Adaptations, alterations and shifted strategies: the pragmatics of knowledge transfer in HIV and AIDS interventions in South Africa

The historical relationship between western and traditional health practitioners in South Africa was always uncomfortable and remote. This paper does not rehearse the complex colonial history of this disjunction, but rather focuses on some of the effects of that history on contemporary medical relationships, especially concerning interventions in the prevention and treatment of HIV and AIDS. The controversy about the rights of HIV positive patients to choose 'traditional' African remedies over biomedical antiretroviral drugs (ARVs) is considered first. The paper argues that by attaching the notion of 'pseudoscience' to traditional medicine in this debate AIDS activists' are reproducing an unhelpful contemporary version of the familiar 'scientific knowledge' versus 'traditional belief' dichotomy, an attitude that alienates traditional health practitioners and discourages useful dialogue and cooperation. The paper then introduces ethnographic coverage of an HIV/AIDS intervention in the Western Cape Province, in which Xhosa traditional health practitioners (THPS)1 have adopted and adapted the techniques of HIV/AIDS counselling, and advocacy of HIV/AIDS testing and ARVs, into their conventional practice. The testimony of the healers themselves is used to discover the effects of this process of medicalisation and the extent to which it has changed the THPs' relationship - real and perceived - with western medicine. The paper will show that although these THPs are eager to be involved with western medicine, this does not constitute surrender to a superior system, but is simply a pragmatic act of conciliation in the face of the HIV/AIDS epidemic. In their practical approach, the healers can be recognised not as 'ignorant' or naïve, but realistic. The paper argues that the 'ignorance' and ineptitude of which traditional practitioners are often accused is in fact a consequence of the disinterest shown by western medicine towards them

Talking with the white: sharing the experiences of white sangoma in contemporary South Africa

The phenomenon of whites who have graduated as sangoma - the ancestrally guided spiritual healing system of South Africa - has become a contemporary cause celebre, a matter for academic and popular debate (de Bruyn 2004; Dowson 2001; Wreford in progress). In some circles the idea is dismissed as inconceivable (Masiba 2001): Other sangoma optimistically embrace the introduction of whites to their ranks as a natural and positive innovation. Biomedicine meanwhile generally dismisses sangoma healing ideas and practice and thus ignores the potential advantages of co-operation with this parallel healing system on which between 60 and 80% of the majority population still depend (Pretorius 1999). This paper examines white sangoma in the context of the social and political conditions of contemporary urban South Africa. Sources for the paper include my personal experience of training and graduation as a sangoma, as well as material gathered from black African sangoma, and, more recently, from white initiates and graduates. The paper examines whether these healers represent a hybrid phenomenon, a development of tradition as a 'changing same' (Clifford 2003: 113) or, as their critics allege, yet another version of colonial exploitation (Mndende 2001), and asks how white sangoma see themselves, how their supporters, mentors and clients view them, and how they respond to their critics. Finally, the paper suggests that whatever their categorisation, there may be a fruitful role for white sangoma in effecting a more collaborative relationship between biomedicine and traditional healers in South Africa, particularly in the face of the AIDS pandemic ravaging the country

Facilitating relationships between African traditional healing and western medicine in South Africa in the time of AIDS: A case study from the Western Cape

As the HIV/AIDS epidemic in South Africa matures, the importance of encouraging a more cooperative approach between biomedicine and traditional African healers (TAHs) becomes paramount. This is not solely based on the potential of the additional human resources which might be released by better relationships with traditional healers - biomedical HIV/AIDS interventions themselves could benefit from a better understanding of traditional ideas of health, disease and healing, ideas which could then be appropriately incorporated into the treatment process. This paper offers a portrait of an innovative project based in the Western Cape Province which aims to make a start in improving cross-sectoral relationships. The paper limits its coverage to the initiatory stages of the scheme, and offers unusual insights into both the potential advantages of cooperation, and into some of the, often mundane, pitfalls and obstacles presented by this sort of approach

Shaming and blaming: Medical myths, traditional health practitioners and HIV/AIDS in South Africa.

