South Africa's Health: Traditional healers in South Africa: a parallel health care system

doi:10.1136/bmj.310.6988.1182

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Rajendra Kale, editorial registrara

^a BMJ, London WC1H 9JR

Correspondence to: Laxmi-Kunj, 37 Shanwar, Pune 411 030, India

“Traditional healers are a very caring people, and extraordinarily skilled in psychotherapy and counselling. Some of them do a damn good job. Of course there are certain horrible ones who poison their patients at every turn,” said Professor Ralph Kirsch of the Department of Medicine in the University of Cape Town Medical School. Traditional healers existed in South Africa before its colonisation by the Dutch in the 17th century. They have flourished in the face of competition from modern medicine. About 200000 traditional healers practise in South Africa, compared with 25000 doctors of modern medicine; 80% of the black population use the services of traditional healers.1 Traditional healers are enshrined in the minds of the people and respected in their community, and they are often its opinion leaders.

Traditional medicine

The theory underlying traditional medicine in the several black ethnic groups of South Africa is essentially similar.2 Disease is a supernatural phenomenon governed by a hierarchy of vital powers beginning with a most powerful deity followed by lesser spiritual entities, ancestral spirits, living persons, animals, plants, and other objects. These powers can interact, and they can reduce or enhance the power of a person. Disharmony in these vital powers can cause illness. Thus, ancestral spirits can make a person ill. Ingredients obtained from animals, plants, and other objects can restore the decreased power in a sick person and therefore have medicinal properties.

Types of healers

Inyangas are herbalists and possess extensive knowledge about curative herbs and medicines of animal origin (table I). Ninety per cent of inyangas are male.

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TABLE I

Traditional healing agencies in South Africa¹

Isangomas are diviners; they determine the cause of illness by using ancestral spirits, and 90% of them are female. A person cannot choose to become a diviner. Only a person “called” by the ancestors can become one. …