**6. Misinterpretation and misrepresentation of indigenous healthcare system**

The introduction of Euro-western culture, practices and religious beliefs, such as the Christian faith, dominated and disregarded the indigenous knowledge system. Indigenous still remained alive among communities even though it was not recognized by colonizers [4]. This had a significant impact on colonizing the minds of indigenous people. It enforced a change in indigenous culture, behavior, practice and belief. The continued alienation and exclusion of indigenous health practitioners in the management of patients is largely based on a monopolistic health system, which recognized allopathic health systems as the only practice of health systems emanating from the prevailing dominant practices by allopathic health practitioners and the lack of respect and recognition of traditional health systems [12]. In many of the formerly colonized countries, indigenous healthcare systems continue to be regarded as less important by Eurocentric healthcare providers and funders of healthcare services [12]. It is often perceived as a threat to western norms of standard of healthcare and at times associated with "witchcraft", actively discouraged and suppressed through powerful legislation [4].

Anecdotal actions, supported by published reports, reinforce the stereotype which appears to suggest that patients belong to allopathic health practitioners [4] and have no right to seek alternative opinions and treatment other than what western medicine prescribes. These actions go against the provisions of the Patient and Human Rights Charter in South Africa. In general, communities and patients are denied the power of self-determination, based on experience and informed by their understanding of health in their own particular context.

Most of the health training curriculums in universities and colleges do not expose students to the science of indigenous health systems, community belief systems and their particular worldviews. When confronted with patients demanding alternative health services from indigenous health practitioners, allopathic health practitioners have the perception that such demands for pluralism would lower their standard of heath service provision and result in inappropriate management of "their" patients by indigenous health practitioners through poor treatment, lack of compliance and a possible overdose of medication. These views of allopathic health practitioners have been commonly expressed to and reported by HIV/AIDS patients using traditional medicine concurrently with allopathic medicine.

Due to misinterpretation and misrepresentation, there is a lack of trust between the allopathic and indigenous healthcare sectors, which is exacerbated by a lack of understanding regarding the knowledge base of each sector. Allopathic healthcare providers simply expect indigenous health practitioners to use allopathic principles to treat ailments and promote health instead of indigenous practices. Throughout the era of colonization, and even during postcolonization in Africa, westernized healthcare training institutions have not incorporated traditional medicine and its philosophies in their curriculums. In instances where mention of indigenous health practices is made, it is usually done in a unilateral manner without incorporation of indigenous health practitioners as tutors and lecturers.

As a result, allopathic healthcare practitioners deny students the opportunity of exposure to the multitude of traditional health practices, among others the traditional preparation and packaging of medicines; reproductive health; indigenous preventative and promotive health practices; diagnostic measures; curative and rehabilitative practices; management of diseases and health promotion; lifestyle and dietary preferences; the status of women; music, ancestral drumming and dance and its influence on wellbeing; spirituality; types of traditional healers; traditional leadership; patient management; palliative care; and maternal and child health.

*Public Health in Developing Countries - Challenges and Opportunities*

indigenous knowledge systems of managing their patients.

compelling claims to recover the "African past" on the other hand.

want indigenous medicine to be recognized as a health science [4, 12].

the delivery of primary healthcare services.

critical of own environment [48].

in the culture and therefore tacit knowledge. It is communal, a shared form of knowledge achieved through experience. It is a linguistic phenomenon. This phenomenon serves cognitive interests of three types namely technical, moral and

Due to globalization, indigenous communities have become increasingly exposed to foreign cultures and practices. There are no aspects of their social life, customary practices or traditional behavior which remained untouched. Communities are now living in countries without borders, and they seem to be short-changed by globalization and colonization. Foreign cultures and practices have intruded into indigenous inner self and being without respect and invaded their living space similar to a declaration of war against cultures that were different to that of the colonizers. The character and nature of globalization and colonization is to perpetuate the dominance of that which is being introduced to communities: western or foreign culture, language and health systems, including diseases against which indigenous communities had no innate immunity, constantly displacing

For centuries, indigenous communities have maintained their dignity and trust in that which worked for their communities and which was gained through experience over many years. They rebelled against colonization and resisted to be mere bystanders and simply witness their indigenous norms and values to become extinct. With the rediscovery of self, communities are increasingly reclaiming their past and striving to retain their cultures and ways of knowing which were previously marginalized and dubbed unscientific and barbaric. This is no easy feat as they are split between claims of global science on the one hand and the equally

