**Abstract**

Most of the health systems in developing countries are dysfunctional and hardly responsive to the needs and demands of patients. Access to a plural healthcare system and reports of patients abandoning western medicine for indigenous medicine are signs of nonresponsive health system. The major contributing factors are the failures of the allopathic health system to recognize that indigenous medicine is a living and practised science, with its own philosophy, beliefs and practices developed over centuries. Indigenous communities and the patient's worldviews are intertwined with indigenous traditions, practices and beliefs. While the two health systems, allopathic and indigenous, coexist in Africa, they must collaborate in the management of patients. The two systems assign different etiological explanations and meanings to health, disease and illness based on worldviews, epistemologies and methodologies developed over time. Change of mindset, attitudes and practices through decolonization will lead to sustainable collaboration.

**Keywords:** indigenous health system, indigenous healers, living science, multiplicity of the epistemologies, colonization and destruction of indigenous practices, indigenous paradigms and euro-western paradigm, decolonization processes, change of mindset, attitude and practices, integration, sustainable collaborations

## **1. Overview**

*"Death is a spiritual illness to eradicate physical and biological life"*

After reading this chapter, the reader should be able to appreciate the need to interrogate the predominant Euro-western mindset, attitudes and practices, which have existed as the results of centuries of colonization. There should be a new approach which enables the reader to explore the multiplicity of epistemologies and worldviews to include the voices of the indigenous communities and its science, which tend to be referred to as witchcraft, evil and inferior practices.

The reader is challenged to critically evaluate the power and extent of the influence of Euro-western history, its culture and philosophy on practices of medicine as science and monolithic approach to the search for answers to illness and diseases. The principles of the Euro-western approach are that if you do not know it, it does not exist and if you do not understand it, it's not science and therefore should be rejected. Their tendency is that of breaking it into pieces and flattening it to fit the mindset.

At the end of the chapter, the indigenous and Euro-western paradigms are compared in terms of what counts as scientific knowledge and ways of knowing, including the respective value systems applied in research. The reader is expected to continue to search for the path which will lead to full discovery of own truth.

As for the indigenous researchers, they should be able to remove the shackles which chained them to Euro-western practices and change their mindset of being loyal followers and consumers of western developed knowledge without considering the relevance thereof in the context of time, space and place. Where the content is alien to community beliefs and practices, it should be analyzed and interpreted through the worldview of the indigenous communities.

The institutions of higher learning, and especially those entrusted with the responsibility of approving, awarding and granting permission to conduct research, should consider whether they are promoting the discovery of unreported knowledge or whether they are promoting existing but unreported indigenous knowledge. Comments and questions from members of ethics committees, such as "Which methodology are you following?" and" Is there a similar approach reported in the literature?", suggest that those members do not understand that an indigenous approach to research and to access knowledge entails a ceremony which often involves communication with ancestors, facilitated by indigenous healers.

It must be indicated from the onset that an indigenous health system consists of multiple connections which indigenous communities experience with individuals around them, the environment, living and nonliving beings and objects in a state of physical, mental and spiritual consciousness. It is the frame of reference through which indigenous communities and their healers see the world and interpret events, including the diagnosis and management of illness and misfortunes in their environment.

It further exposes the reader to the existing ignorance and misunderstanding regarding the science behind indigenous health systems and the philosophy of Ubuntu applied in the management of patients in indigenous communities.

The authors strongly advocate that an environment of professional neutrality and open-mindedness should be the premise on which negotiations for collaboration between indigenous and Euro-western health systems are conducted.

## **2. Background**

*"When the body is smarter than the brain…"*

Most of the Euro-western-based social and health sciences disciplines have inherited the logic that when they mediate and interact with indigenous communities, their disciplines constitute the gold standard [1]. This logic represents a colonial mindset of authority over and superiority to indigenous knowledge systems and is critical of any systems and science, which does not adopt or conform to their views of what constitutes science [2–4]. The sciences and philosophies of indigenous knowledge systems are labeled as witchcraft, pagan and barbaric. In the past this approach has resulted in representatives from indigenous communities to abandon their indigenous character, practices and own particular scientific reasoning and methodology [5, 6]. Where colonization to change indigenous practices failed after applying the conventional methods and means, it resorted to drastic and draconian actions such as banning it [7]. In order to survive the powers of colonialism, it appeared that those representing indigenous health systems and knowledge have adapted to "a new knowledge" and experienced their environment along the rules of a western system [8, 9].

**69**

organized [9].

ancestors [1, 9, 15].

