A University [UNISWA] Research Project: TENSIONS BETWEEN TRADITIONAL AND MODERN MEDICAL PRACTITIONERS, A SEARCH TOWARDS COLLABORATION

UNIVERSITY OF SWAZILAND

FACULTY OF HUMANITIES

DEPARTMENT OF THEOLOGY AND RELIGIOUS STUDIES

TITLE: TENSIONS BETWEEN TRADITIONAL AND MODERN MEDICAL PRACTITIONERS: A SEARCH TOWARDS COLLABORATION
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NAME: Mbulelo Ndlangamandla

ID NUMBER: 141083

A research project submitted to the Department of Theology and Religious Studies in a partial fulfillment of the requirement of the award of a Bachelor of Arts in Humanities

[subsahararesearch.blogspot.com]

Declaration

I ________________________ declare that this research project is my own and has not been submitted for any degree or examination in any institution.

____________________ ______________________

Signature Date

Acknowledgments

I wish to thank my supervisor Mrs. S. Nyawo, for guiding me thorough the writing of this project. I also wish to thank modern and traditional medical practitioners who willingly participated in this study. Special thanks also go to Mr. V. Simelane for introducing me to other traditional medical practitioners. My sincere gratitude also goes to the Swazi Government for providing me with the much needed financial assistance to conduct field research and then compile this research. Finally, I am indebted to my family for providing me with the much needed support and the inspiration throughout my study. [subsahararesearch.blogspot.com]

Abstract

This study explored the bases of the tensions between traditional medical practitioners (TMPs) and modern medical practitioners (MMPs) in attempt to forge a way forward towards collaboration. It was conducted with seven participants selected on the bases of their education level, type of practice, and their proximity to the researcher. It emerged from the data that tensions between TMPs and MMPs were caused by socio-religious perceptions held by the practitioners. My interpretation of the data has shown that TMPs and MMPs are more constructive to each other as independent medical systems. Further, I suggested that the proposed registration by some MMP informants could be an effective strategy to regulate the services of TMPs and MMPs.

Chapter One   
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1. Background

Traditional healing and modern medicine are important health care systems in Swaziland. Their collaboration is crucial because it can ensure an adequate and improved health care system in the country. The University of Swaziland in particular is in full support of an anticipated collaboration between both health care systems. This is attested by the UNISWA Vice-Chancellor’s report of 2011/2012, which states the mandate of the UNISWA research Centre that it is to conduct a multidisciplinary research on medical and indigenous wild edible plants (2012). The report further posits that in fulfilling the above mandate, the involvement of different stakeholders such as traditional health practitioners and scientists is critical (2012). Emeritus Prof. Makhubu, stating the urgency of the collaboration made a remark in her book Traditional medicine and healing in Swaziland that in Africa alone 80 per cent of the population is known to rely on traditional medicine for primary health care (2009). Makhubu’s statement shows that a majority of the population still has confidence in traditional healing; hence the need to allow the two types of healing practices to collaborate.

As stated above, empirical research has shown that the majority of Africans rely on traditional medicine as primary health care. An article published on the 29^th of June 2012 by the Mail & Guardian further emphasizes this importance by stating that “healers fill the Swaziland medical gap.” Put differently, traditional medicine complements modern medicine. According to Adeniji the reason traditional medicine is widely used is because it is deeply rooted in African culture and is closely intertwined with beliefs on the causes of illnesses (2001). Mbiti echoes Adeniji by saying, every village in Africa has a medicine man within reach and he is the friend of the community; he is accessible to everyone, and at almost all times (1970).

However there seems to be existing tensions between the two types of healing practices. In an article published by the Times of Swaziland on the 14^th of August 2009, Nhlavana Maseko, a renowned traditional healer is reported to have acknowledged the collaboration between traditional medical practitioners and modern medical practitioners, but accused modern medical sector of defaming traditional healing, whilst referring to the traditional practitioners as witches. The incidences quoted above therefore shows that collaboration between traditional healing and modern health care is crucial, but it has not been achieved as yet. The logical question that comes to mind is why; hence, the focus of this research.

2. Statement of the Problem

In a report about the Proceedings of the workshop on the Integration of Traditional Medicine with Conventional in the Health Delivery System in Swaziland, Maseko (2007) accused the University of Swaziland, World Health Organisation (WHO), and Ministry of Health and Social welfare of failing Traditional Medical Practitioners. Furthermore, in an article published by the Times of Swaziland on the 14^th of August 2009, He “slammed” modern medical practitioners and accused them of defaming traditional medical system. As of now, there seems to be little progress made towards collaboration between traditional medical practitioners (TMPs) and modern medical practitioners (MMPs).

