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The Role of Indigenous Healers in Disease Prevention and Health Promotion Among Black South Africans: a Case Study of the North West Province

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The Role of Indigenous Healers in Disease Prevention and Health Promotion Among Black South Africans: a Case Study of the North West Province THE ROLE OF INDIGENOUS HEALERS IN DISEASE PREVENTION AND HEALTH PROMOTION AMONG BLACK SOUTH AFRICANS: A CASE STUDY OF THE NORTH WEST PROVINCE by SOPHIE NKINKI SHAI-MAHOKO submitted in accordance with the requirements for the degree of DOCTOR OF LITERATURE AND PHILOSPHY in the DEPARTMENT OF ADVANCED NURSING SCIENCES at the UNIVERSITY OF SOUTH AFRICA PROMOTER: PROF. JM DREYER JOINT PROMOTER: DR. 0 MAKHUBELA-NKONDO JUNE 1997 DECLARATION I declare that "The role of indigenous healers in disease prevention and health promotion among Black South Africans: A case study of the Northwest region" is my own work, and that all the sources I have used or quoted have been indicated and acknowledged by means of complete references. S.N. SHAI-MAHOKO DEDICATION This work is dedicated to Badimo ba ga-Shai: my grandfather Mokgona, my grandmother Mmantwa, my father, my late youngest sister Mmangata, and to all those men and women who dedicate their lives to the service of mankind through indigenous healing in an attempt to make health care accessible, available, and affordable to the people of South Africa. A Lady Sangoma 11 SUMMARY THE ROLE OF INDIGENOUS HEALERS in DISEASE PREVENTION and HEALTH PROMOTION AMONG BLACK SOUTH AFRICANS: A CASE STUDY of the NORTHWEST PROVINCE The majority of black South Africans utilize the services of indigenous healers and the new National Health Plan for South Africa makes provision for cooperation between the healers and formal health practitioners. The purpose of this study was to determine the role played by indigenous African healers in the prevention of diseases and the promotion of health, and to design a model which will provide guidelines for cooperation between indigenous healers and formal health workers. This study was ethno-medical, contextual, exploratory and qualitative. It was designed to look into the health care of a specific cultural group to explore in depth the experiences of indigenous healers in providing health care within their cultural context. Data was collected by individual free-type interviews from indigenous African healers, users of formal health services and by observation. It was found that there is dual utilization of both formal and indigenous health service systems by clients. A specific culhrral terminology relating to health was found to be used. Such terminology could result in communication gaps and breakdowns if not known to or used by formal health workers. The findings show that cultural beliefs are still strongly adhered to. These were found to influence the life-styles and health maintenance behaviour of a cultural group. The findings show that divination forms the core of health assessment and health-problem diagnosis. It was found that no health problem could be attended to without first going through a divination session. The findings also show involvement of indigenous healers in primary health care workers at first contact levels of prevention in the field of paediatric preventive care. Diarrhoea and vomiting in children was found to be the preventable disease in which healers specialize. Infertility and impotence were found to be conditions taken to healers for treatment. Other sexually transmitted diseases as well as culture-bound syndromes treated by indigenous healers were found in this study. The use of rituals and rites of passage and the involvement of ancestors were found to form part of holistic health care. The findings show the willingness of healers to collaborate with formal health workers. A model is designed to guide the process of collaboration. 111 Key terms: Health promotion; disease prevention; primary health care; mental health; family well-being; acceptable health care; relevant health care; culture-bound syndromes; ethnocentric tendencies; cross-cultural health care. IV ACKNOWLEDGEMENTS The author wishes to express her sincere gratitude to all those people who contributed towards the successful completion of this degree. She particularly wishes to acknowledge the contributions made by the following: Modimo, The Almighty, for the health, the energy and the strength to undertake this study, and my ancestors, Badimo ba ga-Shai, for protecting me against all odds, and ensuring that this study is completed. My promoters Professor M. J. Dreyer and Dr. 0. N. Makhubela-Nkondo, who gave many hours of their precious time to supervise and encourage me during this time. Their constant advice and untiring guidance is highly appreciated. The Research and Publication Committee of the University of the Northwest, University of Venda, and Department of Health (South Africa) for the financial assistance they provided towards the successful completion of this study. My special thanks go to Mrs Ann Preller (Department of Health, Northwest), Professor Mary Kau and Dr 0. H. Kaya of the University of the Northwest for their encouragement and support during the course of this study. I thank specifically Mr M. J. Mogodi, a brother and friend without whose assistance this study would not have been possible. I am grateful also to Ms Gabahediwe Makwati and Constance Sepeng who, as research assistants, worked untiringly towards the success of this study. My special thanks go to Ms C. J. Conerly who, despite her tight work schedule, managed to type, edit and do all the technical work in this study. Without her the production of the final work would have been impossible. My mother Mosadi Shai for being alive for me and the children; my children: Dineo, Sarah, More, Mosadi, Tshegofatso and Goitse-modimo; and my grand-children Ontlotlile, Tumelo, Kgothatso, Modisaotsile Taola and Popo, for being there all the time when I was doing field work, and for looking after the home; and to my helper, Aus Nono Funde, for assuming the role of both mother and grandmother to my children during the course of this study. v Table of Contents Declaration . i Dedication ....................................................................... ii Summary . iii Acknowledgements ................................................................ v Table of Contents . vi Tables ........................................................................ xiii Figures ........................................................................ xv Annexures . xvi .r. • .I' •• De,.nztion o, Terms ............................................................ XVII CHAPTER 1 : INTRODUCTION ................................................... 1 Historical Background to the Study .................................................. 1 Legal Control .................................................................. 1 The failure of formal medicine to provide adequate health care ...................... 2 Moving towards an inclusive health care policy .................................... 5 Statement ofthe Problem ......................................•................... 6 The Present Situation ............................................................ 7 The Northwest Region: Background Information ...................................... 9 Description of the Province ....................................................... 9 Structure of health services ..................................................... 9 Purpose ofStudy ................................................................ 12 Significance of the Study . 12 Research Model .............................................................. 12 Paradigmatic view ........................................................... 14 Meta-theoretical assumptions .................................................. 14 Theoretical perspectives ...................................................... 15 Research Question ...............•............................•......•........... 15 Basic Assumptions . 15 Research Methodology ........................................................... 16 Research Design . 16 Study Population (need more appropriate heading for this section) . 16 Sampling Procedures . 16 V1 Data Collection . 17 Data Analysis . 17 Validation of Data . 17 Delimitation ofthe Study .......................................................... 17 Structure of Thesis ............................................................... 17 Summary ....................................................................... 18 CHAPTER 2 : LITERATURE REVIEW ........................................... 19 Introduction .................................................................... 22 Utilization ofIndigenous Healers .................................................. 22 Indigenous African Religious Views ................................................ 23 African Religion .."-. 23 Modimo - The supernatural being ............................................. 23 Badimo ..................................................................... 24 Indigenous healers ........................................................... 24 The African World View of Life After Death ..................................... 25 African Beliefs About Causes of Illness . 27 Oassification of causes of illness ................................................ 28 Culture-bound syndromes . 28 Mystical causes . 29 Witchcraft causes . 30 Impersonal causes . 30 Maternal and Child Health Care . 34 Preventive Health Care . 34 Social Well-being ............................................................. 36 Mental Health Care .............................................................• 38 Culture-bound Syndromes . 42 Summary ....................................................................... 45 CHAPTER 3 : Methodology
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