COMPLEMENTARY AND ALTERNATIVE MEDICINE

AFRICAN TRADITIONAL HEALERS:

Cultural and religious beliefs
intertwined in a holistic way
Ilse Truter
Drug Utilization Research Unit (DURU),
Department of Pharmacy, Nelson Mandela Metropolitan University

African traditional healing

is .... intertwined with
cultural and religious
beliefs, and is holistic in
nature. It does not focus
only on the physical
condition, but also on the
psychological, spiritual
and social aspects of
individuals, families and
communities.

raditional medicine plays an impor

tant role in primary health care in
many developing countries.1 There
were approximately 200 000 traditional
healers practising in South Africa in
1995, compared to 25 000 modern doctors.1,2 In SubSaharan Africa, the ratio
of traditional healers to the general
population is approximately 1:500,
while doctors trained in Western medicine have a 1:40 000 ratio to the rest of
the population.3 It is estimated that 70%
to 80% of the population in Africa makes
use of traditional medicine.1,4,5 Also in
South Africa, it is estimated that between 60% and 80% of people consult
a traditional healer before going to a
primary health care practitioner,1,6,7 and
it is estimated that traditional birth attendants deliver approximately 60% of
all babies born.1,8

DEFINITION OF TRADITIONAL
MEDICINE
Traditional medicine is defined in the
Traditional Health Practitioners Act9 as:
an object or substance used in traditional health practice for
(a) the diagnosis, treatment or prevention of a physical or mental illness; or
(b) any curative or therapeutic purpose,

56

including the maintenance or restoration of physical or mental health or

well-being in human beings,
but does not include a dependence-producing or dangerous substance or drug.

Traditional health practice9 means the

performance of a function, activity, process or service based on a traditional
philosophy that includes the utilisation
of traditional medicine or traditional practice and which has as its object
(a) the maintenance or restoration of
physical or mental health or function;
or
(b) the diagnosis, treatment or prevention of a physical or mental illness; or
(c) the rehabilitation of a person to enable that person to resume normal
functioning within the family or community; or
(d) the physical or mental preparation of
an individual for puberty, adulthood,
pregnancy, childbirth and death,
but it excludes the professional activities of a person practising any of the professions contemplated in the Pharmacy
Act, the Health Professions Act, the Nursing Act, the Allied Health Professions Act,
or the Dental Technicians Act, and any
other activity not based on traditional
philosophy.

SA Pharmaceutical Journal September 2007

COMPLEMENTARY AND ALTERNATIVE MEDICINE

African traditional medicine is defined
by the WHO Centre for Health Development as5,10: The sum total of all knowledge and practices, whether explicable
or not, used in diagnosis, prevention and
elimination of physical, mental, or societal imbalance, and relying exclusively
on practical experience and observation
handed down from generation to generation, whether verbally or in writing.
African traditional healing is therefore
intertwined with cultural and religious
beliefs, and is holistic in nature. It does
not focus only on the physical condition,
but also on the psychological, spiritual
and social aspects of individuals, families and communities.
Western medicine (or biomedicine) is
often contrasted with the approach taken
by traditional medicine practitioners. The
former is usually associated with diseases of the physical body only, and is
based on the principles of science, technology, knowledge and clinical analysis
developed in Northern America and
Western Europe.5 Yet, modern allopathic
medicine has its roots in ancient traditions of healing, and some aspects of
those traditions are still relevant and
complementary to modern medical practice. Biomedical literature refers to the
use of traditional medicines as phytotherapy.5 Traditional medicine and traditional healers form part of a broader field
of study classified by medical anthropologists as ethnomedicine.5 In South Africa,
most people associate traditional medicine with the herbs, remedies (or muti)
and advice imparted by sangomas or
inyangas, and with strong spiritual components.

