**4. Convergent and divergent views between allopathic health practitioners and indigenous health practitioners**

Apart from a few areas of possible convergence between the two health systems, it is the divergent views which have obstructed the development of sustainable collaborations between allopathic and indigenous health practitioners. Some are highlighted in **Table 1** below.

The areas of convergence between the two systems are that both display sympathy towards their patients and care about the wellbeing of their patients. In addition, they accept accountability for their patients' health, work from a body of underlying empirical knowledge and both engage in elaborate processes of discernible empiricism in their efforts to diagnose and treat their patients [16]. There is, however, a view among allopathic health practitioners that indigenous medicine in terms of its body of knowledge and practices had remained stagnant during the course of human evolution [19]. The irony is that much of western knowledge, which is vowed to be scientifically based, originated from indigenous medicine by selecting certain practices from the latter, subjecting it to analyses and then


#### **Table 1.**

*Simplistic comparison of the two health systems.*

*Public Health in Developing Countries - Challenges and Opportunities*

ancestors [9, 15].

are discussed below.

**3.1 Diviners**

**3.2 Herbalists**

**3.3 Traditional birth attendants**

**3.4 Spiritual healers/prophets/faith healers**

While the knowledge about diseases is passed on from the training supervisor to the intern/thwasana during apprenticeship, the knowledge of medicines, preparation and application thereof is directly communicated to the thwasana by his/her ancestors only. Both the trainer and thwasana closely guard these secrets from the

Indigenous health practitioners are broadly categorized according to the techniques they employ and the methods of diagnosis [15]. The three main categories

Diviners are a category of indigenous health practitioners who diagnose diseases and illness through divination. It's the unique and special process of interpreting the message of ancestors through possessed crafted objects such as bones, shells, wood, etc. This category of indigenous health practitioners also possesses the spirit to interpret misfortune and to perform family rituals to secure the protection and guidance of ancestors. They represent the memories of ancestors in human form and establish a crucial link between humans and the supernatural [2, 16, 17].

Unlike diviners, this category of practitioners are predominantly ordinary people who have acquired an extensive knowledge of herbal medicine and the application of plant components such as roots, barks, leaves, oils, minerals, etc. in treatment. It is a category in which skills are learned and acquired without the involvement of ancestors. They voluntarily decided to undergo training with an established herbalist and then practice independently. They diagnose and prescribe medicines to prevent and to alleviate illness and to provide protection against witchcraft and misfortune or evil, as well as to bring prosperity and happiness [16].

This category probably existed long before all other categories of health practitioners. Through the centuries their services had been utilized by all humanities albeit as a matter of necessity due to cultural beliefs or medical conditions which allopathic health practitioners were not able to explain and manage, such as birthmarks [15]. Their focus is on mother and child health, starting from conception right through till the child reaches the age of 5 years. The health of the nursing mother is managed together with that of the child. It is believed that the newborn will not survive unless prenatal conditions and infections that the mother may develop are left untreated. The traditional birth attendants are mostly elderly women of 60 years or older and use herbal medicines to treat their patients.

The spiritual or faith healers and prophets have recently emerged as another category of indigenous health practitioners, and whether they should be recognized

They use prophesy and faith in supernatural beings as the source of their power. A common practice among them is the use of prayer, candlelight and or water to

There is division within this category of indigenous health practitioners, and it is based largely on legitimacy and beliefs. Prophets/spiritual healers among

and accepted as indigenous health practitioners continues to be debated.

**70**

heal their patients [18].

incorporating some of that into allopathic settings. Very little, if any, recognition is given to the science and philosophy of indigenous knowledge, let alone assigning intellectual ownership.

From the above table, it is evident that the two health systems display differences in their approach to knowledge and science. These differences could be explained using ontology as it evolved culturally and historically over time. The allopathic perspective is based on western science, while indigenous medicine is based on indigenous sciences. Allopathic health practitioners seem to find it difficult to accept the indigenous sciences into their "rational" scientific framework because it does not fit their model.

Another difference relates to the belief of what causes disease and illness. Allopathic medicine associates disease and illness with invading pathogens such as bacteria, parasites and viruses and or physiological changes. The indigenous system believes that disease and illness are caused by supernatural forces. Various explanations are offered for "why me and now" [20–22]. It can be as a result of the individual's own spiritual mishaps, provocation of ancestors by violating taboos, obligations or responsibilities or a mere "call" by ancestors to perform certain rituals. Witchcraft and evil spells are regarded as common causes [7].

Another aspect on which the two systems differ is on what is understood to be science. The point of departure would be on how knowledge or empiricism as a science is defined. Science as it is known from a western perspective in modern times is the accumulation of knowledge through experience/experimentation and observation, and it is stored in books or electronically [23]. In order to be educated, one has to read the books or access the information electronically. For this reason, allopathic medicine utilizes textbooks and other archived material to pass knowledge on. On the other hand, among indigenous health practitioners, knowledge is handed down, often verbally, from healer to apprentice, from one generation to the next [24, 25]. It provides the "paradigm" through which and by which they understand and interpret their environment. The entire constellation of beliefs, values, techniques, etc. is shared by the members of a given community as health practices [12, 18, 26].

