Thokozani Xaba

The collision of African political, economic, social, religious and cultural practices with modern civilisation has had an overwhelming and lasting impact on Africans. Within a short period of time, Africans were transformed from being peasants living on the produce of the land and their cattle by being forcibly incorporated into a universalistic, 'mono-economic' and 'mono-cultural' 'world economic system'. Together with such economic changes, their lives went through political, social and cultural transformations through which the cultural, social, economic and political practices and institutions were suppressed and marginalised.

This chapter is about the socio-cultural impact of the marginalisation of African medical practices. It argues that modern development, which is intolerant of competing points of view, sought to change or supplant indigenous medical beliefs and practices with modern ones. Consequently, Africans find themselves constantly destabilised and the benefits derived from the holistic approach and the egalitarian nature of indigenous medicines are not being realised. Instead, Africans are subjected to modern practices among which are the invasive techniques of 'scientific' medicines.

The chapter also argues that, while some proponents of moderns civilisation believed and practised it like a religion and their dogmatism blinded them to the value of indigenous practices, others were motivated by economic competition which spurred them to remove any form of competition emanating from indigenous practices. Among the historical bastions of development were political institutions represented by the state, the religious institutions represented by missionaries, and the medical and pharmaceutical institutions representing 'scientific' medicine.

The argument in this chapter flows out in five sections. The first section provides the theoretical trajectory of the arguments for and against development. The second section discuses the 'ideal typical' African indigenous medical practices that had evolved before the advent of colonialism. The third section shows how African indigenous medical systems were undermined, circumscribed, and prevented. The fourth section addresses the consequences of the disruption and restrictions on indigenous medical practices. The last section is the conclusion.

1. Development and Its Malcontents

This chapter looks at 'development' as a descendent of what has been referred to as 'modern civilisation'. 'Modern' in 'modern civilisation' refers to the epistemological foundation of the worldview that is considered as 'scientific'. The concept 'development' has been (and continues to be) a bone of contention and has metamorphosed from colonialism/imperialism, modernisation or civilisation, development/underdevelopment/dependent development to globalisation. However, it remains that 'development' still largely refers to the 'westernisation' of the world. That is, making the rest of the world conform to the economic, socio-cultural and political norms that have developed in the 'west'.

The advocates of this view and their followers saw colonialism as a catalyst to bringing the advantages of development to people in other parts of the world (the 'South'). They identified the economic, political, cultural, religious and social institutions of the people in the 'South' as a stumbling block to the potential progress realised in the 'North' (Hoselitz, 1960; McClelland, 1960; Inkeles and Smith, 1974). They prescribed ways and means to manipulate, alter and destroy those institutions and aspects of the 'South' that blocked progress to development (Huntington, 1968; Parsons, 1951). In pursuing such a project, they did not always agree among themselves. However, originating from people who held similar beliefs regarding the appropriateness of propagating the advantages of development, the critiques were meant to strengthen the argument for the proliferation of the practices, values and institutions of development.

There were various detractors to the promise and the strategy of development. One set of opponents of modern civilisation rejected the superiority of 'modern' values and institutions implied in the propagation efforts. They renounced the claims of progress and popular welfare implied in neo-classical economics (Hobsbawm, 1963; Scott, 1976) and politics (Myrdal, 1968) as well as the displacement of traditional behaviour and practices and their replacement with practices based on 'rational' individualism (Hirschman, 1965). They, instead, tried to uncover the rationality of the behaviour and institutions of the people in the 'South' (Scott, 1976; Popkin, 1979).

The more radical critics identified the state as an arena of conflict that reflects power relations in society and not as a custodian of popular welfare or a representative of the democratic sentiments (Baran, 1952; Frank, 1967; and Cardoso, 1972). They argued that the causes of such conditions were not unrelated to the relations of the 'centre' and the 'periphery'. This group considers alienation, resistance and protest in the 'South' as an expression of the loss of control by ordinary people as opposed to the dominant groups (especially, ordinary people's relation to technology and the organisation of work and life). This argument is best represented by the writers of the Frankfurt School (e.g. Marcuse, 1964 and Habermas, 1984).

Writers in the 'South' and their supporters highlight the role of culture in development. They argue that the 'scientific' proclivity of modern civilisation leads to the technocratisation of society that not only does not serve popular interests but is inimical to them (Parekh, 1989; Verhelst, 1987; Nandy, 1987; Marglin, 1990; Nandy and Visvanathan, 1990). Gandhi decries the mechanisation that was followed by technological inventions which turned humans "into helpless and passive victims of its inexorable momentum" (Parekh, 1989:23). The social, cultural and natural environmental deterioration is blamed on the bureaucratisation of society that removes decisions from ordinary people and vests them on the bureaucratic institutions of the state. Consequently, Gandhi continues,

Modern man has become abstract and empty, he is not internally or organically related to others and his relations with them were not grounded in the sentiments of fellow feeling and good will ... Morality has been distorted, other people matter not because one cares for them but because the laws demand it, rather than a fulfillment of man's nature, morality is seen as a necessary but painful restriction on freedom, morality has been reduced to its barest minimum i.e. the need to prevent people from destroying one another ... A society of unrelated beings gets dominated by fear, hostility and tension ... Modern man spends most of his time trying to steady himself in a hostile and unsteady environment. He lives outside himself and exhausts himself physically and spiritually ... The exploitation of others was built into the foundation of modern civilisation ... That is why modern civilisation rests on and is protected by massive violence (against others, animals and the environment) (Parekh, 1989: 23, 24, 25)

While Gandhi throws light on the consequences of the technocratisation of society, Banuri (1990) maintains that the development of the "South' has been disadvantageous

not because of bad policy advice or malicious intent of advisers, nor because of the disregard of neo-classical wisdom, but rather because the project has constantly forced indigenous people to divert their energies from the positive pursuit of indigenously defined social change, to the negative goal of resisting cultural, political, and economic domination by the West [emphasis in original]

He continues to insist that, to improve the welfare in the 'South', the West should stop imposing measures of 'development' (such as 'quality of life' indices) because such measures "disenfranchise people," "make it unnecessary for their opinion to be sought," and "make it impossible for them to change their preferences in the face of manifest problems". He insists that the right to define welfare and progress should be "unconditionally restored to indigenous people." Along the same lines Verhelst (1987) insists that "poor people have a right to be poor" (i.e. to remain outside the 'world system' which oppresses them). Banuri is, however, under no illusion that the people in the 'South' will necessarily succeed where development professionals have failed and maintains that "unlike the latter, they will learn from their mistakes and they will adjust their behaviour, instead of continually trying to rationalize their errors, or to justify their actions, their privileges, and their right to intervene."

