‘Agbo’ takes over medicine cabinets

After covering more than 740km from Abuja, Peter Onifade wound up in front of a corner shop behind MKO Abiola Stadium in Abeokuta. Darkness was falling, rain drizzling. The elderly shop owner was set to shut for the day, but she listened like a doctor as Onifade complained of back ache. He reached behind him […]

After covering more than 740km from Abuja, Peter Onifade wound up in front of a corner shop behind MKO Abiola Stadium in Abeokuta. Darkness was falling, rain drizzling.

The elderly shop owner was set to shut for the day, but she listened like a doctor as Onifade complained of back ache. He reached behind him to indicate just the spot: right of the midline, just under his right shoulder blade.

“I have been taking Ibuprofen off and on for two years for this pain, but I got curious and wanted to try something else,” he says.

The woman sorted three plastic bottles and lined up a stainless steel cup. She measured two shots from each bottle into the cup and handed it over.

Onifade paid N100, and gulped down the mixture in seconds with a grin. It was bitter and smelled of gin. Cuts of beef and cowhide in pepper sauce are on hand to neutralize the bitter taste.

Ten and half hours by road back to Nasarawa, car mechanic Akiti John was having a bad day. It wasn’t just hectic work. He had caught a sexually transmitted infection from a casual hookup.

“I was feeling this burning pain whenever I went to urinate. I even saw some blood,” he recalls.

He didn’t go to hospital, didn’t visit a pharmacy or some petty drug store. His saviour was a woman who has become popular for selling “agbo” at a spot in Mararaba.

At a junction nearby, a loudspeaker is on, announcing the presence of a father-and-son team that uses herbs to cure almost any ailment within 72 hours.

Agbo is a Yoruba word that describes a concoction of plant parts – bark, root, trunk, leaves – steeped or boiled in alcohol or water.

And like plants, it is everywhere. Herbal medicines, both crude and refined, aren’t new.

Nearly 5.7 billion people around the world – that’s three-quarters of the world’s population – use some herbal medicine for health care, some studies show.

A study in Nigeria found urban residents used 12 different herbal medicines, either alone or in combination with others.

Half of all residents who took part in the study considered the medicines safe, even though one in five of them had experienced “mild to moderate” adverse effects.

A typical agbo brew is believed to be a silver bullet than can cure anything.

But five brews are: agbo iba for malaria, agbo iba ponto for typhoid fever, agbo jedi jedi for dysentery, agbo ara riro for body aches and agbo atosi touted to cure sexually transmitted infections. There’s even a brew rocking the market as an aphrodisiac.

In 2011, Idowu Akande and three other researchers evaluated five popular brews and raised concerns about their growing popularity, their potential as sources of natural antioxidants and the probability of their being harmful to human health.

The study published in the Journal of Drug Metabolism & Toxicology called for a need to standardize dosage regimens and for authorities to closely scrutinize the pedigree of herbal medicine peddlers. Most were young girls and women with little or no knowledge of what they sold.

Seven years on, “the concerns we raised are still as valid,” says Akande. “They are not being addressed. Most people are not looking at them, especially from the government side.”

Agbo heartland

A number of factors have helped agbo stay in demand: increasing cost of drugs dished out in health centres, literacy level, the potency associated with it, and comparatively fewer side effects considering they are natural products. “You know our people like cheap things, forgetting it has negative effect on them,” says Dr Segun Okikuolu, based in Ibadan.

“I hope government begins sensitization on this new trend.” One dealer, an Ibadan woman named Alimi, swears by the efficacy but says doctors are attempting to ruin agbo market because it is eating away patronage of hospitals.

Reaction from patrons like Sikiru Akanda, a driver at Challenge Motor Park in Ibadan, when asked what significance agbo has for him, is classic.

“My brother, what kind of question is this? If I may remember, the last time I visited hospital was about 26 years ago. How many people can afford to pay hospital bills now? That is what we use whenever we are having slight malaria,” he said.

The sight of hawkers and their patrons at motor parks pervade the city of Ibadan. Over time, Bode Market in Molete area of the city has become a Mecca for agbo sellers.

Steeping the plant part in alcohol is helping make alcohol chic, says Falade Titobioluwa, a 72-year-old retiree.

