Academic journal article Africa

Zulu Ritual Immunisation in Perspective

Academic journal article Africa

Zulu Ritual Immunisation in Perspective

Article excerpt

Making incisions (umgcabo) and punctures (ukutshobha) in the skin for the purpose of introducing medication (umuthi, pl. imithi) into the human body is a widely used technique in traditional Zulu medicine. It may be ranked with the use of injections in Western medicine, with which it is often compared. Most people who have consulted a traditional healer, which includes the overwhelming majority of the urban and rural black population of KwaZulu/Natal, will have been treated with umgcabo or ukutshobha at one time or another. In its current form it is a potential route for infection by blood-borne pathogens, both viral, e.g. Hepatitis B (HBV), Hepatitis C (HCV) and HIV, and bacterial, e.g. staphylococci and streptococci. This brings it into direct conflict with modern medicine and by extension with government health policy. However, it is arguable that such was not always the case, rather that the present situation represents a misuse of umgcaba and ukutshobha which arose as a result of colonial legislation and attendant economic pressures dating back .to the nineteenth century (Berglund, 1976:190; Jolles and Jolles, 1998). These and other problems associated with traditional medicine, many of them equally sensitive, present the government with something of a quandary. On the one hand legislation leading to the `full legal recognition of traditional healers as health-care professionals' and their integration into the state health-care system (Natal Witness, 5 August 1998, p. 5) is in the process of being drafted. On the other, the Minister of Health, Dr Nkosazana Zuma, has stated that traditional healers should be allowed to continue practising in a private capacity (which represents the status quo) but that they should not be taken into employment or paid by the national health service(1) (SABC TV2, 30 January 1999).

South Africa is something of a latecomer in addressing these concerns. The fiction of `separate development' made it too easy for the pre-1994 government to avoid them. So all issues connected with the organisation and standardisation of traditional medicine, the training of practitioners and their integration into national health care provision were barely broached whilst most of the neighbouring countries of southern Africa were grappling with them.(2) Since then the problem has become ever more urgent in view of the inability of the national health service to budget for increasingly expensive care for victims of the AIDS epidemic,(3) leaving it to traditional healers to give such support as they can. We shall return to this point. There is one aspect in which Zulu medicine differs from that of most of its neighbours: the separation of the roles of the diviner-diagnostician (isangoma, (pl. izangoa) and the healer (inyanga, pl. izinyanga).(4) Over the last hundred years or so this relationship has been profoundly. modified by colonial and post-colonial legislation. The practice of making incisions was probably the main area of overlap between the functions of the traditional isangorna and the inyanga, so a case study of this component of Zulu medical practice should help to clarify the nature and the implications of the changes that have taken place.

The custom of making incisions for medical, ritual and cosmetic purposes is widespread throughout Africa, and there has been much discussion of the risk of transmitting blood-borne diseases, particularly HIV, through such practices as scarification and circumcision (Caldwell and Caldwell 1994; Katz, 1989; Zavriew, 1994: 815). In many areas, including South Africa, this has led to the introduction of more hygienic practices, such as the use of new razor blades for each procedure. The effect of these practices on the transmission of diseases is difficult to quantify in an environment in which the diseases are endemic. It would require a prospective study in patients who were negative for HBV, HCV and HIV and subsequently became positive, with the ability to confirm that the source of the viral strain was the incision by polymerase chain reaction (PCR). …

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