Health systems are defined as all activities in the community which serve to promote, restore and maintain people's health. In a postcolonial and globalization context, both the indigenous and allopathic health systems are operating side by side. For the two systems to function optimally, it would require the leveling of the playing field through decolonization of mindsets, attitudes and practices. The desired outcome should be the gaining of knowledge, together with acknowledgment and recognition of the important role that indigenous health system plays in

Globally, indigenous medicine has been declared a component of Primary Health Care (PHC) by the World Health Organization's Health Promotion: Strategy for the African Region. The strategy recommends that different countries should promote and incorporate their indigenous health practitioners into healthcare systems. The implementation of the recommendation has been met with resistance and criticism from allopathic practitioners [9]. A significant number of indigenous communities prefer indigenous medicine as their first choice. Indigenous medicine has always been acceptable, accessible, available, affordable and attainable to them. Several countries have adopted legislation promulgating traditional medicine initiatives. In response to the World Health Organization's Health Promotion: Strategy for the African Region, South Africa promulgated the Traditional Health Practitioners Act [49], to establish a regulatory body controlling the registration and education of THPs [49]. Despite this legislation, allopathic and traditional healthcare sectors remain in conflict and disjointed. Few allopathic health practitioners understand the philosophy, ontology and epistemology of indigenous medicine, let alone accept it as scientific with its own long-standing experiments and standards comparable to western medicine [4, 12]. Simply stated, most of the allopathic practitioners are not able to free themselves from the shackles and deeply embedded mindsets of colonization. Because there is no true understanding of indigenous healthcare systems and its sciences, allopathic health practitioners do not

**74**

Although traditional health practices are considered to be primitive and backward, they continue to thrive due to its cultural importance among communities. In some communities, traditional healthcare practices are the only available healthcare services, given the prohibitive cost and inaccessibility of allopathic healthcare. It is estimated that to this day between 60 and 80% of patients in Africa consult indigenous health practitioners [41].

Despite years of colonization, the prohibition of indigenous health practices and its sciences, indigenous communities have not completely abandoned their ways of life, practices and beliefs [37]. For an outsider, this may be construed as being stubborn, backwards and ignorant of modern sciences and its achievements. For the local and indigenous communities, the allopathic health system has until now been unable to offer explanations for the onset of illness, the "Why me? Why now?" rationale which forms a crucial part of African indigenous understanding of health and healing [50]. In many instances the instructions by allopathic health practitioners to not use and mix allopathic medicine with traditional herbs confuse patients and do not achieve the desired effect [33]. Patients perceive it that they are expected to abandon their indigenous practices and roots and become part of the western culture.

If parity is to be reached, the two healthcare systems should embrace pluralism and respect the rights of choice for all communities. All parties should acknowledge that globalization created contemporary societies where there are different and coexisting competing health systems arising from different traditions, practices and bodies of knowledge. Although pluralism is now recognized as a global phenomenon, its application in colonized communities seems to remain a pipe dream. It will remain a challenge until such time as allopathic healthcare practitioners and students respectively provide and receive training based only on a western-orientated curriculum that excludes alternative methods of care acceptable to the indigenous communities. The worldviews that inform the current curriculum for allopathic healthcare practitioners are monolistic, hospital-centred and disease-oriented and exclude self-care or healing. Furthermore, the curriculum perpetuates health disparities and power imbalances that adversely affect patient outcomes [4, 12, 31].

#### **6.1 Indigenous health systems as a living science**

One of the common arguments by proponents of exclusivity health systems is that "our value system, science of medicine and standard of care will be compromised if we recognize and accept indigenous health practitioners to treat our patients" [4].

There are three fundamental problems associated with this approach, which require elaboration.

Firstly, it's the mindset and attitudes which seem to suggest that patients and communities are owned by health providers.

Secondly, the perception that allopathic medicine is the standard against which all health knowledge is measured.

Lastly, the notion that for "others" (indigenous health practitioners) to exist, function and be accepted by communities, it will require approval and support from allopathic health practitioners.

The plausible explanation for the above problems could be lack of knowledge and understanding of indigenous health systems and its sciences. In life, what we do not know or understand does not mean that it does not exist or does not make sense/work. It may possible mean that one does not understand and comprehend the whole picture and/or is not yet exposed to it.