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

*"Knowledge is acquired, without respect it's a self-imprisonment"*

Despite an increase in awareness of indigenous beliefs, forms of living and practices, the latter still get destroyed when they do not meet western standards. Destruction takes place through inquiries based on the relational realities and forms of knowing that are predominantly western, and anything not complying with this

Ways of knowing follow a particular trajectory of searching for knowledge and is influenced by how one relates to the source of knowledge and the people who own and share that knowledge. Most of our understanding of science as determined by western standards is about compartmentalizing knowledge as it is being discovered and fragmentation thereof to fit the western model while ignoring the environment in which it is to be applied. It is common for practitioners of western-based science in the process of the so-called "new discoveries" of things that have existed in indigenous communities to disregard indigenous characters and names and rename them according to western concepts. Where there is poor understanding of the indigenous sciences, the *modus operandi* would be to destroy it to prevent it from competing with western standards. As Kaptchuk and Miller [10] explains it, western science seems not to understand that indigenous sciences do not characterize ways of knowing as higher and lower knowledge. The dominant Eurocentric model of thinking and relating to items and experiences is an attempt at homogenizing

There are different categories of indigenous health practitioners in Africa. Depending on the region, most of them are also known as a traditional healers, medicine doctors [15], etc. For our readers, an indigenous health practitioner is defined as someone who is recognized by the community in which she/he lives as a competent person to provide advice on the causation of disease, misfortunes and disabilities in their community and diagnose and provide treatment for both physical, spiritual and psychological conditions in individuals and the community as a whole [14]. The calling to become an indigenous health practitioner may manifest in different ways and at different ages or times in life. Some are "called" before they are born, while others are "called" during childhood or adulthood. Some are "called" through illness, while others are "called" by experiencing persistent unnatural occurrences in their lives such as dreams and visions of departed relatives and

There are instances where the call is either not realized soon or sometimes the person ignored it [15]. If the "calling" is not obeyed, the person becomes ill or continues to suffer until he or she accepts the "calling" and enters into an apprenticeship with a more experienced indigenous health practitioner [12]. In South Africa, the process of training to become a health practitioner is called "u thwasa" [15]. The training period may range from a few weeks to months. During this period the intern/thwasana discovers his or her ancestors and means and methods in which they would communicate with and through him or her [9]. Visits by ancestors would often take place during the night, and prescriptions and directions would be provided on how and where to obtain treatment for the patients. Upon mastering the art of abiding and obedience to the ancestral spirits, a graduation function is

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

should be revised to fit the mold [9].

everything to become comprehensible [1, 11–14].

**3. Indigenous health practitioners**

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

Despite an increase in awareness of indigenous beliefs, forms of living and practices, the latter still get destroyed when they do not meet western standards. Destruction takes place through inquiries based on the relational realities and forms of knowing that are predominantly western, and anything not complying with this should be revised to fit the mold [9].

#### *"Knowledge is acquired, without respect it's a self-imprisonment"*

Ways of knowing follow a particular trajectory of searching for knowledge and is influenced by how one relates to the source of knowledge and the people who own and share that knowledge. Most of our understanding of science as determined by western standards is about compartmentalizing knowledge as it is being discovered and fragmentation thereof to fit the western model while ignoring the environment in which it is to be applied. It is common for practitioners of western-based science in the process of the so-called "new discoveries" of things that have existed in indigenous communities to disregard indigenous characters and names and rename them according to western concepts. Where there is poor understanding of the indigenous sciences, the *modus operandi* would be to destroy it to prevent it from competing with western standards. As Kaptchuk and Miller [10] explains it, western science seems not to understand that indigenous sciences do not characterize ways of knowing as higher and lower knowledge. The dominant Eurocentric model of thinking and relating to items and experiences is an attempt at homogenizing everything to become comprehensible [1, 11–14].

## **3. Indigenous health practitioners**

There are different categories of indigenous health practitioners in Africa. Depending on the region, most of them are also known as a traditional healers, medicine doctors [15], etc. For our readers, an indigenous health practitioner is defined as someone who is recognized by the community in which she/he lives as a competent person to provide advice on the causation of disease, misfortunes and disabilities in their community and diagnose and provide treatment for both physical, spiritual and psychological conditions in individuals and the community as a whole [14]. The calling to become an indigenous health practitioner may manifest in different ways and at different ages or times in life. Some are "called" before they are born, while others are "called" during childhood or adulthood. Some are "called" through illness, while others are "called" by experiencing persistent unnatural occurrences in their lives such as dreams and visions of departed relatives and ancestors [1, 9, 15].

There are instances where the call is either not realized soon or sometimes the person ignored it [15]. If the "calling" is not obeyed, the person becomes ill or continues to suffer until he or she accepts the "calling" and enters into an apprenticeship with a more experienced indigenous health practitioner [12]. In South Africa, the process of training to become a health practitioner is called "u thwasa" [15]. The training period may range from a few weeks to months. During this period the intern/thwasana discovers his or her ancestors and means and methods in which they would communicate with and through him or her [9]. Visits by ancestors would often take place during the night, and prescriptions and directions would be provided on how and where to obtain treatment for the patients. Upon mastering the art of abiding and obedience to the ancestral spirits, a graduation function is organized [9].

*Public Health in Developing Countries - Challenges and Opportunities*

through the worldview of the indigenous communities.

