By Emily Geminder
30 October 2008 [MEDIAGLOBAL]: There are few things traditional healers in Africa and the biomedical community agree on when it comes to HIV/AIDS. Rumors and misconceptions abound on both sides. But both also share a common truth: neither the herbal and spiritual regimens prescribed by healers nor the antiretrovirals of biomedicine can cure.
Sibongile Nene, a South African Zulu traditional healer. (Photo: Sibongile Nene)
Jo Wreford, a British born trained and practicing sangoma, a healer, calls it the “treatment gap” – the time from when a person is diagnosed HIV positive up until the time their CD4 count drops below 250, making them eligible for antiretroviral therapy. And antiretrovirals, she hastens to add, are not easy to come by in South Africa. In an interview from Cape Town, she told MediaGlobal, “In that period, which should be as long as we can make it, because we know that ARVs are incredibly invasive medicines and once on them, patients must take them for the rest of their lives, Western medicine has very little to offer in this country and probably elsewhere. You can give antibiotics for opportunistic infections, but actually they may undermine the immune system even more and so accelerate the time when the person has to go on ARVs… What I’m most interested in at this point is to try and use the herbs and medicines the traditional healers are confident will help to boost the immune system and to treat infections like shingles.”
Traditional healers are often the first and only point of contact for South Africans who fall ill. According to World Health Organization statistics, roughly 80 percent of Africans regularly seek the consul of traditional healers. While biomedicine has brought dramatic benefits to the continent’s healthcare systems, most of its vaccines, doctors, hospitals, and treatment programs remain largely inaccessible to all but a privileged minority. There are roughly 40,000 people to every medical doctor in Africa. Traditional healers, on the other hand, are in every town and village – one for every 500 people. The cost differential is equally gaping.
To say it is just a matter of cost or accessibility, however, would be to ignore the depth traditional healing reaches in the collective psyche. And it is this depth, perhaps, that the Western medical community misses, for all the desire to tap into it. Even the term ‘healer’ itself belies the many and varied roles traditional practitioners take on. Forms of African traditional medicine may revolve around herbal medicines or spirituality and often combine elements of both. The term inyanga refers to an herbalist, while the sangoma is a diviner or spiritual healer.
Sibongile Nene, who trained to become a sangoma in her native village in KwaZulu-Natal, now lives and practices in Toronto, though she makes frequent visits home to South Africa. In an interview with MediaGlobal, she noted that any process to forge partnerships between allopathic and traditional healing must take into account the long history of oppression traditional healers have faced. “If your true motive is healing and bridging the gap between the two, then there has to be a plan that is traditional healer-centered and addresses where they are coming from,” she said.
Under apartheid in South Africa, traditional healers were banned from practicing. Deemed to be operating outside the rule of law, they were severed from their identities. They were not only forbidden from practicing; they were not allowed to be. It was a marginalization established through torture, exile from their families and communities, murder. Still, many continued to work in secret, sometimes incorporating aspects of Christian ritual into their practice – both in an attempt to disguise their faith and merely in accord with the realities of cultural merging.
“There were dramatic things that occurred during those centuries that caused many healers to not come out and be what they were called to be,” says Nene. “Or if they had to be what they had to be, they had to somehow do what they had to do in disguise and hide.”
Part of the legacy of apartheid is a deep mistrust of Western medical interventions. In South Africa, healthcare professionals and their institutions largely supported the racist architecture of apartheid. In one of modern history’s starkest examples of the severing of biomedicine from basic human rights, the apartheid government’s Project Coast developed biological and chemical weapons and deployed them on hundreds of black citizens.
In many ways, the remnants of apartheid’s gross racial discrepancies continue to ebb at the national healthcare system. You don’t have to be conspiracy-minded to note that HIV/AIDS thrives largely among South Africa’s poor and black communities, that the solutions touted by a traditionally white medical system are so prohibitively expensive, few can afford a lifetime of them. After apartheid, Virodene, a drug touted as an AIDS cure by the South African government, turned out to be toxic. It was also revealed that the drug had been illegally tested on Tanzanian subjects.
Nelson Mandela did not address HIV/AIDS until three years into his term. That was 1997, when the casualties already numbered in the millions, and one in ten South Africans was infected. The record of Mandela’s successor, Thabo Mbeki has been bafflingly obtuse. In 2001, under pressure from AIDS activists, his government successfully battled a lawsuit brought by multinational pharmaceutical agencies over patent law, allowing South Africa to produce substantially cheaper generic versions of antiretroviral drugs. At the same time, from the very beginning of his term, Mbeki pursued relationships with so-called “dissident” scientists, who questioned the link between HIV and AIDS, and their views recurrently surfaced in his policies and speeches. Pressed by activists, scientists, and the international community to make antiretrovirals available to pregnant women, Mbeki continually stalled. As local and international pressures mounted, the denials of Mbeki’s early days turned to muted ones, which in turn gave way to a silence no less unsettling.