The study sought to find the bases of the tensions between TMPs and MMPs, in an attempt to explore the possibility of the two medical systems collaborating.

3. Literature Review

Literature shows that scholars writing from different perspective have made some contributions on the subject of collaboration between traditional and modern medical system. Adeniji (2001), Dlamini (2006), Makhubu (2009) and Mbiti (1970) have agreed with one another that traditional healers and traditional medicine form a very important system of the African people such that it is used by a majority of the people in Africa. Makhubu echoes Mbiti and Dlamini that a large portion of the population will visit a modern health facility as well as consult traditional healers in times of sickness.

Dlamini further commends the traditional healer’s approach to illness that it is more holistic; it addresses the physical, mental, social and spiritual aspect of the individual. These are sentimentalities she shares with Mbiti and Makhubu. The approach of traditional healing has been identified by these scholars as the primary reason for its survival in the age of western scientific healing. Moreover Makhubu and Adeniji agree that traditional healing is embedded in the culture of Africans.

Makhubu and Mbiti both identify that there is stigma towards the use of traditional medicine in African emanating from the colonial period. Mbiti adds that the educated go secretly to the medicine-men or follow treatment. Makhubu and Mbiti show us a negative depiction of traditional medicine which continues to develop over the years, and they discouraged such an attitude.

The place of traditional medicine reveals to us that traditional healing is very important to the African people. Moreover, the distinctiveness of this form of medicine from modern medicine discloses that it should be preserved as it possesses some advantages when compared to the latter. The scholars also reveal to us the damaging impact posed by the negative perception of African medicine. Both health systems play a crucial role in facilitating a good health care to Swazis, but there are existing tensions which hinder progress in realising collaboration between the two. The focus of this study therefore is to explore the factors which make this much needed collaboration a pipedream in Swaziland.

4. Significance of the Study

Collaboration between traditional and modern medical systems would create an environment where by medical problems could be shared between TMPs and MMPs. A problem shared is a problem halved. TMPs could make referrals to MMPs and vice versa depending on which best deals with that particular illness. In a society stricken by the HIV pandemic, modern medical system in the country needs all the help it could get. Collaboration between traditional and modern medical system could provide that.

5. Methodology

A qualitative approach was proposed for this study because qualitative research aims to gather an in-depth understanding of human behaviour and reasons that govern such behaviour. I used a semi-structured interview guide comprising of both open and closed ended questions. The semi-structured interview guide was useful in getting mixed responses. I also conducted unstructured interviews with students from the medical health sciences; this was useful for questions that had developed during the course of the field research. I took notes during the interviews.

This study used purposive sampling method to select the sample. Purposive sampling allowed me to use a variety of criteria to take decisions concerning the individuals to be included in the sample. My sample included traditional medical practitioners, modern medical practitioners and students from the medical health sciences. They were selected from the Shiselweni and Manzini region because of their proximity with the researcher. Secondary sources were also consulted to supplement the primary data. The total number of the sample was seven.

1. Objectives

1. Discuss the current state of the collaboration between MMPs and TMPs.
2. Establish the bases of the tensions between TMPs and MMPs.
3. Discuss the strategies that can facilitate a successful collaboration between TMPs and MMPs.

7. Limitations

During the field research some practitioners agreed to give an interview, however they declined to sign the consent form. Further, the interviews took place at the workplaces of the medical practitioners, so there were constant interruptions by patients who sought medical assistance; the interviews had to be stopped and rescheduled. One TMP could not be reached for a follow up interview. Another limitation was the refusal of the use of a recording gadget by some medical practitioners while in other instances the workplaces were too noisy to record properly. A poor response to certain key questions was another limitation encountered during the data collection process. As a result of the above mentioned limitations some responses had to be excluded from study. However, follow up interviews were conducted to make up for the interruptions. Additionally, I conducted informal interviews with students from the medical health sciences to compensate for some of the above mentioned limitations.

