Illness and Health as Constructions: Narratives ofSangomaNurses (original) (raw)
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Illness and Health as Constructions: Narratives of Sangoma 1 Nurses
This study involved a group of isiZulu-speaking nurses who were also traditional healers or izangoma 2 within the South African amaZulu culture. The paper explored traditional healing beliefs and practices through the perspectives of this group of traditional healers who were also formally trained nurses. The narratives shared by the nurses, referred to as 'sangoma-nurses', revealed that their 'cultural' training and experiences dominated the manner in which they understood many of the illnesses that presented at the hospital. Working through the lens of social constructionism and through narrative analysis, the paper reveals that much of their views on ill health, even within the 'biomedical' defined hospital space, articulated by and large through the lens of their cultural worldviews, rather than the training they underwent as nurses. Findings reveal that the sangoma-nurses, in large part, struggled to straddle their dual positionality; as so called 'western' nurse and traditional isangoma and were often compelled to 'suspend' their traditional beliefs while at work.
Particular communities and groups of people develop particular prevailing points of view, including how health and illness is understood. Our prevailing points of view, 'worldviews' or positioning, are a result of the 'dialogue' between us and our wider society (see Creswell 2009:8) and is a process of " active construction " (Fox 2001: 23). As such, we approach reality from our particular point of view which has been constructed and developed over time (see Rosaldo 2003: 583). Different societies have in turn, their specific practices and beliefs, as well as their approach to health and illness (see Naidu 2013: 257; Naidu 2014: 147; Vaughn, Jacquez, and Baker 2009: 65). As Whyte, van der Geest and Hordon (2002: 118) assert, many factors " influence people's response to ill-health, including entrenched beliefs ". As such, the understanding and approach to illnesses vary from one society to another, one setting to another, and one belief system to another. This paper looked at what isiZulu-speaking nurses understand by illness and healing. It explored what sickness means to the Ama Zulu African nurses. In exploring this understanding of nurses, the paper explored the wider cultural belief system of the isiZulu-speaking nurses within which their understandings are deeply embedded.
The ancestors have caused this: isiZulu-speaking nurses' understandings of illness and patient care
This paper takes an ethnographic and participant observational approach to exploring how a particular group of isiZulu speaking nurses' understanding(s) and assembled constructions of illnesses and health shape their approach to patient care within the hospital setting. The paper probes how African isiZulu-speaking nurses observe and " group " patient's illness according to personal understandings of illness and looks at how these understandings contribute to their clinical decision-making and practice. Findings reveal that the nurses appear to operate in a dual system that is oftentimes fraught and conflicted between what their biomedical training dictates, and what their culturally and cosmo-logically embedded upbringing and Pan African worldview of ancestors and bewitchment compels.
2018
Despite playing essential and parallel roles in the lives of patients, there exists a frictional, imbalanced relationship between traditional healers and Western doctors in South Africa. While national policy encourages a seamless system rooted in both Western science and indigenous knowledge, biomedical institutions are hesitant to accept traditional medical practices, which are based on less tangible and more spiritually-oriented elements. This research project turns to these two ideologically different entities to assess their perspectives on the roles of themselves and the other within the context of the South African health system. Responses from semi-structured interviews with seven health practitioners from KwaZulu-Natalizangoma and doctors-were the primary sources used for the knowledge acquisition process. Given that I was the lens through which these participant stories were told, my own narrative and perspectives on the subject were interwoven throughout this report. Participant narratives suggest that there is no consensus within either biomedical or traditional health domains about perceptions of the other, save for the agreement that the South African health system is disconnected with both modalities working in parallel. However, there are five overarching points of engagement throughout the practitioner-patient healing process through which the modalities directly or indirectly interact with one another and form crossdisciplinary opinions. These serve as points of discussion in this report. Elements keeping the domains separated include miscommunication, suspicion, and adherence to cultural paradigms.
2016
Culture, traditional practices, and social norms of different societies have been found to have great impact on healthcare systems and people understanding of health and illness. This paper discusses how the Dagomba of Ghana theorizes health and illness and the impact of language and secrecy in traditional healing. Using the Dagomba lay theories of health and illness and that of medical pluralism, the paper found that among Dagomba, the concepts of health and illness are complex, holistic and interrelated. The Dagomba theorized that health is a discourse and a relational concept. It is also seen as being in a state of balance with the self, others, the society and the spiritual world but not the absence of illness. The paper argues that illness among Dagomba has both internal and external dimensions. It is seen as something which is part of life and growing up. Accordingly, some illnesses are innate while others come and go. Within their traditional healthcare system, language and secrecy are found to have both pragmatic and psychological functions. Language is not only used in naming illnesses and expressing other medical conditions but it is also used as a means of communication such that patients and healers engagement in the medical discourse promote good health. Secrecy is found to perform the role of patent law (intellectual property rights) to healers' traditional knowledge. It is also used to protect both patients and the potency of traditional medicine and healing. Finally the paper draws the attention of medical practitioners, especially those in the formal health systems, to the fact that cultural sensitivity and the respect for people lay theories of health and illness need to be taken seriously since that could help to promote effective healthcare delivery and reduce conflicts between patients and healthcare professionals.
