The World Health Organisation (WHO), BBC News and books published on traditional medicine often report that 80% of the South African population uses traditional medicine as their primary healthcare. Although it is unclear where that statistic comes from, according to a WHO-SAGE (Strategic Advisory Group of Experts) study published in 2016, the number seems to have first appeared in 1983, under the pen of Robert Bannerman, who served as WHO regional adviser and at one time managed the WHO’s traditional medicine programme; since then it was repeated several times over, unquestioned. More recent research, done as part of the said 2016 study, reveals a much lesser number: less than 3% of the respondents reported using traditional medicine as their frequent source of healthcare, and less than 2% responded as using traditional medicine in the last year.

Many of the sources quoting the 80% statistics added that there are about 200,000 practitioners of traditional medicine in South Africa even though here again, it seems difficult to confirm the exact estimate on the number of traditional healers. There is also a shortage of research on the efficacy of traditional medicine. There are examples as well as studies of cases where indeed, people have been successfully treated with herbal medicines, and the healing properties of many plants have already been tested, proven, and incorporated into mainstream pharmaceuticals. However, it is unclear what the split is between the cases where traditional healers succeed versus cases where they may fail, or possibly make matters worse due to possible misdiagnosis or prescription of potentially toxic plants.

In South Africa, traditional healers are primarily split into Sangoma(s) and Nyanga(s), both Zulu words, although there are different words in different languages. The former are spiritual mediums as well as herbalists, the latter are straightforward herbalists. While there are some efforts towards regulation, it is still a largely unregulated profession. In a world where attitudes are shifting towards the use of medicinal plants, whether for general well-being, prevention or as part of a specific treatment, is there value in paying closer attention to the work done by Sangomas in South Africa, and the ancestral knowledge that they pass on from one generation to the other? Should there be more regulation around the practice and more rigorous testing of the plants used for healing?

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“In general, we’ve been marketed as the ignorant part of the health and wellness industry. Everything we do is viewed as rudimentary,” says Wacy Zacarias, a Mozambican Sangoma who is also an accessories designer, as well as a founder of textile design company geared towards the creation and promotion of original African textile designs. As a practising Sangoma who completed her training in 2017, her focus has also been on the research and documentation of plant medicines. To this end, she has been volunteering with the Centro de Investigacao e Desenvolvimento em Etnobotinca (CIDE), an institute of “scientific research, technological development and production based on plants” in Mozambique.

The institute works under the Ministry of Science and Technology: “They are looking at studying and preserving the indigenous and medicinal plants in Mozambique. They do testing as well as preserving and protecting the recipes of the Sangomas. For example, if a Sangoma discovers a healing plant, and he’s the first to successfully use a (formula), how do you make sure that should that (formula) get industrialised, that he/she benefits from it?” she adds. “I think we’re definitely selling ourselves short. We should take advantage of the wellness industry and try to brand ourselves, and learn from how Western society brand themselves in terms of the natural medicine industry, how the Asian natural medicine industry brand themselves. The way they promote their natural medicine industry is completely different.”

A digitally savvy well-travelled millennial, Zacarias stresses the importance of access to information: “In today’s age, if somebody doesn’t tell me exactly what I’m taking, I don’t want to take it. There was this blind faith that was there before. You went to the Sangoma, who told you to take this muti (medicine), and you took it no questions asked. Now, people want to know: ‘What are the ingredients? Can I go look it up on Google?’”

Buhlebezwe Siwani is a South African Sangoma and an artist currently residing between Cape Town and Amsterdam, whose well-publicised artistic practice has seen her travel and exhibit in numerous countries and cities, from Harare to Zurich to the Louis Vuitton Foundation in Paris. She 0ften explores themes of African spirituality through the lens of her practice as a Sangoma; she also feels strongly about the passing on of correct knowledge: “Knowledge is lost because it’s not being passed down in the correct way. I’m tired of fake Sangomas, they are taught the wrong things. They are just taken through the paces. You’ll find people who come out of (their training) not knowing what a simple herb does, not knowing which part to use. We need to make sure that when these things are passed down and they’re being taught, that we’re very aware of how we’re teaching, who we’re teaching, and whether these people are learning.”

Phephsile Maseko, the national co-ordinator for the Traditional Healers Organisation (THO), South Africa’s largest body of traditional medicine practitioners, questions the efficacy of the government’s role when it comes to regulating the practice: “In 2007, Parliament established the Traditional Health Practitioners Act, which regulates and recognises traditional health practice in South Africa. A council was established but however, the council has a number of stakeholders that are not necessarily healers, including pharmacists and doctors. You can’t bring in people that are foreign to traditional medicine practice to police our profession. Most of the power is also given to the health minister who does not necessarily care about traditional medicine; they only care about pharmaceuticals.”

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According to the act, would-be traditional healers need to register with the department of health prior to their training. Clause 21. of the act states: (1) No person may practise as a traditional health practitioner within the Republic unless he or she is registered in terms of this Act. (2)(a) Any person who wishes to register as a traditional health practitioner or a student must apply to the registrar. (i) proof that the applicant is a South African citizen; (ii) character references by people not related to the applicant; (iii) proof of the applicant’s qualifications.