Chapter Two  
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1. Introduction

This chapter presents data collected from the Traditional Medical Practitioners (TMPs) and Modern Medical Practitioners (MMPs). Themes have been created from the responses, to answer questions on the bases of the tensions between TMPs and MMPs. There were seven informants that responded to three different sets of questions. Secondary sources were also consulted to supplement the primary data. The following factors were considered when choosing the informant: the education level, the type of practice, and their proximity to the researcher. Informal interviews were conducted with two students in the medical health sciences who were exposed to the operations of both medical systems.

2. Profile of the informants

3. Traditional Medical Practitioners (TMPs)
   1. Collaboration between TMPs and MMPs according to TMPs

Having explained to the three informants what collaboration meant, I asked them whether it existed between TMPs and MMPs. They were representing the traditional medical system.

Vusie Simelane said that there was collaboration between TMPs and MMPs; for example through the collaboration he had since learnt that people on ARVs should not be allowed to take traditional medicine. Simelane added that he was empowered in workshops for TMPs where they were taught by medical doctors on how to better handle certain lifestyle diseases. However, Simelane shared his concern that MMPs dominated in these workshops since they did not bother asking for the input of TMPs.

Jabulani Mhlanga was somehow sceptical about the collaboration, such that he shared his fears on it. He said that the collaboration between MMPs and TMPs was dominated by MMPs who they wanted to change the way TMPs practiced, yet each TMP had his/her own way of treating patients. Mhlanga added that the collaboration was not beneficial to TMPs, because they had been stopped from using certain roots from plants that had been labelled as endangered species.

However, Mr M on a more positive note had this to say, “mine nginebudlelwane lobuhle nabo dokotela, ngoba tigulane letinabo TB ngivele ngitichubekisele kibo bodokotela, ngoba ngiyati kutsi umutsi wesilungu ngiwo lowulapha kahle tifo letinjenga leti” (I have a good working relationship with medical doctors, because I usually refer patients diagnosed with TB to them; I am aware that modern medicine can heal such illness better than traditional medicine). Mr M added that MMPs working for the Ministry of Health had also contributed on how he could better run his herbal shop, in terms of which prescriptions to make his patients.

2. Strategies for a successful collaboration according TMPs

Simelane and Mr M responded positively to the question on how best collaboration could be achieved, whilst Mhlanga remained hesitant about the intentions of the MMPs.

Mr M suggested education could go a long way in facilitating a successful collaboration. He posited that TMPs should to be educated about the aims and the benefits of the collaboration which included exposing them on new trends in healing which could only be achieved through meaningful interaction with MMPs. However, Mr M believed that TMPs, especially those in rural areas, should be given the autonomy to practice so that they would not feel threatened by MMPs and the government.

Simelane on the other hand suggested that focus on a common goal could help in easing the tensions between MMPs and TMPs. He said, “lokusebentisana kufanele kubukane netifo letifana nengculazi esikhundleni sekubukelana phasi” (our collaboration should focus on issues such as HIV instead of looking down upon each other). He further emphasised that focusing on one goal, such as addressing the issue of HIV/AIDS could help in shifting the focus from their differences and help TMPs and MMPs to be united by a common objective.

3. Bases of the tensions between TMPs and MMPs according to TMPs

Respondents raised possible causes of tensions between TMPs and MMPs which were lack of transparency, lack of support, preference of autonomy, religious beliefs, incompatibility of traditional and modern medicine and the prejudicial reports by the print media.

Mhlanga and Simelane spoke convincingly about secrecy that it had caused tensions between TMPs and MMPs. Mr M said that TMPs did not disclose the contents of their medicine to patients and to fellow TMPs. According to Mr M, MMPs have accused TMPs of being uncooperative and referring to some of them as bogus doctors because they refused to reveal the contents of their medicines.

Simelane justified secrecy in traditional medical system by saying, “kulapha ngemutsi wesitfu kuhlukile kunekulapha ngemutsi wasesibhedlela; kufaka ekhatsi emadloti; manje akusiko konkhe lokufaka emadloti lokungakhishelwa ebaleni” (healing in traditional medicine is different from healing with hospital medicine; it involves the ancestors; it is not everything that involves the ancestors that one can disclose). Simelane lamented that MMPs did not understand traditional medical system and mistook the lack of transparency for lack of knowledge of traditional medicine.

Dr Nhlavana Maseko was also quoted admitting that there was lack of transparency in traditional medical system. Maseko (2007) explained that the fear of neglect always led to secrecy – only equal partnership could lead to a good working relationship. Maseko (2007) put the blame on MMPs for neglecting and being uncooperative with traditional healers.