This paper examines some often repeated 'medical myths' about Traditional Health Practitioners (THPs) in South Africa, in the context of the HIV/AIDS epidemic. Narratives have served many purposes in the pandemic: the stories included here provide specific commentary, often implicitly derogatory or critical, on the role of THPs. The anecdotes can be seen to reflect the uneasy interaction generally prevailing between the traditional and biomedical paradigms in South Africa. The paper first examines some of the reasons for the biomedical presumptions that underlie these narratives. It argues that in attributing blame, the stories exert an unhelpful effect and undermine confidence in the possibility of collaborative medical efforts against HIV and AIDS. In contrast, the paper utilises field evidence to suggest that, given mutual respect, THPs can be successfully drawn into biomedical prevention and treatment interventions, and thereby improve their efficacy

'We can help!' - A literature review of current practice involving traditional African healers in biomedical HIV/AIDS interventions in South Africa

This review describes the available research literature involved with efforts at collaboration between Traditional African Healers (TAHs) and biomedical practitioners in HIV/AIDS interventions in Southern Africa. The paper draws on academic texts including published and unpublished research papers, books and reports, and press comments on the subject. The focus is on Southern African literature, but selected texts from elsewhere on the continent are also included. The paper interrogates, in particular, the roles assigned to more spiritually inspired practitioners, such as sangoma, in these interventions. The paper considers the effects on relationships between biomedicine and the traditional health sector and explores some of the obstacles in the way of successful future collaborations. The analysis addresses the following questions: What are the roles assigned to sangoma and other traditional health practitioners in biomedically constructed HIV/AIDS interventions to date? What has been the experience of sangoma and traditional health practitioners of these interventions, and how have biomedical professionals involved in these interventions responded to the traditional health practitioners? What factors contribute to negative responses where these occur, and how might these be addressed? Could the roles of sangoma and traditional health practitioners be enhanced to improve the effectiveness of HIV/AIDS interventions

Trade liberalisation and greenhouse gas emissions: the case of dairying in the European Union and New Zealand

International Relations/Trade,

Ukusebenza nethongo (Working with Spirit): the role of sangoma in contemporary South Africa

This thesis represents a typically boundary-crossing ethnographic experience and an unconventional anthropological study, its fieldwork grounded in the author's personal experience of ukuthwasa - initiation, training and graduation - to become a sangoma, a practitioner of traditional African medicine, in contemporary South Africa. The study is contextualized within the contemporary health dispensation in South Africa in which two major paradigms, traditional African healing, considered within the spiritual environment of sangoma, and biomedicine, operate at best in parallel, but more often at odds with one another. Given the unprecedented challenge of the HIV/AIDS pandemic in the country, the thesis suggests that this situation is unhelpful and proposes first, that a more collaborative relationship between medical sectors is vital. Secondly, the thesis suggests that anthropologists can play an important role in achieving an improved dialogue, by producing research grounded in the spiritual aetiology of sangoma but comprehensible to academic science and applicable within collaborative medical interventions. The thesis introduces 'sacred pragmatics' to embody the disarmingly matter-of-fact quality of sangoma healing which is nevertheless always underpinned by the authority of ancestral spirit solicited in terms that are reverent. Ancestral authority in sangoma is advanced as a credible near equivalent to Jung's 'collective unconscious', and the contemporary phenomenon of white sangoma is proposed as a potential source of social and political healing. In the light of the spiritual foundation of sangoma, the absence of spirituality in biomedicine is discussed and its effect on relationships between medical sectors analysed. The umbilical and ambiguous connection of sangoma and witchcraft is acknowledged, a relationship theorised as having transformative potential within kin and community. The theoretical arguments are set against the evidence of fieldwork which is characterised as experiential and described reflexively. The thesis constitutes a start in what the author hopes will develop into an ongoing conversation between traditional African healing, academe and biomedicine in South Africa

Critical Success Factors in the Offshore Business Process Outsourcing of Debt Collection to India

This research identifies critical success factors for the offshore business process outsourcing of debt collection to India. It develops a critical success factor model for offshore debt collection incorporating the new concept of Opaque Indifference. Opaque Indifference is a series of constructed states eliminating negative cues for debtors dealing with offshore debt collectors. The research contributes to the existing literature by applying information systems outsourcing theory to the offshore business process outsourcing of debt collection