This paper is interested in that process of 'disenfranchisement' that forced Africans to abandon what was useful in the indigenous cultural and medical systems for the products of 'scientific' medicine. It argues that the universalising process of development in South African disembedded Africans from their epistemological foundations. Consequently, the dis-centred Africans have lost and are losing some of the essential qualities of their cultural practices. One such cultural practice is a holistic view of health and illness as well as the causes and cures of illnesses. The 'scientific' medicine, which has been imposed on them, instead, does not only ignore the remedies of indigenous medicines and practices but also seeks their suppression. Therefore, some of such remedies have been lost and are increasingly diminishing among the compendium of medicines consulted by Africans when they face "manifest (medical) problems." Consequently, the advantages of a holistic, non-invasive and egalitarian medical system are being systematically undermined. Also, as a consequence, the possible benefits of the co-operation between indigenous medical practitioners and practitioners of 'scientific' medicine remain unrealised.

The paper also maintains that 'scientific' medicine has not achieved its elevated position because of its superior powers but because of the power of the state to proscribe and marginalise indigenous medicines and practices as well as the dominant position of those who espouse modern ideas of health and progress. There is a tendency among the critics of development to always impute ideological interests to its proponents. However, in South Africa, many of the zealous proponents of 'scientific' medicine are spurred by the threat to their pecuniary interests. Such interests are presented in the ideology of modern civilisation that does not accommodate other points of view.

 

2. Indigenous African Systems of Healing

Long before the advent of Europeans on the African landscape, Africans had developed 'medical systems' which they used in prevention and cure of diseases and illnesses. Those medical systems were founded on the archeology and epistemology of African religions. In such religions, a person is more than the body that stands in front of you but the personification of past, present and future relations between the living and the dead. As such, those types of ailments and suffering which seem to have no evident cause and defy recognised forms of relief are considered to originate from fractures in relations between the living or between the living and the dead or the spirit world. Accordingly, the solutions for such suffering should emerge from the restoration of the status quo ante.

The system of medical knowledge that evolved was egalitarian and not all the preserve of specialists. As part of this system, the average person and household were exposed to general medical knowledge that enabled them to keep healthy and to cure minor ailments. Each household had a designated 'medicine men' who looked after the health of the family. When the family's 'medicine men' was not successful, the patient was referred to the professional medicine men. The practice of having a 'medicine men' in each household ensured that medical knowledge and skills were widely available. The ready availability of medicines in plants and animals ensured the egalitarian nature of the system.

When the illness was considered to be more than just a body ailment and when the cause of the ailment seemed to have no understandable material cause, a sangoma (diviner) and inyanga (herbalist) were consulted. Steeped in the understandings of African cosmology and cosmogony as well as in the epistemology of African religion, izangoma and izinyanga practiced a holistic approach to medical treatment. The sangoma would identify the origins and causes of the ailments or sickness, would advise the family of the causes of the ailment and the necessary rites that had to be fulfilled, if any, and would then refer the ailing person to a medicine man who would help him or her. In the event that the solution to the ailment or suffering lay in the performance of certain rites, a designated person or the sangoma herself or himself could assist the person or the family in the performance of such rites.

In the event that the suffering required the interventions of inyanga, a sangoma would refer the person to a qualified inyanga who would provide him or her with the necessary medicines to cure the ailment. As part of their arsenal against ailments, izinyanga produced medicines from various types of plants, roots, and animals as well as mixtures of such plants and animal products. Izinyanga were assisted by their students in the procurement, preparation and administration of medicines. Such assistance was part of the students' education that was understood to take anytime between 10 years and a lifetime (Gumede, 1990: 154)

The causes of suffering that izangoma and izinyanga were consulted for ranged from abathakathi (wizards and witches), izigigaba (calamities or catastrophes), izimila (swellings and tumours), imikhuhlane (colds), izishayo (visitations), imimoya emibi (wanton spirits) to abaphansi (ancestral spirits) (Gumede, 1990: 43-47). There were specialists for the various kinds of ailments from which Africans suffered. (Ngubane, 1977: 105-106).

Izinyanga and izangoma treated their patients as in and out patients. The in-patient came to live with the indigenous healer at his or her home. Often, a relative accompanied the sick person and stayed with them at the healer's lodge until the sick person got well (Ngubane, 1977:106) The presence of a relative during treatment provided emotional and psychological support to the sick person. The outpatients travelled between their home and the healers residence or place of practice.

When izangoma were banned through various Anti-Witchcraft Acts (discussed below), the need for divination and healing did not suddenly disappear. Some of the work done by izangoma was taken over by abathandazi (Christian diviners) who, because they were a new phenomenon and largely unknown, could function under the cover of church garments. Abathandazi function in that liminal space between izangoma and Christian religious healers or mediums. Their knowledge is informed by (and balances) both African and Christian epistemology and cosmology. Their methods of intervention range from prayer, using the name of Jesu (Jesus) or Mariya (Jesus' mother), to the use of blessed water and other objects as well as the use of indigenous medicines.

Most notable among abathandazi are Mr Isaiah Shembe, the 1911 founder of Isonto LamaNazaretha (the Nazareth Church) who became an eminent religious leader, prophet and prolific religious song-writer, as well as Mr Maphithini Thusi (a child of isangoma (Gumede, 1990: 192) who founded the eMakhehleni Church (in the 1930s) which adopts the Zulu code of living and social structure). There were many other abathandazi who worked during the times of Prophet Shembe and Prophet Thusi and there have been many others since then. Those who became successful started their own African Independent Churches such as African Faith Mission, African Free Bapedi Church, African Native Ndebele Church, African St. John Baptising Church, The New Jerusalem Church, and various other Zionist and Ethiopian churches. Many others did not start any churches but service the public from their own houses and even from the backyards of their rented houses.