Mr M and Simelane cited the lack of support for traditional medical system by MMPs and the Ministry of health as another cause for the tensions. Simelane said that TMPs were not supported in Swaziland like in other countries; the Ministry of Health only got involved when it wanted TMPs to stop them from using roots from certain protected trees. Simelane added that the lack of support for TMPs had caused tensions between TMPs and MMPs because it seemed that MMPs were supplied with all the medicine they needed by the government, yet the same government was trying to take from them the little source of medicine they had.

Mr M added this observation, “ngicabanga sizatfu natsi kutsi sitfola kusitakala lokuncane kutsi sitfolakala emadolobheni ngoba tinyanga letitfolakala emakhaya atikutfoli kunakekeleka” (I think that the reason we get the limited support from the government is because we are located in the city; TMPs in rural areas are not taken care of). However, Mr M lamented that they were no longer allowed to sell roots from trees that had been labelled as protected by the Ministry of Tourism and Environmental Affairs.

The tensions between TMPs and MMPs were further confirmed by Maseko (2007) who posited “TMPs received no support from, and were deceived when they approached by the University of Swaziland, World Health Organisation (WHO) and the Ministry of Health and Social Welfare.” He further criticized MMPs for attempting to take control of the collaboration. According to Maseko “the University of Swaziland, WHO and the Ministry of Health and Social Welfare have failed the traditional healers.”

Mr M posited that TMPs would like to practice autonomously whilst MMPs wanted an integration of traditional medical health system with modern medical system and this was causing tension between TMPs and MMPs. According to Mr M, recent events suggested that MMPs preferred integration of traditional medical system with modern medical system. Mr M was echoed by Simelane and Mhlanga.

Elaborating on the tensions between TMPs and MMPs traditional medical system Mr M asserted that traditional healers have various specialities and their approach in healing differed from each other. Their fear of the collaboration stemmed from that TMPs would be intimidated by MMPs and would no longer be able to heal patients as they usually did. Mhlanga and Simelane spoke persuasively that TMPs needed their freedom to practice, not be controlled and dictated to by MMPs on how to conduct their practice.

In Maseko (2007), such concerns were raised when the president of traditional healers association expressed in a workshop report titled Proceedings of the Workshop on the Integration of Traditional Medicine with Conventional Medicine in the Health Delivery System in Swaziland held on 4^th April 2007. Maseko (2007) argued “the integration of traditional medicine with modern medicine is not acceptable to traditional healers.” He posited that TMPs under normal circumstances could prefer collaboration, but they were unfortunately deceived by MMPs into what seemed like collaboration. On this matter Prof. Emeritus Makhubu (2009) added that TMPs have long opposed the idea of integration, preferring collaboration instead.

Religious beliefs were raised by Mhlanga and Simelane as another cause of the tensions between TMPs and MMPs. Simelane said that the problem was that most TMPs were born-again Christians they had misconception that Christianity was against the use traditional medicine. He further revealed that he was a Jericho pastor, yet he also practiced traditional healing.

Contrary to Simelane and Mhlanga’s views, Mr M argued that Christianity did not have any influence in people’s decision to despise traditional medicine. He made example of himself that he was a Christian and yet he used traditional medicine. Mr M claimed that Christians did not despise traditional medicine; however they were against traditional medicine on which divination had been performed on.

The incompatibility of traditional and modern medicine was identified by the TMPs as another cause of the tensions between traditional and modern medicine. Mr M and Simelane pointed out that in some cases traditional and modern medicines were not compatible. Conversely, Mhlanga also found the incompatibility.

Mr M claimed that most TMPs were aware of the complications of mixing modern and traditional medicine together, that was why they did not allow their patients to be injected while taking traditional medicine. Mr M added that some traditional and modern medicine worked against each other, which worsened an illness. MMPs have revealed TMPs who refused their patients to be injected made their work difficult and were a threat to the lives of the patients.

According to Simelane some traditional and modern medicines worked against each other; nonetheless some TMPs ignored this and caused harm to their patients. Simelane commented that in this era of HIV/AIDS one could not expect patients who were HIV positive to use traditional medicine even on illnesses that could be better cured by traditional medicine. He claimed that TMPs who had ignored this had created a rift between TMPs and MMPs.

Mr M also pointed out that disease such as libhande (herpes zoster) which was linked to HIV infection was better cured with traditional medicine. However, he added that this was no longer possible since ARV drugs worked against traditional medicine. Mr M added that some TMPs were either unaware or ignored these facts, and this had led to tensions between TMPs and MMPs.

