Author(s): Lenna Liu, MD

Date Last Reviewed: February 1, 1995

Photo Jack Lawrence (cc license)

Disease Recognition

The following information was obtained from a man who was originally from the countryside and a woman originally from the city. She has a child with asthma and has been in the United States for over ten years. Some of her responses may reflect knowledge about asthma that she has received while living here.

Asthma is called /az’ ma/ in Tigray. Although it is virtually unknown in the rural villages, asthma is seen in the towns and cities, although not as commonly as in the US. Asthma was also seen in the Sudanese refugee camps.

People recognize a difference between asthma and tuberculosis. Asthma comes and goes while tuberculosis stays and makes one very sick, causing joint pain and fever. Colds occurred at different times, places, and weather conditions. There was no stigma or taboo associated with asthma; they both stated it was much worse to have tuberculosis and be quarantined.

Symptom Recognition

Symptoms reported included “shut off breath, hear something from the lungs,” noisy breathing, breathing problems, and cough. There was no word for wheeze in their language.

Disease Causation

People reported that things in the environment caused asthma.

Symptom Exacerbation / Relief

Asthma symptoms were caused by colds, food, weather, cleaning the house, smelling bad things (such as cow dung or dirty things), and dust. People knew to avoid smells that made their symptoms worse. Attacks of asthma could be cured by moving away and changing residence.


Old people in the community in the villages and towns would be consulted for treatment of asthma. They were called /fel’ aht aht/ or the “knowledgeable people”. They had remedies that were passed on from generation to generation. In towns, western trained doctors or healers could also be consulted.

Asthma was treated in both urban and rural areas with herbal medicine. The home remedy consisted of a very special honey /ma ahr’ tsedenay/ (the name of the bee and the honey it produces in the ground) melted together with butter. The honey could be obtained in the market. It was good for many ailments including heart disease, chest tightness, bad cough, and the cough of tuberculosis. In the Sudanese refugee camp, asthma was treated by drinking a type of oil. One woman said she had good experiences with western medication, and that they worked.

Concept of Prevention

We discussed the issue of compliance. Both agreed that compliance should not be a problem because “doctors and the aged are `second to God.'” “We go to a doctor for help, we completely trust them.” There was no concept of taking a medicine to prevent getting sick. Medication was only for people when they are sick. The only analogy for prevention was vaccination which is familiar to all people. With regard to chronicity of disease, they did believe people understood that some illnesses did not go away. “You just live with it.” They said that in general people do not like to use medicine. It was preferred to “just eat or sleep and get better.” Families were knowledgeable about illness through their own experience and knew what was more or less serious and what to do for each illness.

Other Cultural Issues

They said smoking was against the religion of the people (both Muslim and Christian). In their culture, smoking was unacceptable, shameful, and disrespectful of others. They both stated that they knew people who developed asthma in the US and not in Africa. They all had to move to a different part of the US to be cured of their illness.

In Sudan, hepatitis was treated by burning parallel marks on the wrist with a particular bark. Migraines were cured by pumping blood from the temples. For throat infections uvulectomy was the cure.