Lagos- He jumped down from the bus ignoring enraged passengers demanding their change on getting to their destination at Pen Cinema, Agege, Lagos. He awkwardly gave a female passenger standing before him N200, ‘marrying’ her with another young man whose change was also N100.
The driver, Bayo Akande, well known as Action, dashed into a small stand displaying a collection of herbal mixtures some metres away. He collected a N100 note from Mrs Bolanle Adisa popularly called Iya Abbey – a short slim woman running the herbal stall – and handed it over to the last commuter yelling at him.
As Akande and his departing angry passenger traded insults, Adisa randomly picked from a line of 150cl plastic bottles housing varieties of soaked herbal concoctions. Without waiting for further directive from the restless driver, she poured some drops into a piece of small white nylon.
“Mama, put more of ale (aphrodisiac),” he ordered as the woman reached for the sixth bottle.
After completing the collections, she shook the content and served it to Akande who, without much ado, gulped the mixture at once and sauntered back to where his bus was parked.
Adisa called the mixture gbobo’nise; all disease-healing herb.
“It will flush out all the dirt in your body system and make you satisfy madam (on bed) very well,” she said wryly, persuading our correspondent to give it a try. “It has alcohol which makes it powerful. That young man (referring to Akande) and many other youths take it every day.”
Interest in traditional herbal medicines is assuming an upward trend globally according to the World Health Organisation, with about 80 per cent of the African population using them.
Easily accessible and usually cheap, herbal products are well preferred by the vast majority of the poor who could not afford orthodox health care.
While herbal mixtures like gbogbo’nise might have served the needs of Akande and many others, their safety remains a source of concerns due to unregulated dosage and high risk of contamination.
Some kilometres away, in Ojodu-Berger, a herbal vendor whose stand overlooks a bank along the road boasts of cures to various health challenges. From aphrodisiac to ‘anti-malaria’ and jedi (haemorrhoids) herbs, Lukman as he prefers to be identified, has endeared himself to many customers – young and old.
One of them is Mr Salako Daodu, a civil servant whom our correspondent met during a visit to the stall.
“I buy agunmu jedi (haemorrhoids powder) and ale (aphrodisiac) in bulk every month,” Daodu revealed. “I take two small spoons of both with water or pap every three days to stay fit and be manly enough,” he grinned, picking up two small white packs of his favourites after paying N800.
Safety risks amid unregulated dosage
Experts have expressed worry over health risks posed by consumption of poorly prepared herbal mixtures. Contaminants, especially those toxic to the body system, and lack of dosage for most herbal medicines have continually raised concerns.
Sunday PUNCH took eight samples of herbal products comprising aphrodisiac, jedi and “anti-malaria” bought from Adisa, Lukman and some other vendors in Ogba, Yaba and Lagos Island areas.
The products, two of which bear NAFDAC numbers, were subjected to microbial analysis at the University of Lagos. Bacteria and fungi isolated from a gram of jedi bought from Lukman include Bacillius subtilis, Penicillium, Aspergillus niger and Aspergillus flavus.
While the specie of the Bacillius (bacteria) found in the products is described as innocuous, Aspergillus, “especially Aspergillus flavus is carcinogenic,” said a professor of Biochemistry at the University of Calabar, Ubana Eyong.
In the same vein, Prof Isaiah Ibeh, a microbiologist at the University of Benin, noted that Aspergillus flavus produces aflatoxin which could be harmful to the liver.
Ibeh stated, “Aspergillus flavus should not be present in herbal products. However, if its load is minimal, the immune system can fight it. Some strains of Penicillium also produce toxins.”
Aspergillus flavus is also present in Lukman’s gbogbo’nise while Penicillum is isolated in the supposed anti-malaria herbal mixture bought at a popular joint in Ogba.
WHO’s guidelines for assessing the quality of herbal medicines specify the maximum limit of yeasts and molds (fungi) present in a plant material for use as teas and infusions – soaking – as 104 CFU/g. In other words, the microbial counts must not exceed 10,000 cells.
At 3.0×102 CFU/g and 102 CFU/g respectively, Aspergillus and Penicillum contained in jedi and gbogbo’nise bought from Lukman are within the threshold recommended by WHO, said Prof Ifeoma Emweani, a mycologist at the Department of Medical Laboratory, Nnamdi Azikiwe University.
