blessed by priests of the Ethiopian Orthodox Tewahedo Church and sought at churches and monasteries for illness of body and of mind. Baheretibeb, Wondimagegn and Law describe the ritual at two Addis Ababa sites as drinking, immersion or washing. Chanting, blessing and prayer surround it, and it is provided free of charge.

Patients stay at these sites for two to five months, and some remain for one to five years. Recovery is treated as a course to be lived through rather than an event to be delivered in an afternoon.

The same study reports a working collaboration between those priest healers and psychiatrists from Addis Ababa University and the Ethiopian Mental Health Society, running eight years at the time of publication. Of 1,888 patients seen at the joint clinic, 54 percent were meeting biomedical services for the first time and 26 percent had been referred by a priest healer. The authors report that up to 98 percent of first contacts in mental health help-seeking in Ethiopia are with traditional practitioners.

The herbalist and the plants

What the plant record of the highlands counts

Plant medicine is the third highland stream, and it has now been inventoried in detail. Alemu and colleagues worked in Habru District in the North Wollo Zone from June 2021 to December 2022, interviewing 388 informants across all thirteen kebeles, with 42 key informants selected on top of that.

They documented 134 medicinal plant species in 110 genera and 54 families, two of them endemic. Leaves were the most used plant part at 47.3 percent, ahead of roots at 22.1 percent, and 58.2 percent of preparations used fresh material.

Healer agreement reached a fidelity level of 91.3 percent for Solanum somalense in diarrhea, 88.9 percent for Ocimum lamiifolium in febrile disease, and 85.7 percent for Verbascum sinaiticum in wounds. Practitioners who never met converging on one plant for one complaint is the signature of a result being observed rather than a custom being inherited.

The wogesha

How Ethiopia's bonesetter works, in the practitioners' own account

The wogesha is Ethiopia's traditional bonesetter, and the craft passes from parent to child and by apprenticeship. Mekonnen and colleagues interviewed ten wogesha and eleven orthopedic surgeons in Addis Ababa between April and September 2023. Most of the wogesha had practiced more than ten years, and most reported between 100 and 500 client visits a year.

The materials are ordinary and precisely chosen. One practitioner listed tape, cardboard, abujedi cloth and bandage, and named bamboo as the most important of them. The work itself is done by hand. A survey of 420 injured patients at Woldia Comprehensive Specialized Hospital reported massage as the most common method at 33.2 percent, then bamboo splinting at 30.2 percent and traction at 23.7 percent. The paper does not state whether those shares are of all 420 patients or of the 232 who used a bone setter.

A wogesha in the Addis Ababa study put recovery at six to twelve months, depending on the degree of the damage and its location. Practitioners counsel patients on eating for a healing bone and appoint them for follow-up. Some travel to patients who cannot travel and treat them at home so the injury does not worsen.

Reduction, binding and a course of months are three separate decisions inside one craft. Each one is a different kind of judgment, and the wogesha makes all three on the same limb.

The clinical record

What the studies of wogesha practice report, including the harm

Wogesha practice is current and heavily used. Seid and colleagues surveyed 420 patients with musculoskeletal injuries at Woldia Comprehensive Specialized Hospital in April and May 2024. Traditional bone setting had been used by 55.2 percent of them, with a 95 percent confidence interval of 50.44 to 59.95. Rural residence, low annual income and extremity trauma each predicted use, and patients with health insurance were less likely to have gone.

The harm is documented with the same care as the reach. Orthopedic surgeons in the Addis Ababa study named malunion and nonunion from the absence of imaging and proper reduction, compartment syndrome and gangrene from constrictive immobilization, and infection and tetanus where sterility was lacking. One surgeon described a child whose arm was saved and left bent.

The most dangerous failure is the binding. Eshete counted 49 amputations over two years in southern Ethiopia, 25 of them for gangrene following splints applied too tightly. Ten one-day instructional courses were then given to 112 traditional healers, and local health assistants received two-day courses with written guidance. The next two years recorded 25 amputations, 7 of them for gangrene.

A systematic review by Onyemaechi and colleagues pooled fifteen hospital-based studies published between 1986 and 2018, covering 1,389 patients who presented with 1,470 complications after traditional bonesetting. Those authors concluded that the practitioners can contribute to primary fracture care when they are trained.

The wogesha interviewed in Addis Ababa wanted access to training and were willing to refer what they could not handle, and one said outright that injuries beyond his control were sent to hospital. The surgeons were skeptical and named lack of expertise and lack of accountability. A regulator at the study workshop described a three-year plan to integrate the two, starting in rural areas.

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