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.
56
T
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 doc-
tors.1,2 In SubSaharan Africa, the ratio
of traditional healers to the general
population is approximately 1:500,
while doctors trained in “Western” medi-
cine 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 be-
tween 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 at-
tendants 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 tradi-
tional health practice for –
(a) the diagnosis, treatment or preven-
tion of a physical or mental illness; or
(b) any curative or therapeutic purpose,
SA Pharmaceutical Journal – September 2007
including the maintenance or resto-
ration of physical or mental health or
well-being in human beings,
but does not include a dependence-pro-
ducing or dangerous substance or drug”.
Traditional health practice9 means “the
performance of a function, activity, pro-
cess or service based on a traditional
philosophy that includes the utilisation
of traditional medicine or traditional prac-
tice and which has as its object –
(a) the maintenance or restoration of
physical or mental health or function;
or
(b) the diagnosis, treatment or preven-
tion of a physical or mental illness; or
(c) the rehabilitation of a person to en-
able that person to resume normal
functioning within the family or com-
munity; or
(d) the physical or mental preparation of
an individual for puberty, adulthood,
pregnancy, childbirth and death”,
but it excludes the professional activi-
ties of a person practising any of the pro-
fessions contemplated in the Pharmacy
Act, the Health Professions Act, the Nurs-
ing Act, the Allied Health Professions Act,
or the Dental Technicians Act, and any
other activity not based on traditional
philosophy.

African traditional medicine is defined
by the WHO Centre for Health Develop-
ment as5,10: “The sum total of all know-
ledge and practices, whether explicable
or not, used in diagnosis, prevention and
elimination of physical, mental, or soci-
etal imbalance, and relying exclusively
on practical experience and observation
handed down from generation to gen-
eration, 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, fami-
lies and communities.
Western medicine (or biomedicine) is
often contrasted with the approach taken
by traditional medicine practitioners. The
former is usually associated with dis-
eases of the physical body only, and is
based on the principles of science, tech-
nology, knowledge and clinical analysis
developed in Northern America and
Western Europe.5 Yet, modern allopathic
medicine has its roots in ancient tradi-
tions of healing, and some aspects of
those traditions are still relevant and
complementary to modern medical prac-
tice. Biomedical literature refers to the
use of traditional medicines as phyto-
therapy.5 Traditional medicine and tradi-
tional healers form part of a broader field
of study classified by medical anthropolo-
gists as ethnomedicine.5 In South Africa,
most people associate traditional medi-
cine with the herbs, remedies (or muti)
and advice imparted by sangomas or
inyangas, and with strong spiritual com-
ponents.
TRADITIONAL HEALERS’
APPROACH TO HEALING
The theory underlying traditional medi-
cine in many Black ethnic groups of South
Africa is essentially similar1, namely that
disease is viewed as a supernatural phe-
nomenon governed by a hierarchy of vi-
tal powers beginning with the most pow-
erful deity followed by lesser spiritual
entities, ancestral spirits, living persons,
animals, plants and other objects. Tradi-
tional medicine has at its base a deep
belief in the interactions between the
spiritual and physical well-being. Tradi-
tional healers therefore use a holistic
approach in dealing with health and ill-
SA Pharmaceutical Journal – September 2007
COMPLEMENTARY AND ALTERNATIVE MEDICINE
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 spiri-
tual, or the physical from the supernatural.
The traditional healing process follows
different stages1,8:
• Identification of the cause or discov-
ery of violation of established order
through supernatural divination.
• Removal of the hostile source by
neutralisation of the sorcerer or seek-
ing of the ancestors’ forgiveness with
sacrifices and rituals to appease their
anger or by prescription of certain
medication.
Patients are treated as integral com-
ponents of a family and of a community
at large rather than as isolated individu-
als. Family members are almost always
involved and the healing process is fa-
cilitated 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 pa-
tient 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, par-
ticular medicine. Different types of Afri-
can 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
of the traditional healers. She is a per-
son who defines an illness (diagnosti-
cian) and also divines the circumstances
of the illness in the cultural context (di-
viner). Diviners are usually (in approxi-
mately 90% of cases) female, although
the calling is open to people of any gen-
der, age or status. They are highly re-
spected in their community for their lead-
ership 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 knowl-
edge of medicinal herbs. A diviner’s spe-
ciality 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 spe-
cific 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 per-
son who then gets apprenticed to a quali-
fied 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 un-
dergoes the ukuthwasa process (a cul-
turally accepted form of ancestral spirit
possession when she is called by an-
cestors to become a diviner). There is no
fixed training period (it may take anything
from six months to 10 years), since quali-
fication depends on two factors.11 Firstly,
the teaching sangoma only qualifies a
pupil once a final fee is paid, and sec-
ondly, the sangoma retains territorial ex-
clusivity, 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 knowl-

edge of curative herbs, natural treatments Table 1: Comparison between selected types of traditional healers8
and medicinal mixtures of animal origin.
