With the many changes in South Africa and a renewed challenge to provide accessible primary health care to all, the role of traditional healers and medicine has once again become an important issue.
A traditional healer can be described as someone who is recognised by the community in which he/she lives as competent to provide health care. He or she supplies traditional medicine by using vegetable, animal and mineral substances and certain other methods based on the social, cultural and religious background of the users. He or she also uses the prevailing knowledge, attitudes and beliefs regarding physical, mental and social well-being and the causes of disease and disability in the community. The healer acts as a druggist, dispensing medicines (muti) made from natural substances including bark, roots, leaves, animal skin, blood or parts of animals, herbs or seawater.
The two main kinds of traditional healer are the diviner and the herbalist. Traditional healers are not witchdoctors (Zulu: izangoma). Diviners use listening, observation and experience to make a diagnosis aided by the supernatural (communication with ancestors) and the throwing of bones. A person normally does not choose to become a diviner, but rather follows a calling (thwasa), which can be disobeyed only at risk of serious (sometimes fatal) illness. An apprentice (ngaka) undergoes an apprenticeship of up to seven years with a fully qualified diviner. Only after a ceremonial ritual and a test of the person’s abilities can he or she start practising as a qualified diviner. Sometimes the diviner also trains as a herbalist (Zulu: inyanga or Xhosa: ixhwele) and can practise both healing vocations simultaneously or separately.
Extent of traditional medicine use
According to surveys, 72% of the Black African population in South Africa use traditional medicine, accounting for some 26.6 million consumers. These consumers are from a diverse range of age categories, education levels, religions and occupations. The trade of these medicines contributes an estimated R2.9 billion to the national economy.
For many people in South Africa, traditional medicine is the treatment of choice; it is not considered inferior to western medicine, but is thought to be desirable and necessary for treating a range of health problems that western medicine does not treat adequately. A survey in Durban indicated that 84% of clinic patients use traditional medicines, with only 18% of the patients indicating that they may reduce their use of traditional medicine in the future. However, 97% of traditional healers’ patients indicated that their use of traditional medicines was by choice and not a result of access and cost issues associated with western medicines.
Understanding traditional medicine
To understand traditional African medicine, it is important to understand the life and world views of traditional Africans. It consists of a complex system in which beliefs concerning ancestral spirits, magic, sorcery, witches and pollution exist side by side. This loose association provides a natural way of understanding misfortune and provides understandable answers to the vexing questions of the purpose of life.
Recognition of traditional medicine
There is a movement towards recognition of traditional healers and their services. Many people are convinced that the traditional healer should be formally and legally recognised as a health care resource, but one that operates within totally different paradigms, each with its own code of ethics and criteria. The traditional and western health care services would (then) run parallel to each other with mutual recognition.
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