Local Perception of Coronavirus and Disease Care in Southwestern Nigeria

The Yoruba Conceptualization of Microscopic Disease

The Yorùbá belief system has a great deal of influence on the causation of illness as well as the caring and curing of illnesses. There are several preter-natural agents believed to be causal factors of these illnesses. Such as some local divinities - who according to Yorùbá cosmology were responsible for the creation of the world; the ancestors - the living dead in the spiritual world, that are viewed by the Yorùbá to have more power than the living; the spirits - who are apparitional entities called different names among the Yorùbá, such as ẹbọra, ànjọ̀nú, iwin and ọ̀rọ-igi. These agents are believed to have mysterious powers which are either good or bad. The ones with good intentions among them help humanity in solving some of the problems associated with all forms of sicknesses through the use of herbal medicine; of which they have more knowledge than any human being. The malevolent ones among them are believed to be part of disease causation in the life of humanity - individual, groups or even the whole world at large.

Since divinities, ancestors and spirits are believed by the Yorùbá to be sources of disease causations, they are controlled by the means of religion through veneration so that the Yorùbá can always have good health. Veneration is done through prayers of worship, offering of sacrifice, appeasement and supplication. They are also brought under control through the use of magic and medicine [6].

Although it is believed that all illnesses or diseases emanate from the spiritual before it is manifested in the physical, there are some diseases or illnesses that are believed to have natural causes. They include biomedical illnesses like headache, stomach ache, cough and so on - which are scientifically linked to poor nutrition, dirty environment, insect bites. These types of diseases are treated with herbs and sometimes incantations [7].

Preter-natural diseases like mental illnesses or obstructed pregnancy and some other difficult child labouring are believed to be caused or influenced by the activities of witches, wizards or sorcerers. Most of the time, some of the ailments with natural causes can become difficult to cure; they are then associated as spiritual diseases. These are cases of “ẹ lọ fẹsẹ̀ ilé tọ́”2 which defied scientific and medical solutions.

Mystical diseases or illnesses are also believed to be caused and influenced by evil spirits called Ajogun. Sometimes divinities and ancestors, as earlier mentioned, can also afflict human with mystical diseases if their rules and regulations are violated or human refuse to hearken to their voices. However, majority of these diseases are caused by Ajogun. Such diseases if it affects individual or few people are referred to as Arun, Àìsàn or òjòjò. However, if it affects a whole community, town city, or countries - like the case of bird flu, Ebola and coronavirus, it is called Àjàkálẹ̀ àrùn; a disease that is transmitted from one community, town, country to another. Thus, commonly referenced due to their frequencies of occurrence among Àjàkálẹ̀ àrùn are measles (measles virus), yellow fever (flavivirus) and smallpox (variola virus).

In the past, before the advent of modern medical practices and provision of modern medical facilities in Nigeria, the Yorùbá had its ways of combating epidemics. In situation of a breakout, the first thing to be done is to consult Ifá oracle. It is usually the Ifa oracle that will direct its steps toward combating epidemics. In situation like that, Ifá would indicate the particular Ẹbọ -sacrifice to be offered to ward off the evil illness and herbs to be used in curing are inferred from Ifa verses. One of such can be found in Odù Ọ̀wọ́nrín Ṣogbe3 where Ifá says:

Bọ́ọyá awo wọn lóde Ìdo Booya the priest of Ido town Ọ̀ gọ̀rọ̀ngbọbì awo wọn lóde Ìjèṣa Ogorongobi the priest of Ijesa land Èrìngùndúdú awo ìlú Ìṣakin Eringundudu the priest of Isakin Àwọn gbinrin àjìja Gbinrin Ajija Àjìjà gbinrin Ajija gbinrin Agogo ẹṣin ní ji It is the gong of the horse that wakes up Ní kó gbinrin gbinrin hánu To place gbinrin gbinrin in its mouth A dífá fáwòdi Casts divination for Awodi (Hawk) Lọ́jọ́ tó nlọ wòréré ayé ṣàkun ṣàkun On the day he was going to gaze into the world Agogoríre Agogorire Bẹ́ẹ̀ni ò gbọ́fa Has no knowledge of Ifa Bẹ́ẹ̀ni ò moògùn At the same time has no knowledge of herbal medicine Ogún ọmọdé bá pé láro If twenty children stay in the blacksmith workshop for a long time, Kò lé mọ̀dí àwòdìòkè Í wo They cannot know the secret of Awodioke A dífá fún Ọlọ́fin Ọ̀jẹ́mbẹ̀lẹ́ Casts divination for Olofin Ojembele Èyí tó nbá nkan ibi sùn Who was sleeping with evil things Èyí tó nbá nkan ibi ji Who was waking up with evil things Èyí tí gbogbo aáburú ilé ayé filé rẹ̀ ṣebùgbe Whom all evil things in the world were living in his house Wọ́n ní kó kára á lẹ̀ He was advised Ẹbọ ni kó má a ṣe To be offering sacrifice Ó gbọ́ rírú ẹbọ ó ru He heard and offered sacrifice Ó gbọ́ ẹrù àtukèṣè ó tu He heard appeasement of Esu, he offered Ọjọ́ pé lóní o It is appointed date today Alápó ngbápo Those who want to carry Apo carried it Ọlọ́run ngbọ́run Those who want to carry Orun carried it Tó bá dìje òni On the seventh day from today, Oun ibi á ṣi kúrò nílẹ̀ yi All bad things will move away from this land Èdú gbálé Edu swept the houses Èdú gbána Edu swept the roads Ifá á gbá oun ibi dà sósà. If a will sweep evil things to the lagoon.

In the reign of Ọlọ́fin Ọ̀jẹ́mbẹ̀lẹ́, there was a breakout of an epidemic named Efori tulu - an equivalent of Corona virus - which started from his household. It was a terrible headache affecting both old and young. All efforts to curb its effects proved futile. Ọ̀ rúnmìlà was sent for, Ọ̀ rúnmìlà consulted Ifá and Ifá revealed that it was one Ajogun- a war lord of left side that resides in the air that caused the problem. Since Ẹbọ (sacrifice) was believed to work faster than medicine, an Ẹbọ – a big pot containing a head of an alligator, head of Ọká- puff adder (a kind of snake), bitter leaf, Ọ̀ dúndún leaf-, Tẹ̀tẹ̀ leaf-, Rinrin leaf - with plenty water was later prescribed. All the leaves were squeezed with the water. The pot was hung at the entrance to the town. Everyone who entered the town was expected to drink from it and rub some of the water on their bodies. This was believed to create an immunity against the disease. This sort of practice can be prescribed for individual homes to fight against any epidemic (Àjàkálẹ̀ àrùn). In addition to the above, the Yorùbá also send their appeal to the ancestors to help in situations of Àjàkálẹ̀ àrùn. Some divinities that the Yoruba believe can cause Àjàkálẹ̀ àrùn like Obaluaye - also known as Sanponna can be appeased for calm.

Information gathered revealed that a total fumigation of the entire village, town and kingdom can also be done by combining different leaves like Ọ̀ dúndún, Tẹ̀tẹ̀, Wọ̀rọ̀wọ́, Rinrin, and Ẹ̀là to mention a few. These leaves, symbolically known as ẹ̀rọ̀ leaves are used to carry out the fumigation of the people and the houses in which such breakout had happened. This may sometimes base on the past experience of the priests and herbalists living in such communities or through the dictate of Ifá like the one mentioned above4, To do this, plenty of those leaves are gathered together, squeezed in pots, virgin boys and girls would carry the pots on their heads. In the mist of songs drumming and dance, like the one below:

Ikú lọ nílẹ̀yí, Death has departed this land Iṣu lọ̀lọ̀ ikú lọ, Lolo yam, death has gone Àrùn lọ nílẹ̀yí, Disease has departed this land Iṣu lọ̀lọ̀ àrún lọ Lolo yam, disease has gone The concoction would be sprinkled on every road in the community, every home and people living in the house5. Besides, herbal recipes, can also be prescribed as a further and physical measure against such epidemic. For instance, after offering the prescribed Ẹbọ as mentioned above, the following herbs can be boiled for drinking and for inhaling: Egbò tinúnpọgbẹ́ (Unidentified), Aporópewọ (Usteria guineensis), Egbò ìpẹ̀ta (Securidaca longepedunculata), E_wé and egbo_̀ òruwọ(Morinda lucida), Èso àbèrè(Parinari spp. Chysobalanaceae), Akọgun (_Aristolochia repens), E_èpo awọpa (S_ansevieria sp. Liliaceae), _Egbò ẹ̀gbẹ̀sì (Coelocaryyon preussii), Egbò àtaparí òbúkọ (Heliotropium indicun), Egbò ifọn (_Dioscorea cayenensis), _Ìrẹ̀sílẹ̀ ewé ipín (_Ficus exaspera), _Ewé dógóyárò, Akọ kánún(_Potash) and _Bààrà (Citrullus lanatus)6. Other herbs mostly mentioned by herb sellers in Bode herb markets include: Shea butter, Palm oil, Garlic, Lemon, Bitter-leaf, Efo Yanrin, Brown onion, and Ginger. They claimed that demand for these herbs has tremendously increased following the outbreak of COVID-19, suggesting their use as anti-microbial to prevent COVID-19. Their preparation are in different forms including boiling a combination of some of the leaves at once and drink. Some are dried, grind and added to palm oil or shea butter used as ointments, while some others are steamed and inhale for quick recovery7. Table 1 below present detail ethnobotanical descriptions of the commonly used herbs against microbial diseases like COVID-19.

In Yorùbá society of southwestern Nigeria, there are different terms used in qualifying diseases or sicknesses. The local term for a symptomatic ailment (disease) is Arun, while a phenomenological ailment (sickness) is referred to as Aisan. While distinction in both is very clear ethno- medically among the people, more often the two terms are interchangeably used. Thus, derogating from their analytical conceptualization. The interchangeableness neither implies confusion in identification of illness behaviours nor care strategies associated with the two. Synonyms like Òjòjò, ailera, aigbadun among others are common expressions of illness state with may generate metaphors like “Òjòjò nṣògún, ara Ògún ò le_”_8. Àrùn is a general term covering many ailments irrespective of their causative agents. Particularly the Yorùbá describes ailments caused by unspecified biological organisms such as virus, bacteria and fungi as arun and contagious disease is called Àjàkálẹ̀ àrùn. The Yorùbá believes in existence of microscopic organisms that could cause ill health, yet analytic description of these organisms as done in modern science is absent. Thus, Yorùbá does not have distinctive classification among virus, bacteria and fungi. All these microscopic organisms are referred to as _Aifojuri_9 (inability to be seen with naked eyes). Their existence is linked with poor hygiene and sanitation, change in weather and affliction due to desecration of society. As exemplified by Ifakunle Awolowo, dirty environment can breed microorganisms. While this was generally supported by all the herbalists interviewed, they also stated that seasonal variations can also bring about breeding of microorganisms capable of causing illness in human.

Àrùn can afflict an individual. In if a chapter of Ogbè’sẹ́ [8] narrative of a hunter who was infected by disease caused by unknown microscopic organism due to his failure to propitiate Ifa is recounted as follows:

Àbàṣẹkẹ́nṣẹ́ke Abasekenseke

Ló dífá fún Ọde Casts divination for a hunter Tí nlọ sóde Ìwo Who was going to the city of Iwo Wọ́n ní kó rúbọ He was asked to offer sacrifice Kò ru, He reused Ó pawo léké, He called the priest a deceiver Nígbà tó dé ọ̀nà, On his way, Àrùn ẹsẹ̀ kọ́lú A sickness afflicted his legs.