He does not receive a calling, and Sangoma Inyanga Spiritual Healer
chooses to become an inyanga. Approxi-
Skills • “Called” by spirits • Individual choice to Trances and contact
mately 90% of inyangas are male. Their • Apprenticed to an ex- become one with spirits
comprehensive curative expertise in- pert • Apprenticed to an ex-
cludes preventive and prophylactic treat- • Medical skills ac- pert
ments, rituals and symbolism as well as quired as an inyanga
preparations for luck and fidelity. Some Method of • Essentially diagnostic • Knowledge of symp- Essentially diagnostic
treat only one disease and become re- service • Throws and reads toms and patient’s
nowned experts on that disease. These “bones” history necessary
• Divination through • Contact with patient
include rainmakers and specialists in dis-
trance necessary
eases of specific organs (for example • Contact with patient
heart, kidney or lung disease consult- not needed for diag-
ants). nosis
• History, symptoms
and nature of prob-
Inyangas generally spend a few years
lem not revealed by
as an apprentice and do not profess to patients
have divine powers. This results in pa-
Nature of • Conflict resolution • C o m p r e h e n s i v e , Lays on hands, prays,
tients having to physically visit the
service • Confirms patient’s curative, prophylac- provides holy water and
inyanga and have a case history taken beliefs tic, ritualistic and other symbols
(unlike the sangoma where the patient • Revelation of mis- symbolic
does not have to be present). Inyangas fortune and illness
generate their business through referrals • Recommends solu-
tion
and often have “shops” where herbs and
• Provides expertise
remedies are sold. and leadership
Accessibility Depends on grades Freely accessible Freely accessible
Umthandazi or umprofiti (relatively few high
(faith healer or prophet) grade, whilst lower
A faith healer (umthandazi in Nguni, and grade much more ac-
muProfiti in Sotho) is usually a professed cessible)
Christian who belongs to either mission
or African independent churches. They patterns of the ceremonial dances of teria. For example, they should have had
heal mostly through prayer, laying hands sangomas. two babies in order to be able to appreci-
on patients, or providing holy water and ate the joys and agonies of childbirth.
ash. They believe that their healing power Traditional midwife/birth Training entails 15 to 20 years of appren-
comes from God through ecstatic states attendant ticeship before assuming the title. Tradi-
and trance-contact with a spirit (uMoya), Traditional birth attendants (ababelithisi) tional birth attendants do not charge for
or sometimes a combination of both are usually elderly women who have their services but donations in the form
Christian Holy Spirit and ancestral spirit. been midwives for many years and are of gifts are usually given. They may also
They use a combination of herbs, rem- highly respected for their obstetric and be invited to be guests of honour when
edies and holy water in their treatment. ritual expertise. They focus their atten- the baby is named.
Their healing system is moulded on the tion on pregnancy problems and assist
sangoma group pattern whereby the af- pregnant women at deliveries. They are There are also other types of traditional
flicted live for months and sometimes responsible for duties such as the teach- healers, such as traditional surgeons
years at the prophet’s residence. ing of behavioural avoidance among (ingcibi) who perform circumcision as
pregnant women, ritual bathing of the part of an African cultural initiation cer-
Their period of training is not prescribed mother, ritual disposal of the placentas, emony.