Unlike 'scientific' medicine that requires a person to hand over the custody of their body to the experts to do what they like with it such that the patient learns nothing from his or her ailments, develops them again, and is treated the same way (Parekh, 1989:27 and Jarret-Kerr, 1960:36-37), the methods of treatment of indigenous medicines are less invasive and have greater advantages for the patient. Their advantage is that they assist people to "acquire a greater understanding and control of their bodies by explaining to them the causes and aetiology of their ailments, how to prevent them and how they (are) integrally related to their way of life" (Parekh, 1989: 26-27) and they activated and energised the body's internal rhythms, resources and built-in intelligence necessary for self-protection and healing. Scientific medicine, on the other hand does not

The system of indigenous medicine that had developed prior to the arrival of Europeans on the African landscape had three main characteristics. It had a holistic approach to health and illness. Its egalitarian nature ensured that the medicines were readily available and the knowledge was not only the preserve of specialists. Its methods of treatment were non-invasive and relied on the participation of patients in the healing process.

That system of healing was affected by the challenges to African culture and beliefs that were systematically introduced through labour, education, conversion and the administration of African affairs by the state. This is the point to which we now turn.

The marginalisation of African religions, customs and practices was methodical and was infused through the 'Trojan Horses' of labour, Christianity, missionary education and the roles the state as well as the medical and pharmaceutical establishments played. In reality, these four processes were not always in harmony with one another. In fact, at times, colonisers and missionaries found themselves on opposite sides of important issues. However, what united them was the zeal to 'develop' Africans (i.e. to change not only the manner in which Africans lived and behaved but also the way the looked). These four issues are considered separately here for analytical reasons. Together, they reveal that, in order to disembed Africans from their epistemological anchor and to entrench modern civilisation, the integrity of African ideas of civilisation, culture and morality had to be discredited and destroyed.

Africans were distanced from their religion and cultural practices through the systematic erosion of their religious and cultural practices. One way in which this happened was by the forcible removal of Africans from their cultural setting and the compulsion to labour in the mines and factories. This section addresses the role played by forced labour and the work environment in distancing Africans from their practices. As Lord Selbourn said, "There will be no surer way of teaching them (Africans) to work than by increasing their wants, and especially the wants of the women. These wants can be engendered, and are engendered constantly, by contact with whites; but education wisely directed, may do much to assists the movement." The wants that Selborne refers to are some of what Atkins (1993) refers to as "gates of misery". They were part of a larger strategy to deprive Africans of their means of livelihood so that they would seek employment either on farms or in urban areas. The accompanying strategy was to require that every African man above the age of 18 pay a certain amount in direct taxation to the central government. The requirement was vigorously and implacably applied; the penalty for failure to pay taxes being imprisonment. Jabavu (in Schapera, 1967) discusses the case of men who were arrested while attending services in churches and of funeral processions that were disrupted due to men being arrested for failure to produce evidence of tax payment.

The mines and factories to which Africans were driven in order to fulfil their wants curtailed their freedom and degraded their humanity. The work they did was not only meaningless and unfulfilling but was also dehumanising. The functions they performed at work were disembedded from the social context that they left behind and only became meaningful in as much as the wage could be used to pay taxes, buy food and to pay rent. Their socialisation into the rhythms of industry represented not only the denigration of their cultural practices (such as living in cramped quarters and altering relations between young and old) but also their subjugation to the repressive 'laws of industry'.

Not only were Africans expected to work in disembedded conditions, they were also expected to dress differently (i.e. to discard their indigenous clothes and to were 'European' clothes). The command that "All (Africans) should be ordered to go decently clothed..."(Magubane, 1979: 61) was made for various reasons. Christians and other Victorian Europeans considered Africans to be unclothed and, having been taught to be ashamed of their bodies, considered it scandalous that Africans should be allowed to walk 'naked'.

The requirement for Africans to wear European clothes brought the missionary and the clothing manufacturers closer together since the requirement served the economic interests of those who stood to benefit from selling clothing to Africans. The enforcement of a 'dress code' was supported by other positive reinforcements that rewarded Africans for 'washing their bodies' and covering their 'nakedness'. Not being arrested was reward enough. The fact that employers increasingly insisted that workers be 'decently' clothed made it imperative for those wanting employment and those wanting to keep their employment to discard their African attire, if only for the duration of their employment. The demand for clothing was made even though it was detrimental to the lives of Africans.

Africans were not only expected to change their outward appearance, they were also expected to change the manner in which they perceived themselves. The pass offices, labour bureaux and other employment offices were disinclined to give work-seekers permits to Africans with African names. In order to get a permit, one had to fill government forms that required a 'Christian name' and this was understood to refer to an English or Afrikaans name. A Christian name, up until the 1990s, was a sign that one was a member of a church. Therefore, Africans were forced to buy church membership at a price afterwhich they would be given a Baptism Certificate with a Christian name. In the early days, when many Africans could not read and write, the bureaux official took the Christian name from the baptism certificate or simply gave one to the African. While the names may have been forced on people initially and some may have even disliked the English or Afrikaans names, the urban environment made such names more acceptable than African names. Some, even, developed a dislike for their African given names.

All the foregoing work-related factors conspired to ensure that urbanised Africans tended to move closer to the 'modern' culture of the cities and away from their African religion and cultural practices. The recently arrived African who still held on to African religion and practices was increasingly considered a relic of the past (Mayer, 1961). Because he/she did not understand the ways of the city, he/she was considered 'stupid' and 'backward'. The lack of understanding the city was thrown into the same pot with his/her belief in African religion and practices and together produced an attitude that looked down upon African religion and cultural practices. How else could African religion and cultural practices be considered if the people who practised them were considered 'stupid' and 'backward'? Claiming belief in African religion becomes the equivalent of claiming 'stupidity' and 'backwardness'.

While compulsion was used to force Africans to discard their 'nakedness', Christianity and education were used to make them sufficiently ashamed of their bodies and embarrassed by their own culture so that they would always be clothed, in the Christian sense. A discussion of this subject follows.

The stream of missionaries who descended upon Southern Africa were inspired, among other things, by the ideal of bringing light to the 'dark continent' (See Gelfand, 1984). They condemned African beliefs as inferior to their own and instilled a spiritual dictatorship that mandated Christianity as the one and only true religion. They systematically worked towards uprooting and destroying all 'heathen beliefs', customs and practices and to replace them with Christian ideals and Christian ways. In their campaign against heathen ways in South Africa, missionaries found support from the state and almost every European (miners, farmers, diamond diggers and other fortune seekers) (Eiselen in Schapera, 1967; 65). They, however, were on their own in spreading the gospel to Africans.