She, however, revealed that the counts would multiply and have adverse effect if the herbal products were preserved for future consumption as Daodu does.
She noted, “Some of them like Aspergillus flavus can produce toxins which can affect the health. They shouldn’t be present at all except if they are strains that are not pathogenic and they have to be at a particular minimal level.
“The Aspergillus flavus is likely to produce toxins that are not good for the body depending on how long it takes before one uses the herb. If it is consumed immediately at that level (3×102 CFU/g), and the person won’t take it again, the chance that it will produce more toxin will be reduced. The immune system can take care of it. If a load is 102 CFU/g and you leave it for 24 hours, it may increase to 1010 overnight.
“The shelf life of a herbal product is an issue. Is it freshly prepared and how long is it going to take for consumption? It is only few big herbal firms that do good packaging and show shelf life. The ones hawked on the street don’t carry shelf life.”
A toxicologist, at the University of Calabar, Prof Friday Uboh, cautioned that plant medicines when contaminated might cure some problems and create another one.
However, a microbiologist at the Olabisi Onabanjo University, Prof Lawrence Adebajo, observed that organisms such as Aspergillus and Penicillum are opportunistic pathogens, especially when the contamination occur after herbal production, adding that they usually cause diseases in people with deficient immunity.
“Aspergillus flavus produces aflatoxin. Its presence gives a red flag and it is possible that such product can contain some harmful substances. Very little load of such organisms will cause problem for consumers that have immuno deficiency. But for normal healthy people, the spores of those organisms have to be in large quantity before they can elicit disease condition,” Adebajo said.
For aerobic microorganisms (bacteria), WHO puts the maximum limit at 107 CFU/g for use as teas and infusions and at most, 105 CFU/g for internal use.
Loads of Bacillus subtilis found in the eight samples analysed range from 2.0×101 CFU/ml to 4.0×102 CFU/g – all of which are within the acceptable limit WHO stipulates.
Also, faecal-based coliforms that could stem from poor personal hygiene during production process are absent in all the samples.
Organisms present in other samples
In the alcoholic-brewed herbal aphrodisiac dispensed by Adisa, mucor, a fungus which equally secretes aflatoxin, is isolated albeit at minimum loads of 101 CFU/ml.
Also, the two liquid alcoholic aphrodisiac (popularly known as manpower) in small-sized bottles bearing NAFDAC numbers, exhibit Rhizopus stolonifer – an opportunistic pathogen – at minimum counts of 101 CFU/ml and 2.0×101 CFU/ml respectively.
In another powdery aphrodisiac procured in Yaba, Rhizopus stolonifer is found at 102 CFU/g. It is equally isolated in a powdery herbal medicine claimed to be a cure to typhoid at the same counts.
A Microbiology professor at the University of Jos, Patricia Lar, told our correspondent that Rhizopus, a food spoilage agent, can cause diarrhoea and skin infection and cautioned against using products containing it.
“By consuming poor quality herbs as a result of contaminants, people will become sick of another ailment instead of being cured. Mucor is also a spoilage organism and should not be found in food or medicine. People have found cheaper alternative in herbal products but the condition in which many of them are produced may not be safe,” Lar said, urging the National Agency for Food Drug Administration and Control to take quality processing seriously.
She added, “It is a matter of public health. They should enforce standards and embark on public education about quality herbal products. There are people that use fake NAFDAC numbers on their products.”
In an interview with our correspondent, a Lagos-based public health consultant, Dr Rotimi Adesanya, said most of the manpower mixtures contained high percentage of alcohol, thereby constituting a potential risk factor for high blood pressure, cancer, heart and liver diseases.
He said, “Manpower contains high percentage of alcohol which has effects on virtually all the organs of the body, especially the heart and the liver. Liver is what detoxifies the body. Once the alcohol intake is much, it affects the liver and the person begins to have abdominal pains and yellowness of eyes. The liver can break down leading to a chronic liver disease.
“The alcohol also has effects on the brain. It can affect the central nervous system and lead to withdrawal syndrome like tremor of the hands, lack of concentration and inability to make good judgments. That is why we advise people that are into it to quit instead of reducing the amount they consume.”