since the “student” is prayed for, goes provision of healing medicine and tradi-
through purification rites, and is in close tional massage after delivery. They also THERAPEUTIC PROCESS AND
contact with the healer. Faith healing is give advice on postpartum and cord care METHODS USED BY AFRICAN
sometimes favoured because the doc- and provide important support for breast- TRADITIONAL HEALERS
trines used seem to integrate both Chris- feeding as well as advice on marriage,
tian and African traditional beliefs. They contraception and fertility. The inyanga Traditional diagnosis is both an art and a
interpret sickness in terms of the patient’s or diviner acts as a consultant in case a method of seeking to discover the ori-
world view and perception. The vigorous difficult labour or complication occurs. gins of the disease and determining what
display of emotions in rhythmic move- it is. The diagnostic process not only
ments and dances which are common Women who aspire to become traditional seeks answers to the question of how
practice in faith healing follow the same birth attendants must satisfy certain cri- the disease originated (immediate

58 SA Pharmaceutical Journal – September 2007


causes), but who or what caused the dis-
ease (efficient cause), and why it has af-
fected this particular person at this point
in time (ultimate cause).7 Diagnosis com-
prises a combination of information,
namely observation (noting physical
symptoms), patient self-diagnosis (report-
ing by patients of their symptoms) and
divination. Three methods of divination
include the casting of divination objects,
mediumistic ability (clairvoyance or te-
lepathy) or dreams, and visions. If nec-
essary, the impressions of other family
members regarding the patient’s illness
may also be obtained.
Herbal medication is the most common
therapeutic method used by African tra-
ditional healers – some are used as pla-
cebos, others for sympathetic magic, but
many have definite medicinal value.
Other methods include psychosocial
counselling, simple surgical methods,
rituals and symbolism. The types of medi-
cations used by African traditional heal-
ers can be classified into three catego-
ries8:
• Preventive and prophylactic medica-
tion
Most of the work of traditional healers
concerns protecting patients from pos-
sible afflictions. This can be achieved in
various ways, for example by performing
ceremonial acts, using medicine against
disequilibrium, or wearing totemic ob-
jects. 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, decoc-
tions, powders, poultices and lotions,
and a variety of earthy ointments that
comprise animal fat, clay and some-
times 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-
SA Pharmaceutical Journal – September 2007
COMPLEMENTARY AND ALTERNATIVE MEDICINE
viduals. A concoction can, for example,
be placed in the enemy’s path and it is
then believed that when the enemy
passes by, he will contract a fatal dis-
ease. Sacrification, blood-letting and
cupping are the commonest surgical pro-
cedures performed by African traditional
healers and these are sometimes per-
formed in full view of onlookers. The let-
ting of blood is sometimes used as a way
of casting out the illness. If the cause of
the sickness is perceived to be bewitch-
ment, a number of rituals may be per-
formed in order to cast out the spell.
These may include the induction of vom-
iting, enemas, blood-letting, whistling or
elaborate rituals such as animal sacri-
fices. Rituals play an important role.
Many Africans believe that if the ances-
tors withdraw their protection and gift of
good fortune, the descendant is left vul-
nerable 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. Tra-
ditional medicine’s 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 healer’s practice is also de-
voted to counselling individuals.
Treatment is comprehensive and has
curative, protective and preventive ele-
ments. It can either be natural or ritual, or
both, depending on the cause of the dis-
ease. 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 sub-
stances, cuts (African mode of injection),
wearing charms, and piercing (African
acupuncture).
A variety of treatment methods are used
in the administration of herbal medica-
tions, 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
incisions – ukugcaba.
• Steaming or use of a vapour-bath
(ukugquma), whereby a patient cov-
ered with a large skin or blanket to
keep out the cold air crouches over a
boiling pot of medicaments. This in-
duces perspiration and reduces fe-
ver.
• Use of enemas for stomach com-
plaints – ukuchatha.
• Use of fomenting treatment for ach-
ing 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 tradi-
tional 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 culture-
bound 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 ac-
cessibility, their familiarity with culture-
bound syndromes and traditions, their
relationships with patients and their fami-
lies place them in a position to serve as
an alternative to mainstream health pro-
viders. 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 super-
natural causes and indicates the dis-
pleasure of ancestral gods or evil spir-
its 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 medi-
cal practitioners in the treatment of cul-
ture-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 Witch-
craft 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 popu-
lation utilises traditional medicine ser-
vices, in many African nations traditional
medicine technically remains illegal. 15
The WHO’s 2001 survey of the legal sta-
tus 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 re-
gionally 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 collaborat-
ing with traditional healers in 1977.5 In
South Africa, a “Traditional Health Prac-
titioners Bill of 2003”, was drafted. Cer-
tain sections of the Traditional Health
Practitioners Act, Act 35 of 2004, came
into operation on 13 January 2006. Ef-
forts are furthermore ongoing to develop
a pharmacopoeia of traditional medi-
cines.8 An extensive project is underway
to document all traditional medicines
derived from indigenous medicinal
plants, but this is no easy task. The con-
centration of active ingredients in medici-
nal 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 Afri-
can societies.17 Their role is that of physi-
cian, 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 coun-
try where the needs are great and the
resources inadequate, traditional heal-
ers can play an important and valuable
role in helping communities to improve
their health and quality of life.

