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26 May 2009

By Eddie Botha

In the first of a two-part series on traditional medicine and psychiatry Eddie Botha looks at the clash between traditional practitioners and western medicine

Traditional healers hold an esteemed and powerful position in southern African societies. Writing in the SA Pharmaceutical Journal in 2007, Ilze Truter of the Drug Utilisation Research Unit at the Nelson Mandela Metropolitan University, concluded that their role was that of physician, counsellor, psychiatrist and priest.

Truter said traditional healers had a role to play in building the health system in South Africa, especially in a country where the needs were so great.

Back in 1998, at a traditional healers' conference, healers from various regions of the Eastern Cape called for co-operation between themselves and western medical doctors. They were convinced that a number of diseases, which could not be cured through western medicine, could be cured through traditional herbs.

Chief Langaliyakhanya Mlanjeni from Lady Frere said the healers wanted to be recognised by the Eastern Cape government. "Our ancestors have the power to give strength to fight whatever disease when we ask them.''

Former Health MEC Pemmy Majodina said there was nothing in law prohibiting traditional healers from treating symptoms of mental illness. She said to protect the mentally ill against exploitation and abuse, legislation – the Traditional Health Practitioners Act No. 35 of 2004 – was put in place to regulate the conduct of traditional healers when executing their traditional health practices.

"It is important for the department including the health practitioners to render cultural congruent care and to have knowledge of the client's cultural background when making health interventions. The legislation was also recommended to bridge the gap between health professionals and traditional healers to build the working relations and establish referral patterns."

In her paper at the Indigenous Knowledge Conference in 2001, which dealt with the perceptions of a group of traditional healers on the treatment of mental illness, psychologist Jane Mufamadi stated that heredity, witchcraft, sorcery and spirit possession (which included the call to become a traditional healer) were regarded by healers as some of the causes of mental illness.

Mufamadi also said most traditional healers considered aggression, uttering incoherently, isolation, shouting, confusion and strange behaviour as common symptoms associated with mental illness. She found that traditional healers commonly use bone throwing and observation and history-taking in the diagnosis of mental illness.

Common intervention strategies used by traditional healers included steaming, taking medicine – prepared as powder, solution and soup –- nasally and orally. This was to induce vomiting, sneezing and the release of mucus which was regarded as an indication that the illness was leaving the body, said Mufamadi. "This will arouse anticipation that the patient will be cured and is in itself psychological in nature."

Modern day psychiatrists, while not disputing the positives that traditional healers bring on occasion, are however concerned of the effect vomiting may have if patients were already taking prescribed psychiatric drugs. Success is normally linked to regular dosages.
The successful treatment of patients was often assessed by the domestic tasks a patient completed. In this respect relatives of a patient assist the traditional healer in observing patients, for example a female patient cleaning pots, sweeping the floor or fetching water indicated successful treatment.

She said she had identified some similarities between traditional healers and Western healers. This included observation of patients to form a diagnosis and dream interpretations, which had been one of Sigmund Freud's main techniques used during therapy.

Family involvement, which often forms part of a modern psychiatrist's consultation method, was also regarded as important by the traditional healer.

Mufamadi said traditional healers could ask for a second opinion from more experienced healers or in difficult cases, transfer the patient to a hospital.

However Mufamadi said the approach by traditional healers often had limitations – mainly that there was no clear definition of what they regarded as mental illness.

She said the traditional healers she had interviewed individualised the illness, often satisfied that a patient was well based on the domestic tasks he or she performed or whether they conducted meaningful conversations with others.

"This would imply that they (the traditional healers) are mainly concerned with maintaining social stability and do not consider the issue of personal happiness or well-being."
Mufamadi was quite critical of some of the methods used by traditional healers in treating mentally ill patients. She cited "whipping", which could lead to physical harm, and echoed the concerns by psychiatrists about excessive vomiting, which apart from negating the effect of psychiatric drugs, she said could also be detrimental to health.

There was also a lack of clear distinction among traditional healers between the different types of mental illness. "Traditional healers' assessment techniques are also too simplistic to be utilised in all cases of mental illness. Some types of mental illness might require more complex assessment techniques."

Mufamadi said traditional healers were also reluctant to admit when they failed to cure some illness.

She argued that traditional healers' approach to the treatment of mental illness was valid if utilised in their relevant cultural contexts. "It can also be argued that traditional healers' view of disease is more in line with the African patient's beliefs than is the Western medical concept of disease."

Clearly traditional practitioners have a role to play in the treatment of the mentally ill – and a relationship of mutual respect between them and medical practitioners would be in the interests of the patients.

Copyright 2009. Used with permission from Eddie Botha and The Daily Dispatch.