TRADITIONAL HEALERS
APPROACH TO HEALING
The theory underlying traditional medicine in many Black ethnic groups of South
Africa is essentially similar1, namely that
disease is viewed as a supernatural phenomenon governed by a hierarchy of vital powers beginning with the most powerful deity followed by lesser spiritual
entities, ancestral spirits, living persons,
animals, plants and other objects. Traditional medicine has at its base a deep
belief in the interactions between the
spiritual and physical well-being. Traditional healers therefore use a holistic
approach in dealing with health and ill-

ness. This implies that the healer deals

with the complete person, and provides
treatment for physical, psychological,
spiritual and social symptoms. Healers
do not separate the natural from the spiritual, or the physical from the supernatural.
The traditional healing process follows
different stages1,8:
Identification of the cause or discovery of violation of established order
through supernatural divination.
Removal of the hostile source by
neutralisation of the sorcerer or seeking of the ancestors forgiveness with
sacrifices and rituals to appease their
anger or by prescription of certain
medication.
Patients are treated as integral components of a family and of a community
at large rather than as isolated individuals. Family members are almost always
involved and the healing process is facilitated by the broader involvement of
members of the community.
Traditional health practitioners basically
follow three principles1,2:
Patients must be completely satisfied
that they and their symptoms are
taken seriously, and that they are
given enough time to express their
fears.
The healer studies the patient as a
whole and does not split the body and
mind into two separate entities.
The healer never considers the patient as an isolated individual but as
an integral component of a family and
a community.

TYPES OF AFRICAN
TRADITIONAL HEALERS
Traditional healers do not all perform the
same functions, nor do they all fall into
the same category. Each of them has
their own field of expertise, with their own
methods of diagnosis and their own, particular medicine. Different types of African traditional healers can be identified
as discussed below.1,8,11,12 Although each
type has its distinctive features, their roles
do overlap considerably. A comparison
between selected types of traditional
healers is given in Table 1.

Sangoma (diviner)
A sangoma or diviner is the most senior

SA Pharmaceutical Journal September 2007

of the traditional healers. She is a person who defines an illness (diagnostician) and also divines the circumstances
of the illness in the cultural context (diviner). Diviners are usually (in approximately 90% of cases) female, although
the calling is open to people of any gender, age or status. They are highly respected in their community for their leadership and mystical powers. Diviners are
known by different names in the different
South African cultures (for example,
amagqira in Xhosa, ngaka in Northern
Sotho, selaoli in Southern Sotho, and
mungome in Venda and Tsonga). Most
South Africans, however, generally refer
to them as sangomas (from the Zulu word
izangoma).
A diviner may or may not have knowledge of medicinal herbs. A diviners speciality is divination where she operates
within a traditional religious supernatural
context and acts as a medium with the
ancestral spirits. Diviners concentrate on
diagnosing the unexplainable. They
analyse the causes of specific events and
interpret the messages of the ancestors.
Although the focus is on divination, they
often also provide medication for the specific case they have diagnosed.
Training to become a sangoma is not a
personal choice but is a calling bestowed
by ancestors (usually a woman) to a person who then gets apprenticed to a qualified diviner for several months. During
this time, she learns to throw the bones
and to control the trance-like states where
communication with the spirits takes
place. On completion of training she undergoes the ukuthwasa process (a culturally accepted form of ancestral spirit
possession when she is called by ancestors to become a diviner). There is no
fixed training period (it may take anything
from six months to 10 years), since qualification depends on two factors.11 Firstly,
the teaching sangoma only qualifies a
pupil once a final fee is paid, and secondly, the sangoma retains territorial exclusivity, where allegiance is paid by the
pupil to the teacher.

Inyanga (traditional doctor

or herbalist)
An inyanga (inyanga in Zulu, ixhwele in
Xhosa, and mganga in Swahili)
specialises in the use of herbal and other
medicinal preparations for treating dis-

57

COMPLEMENTARY AND ALTERNATIVE MEDICINE

ease. He possesses an extensive knowledge of curative herbs, natural treatments
and medicinal mixtures of animal origin.
He does not receive a calling, and
chooses to become an inyanga. Approximately 90% of inyangas are male. Their
comprehensive curative expertise includes preventive and prophylactic treatments, rituals and symbolism as well as
preparations for luck and fidelity. Some
treat only one disease and become renowned experts on that disease. These
include rainmakers and specialists in diseases of specific organs (for example
heart, kidney or lung disease consultants).
Inyangas generally spend a few years
as an apprentice and do not profess to
have divine powers. This results in patients having to physically visit the
inyanga and have a case history taken
(unlike the sangoma where the patient
does not have to be present). Inyangas
generate their business through referrals
and often have shops where herbs and
remedies are sold.

