The results of the study reflect the fact that traditional healers are positive about the integration process. The integration of traditional healers into the South African (SA) health system has been debated by a number of researchers within the last two decades (Bodibe, 1992; Hopa, Simbayi & du Toit, 1996; Kottler, 1988).
Motivation for the study
Aims ofthe study
Research questions
Layout of the rest of the thesis
- African World View
- Spiritualism
- Mysticism
- Witchcraft and sorcery
In addition, the possible obstacles to integration, as well as the advantages and disadvantages of the traditional healing system are reviewed. The latter conceptual system is characteristic of the African worldview, which forms the basis of the traditional healing system, and this will be discussed in the following section Myers (1988).
The notion of health and disease
Natural causes of illness (Umkuhlane)
- Biological understanding
- Ecological understanding
Unlike the natural causes of disease, are the supernatural causes of disease, discussed in the next section. According to mystical theories, disorders result from an action or experience of the affected individual (Hop a, et. aI., 1996).
Categories of traditional healers
The inyanga (Indigenous doctor)
- The training of the indigenous doctor
These strict regulations are evidence of the structured way in which the traditional healing practice is carried out and this in contrast to the way in which the practice was viewed in the past by Western professionals. The function of the isangoma is generally to diagnose illness and its cause and then refer the client to the inyanga for treatment.
The isangoma (diviner)
- The training of the diviner
This unification includes the conscious and unconscious, emotions, as well as the physical and psychological aspects of the initiate. Even in their practice, fortune tellers continue to consult with both their ancestors and the ancestors of the patients.
The role of traditional healers
The question is whether traditional healers should be integrated into the mental health system of the country or not. Halley Scott (the founder of the Valley Trust) established a relationship with traditional healers in the area.
Calls for integration
Consequently, there has been widespread support for the integration of traditional healers into the mental health system (Nzima et. a11992). The Center for Health Policy has called for the development of a policy regarding the role of traditional healers in the S.A health care system (Freeman 1992).
Attitudes towards integration
- Intensive training as a requirement for professionalisation
- Professionalization within the traditional hl~aling system
- Collaboration and co-operation
- Incorporation versus total integration
THO), the National Traditional Healers Association of South Africa (NTHASA) and the Kwa-Zulu Natal Inyanga's Association (KZNIA) are some examples (Hess, 1998; Clarke, 1998). The question also needs to be answered as to how to deal with the different categories of traditional healers. The existing organizations of traditional healers do not have financial support to support the activities of the members.
Proposed policy for traditional healers
A call was made for the registration and coordination of traditional healing activities to be carried out at the provincial level. A registration body will be established for the purpose of control and registration of traditional healers, composed of traditional healers themselves. Both the Council and the associations will serve the functions of promoting health, protecting the interests of traditional healers, and making recommendations to regulatory authorities on matters of registration and control (Freeman, 1992, p.2).
Integration in other African countries
Integration in Zimbabwe
The last option was chosen, as the first two alternatives seemed dangerous in terms of the possibility of imposing the bio-medical concepts of Western medicine on traditional healers. Traditional healers were then integrated through a policy of registration and inclusion of traditional healers into Zimbabwe's national health system. One of the reasons for such resistance is the fact that some African professionals see traditional healers as a threat to their professionalism and an obstacle to greater cooperation.
Integration in Swaziland
The task of the association is to regulate the integration process under the Traditional Healers Act of 1981 (Freeman & Motsei, 1992). The third was collaboration between Western doctors and traditional healers, which would work as independent systems. Despite this official recognition, there is still much resistance among both modem and traditional practitioners to the policy (Freeman & Motsei, 1992).
Integration in Mozambique
Chapter Summary
Will traditional healing be regulated by the modern healthcare industry and what will be the implications of such an exercise? What are the possible boundaries within which they want to operate within an integrated system? What obstacles do they foresee that could hinder the integration process and what measures can be taken to overcome them?
Introduction
Participants
Instruments and methods of data collection
Pilot study of the instrument
Zuuren, Wertz & Mook (1987), who defend the use of small samples in qualitative studies and emphasize that such small numbers provide a good basis for analyzing the data.
Procedures
Research design and analysis
Some participants were re-interviewed to confirm the reliability of the original information. This refers to the question of whether the study's findings make theoretical sense (Miles & Ruberman, 1994). Information about the right not to participate or withdraw from the study was part of the informed consent procedure.
Introduction
The role of traditional healers
Alternative healing
Treatment of "spiritual illnesses"
Medium of communication with ancestors (through impepho)
Divination and the burning of incense (as a medium for communication with ancestral spirits) were identified as the main methods used by healers in their diagnosis and treatment of diseases. The other alternative method of healing was the use of herbs, especially by izinyanga (herbalists) to treat various diseases. The aforementioned healing methods are seen by the participants as a holistic approach to ill health and its treatment, as well as alternatives to Western healing procedures.