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man rights in South Africa. XV International
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on the web: http://legacy.hst.org.za/sahr/99/
chap18.htm (date accessed: 10 July 2007).
OSTEOPOROSIS DAY : 20 OCTOBER 20 0 7
International speaker to address the importance of calcium
supplementation in teenagers to ensure lifelong bone health
I t is estim ated that 40% of w om en w ill suf
fer an osteoporosis fracture in their life-
tim e. The cost of osteoporosis exceeds $30
billion w orldw ide. The only cost-effective ap-
proach to osteoporosis is prevention.
To raise aw areness around Osteoporo-
sis Day 20 October 2007, Wyeth Consum er
Healthcare w ill host the internationally re-
now ned Professor Connie Weaver, together
w ith South African specialists, on a lecture
tour addressing the South African m edical
fraternity.
Prof Weaver is a distinguished Professor
and Head of the Foods and Nutrition Depart-
m ent at Purdue University in the United States
and has conducted several groundbreaking
research studies on calcium m etabolism , in-
cluding a landm ark study finding that cal-
cium absorption peaks in young girls near
the onset of m enses. The research provided
insight into factors affecting developm ent of
peak bone m ass during grow th, w hich deter-
m ines the risk of osteoporosis in w om en. The
results of Prof Weaver and her research team’s
studies are being used to determ ine recom -
m endations for calcium supplem entation
around the w orld.
South African specialists, including Dr
Stanley Lipschitz, Prof Stephen Hough and Dr
Aslam Am od w ill present various topics rang-
SA Pharmaceutical Journal – September 2007
8. Abdool Karim SS, Ziqubu-Page TT & Arendse R.
1994. Bridging the Gap: Potential for a health
care partnership between African traditional heal-
ers and biomedical personnel in South Africa.
Project report prepared for the South African
Medical Research Council. South African Medi-
cal Journal, 84 (December, Supplement): 1-16.
9. Republic of South Africa. 2004. Traditional
Health Practitioners Act, Act 35 of 2004.
Pretoria: Government Printers.
10. 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).
11. Moskovitz S. 1996. Traditional healers in modern
medicine. The SA Retail Chemist, August: 2.
12. Troskie R. 1997. The role of health care work-
ers in collaborating with traditional healers in
primary health care. Part 1. Health SA
Gesondheid, 2 (1): 29-35.
13. Kgoatla P. 1997. The use of traditional medi-
cines by teenage mothers in Soshanguve.
Health SA Gesondheid, 2 (3): 27-31.
14. Stanhope M & Lancaster J. 1988. Community
Health Nursing: Process and Practice for Pro-
moting Health. St Louis: Mosby.
15. Gbodossou EVA, Floyd VD & Katy CI. Aids in
Africa: Scenarios for the future. The role of
traditional medicine in Africa’s fight against HIV/
AIDS. Available on the web: http://
www.prometra.org/Documents/AIDSinAfrica-
ScenariofortheFuture.pdf (date accessed: 10
July 2007).
16. WHO Report: Legal Status of Traditional Medi-
cine and Complementary/Alternative Medicine:
A Worldwide Review, 2001. Geneva: World
Health Organization.
17. Hewson M. 1998. Traditional healers in South-
ern Africa. Annals of Internal Medicine, 128
(12): 1029-1034.
ing from the im portance of Vitam in D and
Calcium supplem entation in the treatm ent
of osteoporosis to an update on the latest
treatm ent options in osteoporosis.
M embers 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, M elrose Arch
Date: 17/ 10/ 07 City: Cape Tow n
Venue : The Table Bay Hotel
Date: 18/ 10/ 07 City: Durban
Venue: 1on1 Events & Conference Centre,
Gatew ay, Um hlanga
Tim e: 18h30 for 19h00
Drinks and food w ill be served follow ing
the lectures.
Application for CPD points has been
subm itted.
To book for any of the events please fax
your d e t a ils t o M a rie t a Fe rre ira on
0 8 6524 6965 or e - m a il your de ta ils to
m ferreira@lantic.co.za . Please include your
contact details.