Experts seek proper regulation of herbal medicines
As a result of increased use, traditional herbal medicines have received significant attention in global health debate. In China, for instance, they played a prominent role in containing and treating severe acute respiratory syndrome, (SARS), according to a report in the 2016 bulletin of WHO.
It is claimed that 80 per cent of African population use some form of traditional herbal medicines with the worldwide annual market for the products nearing $60bn.
In the global research on herbal medicines, Nigeria is regarded to have also made substantial contributions. However, ethical issues bordering on safety standards continue to plague the use of herbs, especially a high number of those sold on the streets without screening.
A medical biochemist at the Ebonyi State University, Abakaliki, Prof Chukwu Edeogu, stated that some herbal products might be efficacious but harmful to the body due to their loose dosage use.
He said, “When we talk about extracts from plants, the phytochemicals on their own could be positive or negative. Some of them have good effects on the body. On the other hand, some of them can cause problems. Some herbs are efficacious but we don’t standardise the dosage.
“There is a problem because the volume that is taken may be more than what the body requires. The side effects may be damaging the liver. For instance, if Aspergillus flavus infects some food substances, there is every probability that it will release toxin called aflatoxin which is dangerous to the body. The body metabolises it into aflatoxin hypo oxide which has been implicated as an excellent candidate in carcinogens and highly dangerous for human consumption.
“If we can have a commission that can standardise the dosage, it will save us millions of dollars from importation of drugs. After all, most of these pharmaceutical products we are using are all derived from herbal plants.”
While discouraging the use of aphrodisiacs, a nutritionist, Mr Francis Ojile, maintained that some herbs could be beneficial if standards were observed.
He noted that poor preparation was responsible for the unsafe consumption of herbs.
He stated, “A lot of them don’t pass through NAFDAC screening and many of them use NAFDAC numbers of other products. The ‘manpower’ (aphrodisac) people take has no benefit to the body. If your system is actively okay and you do physical exercise, you don’t need to take such stimulant.
“It weakens the man’s libido. It is not healthy and the way to regulate it is by creating awareness. We should start the awareness with those selling the products. They are giving louts opportunity to commit crimes such as rape and domestic violence.”
Emweani, a mycologist, stated that there was the need for NAFDAC to properly screen herbal products to ascertain the safety of their microbial contents.
She said, “The problem is that we don’t know how the quality of the herbal concoction is assessed. I once asked NAFDAC whether they really ascertain the microbiological quality of the herbal drinks before they allocate number, the answer they gave me was that the number was for listing and not for quality assurance.
“Whereas, all these herbal vendors claim they have NAFDAC number. How can an average Nigerian know that a herb is not microbiologically safe to be consumed despite having NAFDAC number? This is wrong.
“There is a high prevalence of kidney failure in society and one of the reasons is that nobody checks the toxin in these herbal concoctions. They go to the kidney and it has to filter everything to remove the toxins. When the kidney is overwhelmed, it fails.
“Another challenge with herbal products is that some of them have resorted to adding antibiotics which is not good. That is why some of them claim that one herbal product can cure several diseases.”
Herbal practitioners speak on results, condemn hawking
A former factional chairman of the National Association of Nigerian Traditional Medicine Practitioners, Lagos State branch, Chief Sikiru Akande, admitted that regular use of sex-enhancing herbal drugs could do more harm to the body than good.
He lamented that a high number of herbal producers and sellers were unknown to the association and cautioned people on the kinds of herbal brands they consumed.
He said, “Sex-enhancing herbs are real but care must be taken in using them. Excessive use of ale for instance can harm the body. The person may suffer erectile dysfunction in the long run. Some men use herbs for penis enlargement which is dangerous. Whatever the size may be, it is normal so far there is libido.
“In the board of traditional medicines, we have had a lot of meetings about herbal medicine hawkers. They need to be registered with NANTMP and get board approval before they can start business and they are not allowed to hawk. They are supposed to have shops where people can go to.
“Anyone who buys a herbal product on the street may not see the hawker again and the medicine may be hamful. But if they know where the seller is stationed, they can easily trace him or her. There are different kinds of herbal practioners now. Some learnt it from their parents while others rely on records from their forebears on traditional medicines; they don’t have knowledge of medicinal plants.
“We don’t want quacks to spoil our name. There is hardly 40 per cent qualified herbal medicine practiioners. Those who have NANTMP certificates are trained and their medicines are usually in capsules, well packaged and NAFDAC approved.”