Umthandazi or umprofiti
(faith healer or prophet)
A faith healer (umthandazi in Nguni, and
muProfiti in Sotho) is usually a professed
Christian who belongs to either mission
or African independent churches. They
heal mostly through prayer, laying hands
on patients, or providing holy water and
ash. They believe that their healing power
comes from God through ecstatic states
and trance-contact with a spirit (uMoya),
or sometimes a combination of both
Christian Holy Spirit and ancestral spirit.
They use a combination of herbs, remedies and holy water in their treatment.
Their healing system is moulded on the
sangoma group pattern whereby the afflicted live for months and sometimes
years at the prophets residence.
Their period of training is not prescribed
since the student is prayed for, goes
through purification rites, and is in close
contact with the healer. Faith healing is
sometimes favoured because the doctrines used seem to integrate both Christian and African traditional beliefs. They
interpret sickness in terms of the patients
world view and perception. The vigorous
display of emotions in rhythmic movements and dances which are common
practice in faith healing follow the same

58

Table 1: Comparison between selected types of traditional healers8

Inyanga

Sangoma
Skills

Spiritual Healer

Called by spirits
Individual choice to Trances and contact
become one
with spirits
Apprenticed to an ex Apprenticed to an expert
Medical skills acpert
quired as an inyanga

Method of
service

Essentially diagnostic Knowledge of symp- Essentially diagnostic

Throws and reads
toms and patients
history necessary
bones
Divination through Contact with patient
trance
necessary
Contact with patient
not needed for diagnosis
History, symptoms
and nature of problem not revealed by
patients

Nature of
service

C o m p r e h e n s i v e , Lays on hands, prays,

Conflict resolution
curative, prophylac- provides holy water and
Confirms patients
tic, ritualistic and other symbols
beliefs
symbolic
Revelation of misfortune and illness
Recommends solution
Provides expertise
and leadership

Accessibility

Depends on grades Freely accessible

(relatively few high
grade, whilst lower
grade much more accessible)

patterns of the ceremonial dances of

sangomas.

Traditional midwife/birth
attendant
Traditional birth attendants (ababelithisi)
are usually elderly women who have
been midwives for many years and are
highly respected for their obstetric and
ritual expertise. They focus their attention on pregnancy problems and assist
pregnant women at deliveries. They are
responsible for duties such as the teaching of behavioural avoidance among
pregnant women, ritual bathing of the
mother, ritual disposal of the placentas,
provision of healing medicine and traditional massage after delivery. They also
give advice on postpartum and cord care
and provide important support for breastfeeding as well as advice on marriage,
contraception and fertility. The inyanga
or diviner acts as a consultant in case a
difficult labour or complication occurs.
Women who aspire to become traditional
birth attendants must satisfy certain cri-

Freely accessible

teria. For example, they should have had

two babies in order to be able to appreciate the joys and agonies of childbirth.
Training entails 15 to 20 years of apprenticeship before assuming the title. Traditional birth attendants do not charge for
their services but donations in the form
of gifts are usually given. They may also
be invited to be guests of honour when
the baby is named.
There are also other types of traditional
healers, such as traditional surgeons
(ingcibi) who perform circumcision as
part of an African cultural initiation ceremony.