Integration: Perceived obstacles and solutions thereof
The participants perceived integration as a necessity and a means of uniting the two major health systems in the country. Evidence of this eagerness is indicated in their efforts to provide the researcher with possible solutions to the obstacles in the integration process. Their main motivation is that they saw it as imperative to work hand in hand with their western counterparts to provide adequate health to all the country's citizens.
Perceived obstacles
- Disunity among traditional healers
- Intellectual property rights
- Insecurities about handling of financial matters
- Collaboration and co-operation
The above excerpt points to the existence of gender and power issues within the traditional healing system. The participants came up with several suggestions that could be used as possible solutions to the identified obstacles. In conclusion, most participants perceived the education of all stakeholders about each other's health systems as one solution to the identified obstacles.
Position of traditional healers within an int4~grated health system
Equality amongst all the stakeholders
According to the traditional African worldview, it is the ancestors that determine the well-being or ill-health of each individual. The concept of health and disease causation seems to be the foundation of the traditional healing system. This understanding will have an impact on the integration process as a whole, as it is completely different from the biological understanding of health and disease of Western doctors.
Concerns raised from this study
All these lead to mental illness and so a person should see a psychologist who will make them aware of the dangers of their lifestyles. The participants made it clear that given all the options to work with the western. This was identified as the most possible and achievable, instead of total integration, which according to the participants could only lead to conflict and failure of any working relationship.
Chapter summary
Introduction
The role of traditional healers
Cultural relativism and world-view
This refers to the unique ability of traditional healers to throw bones and use their powers to communicate with the patient's ancestors for diagnostic purposes. Perhaps the way forward would be for traditional healers to sit down with their westerns. Khokho indicates that the relationship between traditional healers and hospital doctors is not smooth.
Perceived obstacles and possible solutions
- Disunity amongst traditional healers
- Concern about future power relations
- Possible financial problems
- Concern about bogus traditional healers
The second obstacle identified by traditional healers was related to the power issues that would come with integration. Another potential obstacle, which was identified by traditional healers, was about possible dishonesty by what they call 'chartalans' or 'fake traditional healers'. Possible solutions identified by traditional healers to the above obstacles included the need for respect, recognition and future cooperative relationships between them and their Western counterparts.
Boundaries for operation
Collaboration and co-operation vs total integration
Collaboration is defined by most participants as working side by side with Western practitioners, 'but not under one roof. This can be seen as a positive attitude towards future working relationships between the two systems and it also indicates that being against total integration does not mean that traditional healers are unwilling to work with their Western counterparts. A practical way to implement this alternative is given in the next section as one of the suggestions from the participants of this study.
Traditional healers to have their own medical centres
It is from this point that it can be said that cooperation and collaboration seem to be the best alternative for establishing any kind of working relationship between traditional healers and Western practitioners. It is important to note that traditional healers report that they refer many patients to the hospital, especially in cases such as dehydration and loss of energy. This is where another aspect of boundaries was identified, namely the freedom to cross-referral between traditional healers and Western practitioners within a collaborative working relationship.
Government protection, support and subsidies
Participants further indicated that they referred their patients to hospitals, although they did so secretly, as they feared that their patients would receive poor treatment if they found out they came from a traditional healer. This issue of referrals within traditional medical practice is at odds with most healthcare professionals. Traditional healing medical centers were therefore seen as another measure in setting boundaries designed for success in any positive working relationship.
Position of traditional healers within an integrated system
When defining what “competent” meant to them, most participants referred to the issue of opportunities to help patients recover from their illness. This alone cannot necessarily serve as a basis for equality between the members of the two systems. This perception is an indication that equality is an important condition for integration and is also seen as a way to avoid any domination of one of the systems.
Traditional healers' understanding of illness
African world-view and notion of causality of illness
According to the participants, in such cases there was a need for the traditional healer to bum the impepho (incense) as a way of communicating with the patient's ancestors and asking them for guidance in diagnosing and treating the illness. The participants indicated that in a case like this they referred patients to the psychologist who could be effective in helping him/her. This is another sign that traditional healers refer patients if they feel inadequate to deal with a particular disease or problem.
Chapter summary
These internal negotiations with the traditional healing system could help traditional healers. come closer together, creating a good foundation for a positive relationship with Western practitioners within an integrated healthcare system. Traditional healers consider themselves equal to Western practitioners because of their... training and the ability to cure a variety of diseases. Bridging the gap potential for a healthcare partnership between African traditional healers and biomedical workers in Johannesburg, South Africa.
INTERVIEW SCHEDULE (ZULU)
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INTERVIEW SCHEDULE (ENGLISH TRANSLATION)
CONTINUED)