Only Mr M identified print media as one factor that exacerbated tension between TMPs and MMPs. Mr M pointed out that the print media only showed the negative side of traditional medical system. Mr M observed that MMPs would cite these publicized deaths in their arguments against traditional medicine. In his words, he said “indlela labaveta ngayo umutsi wesintfu ayisilo liciniso; tiwasho atisuye umutsi wesintfu, netintfo letifakwa kiwo atifani; kepha emaphepheni kuvele kutsiwe umutsi wesintfu ubulele bantfu” (the portrayal of traditional medicine is incorrect; concoctions (tiwasho) are not the same thing as traditional medicine; even the ingredients differ, however the print media claim that traditional medicine kills people). Mhlanga and Simelane on the other hand expressed that they did not follow news in the print media.

4. Modern Medical Practitioners
   1. Collaboration between TMPs and MMPs according to MMPs

Two modern medical practitioners were asked if there was collaboration between modern and traditional medical systems; it was Calsina and Ntombi. These were nurses that have practiced for more than 30 years in the medical field.

Calsina argued that there was no collaboration between MMPs and TMPs. In her view, “kute kube khona kusebentisana, tinyanga kudzinga tibhaliswe njengoba natsi (bonesi) sibhalisiwe” (in order for collaboration to take place, TMPs would have to be registered first as we (nurses) are registered). She further advanced that TMPs rarely referred their patients to clinics until they were very ill and required extensive care.

Ntombi echoed Calsina by saying that there was no collaboration between TMPs and MMPs. She posited that this could be seen during workshops that most of the people present were MMPs. TMPs therefore seemed to be less interested in working with MMPs. Ntombi and Calsina pointed out that TMPs were very secretive with the contents of their medicine and its side-effects, hence their unwillingness to work with MMPs.

2. Strategies for a successful collaboration according MMPs

The two informants proposed strategies that would facilitate a successful collaboration between TMPs and MMPs.

Ntombi pointed out that education for both TMPs and MMPs was necessary to facilitate a successful collaboration. She said that there should be training of MMPs in order for them to understand the traditional medical system. Furthermore, medical universities and colleges should also offer courses especially on collaboration between traditional and modern medicine. She further posited that it was now a difficult subject to understand because she was had been practicing for years without collaborating with TMPs. Ntombi also shared that there should also be training for TMPs who still used conservative approaches in healing. Calsina added that there should be a standardized training period for TMPs because lately some TMPs no longer went through the training process which used to be obligatory in the past.

Calsina argued that in order for the collaboration to be success there should be a registration of TMPs and integration of traditional medical system. Calsina posited “lokumele kwenteke kutsi tonkhe tinyanga tibhaliswe nguhulumende njengoba natsi (bonesi) sabhalisa; loku kungasita sigweme naba bemanga” (what needs to happen is that all TMPs should be registered by the government as we (nurses) are registered; this can help us avoid bogus doctors). Calsina argued that currently TMPs followed no rules; if they could be integrated they would work well together because they would be under the same operational guidelines. Calsina insisted that there should be integration and not just collaboration between traditional and modern medical systems. She pointed out that it would only be through integration of traditional medical system that MMPs could have confidence in all TMPs.

2. Bases of the tensions according to MMPs

Respondents raised possible causes of tensions between TMPs and MMPs. They were the lack of transparency, questionable credibility of TMPs, incompatibility of traditional and modern medicine and incorrect diagnosis for diseases.

According to Ntombi the secrecy of TMPs was a major cause to the tensions between TMPs and MMPs. She commented, “tinyanga tiyafihla kakhulu, abafuni kuveta kutsi imitsi yabo ifakwe ini, loku kwenta singakhoni kusebentisana nabo ngoba lemitsi yabo bese igulisa bantfu” (TMPs are secretive, they refuse to reveal the contents of their medicine; this makes any attempt to collaborate with them very difficult, because their medicine makes people ill). Calsina Dlamini also said that in this current condition collaboration was impossible. She added that the repercussion of lack of transparency on the part TMPs would be a multiplication of fake traditional medicine.

Dr Priscilla Dlamini (2002), in a report titled, Research Board Report Series: Facilitating Collaboration between Traditional Healers and Western Trained Health care workers in managing illness in Swaziland, posited “due to the lack of transparency, there was a danger of combining both traditional and modern medicine which has the same effect and hence resulting in unwanted reaction as well as over dosage and exaggerated side effects without the awareness of the other health care worker.”