The activities of the missionaries did not go without opposition. Since they attacked the organisation, customs, religion and practices of Africans, their efforts were resisted. They were resisted because they exercised authority over converts in ways that challenged the authority of amakhosi (chiefs) and izinduna (headmen) (Eiselen in Schapera, 1967; 69-70). They separated converts from their group and harboured them as refugees. In such internal colonies called 'missions', the missionaries had free reign to distance Africans from their institutions, culture, customs and practices. The 'mission' refugees were not sufficient. Missionaries continued to proselytise among those who had not decided to emigrate, mentally and physically. They used all manner of subterfuge to convert Africans. For instance, they used medical missionaries to draw Africans to Christianity (Gelfand, 1984; 20-21). While preaching the brotherhood of man, they instilled religious intolerance towards African religion and assaulted the organisation of the African family, the socialisation of children as well as the rites of passage conducted at different stages of the lives of Africans. To lure Africans to the refugee camps of missions, some missionaries even dangled political and social rights (which were, supposedly, enjoyed by 'mission' Africans) in front of unconverted Africans (Eiselen in Schapera, 1967; 80).

The triumph of the missionaries' work among Africans was realised in the proliferation of churches of different denominations among Africans, Christian Societies and Associations as well as in the numbers of those who proclaimed themselves either 'Christian' or 'saved'. The success of the 'scare tactics' of burning in an eternal fire of brimstone was in the numbers of people who were "afraid of dying without being baptised" (Jarret-Kerr, 1960:22). The many denominations and churches signified the numbers of Africans who had finally been persuaded that their own religion was nothing but obscurantism and superstition. Such people discarded their pagan ways and adopted 'civilised' and Christian morals and conduct.

The manner in which better educated and Christian Africans see themselves vis-a-vis the poor and 'uneducated' African was aptly captured in the comments of one of Mayer's respondents;

It is doubtful whether many contemporary African Christians would express the differences between themselves and those who "do not believe" as clearly as Mayer's respondent.

However, the conversion to the new faith was not completely total. For many, the Christian message had to be tempered with the message of African epistemology, cosmology and cosmogony. Through such a view, African Independent Churches (AICs) were born. The open acknowledgement of the value of African beliefs in AICs allowed the believer to claim both African beliefs and Christianity. As such, the believer who is a member of an AIC may not have a religious reason to deny consulting izinyanga or izangoma.

For the most part, the African leadership of the other Christian Churches (Methodists, Lutherans, Catholics etc.) do not openly acknowledge the value of African traditional beliefs. Nonetheless, the behaviour of 'believers' in these churches suggests a belief system that is much more nuanced than is preached by the church leadership. The behaviour of African Christians, by and large, reveals that African Christians do not subscribe to the Christian view that sees the world in polar opposites of 'Christian' and 'heathen'. Such an environment leads to believers saying one thing and doing another. It is most likely that it is believers in such churches who would deny their consultation of izinyanga and izangoma. The followers of Reverend Livingstone September are some of the people who have found comfort in the mix of Christianity and practices of African cultural healing rituals and are not ashamed to show it:

From the outside, Reverend September's church looks like any other Christian church. But from close up, it appears quite different. Some of the practices conducted in the church may be considered by some to be even un-Christian.

This section discusses the work of missionaries in converting Africans to Christianity. While many converted, many more tempered their conversion with African cultural practices. Thus, subverting the notion that the two forms of beliefs are mutually exclusive and that one is superior to the other.

The missionaries' initial motivation to 'educate' Africans was largely so that they could learn to read the Bible. As Africans progressed in education and as this bore fruits of Christianised Africans, missionaries accelerated their advocacy for the education of Africans. As more missionaries were allowed to establish schools and as more and more Africans were persuaded to go to school, increasing numbers of Africans became exposed not only to the new education but also to Christianity.

Therefore, it was not accidental that the extent of one's education was measured in the distance that one had created between themselves and African indigenous religion and cultural practices. And, most importantly, evidence of continued belief in African religion and performance of cultural practices became the mark of lack of 'education'. It is clear how anyone who wants to be considered as educated would respond to whether they are Christian or not.

Also, the association of education with 'science' and the products of modern development such as electricity, running water, and the modern transportation infrastructure impresses upon the educated African the distance that he/she should put between him/herself and the rural areas. Because he or she considers it to be 'unscientific', the educated African disregards African epistemology, metaphysics and axiology and their criticism of 'science' and 'Christianity'. His or her world is the world founded on the epistemology of modern civilisation. Is it any wonder, therefore, that teachers, nurses, doctors and other educated Africans are disinclined to work in rural areas?

The medical missionaries were used by missions to draw Africans to Christianity. (Gelfand, 1984: 20-21) They were the first to come across African beliefs and the use of indigenous medicines (Sundkler, 1948). While most of them, like their fellow brethren, condemned such beliefs and practices, some sought to understand the practices, if only, to prove their uselessness or harmfulness. A few, however, found value in such beliefs and practices so much so that Etherington (1987) refers to some such relations as "characterised by ... mutual understanding." Such "mutual understanding", if not tolerance, is evident in Father Apolinaris's admonitions to Dr Max Kohler;

Missionary doctor and Medical Superintendent at Charles Johnson Memorial Hospital in KwaZulu (Nquthu), Anthony Barker provides an explanation for the doctor who may need to know the difference between the African world (that Father Apolinaris talks about) and his world;

The continued consultation of indigenous healers by Africans may, partly, be an index of the failure of the satisfaction of the sick African's consciousness. It may also partly be due to lack of confidence in 'scientific' medicine as medical missionary Jarret-Kerr noticed (1960: 30-32) and the recognition of the power of indigenous medicines (1960: 43-44, 47-48).

In urban areas, the practices of indigenous doctors came in direct conflict with the practices of 'scientific' doctors and pharmacists. Indigenous practitioners who wanted to be successful in urban areas modelled their practices after the practices of 'scientific' medical practitioners. They set-up their practices in towns and referred to themselves as 'doctors'. Those who produced medicines called themselves 'pharmacists'. The doctors of 'scientific' medicine as well as pharmacists were financially threatened by such practices and demanded that the state proscribe the use of indigenous medicines. As will be mentioned below, the state pursued an ambiguous policy that resulted in the proliferation of indigenous practices in urban areas.

