Chapter 2 Literature Review Literature Review
3.4. Integration of Western and Indigenous African Practices
Previously, efforts to promote interdisciplinary work between Western and indigenous African practices were discouraged by research which indicated that such collaboration might have unintended detrimental impacts (White, 2013).
Indigenous practices were not respected for the integrity inherent in them and scientific paradigms were often used to deny their time-tested, reliable and successful practices (Solomon & Wane, 2005). It is, however, becoming evident in the current era of rapid globalisation, that mental health practitioners, social scientists and anthropologists need to colloborate and engage in constructive dialogue aimed at developing cross-cultural understanding of how best to meet the mental health needs of people across the globe (White, 2013).
During the apartheid era, the Health Professions Act, No. 56 of 1974 and its 1982 amendments restricted traditional healers’ performance of any acts related to medical practice (Ross & Deverell, 2010). However, even though South Africa at that time promoted Westernised medical practices as the norm, there is evidence to suggest that, despite these laws, traditional healing practices remained resilient and have always formed a component of the healthcare system (Koen, Niehaus,
& Muller, 2003; Puckree et al., 2002). Patel (2011) argues that in spite of considerable growth in the awareness of biomedical perspectives on mental illness and the evidence base on the effectiveness of biomedical treatments, substantial numbers of people with mental illness continue to seek help from the traditional sector. Studying the profiles and outcome of traditional healing practices for severe mental illness in Uganda, Abbo (2011) reports that over 80% of patients from their sample suffering with psychosis used both biomedical and traditional healing systems. Similar trends have been recorded in South Africa by Mzimkulu and Simbayi (2006) and in other parts of the African continent by Kamsu-Foguen et al.
(2013). Abbo’s (2011) study revealed that those who combined the biomedical and traditional healing systems seemed to have better outcomes. In South Africa, Ross and Deverell (2010) found that when people were asked about their reasons for consulting traditional healers, a common response was dissatisfaction with treatment received from or negative experiences with Western medical practitioners. Other common themes, according to these authors, are: 1) the holistic focus of traditional healing; 2) traditional healers’ close association with cultural and religious beliefs and practices of their patients; and 3) the fact that these healers speak the patients’ language, spend time with them and provide explanations for their health conditions. Kamsu et al. (2013) as well as King (2000) make some of the following points in favour of collaboration between Western and traditional healers:
§ Traditional healers often considerably outnumber Western-trained doctors, and they therefore provide a large, easily accessible and affordable human resource pool;
§ Traditional healers provide client-centred, personalised healthcare that is culturally appropriate, holistic and tailored to meet the needs and expectations of the patient;
§ Traditional healers are culturally close to clients, which facilitates communication about diseases and related social issues;
§ Traditional healers use traditional medicines that are more affordable and less expensive than pharmaceutical drugs; and
§ Traditional healers often see their clients in the presence of other family members, which sheds light on the family’s role in promoting social stability and counselling.
From the preceding paragraphs, it is evident that there is increasing recognition by modern Western-trained mental health professionals of the need to take cultural factors into account in the diagnosis and treatment of traditionally- oriented patients (Edwards et al., 1983). According to Honwana (1998), it is now common to see people consulting both the hospital and the traditional healer, or even the prophet of a religious healer, simultaneously, and in some cases people start with one and move on to another. Therefore, an integration of Western and African practices in the approach to healing should be considered without any one practice imposing superiority over the other. An atmosphere of understanding, trust and respect should be created between Western-trained health professionals, traditional healers and the communities they serve (Hoff, 1992). In clinical practice, this is likely to increase clinician-patient (Western or traditional) rapport and the effectiveness of treatment (Edwards et al., 1983).
The obvious question that emerges, according to Patel (2011), is whether traditional healers may play a role in the formal mental healthcare system alongside biomedical providers. Koen et al. (2003) suggest that a more proactive stance needs to be taken to ensure co-operation with traditional healers in order to ensure a more integrated Westernised-traditional approach which promotes health for all. This can only happen if alternative healthcare methods are recognised and accommodated on an official level and if traditional healers and Western-trained healthcare workers are officially regarded as being of equal
importance in status in spite of the diversity and differences in methods, techniques, treatments and worldview (Peu et al., 2001).