At the end of the chapter, the indigenous and Euro-western paradigms are compared in terms of what counts as scientific knowledge and ways of knowing, including the respective value systems applied in research. The reader is expected to

The institutions of higher learning, and especially those entrusted with the responsibility of approving, awarding and granting permission to conduct research, should consider whether they are promoting the discovery of unreported knowledge or whether they are promoting existing but unreported indigenous knowledge. Comments and questions from members of ethics committees, such as "Which methodology are you following?" and" Is there a similar approach reported in the literature?", suggest that those members do not understand that an indigenous approach to research and to access knowledge entails a ceremony which often involves communication with ancestors, facilitated by indigenous healers.

It must be indicated from the onset that an indigenous health system consists of multiple connections which indigenous communities experience with individuals around them, the environment, living and nonliving beings and objects in a state of physical, mental and spiritual consciousness. It is the frame of reference through which indigenous communities and their healers see the world and interpret events, including the diagnosis and management of illness and misfortunes in their environment. It further exposes the reader to the existing ignorance and misunderstanding regarding the science behind indigenous health systems and the philosophy of Ubuntu applied in the management of patients in indigenous communities.

The authors strongly advocate that an environment of professional neutrality and open-mindedness should be the premise on which negotiations for collabora-

Most of the Euro-western-based social and health sciences disciplines have inherited the logic that when they mediate and interact with indigenous communities, their disciplines constitute the gold standard [1]. This logic represents a colonial mindset of authority over and superiority to indigenous knowledge systems and is critical of any systems and science, which does not adopt or conform to their views of what constitutes science [2–4]. The sciences and philosophies of indigenous knowledge systems are labeled as witchcraft, pagan and barbaric. In the past this approach has resulted in representatives from indigenous communities to abandon their indigenous character, practices and own particular scientific reasoning and methodology [5, 6]. Where colonization to change indigenous practices failed after applying the conventional methods and means, it resorted to drastic and draconian actions such as banning it [7]. In order to survive the powers of colonialism, it appeared that those representing indigenous health systems and knowledge have adapted to "a new knowledge" and experienced their environment along the

tion between indigenous and Euro-western health systems are conducted.

*"When the body is smarter than the brain…"*

continue to search for the path which will lead to full discovery of own truth. As for the indigenous researchers, they should be able to remove the shackles which chained them to Euro-western practices and change their mindset of being loyal followers and consumers of western developed knowledge without considering the relevance thereof in the context of time, space and place. Where the content is alien to community beliefs and practices, it should be analyzed and interpreted

**68**

rules of a western system [8, 9].

**2. Background**

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 ancestors [9, 15].

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

#### **3.1 Diviners**

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].

## **3.2 Herbalists**

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].

#### **3.3 Traditional birth attendants**

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.

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

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

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 heal their patients [18].

**71**

*a*

**Table 1.**

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

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

Apart from a few areas of possible convergence between the two health systems,

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

it is the divergent views which have obstructed the development of sustainable collaborations between allopathic and indigenous health practitioners. Some are

**Indigenous health system Characteristics Allopathic health system**

Source of healing/who heals patients

Source of medications and treatment

Source of that knowledge

Common diagnostic process/procedure

For spiritual/psychological cases Ideal For physical entities and body

Treatment and intervention

Ancestors/God Ownership of knowledge Individual

*Evil spells are thought to be in a form of a small nocturnal animal, capable of causing insanity.*

Memory At death

Disease/illness Disease and illness are the result of

pathogens or physiological changes

God/supernatural powers in the unit

Human, library/books and learning

Investigations such as X-rays, FBC, examination, stethoscope, etc.

Biological and endogenous

cell/energy: micro level

Endogenous

Improvements/growth Training and development

Rely on memory End of knowledge

Plants, animal by-products

**practitioners and indigenous health practitioners**

themselves differ on the legitimacy of spiritual healers based on calling and supernatural sources of communication. One group of spiritual healers claim to have revelations and visions related to supernatural beings and a so-called heaven as their calling. This group also claim to communicate directly with God in the healing process and do not make use of roots and other raw plant materials to prepare traditional medicines. Instead, they use water and processed herbs to heal. However, the second group of spiritual healers claim to have visions of objects and people as their

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

calling, similar to diviners.

highlighted in **Table 1** below.

Diseases and illness are caused by supernatural forces (thuria

God/supernatural powers in human/plant system; macro level

Plants, animal by-products

Obedience to and compliance with wishes of ancestors

Biological and endogenous spiritual and exorcism

*Simplistic comparison of the two health systems.*

Ancestors/spirits/God Spirits do not forget Carried to next generation

for a reason

Endogenous

Divinations Supernatural powers ) and

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

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

themselves differ on the legitimacy of spiritual healers based on calling and supernatural sources of communication. One group of spiritual healers claim to have revelations and visions related to supernatural beings and a so-called heaven as their calling. This group also claim to communicate directly with God in the healing process and do not make use of roots and other raw plant materials to prepare traditional medicines. Instead, they use water and processed herbs to heal. However, the second group of spiritual healers claim to have visions of objects and people as their calling, similar to diviners.