The doctors of 'scientific' medicine were not alone in marginalsing indigenous healers. They worked hand in hand with psychologists and psychiatrists who were similarly threatened by izangoma and their practice. It is not an overstatement that psychologists and psychiatry have done very little or nothing for the African in South Africa. It is not untrue also to state that, save for those confined in mental institutions, the African has generally not needed the services of the psychologists or psychiatrists. In izangoma, Africans have psychologists and psychiatrists who do not only come from the same cultural environment but are also steeped in the belief systems of the patients. Izangoma's role in keeping many Africans sane during the darkest periods of apartheid rule has never been acknowledged and most probably never will. The upheavals of the late 1980s and early 1990s did not only distabilise the former state, they also destabilised people's psychological anchors. Here too, izangoma have not been recognised as contributors to the psychological stability of many during those turbulent times.

This lack of recognition stems from the marginalisation of all indigenous practices. It has deprived the practitioners of both systems of psychological help with the advantages from the cross-pollination of these practices. Here too, the co-operation that one sees between practitioners trained in the 'scientific' method and the practitioners of Eastern forms of psychiatric illness such as Yoga, is not replicated in South Africa or anywhere in Africa. The general South African psychiatrist, if he or she has dared to search, has seen nothing valuable in the indigenous systems. Jungian psychotherapist Dr Verah Buhrman is among the minority who think that

Unlike Dr Buhrman, Dr Barker and Father Apolinaris, the doctors of 'scientific' medicine and psychotherapy were willing to abandon the principles of scientific investigation (i.e. making deductions from observable facts) and propound their uninformed beliefs and superstitions regarding indigenous medicines and practices. The marginalisation of indigenous medicines had little to do with their efficacy or their hygiene and more to do with the religious and cultural superstitions of doctors as well as the threat posed by competition from indigenous healers.

The results of the activities and campaigns by missionaries and the medical establishment can be appropriately realised in the legislation that was enacted over time.

The South African state (in all its former incarnations) played an active and ambiguous role in the marginalisation of African practices. On the one hand, the state was influenced by missionaries and the medical establishment to curtail the practices of izinyanga and izangoma, and became interested in protecting Africans from the 'primitive ill' perpetrated by izangoma and izinyanga. On the other hand, reconciling the state's ideologies of separate development and apartheid meant that some African cultural practices had to be tolerated. In Natal, izinyanga were recognised and licensed from as early as 1890s through the Natal Code (Section 268 of the Natal Code of Native Law, No. 19 of 1891) and Zululand Proclamation (No. 7 of 1895). However, those practices which were purely religious and psychological (i.e. practices of izangoma and other mediums) were prohibited and criminalised. Thus the practice and trade in 'philtres, charms, divining and witchcraft' were prohibited. The Natal Code was, however, a compromise between the demands of missionaries and the imperative to maintain some semblance of African culture as well as a rational response to the shortage of doctors of 'scientific' medicine in Natal. The Natal Code, however, restricted African herbalists to treating Africans only and only in African areas.

While the recognition of izinyanga did not herald an era of full acceptance and support, it created an environment that fostered the survival of medical practices in urban areas. The Natal Code created conditions for indigenous medical practitioners to apply for annually renewable licenses. A provision was made for practitioners to charge ugxa (consultation fee) for consultation between 2s., 6s., and 10s. and to charge for other services, if necessary. The exorbitant license fees (1 pound initially which was later raised to 3 pounds) discouraged many from applying. The restrictions placed against the practice of indigenous medicines were not sufficient for missionaries. In the early 1910s, the Natal Missionary Conference opposed (and worked for the reversal of) the decision to license indigenous medical practitioners.

Over the years, missionaries, the medical establishment and the pharmaceutical industry found common cause in the prohibition and marginalisation of indigenous medical practice. Together, they put pressure on the state to curtail the practice. In 1912, the license fee for indigenous medical practitioners was raised three times and the chiefs (on whose recommendations licences were renewed) were encouraged not to recommend renewal of licenses (Dauskardt, 1994). To stop izinyanga from competing with practitioners of 'scientific' medicine and pharmacists, the Black Administration Act (No.38 of 1927) formally restricted the advertising of indigenous medicines (Nesvag, 1999). The Medical, Dental and Pharmacy Act (No. 13 of 1928) was enacted to restrict the economic functions of herbalists (by recognising biomedicines only) as well as to stop the activities of the organisations of indigenous medical practitioners which sought to defend indigenous medical practitioners and to strengthen their position.

Competition between indigenous practitioners and practitioners of 'scientific' medicines and pharmacists had led to indigenous practitioners advertising themselves, through their 'mail-order' advertising, as 'doctors' and 'chemists'. Complaints and appeals to the state by modern medical practitioners and pharmacists resulted in Proclamation (No.168 of 1932) which prohibited izinyanga from "assuming the European title of 'doctor' or 'chemist'" and restricted the issuing of new licenses to the order of the Minister of Public Health.

The apartheid government, which came to power in 1948, continued on the steps of the previous governments. The Witchcraft Suppression Act (No.3 of 1957) re-established the government's position of recognising indigenous medical practice as part of the 'cultural heritage' of Africans and the suppression of the practice of divining. The Pharmacy Act (No.53 of 1974) was passed to protect pharmacists from competition from indigenous pharmacists ('herbalists'). The Medical, Dental and Supplementary Services Act (No.56 of 1974) was introduced to replace the Medical Dental and Pharmacy Act (No.13 of 1928). The Homeopaths, Naturopaths, Osteopaths and Herbalists Act (No.52 of 1974) was passed to regulate the activities of medical practitioners who were not officially considered as 'doctor' or 'pharmacist'. The Associated Health Services Act (No.63 of 1982) established the Associated Health Service Professions Board to control homeopathic activities.

There are three major consequences of the actions of missionaries, the medical and pharmaceutical industries as well as the state. The first was that the prohibition of izangoma meant that each inyanga had to do his own divining. Also, some izangoma applied for licenses as izinyanga (Berglund, 1976: 190) and had to prescribe medicines for the ill and injured. Second, the practice of divining was driven underground and, in urban areas - despite gallant resistance from some of the members - even izinyanga were eventually marginalised. The marginalisation of izinyanga and the driving underground of izangoma impressed upon African practitioners the need to protect their practices. Therefore, from as early as 1930, indigenous doctors Solomon Mazibuko and Mafavuke Ngcobo established the Natal Native Medical Association (later known as Natal Inyangas Association) that sought to protect the interests of indigenous practitioners as well as to campaign for the acceptance of indigenous medical practices.