Calsina echoed Ntombi by saying that traditional medical system was vulnerable to bogus traditional doctors such that MMPs were now distrustful of all TMPs. Calsina shared, “kulamalanga awusati kutsi inyanga mbamba nguyiphi longasiyo nguyiphi” (these days MMPs are never sure who is a real TMP is and who is not). She further claimed that TMPs that healed in the past were more effective than those that were healing nowadays. She stated that in the past TMPs used to specialise on certain illnesses; unlike nowadays where they claim to cure every illness.

Ntombi further claimed that the questionable credibility of traditional healers was another cause to the tensions between TMPs and MMPs; thus MMPs treating all TMPs with suspicion. Ntombi and Calsina were concerned that the bogus traditional doctors tarnished the image of the whole traditional medical system, and collaboration therefore was the only way to weed out these bogus traditional healers from the medical system. Furthermore TMPs should be screened and be obligated to have licenses, in order to better regulate the medical services in the country.

Calsina and Ntombi also observed that there tensions were also as a result by reports by patients who noticed side-effects of using traditional and modern medicine simultaneously. Ntombi said “kuke kwenteka kutsi tigulane tibuye tibika kutsi tikhukhumuka tisu umabasebentisa umutsi wesilungu newesintfu sikhatsi sinye” (I have experienced situations where by patients have reported the swelling of the stomach when they have used traditional and modern medicine simultaneously). According to Calsina and Ntombi the incompatibility of traditional and modern medicine had forced them to discourage their patients from taking traditional medicine and this had not been well received by some TMPs and other members of the public.

Ntombi said that some patients refused injections on their TMPs’ advice. Ntombi argued that this made their work difficult because in modern medical system injections were essential for curing certain illnesses. She added that this meant that certain known illnesses could no longer be cured successfully. Ntombi confirmed that this created a rift between MMPs and TMPs.

Incorrect diagnosis by TMPs had led to tensions between TMPs and MMPs according to Calsina. She posited that TMPs misinformed their patients that they had sidliso (chest pains) when in fact it was either TB or ulcers. Calsina further posited that illnesses such as TB needed to be treated in the early stages; however due to incorrect diagnosis by some TMPs this was very difficult.

Dlamini (2002) revealed that the intolerance of MMPs towards TMPs caused the tensions them. Dlamini quoted an MMP who argued, “I do not want to collaborate with traditional healers because I believe they do not know what they are doing. I feel we, western trained practitioners are able to diagnose and treat illnesses, so we do not need them. Traditional healers make cuts on the body and put in dirty staffs which caused infection on a diabetic patient.” Ntombi echoed the same as Dlamini about other MMPs by saying that some MMPs were intolerant even towards each other, consequently unwelcoming to collaboration with TMPs as well.

5. Health Science Students

5.1 Bases of the tensions according to health science students

Through informal interviews, two students from the medical health sciences raised possible causes of bases of the tensions between TMPs and MMPs. According to Simanga and Mzwandile they were the difference in approach, and the portrayal of traditional medicine by the print media.

According to Mzwandile the print media had published biased reports about TMPs in recent times. He asserted, “The newspapers have published stories of ritual killings and harmful medicines all involving traditional healers; as a result western trained healers and the public at large have developed a negative attitude towards traditional healers and traditional medicine.” Furthermore, he noted that one could hardly find positive reports about TMPs; therefore MMPs who read these reports would not see a reason to collaborate with badly portrayed TMPs.

Simanga and Mzwandile both noted the difference in approach as another cause to the tensions. Simanga posited, “bodokotela netinyanga balapha ngetindlela letihlukile; kute dokotela akulaphe ucale abuke emabhuku akho kutsi uke watsatsa umutsi lonjani wakuphatsa njani, kani tinyanga tiyaphengule tikunike umutsi” (MMPs and TMPs have a different approach to curing diseases; in order for a doctor to attend to your illness he first checks your previous health records to determine which medicine you have used and your reaction to that particular medicine, whilst TMPs perform a divination and then give you your medication). Simanga added that the approach by TMPs could cause complications since patients were at risk of mixing medicine that reacted negatively together.

