Where Western medicine holds sway, there is little space or tolerance for sangomas and other traditional healers.
The reality, however, is that as many as 80% of the South African population makes use of "traditional health practitioners" (THP) – that's the official collective name for izinyanga (herbalists), izangoma, abathandazo (faith healers), birth attendants and traditional surgeons.
But with no regulation in place, says KwaZulu Natal traditional health practitioner, Doreen Buthelezi, "some wayward practitioners give us all a bad reputation".
Regulation would involve the integration of traditional health services into the formal health system, standardisation of traditional health practices, registration of practitioners and formalising the education and training methods for student traditional health practitioners.
Incorporating traditional healthcare practices into the formal health system is not a concept unique to South Africa. Many countries, including China, Canada and Nigeria, have developed national policy for traditional or complementary medicine, and practice it at all levels, including public hospitals.
The World Health Organisation (WHO) also encourages the integration of traditional medicine (TM) into the health system – especially in developing countries where THP is more accessible in rural areas than allopathic (conventional/Western) practitioners, and TM is sometimes the only affordable source of health care. "Greater accessibility to TM practitioners probably explains why most Africans living with HIV/Aids use traditional herbal medicines to obtain symptomatic relief to manage opportunistic infections," reads the WHO's Traditional Medicine Strategy report.
Without aiming to replace mainstream medical practices, TM can be enlisted to complement or supplement allopathic medicine – especially when there is little access to clinics or medical health practitioners, as is often the case in rural areas.
What is TM?
According to the DoH's Draft Policy on African Traditional Medicine for South Africa: "African Traditional Medicine is a body of knowledge that has been developed over thousands of years which is associated with the examination, diagnosis, therapy, treatment, prevention of, or promotion and rehabilitation of the physical, mental, spiritual or social wellbeing of humans and animals."
"There is a lot of history, a lot of complexity, a lot of layers," says Dr Bernhard Gaede a family physician working at Emmaus Hospital in the Northern Drakensberg (KZN), and chairperson of the Rural Doctors Association of South Africa. "Traditional medicine is often seen as a lot more sensitive to people's cultural setting.
"Healing is very diverse; it addresses a whole range of issues, like explanation of the illness or anxiety around the illness, and also a ritual to end the illness," explains Gaede. "Often the way biomedicine and the dominant health care system approaches traditional medicine is focused on the substance that is being given, not necessarily on the whole process and everything that comes with it."
According to Gaede it boils down to the psychological or spiritual aspects of being ill. "The experience of healing is much more integrated into the process you are following in traditional medicine."
The WHO's report also acknowledges this concept: "Traditional medicine is based on the needs of individuals. Different people may receive different treatments even if, according to modern medicine, they suffer from the same disease. Traditional medicine is based on a belief that each individual has his or her own constitution and social circumstances which result in different reactions to 'causes of disease' and treatment."
What the DoH is doing?
Although TM is far from being incorporated or regulated by South Africa's formal health system, the DoH has taken steps in that direction. Currently we have a Traditional Health Practitioners Act (Act No. 22, 2007) that basically aims to establish a Traditional Health Practitioners Council. Once established, the council will be responsible for ensuring the safety of traditional medicine and services, and serve as a regulating body for traditional health practitioners.
"The Act makes mostly provisions for how the traditional healers are organised," said Gaede. "So it makes provisions for different councils, for national provincial and local bodies where traditional health practitioners register and become part of bodies. There's also a section on how traditional health care practitioners can be disciplined. It's really creating a bureaucratic structure of how traditional healers are organised."
The Department of Health has also drafted a policy on African Traditional Medicine for South Africa. The proposed policy provides a framework for the institutionalisation of African Traditional Medicine into the South African healthcare system.
In order to facilitate the institutionalisation of African Traditional Medicine the policy recommends:
Regulation of African Traditional Medicine
This refers to the registration, regulation/standardisation of African Traditional Medicine products. This proposed act will also protect the intellectual property rights of those involved in the discipline.
Education, training, research and development
This point calls for the establishment of a National Institute of African Traditional Medicine. The institute will be involved with the standardisation of training of student traditional health practitioners, and will lead research into traditional medicine.
Cultivation and conservation of South African Medicinal Plants
Pharmacopoeia (on official compendium of quality standards for pharmacologically active substances and drug products)
"What we have been lacking in South Africa and globally in terms of African traditional medicine, is to move to clinical research," said Prof Nceba Gqaleni, chair of the Indigenous Health Care Systems Research. "It takes long and there has not been much investment in the field."
Gaede explains that: "with traditional medicine, there is a large degree of variability. Even if the medicine itself has got the same name, what is in the medicine may vary quite radically. And that is because different traditional healers have got different recipes."
Guarding our national heritage
An important aspect to keep in mind while researching and formalising African TM, is to protect our national heritage. The last thing we want is a large pharmaceutical company to grab the patent on some 'super' African TM, who will then develop it, bottle it, and make billions in profits selling our recipe to the rest of the world.
As said in the DoH's policy on TM: "African Traditional Medicine is a body of knowledge that has been developed over thousands of years…" The recipe belongs to Africans and the people and communities that developed it initially should profit from it.
"If we are careless about that we will lose out in terms of how our heritage benefits our economy," says Gqaleni, "this is an industry, like the taxi industry, it's a huge service industry, it has great potential to our economy. If we can tap it in an appropriate way and find the right legislation to ensure you protect it, yet it can be researched and developed in an appropriate way."
- Wilma Stassen, Health24, October 2008
(Last updated August 2010)