**77**

**Figure 1.**

*Understanding the Science of Indigenous Health System: Key to Sustainable Collaborations*

Indigenous health systems constitute a life force of science practised by indigenous health practitioners before and after colonization; It has a history, origin, philosophy and epistemology [51–53]. Indigenous health system has its own level of excellence in providing an answer to-"why me, why now", resources, the dynamic that carries communities forward. Indigenous communities consider it as the knowledge inherent to its own identity, with its own science and technological advances beyond physical limitations. It is an institution in its own right, with

Long before colonial rule invaded indigenous communities, indigenous health practitioners were developed and advanced comparable to the allopathic health system. This is supported by a report by a Scottish medical anthropologist who witnessed the indigenous surgeons in Buganda performing a cesarean section (**Figure 1**). The Scottish colonizers interacted with the indigenous communities and learnt from them while conducting studies through observation. It culminated in the publication of an article that appeared in the *Edinburgh Journal of Medicine* and in a dissertation titled "Ueber die Lage und Stellen bei der Geburt" which he submitted

That article is now part of the *Annals of Obstetrics and Gynecology* history, describing in detail how cesarean section was performed. He gave an illustration of procedures and how they were carried out: anesthetics practices, aseptic measures, performance of the actual cesarean section, how the uterus was massaged and delivery progressed, the final postoperative measures and how the mother and baby responded were all included. From this it is evident that the procedures and the science practised by indigenous healthcare providers at that time compared to the best

Research reports and dissertations published by medical anthropologists in 1885 confirmed that indigenous health practice is a field of health science practised by indigenous health practitioners with high ethical standard of care and value systems. The question of what is defined as science, how it is practised and how the standard thereof is measured is worth exploring and explained in this context. It is not disputed that science is an art, a pathway and systematic process of finding solutions to societal problems. There are also different pathways of knowing and finding solutions to problems facing communities. Different communities had explored different mechanisms and at different times during the development of their healthcare systems, through experimentation and testing the efficacy of their different

standard of performing a cesarean section that existed in Europe.

*Indigenous health practitioners of 18th century performing caesarean delivery.*

*DOI: http://dx.doi.org/10.5772/intechopen.92090*

consumers and pioneers [51, 52].

to the Marburg University in Germany in 1885 [53].

#### *Understanding the Science of Indigenous Health System: Key to Sustainable Collaborations DOI: http://dx.doi.org/10.5772/intechopen.92090*

Indigenous health systems constitute a life force of science practised by indigenous health practitioners before and after colonization; It has a history, origin, philosophy and epistemology [51–53]. Indigenous health system has its own level of excellence in providing an answer to-"why me, why now", resources, the dynamic that carries communities forward. Indigenous communities consider it as the knowledge inherent to its own identity, with its own science and technological advances beyond physical limitations. It is an institution in its own right, with consumers and pioneers [51, 52].

Long before colonial rule invaded indigenous communities, indigenous health practitioners were developed and advanced comparable to the allopathic health system. This is supported by a report by a Scottish medical anthropologist who witnessed the indigenous surgeons in Buganda performing a cesarean section (**Figure 1**).

The Scottish colonizers interacted with the indigenous communities and learnt from them while conducting studies through observation. It culminated in the publication of an article that appeared in the *Edinburgh Journal of Medicine* and in a dissertation titled "Ueber die Lage und Stellen bei der Geburt" which he submitted to the Marburg University in Germany in 1885 [53].

That article is now part of the *Annals of Obstetrics and Gynecology* history, describing in detail how cesarean section was performed. He gave an illustration of procedures and how they were carried out: anesthetics practices, aseptic measures, performance of the actual cesarean section, how the uterus was massaged and delivery progressed, the final postoperative measures and how the mother and baby responded were all included. From this it is evident that the procedures and the science practised by indigenous healthcare providers at that time compared to the best standard of performing a cesarean section that existed in Europe.

Research reports and dissertations published by medical anthropologists in 1885 confirmed that indigenous health practice is a field of health science practised by indigenous health practitioners with high ethical standard of care and value systems.

The question of what is defined as science, how it is practised and how the standard thereof is measured is worth exploring and explained in this context. It is not disputed that science is an art, a pathway and systematic process of finding solutions to societal problems. There are also different pathways of knowing and finding solutions to problems facing communities. Different communities had explored different mechanisms and at different times during the development of their healthcare systems, through experimentation and testing the efficacy of their different

**Figure 1.** *Indigenous health practitioners of 18th century performing caesarean delivery.*

*Public Health in Developing Countries - Challenges and Opportunities*

enous health practitioners [41].

culture.

outcomes [4, 12, 31].

patients" [4].

require elaboration.

