This study explored how the concept of ikirimi is understood in a Rwandan community; its perceived causes and cures, and the barriers to seeking modern healthcare. Even though traditional medicine and the use of ikirimi are officially not accepted in Rwanda and traditional healers are arrested, it is still widely used in the community. The findings in this research show ikirimi as a culturally recognized illness, primarily treated through traditional uvulectomy ‘guca ikirimi’, and it highlights the interplay of social constructs, Indigenous knowledge, and modern healthcare challenges in addressing the condition.

Participants identified ikirimi as a traditional illness affecting the uvula, believed to be life-threatening if untreated. Also, ikirimi was also reported in Burundi, and traditional illnesses similar to ikirimi affecting uvula called Akamiro in Uganda and kimeo in Tanzania have been reported [28,29,30]. In fact, traditional uvulectomy practices are not only in Rwanda but also across Africa, suggesting that the perception of uvula-related diseases is widespread and deeply rooted in cultural contexts [13,14,15,16,17,18,19,20,21,22, 28,29,30]. Therefore, to know how ikirimi emerged in Rwanda communities would be a mystery. However, its prevalence and associated practices underscore its significance in local health narratives.

Our findings suggest that a significant portion of the community may have undergone uvulectomy, emphasizing the need for epidemiological research to quantify its prevalence and implications. Comparisons with other culturally rooted surgical practices, such as female genital mutilation, highlight the existence, impact and cultural significance of traditional medical interventions, but also the negative consequences [31, 32].

The understanding of ikirimi as a condition reflects Indigenous knowledge systems, which combine beliefs, experiences, and practices passed through generations. This knowledge has historically contributed to community health and resilience [33]. On the other hand, uvula infection was reported to be caused by Hemophilus influenze type b and Group A streptococcus pharyngitis, and characterized by swelling of uvula and may present with pharyngitis or epiglottis [34,35,36]. However, it remains unclear whether ikirimi represents a biomedical condition or a culturally constructed illness. Future studies could investigate the symptomatology, clinical pathology, and potential biomedical correlates, such as tonsillitis or tonsillopharyngitis, which are common in children and, if untreated, can lead to serious complications like rheumatic fever and rheumatic heart disease which are more prevalent in sub-Saharan Africa [37,38,39].

Post-treatment after traditional uvulectomy such as taking salt and antibiotic underscores the need to contextualize it within both modern and traditional medicine frameworks. Traditional medicine has been essential in communities long before integration of modern healthcare in Africa, thus could have revolutionized in working together. Future direction of collaboration and bridging the gap between traditional medicine and modern healthcare in Africa society could also better directed [40, 41].

The findings reveal that ikirimi is socially constructed, with its recognition and management rooted in local beliefs, sayings, testimonies, and cultural practices. The intergenerational transmission of knowledge about ikirimi ensures its persistence and relevance in the community. Local sayings, such as the belief that pus from the uvula is poisonous, contribute to the fear and urgency associated with the condition, driving individuals to seek traditional treatments. This has some similarities in Uganda and Tanzania study, Akamiro and Kimeo are deeply social constructed illnesses. For instance, in Uganda study it is also believed that if it bursts you die, and both studies indicate that traditional healers are acknowledged to know what they are doing [29, 30].

Social interactions and testimonies play a critical role in shaping health-seeking behavior. Participants described how observing others’ experiences with ikirimi reinforced their belief in the illness and the efficacy of traditional uvulectomy. In fact, illness has a cultural meaning, and biomedical and experiential dimensions [42]. Therefore, if communities of Africa learnt illnesses not only uvula-related (such as ikirimi) in the past through experiences and have contributed to a health community, this reflects the broader role of culture in shaping health perceptions and decisions, as noted in prior studies emphasizing the sociocultural determinants of illness experience and coping [42, 43].

Culturally, elders are seen as custodians of knowledge and are consulted for their wisdom, including in health matters. Traditional healers, who openly demonstrate their procedures and explain their practices, hold significant authority in validating the existence of ikirimi. Traditional healers, in turn, play a pivotal role in maintaining cultural harmony, offering treatments that align with community values and beliefs [44].

The study highlights significant barriers to integrating modern healthcare into the management of ikirimi. Participants expressed skepticism about modern healthcare providers’ understanding and acknowledgment of traditional illnesses. Healthcare providers, in turn, reported difficulty reconciling ikirimi with biomedical concepts, leading to a lack of effective communication and trust.

Poor patient–provider communication emerged as a key barrier. Participants often felt judged or dismissed when discussing ikirimi, which discouraged them from seeking care at modern health facilities. This aligns with existing literature emphasizing the importance of cultural humility and a biopsychosocial approach in addressing patients’ culturally rooted health beliefs [45, 46]. To address these barriers, healthcare providers need training in cultural competence and humility to better understand and integrate traditional health beliefs into care. This could facilitate mutual understanding and improve patient outcomes, as suggested in other contexts of culturally sensitive care [46].

Traditional uvulectomy has risks and serious negative consequences can occur as with any traditional and surgical intervention [14,15,16,17,18,19,20,21,22]. The practice of traditional uvulectomy is illegal in Rwanda, which may have influenced participants’ willingness to share their experiences openly [47]. Despite this, the practice persists, indicating its deep cultural significance and the limitations of legal restrictions in altering entrenched behaviors. Indigenous practices and traditional medicine could be explored more and be revolutionized for the benefit of patients, as some studies revealed better outcomes of patients when traditional medicine approach is combine with modern healthcare [48, 49].

This study has limitations. Traditional healers may have been less forthcoming due to the illegal status of traditional uvulectomy, potentially introducing bias. To mitigate this, interviews were conducted in their homes to provide a comfortable and confidential environment. Additionally, the translation of Ikinyarwanda concepts into English posed challenges, as some Indigenous terms lack direct equivalents. To preserve the original meaning, data were analyzed in Ikinyarwanda, with codes translated into English and reviewed collaboratively by co-authors. Lastly, this study is a qualitative research, and its purpose was to generate knowledge around ikirimi treated with traditional uvulectomy.