NANTMP Chairman in Lagos, Chief Wahab Oshodi, said production and use of safe herbal medicines were achievable if practitioners subjected themselves to training.
He said the board of traditional medicines frowned on hawking and resolved to arrest those found wanting.
Oshodi stated, “We make sure that all members are being trained and retrained. The problem we have is that the practitioners that are members of the association are not up to 30 per cent. And going by the Nigeria constitution, you cannot force anybody to belong to an association. We can only convince them to join.
“There can be substances which are not good in some herbal medicines but if the sellers can be convinced to join the association, it will be better of. Most likely, those people you collected samples of their products do not belong to the association. If they join the association, they will be trained.
“The board should not issue government certificates to those without certificate of proficiency from NANTMP and ATMP (Association of Traditional Medicine Practitioners of Lagos State). But where that does not happen, many people will not be interested in joining the association and we won’t be able to train them.
“If you want to sell any product, look for a permanent space so that even if you sell anything harmful to your customers, they can easily locate you. We also urge users to buy from genuine practitioners. If need be, ask for their identity. It is not advisable to buy herbs on the streets.”
Herb sellers, users indifferent
Sunday PUNCH revisited two stands in Pen Cinema and Ojodu where some of the samples analysed were collected. When Adisa was told of harmful organisms found in her gbogbo’nise, she brushed the result over, saying that none of her customers ever complained of any negative effect.
“I learnt this work from my late mother for many years and I know about it very well. I stopped selling the one without alcohol because customers complained it was not effective. This one works for them perfectly,” she added, beaming with confidence.
A customer met at her shop, Wale Adekunle, affirmed Adisa’s claim. He is not convinced regular use of the mixture has any health implications.
“Well, even if it is harmful, so far it has been working for me, I will continue using it,” he asserted. “It makes me perform very well on bed.”
Lukman, also shunned experts’ warning on the potential carcinogens the Aspergillus in his jedi herb portends, stating that since he started the business bequeathed to him by his grandfather about a decade ago, customers’ review of his products had been largely positive.
He added, “I don’t belong to any association but I am sure of the quality of what I sell. As you can see, I have a permanent stand and customers can always come here if there is any side effect.”
“Abeg, all those things (referring to the results) are just science,” a tall young man waiting to buy jedi herb and ale, intruded.
When our correspondent told the man, who identified himself simply as Tunji, that exposing the herbs to sun and poor storage before use might endanger his health, he had some rethink. He reduced the volume of what he initially planned to buy by half.
“This would take me just two weeks. As advised, I would keep the remaining herbs inside a fridge after use,” he said.
On her part, the NAFDAC DG, Prof Mojisola Adeyeye, told Sunday PUNCH that the agency sensitised members of the public to the dangers of using unregistered herbal medicines and carried out routine raids on the streets.
She stated that NAFDAC also enlightened herbal practitioners selling their products on the streets to desist from such practice, adding that the agency would continue to crack down on drug hawkers.
Adeyeye said, “We don’t allow people to sell medicines that we regulate on the streets. Those who register with us will not sell on the streets. Most of the drugs sold on the streets by hawkers are not registered. We do a lot of raids, seizure and destruction of the seized medicines. We will continue to do more because when you have 100 today, next month, they are 150. We have to continue to do it throughout the country. It is more common in the cities and smaller towns.
“If they use NAFDAC numbers, they very likely falsify the numbers. Don’t buy medicines from people selling on the streets. Herbal practitioners don’t take their medicines to the streets but we enlighten those who do. We cannot rule that out. We will continue to educate herbalists registered with us to ensure that their products don’t get on the streets. If we see their products on the streets, we will seize them whether they are registered or not.”
The NAFDAC boss described the health risks of using herbal products displayed by the roadside as “a short-cut to getting seriously ill.”
“When you expose the medicine to the sun, it beats on it and breaks it down. If it is liquid, bacteria grow there because they (the hawkers) don’t put them in the refrigerator and so on,” she added.
Even though herbal vendors such as Adisa, Lukman and others across the country flout the safety standards as noted by Adeyeye, they continue to be in business. Their products remain potent in the eyes of their teeming customers, including Akande, the bus driver and Daodu, the civil servant, despite the health risks inherent in consuming them.