“If you notice the rate at which our people are consuming it, especially the young people, you will be amazed,” Titobioluwa says. “I see it as a stylish way of consuming alcohol. Most of the roots in those bottles they are hawking around are soaked in ogogoro [gin] and they deceive their people by taking ogogoro in the name of agbo.

“However, I am not against taking agbo because that is what our forefathers used to treat themselves in those days before modern medical inventions but it must not be a deceptive ways of consuming ogogoro.”

One 2012 study called it “taking alcohol by deception” and called for such herbal mixtures to be classified as alcoholic and their sale restricted. Researchers in the study analysed samples of the drink known as “paraga” sold in or near motor parks.

“There were no formal recipes, production involved no calibrations, or weighing and thus the components and concentration of different batches varied,” researchers in the study reported.

The samples contained as high as 21% alcohol by volume: nine were equivalent to beer; the rest were equivalent to wine or stronger. Recent brews can have up to 40% alcohol by volume.

Agbo hits Middle Belt

Herbal medicine permeates all of Africa, but agbo is shifting from its Yoruba origins and invading societies across Nigeria.

In Makurdi, 20-year-old Nike Ayoola is well known at High Level Motorpark. Her customers have nicknamed her brew “quick cure” – claiming they get relief faster with it. She measures up shots for as low as N50, enough for three takes a day.

Johnson Ede haunts Wurukum area of Makurdi for a daily cup of agbo, every morning and every evening to “clear impurities” in his system.  His choice is “wash and set”.

“Whenever I take Agbo, I feel so well because it flushes my abdominal system of any impurities, making me fit to undertake any task at work,” he says.

He is confident the roots, fruits, leaf extracts that go into agbo are at their best in the hands of the vendors because they haven’t undergone processing.

Uwem Uwem, another user in Makurdi, was won over after agbo shooed away sexual challenges.

“I’m a testimony that Agbo works for men who can hardly impress their sexual partners,” he says. “I have recommended it to some of my friends who have similar problems and they have testimonies too,” Uwem posited.

Tor James hasn’t been won over. He has deep reservations about dosages prescribed by sellers “who know nothing or little about the health implications of the mixture given to their customers to drink,” he says.

North is up

From motor parks and mechanic garages to market areas, business premises and street corners, agbo has established its presence in the north of Nigeria. Its travel north is buoyed by its affordability and claimed potency.

In some countries, herbal medicine has been designated interventions as traditional or alternative medicine. The rich go on medical trips abroad, the poor seek out agbo dealers on street corners.

People who reside in villages or remote areas where health facilities are not easily accessible in Kaduna resort to traditional herbs for cure of their diseases; particularly pregnant women and children.

One study found women had “positive perception” about safety and efficacy of herbs over conventional drugs in pregnancy.

Many involved in the study had used herbs at one point at least during pregnancy. Agbo was the most used.

The lack of empirical evidence behind agbo use prompted the study to call for the herbs to under laboratory examination. But it is weak.

Seun Olajide is a staff of the Nigerian National Petroleum Corporation and a big fan of agbo. “God created these plants for the use of man. Herbal drugs have been in existence since the days of our forefathers and they have been working,” he says.

“Though, some say it is not hygienic, but most of the agbo are cooked before consumption and I believe once something is well cooked, every germ or dirt in it must have been killed. If, truly, agbo is not good, why are people still consuming it?”

Rabi Musa is not about to stop. She isn’t the only patron mixing agbo and orthodox medicine. No matter the quantity of medicines she gets from a hospital or pharmacy, she never gets better until she “crowns it” with herbal medicine. And that’s mostly for typhoid or malaria.

“Most times, these orthodox drugs only suppress the ailment but the herb flushes it out of your system,” she says.

Sidikat is one of countless, unregulated dealers of agbo in Kaduna. She spent two years training in the art of agbo under an older woman before relocating to Kaduna to ply her trade.

And it is in full swing. “With just N50 or N100, you can buy agbo for malaria, typhoid, sugar disease (jedijedi), and prolonged erection for the men,” says Sidiqat.

“We also prepare herbs for cure of watery sperm, fibroid and infection among others but these are based on order from people who want them.”

Now East is West

Eastern Nigeria has its traditional medicines for common ailments. They are dispensed by their dealers or herbalists upon request. Agbo,Yoruba style, has recently joined the arsenal of herbal concoctions and is rapidly climbing to the top of the pile.