Culture, traditional practices, and social norms of different societies have been found to have great impact on healthcare systems and people understanding of health and illness. This paper discusses how the Dagomba of Ghana theorizes health and illness and the impact of language and secrecy in traditional healing. Using the Dagomba lay theories of health and illness and that of medical pluralism, the paper found that among Dagomba, the concepts of health and illness are complex, holistic and interrelated. The Dagomba theorized that health is a discourse and a relational concept. It is also seen as being in a state of balance with the self, others, the society and the spiritual world but not the absence of illness. The paper argues that illness among Dagomba has both internal and external dimensions. It is seen as something which is part of life and growing up. Accordingly, some illnesses are innate while others come and go. Within their traditional healthcare system, language and secrecy are found to have both pragmatic and psychological functions. Language is not only used in naming illnesses and expressing other medical conditions but it is also used as a means of communication such that patients and healers engagement in the medical discourse promote good health. Secrecy is found to perform the role of patent law (intellectual property rights) to healers' traditional knowledge. It is also used to protect both patients and the potency of traditional medicine and healing. Finally the paper draws the attention of medical practitioners, especially those in the formal health systems, to the fact that cultural sensitivity and the respect for people lay theories of health and illness need to be taken seriously since that could help to promote effective healthcare delivery and reduce conflicts between patients and healthcare professionals.
Sick Healers: Chronic Affliction and the Authority of Experience at an Ethiopian Hospital
2015
At fistula hospitals in Ethiopia, patients who are not cured of their incontinence are hired as "nurse aides" to perform essential nursing duties in the ward and operating theater. An array of tensions surrounds the work of these women, tensions that are emblematic of their chronic-but secret-patient status. If accidentally disclosed, the women's ongoing illness episodes sabotage their ability to administer treatment, such as injections.
Constructing Patient and Patient Healthcare: Indigenous Knowledge and the use of Isihlambezo
Traditional' health practice has, in the last decade, been 'mainstreamed' within South Africa in 2004, by the active promulgation of the 'Traditional Health Practitioners Act, No. 35'. However, this, in some respects lies in legislature and policy, and may still not impact on health care models, constructions of patient and constructions of 'health' itself. This paper is an exploratory inquiry and focuses on popular and indigenous constructions of reproductive health and some of the antenatal health needs of pregnant women. By working through the qualitative narratives of 15 pregnant isiZulu women and women who have had children and their use of antenatal indigenous herbal medicine, the paper reveals the tension and dichotomised positioning between Western allopathic approaches and those considered traditional and indigenous. While drawing the necessary attention to the untested and contested background to some of the (potentially dangerous) pharmaceutica...
2006
Traditional healing in South Africa is undergoing a process of change. Recognition of the role of traditional healers in health care, especially in the face of the HIV and AIDS pandemic, has led to government calls for professionalisation amongst this group. Traditional healers themselves have been increasingly experiencing a need to professionalise in order to gain more equal treatment in the public health sector and to secure access to state resources and support. In response to these developments, the government passed the Traditional Health Practitioners Act in 2004, which sets the parameters for official recognition of healers under the state. This paper focuses on the dynamics and politics amongst traditional health practitioners as they undergo this process of professionalisation, focusing on the KwaZulu-Natal Traditional Healers Council, the official body responsible for representing healers in the Province. It explores and analyses several key tensions amongst healers withi...
Becoming a Xhosa traditional healer: The calling, illness, conflict and belonging
South African Journal of Psychiatry
This study aimed to explore the experience of becoming a TH, including accepting the calling, and sheds light on how the experience is conceptualised within the cultural and communitarian context of THs. Setting: This study was conducted amongst Xhosa THs in the Western Cape, South Africa. Methods: In-depth phenomenological interviews (n = 4) were conducted with Xhosa THs and analysed using Giorgi's descriptive pre-transcendental Husserlian phenomenological analysis. Results: The experience of becoming a TH can be summarised in the context of three units of significance: (1) the gift of healing as an illness; (2) the experience of conflict (including with their families, the church and self-conflict); and (3) the experience of belonging. Familial conflict, specifically, was fuelled by the financial burden of becoming a TH and a lack of understanding of the process. Conclusion: To develop a workable model of collaboration in the future, it is crucial that mental healthcare providers develop a better understanding of the experiences of THs in becoming care providers. The findings highlight an appreciation of the challenging process of becoming a TH. Finally, further research and culturally appropriate psychoeducation can provide trainee THs and their family members with the skills and knowledge to support each other through a difficult process.