**6.1 Indigenous health systems as a living science**

communities are owned by health providers.

the whole picture and/or is not yet exposed to it.

all health knowledge is measured.

from allopathic health practitioners.

Although traditional health practices are considered to be primitive and backward, they continue to thrive due to its cultural importance among communities. In some communities, traditional healthcare practices are the only available healthcare services, given the prohibitive cost and inaccessibility of allopathic healthcare. It is estimated that to this day between 60 and 80% of patients in Africa consult indig-

Despite years of colonization, the prohibition of indigenous health practices and its sciences, indigenous communities have not completely abandoned their ways of life, practices and beliefs [37]. For an outsider, this may be construed as being stubborn, backwards and ignorant of modern sciences and its achievements. For the local and indigenous communities, the allopathic health system has until now been unable to offer explanations for the onset of illness, the "Why me? Why now?" rationale which forms a crucial part of African indigenous understanding of health and healing [50]. In many instances the instructions by allopathic health practitioners to not use and mix allopathic medicine with traditional herbs confuse patients and do not achieve the desired effect [33]. Patients perceive it that they are expected to abandon their indigenous practices and roots and become part of the western

If parity is to be reached, the two healthcare systems should embrace plural-

One of the common arguments by proponents of exclusivity health systems is that "our value system, science of medicine and standard of care will be compromised if we recognize and accept indigenous health practitioners to treat our

There are three fundamental problems associated with this approach, which

Firstly, it's the mindset and attitudes which seem to suggest that patients and

Secondly, the perception that allopathic medicine is the standard against which

Lastly, the notion that for "others" (indigenous health practitioners) to exist, function and be accepted by communities, it will require approval and support

The plausible explanation for the above problems could be lack of knowledge and understanding of indigenous health systems and its sciences. In life, what we do not know or understand does not mean that it does not exist or does not make sense/work. It may possible mean that one does not understand and comprehend

ism and respect the rights of choice for all communities. All parties should acknowledge that globalization created contemporary societies where there are different and coexisting competing health systems arising from different traditions, practices and bodies of knowledge. Although pluralism is now recognized as a global phenomenon, its application in colonized communities seems to remain a pipe dream. It will remain a challenge until such time as allopathic healthcare practitioners and students respectively provide and receive training based only on a western-orientated curriculum that excludes alternative methods of care acceptable to the indigenous communities. The worldviews that inform the current curriculum for allopathic healthcare practitioners are monolistic, hospital-centred and disease-oriented and exclude self-care or healing. Furthermore, the curriculum perpetuates health disparities and power imbalances that adversely affect patient

**76**

**Figure 2.** *Allopathic health practitioners of the twenty-first century performing caesarean delivery.*

medicinal products, beliefs and practices. Some solutions are yet to be explored and discovered. Reports confirmed that indigenous health practitioners have perfected the art of sciences long before colonizers and missionaries introduced western medicine. Their processes of diagnosis and patient management are documented as being thorough, scientific and of comparable standard to other practices.

Despite what Felkin witnessed as being no different, in principle at least, from what modern doctors do, allopathic health practitioners of the twenty-first century do not recognize that indigenous health systems are a science and could play a significant role in existing health systems. There are several factors which contributed to poor working relationship between the two systems. Key among them is the effect and impact of colonization, globalization and commercialization of health and healthcare services as a commodity. Indigenous communities were encouraged to abandon their practices, beliefs and sciences. High levels of suspicion and mistrust supported the enforcement by law that prohibited the use of indigenous medicines.

There is no doubt that the impact of colonization extended beyond politics and the economic life of indigenous communities, for it disorientated and destabilized their psychosocial interactions with reality. There are perceptions that most scientific scholars raised and educated according to the western doctrine are unable to use their worldview to interrogate and interpret the world and environment, unless it meets the western worldview. They subscribe to western principles despite its limitations in African settings. While most of the colonized countries may have achieved political freedom from their erstwhile masters, the pervasive socioeconomic mindset persists and liberation from western scientific inclinations evades indigenous scholars.

**Figure 2** Allopathic health practitioners of the twenty-first century applying similar principles, protocol and standards to that of indigenous health practitioners reported by medical anthropologist in 1885 during the delivery of a baby through Cesarean section (Google source).
