ILLNESS
4.8 UBUNTU (AFRICAN PHILOSOPHY)
115
Traditional healers have also been criticised for complicating the fight against HIV and AIDS. In a study by Mbereko and Mahlatini (2014), some traditional healer respondents reported that they discourage their patients from using condoms because they believed condoms have AIDS. Generally, practices and instruments used by traditional healers have frequently been blamed by western doctors for exacerbating HIV and AIDS (Mbereko and Mahlatini, 2014). The castigation of traditional healing methods has been fuelled by whites who, upon their settlement in Africa, described TM as primitive, barbaric, ignorant knowledge, superstition and unscientific (Shizha, 2008; Shizha &
Charema, 2012).
116
form of discrimination (Museka & Madondo, 2012). Museka and Madondo (2012) further argue that it is a way of living that contributes positively to the welfare of all members who make up the universe. Ubuntu philosophy is important in the study of chronic illnesses in an African setting for two reasons; it is enshrined in traditional African values and belief systems, and it shapes the behaviour and the thinking people of African descent. Ubuntu is also seen as an effort to help people in the spirit of service, to show respect to others and to be honest and trustworthy. The concept has originated from the Nguni tribes of South Africa, and it has equivalents among other Bantu languages. For example, the word hunhu is used among the Shona. Lately, the ubuntu philosophy has taken a centre stage in jurisprudence, management, health in Africa and the African diaspora.
The philosophy of ubuntu plays a critical role in the care and treatment of people with chronic illness in African communities. Mhame et al (2010) postulate that the ubuntu philosophy requires traditional medical practitioners to provide health care services for humanitarian reasons first, and not for material gain. Engelbrecht and Kasiram (2012) also argue that in accordance with the principles of ubuntu, people with mental illness should be well supported and cared for by their families and the wider community. This is further buttressed by the fact that according to the ubuntu philosophy, the community is important and individual needs are secondary to family and community needs. If a person‘s behaviour is deemed to benefit the community, then one is deemed to be human. As shown by its values, ubuntu affects the way people with chronic illness are looked after in African communities. This is supported by the South African White Paper on Welfare which views ubuntu as a principle of caring for each other‘s well-being. The
117
African expression of ubuntu says ―Your pain is my pain‖. This may suggest that when one is chronically ill, community members may sympathise with that person and may consequently be obliged to help. Under the ubuntu philosophy, a person should involve others as brothers and sisters for life and this makes one‘s problems lighter (Broodryk, 2006).
Writing on ubuntu philosophy, Mbigi (1995:111) talks of the African Collective Fingers Theory which implies that the thumb needs other fingers to work effectively. Under ubuntu philosophy, all the people should be treated with dignity and worth, whether they are fit or ill. As noted by Broodryk (2006), sympathy is important in Ubuntu, and it is practised when a problem befalls a community member. The communal nature of African ways of dealing with social problems is enshrined in some Shona adages. For example;
Rume rimwe harikombi churu- one man cannot surround an anthill
Kutsva kwendebvu varume vanodzimurana- when men‘s beards catch fires, others assist.
For some Shona people, healing and well-being are a communal endeavour as all members of the community work together towards preserving and securing life, health and wellbeing (Chirongoma, 2013). Among the Shona people, the process of obtaining diagnosis from a traditional healer is not an individual affair. A sick person is usually accompanied by relatives in most cases family elders (Shoko & Burck, 2010). They also have to agree with or refute the results of the diagnosis.
118
Ubuntu is thus the fountain from which actions and attitudes flow. It is the bedrock of African life that promotes communalism, a spirit of participatory humanism. According to Nyengele (2013), participating in community matters, gives a person a place of belonging, an identity, human dignity and personhood. Interdependence is thus highly valued in African communities than individualism.
4.8.1 Caring for the Sick in African Communities
According to de Graft Aikins (2010), most of the burden of the care of the chronically ill is carried out by their families, households and the community. Communities shape people‘s interpretations and responses to pain and suffering. In traditional African communities, a person relies on the community when faced with insurmountable problems such as illness. This is shown by Matolino (2011:75) who notes that ―In the event of an illness, the community, being one with the individual has the responsibility of taking care of the sick individual and getting rid of the sickness‖. Mapuranga (2010) states that the idea of doing well to other people as enshrined in the African kernel of ubuntu provides a helping hand in the HIV and AIDS prevention and care.
Caring entails giving love and providing for the needs of the person who is in need.
Care can be physical, emotional, financial, psychological or any other form (Mapuranga, 2010). Africans recognise the vitality of human life and any action which increases human life is promoted. Mapuranga (2010) argues that discrimination of PLWHA is a problem that violates the African vitality of human life. Usually, the relatives of the sick person engage a spiritual person to find out the causes and remedies of the sickness.
Matalino (2011) notes that in the event of mental illness, the person who is afflicted by such a disease would not be sent to some lunatic asylum to be taken care of. Those
119
close to the person would report the matter to the ancestors so that s/he could be restored to his/her normal state. In African communities, the family plays an important role during one‘s illness. Among many African communities, it is assumed that an ill person deserves to be treated as a child and therefore, deserves protection (Mufamadi, 2009). Of importance to note is the fact that in African communities, accomplishments of individuals are attributed to the whole family. This also applies to shame and misfortune.
4.8.2 Community and Home- based Care in Zimbabwe
Zimbabwe has a national strategy called National Community Home Based Care Strategy which provides for the care of chronically ill people in their communities.
Home-based care has been offered in Zimbabwe for more than two decades for people with chronic illnesses. HOSPAZ (2005) notes that between 70% and 90% of illnesses in Zimbabwe, care takes place at home. Home Based Care (HBC) may be defined as any form of care given to the sick in their homes. HBC is the best way for people to be cared for and to die (Tom & Sadomba, 2013). The current National Community and Home Based Care 2010-2015 policy document notes that the goal of Community and Home Based Care (C&HBC) is to contribute towards an improved quality of life for chronically ill clients and their families through provision of standardised and comprehensive care at community and home level in Zimbabwe (Ministry of Health and Child Welfare and National Aids Council, 2010). HBC has two major strengths; families and communities.
Families are the central focus of care and form the basis of HBC team while communities are places where people live and where some community members support their families and their sick individuals. Writing on diabetes, Young and Unachukwu (2012) argues that the relationship that patients have with family members
120
and colleagues is a very critical factor in improving a patient‘s sense of wellbeing and leads to more effective management of the disease.
4.8.3 Self-care/ Self-management of Chronic Conditions
There is no agreed definition of disease management. In disease management, care is focused on and integrated across the entire spectrum of the disease and its complications, the prevention, comorbid condition and the relevant aspects of delivery system. Self-management as a component of disease management may be defined as a person‘s ability to manage the symptoms, treatment, physical, psychological and lifestyle changes inherent in living with a chronic condition (Johnston, Liddy, Lves &
Soto, 2008). Self-care encourages patients to be in control of their lives and to be independent. Self-care is an essential component of management of chronic illness among Africans especially where pharmacological treatment is limited. As noted by Harvey (2005), the psychological and spiritual aspects of chronic illnesses are critical in self-care. However, cultural differences should be recognised. Psychological and spiritual elements of self-care include meditation, prayer and traditional spiritual healing.