The two systems have a different understanding and explanation of what constitutes a healthy individual and society and illness in the community. The allopathic health system subscribes to World Health Organization's (WHO) definition of health as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity" [27]. This definition of health is limited to an individual within the society and does not comply with the indigenous standard of health. For the indigenous communities, health is not experienced at an individual level. It is defined in terms of the completeness of society as a whole, connectedness and harmonization between the living human kingdoms/beings and their ancestors, animal kingdoms and environment. It values health as a system, similar to the human system, with different components, and each component contributes to the functionality and completeness to purpose [28, 29].

There is growing evidence that the two main health systems—indigenous and allopathic—are operating side by side in Africa [9, 30]. Depending on the country and history of colonization, allopathic health practitioners tend to be well resourced and supported by the government, while neglecting and, in some situations, suppressing indigenous health systems and its practices. At times, the lack of communication and the adversarial relationships between the two systems impact negatively on the delivery of health services to communities [31, 32]. Patients are receiving conflicting advice from their health practitioners. Treatment overdose and drug interactions are very common, and this is not surprising as the two systems have divergent worldviews of the causes of diseases; why, when and how a person becomes ill; and finally the diagnostic tools, processes and approaches to

**73**

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

management of patients [33]. Their understanding of what constitutes a diseased patient and or community and the healing process is largely influenced by their respective values and meaning of life and death. Why people get sick and why they should die or live longer will determine their acceptance of the outcome: death or recovery to health/healing. For example, if the death of a diseased individual is viewed as a means of joining the ancestors to provide guidance and advice to the living, the outcome of healing will not be considered as good and beneficial to the

Indigenous health systems acknowledge that there are diseases and/or illness which infect or attack the human spirit without affecting the physical body [34]. The illness could be as a result of spiritual attacks by evil spirits or evil spells, demonic forces, ancestors' way of communicating with an individual, family and communities. While western science has not accepted this concept of disease, not everything that western science practices and observes meet their own standard of science. For example, western science believes that life in human beings constitutes the coexistence of the physical body, spirit or soul. The existence of the spirit as part of giving life to the body

is not based on sciences, but on a belief system which is common to all [35–37].

Indigenous science believes that the spirit, which inhabits individuals, does not present with physical signs and symptoms which could be detected and diagnosed by modern technology as employed by allopathic health systems, e.g. a stethoscope, diagnostic radiography (X-rays), ultrasound, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans and nuclear medicine scans. The opposite is also true. There are diseases, which infect/attack the physical body without affecting the spiritual aspect [35, 38–40]. Allopathic practitioners are well resourced to diagnose and manage both that of the body and spirit. At the centre of the two health systems is the phenomenon of dual consultation which is being exercised by patients based on their preferences of health provider, accessibility and affordability of the services and integration of the disease management model with their belief systems and practices. The perception created over the years under colonial rule by western authorities is perpetuated with the mindset suggesting that patients belong to the allopathic health system with no right of choosing and consulting health providers other than allopathic health practitioners [4]. Failure to recognize indigenous worldviews and beliefs had created a crisis for allopathic

This is particularly evident among HIV/AIDS and TB patients who are reported to be abandoning western treatment in favor of indigenous remedies and practices. In most cases allopathic health practitioners are made aware of this, often at an advanced stage of treatment, when patients who have been exercising their rights to choose disclose that they are also receiving treatment from indigenous health

Without the recognition of patients' rights and the establishment of collaborations and referrals of patients between the two systems, the postcolonial health system will remain dysfunctional and ineffective to fully respond to the needs of

The point of departure should be the interrogation and understanding of the existing health system which was operating in communities before colonization and globalization of their environment [46, 47]. The definition of indigenous in our context refers to the root, something natural or innate (to), a way of life, living, beliefs and practices which is an integral part of community culture. It is embedded

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

healthcare which persists to this day [41, 42].

**5. Integration of the two healthcare systems**

practitioners [43–45].

the indigenous communities.

indigenous communities.

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

management of patients [33]. Their understanding of what constitutes a diseased patient and or community and the healing process is largely influenced by their respective values and meaning of life and death. Why people get sick and why they should die or live longer will determine their acceptance of the outcome: death or recovery to health/healing. For example, if the death of a diseased individual is viewed as a means of joining the ancestors to provide guidance and advice to the living, the outcome of healing will not be considered as good and beneficial to the indigenous communities.

Indigenous health systems acknowledge that there are diseases and/or illness which infect or attack the human spirit without affecting the physical body [34]. The illness could be as a result of spiritual attacks by evil spirits or evil spells, demonic forces, ancestors' way of communicating with an individual, family and communities. While western science has not accepted this concept of disease, not everything that western science practices and observes meet their own standard of science. For example, western science believes that life in human beings constitutes the coexistence of the physical body, spirit or soul. The existence of the spirit as part of giving life to the body is not based on sciences, but on a belief system which is common to all [35–37].