It is unclear what the qualification needed prior to training might be. According to Maseko: “When Sangomas get their calling, a lot of them get really sick, and are not in a state to go through the application process. There are also many who can’t read and write. And of course, some won’t complete their training, but if they are already registered, then they would be able to practise even though they are not properly trained. These and many other issues demonstrate that there wasn’t adequate research and consultation with healers done before the act was written into law. It’s a catalyst for misbehaviour and unprofessional conduct.”

When the THO met for their Leadership Summit, on 5-6 February 2019, the issue of regulation and amendment to the act came up: “We decided we would go back to government and propose that they allow us to be a self-regulating profession. We also want to review the act, and send it back to Parliament, and ask them to commission a team of experts that are going to work with us and do proper research on our profession. As things stand, traditional healers are not registering with the Department of Health. The current law displays a poor understanding and a lack of respect for our profession,” says Maseko.

Historically, the role of the Sangoma has been that of a spiritual medium, who could give diagnoses as well as treatments of physical ailments; it also included a role that could be compared to a priest, a sort of connection to the spiritual world. Whereas in Christian practice, priests and pastors are often looked to for spiritual guidance, hearing confessions and providing advice following the words of God, the Sangoma is viewed as offering a connection to the ancestors. Sangomas are said to be called to their vocation to go through a process of ukuthwasa, when their ancestors call on them to undergo training. During their training, in addition to the knowledge passed on to them by their mentors, they will also learn through dreams, which are interpreted as messages from their ancestors, guiding them to specific plants and medication.

“When I came out of training, the plants would come to me in dreams, as Latin names, or as a pictorial image, with a description of their healing power. I would note those dreams, and then I would phone up botanist friends and ask ‘what is this plant? This is the Latin name’. Or I would say, ‘this is how the plant looks and this is what it does,’ and they’ll say, ‘oh, it’s this plant,’” says Julia Rainham, an artist and Sangoma with 16 years of practice. She was trained in Botswana, in the “Tswana-Tsonga-Swazi-Pedi divination and healing methods”. In her practice, she goes as Julia Rosina, taking the name of her grandmother, Rosina Meyer Theron, whom she says called her to follow this spiritual path. “I come from a lineage of plant women, which I’m thrilled about. And I never knew this. I was working as a musician in a band before I got sick.” Indeed, when being called to ukuthwasa, Sangomas report going through a period of sickness, that is eventually healed once they respond to the calling and start their training.

With a strong focus on the spiritual side of her training, Rosina questions if the documentation of plant medicines and their effects is the right way to go: “When one writes things down, when one fixes an idea, one fixes a meaning, which I think is certainly reductive. In my practice, I find myself working for years and years with plants, and what it means to gather medicines, to harvest, what it means to go to the big markets and buy the plants, what it means to go to the mountains and pray and dig up the plants, what it means to invoke a relationship with plants so that they can bring healing. I really would say that I work on behalf of plants. To work as a Sangoma is such a completely separate reality from a normative Western life. The learning about plants doesn’t come from rational knowledge systems. It comes through a profound oral narrative. The plant presents itself and teaches you. To be in a relationship with the spirit of a plant is a whole other dynamic that I don’t think many people are aware of.”

Like Zacarias, Rosina has worked with formal organisations as well as government departments working towards formalisations of certain aspects of plant medicines and forms of indigenous knowledge. She notes the difficulty in getting Sangomas’ formulas verified, in a way that might open them up to mainstream markets: “Say as a Sangoma, I dream of a plant, and my ancestors instruct me to go and get this plant and prepare it in this way, which is often what happens, and they tell me what its curative power is. If I want to share this in my practice or if I wanted to market that, I couldn’t, because I cannot scientifically prove its efficacy.

“Most pharmaceutical herbalism medicines have to go through very stringent tests. It’s very difficult to access that thin upper-middle-class space of refined herbal medicines, because it requires a huge amount of investment. The South African state does not recognise plants as having spiritual efficacy. And that’s part of the problem of regulating the practice of Sangomas or regulating the way that we work in relation to plants. There aren’t methodologies of understanding our medical practice, because western biomedicine is such a huge primary field of medicine, and it’s based on Newtonian physics and evidence-based medicine. What do you do? For me it’s a philosophical question,” says Rosina.

Kgereshi P Mokwena, the Interim Registrar of the Interim Traditional Health Practitioners Council of South Africa, says that he is currently the council’s only employee, and after promising to clarify the council’s role with regards to regulation, he reverted to saying that it was against the department’s communication protocol for him to respond directly, and that all communications would have to go through Popo Maja, the head of communications for the National Department of Health. At the time of publication, Maja health had not responded to our emails and telephone calls to enquire about the role the National Department of Health plays in the regulation of traditional health practitioners. According to Maseko, from the THO, as things stand, “there is effectively no formal regulatory body in South Africa that understands traditional medicine”. ML