Background
Methods
Study design
Study setting
Sampling
Data collection
Time point 1 | Time point 2 | Time point 3 | Time point 4 | Time point 5 | |
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FGD 1 | FGD 2 | FGD 3 | Community walk/taking of photos | FGD 4 | |
Topics covered: | Understanding THPs: who are THPs, how do they become, what are their practices | THPs approach to illnesses including HIV/AIDS: How do they manage illness, do they refer patients to Western biomedical practitioners, when do they refer. | Local traditional practices that support or prevent HIV testing, initiation and retention in HIV/AIDS care | Community Walk and taking of photos representing facilitators and barriers to HIV testing, treatment initiation and adherence | Group discussion based on the photos taken in time point 4 about facilitators and barriers to HIV testing, treatment initiation and adherence |
Dates | 22/02/2013 | 30/05/2013 | 31/07/2013 | 09/10/2013 | 13/11/2013 |
Attendance | 9 attended/0 absent | 9 attended/0 absent | 8 attended/1 absent | 8 attended, 1 absent | 7 attended, 2 absent |
Method used to gather data | Individual and group narrative | Individual and group narrative | Individual and group narrative | Community walk; taking of photos | Individual and group narrative |
Data analysis and interpretation
Category | Description | Content codes | Examples from transcripts |
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Typology | Type of healing practitioner | ISangoma_associated to ancestral spirits, is a diviner |
1.“……All the ones I have mentioned are all Sangomas. There are many of them, I have just mentioned a few of them” (Male, Interview 3)
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INyanga _acquires knowledge of healing using plants, herbs and animal parts, is a herbalist | |||
2. “…..there is someone that I know who is a Sangoma, and we are coming from the same family. She also works both as Umthandazi and Inyanga like me” (Female, FGD1, Traditional healer)
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UMthandazi _associated to religion & ancestral spirits, is a spiritualist/faith healer | |||
Calling Initiation Training | Process or journey of being appointed to become a traditional healer which includes training & completion (graduation). The process is characterised by performing different activities and rituals | Spiritual |
1.“This Spirit just comes to you unexpectedly. It comes as a messenger, the Holy Spirit just comes down to you and you will not have an idea of what happened to you” (Female, FGD1, Traditional healer)
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Ancestral | |||
Personal Choice | |||
Refusal/Consequences | |||
Training Institution | |||
Apprenticeship | |||
Rituals | |||
Graduation | |||
Healing Practice | Process that a healer & patient go through to identify, explain, discuss & negotiate appropriate treatment with patient. | Causation |
1.“ The patient told me that umndawe [spirit] is high and he needs to start doing amagobongo [traditional ritual]. He was giving me an instruction as a healer! I am the one who is supposed to know what is wrong with him, and what help he needs, I am not supposed to take instructions from him. (Female, FGD 3, Traditional healers)
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Source | |||
Co-production | |||
Assigning | |||
Prescribing | |||
Preparing |
Ethics permission
Results
Profile of participants
The calling to become a traditional healer
“What I was trying to explain to you is that we do not call for this. It is something that you just get and you don’t invite it. It is like an illness, you don’t invite it”. (Female, FGD1, Isangoma/Inyanga)
“…..it comes to you uninvited it will come like a disease you can’t refuse” (Female, FGD1, Isangoma/Inyanga)
“…. I stopped school because in the course of the year, I will perform well and do like other learners. But when we were about to write exams, I would not hear the teacher and I would just feel like leaving the class and just wander around. I would not disturb other learners at school…. (Male, FGD1, Traditional healer)
“It is something that I was born with. When I started going to the Zionist church, I already had this thing (ancestral spirit) in me” (Male, FGD1, Isangoma/Inyanga)
“When I started speaking in tongues because of the spirits that I had in me, my family refused to believe it. Most families do not accept such a thing when it happens to their own family members, especially children. I will be very thankful if there are families who accept this kind of thing when it happens. It is not easy for the family to just send you to a place where you can get initiated. Instead they will do a cleansing ceremony for you to get the spirits out” (Female, FGD1, Isangoma/Inyanga).