While disease as infection caused by microscopic organisms can afflict individual, it can also be an endemic infection affecting a whole family. In another Ifa chapter Odù Ọ̀kànràn Méjì [9] narrative of an infection caused on a husband, wife and children in a household was related as follow:

Oye ni o san ara Harmattan does not produce thunder strike Kurukuru o ta monamona The fog does not produce lightning Ako aparo, abo aparo The male and female bush fowls Won o lagbe lori sanansan Do not produce comb on their heads A difa fun olofin Casts divination for Olofin

Olofin nrunte Olofin was bedridden

Won ni ko gbodo ku sinu ite They told him (his priests) he must not die in bedridden Onase aya a re nsojojo arun, Onase his wife was afflicted with a disease Won ni ko gbodo ku sinu arun She was told (the priests) she must not die with a disease Okanbi omo o re nsorengede, Okanbi his son was seriously sick Won ni ee forengede ku They said (the priests) he must not die with sickness Oni dudu gba dudu, oni pupa gba pupa Those who will collect black and red for offering did Alayinrin gbayinrin Those who will collect multi- colour did Barapetu, Barapetu (Orunmila) O ba mama koku o karun We wish you carry death and sickness Baraapetu Barapetu Another Ifa chapter, Odù Ọ̀sá Méji as narrated by Ifalowo Alabi10 suggests that Arun can also afflict a group, village, town city, country. This chapter narrates as follows_: _Ifa ni won o k un mojo mojo Ifa ni won o k un mojo mojo Ifa ni won o ki un meji meji Ifa ni won o ki un meji meji Ifa pele mojo mojo Ifa pele mojo mojo Ifa pele meji meji Ifa pele meji meji Ifa pele Ifa pele Omo ologbaagbara eti ode Ofa The son of Ologbagbara besides Ofa Orunmila loun kii sara ode Ofa Orunmila says he was not from Ofa O loun dode ofa He said he got to Ofa O loun bawon, ojojo kege kege ni nsewon He met them with various sicknesses Ori nfo won, edo ndun won They had headache, liver problem Lara won o piye They were not completely whole Oun ni won difa si They consulted the Oracle because of this Pe oun ti nse awon yi nko, o se le san? That with what afflicted them, would they be healed?

Orunmila says two hundred hard stones, two hundred cocks, Orunmila ni igba ako okuta, igba akuko adie, Ki won ni egbeegbaa igba Two hundred cowries in two hundred places O ni ki won o rubo lode Ofa He said they should offer it as sacrifice L’Òrúnmìlà bá gbá ìyẹ̀ Ifá sí àwọn òkúta wọ̀nyẹn Orunmila sprinkle Ifa powder on the stones O ni ki won lo ma jijagudu e He said they should scramble for the stones Eni ti o ba ti ri mu, Whoever did not get from it Tie tan His/her own has finished Nibi tawon marun mefa gbe njijagudu okuta kan, Where five or six people were scrambling for one stone, Ni gbogbo Àìsàn ti nsewon lode of aba san All the sicknesses that afflicted them disappeared Oun ni eyi ti won se npe That was the reason why people said Ijakadi loro ofa Street fight is the Ofa Oro- festival According to the chapter, a whole continent or the entire globe could also be affected by Àrun [10].

Local Perception of COVID-19

The Yoruba of southwestern Nigeria emphasizes two, often contrasting constructions of illness. The first being the modern, analytical and scientific construction based on knowledge generated from modern biological science that establishes germ theory of disease causation and care. The second construction is the local explanation of etiology and etymology of the disease, resting on local ethno-scientific understanding of illness. Social class featuring education, income and religion largely determine construction of illness among individual Yorùbá. Mostly the high income educated Christians and Moslems hold on to modern construction, albeit occasional swift to local explanation when considering the mode of the disease transmission and the severity of the illness with the attendant expression of panic and fear through which modern construction is mostly defied like the case of “ẹ lọ fẹsẹ̀ ilé tọ́” earlier mentioned. The local construction of illness structures the perception of mostly non-educated low income traditional religious believers. These two constructions shape the local perception of COVID-19 among the Yorùbá of southwestern Nigeria.