5.2 Strategies for a successful collaboration

Mzwandile and Simanga stressed the importance of education for both TMPs and MMPs as a strategy for successful collaboration. Zwandile posited that MMPs needed to be educated about the approaches of TMPs. Further he argued that MMPs should be in a position to know what was negotiable to change and what was not in traditional medical system. Simanga had this to say about the importance of education in the collaboration, “tinyanga kumele tifundziseke ngebumcoka bekushitja indlela lekulashwa ngayo, nabo bodokotela abalaphi ngendlela bebalapha ngayo kadzeni; incubekela phambili imcoka ekulapheni” (TMPs need to be educated about the importance of change in healing approaches, even modern healing has evolved over the years, MMPs do not cure diseases the same way they did in the past; progress in medical health is important).

Chapter Three  
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6. Discussion

This study aimed at assessing the bases of the tensions between TMPs and MMPs and strategies which could aid in facilitating a successful collaboration. As mentioned in the literature review there is a negative perception of traditional medicine in the modern African society. The current study found that according to TMPs there was to certain extent collaboration between TMPs and MMPs. TMPs lamented that in most instances MMPs did not value their opinions. Another major grievance by TMPs was that MMPs with the help of the Ministry of Tourism and Environmental Affairs have barred them from using herbs from certain trees that have been labelled as endangered. On the other hand MMPs posited that there would be no collaboration between TMPs and MMPs unless TMPs met certain requirements. TMPs and MMPs are not content with the current state of the collaboration; this further emphasises the necessity of addressing the tensions before attempting collaboration.

This study has established tensions between TMPs and MMPs which informants attributed to the lack of transparency by TMPs, lack of support for TMPs, preference of autonomy by TMPs, religious beliefs of MMPs, incompatibility of traditional, modern medicine and the prejudicial reports by the print media, questionable credibility of TMPs, incompatibility of traditional and modern medicine and incorrect diagnosis for diseases by TMPs. Some responses by TMPs and MMPs on the bases of tensions between MMPs and MMPs overlap whilst others are unique to each group. These tensions are an impediment to any meaningful collaboration; hence the importance to address these tensions before an attempting to collaborate. The results of this study indicate that MMPs prefer integration of traditional medical system than collaboration whilst TMPs preferred the latter.

However, existing literature has shown that integration of these two systems is not practical. According to Staugard, (1985) the system of modern and traditional medicine appear, to some extent, to be incompatible, making efforts to integrate them in a comprehensive health care sector deleterious to both. As indicated in the literature review, traditional and modern medical systems have different approach to curing illnesses, so they are more beneficial to each other as independent medical systems. However, integration instead of collaboration may affect this approach by traditional medicine. As Makhubu (2009) puts it, collaboration, rather than integration, is a more useful starting point.

Having established the bases of the tensions the study then explored strategies that could facilitate a successful collaboration. Among the propositions were: integration of traditional and modern medical system, equal recognition of TMPs in the collaboration and the registration of TMPs to the relevant health association bodies in the country. In my view, the integration of traditional medicine is not practical due to the distinctiveness of each medical system. However, the proposed registration by some MMP informants could be an effective strategy to regulate the services of both TMPs and MMPs. Further this proposed registration could also be effective in reducing bogus traditional doctors that tarnish the image of the traditional medical system.

1. Summary

This study has shown that TMPs and MMPs would like to see a successful collaboration between traditional and modern medical system. It was also shown that there were complications between the two medical systems in the attempt to forge collaboration. Both TMPs and MMPs raised the bases of the tensions between traditional and modern medical system. Further, MMPs, TMPs and Students in the medical health sciences suggested strategies on how this collaboration can be successful.

2. Conclusion

This paper has given an account of and the bases for tensions that have hindered progress in the collaboration between traditional and modern medical systems. It has argued that the tensions existed before the collaboration was proposed. Further it argued that TMPs and MMPs currently do not have a good relationship. However, the study was able to demonstrate that both TMPs and MMPs want the collaboration since a majority proposed strategies that may facilitate a successful collaboration.

Reference

Adeniji K. O. (2001), Traditional medicine and pharmacopoeia: contribution to ethno botanical and floristic studies in Swaziland, Lagos: Organization of African Unity, Scientific, Technical & Research Commission

  Dlamini Priscilla S. (2002), Facilitating collaboration between traditional healers and the Western trained health care workers in the management of illnesses in Swaziland, Kwaluseni: University of Swaziland

Makhubu Lydia P. (2009), Traditional medicine and healing in Swaziland, Kwaluseni: University of Swaziland

Maseko N. (2007), integration of conventional and traditional medicine: A Traditional Medical Practitioners perspective. In Amusan O. O. G. (Ed.), Proceeding of workshop on integration of traditional medicine with conventional medicine in the health delivery Systems in Swaziland Held 4^th April, University of Swaziland, Kwaluseni, Swaziland.

