Even more important are the ethical questions of trust involved in such incorporation. The first of these trusts being that between the healer and the patient. If traditional healers were indeed trained in the ways of Western, modern medicine and sent back into their communities, there may be a sense of betrayal; suddenly the patient would have no choice but to prescribe to modern medicine. Even if the healer retains most of their previous practices, the integration of new Western ideas may be confusing to both the patient and the healer. Furthermore, these ideas may clash with long-held beliefs about the root and cure of the illness resulting in a confused stew of old and new methodologies.
The second, more ambiguous issue of trust on the table deals with that between the healers and the governmental body registering and training them. While the basic concept behind the integration of traditional healers is to ensure “proper” health care for a larger, less accessible portion of the population, one can’t help but question the motives of the health care sector. The notion of the traditional healer as a mere pawn of the larger, biomedical system is hard to avoid; Nzimande suggests that incorporation “may be a paternalistic way of making the clients of traditional healers available to western intervention” (Freeman, 1992: 1187).
By providing traditional healers with just enough knowledge to formulate a diagnosis and prescribe medicine, western doctors are conditioning healers to refer anything out of this realm to them, thus introducing them to a new pool of possible patients with minimal work involved on their part. Proof of this is evident in assessments of previous programmes in other countries; in an UNAIDS evaluation of an incorporation programme in Uganda in 1992 they list “Traditional healers make increased referrals to biomedical health providers” (UNAIDS, 2000: 49) as direct proof of the project’s effectiveness.
In addition, one must remember that the transfer of information in this partnership is not solely from practitioners of modern medicine to those of traditional medicine. The possibility of exploitation of healer’s vast knowledge of alternative treatments is very real; businesses such as Shaman Pharmaceuticals directly utilize acquired knowledge from traditional healers to make a fortune for themselves in the western market (Rekdal, 1999: 5). Who is to say that the same will not happen to healers who have no sense of patenting or legal rights to their own cures in the case of incorporation?
Aside from moral questions raised by a possible incorporation, the sheer impracticalities of the idea are plentiful; logistically, financially, beaurocratically, and ideologically, ambitions to incorporate traditional healers are flawed. To begin with, registration and certification of the healers would be virtually impossible and entirely ineffective. Studies have shown that the only healers who have a desire to become registered are those who already exhibit an interest in biomedicine, others simply don’t see what a piece of paper stating their registration will do for them, and would likely not register at all (Freeman, 1992:1188). If indeed registration were a requirement in order to practice, this would serve as yet another example of forced acceptance of Western medicine. This is an arrogant and dictatorial stance for the government to take against a union of workers that has been in existence for far longer than they have.
Another important question of judgment comes into play when deciding who qualifies as a traditional healer. How does one prove the efficacy of their treatment of patients when many of their diagnoses rely on the presence or absence of spirits? In the case of diviners who are believed to act in medium with ancestors and are “chosen” into their profession by supernatural powers, certification and regulation are almost impossible. Lastly, statistics show that there are upwards of 200,000 traditional healers in South Africa (Kale, 1995: 1182), all of whom would need to be trained and certified in order for incorporation to work. The questions then arise: who would pay for this, and provide the materials and transportation for training?
While traditional healers will come away from training with a greater comprehension of the workings of modern medicine, they will by no means have the extent of knowledge that a doctor of Western medicine has upon certification. This poses several problems, both for the healers themselves and the doctors they would supposedly work alongside. To begin with, traditional healers are viewed within their communities as people of high status, comparable to that of a biomedical doctor in a Western society; however, in the eyes of modern medicine, healers will never be seen as attaining the same level as a certified physician.
In talking about the effects of incorporation on traditional healers, Melwyn Freeman of the Department of Community Medicine in the University of Witwersrand in Johannesburg writes,
They seem to have open minds and accept new ideas. But would they be willing to accept the secondary role of health care workers? The range of illnesses that traditional healer would be allowed to treat after integration would be limited; they would thus have to accept the superiority of modern medicine and their status would be reduced (Kale, 1995: 1184).
The notion that modern medicine is universally accepted as “superior” and the idea that traditional healers would have to come to terms with this fact makes a lot of assumptions about the willingness of healers to conform. This idea is further discussed by Abdool-Kareem, who warns that with incorporation, “there is a danger of the traditional healer becoming a second-rate paramedic or stop-gap health worker without appropriate compensation from the government” (Abdool-Kareem, 1994: Ch 8).