THERAPEUTIC PROCESS AND

METHODS USED BY AFRICAN
TRADITIONAL HEALERS
Traditional diagnosis is both an art and a
method of seeking to discover the origins of the disease and determining what
it is. The diagnostic process not only
seeks answers to the question of how
the disease originated (immediate

SA Pharmaceutical Journal September 2007

COMPLEMENTARY AND ALTERNATIVE MEDICINE

causes), but who or what caused the disease (efficient cause), and why it has affected this particular person at this point
in time (ultimate cause).7 Diagnosis comprises a combination of information,
namely observation (noting physical
symptoms), patient self-diagnosis (reporting by patients of their symptoms) and
divination. Three methods of divination
include the casting of divination objects,
mediumistic ability (clairvoyance or telepathy) or dreams, and visions. If necessary, the impressions of other family
members regarding the patients illness
may also be obtained.
Herbal medication is the most common
therapeutic method used by African traditional healers some are used as placebos, others for sympathetic magic, but
many have definite medicinal value.
Other methods include psychosocial
counselling, simple surgical methods,
rituals and symbolism. The types of medications used by African traditional healers can be classified into three categories8:

Preventive and prophylactic medication

Most of the work of traditional healers
concerns protecting patients from possible afflictions. This can be achieved in
various ways, for example by performing
ceremonial acts, using medicine against
disequilibrium, or wearing totemic objects. Among the Zulus, for example,
medication for self-fortification is called
amaKhubalo. IzinGqunda or IziNtelezi is
sprinkled around and about the kraal to
ward off lightning or to cause the
umthakathi (witch) discomfort in his bad
endeavours.
Treatment for ailments
These are prepared in different forms
such as cold and hot infusions, decoctions, powders, poultices and lotions,
and a variety of earthy ointments that
comprise animal fat, clay and sometimes ashes. These formulations are
made into different medicine mixtures
(umuthi or imbiza). The recipes are
usually a secret and are part of the
knowledge that the healer will pass onto
his apprentice.

Medications used to destroy the

power in others
These medications target specific indi-

viduals. A concoction can, for example,

be placed in the enemys path and it is
then believed that when the enemy
passes by, he will contract a fatal disease. Sacrification, blood-letting and
cupping are the commonest surgical procedures performed by African traditional
healers and these are sometimes performed in full view of onlookers. The letting of blood is sometimes used as a way
of casting out the illness. If the cause of
the sickness is perceived to be bewitchment, a number of rituals may be performed in order to cast out the spell.
These may include the induction of vomiting, enemas, blood-letting, whistling or
elaborate rituals such as animal sacrifices. Rituals play an important role.
Many Africans believe that if the ancestors withdraw their protection and gift of
good fortune, the descendant is left vulnerable to all sorts of misfortunes and
diseases. The wrath of the ancestors is
usually evoked by discord in the home,
the violation of customs and traditions or
non-observance of certain taboos. Traditional medicines rituals aim to restore
balance and harmony in terms of the
beliefs and values of its culture. These
rituals reduce patients anxiety and serve
to relieve feelings of guilt. Completion of
the rituals often has a calming effect on
the patient. A large part of the African
traditional healers practice is also devoted to counselling individuals.
Treatment is comprehensive and has
curative, protective and preventive elements. It can either be natural or ritual, or
both, depending on the cause of the disease. It includes among others, ritual
sacrifice to appease the ancestors, ritual
and magical strengthening of people and
possessions, steaming, purification (for
example, ritual washing, or the use of
emetics or purgatives), sniffing of substances, cuts (African mode of injection),
wearing charms, and piercing (African
acupuncture).
A variety of treatment methods are used
in the administration of herbal medications, for example8:
Sucking of hot medicated liquid from
fingertips unkuncinda.
Inhalation of powdered medicine in
its dry form as snuff ukubhema.
Induction of vomiting via the use of
an emetic ukuphalaza.
Rubbing of powdered medication into

SA Pharmaceutical Journal September 2007

incisions ukugcaba.
Steaming or use of a vapour-bath
(ukugquma), whereby a patient covered with a large skin or blanket to
keep out the cold air crouches over a
boiling pot of medicaments. This induces perspiration and reduces fever.
Use of enemas for stomach complaints ukuchatha.
Use of fomenting treatment for aching feet ukuthoba.
Burning of incense which is said to
appease the ancestors.
Use of an amulet manufactured from
animal skin to ward off evil spirits.