A slow move in this direction is noted in an article by van Rensburg (2009), which states that traditional African healing practice was mainstreamed in South Africa through the promulgation of the Traditional Health Practitioners Act, No. 35 of 2004.
According to van Rensburg (2009), this Act has significant importance in the mental healthcare scenario considering its emphasis on mental health in the definition of traditional health practice, namely:
“the performance of a function, activity, process or service that includes the utilization of a traditional medicine or practice with the object: (a) to maintain or restore physical or mental health or function; (b) to diagnose, treat and prevent physical or mental illness; (c) to rehabilitate a person to resume normal functions; and (d) to physically and mentally prepare a person for phase of life changes (puberty, adulthood, pregnancy, childbirth and death)”
(p. 158).
Prior to the instatement of the Traditional Health Practitioners Act, Puckree et al. (2002) suggest that there was legislation in place allowing traditional healers to apply for licenses and to call themselves ‘doctors’.
There are many organisations that can register traditional healers in South Africa, and these healers are licensed in terms of the Companies Act (Pretorius, 2001). These organisations include the Southern African Traditional Healers Council, the Congress of Traditional Healers of South Africa, and the African Dingaka Association, to mention a few (Kale, 1995). During 1997 public hearings were conducted into the legitimisation of traditional healers, which resulted in a proposal for the creation of an Interim Co-ordinating Committee whose task was to establish a statutory Council for Traditional Healers (Pretorius, 2001). However, not all traditional healers have registered with these organisations.
Even though traditional healers in South Africa can now obtain licences to practice, very little formal assessment has been done on the extent of their contribution to healthcare (Koen et al., 2003). Although traditional remedies are believed to be effective in treating diarrhoea, headaches and other pains, as well as psychological problems, unfortunately there have been no studies on their efficacy (Kale, 1995). To compound the picture, the actual contribution of
traditional healers to healthcare in the province of KwaZulu-Natal or South Africa is not known (Puckree et al., 2002). Bhugra and Bhui (1997) recommend that research needs to be conducted in which a clinician identifies whether a specific cluster of symptoms, signs and behavioural changes demonstrated by the patient are interpreted consistently by the patient and their relatives, and how the personalised diagnostic model offered by the traditional healer fits in with the psychiatric model.
Even if traditional healing is found to be effective, the challenge, as documented by van Rensburg (2009), is that the inclusion of traditional healers into the formal health and mental health system may still prove to be too costly to implement, especially within the current context where resources are generally strained by characteristically low priority allocated to mental health services. This author also adds that as traditional health practice may over time become more integrated with public health services, some concern from a health system perspective can be raised relating to the practical challenges of the employment of different categories of spiritual and traditional health workers in the formal health and hospital environment.
The considerable diversity of traditional healers, encompassing a wide range of practitioners including herbalists, spirit mediums, diviners and faith healers is a major barrier to their integration into the formal health environment (Patel, 2011).
Added to this is Pretorius’ (2001) view that the testing and certifying of traditional remedies, as well as the licensing and monitoring of traditional healers, could also prove to be costly and difficult to implement. According to this author, the most important constraint could prove to be the lack of funds required to monitor registered traditional healers, to measure their knowledge and to evaluate any modification in their practices according to desired standards. In order to overcome these barriers, Puckree et al. (2002) suggest that the first step is for Western-trained healthcare professionals to acquaint themselves with knowledge regarding the exact role of the traditional healer in the provision of healthcare.
Without this knowledge it would be difficult for healthcare professionals to know whether it is advisable to refer patients to traditional healers in certain instances. It is important to note that, similarly, traditional healers may also want to know whether Western healthcare facilities contribute anything that service users value and regard as useful, before referring patients (Ensink & Robertson, 1999).