This conviction of the innate superiority of modern medicine presents many obstacles in the formation of relationships of mutual respect between traditional healers and doctors of western medicine. A poll of African doctors by Ojanuga found that 76% of physicians would never refer their patients to a traditional healer, despite having reported positive experiences with them as children (Abdool-Kareem 1994: Ch 6). Conversely, traditional healers were also found to harbor similar feelings for modern medical doctors, viewing them as, “angry, uncompromising, and arrogant people who are waiting to grab their business, and not only take over their patients but also usurp their position in society” (Abdool-Kareem, 1994: Ch 6).
Despite the discussed flaws in plans for incorporation, and attempts at such modifications have failed in countries like Swaziland and Zimbabwe, it is not to be said that there is no hope for interactions between biomedical doctors and traditional healers to have positive effects. Many programmes, such as the tuberculosis control programme in Hlabisa, South Africa are making a difference in the lives of countless patients across the continent. Formed in 1992, the DOTS programme, as it is abbreviated, seeks to train traditional healers in rural communities about modern medicinal methods for dealing with tuberculosis, which has reached epidemic proportions in areas of Eastern South Africa. All of the healers who participated in the project were volunteers, and were closely observed throughout the course of the study to ensure reliability. Overall, 89% of the patients supervised by traditional healers completed their treatment, and all patients questioned said that traditional healers should be DOTS supervisors (UNAIDS, 2001).
This case study is an excellent illustration of the fact that total integration of traditional healers into the biomedical sphere is not necessary in order to bring about a positive change in overall public health. Because all of the healers participating in the project were volunteers, the concepts of modern medicine were not forced upon any of them, and patients still retained the right to choose between modern medical treatment and more traditional means.
Instead of discussing methods of incorporating traditional healers into the dictatorial business of biomedicine, perhaps we should consider the option of making modern medicine more acceptable to both traditional healers and their patients. Freeman writes:
“Compared with other African countries, however, South Africa is fairly well endowed with health personnel, and the problem of lack of adequate ‘modern’ health care for the majorities is not so much a lack of resources, as much as a problem with distribution and approach to care” (Freeman, 1992: 1185).
By putting the pressure on the traditional healers to reform to the ideas of modern medicine, the government is only forcing their burden to care for the masses onto the shoulders of the healers. All citizens of South Africa deserve the right of access to medical care, whether it is a traditional healer, a biomedical doctor, or some other means. It is not until the average person is presented with these options that the health care system will be effective. Rather than conquering the enigma that is “traditional medicine” the South African government needs to recognize, respect, and encourage the evolution of the many health institutions already in place. Only then can the country successfully pursue the ideal of improved health care for all citizens.
References
Abdul Kareem, S.S. & Ziqubu-Page, T.T. & Arendse, R. 1994. Bridging the Gap: Potential for a health care partnership between African traditional healers and biomedical personnel in South Africa. Pinelands: South Africa, Medical Association of South Africa.
Colvin, Mark & Gumede, L. & Grimwade, K. & Wilkinson, D. 2002. Integrating traditional healers into a tuberculosis control programme in Hlabisa, South Africa. Durban: South Africa, Medical Research Council.
Freeman, M. & Motsei, M. 1992. Planning Health care in South Africa- Is there a role for traditional healers? Soc. Sci. Med. 34 (11): 1183-1190.
Hopa, M. & Simbayi, L.C. & du Toit, C.D. 1998. Perceptions on integration of traditional and western healing in the new South Africa. S. Afr. J. Psychol. 28 (1).
Kale, Rajendra. 1995. Traditional healers in South Africa: a parallel health care system. British Medical Journal. 310: 1182-1185.
Last, M. & Chavanduka, G. (eds). 1986. The Professionalisation of African Medicine. Manchester: IAI, Manchester University Press.
Rekdal, -Ole-Bjorn. 1999. Cross-cultural healing in East African ethnography. Medical Anthropology Quarterly. 13 (4): 458-482.
UNAIDS. 2000. Collaboration with traditional healers in HIV/AIDS prevention in sub-Saharan Africa. Geneva: Switzerland, Joint United Nations Programme on HIV/AIDS.