It is in the light of the foregoing discussion that Vachon's (1983) caustic remarks regarding the development mission become understandable;

And, in the name of 'scientific' medicine, indigenous systems of medicine have been systematically undermined and destroyed, with far-reaching consequences.

The efforts to marginalise African religion, customs and practices were not completely successful. While the destruction of the old way of life facilitated the labour, education and christianisation as well as distanced Africans from their systems of medical practice, resistance to such destruction, albeit disarticulated by disembeddedness, was relatively successful. The success was, to a large part, due to the socio-economic conditions of Africans. However, in order to respond to the changed conditions of Africans, indigenous medical practice and medicines had to be transformed. This section highlights the socio-economic conditions of Africans which led to the successful resistance of indigenous medical practice and the conditions which led to the transformation of the practice.

The socio-economic and socio-political environment of the mid-1980s to the mid-1990s produced high levels of political violence and violent crime. (Sitas, 1986 and Mare and Hamilton, 1987) The economy was in a recession and, consequently many people lost their jobs and many others could not find work. The drought during this period seems to have pushed large numbers of people out of rural areas to seek opportunities in urban areas. The political conflict between the two main political parties in KwaZulu-Natal, coupled with the rising level of property crimes owing to the poor economic conditions, left most people feeling vulnerable. (Mare and Hamilton, (1987:181-216) Consequently, the demand for indigenous medicines to be used in protection against the consequences of the recession, as well as against crime and violence increased. Such demand resulted in changes in indigenous medicines themselves. Medicines were improved and made to respond to the new socio-economic and socio-political conditions of Africans at the time.

There were two notable sets of changes that occurred. The first set of changes occurred to the use of indigenous medicines. The second set of changes occurred to the practice itself. This discussion is limited to medicines used to procure employment, to protect property and oneself from both physical and metaphysical harm.

Changes in the use of medicines reflected the manner in which people felt vulnerable and the various needs for protection during a time when there were high rates of violence and crime and the state institutions seemed unwilling or unable to address their concerns.

The first set of changes occurred to people consulting practitioners. The recession saw large numbers of people losing their jobs as well as many being put on short-time. The numbers of the jobless swelled as recent matriculants failed to find employment. It became harder and harder to find employment, particularly, permanent employment. Those who were looking for work could rely on the extra advantage from indigenous medicines to get employment. There were medicines to make one attractive to employers. Since, during this time better educated Africans could apply for employment - which meant that they could be called for interviews, many used indigenous medicines, such as isimatisane (odenlandia corymbosa), not only to make themselves attractive to selectors but also to enable them to 'sweet-talk' the selectors. Isimatisane as well as love charms were used by those who were lucky enough to be employed and who still wanted to keep their employment.

Also, known forms of medicines were modified to respond to new conditions, and new medicines, which did not exist before, were developed to respond to such conditions. An example of known medicine that was modified for use in a new environment was medicine used in courting women. Normally, the young men would break a small piece of the root of the medicine and keep it under his tongue while talking to the woman. The medicine was supposed to make his voice sound musical to the woman and thus make the woman fall in love with him. During the 1980s and 1990s, that medicine was prescribed for people going for interviews. At interviews, the medicine was expected to make the voice of the interviewee sound musical to the interviewers and, in this way, make them choose the person for the job.

The following case reveals both that people in troubled relations with their employers seek solutions from indigenous medicines as well as the potential threat to indigenous healers when their medicines fail to produce the desired results;

What is important in this case is that the man sought relief for his troubles in indigenous medicines. For him to have done so, he must have either witnessed or heard of indigenous medicines producing such relief. While the report does not mention the name of the 'medicine' used, various medicines which, in the past, were used to make men likeable to women, were modified during the 1980s and 1990s to make people get and keep employment.

The high rates of crime and violence, as well as the seeming reluctance and inability of the police to curb it, led many to seek the powers of indigenous medicines to protect themselves as well as their property. It is during this time that medicines to protect one's property such as house and car as well as one's family proliferated. The case of Doom's car provides evidence for what people did when they lost their property and found that the police could not help them. Doom was born in Greytown and grew up in the Durban townships. After working for sometime, he started a taxi business with his co-worker, Zitha - a man from the Midland of KwaZulu-Natal. One day, Doom's taxi was stolen from his yard and he tried to use the help of indigenous healers to find it:

During the mid-1980s and the early 1990s, when violent crime engulfed large parts of South Africa, people who lost their property could not rely on the police. Indigenous medical practitioners served both to protect people's property as well as to find it when lost. In the case mentioned above, Doom found out what happened to his car but did not find his car nor the man who stole it. If Doom wanted to punish the person who stole his minivan, he would not have gone to the police. The police had already demonstrated their impotence to him. Like many others, he would have both sought and punished the person himself, assisted by either relatives or friends or he would have sought such assistance from the powers of indigenous medicines.

The ubiquitous crime and violence that seemed to strike at any person anywhere impressed on many the need for protection should they become victims of crime and violence. One way in which this was done was to use intelezi to ensure that bullets would not penetrate a person's body. Intelezi was used to strengthen and protect warriors during wars. In the 1980s and 1990s, it was used to protect ordinary people from violence. The case of Madlangala who needed protection from people who wanted to take his house provides evidence for the use of medicine to protect one's body as well as house. Madlangala and his wife were asked by an elderly neighbour to look after her because she could not look after herself. To thank them, she bequeathed her only possession, her house, to them. The woman passed away a year and seven months after the date of the will. After the woman passed away, her niece came, claiming to be the woman's daughter, and demanded to get the woman's body so that she could get it buried. After about a week of arguing, Madlangala gave the body to the niece.

In this case, the fortification of Madlangala's family as well as his houses seemed to have worked in protecting them from a planned assault. What seems to have happened to the men who came in minibus vans is commonly known as ukudungeka kwengqondo (befuddlement of the mind) which is understood to be induced by certain types of indigenous medicines. In this case, it was used to protect Madlangala's family property and lives.

Changes to the practice were evident in two areas. The hard economic conditions in rural areas coupled with the drought forced large numbers of women into the informal economy. Some of these women traded in ingredients used in preparing and producing indigenous medicines. On the other hand, the economic conditions in urban areas led many to establish themselves as 'indigenous' healers when they had neither the training nor the know-how.