  Mbiti John S. (1990), African Religions and Philosophy, Oxford: Heinemann

Times of Swaziland, 85% of Swazis consult tinyanga - Nhlavana, 14^th August 2009

Mail & Guardian, healers fill the Swaziland medical gap, 29^th June 2012

UNISWA Vice-Chancellor’s report of 2011/2012 (2012) Kwaluseni: The Cooperate Affairs office

Appendix A

INFORMED CONSENT FORM

University of Swaziland

Department of Theology & Religious Studies

The purpose of this form is to explain the nature of the study so that you may have necessary information for agreeing to participate in it willingly. All aspects of your participation in the study are described below. If after reading this form, you have any questions or concerns, please discuss them with Mrs. S. Nyawo the supervisor of this project whose name and contact details appear at the end of this form. Once you are entirely satisfied with this explanation and freely consent to participate in this study, you may indicate your willingness to participate by signing in the space provided below.

Request for your participation in the Study

You are invited to participate in a research project I am conducting as an individual academic piece of work under the department of theology & religious studies at the University of Swaziland. This study seeks to examine the bases of the tensions between traditional and modern medical practitioners.

Purpose of the Study

This study seeks to examine the bases of the tensions between traditional and modern medical practitioners.

Your Involvement in the Study

You have been identified as part of the subject population. As such, you are requested to be one of my interviewees. I request an in depth oral interview with you at a location of your choice and at a time you will agree on.

Interview/ Data Gathering Procedures

I will write down your responses and also record them on tape.

Benefits and Risks of the Study

There is no material benefit that you will receive for participating in the study. It is expected that the results of the study will shed light to the society on the bases of the tensions between traditional and modern medical practitioners and the strategies which can facilitate a successful collaboration. There is no predictable risk of physical injury associated with your participation in the study.

Consent Statement

I understand the explanation provided in this form about the study I am being asked to participate in. in light of this, I voluntarily agree to participate in the study. I have been given a copy of the consent form which I have signed and will keep.

Signature & contact number

Date

Researcher’s Signature

Name of Supervisor

Mrs S. Nyawo

Signature:

Contact Details

Tel: (00268) 25170217

Fax: (00269) 25184391

Mobile: 76125593

E-mail: snyawo@uniswa.sz

Appendix B

Research Questions

A. BIOGRAHICAL INFROMATION

1. Name of Participant :

2. Age :

3. Occupation :

4. Profession Certification :

5. Work area :

6. Years Active in the Field :

7. Education Level :

B. Traditional medical practitioners’ Questions

1. What is your view about the use of modern medicine?
2. Why are some patients advised not to take modern medicine while they are being treated with traditional medicine? Do you think that Traditional and Modern medicine can collaborate while there is the problem of incompatibility?
3. Is there a way for Traditional and Modern medical system work together successfully?
4. What has caused to the tarnished image of Traditional medical system?
5. In what way has religion been a factor in the tensions between Traditional and Modern medical system?

Modern medical practitioners’ Questions

1. What is your opinion about the use of Traditional medicine in the age of modern medicine?
2. What is the cause for tensions between Traditional and modern medical practitioners?
3. How can the tensions between TMPs and MMPs be ironed out?
4. How will integration of traditional medical system and modern medical system improve relations?
5. Do you think that a successful collaboration between Traditional and Modern medical system is possible? How?

Health Sciences students (informal interviews)

1. What do you think is the cause of the tensions between Traditional and Modern medical practitioners?
2. In your opinion is traditional medicine still relevant in our modern era?
3. How can these tensions be address in order to facilitate a successful collaboration?

Appendix C

Overall interviews Date of Interviews Duration

Nelson Mr M                        31-01-2014                                   1hr 25min

Ntombi -                               21-01-2014                                          55min

Calsina Dlamini                    27-01-2014                                  1hr 10min

Vusi Simelane                      26-01-2014                                          45min

Jabulani Mhlanga                 28-01-2014                                          30min

(Informal Interviews)                Date of interview Duration

Mzwandile Simelane                               03-02-2014 

Simanga -                                                03-02-2014              25min