In Owerri, the sight of young girls and women with a bowl of agbo bottles balanced on their head is becoming comer. And designated agbo points are taking root.

The points are where anyone can get shots of “paraga”, a mix of gin and root or herbal drink, but still 80% gin. For those not wanting a high, there is “gbogbonise”, a Yoruba word that literally means “works for everything”.

The silver bullet has gained ground in homes in the east but lost the “shay” sound at its end, replaced by a sharp sibilant “say”.

On Douglas Road in Owerri, Hadiza is famous for the efficacy of her stock. And her patron base is widening to include the “high and mighty”, she says.

“Gone were the days when our clients were motor park boys or mechanics, who take ‘paraga’ first thing before they begin work,” boasts Hadiza.

“We now have bankers, and even lawyers as our customers. All of them testify to the goodness of the herbal medicine and even confessed they get healed faster than conventional drugs.”

But her customers have a preference. Her biggest selling agbo are brews for malaria and sexual performance. She and her customers call the latter ‘man power’.

Girls like Hadiza are common sight, sometimes in pairs or trios, walking the streets of Owerri. They are eating into the market for patent medicine dealers.

Ifeanyi, who runs a patent medicine store, says patronage has dropped. “People no longer just stray in and buy drugs. Even common paracetamol is hard to sell because ‘gbogbonise’ has taken over the market,” says Ifeanyi.

“Apart from young girls, the new method is that it’s being advertised by microphone-blaring vehicles.”

Potential hazards

That agbo is natural and nature is a big claim. It is not in doubt. Many drugs dispensed in hospitals have their origins in plants. But Mohammed Ibrahim, of the Association of Public Health Physicians of Nigeria, draws a line.

“Even though many drugs have their origin in herbs and plants, they have been refined, the toxic components have been removed while experiment must have been carried out to determine the level of consumption for human beings,” he says.

“But the problem with herbal medicine is that we cannot tell whether they are refined or not, we don’t know the plants or leaves used to prepare the concoctions.

“We cannot say whether the active ingredient has been extracted or not because experiments have not been carried out publicly to determine the appropriate dose required for the disease as well as the effectiveness. So it becomes difficult to determine whether they are safe or not because there’s no proper scrutiny of the processes involved.

“All the drugs in the markets have gone through various stages of scrutiny but some of those who are into herbal medicine business inherited the business from their parents or grandparents and it continues like that without adequate knowledge of the things involved. So while some of them could be genuine, many others may not,” he said.

For all the potency attributed to agbo, it remains a silver bullet that continues to raise questions.

“Drugs are produced under controlled environments, dispensing them is also controlled,” says Dr Joel Jir. “A woman who just carries herbal drugs and dispenses any quantity to people is doing a lot of harm to people’s liver. This is why we have increased rate of liver-related illnesses like liver cirrhosis.”

Nearly three in four people who took part in a study on pharmacovigilance of herbal medicines claimed they saw no side effects. The other one in four reported side effects to include nausea, diarrhoea and weight loss.

Only 19% of side effects reported were documented, but none of the documentation was forwarded to regulatory bodies like the National Agency for Food and Drug Administration and Control or any other pharmacovigilance centre in Nigeria.

The concerns raised by the 2011 study prompted a proposal for a World Bank-backed African Centre of Excellence but traction on that front is uncertain.

“The concern really is the people involved in making it. Some of them don’t have knowledge of dosage regimen. They just tell you you can drink three cups,” says Akande, looking back on the response to the biological evaluation of herbal medicines years later.

“Most of them contain natural products, and many of these natural products are like food. As Socrates said, ‘let your food be your medicine, let your medicine be your food’. But the truth is that the usage – in terms of dosages, are not regulated.”

Like food, a lot of everything may not be the best, doctors warn.

“I will explain myself in a layman’s language so that you could understand,” Ibadan-based Okikiolu warns. “Many of our inner parts are very fragile and sensitive. How we use these sensitive parts of our body determines our healthy future. As a trained medical person and a Yoruba man, I also believe in agbo but our people are abusing it.

“We discourage people from taking it because of their indiscriminate ways of consuming it without proper diagnostic process. It is when you know what is wrong in your body system that you will know the drug to use but it is not so in this case.”