The second set of changes occurred to the practice of indigenous medicines. The economic conditions were hard for most Africans in the mid-1980s and early 1990s but were felt even harder in rural areas that relied on remittances from people working in urban areas. Over the years, rural communities could resort to supplementing remittances with food grown on their fields. However, the drought of the early 1990s eliminated that option. (Padayachee, 1997) It is during this time that many women, forced by poverty in rural areas, were catapulted into the 'informal economy'. Most women sold fruit and vegetables. But many started cutting indigenous medical plants for sale in urban areas. The entry of these women changed the nature of harvesting indigenous plants and the manner in which medicines were sold. Anyone could then buy medicines from the women in the established Durban's Muthi Martket and then set themselves up as indigenous healers. The sales of indigenous medicines proved very lucrative for many sellers.

According to amakhosi who participated in the 1915 hearings, traditionally, a healer or diviner found indigenous medicines through the help of his or her ancestors. Once the medicines had been found, rituals for harvesting - such as prayer and thanks to the ancestors - were performed. In most cases, the person would only harvest the part of the tree or plant (such as bark, leaves, roots etc.) that he or she needed. The rest of the tree would be saved for future use. Medicines were harvested at particular times during the year, mostly during the time when harvesting would do less damage to the tree or plant. The 'just-in-time' nature of the use meant that people only harvested the medicines they needed.

However, the entry of large numbers of women who were only traders and not healers or diviners completely changed such relationship with the environment. Interested in the money they got for the medicines, praying to the ancestors for the medicines would not be the first thing that came to their minds. To lower their transport costs to urban areas, it became necessary for them to transport the medicines in bulk. Competition with others meant that medicines were harvested throughout the year and that the whole tree or plant would be harvested instead of its primary parts. Such processes resulted in the over-exploitation of indigenous medicines and threatened the survival of some species. (Cunningham, 1992).

There were, also, people who entered the practice as practitioners when, in fact, they had not gone through the training or they had not been called to the practice. The worsening economic conditions led many to set themselves up as indigenous medical practitioners. People who, for one reason or another, did not want to go to hospitals, were susceptible to being taken advantage of by such self-styled 'traditional healers'. The case of Mrs Ndlovu shows how charlatans promised false relief to a woman suffering from cervical cancer.

Mrs Ndlovu's case reveals how some of the self-styled 'healers' work. They claim to have solutions to all the problems that people present to them. They invariably claim to have 'medicines' which address people's shortage or lack of money, good luck, employment as well as good social relations. And, their charges are exorbitant. Quite a few have 'certificates' which claim to be from one or other 'association' or 'organisation' of 'traditional healers'. They are notorious for claiming to use human body parts in their medicines. Speculation regarding the use of body parts cast away in bushes, which parts are used for what as well as the effect of such 'medicines' captivated the nation in the early 1990s. The discovery of bodies (especially of children) with mutilated body parts, during this time, added to the increasing calls for the proscription of all forms of indigenous medical practice.

In sum, the period 1980-1994 saw indigenous medical practice play a role in assisting Africans to cope, first, with the repression and, later, with the rise in crime and violence. Changes in the practice of indigenous medicines around this time pertained to the use of medicines to procure and keep employment, the use of medicines to protect oneself as well as one's relatives and property from crime and violence, and to the proliferation of charlatans who preyed on a besieged, unsuspecting population. As this period drew to a close, there were calls for the proscription of the indigenous medical practice.

The resort to indigenous medical practice between the mid 1980s and early 1990s, coupled with the distorted coverage by a sensationalist mass media, spurred interest in the practice from various quarters. Such interest led to a call to proscribe indigenous medical practice. The proliferation of charlatans and the seeming burgeoning spectre of 'witch killings' and 'muti killings' resulted in calls for the proscription of witchcraft such as the call made in the Ralushai Commission Report (discussed below). During this period numerous studies (such that conducted by the Institute for Multi-Party Democracy) were conducted and conferences (such the conference on the Witchcraft Suppression Act of 1957 called by the 'Gender Commission') as well as hearings held in order to determine the dangers of indigenous medical practice.

Most notable among the calls for some control over the practices of indigenous healers was the report of the Ralushai Commission. In 1996, after a spate of "witch killings", the Northern Province government instituted a Commission of Inquiry, chaired by Professor NV Ralushai, to investigate the reasons behind and the causes of the widespread "witch killings". The report presents a plethora of macabre practices in human mutilation which some of the "traditional healers" supposedly practice. Among the recommendations of the Commision were (i) the institution of a code of conduct for traditional healers, (ii) the liberation of people through education from belief in witchcraft, (iii) the institution of different penalties for witches and those who sniff them out and (iv) the criminalisation of the forced collection of money required to pay izangoma.

In 1998, the Institute for Multi-Party Democracy (IMPD) initiated a review of the Anti Witchcraft Act of 1957 by talking to stakeholders in various communities particularly the affected Northern Provinces. In 1999, the IMPD issued a discussion document entitled Witchcraft Summit, Towards New Legislation in which it recommended and drafted a Witchcraft Control Act, which was meant to replace the Anti Witchcraft Act. Among the recommendations were the creation of "special witchcraft courts as appendages to the formal court system" to work with the Departments of Health and Justice as well as setting fines for people "making reckless or self-serving witchcraft accusations and on those found actually practicing witchcraft."

In 1999, the Commission on Gender Equality hosted the Legislative Reform Conference that sought to make recommendations on the reform of the Witchcraft Suppression Act of 1957. Among the key presentations made at the conference were those from Dr Esther Njiro, advocate Seth Nthai and professor Ralushai. Dr Esther Njiro, the director of the Centre for Gender Studies at the University of Venda, presented a paper entitled "Witchcraft as Gender Violence in Africa" in which she argues that the 'smelling of witches' who are mainly females by youth (who are mainly males) is a form of gender violence (Njiro, 1999). Advocate Nthai's paper contrasted the manner in which the previous governments treated "traditional healers" and appealed for the government established in 1994 not to address its relations with "traditional healers" in the same manner (Nthai, 1999). Professor Ralushai briefly discussed the findings of the Commission over which he presided in 1996.