Traditional healers also deal with traditional ailments. These culture-bound

syndromes usually do not respond to
Western medicine and must be treated
by traditional healers (Zulu: ukufa
kwabantu). There are five such culturebound syndromes: spirit possession,
sorcery, ancestral wrath (esinyanya),
neglect of cultural rites or practices
(amaseko), and defilement.

REASONS WHY PEOPLE VISIT

TRADITIONAL HEALERS
Traditional healers availability and accessibility, their familiarity with culturebound syndromes and traditions, their
relationships with patients and their families place them in a position to serve as
an alternative to mainstream health providers. 13 Reasons that are given why
people go for traditional healing are13,14:
Know healers quite well.
Visits are not only for health problems
but also for other problems.
Belief that illness arises from supernatural causes and indicates the displeasure of ancestral gods or evil spirits or is the effect of black magic.
A firmly and irrevocably established
health care system throughout the
whole continent of Africa.
Forms part of the culture and custom.
Traditional medicine and the various
African cultures go together. They
cannot be separated.
Lack of satisfaction with treatment.
Lack of trust in the ability of Western
medical practitioners to effectively
treat psychosocial problems.
Lack of knowledge of Western medical practitioners in the treatment of culture-bound syndromes.

59

COMPLEMENTARY AND ALTERNATIVE MEDICINE

REGULATION OF AFRICAN
TRADITIONAL MEDICINE
It has been said that traditional healers
existed in South Africa before the Dutch
colonised it in the 17th century.1 Various
pieces of legislation (such as the Witchcraft Suppression Act of 1957 and the
Witchcraft Suppression Amendment Act
of 1970) explicitly prohibited diviners from
practicing their trade (as early as 1891 in
colonial Natal).5
Although the majority of the African population utilises traditional medicine services, in many African nations traditional
medicine technically remains illegal. 15
The WHOs 2001 survey of the legal status of traditional and complementary/
alternative medicine revealed that of the
44 African nations surveyed, only 61%
had legal statutes regarding traditional
medicine and not all national policies
have necessarily been implemented.16
Increasing efforts have been made regionally and internationally to formally
include traditional healers in primary
health care, as well as in HIV/AIDS care
and prevention. The WHO formally
recognised the importance of collaborating with traditional healers in 1977.5 In
South Africa, a Traditional Health Practitioners Bill of 2003, was drafted. Certain sections of the Traditional Health
Practitioners Act, Act 35 of 2004, came
into operation on 13 January 2006. Efforts are furthermore ongoing to develop
a pharmacopoeia of traditional medicines.8 An extensive project is underway
to document all traditional medicines
derived from indigenous medicinal
plants, but this is no easy task. The concentration of active ingredients in medicinal plants is, for example, said to vary
according to the season. This constitutes
a potential danger of overdose during
drier seasons when the concentrations
of active ingredients are higher.

IN CONCLUSION
Traditional healers hold an esteemed
and powerful position in southern African societies.17 Their role is that of physician, counsellor, psychiatrist and priest,
and people visit a traditional healer for
problems ranging from social dilemmas
to major medical illnesses. They there-

60

fore have a role to play in building the

health system in South Africa. In a country where the needs are great and the
resources inadequate, traditional healers can play an important and valuable
role in helping communities to improve
their health and quality of life.

