Clinical Features
Difficulty breathing and the struggle for air were the most commonly reported symptoms of asthma. One person interviewed said the struggle for air \ usually occurred suddenly and to the point of making a sound (he made the sound and pointed to the suprasternal tug that occurred). He called this sound sikek. He also said that a seasonal pattern of coughing (in the spring, when the flowers are blooming) was consistent with asthma.
Translation or Language Equivalents
Peoples’ familiarity with asthma depends on where they live in Ethiopia. For the Amhara people the country can be divided into the dga or northern-most region (high elevation, colder in temperature), the weyna dga or middle region (more temperate), and the khola or lower region (hot, mostly dry, low land). In the northern and middle regions, asthma is not as common and is less familiar. There it is called a’ fen. This name is derived from the symptom it causes called ma’ fen which describes the difficulty breathing, lack of air, or struggle for breath which is seen with the disease. In the lower region where asthma is more common and where there has been more of an urban or western influence, it is called azm derived from the English name, asthma.
Cultural Knowledge and Traditional Treatment
Asthma was distinguished from colds, pneumonia, tuberculosis and other illnesses of the lung. Pneumonia is very common, associated with cold air exposure, and treated with cupping in the home. Tuberculosis or samba nkersa (samba means lungs, nkersa means cancer) is recognized as a more serious and severe illness, treated by isolation due to its communicability. There was no stigma or taboo associated with asthma. People were aware that one can die from asthma and although it is occasionally seen in children, it is more common in the elderly. Children are also thought to grow out of their symptoms.
The etiology of asthma was unclear. Some thought it was contagious to some extent because it was associated with tuberculosis which is known to be communicable. One woman recognized that it ran in families and was hereditary, but this concept was not universally known.
Changes in weather and seasonal changes (especially the spring) were most commonly reported to worsen asthma. The spring was particularly bad due to the “contamination of the air” from the flowers. Dust was also mentioned. One person mentioned that people would sprinkle water on the floor of homes where the floors were very dusty. They would not sweep because that would bring up the dust and make symptoms worse. I asked about pesticides in agriculture which people said were not particularly common for the majority of farmers who grew for their own sustenance. Pesticides or special fertilizers were only used by cash crop farmers who also used modern methods of farming. Smoking was not common in the countryside.
Asthma episodes are treatable by using the proper medicine (from a healer). It can be “cured” by changing residence and moving away from a climate or environment which makes it worse. It can also be prevented by avoiding things that make it worse. People recognize that “it is something that you live with” and may last a lifetime.
It is treated in the home by using a special honey called tazma mar. This honey can be found in the markets of Ethiopia and is easily available. It is also used for other types of cough. One man did not know if this honey was available in the United States; however, he thought that people would continue to use regular honey bought in supermarkets as a home remedy here. There are two types of healers in Ethiopian countrysides. The bone setter called wogesha treats fractures. The medicine man or knowledgeable person called medihanit awakge (medihanit means medicine, awakge means wise) treats other common illnesses and dispenses herbal remedies. The medihanit awakge provides herbal medicine to treat asthma. People did not know what herbs are used; this is not common knowledge of the people. The healing secrets of the medihanit awakge are passed down from generation to generation. Western medicine to treat asthma is available in the cities and was most influenced by the British and French. People did not know what medication was used.