Edited by: Gubela Mji the Walk without limbs the Walk Searching for Indigenous Health Knowledge in a Rural Context of South Africa Gubela Mji (ed.) the Walk without limbs THE WALK WITHOUT LIMBS Searching for Indigenous Health Knowledge in a Rural Context in South Africa Published by AOSIS (Pty) Ltd, 15 Oxford Street, Durbanville 7550, Cape Town, South Africa Postnet Suite #110, Private Bag X19, Durbanville 7551, South Africa Tel: +27 21 975 2602 Fax: +27 21 975 4635 Email: [email protected] Website: https://www.aosis.co.za Copyright © Gubela Mji (ed.). Licensee: AOSIS (Pty) Ltd. The moral right of the authors has been asserted. Cover image: Original photograph used on cover provided by and used with permission from Dr Ntombekhaya Tshabalala, Stellenbosch University, Imijeloyophuhliso. All rights reserved. No unauthorized duplication allowed. Published in 2019 Impression: 2 ISBN: 978-1-928523-10-9 (print) ISBN: 978-1-928523-11-6 (epub) ISBN: 978-1-928523-12-3 (pdf) DOI: https://doi.org/10.4102/aosis.2019.BK98 How to cite this work: Mji, G. (ed.), 2019, The walk without limbs: Searching for indigenous health knowledge in a rural context in South Africa, pp. i–428, AOSIS, Cape Town. Printed and bound in South Africa. Listed in OAPEN (http://www.oapen.org), DOAB (http://www.doabooks.org/) and indexed by Google Scholar. Some rights reserved. This is an open access publication. Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license (CC BY-NC-SA 4.0), a copy of which is available at https:// creativecommons.org/licenses/by-nc-sa/4.0/. 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The walk without limbs Searching for Indigenous Health Knowledge in a Rural Context in South Africa EDITOR Gubela Mji Health and Veterinary Sciences domain editorial board at AOSIS Commissioning Editor: Scholarly Books Andries G. van Aarde, Post-Retirement Professor in the Dean’s Office, Faculty of Theology, University of Pretoria, South Africa Editorial Board Members Raymond Abratt, Professor, University of Cape Town, Cape Town, South Africa John M. Pettifor, Professor, University of the Witwatersrand, Johannesburg, South Africa Stuart A. Ali, Doctor, University of the Witwatersrand, Johannesburg, South Africa Charlene Downing, Doctor, University of Johannesburg, Johannesburg, South Africa Jan De Maeseneer, Emeritus Professor, Ghent University, Ghent, Belgium Phelix A. Majiwa, Professor, United Nations Division for Sustainable Development, Nairobi, Kenya Michelle Moorhouse, Doctor, University of the Witwatersrand, Wits RHI, Johannesburg, South Africa Voster Muchenje, Professor, University of Fort Hare, Alice, South Africa Caryn Zinn, Doctor, AUT University, Auckland, New Zealand C.W. van Staden, Professor, University of Pretoria, Pretoria, South Africa Michael Pather, Doctor, University of Stellenbosch, Stellenbosch, South Africa Jeanne Grace, Doctor, University of KwaZulu-Natal, Durban, South Africa Dirk Bellstedt, Professor, University of Stellenbosch, Stellenbosch, South Africa Alan Rubin, Professor, University of Johannesburg, Johannesburg, South Africa Anthony Afolayan, Professor, University of Fort Hare, Alice, South Africa Greta Dreyer, Professor, University of Pretoria, Pretoria, South Africa Peer review declaration The publisher (AOSIS) endorses the South African ‘National Scholarly Book Publishers Forum Best Practice for Peer Review of Scholarly Books’. The manuscript was subjected to a rigorous two-step peer review process prior to publication, with the identities of the reviewers not revealed to the author(s). The reviewers were independent of the publisher and/or authors in question. The reviewers commented positively on the scholarly merits of the manuscript and recommended that the manuscript should be published. Where the reviewers recommended revision and/or improvements to the manuscript, the authors responded adequately to such recommendations. Research Justification In a country as diverse as South Africa, sickness and health often mean different things to different people so much so that the different definitions of health and health belief models in the country seem to have a profound influence on the health-seeking behaviour of the people who are part of a vibrant multicultural society. This book is concerned with the integration of indigenous health knowledge (IHK) into the current Western-oriented primary health care (PHC) model. The first section of the book highlights the challenges of training health professionals using a curriculum that does not draw its knowledge base from a certain context and the people of that context. Such professionals will in due course realise that they are walking without limbs on health matters. KwaBomvana in Xhora (Elliotdale), Eastern Cape province, in rural South Africa, inhabited by the Bomvana people (also called the AmaBomvana), was chosen for conducting this study. This area is served by the Madwaleni Hospital and eight surrounding clinics. Qualitative, ethnographic, feminist methods of data collection support the research conducted for Section 1 of the book. Section 2 comprises translation and implementation of PhD outcomes and had chapter contributions from other researchers as well. In the critical research findings of the PhD study, older Xhosa women suggested the inclusion of social determinants of health as key to health problems that they managed within their homes. For them, each disease is linked to a social determinant of health, and the management of health problems includes the management of social determinants of health. For them, it is about the health of the home and not just about the management of disease. They believe that healthy homes create healthy villages, and that the prevention of disease is essential for strengthening of the home. Health and illness should be seen within a physical and a spiritual context, and without health, there can be no progress in the home. When defining health, the older Xhosa women added three crucial components to the definition of health by the World Health Organization (WHO), namely, food security, healthy children and families, and peace and security in their villages. Mji further proposes that the above- mentioned three elements should be included in the next revision of the WHO health definition because they are not only important for the Bomvana people where the research was conducted but also for the rest of humanity. In the light of the promise of National Health Insurance and revitalisation of the PHC, this book proposes that these two major national health policies should take cognisance of the IHK utilised by the older Xhosa women. In addition to what this research implies, these policies should also take note of all IHK practised by the indigenous peoples of South Africa, Africa and the rest of the world, and that there should be a clear plan as to how this knowledge is to be supported within a healthcare systems approach. The target audience of this book are academic educators, students mainly from the health sciences domain, professionals and policymakers. This book contains original research and no part of the book has been plagiarised. I also declare that this book has not been submitted to any other publisher for publication. Gubela Mji, Centre for Rehabilitation Studies, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. Contents Abbreviations, Boxes, Figures and Tables Appearing in the Text xix List of Abbreviations xix List of Boxes xxi List of Figures xxi List of Tables xxiii Notes on Contributors xxv Declaration xxix Introduction 1 Gubela Mji Section 1: Presentation of critical research findings that emerged from the PhD study: The walk without limbs Chapter 1: Evolution of the book – Recognising the absence of limbs 9 Gubela Mji, Melanie Alperstein, Karen Galloway & Nondwe Bongokazi Mlenzana Introduction 10 The 1994 contextual and political democratic changes in post-apartheid South Africa that impacted primary health services in disadvantaged communities such as Khayelitsha 10 Identifying health promotion and disease prevention as a basis for effective primary healthcare and public health systems 14 The identification of the older women as key to strengthening primary and public health systems 19 vii Contents Reflection from students and a facilitator on their experiences of overcrowding of community health centres and availability of indigenous health knowledge in Khayelitsha 22 The fourth-year physiotherapy student’s story 23 The facilitator’s story: Reflections on exploring indigenous health knowledge in Khayelitsha 26 The master’s student’s story: Reflections