At the onset of COVID-19 in the early year of 2020, just like initial Yorùbá perception of HIV/AIDS in the 1980s, due to the pervading knowledge of the disease, the Yorùbá disbelieved COVID-19. Attaching the emergence of the virus and the disease with the cultural absurdity leveled against Asians especially the Chinese. Shortly before the global awareness of the disease, an online video showing some Chinese eating raw animals and insects went viral online through Facebook and What Sapp media images. In addition, over the years of Chinese invasion of Nigerian economy and technological development, a good number of Yorùbá perceived the Chinese as being shrewd and fake. So when COVID-19 was associated with Chinese origin, the Yorùbá had no excuse rather than linking the disease with cultural perception of the Chinese, disbelieving the reality of the infection based on Yoruba perceived shrewdness of Chinese international economic culture. Mode of the disease transmission further akin to Yorùbá perception that COVID-19 is foreign and could not infect locally resident people. Up till April 4th 2020, data released by Nigerian National Centre for Disease Control (NCDC) suggest that 75% of all Nigerian infected with COVID-19 were returnees from foreign countries like Italy, US, Ivory Coast, Italy and China and the rest 25% are those having contacts with foreign countries’ returnees.

The dreadfulness of the disease in China claiming several lives, spread to other countries of the World with its attendant devastation especially on morbidity, mortality and international economy, the Yorùbá schism of disbelief started to decline. In February 2020, when the first incidence was noticed in Lagos, Nigeria; the reality of the disease was gradually dawning on the people. Albeit the perceived notion that COVID-19 is a disease affecting corrupt politicians and Diasporas who live abroad where the disease had heavy tolls. Many corrupt politicians in Nigeria are often in the habit of incessant traveling abroad for holidays and tourism, governmental meetings, and medical tourism in a bid to save their loots. Since the initial and majority (98%) of the disease contacts fell into these categories, the public sentiment was in line with God punishment for corrupt politicians and disease that can only affect the rich people.

As a defensive narrative against public transmission of the disease, high humidity, high temperature, low contact with diasporas and returnees from foreign countries were held as protective devices that could not make wider infection possible in southwestern Nigeria. Similarly the Yoruba believe that consumption of certain foods like hot pepper soup and local herbs which are common diets among the Yoruba would largely prevent the spread of infection.

Another contrasting view about COVID-19 commonly held among the local herbalists is that of biomedical construction and preter-natural explanation; and that of being a deadly viral disease and virulent catarrh which is treatable with the use of anti-microbial drug solutions. Since the local media information about the disease suggests a biomedical infection which is alien to Yorùbá society, local herbalists tend to believe so, but treating the disease as microbial disease which shares symptoms of virulent catarrh and respiratory tract infections. They also weave the causative understanding of the disease around the general preternatural causative perception of diseases and illness. At first seen it as a punishment for societal desecration caused by the corruption of the political elites and also as affliction by preternatural forces of Ajogun11 . Thus, care patterns reflect these local perceptions.

Care Strategies

Informed by biomedical causation of COVID-19, care strategies include health promotion and education, ‘stay safe’, ‘social distancing’, ‘limited contact’, ‘self-isolation’, ‘stay at home’, lockdown and use of palliative drugs, while the use of local herbs is informed by cultural perception of the disease. Health promotion and education featured campaign for improved sanitation and propagating the preventive knowledge against COVID-19. Through health campaign, knowledge about the disease symptoms were made public and responses to the expression of the disease symptoms were related through online, electronic and print media. Health care infrastructures were improved upon to be able to cope with the outbreak of the disease. Research institutes like Nigerian National Centre for Disease Control (NCDC) and universities research centres were reactivated to generate data useful in controlling the outbreak of the disease. Specifically, in line with World Health Organization (WHO) NCDC set out basic information on the disease. Governments at all levels also set up committees dealing with management of the disease. Preventive measure of stay safe was also grossly engaged through regular washing of hands with detergent and ethanol solution; use of face covers and rubbing of hands with hand sanitizer.