Indigenous science believes that the spirit, which inhabits individuals, does not present with physical signs and symptoms which could be detected and diagnosed by modern technology as employed by allopathic health systems, e.g. a stethoscope, diagnostic radiography (X-rays), ultrasound, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans and nuclear medicine scans. The opposite is also true. There are diseases, which infect/attack the physical body without affecting the spiritual aspect [35, 38–40]. Allopathic practitioners are well resourced to diagnose and manage both that of the body and spirit. At the centre of the two health systems is the phenomenon of dual consultation which is being exercised by patients based on their preferences of health provider, accessibility and affordability of the services and integration of the disease management model with their belief systems and practices. The perception created over the years under colonial rule by western authorities is perpetuated with the mindset suggesting that patients belong to the allopathic health system with no right of choosing and consulting health providers other than allopathic health practitioners [4]. Failure to recognize indigenous worldviews and beliefs had created a crisis for allopathic healthcare which persists to this day [41, 42].

This is particularly evident among HIV/AIDS and TB patients who are reported to be abandoning western treatment in favor of indigenous remedies and practices. In most cases allopathic health practitioners are made aware of this, often at an advanced stage of treatment, when patients who have been exercising their rights to choose disclose that they are also receiving treatment from indigenous health practitioners [43–45].

Without the recognition of patients' rights and the establishment of collaborations and referrals of patients between the two systems, the postcolonial health system will remain dysfunctional and ineffective to fully respond to the needs of the indigenous communities.

### **5. Integration of the two healthcare systems**

The point of departure should be the interrogation and understanding of the existing health system which was operating in communities before colonization and globalization of their environment [46, 47]. The definition of indigenous in our context refers to the root, something natural or innate (to), a way of life, living, beliefs and practices which is an integral part of community culture. It is embedded

*Public Health in Developing Countries - Challenges and Opportunities*

intellectual ownership.

does not fit their model.

incorporating some of that into allopathic settings. Very little, if any, recognition is given to the science and philosophy of indigenous knowledge, let alone assigning

Another difference relates to the belief of what causes disease and illness. Allopathic medicine associates disease and illness with invading pathogens such as bacteria, parasites and viruses and or physiological changes. The indigenous system believes that disease and illness are caused by supernatural forces. Various explanations are offered for "why me and now" [20–22]. It can be as a result of the individual's own spiritual mishaps, provocation of ancestors by violating taboos, obligations or responsibilities or a mere "call" by ancestors to perform certain ritu-

Another aspect on which the two systems differ is on what is understood to be science. The point of departure would be on how knowledge or empiricism as a science is defined. Science as it is known from a western perspective in modern times is the accumulation of knowledge through experience/experimentation and observation, and it is stored in books or electronically [23]. In order to be educated, one has to read the books or access the information electronically. For this reason, allopathic medicine utilizes textbooks and other archived material to pass knowledge on. On the other hand, among indigenous health practitioners, knowledge is handed down, often verbally, from healer to apprentice, from one generation to the next [24, 25]. It provides the "paradigm" through which and by which they understand and interpret their environment. The entire constellation of beliefs, values, techniques, etc. is

shared by the members of a given community as health practices [12, 18, 26].

There is growing evidence that the two main health systems—indigenous and allopathic—are operating side by side in Africa [9, 30]. Depending on the country and history of colonization, allopathic health practitioners tend to be well resourced and supported by the government, while neglecting and, in some situations, suppressing indigenous health systems and its practices. At times, the lack of communication and the adversarial relationships between the two systems impact negatively on the delivery of health services to communities [31, 32]. Patients are receiving conflicting advice from their health practitioners. Treatment overdose and drug interactions are very common, and this is not surprising as the two systems have divergent worldviews of the causes of diseases; why, when and how a person becomes ill; and finally the diagnostic tools, processes and approaches to

functionality and completeness to purpose [28, 29].

The two systems have a different understanding and explanation of what constitutes a healthy individual and society and illness in the community. The allopathic health system subscribes to World Health Organization's (WHO) definition of health as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity" [27]. This definition of health is limited to an individual within the society and does not comply with the indigenous standard of health. For the indigenous communities, health is not experienced at an individual level. It is defined in terms of the completeness of society as a whole, connectedness and harmonization between the living human kingdoms/beings and their ancestors, animal kingdoms and environment. It values health as a system, similar to the human system, with different components, and each component contributes to the

als. Witchcraft and evil spells are regarded as common causes [7].

From the above table, it is evident that the two health systems display differences in their approach to knowledge and science. These differences could be explained using ontology as it evolved culturally and historically over time. The allopathic perspective is based on western science, while indigenous medicine is based on indigenous sciences. Allopathic health practitioners seem to find it difficult to accept the indigenous sciences into their "rational" scientific framework because it

**72**

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 critical of own environment [48].

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 indigenous knowledge systems of managing their patients.

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

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 the delivery of primary healthcare services.

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

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

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

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

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

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

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.

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

and suppressed through powerful legislation [4].

their understanding of health in their own particular context.

indigenous health practitioners as tutors and lecturers.

**system**