“When you are at church you can see a child or an older person and see that they have the ancestral spirits. You can feel their spirit. When we are talking amongst ourselves we say, that person is a Sangoma, but has not yet realized it, we laugh. Others will say that just because I am a Sangoma now I am saying everyone is a Sangoma. I tell them that I can feel another Sangoma’s spirit” (Female, FGD1, Isangoma/Inyanga)
“ehhhh my child there are many, I will give you a wrong figure if you want to know the numbers, there are many of them, others don’t want to be known. Others they have hidden themselves, they don’t want to be known” (Female, FGD1, Isangoma/Inyanga)
Typology and role of traditional healers
“…..for a Sangoma, someone [an ancestor] will come to you in a dream and tell you that you have to go and be initiated. After that you will run away crying until you reach another [a sangoma who will facilitate the process of training] Sangomas house. When you get there, that Sangoma [trainer] will welcome you. She will talk to her own ancestors and let them know that you are there to be initiated. The (ancestor) who came to you in a dream will also be with you [spiritually] to teach you how to do ukuhlola (divination). That Sangoma will do everything until the end. At the end she will take you back home, accompanied by other Sangomas. After that you will be able to talk and connect to ancestors, you will be able to tell people their problems” (Female, FGD1, Isangoma/Inyanga)
“….It is because of the spirits that possess us, they are called Umndiki or Umndawe” (FGD3, Female, Isangoma/Inyanga)
“….when the spirits arrive it is unexpected as he was explaining. We usually say it is bursting [surprising and shocking] just because we do not expect it to happen, especially in front of other people. I was born in a home where we were praying a lot under the church of Nkonyane Zion” (Female, FGD1, Umthandazi/Inyanga)
“When the spirits rise [start working] it means that the person starts speaking in a way that he does not know. He does not know how he got to speak like that. That is how the spirits start to operate in him” (Male, FGD1, Umthandazi/Inyanga)
“When I pray as Umthandazi, I use water and salt. I cook those little things (salts). You pray by using water, ash and incense those kinds of things”. (Female, FGD1, Umthandazi/Inyanga)
“When a person comes to me and enters at Endumbeni [consultation room], I then consult with the ancestors and come back to mix umuthi [medicine] for a patient” (Female, FDG4, Traditional healer)
“Yes the child will drink the medicine outside (household premises) and also take the bath outside. We do not use a bath tub. I just pour the mixture over the child’s head and the mother will run her hands through the child’s body. We all walk back to the house and we do not look back. When we look back, it means that we are looking at the thing that we were removing from this child and it will come back again to trouble the child” (Female, FGD4, Inyanga)
“…..here is someone among us, we know that she is a leader in her church but she is also a Sangoma. It has not been even five years since she started being a Sangoma. She has been helping people within the church (as Umthandazi). But she is now a Sangoma. She went for initiation and stayed in someone (trainer) else’s home [to train as a Sangoma] even though she has ISithunywa” (Female, FGD1, Isangoma/Inyanga)
“When a person comes to me for assistance, I can tell if I need to use ISithunywa (as Umthandazi) or if I need to use the herbs (as Inyanga). That is how a person becomes both Umthandazi and Inyanga or Sangoma”. (Female, FGD1, Umthandazi/Inyanga)
“…..I stayed like that, I was never initiated until I reached a stage of having a boyfriend and having children. That person [partner] did not pay any lobola [bridewealth] for me; we just stayed in a relationship [cohabited]. I had four children, one of my daughters even got married but my partner did not pay lobola for me because the ancestors were angry when I did not take up the calling, this was their way of communicating with me and my family” (Female, FGD1, Isangoma/Inyanga)
Ancillary roles of traditional health practitioners
Counselling
“When you are quarrelling and the woman does not even want to have sex with the husband, the other one doesn’t want the other one [estrangement between partners]. If one of them comes to me and tells me that he wants to make things right in their marriage, I will tell him to come back with his partner so that I can give them umuthi together” (Female, FGD 3, Isangoma)
“…..they ask you to give them amagobongo [a mixture of traditional herbs used for cleansing the body or treating a particular illness]. Like P5 was saying, I also agree with her. People come and ask for amagobongo when you can see that what they have has nothing to do with idlozi (ancestor)” (Female, FGD3, Inyanga)
“We were given referral cards. We use them to refer patients which we cannot help spiritually or with traditional medicine. We write on this referral card all the symptoms that they tell us and ask them to take it to the clinic” (Female, FGD3, Isangoma/Inyanga)
Protection
“I use it to sprinkle the yard to chase away bad spirits and thieves or imikhovu [a spirit of a dead person that is used in witchcraft]. You see there have never been any thieves in my house. Maybe they are afraid of my boys, I don’t know. But I believe that it is this intelezi [African plant that people use to cleanse themselves or rid themselves of evil spirits in their homes or places of businesses] that is helping me. I mix the herbs with water and I sprinkle in the yard and in the kraal. I sprinkle it all over” (Female, FGD4, Isangoma/Inyanga)
“Sometimes when people go to the clinic, they will not be taken care of because they have isinyama (dark omens) that is following them. People will not even want to look at them and nurses will not want anything to do with them. So when such people come to me, the first thing I do is to cleanse them, to remove isinyama so that people can be able to look at them and they must be attractive to people” (Female, FGD3, Inyanga)
Mediation
“While I was seeing people’s secrets in the church, then someone came to me at night [in a dream] when I was sleeping. That person said “I can see that you are able to see people’s secrets”, but he said he wanted me to smear ibomvu (traditional red clay). I asked [again] if they wanted me to smear ibomvu”. (Female, FGD1, Umthandazi/Inyanga)
“…..someone from the family gave me a cow to slaughter to appease the ancestors”. (Female, FGD1, Isangoma/Inyanga)
“…..When they are at endumbeni [Healers consultation room], I do ukuhlola (divination) using my bones. Once I see what their problems are….the bones will show me what is troubling the person” (Female, FGD4, Isangoma)
Typology of traditional health practitioners | |||
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ISangoma | UMthandazi | INyanga | |
Process to become THP | . Called by Amadlozi. Trained by an expert through the guidance and instruction of Amadlozi | . Invoked by the spirit of Isithunywa and Amadlozi | . Individual choice to become an Inyanga |
. Apprenticeship with an expert | |||
Role | . Divination Contact and communication with Amadlozi (those of healer and those of a patient) | . Prayer Provides holy water and other mineral substances such as ash and salt to facilitate healing | . Treatment, which includes herbs, plants and traditional rituals |
. Traditional rituals | |||
Ancillary roles | |||
• Counselling • Protecting • Mediating |