Important aspects of preventive care in COVID-19 were social distancing and limited contact. Social distancing specifies limited number of people clustering together in places of worship, mauls, schools, motor parks, night clubs and places of work. Gathering of people of more than five persons was prohibited to avoid disease contact and majorly to allow for easy tracing of the disease infections. Based on the expression of social distancing, schools, places of worship, local markets (except those dealing with sales of food items and pharmaceuticals), motor parks and night clubs were shut down and curfew was imposed in Oyo state between 7pm and 6am. In three states of south western Nigeria (Lagos, Osun and Ogun) were imposed with lockdown and stay at home. Up till April 4th 2020, Osun and Oyo states had higher prevalence of COVID-19 cases in Nigeria (89 and 19 cases respectively). Although as at April 4th, 2020 Ogun state had low prevalence of four cases, but since Ogun state shares borders with Lagos and has many international border outlets, lockdown and stay at home became imperative in the state. Lockdown emphasises closure of all land, air and water entries to Lagos, Ogun and Osun states and restriction of movement within the states. It also includes stay at home backed by state legislations whereby people are enforced by security operatives to stay in their homes.

Curative caring includes testing for COVID-19, self- isolation and use of palliative drugs. COVID19 test kits were acquired by each state government in south-western Nigeria. Upon tested positive, the patients were admitted in isolation-centres built by governments. The isolation centres were equipped with ventilators and provision of intensive care for the inmates who are patients of COVID-19. The use of palliative drugs mostly anti-malaria drugs, and vitamin C, were commonly administered since no drug has been invented specifically against COVID-19. Home remedies featured the use of locally-formulated anti-microbial drugs by Yoruba herbalists. Claimed to be very effective considering their use in previous outbreak of microbial diseases like Cholera, Lasa fever and small pox among others, the local herbalists in south western Nigeria prepared these drugs locally and made case for government patronage, using them in treating COVID-19. While the call on government by herbalist’s not yet yielding, unofficial patronage of local herbalists for anti-microbial drugs by individuals who used the drug as prevention increased. According to herb seller in Bode market “there is an increase in demand for garlic, ginger, lemon and lime due to the outbreak of Corona disease”12. The increase is because, garlic, ginger, lemon and lime are anti- microbial agents.

Utilization of Local Herbs against COVID-19

Local conceptualization of COVID-19 influences the use of local herbs against the disease. The Yoruba of southwestern Nigeria has local knowledge of extracting local herbs for medicinal purpose, mostly drawn from ancient Ifa verses and age long discovery in local medicine. According to Ifawole, a position corroborated by all interviewed Ifa priests, Orunmila refers to microbial infections as Arun Aifojuri, and in Ejiogbe and Ofun-meji chapters of Odu ifa, instructions on the care and preventions were coded.

Although most microbial diseases are contagious and if not checked on time, they can cause population decline in community. Nonetheless they are curable. As narrated in Ejiogbe and Ofun Meji, common herbs used in preventing and curing microbial disease are Oju oro (water lettuce), Ewe Ewuro (Bitter leaf), Omi Igbin13. (Cornu aspersum), Ori (sheabutter), Epo Pupa (palm oil), Oti (wine) and Emu (Palm wine) among others. Also included are the blackseed oil, honey and carrot. Detail ethno-botanic descriptions of the herbs that have prevalent use among the Yoruba during the era of COVID-19 are contained in Table 2 below.

Following the interviews held with local herbalists and herb sellers in southwestern Nigeria, and the validation of some of the mentioned herbs, Tables 3 contains lists of local herbs commonly used to prevent and cure microbial diseases while Table 4 consists of the local herbs used in treatment of Respiratory Tract Infection among the Yoruba of southwestern Nigeria. The mentioned herbs are being subjected to further research for possibility of drug delivery.

Table 5 below further collated some herbal drugs preparations used in prevention and treatment of microbial infections among the Yoruba of southwest Nigeria. These were collected from the interviewed Yoruba local herbalists and subjected to ethno-botanical analysis.