7.3 Emerging themes and subthemes
7.3.6 Theme 6: Views regarding the collaboration of clinicians and traditional health practitioners
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mechanisms. Even with schizophrenia, all is dependent on the patient‟s main challenges, their needs as well as the most suitable methods that can address those needs and help them recover.”
(Participant CP3)
As can be seen from the above extracts, there are many treatment modalities and techniques according to psychologists. These all depend on how the practitioner understands the presenting problem and the causes of those presenting problems.
7.3.6 Theme 6: Views regarding the collaboration of clinicians and traditional
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treat these patients from the three domains, we might miss out on the spiritual domain which may be a major contributing factor on how people interpret what they are going through.” (Participant CP2)
“I think if this is well managed, it will be a way of these two systems complementing each other and catering for the best health needs of the patients with the patients‟ beliefs, needs and autonomy in mind.” (Participant CP3)
Some of the participants went further to suggest that the idea of collaboration will create space for the clarification of the misconceptions about how either of these systems practice, enhancing a holistic approach to patient management. The participants further report that the collaboration will create an opportunity for either of the systems to learn how the other system operates as illustrated in the extracts below:
“..the two systems can be oriented to how each of them practices so that it nullifies the misconceptions that already exist, especially about the African health system. (Participant CP3)
“There is a need to educate both sides on the scope of each. It will direct practitioners of who and when to refer to whom and for what.” (Participant CP6)
“..if they bring them under one umbrella, one group will have the opportunity to learn how one group does their things vice versa.”
(Participant CP1).
“I think collaboration is a good thing because it enhances the element of a holistic approach and the making of proper diagnosis with no doubts and flaws.” (Participant CP2)
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One participant has indicated the need for the formulation of legislative frameworks and models that will facilitate the process of collaboration with particular reference to the location of practice and the referral processes.
“The only challenge is the model of collaboration; how the collaboration has to go about. Are we then saying all those traditionalists and spiritual pastors have to come to the hospital or they can treat where they are where we have a link with them, further sending them the patients who require their intervention?
Another question is if they have to be part of the MDT (multidisciplinary team).” (Participant CP2)
Another participant has reported about the need to have specialised institutions for the traditional health practitioners on the notion that, putting them in hospitals may infringe on other people‟s rights regarding their beliefs.
“..it might be difficult for them (THPs) to practice in hospitals since not everybody believes in traditional practices. Remember there are Christians who may not believe in such practices, which might be affecting them negatively. I think if there was to be a place where they practice from, like an institution for them, where we would refer patients to if there is a need and without imposing on patients, it might be better.” (Participant CP3)
There seems to be a suggestion that a well-coordinated collaboration, with well- developed practice models and referral procedures, will create more opportunities for learning between the two health systems and further provide a holistic approach in the management of mental illness with particular incorporation of spiritual factors that are in play. It will further provide an opportunity for both systems to complement each other‟s shortfalls to the benefit of their service recipients.
Subtheme 2: Negative views regarding the collaboration
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One participant has expressed some concerns about the collaboration of the western and African traditional healing systems based on unscientific training of traditional health practitioners, lack of legislative frameworks for the governance of the collaboration as well as different conceptual orientations. She views these factors as detrimental hindrances to the process of collaboration of the two systems as illustrated in the extract below:
“..as psychologists, we went to school, we studied psychology and are of the notion that psychology is a science. Even though they also receive training, their training is not a science. So, I don‟t see how I personally can collaborate with them. I actually do not see it as a possibility. To start with, if I had to refer to them, what policy would be guiding that referral? What frame of work, frame of reference or theoretical perspective would I be acting from? We are using an art, a science, and the way we view the causes of conditions is quite different. I can give an example of the fact that, with most of the traditional practitioners, when patients with such conditions go to them, they often attribute the causes to witchcraft.
With us, it is completely different. We have theories that can help us to attribute causes.” (Participant CP4)
This seems to suggest that the absence of legislative frameworks that govern the processes of referral, training and practice works against the possibility of the collaboration of the western and African traditional health systems.
PART B: EMERGING THEMES FROM TRADITIONAL HEALTH PRACTITIONERS 7.3.7 Theme 1: Divination as the main process of inquiry
The results of this study revealed the significance of divination as the main form of enquiry during a consultation with traditional health practitioners. All the participants have emphasized the importance of the throwing of divination bones (go tšholla ditaola) as the entry point during their interaction with their clients. The results further explain
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some reasons associated with the need for divination before any intervention can be provided. These reasons include a) seeking clarity about the nature, cause, and other related factors of the main complaint, b) avoidance of attempting to treat conditions that may have resulted from the ill person‟s mischievous acts, which may, in turn, affect the healer, and c) seeking direction regarding the treatment procedures to be followed and the items to be used. These are further discussed in the following subthemes.
Subtheme 1: Enquiry about the nature, cause, and other related factors
The participants have shown the importance of divination as a method through which they can be guided about the nature of the problem that is being presented, the causes as well as all the factors that may be involved in the presentation at hand. The divination bones can provide guidance taking into cognisance the individual differences. This assertion is supported by the extracts below:
“There is no way you can understand a person without knowing the types of problems he is coming with. You will need to consult your bones first.” (Participant THP9)
“There is nothing more important than being guided by the divination bones because conditions are different, people are different, and what they want is different. If you cannot make it a point that you are guided by the bones, you will get into trouble.”
(Participant THP8).
Divination has been deemed by the healers as an important tool that helps them to understand the causes of an illness that is presented to them. It complements the information that is provided to them about understanding the illness as understood by the collateral sources.
Subtheme 2: Illnesses resulting from mischievous acts
The results of the study have further shown that there are instances where people fall ill as a result of having committed mischievous acts. These acts are said to include
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bewitching other people or killing other people. The process of divination guides the healer about the causes of the illness that is presented. They further guide the healer about whether to intervene or not and the reasons thereof. If the healer provides intervention in cases where the illness was caused by the commission of mischievous acts, they will relieve the person‟s suffering from the illness and inherit it themselves.
This is illustrated in the extracts below:
“In some instances, they would have bewitched people. He has killed a person, and you are releasing/relieving him (go mo swarolla), then I help her but whatever that is troubling her then come back to me.” (Participant THP8)
“We are guided by the divination bones. We are assisted by consulting them first. We are afraid of the fact that I can just jump straight to treating her while she has a problem herself. Then that problem passes on to me.” (Participant THP9)
The above information seems to suggest that divination is an important tool that is used by traditional health practitioners to avoid treating conditions that may be incurred from their service seekers through their mischievous acts.
Subtheme 3: Intervention to be provided
The results have shown that it is through the process of divination that they can understand whether or not to provide intervention, as well as the type of intervention to be provided. The divination bones can provide answers to all the questions they may have before intervention can be provided. In the case where medicines have to be prepared, the divination bones can guide the types of medicines to be given. This is illustrated in the extracts below.
“..once I throw the divination bones, they will tell me everything.
They will tell me that this person is suffering from this illness. I will then ask the bones again, whether to provide the medicines or not.
They will tell me to provide. If they deny that we should not provide
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the medicine, nothing we can do because they have the tendency of denying. We will then ask them the reasons for not providing.
They will tell us that we should not provide because of this and that.” (Participant THP10)
This seems to suggest that divination is the critical tool that informs the healers about the guidance in the process of intervention.