The recommendations from the Ralushai commission, the IMPD's Witchcraft Summit and the Commission on Gender Equality's Legislative Reform Conference were largely for controls to be exercised on the practices of indigenous practitioners, especially those accused of either practicing or 'smelling' those who practice witchcraft. The recommendations included the establishment of traditional courts to adjudicate matters related to witchcraft, the establishment of traditional police to investigate witchcraft-related crimes, the sentencing of people who practice witchcraft or those who 'smell out' the witches.

The second response, however, appealed for the 'normalisation' of indigenous medical practice, pointing to the benefits that would be lost should the practice be banned. There were three aspects to the second response. First, the government instituted its own review of existing legislation that pertained to indigenous medical practice such as the Anti Witchcraft Act of 1957. On the 4th August 1998, the Select Committee on Social Services tabled its report with recommendations relating to indigenous medical practice. One of the most important recommendations was for the 'formation of a statutory national traditional medical council'.

The second aspect of the second response was the establishment of 'research centres' which sought to identify the biological properties and medicinal advantages of various indigenous medicines. Most notable among these was the establishment of a Medical Research Council-supported collaborative project between the pharmacology departments of the Universities of Cape Town and Western Cape to test plants supplied to them by indigenous healers for medicinal qualities.

The third aspect on the second response was an attempt by practitioners to institutionalise indigenous medical practice. First was the establishment of indigenous medical hospitals. In Durban, 5 'Traditional Hospitals' were established between 1994 and 1998. Since the 'traditional hospitals' did not get subsidies from the government and relied only on fees paid by patients, they soon found it difficult to continue operating. Owing to lack of funds, all five hospitals had stopped to function by the year 2000. Second was the acceptance of indigenous medical practice by some employers and the agreement to allow indigenous medical practitioners to claim against medical aid funds. Third was the establishment of the KwaZulu-Natal Traditional Healers' Council (KZNTHC). The KZNTHC brings together various Traditional Healer's Associations from KwaZulu-Natal. One of its major functions is to give practical tests to its members before they are issued with the Health Ministry recognised 'certificates of competence' as well as 'membership cards'.

In sum, the socio-economic conditions of Africans and the lack of support from state institutions were such that African shad to rely on the protections of indigenous medical practices. The proliferation of charlatans during this time led to calls for the proscription of witchcraft, which, to many meant the proscription of indigenous medical practice. The call for proscription was accompanied by a call for the normalisation of indigenous medical practice. The process of normalising indigenous medical practice was supported by the state, some research institutes and the practitioners themselves.

This paper has argued that agents of modern development sought to marginalise the medical practices of Africans. Such agents included, but were not limited to, missionaries, the medical and pharmaceutical establishments as well as the state. The marginalisation they sought was implemented through the processes of labour, religion, education and law. While the attempts at marginalisation achieved some success, they also faced resistance. For our purposes, resistance was in the form of people either refusing to be converted or tampering the Christian message with African religious and cultural practices. Such practices included the use of indigenous medical services.

What contributed greatly to successful resistance was the non-responsiveness of state institutions to the needs of Africans as well as the socio-economic conditions of Africans. However, the practices of the mid-1980s to the mid-1990s were such that calls were made for the proscription of witchcraft. Since no distinction is made between indigenous medical practice and witchcraft, all forms of indigenous medical practice were threatened by such calls for proscription. A response to such calls was a different call for the 'normalisation' of indigenous medical practice.

The 'normalisation' of indigenous medical practices, so far, has been the 'normalisation of the practices of izinyanga and the shunning of the practices of abathandazi. The Select Committee recommended the exclusion of abathandazi (Christian spiritual healers) 'because they are not traditional in nature and their training and accreditation is unclear and ill-defined.' The exclusion of abathandazi was rooted on the lack of knowledge and understanding of their practices by the Select Committee. Was this not the main reason for the exclusion of izangoma by previous legislation? Thus, we have gone full circle from the Natal Code of Native Law (No.19 of 1891) which legalised the practices of izinyanga and banned the practices of izangoma. Only this time, while the practices of izangoma are accepted, the practices of abathandazi are banned. This is despite the work done on the value of the practices of izangoma and abathandazi in diagnosing causes of illness, resolving psychiatric disorders as well as in treating mental illness.

The 'normalisation' of indigenous medical practices may produce far-reaching changes in the practice of indigenous healing. However, such 'normalisation' is not only based on an old understanding of indigenous medical practice and does not take account of its transformations and commodification, but it is also prefaced on indigenous medical practitioners subjecting themselves and their practices to 'scientific' tests. Such a view presupposes the superiority of one form of medical system over another. While there are fields in which 'scientific' medicine is far superior to indigenous medicine, there are fields in which indigenous medicines are unrivalled. Therefore, the medical emancipation of Africans from unnecessary suffering will be realised when indigenous medical practice is recognised and accepted as a form of medical help in its own right and, sometimes as an alternative to 'scientific' medicine. Such recognition should include the establishment and support of necessary institutions and facilities for indigenous medical practice. And the social emancipation of Africans will be assured when their cultural practices are allowed to flourish and to be useful to them if and when Africans deem so.

The lack of communication between the two systems, which owes its origin to the reluctance of 'scientific' medicines to interface with indigenous medicine, is such that people in South Africa suffer and die from illnesses and diseases that may be mediated and cured if the two medical systems combined their efforts or, at least, recognised each other. The benefits that Gumede (1990) and others have reaped from their collaboration with indigenous healers remain accessible only to the maverick fringe and assist those desperate enough to try anything. The programme in which the co-operation of indigenous healers and 'scientific' doctors is used in the health care of the residents of the ODI District which was run by associate professor of the University of Pretoria's Department of Psychiatry, Professor D.J. Oberholzer, was certainly a ground breaker. (Oberholzer, 1985). As such, despite the successive Reports of the World Health Organisation (1978 to 1983) for collaboration between the two fields of medicine, the South African public continues to be denied the benefits of such collaboration as well as other related medicines and treatment.

The losers in this are the users of indigenous medicines who, unlike the users of 'scientific' medicines, which benefits from state subsidies for research and development, solicit the services of a system which has been suppressed, undermined, never funded and not properly researched. The effect of marginalisation is that some of the accumulated knowledge of cures remains unresearched, poorly developed and continues to be lost. As a result, some of the users of indigenous medicines continue to die unnecessarily from curable diseases. Their emancipation lies in the establishment and support of institutions for the research, development and propagation of appropriate indigenous medical practices.

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