REFERENCES:
1.
Setswe G. 1999. The Role of Traditional Healers and Primary Health Care in South Africa.
Health SA Gesondheid, 4 (2): 56-60.
2.
Kale R. 1995. South Africas Health: Traditional healers in South Africa: a parallel health
care system. British Medical Journal, 310 (6
May): 1182-1185.
3.
Richter ML. 2004. Traditional healing and human rights in South Africa. XV International
AIDS Conference, Bangkok, 11-16 July (Abstract no.: MoPeE4200).
4.
WHO Traditional Medicine Strategy 2002-2005.
2002. Geneva: World Health Organization.
5.
Richter M. 2003. Traditional Medicines and
Traditional Healers in South Africa. Discussion
paper prepared for the Treatment Action Campaign and AIDS Law Project. Available on the
web: http://www.tac.org.za/ Documents/
ResearchPapers/Traditional_Medicine
_briefing.pdf (date accessed: 10 July 2007).
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Healers licensed in South Africa. 2004. BBC
News. Available on the web: http://news.
bbc.co.uk/2/hi/africa/3640270.stm (date accessed: 9 July 2007).
7.
Pretorius E. 1999. Traditional Healers. Chapter 18. South African Health Review. Available
on the web: http://legacy.hst.org.za/sahr/99/
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1994. Bridging the Gap: Potential for a health
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Project report prepared for the South African
Medical Research Council. South African Medical Journal, 84 (December, Supplement): 1-16.
Republic of South Africa. 2004. Traditional
Health Practitioners Act, Act 35 of 2004.
Pretoria: Government Printers.
Planning for cost-effective traditional medicines
in the new century a discussion paper. WHO
Centre for Health Development. Available on
the web: http://www.who.or.jp/tm/research/bkg/
3_definitions.html (date accessed: 10 July
2007).
Moskovitz S. 1996. Traditional healers in modern
medicine. The SA Retail Chemist, August: 2.
Troskie R. 1997. The role of health care workers in collaborating with traditional healers in
primary health care. Part 1. Health SA
Gesondheid, 2 (1): 29-35.
Kgoatla P. 1997. The use of traditional medicines by teenage mothers in Soshanguve.
Health SA Gesondheid, 2 (3): 27-31.
Stanhope M & Lancaster J. 1988. Community
Health Nursing: Process and Practice for Promoting Health. St Louis: Mosby.
Gbodossou EVA, Floyd VD & Katy CI. Aids in
Africa: Scenarios for the future. The role of
traditional medicine in Africas fight against HIV/
AIDS. Available on the web: http://
www.prometra.org/Documents/AIDSinAfricaScenariofortheFuture.pdf (date accessed: 10
July 2007).
WHO Report: Legal Status of Traditional Medicine and Complementary/Alternative Medicine:
A Worldwide Review, 2001. Geneva: World
Health Organization.
Hewson M. 1998. Traditional healers in Southern Africa. Annals of Internal Medicine, 128
(12): 1029-1034.

OSTEOPOROSIS DAY : 20 OCTOBER 2007

International speaker to address the importance of calcium
supplementation in teenagers to ensure lifelong bone health

t is estimated that 40% of women will suf

fer an osteoporosis fracture in their lifetime. The cost of osteoporosis exceeds $30
billion worldwide. The only cost-effective approach to osteoporosis is prevention.
To raise awareness around Osteoporosis Day 20 October 2007, Wyeth Consumer
Healthcare will host the internationally renowned Professor Connie Weaver, together
with South African specialists, on a lecture
tour addressing the South African medical
fraternity.
Prof Weaver is a distinguished Professor
and Head of the Foods and Nutrition Department at Purdue University in the United States
and has conducted several groundbreaking
research studies on calcium metabolism, including a landmark study finding that calcium absorption peaks in young girls near
the onset of menses. The research provided
insight into factors affecting development of
peak bone mass during growth, which determines the risk of osteoporosis in women. The
results of Prof Weaver and her research teams
studies are being used to determine recommendations for calcium supplementation
around the world.
South African specialists, including Dr
Stanley Lipschitz, Prof Stephen Hough and Dr
Aslam Amod will present various topics rang-

ing from the importance of Vitamin D and

Calcium supplementation in the treatment
of osteoporosis to an update on the latest
treatment options in osteoporosis.
Members of the medical fraternity and
medical media are invited to attend these
seminars. Prior booking is essential.
Date: 16/10/07 City: Johannesburg
Venue : The Venue, Melrose Arch
Date: 17/10/07 City: Cape Town
Venue : The Table Bay Hotel
Date: 18/10/07 City: Durban
Venue: 1on1 Events & Conference Centre,
Gateway, Umhlanga
Time: 18h30 for 19h00
Drinks and food will be served following
the lectures.
Application for CPD points has been
submitted.
To book for any of the events please fax
your details to Marieta Ferreira on
0865246965 or e-mail your details to
mferreira@lantic.co.za. Please include your
contact details.

SA Pharmaceutical Journal September 2007