But the silence was not just his. Kofi Annan once said there had been a continent-wide “dearth of leadership” as the crisis of AIDS was becoming apparent in South Africa. Infection rates exploded, and no one spoke up. Entire generations were stunted, and orphans numbered in the millions, and still no one spoke up. Annan: “We needed leadership at all levels. But it was most important to get the presidents and the prime ministers speaking up and that was not happening. I thought we should do whatever we can to raise awareness and to get them involved.” But Annan himself did not broach the subject with African leaders until 2000.
The call for collaboration with traditional health practitioners was not new. The World Health Organization had been urging for the integration of traditional healers into biomedical systems as early as the 1970’s, and UNAIDS had more recently echoed the sentiment as a strategy for HIV/AIDS prevention. Stirrings of a similar nature made their way through South African Parliament, and in 2003, a bill was introduced that would provide a regulatory framework for all individuals providing traditional healthcare services. But though the bill – with its gestures toward standardization such as the establishment of registration for traditional health practitioners – has been on the books for several years, little has been done to enact it. The UNAIDS protocol of best practices, which similarly advises streamlining traditional healers into a regulated system, also has limited reach, rarely translating into real action on the ground.
Jo Wreford echoes the sentiments of many sangomas when she says the problems with enacting such policies underscore the larger rifts between the two communities of healing. She says of the South African bill: “It’s about structuring traditional medicine in a way that suits Western medicine. It’s about regularizing [healers’] qualifications, standardizing their educations, setting up schools of healing and so on. Many of these notions run directly contrary to the ideas of spiritual empowerment that come particularly with the diviner-healers. For an herbalist it’s not so peculiar, for a traditional birth attendant, for a bone-setter – you can see how they might be structured within Western categories of medicine. But for diviner-healers, they really struggle. The idea that a sangoma must have the equivalent of a secondary education or else they cannot go through the training to be a sangoma is nonsense because a sangoma can be called at the age of 10 or the age of 50, and it has nothing to do with the level of education they have in Western terms.”
In other words, the slippery metamorphoses of spiritual healing cannot be regulated, whether by the apartheid government that tried to ban traditional healers or by the new eagerness of the post-apartheid government, along with international efforts, to address local and cultural specificity. The problem is that UNAIDS, the World Health Organization, and any government hoping to maintain an image of modernity in the eyes of the international community are all housed on a foundation of an empiricism that makes little room for the fluctuations and uncertainties of the spiritual world. Conversely, the very idea of putting into writing a standard set of rules and regulation is antithetical to a tradition that has been passed down orally from one healer to the next over centuries.
“Traditional medicine does not have the formal research capacity required by Western medicine in order to prove the efficacy of interventions and approaches,” admits Andy Seale, a UNAIDS senior advisor for Southern and Eastern Africa. “Yet traditional practitioners will point out that they have centuries of accumulated knowledge and experience.” But he also points to the growing trend of individuals seeking out both forms of healthcare. It is a trend that points to the potential for both systems to work complimentarily.
Susan Watkins, a research scientist and sociologist who has long studied AIDS responses in rural sub-Saharan Africa, also sees people seeking the help of both healthcare systems. She told MediaGlobal, “People respect both the health workers and the traditional healers and are very pragmatic. If they think this is an illness that the clinics can deal with, they go there. If they think the traditional healers can deal with it, they go to them. And if they try one and it doesn’t work, they go to the other.” But here Watkins differs with UNAIDS on a key point. “I don’t see a lot of point in spending money on elaborate programs to get them to work together.”
The degree to which each system retains the features that define it is a major question for any effort addressing the way the two communities may work together. Lefate Makunyane, a social worker in Cape Town, runs trainings for local traditional healers, discussing issues such as when to refer patients to clinics and how to sanitize materials. “A lack of regulation within the traditional healers allows for a few individuals to abuse the profession,” he told MediaGlobal. He is also working on an initiative to include traditional healers alongside medical practitioners in clinics.
Sibongile Nene questions the immediate leap from the premise of collaboration to a solution based primarily on consulting healers within clinics. “It shouldn’t be about traditional practitioners fitting into a doctor’s model. It should be about both models being developed to their fullest capacity and then being able to work together from their individual perspectives and their individual practices as they are. What I find is happening more and more is there’s more encouragement of traditional health practitioners going the other way – going into clinics and working in clinics, which is not a traditional way of working. There’s less emphasis on doctors leaving their clinics and hospitals and offices and going into the villages and workings with traditional healers in their own environments. So to me still there’s this perpetuation of a euro-centric superiority. There is a sense of, ‘Well, we are established and you are not, so come and learn from us.‘”
While Nene advocates a broad conception of collaboration, she says it would take far more resources and time on the part of organizations like UNAIDS to be effective. “The language barrier is huge, the gap between the environments which we work in is enormous, and our methodologies are very different. We have to first understand our differences before we can find a plan. At the moment, I don’t think whoever’s trying to bridge this gap understands how truly different our premises are, of where we’re coming from.”